Success rate of immediately loaded implants in the posterior zone

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.

An innovative application of pre-medicated collagen sponges with regenerative biomaterials for management of an infected extraction socket: A case report

Localized infection of the extraction socket can compromise bone quality and quantity within the socket and bone support for the adjacent dentition. These events can preclude immediate rehabilitative interventions, such as implant placement, and increase the technical sensitivity of guided bone regeneration procedures for successful tissue and bone gain. The use of local scaffolds containing effective antimicrobial agents may suppress local infection and facilitate the regenerative process related to the introduced bone graft particles and barrier collagen membrane. In this case report, pre-medicated collagen sponges containing chlorhexidine and metronidazole were used in conjunction with a bone graft and collagen membrane for guided tissue and bone regeneration, which was followed by delayed implant placement with 2 years of follow-up evaluations.

ECG Changes during Adult Life in Fabry Disease: Results from a Large Longitudinal Cohort Study

Background: Fabry disease (FD) is an X-linked, lysosomal storage disorder leading to severe cardiomyopathy in a significant proportion of patients. To identify ECG markers that reflect early cardiac involvement and disease progression, we conducted a long term retrospective study in a large cohort of FD patients. Methods: A total of 1995 ECGs from 133 patients with classical FD (64% females, 80% treated with enzyme replacement therapy), spanning 20 years of follow-up, were compared to ECGs from 3893 apparently healthy individuals. Generalized linear mixed models were used to evaluate the effect of age, FD and sex on: P-wave duration, PR-interval, QRS-duration, QTc, Cornell index, spatial QRS-T angle and frontal QRS-axis. Regression slopes and absolute values for each parameter were compared between FD patients and control subjects. Results: At a younger age (<40 years), the Cornell index was higher and frontal QRS-axis more negative in FD patients compared to controls (p < 0.05). For the other ECG parameters, the rate of change, more than the absolute value, was greater in FD patients compared to controls (p < 0.05). From the fifth decade (men) or sixth (women) onwards, absolute values for P-wave duration, QRS-duration, QTc and spatial QRS-T angle were longer and higher in FD patients compared to control subjects. Conclusions: ECG abnormalities indicative of FD are age and sex dependent. Tracking the rate of change in ECG parameters could be a good way to detect disease progression, guiding treatment initiation. Moreover, monitoring ECG changes in FD can be used to evaluate the effectiveness of treatment.

The microbiome-derived metabolite TMAO drives immune activation and boosts responses to immune checkpoint blockade in pancreatic cancer

The composition of the gut microbiome can control innate and adaptive immunity and has emerged as a key regulator of tumor growth, especially in the context of immune checkpoint blockade (ICB) therapy. However, the underlying mechanisms for how the microbiome affects tumor growth remain unclear. Pancreatic ductal adenocarcinoma (PDAC) tends to be refractory to therapy, including ICB. Using a nontargeted, liquid chromatography-tandem mass spectrometry-based metabolomic screen, we identified the gut microbe-derived metabolite trimethylamine N-oxide (TMAO), which enhanced antitumor immunity to PDAC. Delivery of TMAO intraperitoneally or via a dietary choline supplement to orthotopic PDAC-bearing mice reduced tumor growth, associated with an immunostimulatory tumor-associated macrophage (TAM) phenotype, and activated effector T cell response in the tumor microenvironment. Mechanistically, TMAO potentiated the type I interferon (IFN) pathway and conferred antitumor effects in a type I IFN-dependent manner. Delivering TMAO-primed macrophages intravenously produced similar antitumor effects. Combining TMAO with ICB (anti-PD1 and/or anti-Tim3) in a mouse model of PDAC significantly reduced tumor burden and improved survival beyond TMAO or ICB alone. Last, the levels of bacteria containing CutC (an enzyme that generates trimethylamine, the TMAO precursor) correlated with long-term survival in patients with PDAC and improved response to anti-PD1 in patients with melanoma. Together, our study identifies the gut microbial metabolite TMAO as a driver of antitumor immunity and lays the groundwork for potential therapeutic strategies targeting TMAO.

Influence of sex and phenotype on cardiac outcomes in patients with Fabry disease

Objective

This study describes the influence of sex and disease phenotype on the occurrence of cardiac events in Fabry disease (FD).

Methods

Cardiac events from birth to last visit (median age 50 years) were recorded for 213 patients with FD. Patients were categorised as follows : men with classical FD (n=57), men with non-classical FD (n=26), women with classical FD (n=98) and women with non-classical FD (n=32), based on the presence of classical FD symptoms, family history (men and women), biomarkers and residual enzyme activity (men). Event rates per 1000 patient-years after the age of 15 years and median event-free survival (EVS) age were presented. Influence of disease phenotype, sex and their interaction was studied using Firth’s penalised Cox regression.

Results

The event rates of major cardiovascular events (combined endpoint cardiovascular death (CVD), heart failure (HF) hospitalisation, sustained ventricular arrhythmias (SVAs) and myocardial infarction) were 11.0 (95% CI 6.6 to 17.3) in men with classical FD (EVS 55 years), 4.4 (95% CI 2.5 to 7.1) in women with classical FD (EVS 70 years) and 5.9 (95% CI 2.6 to 11.6) in men with non-classical FD (EVS 70 years). None of these events occurred in women with non-classical FD. Sex and phenotype significantly influenced the risk of major adverse cardiovascular event. CVD was the leading cause of death (75%) to which HF contributed most (42%). The overall rate of SVA was low (14 events in nine patients (4%)).

Conclusions

Sex and phenotype greatly influence the risk and age of onset of cardiac events in FD. This indicates the need for patient group-specific follow-up and treatment.

Factors Affecting Clinical Decision-Making and Treatment Planning Strategies for Tooth Retention or Extraction: An Exploratory Review

Dentists are often confronted with challenges concerning the determination of the treatment type for questionable teeth (retention or extraction) in their routine dental practice. The objective of this review was to explore the available literature pertaining to the factors influencing clinical decision-making and treatment strategies of dentists regarding tooth retention or extraction. Explorative analysis of the literature was conducted based on its relevance to the subjected study area and scope. Primarily, the papers were extracted from sources such as ERIC, PubMed, Scopus, and Medline. The keywords used for searching articles include Clinical Decision-Making, Treatment Strategies, Tooth Extraction, and Tooth Retention. Papers published up to 2018 were extracted and evaluated. The analyzed studies highlighted that a successful treatment plan is based on the practitioner's knowledge, abilities, and skills as well as patients' preference, which is also a determinant of treatment success in restorative dentistry. Multidisciplinary dental treatment is generally adopted for decision making in dental clinics. Overall, the treatment plan should be based on the extensive learning and keen observation of the disease and the associated factors which enable long-term success of the treatment.

Effect of Layering Techniques on Polymerization Shrinkage Stress of High- and Low-viscosity Bulk-fill Resins

CLINICAL RELEVANCE

The use of layering techniques is still advisable with many bulk-fill resins and should be the default unless a particular resin is known to not need it.

SUMMARY

Objective: The purpose of this study was to investigate how layering techniques affect polymerization shrinkage stresses of high-and low-viscosity bulk-fill resins.Method: Six high-viscosity and six low-viscosity bulk-fill resins were evaluated. Aluminum blocks with a mesial-occlusal-distal (MOD) cavity were machined and randomly divided into groups for different filling techniques (bulk-fill vs horizontal layering vs oblique layering) and further subdivided according to type of resin (high- vs low-viscosity). The cuspal deflection resulting from the polymerization of bulk-fill resin bonded to a MOD cavity within an aluminum block was measured with a digimatic micrometer. Scanning electron microscopy analyses of tested resins were also conducted.Results: In the high-viscosity bulk-fill resins, cuspal deflection of the MOD cavity ranged from 11.2 to 18.2 μm with the bulk-filling technique, from 10.7 to 15.5 μm with the horizontal layering technique, and from 10.9 to 15.2 μm with the oblique layering technique. In the low-viscosity bulk-fill resins, cuspal deflection of the material ranged from 9.2 to 19.8 μm with the bulk-filling technique, from 8.2 to 15.7 μm with the horizontal layering technique, and from 8.4 to 16.4 μm with the oblique layering technique.Conclusion: Cuspal deflections for some high-and low-viscosity bulk-fill resins were significantly reduced by using layering techniques, but the resultant improvement of layering techniques was not applicable to all the bulk-fill resins used in this study.

A rare case of cystic hygroma in neck and extending into thoracic cavity

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Cystic Hygroma in Neck and Thorax.

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Multi disciplinary team approach in the treatment of neck and thorax cystic hygroma.

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Surgical management of huge cystic hygroma.

Introduction

Cystic hygroma is a benign swelling of the neck among the pediatric population. It is a fluid-filled sac resulting from blockage in the lymphatic system and is commonly located in the cervical region and axilla.

Case presentation

We present a rare case of a large cystic hygroma in the neck and the thorax in a 12 year’s old male. The lesion was diagnosed with the help of MRI which showed a cystic lesion extending from the carotid sheath to the mediastinum. And confirmed by fine-needle aspiration cytology (FNAC). The lesion was treated by surgical excision along with a cardiothoracic team.

Discussion

We will explore in our discussion the diagnostic modalities for such lesions and the different treatments available for Cystic Hygromas.

Conclusion

We concluded from this case that accurate diagnosis and careful planning with multidisciplinary team approach and choosing the right treatment as indicated has a great impact on the results for such difficult cases.

Two-piece mesostructure and vertically oriented locking screws design for implant-assisted prosthesis in the esthetic zone

Restoration of the malaligned dental implants in the esthetic zone is a challenge for dental practitioner because of the difficulty in obtaining balance and harmony between position and color of the final prosthesis and the adjacent teeth. Mesostructure is a part of the prosthesis that located ontop of the dental implant and bearing the final prosthesis. It has a form of milled bar to bear an overdenture or as abutment used for the correction of malaligned dental implants. Such approach maintains screw-retained prosthesis option while allowing complete retrievability, improved accessibility, usage of thicker abutment screws, and acceptable esthetic outcomes. In this case report, a two-piece mesostructure was designed to correct the malposition of dental implants in the esthetic zone with 1-year follow-up system.

Determinants of cerebral radiological progression in Fabry disease

BACKGROUND AND AIM

It is unclear which patients with Fabry disease (FD) are at risk for progression of white matter lesions (WMLs) and brain infarctions and whether enzyme replacement therapy (ERT) changes this risk. The aim of this study was to determine the effect of ERT and clinical characteristics on progression of WMLs and infarctions on MRI in patients with FD.

METHODS

MRIs were assessed for WMLs (Fazekas scale), infarctions and basilar artery diameter (BAD). The effect of clinical characteristics (renal and cardiac involvement, cardiovascular risk factors, cardiac complications, BAD) and ERT on WML and infarction progression was evaluated using mixed models.

RESULTS

One hundred forty-nine patients were included (median age: 39 years, 38% men, 79% classical phenotype). Median follow-up time was 7 years (range: 0-13 years) with a median number of MRIs per patient of 5 (range: 1-14), resulting in a total of 852 scans. Variables independently associated with WML and infarction progression were age, male sex and a classical phenotype. Progression of WMLs and infarctions was not affected by adding ERT to the model, neither for the whole group, nor for early treated patients. Progression was highly variable among patients which could not be explained by other known variables such as hypertension, cholesterol, atrial fibrillation and changes in kidney function, left ventricular mass or BAD.

CONCLUSION

Progression of WMLs and cerebral infarctions in FD is mainly related to age, sex and phenotype. Additional effects of established cardiovascular risk factors, organ involvement and treatment with ERT are probably small to negligible.

Undiagnosed impacted knife blade from a penetrative orbital injury: A case report

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The mode of entry of the foreign body was unique as well as the force required to impale and break a knife blade in bone.

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The authors present a minimally invasive technique for dealing with this type of injury and highlight its challenges.

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This case report emphasis the need for baseline radiology in cases of traumatology especially those with vague history.

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The patient was examined by multiple physicians who did not detect the foreign body which could raise medico-legal issues.

Introduction

Impacted foreign bodies in the complex maxillofacial region is uncommon and their safe removal is a challenge.

Case presentation

The authors report an unusual case of a 41 year old male patient who suffered from violence-related orbital trauma with a knife. The presence of this foreign body was not diagnosed for a period of 20 months. After proper clinical and radiologic examination it was localized and extracted in the theater in a safe controlled manner. Although the tip of the blade was left in situ, the patient had a rapid uneventful recovery and follow up.

Discussion

The path of penetration of the foreign body in presented case didn't follow the predicted patterns of orbital injury described in literature. A dilemma exists as to how aggressive such injuries should be managed. Thus the surgical approach implemented for retrieving the current foreign body was highlighted.

Conclusion

Radiographs are a crucial element for early diagnosis and proper management of foreign body injuries. Rapid postoperative recovery can be achieved with simple safe surgical retrieval maneuvers.

Removal of large impacted foreign body from the base of the skull through submandibular access: A multidisciplinary approach

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Cut wounds in the face, should be repaired after proper investigations.

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Trismus following trauma should be managed seriously.

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Removal of a foreign body from the maxillofacial region should be managed with Multidiscplinary team approach.

Introduction

This report describes the removal of a missed impacted large piece of a glass that reaches the infra-temporal region after a traumatic injury at the submandibular area.

Case presentation

A nine year-old patient presented with a limited mouth opening (0.5 cm). Initial examination showed a scar of an old trauma in the submandibular area two months prior to presentation. The radiographic study showed a large knife-shaped foreign body with its tip at the infra-temporal region, and its base at the submandibular region. Further multi-slice computed tomography with angiography was done that showed close proximity of the foreign body to the branches of the external carotid artery; maxillary, lingual and facial branches. The foreign body was removed via extra-oral approach through the old scar of the past injury under general anesthesia. Dissection, exposure of the external carotid artery and preparing it for emergency ligation, were done before extraction of the foreign body. The patient’s mouth opening increased to 2.5 cm without any complications.

Conclusion

Cut wounds in the face should not be repaired in the primary care without detailed history, systematic examination and proper investigations.

Neoadjuvant Chemotherapy With Capecitabine Plus Cisplatin in Patients With Locally Advanced Nasopharyngeal Cancer: Case Series Study

Purpose

Capecitabine, an oral fluorouracil (5-FU) derivative, has replaced 5-FU in many chemotherapy regimens used in various GI tract cancers. The experience with capecitabine in nasopharyngeal carcinoma (NPC) is limited.

Patients and Methods

We report on eight patients with locally advanced NPC treated with neoadjuvant chemotherapy with capecitabine and cisplatin.

Results

All eight patients responded well to the chemotherapy combination and achieved complete remission after definitive chemoradiotherapy. No grade 3/4 toxicities were observed. Five patients experienced a relapse after 6, 8, 9, 12, and 17 months.

Conclusion

In the patients studied, capecitabine (in combination with cisplatin) was a safe and effective substitution for 5-FU for the neoadjuvant treatment of locally advanced NPC. Larger prospective clinical studies are required to confirm these results.

Effect of a single injection of gonadotropin-releasing hormone (GnRH) and human chorionic gonadotropin (hCG) on testicular blood flow measured by color doppler ultrasonography in male Shiba goats

Although color Doppler ultrasonography has been used to evaluate testicular blood flow in many species, very little has been done in goat. Eight male Shiba goats were exposed to a single intramuscular injection of either gonadotropin-releasing hormone (GnRH group; 1 µg/kg BW) or human chorionic gonadotropin (hCG group; 25 IU/kg BW). Plasma testosterone (T), estradiol (E2) and inhibin (INH) were measured just before (0 hr) and at different intervals post injection by radioimmunoassay. Testis volume (TV) and Doppler indices, such as resistive index (RI) and pulsatility index (PI) of the supratesticular artery, were measured by B-mode and color Doppler ultrasonography, respectively. The results indicated an increase in testicular blood flow in both groups, as RI and PI decreased significantly (P<0.05), but this increase was significant higher and earlier in hCG group (1 hr) than in the GnRH group (2 hr). A high correlation was found for RI and PI with both T (RI, r= −0.862; PI, r= −0.707) and INH in the GnRH group (RI, r=0.661; PI, r=0.701). However, a significant (P<0.05) correlation was found between E2 and both RI (r= −0.610) and PI (r= −0.763) in hCG group. In addition, TV significantly increased and was highly correlated with RI in both groups (GnRH, r= −0.718; hCG, r= −0.779). In conclusion, hCG and GnRH may improve testicular blood flow and TV in Shiba goats.

Evaluation of fetal pulmonary vasculature by power Doppler imaging in congenital diaphragmatic hernia

OBJECTIVE

To evaluate the feasibility of prenatal power Doppler imaging of pulmonary arteries in congenital diaphragmatic hernia and to study its potential to predict outcome.

METHODS

A prospective observational study was conducted. Forty-two cases of congenital diaphragmatic hernia (32 left and 10 right) without associated anomalies were analyzed. Qualitative evaluation of pulmonary vasculature was based on power Doppler imaging performed at 26 to 38 weeks. The pulmonary arteries were studied in the lung contralateral to the hernia. Pulmonary Doppler angiography was considered satisfactory when 3 levels of bifurcation defining 3 distinct segments of the pulmonary arteries were imaged and was otherwise considered poor. We also recorded the gestational age at diagnosis, side of the hernia, abdominal circumference below the third percentile, amniotic fluid volume, lung/thoracic area ratio, left/right ventricle ratio, and, in left-sided hernias, stomach position, and we carried out a multivariate analysis to determine the contribution of each factor to predict neonatal mortality.

RESULTS

More than 3 divisions of the fetal pulmonary arteries were imaged in 20 cases; 1 or 2 divisions or none were imaged in 22. Neonatal mortality was significantly greater when fewer than 3 divisions of the pulmonary arteries were imaged (18 [82%] of 22) than when 3 divisions could be identified on power Doppler imaging (5 [25%] of 20; P = .0005). However, the lung/thoracic area ratio was the only factor that remained significantly associated with mortality in the multivariate analysis.

CONCLUSIONS

An altered pulmonary power Doppler image is associated with neonatal mortality, but estimation of the lung area remains the best predictor of neonatal outcome.

Technetium-99m-MIBI myocardial SPECT: supine versus right lateral imaging and comparison with coronary arteriography

Myocardial perfusion SPECT using the prone position improves inferior wall counts and decreases motion problems as compared with the usual supine position. Nonetheless, it is not suitable for women. In addition, it is associated with artifactual anteroseptal defects and hot spots.

METHODS

The right lateral (RL) position was evaluated instead of the prone position in 72 patients (26 women). RL imaging was performed immediately after the supine imaging during a routine 2-day 99mTc-sestamibi exercise protocol. The SPECT images were scored semiquantitatively by three physicians. Moreover, regional myocardial counts, as well as extent and severity of defects, were assessed by quantitative polar map analysis.

RESULTS

All patients tolerated the RL position well and there was no significant patient movement in either position. Higher inferior myocardial counts per pixel were observed in the RL than in supine images. Inferior wall defects (especially mild ones) were more common in the supine than the RL images, whereas defects in other regions were not different. Quantitative analysis confirmed these findings. Analysis of 34 patients with recent coronary arteriography revealed an overall coronary artery disease (CAD) supine- and RL-imaging specificity of 50% and 75%, respectively, and the sensitivities of both were 93%. Right CAD sensitivity, specificity and normalcy rates for the supine position were 100%, 44% and 55%, whereas those of the RL position were 94%, 75% and 90%, respectively.

CONCLUSION

The RL position improves CAD diagnostic accuracy, particularly right CAD, without significant artifacts in other myocardial regions. Unlike the prone position, the RL position is well tolerated by both women and men.

A comparison of two radionuclide ejection-fraction techniques with contrast angiography in ischemic heart disease and valvular heart disease

First-pass radionuclide angiography (FPRA) in the 30 degree right anterior oblique and equilibrium gated radionuclide angiography (EGNA) in the 45 degree left anterior oblique were used for quantitative measurements of left ventricular ejection fraction (LVEF). Equipment used was a 400T gamma-camera interfaced with a Simis III Informatek computer. The results were compared with contrast angiography (CA). The aim of this study was to determine the sensitivity of both radionuclide techniques. The present data are based on 65 patients in whom CA and EGNA were performed. In 47 patients both FPRA and EGNA were performed. Results suggested that in ischemic heart disease (IHD) and valvular heart disease (VHD) the EGNA technique is well correlated with CA (r = 0.9 and 0.73, respectively). FPRA correlated well only with CA in IHD (r = 0.86), but not in VHD (r = 0.18). This study indicates that both FPRA and EGNA are sensitive, noninvasive techniques for measuring ejection fraction in IHD, while in VHD, EGNA is more sensitive technique than FPRA.