Has the 8th American joint committee on cancer TNM staging improved prognostic performance in oral cancer? A systematic review

BACKGROUND

The 8th edition of the American Joint Committee on Cancer (AJCC) classification has introduced two new parameters: depth of invasion (DOI) and extranodal extension (ENE). The aim of this systematic review was to determine whether this 8th edition referred to oral squamous cell carcinoma (OSCC) offers performance superior to that of the 7th edition in relation to overall survival (OS) and disease-specific survival (DSS).

MATERIAL AND METHODS

The review was carried out following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed (MEDLINE), Scopus and Cochrane Library databases were searched covering the period up until April 7th, 2022.

RESULTS

Thirteen retrospective cohort studies were finally included. The introduction of DOI and ENE in the 8th edition of the AJCC classification resulted in improved prognostic performance of the classification.

CONCLUSIONS

Patients with OSCC can be better classified in relation to OS and DSS, while maintaining the simplicity and ease of use of the classification. This allows more appropriate treatment protocols to be applied and affords a better estimation of the prognosis of each patient.

Early complications and quality of life in patients with immediately loaded implant-supported maxillary partial rehabilitations: A prospective cohort study

BACKGROUND

Immediate loading of dental implants is considered an excellent option to reestablish function and aesthetics in a short period of time, thereby reducing the psychological impact of edentulism. The aim of this study was to describe the incidence of complications in immediately loaded implant-supported single or partial maxillary provisional rehabilitations; to assess changes in patient quality of life (QoL); to evaluate patient overall satisfaction; and to determine whether the occurrence of complications affects these outcomes.

MATERIAL AND METHODS

Patients requiring partial rehabilitation with implants in the maxilla were included in a prospective cohort study. In all cases, implant-based restoration with an immediate loading protocol was indicated. A provisional restoration was placed within 72 hours after implant placement. Patient QoL was measured at the first appointment and just before placing the final restoration, using two validated questionnaires. All mechanical and biological complications occurring up until placement of the final restoration were documented. A descriptive and bivariate analysis of the data was performed.

RESULTS

Thirty-five patients with 40 prostheses supported by 60 implants were analyzed. Three implant failures were observed, yielding a 95% survival rate. Five provisional prosthesis fractures and two prosthetic screw loosenings were recorded in four patients. A significant reduction in OHIP-14 score was observed. Likewise, significant differences were found in the results of the QoLFAST-10, with a mean difference in score of 7.3 between the initial and final evaluation.

CONCLUSIONS

Patients receiving immediately loaded implant-supported single or partial maxillary provisional rehabilitations seem to have a low risk of developing early mechanical (13.3%) or biological complications (5%). These patients appear to experience significant improvement in QoL and report excellent overall satisfaction with the treatment received - though the occurrence of complications seems to affect these outcomes.

Diagnosis and indications for the extraction of third molars - The SECIB clinical practice guideline

BACKGROUND

The removal of third molars (3Ms) is the most frequent surgical procedure in the field of Oral Surgery. As a result, the Spanish Society of Oral Surgery (SECIB) aims to create a Clinical Practice Guideline (CPG) that offers evidence-based recommendations for optimal clinical practice. Specifically, the CPG will focus on providing guidance regarding the indications and criteria for clinical and radiological diagnosis of patients with 3Ms.

MATERIAL AND METHODS

This CPG was developed by the SECIB, following the methodological guidelines described in the methodological manual for the "Development of Clinical Practice Guidelines in the National Health System". Several PICO questions related to the diagnosis and indications for the extraction of 3Ms were formulated. The leading experts carried out the evaluation of the evidence and the formulation of specific recommendations.

RESULTS

A total of 17 PICO questions were evaluated, addressing the indications, prognosis, diagnosis, and cost-benefit relationship of 3M extraction.

CONCLUSIONS

The present Clinical Practice Guideline provides evidence-based recommendations on the diagnosis and indications for 3M extraction. These evidence-based recommendations can assist healthcare professionals and the general population in making informed decisions regarding the management of 3Ms.

Predictors of surgical difficulty in upper third molar removal: a prospective cohort study

BACKGROUND

Upper third molar (U3M) removal is a common surgical procedure. The aims of this study were to assess the patient-specific, radiological and surgical factors related to the difficulty of U3M removal, and to determine the incidence of intraoperative and postoperative complications.

MATERIAL AND METHODS

A prospective cohort study was carried out in adult patients undergoing U3M removal. Operative time, surgeon-reported difficulty and the Parant classification were used to assess extraction difficulty. Clinical, radiological and surgical factors were recorded to determine their relationship with surgical difficulty. A descriptive, bivariate and multivariate statistical analysis was carried out.

RESULTS

A total of 250 patients were included. The mean operative time was 10.4 (±12.3) minutes, mean surgeon-reported difficulty was 3.2/10 (±2.3). The multivariate analysis showed greater impaction against the second molar and greater soft tissue and bony impaction to significantly increase operative time and surgeon-perceived difficulty. Additionally, surgeon experience was related to perceived difficulty. The overall incidence of intraoperative complications was 0.8%, and no postoperative events were recorded.

CONCLUSIONS

Upper third molars in close relation with the roots of the adjacent second molar and with soft tissue and bony impaction are significantly more difficult to extract. Perceived difficulty was related to surgeon experience. This procedure appears to produce few intra- and postoperative complications.

Psychopathological networks in psychosis and changes over time: A long-term cohort study of first-episode psychosis

Introduction

First-episode psychosis is a critical period for early interventions to reduce the risk of poor outcomes and relapse as much as possible. There are now many studies revealing the patterns of course in the short and medium terms, but uncertainties about the long-term outcomes of symptomatology remain to be ascertained.

Objectives

First, we ascertained whether the structure of psychopathological symptoms, dimensions and domains of psychopathology remains invariant over time between first-episode psychosis and long-term follow-up. Second, we analysed the changes in the interrelationships of psychopathological symptoms, dimensions and domains of psychopathology between FEP and long-term follow-up at three levels.

Methods

We performed network analysis to investigate first-episode and long-term stages of psychosis at three levels of analysis: micro, meso and macro. The sample was a cohort of 510 patients with first-episode psychoses from the SEGPEP study, who were reassessed at the long-term follow-up (n = 243). We used the Comprehensive Assessment of Symptoms and History (CASH) for their assessments.

Results

Our results showed a similar pattern of clustering between first episodes and long-term follow-up in seven psychopathological dimensions at the micro level, 3 and 4 dimensions at the meso level, and one at the macro level. They also revealed significant differences between first-episode and long-term network structure and centrality measures at the three levels.

Conclusions

Our findings suggest that disorganization symptoms have more influence in long-term stabilized patients. The main results of the current study add evidence to the hierarchical, dimensional and longitudinal structuring of first-episode psychoses.

Disclosure

No significant relationships.

Third molar surgical difficulty scales: systematic review and preoperative assessment form

Background

The main objective of this systematic review was to collect the pre-existing scales for assessing the difficulty of third molar extraction. The secondary objective was to design a proposal for a preoperative evaluation protocol for the difficulty of third molar extraction.

Material and Methods

Two independent researchers conducted an electronic search in Pubmed (MEDLINE), Cochrane, and Scopus databases during March 2021. Included studies evaluated the prediction of the difficulty of surgical removal of impacted upper or lower third molars using new indices/scales or pre-existing scales with or without modifications. Articles referring to coronectomies or assessing pre-surgical difficulty using other tools were excluded. Neither language nor publication date restrictions were applied.

Results

Out of 242 articles, 13 prospective cohort studies were finally selected. Seven developed new indices/scales, and 6 assessed the predictive ability of some pre-existing scales. Most of the indices/scales contained radiological variables and few added any patient-related variables. We proposed a preoperative assessment protocol of the difficulty of third molar extraction to facilitate treatment planning and/or considerate referral in cases of high difficulty. This proposal used patient-related, radiological and surgical variables.

Conclusions

Using a preoperative protocol to evaluate the surgical difficulty, including different patient-specific, radiological and surgical variables, could facilitate treatment planning, help clinicians prevent complications and assess the possibility of referral.

Key words:Wisdom teeth, patient characteristics, radiological variables, surgeon experience, assessment form.

Alveolar ridge preservation: an overview of systematic reviews

The aim of this overview was to assess the methodological quality of systematic reviews of randomized clinical trials on alveolar ridge preservation after a tooth extraction. During March 2020, two independent reviewers performed an electronic search of the PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library databases to identify all relevant systematic reviews including randomized clinical trials on alveolar ridge preservation. A manual search of articles in renowned journals was also conducted. The methodological quality of the included reviews was determined using the AMSTAR-2 tool. From the 53 initially retrieved studies, 11 were finally included: three systematic reviews and eight systematic reviews with meta-analyses. The methodological quality of the included reviews was low or critically low. Higher quality clinical studies should be conducted prior to performing further reviews and these should meet the methodological requirements that are fundamental to this type of research.

Retrograde filling material in periapical surgery: a systematic review

Background

Periapical surgery focuses on the treatment of teeth with persistent periapical lesions when orthograde root canal treatment fails. Although MTA® is the gold standard material for retrograde filling, Biodentine® - a tricalcium silicate-based cement - has been proposed in order to resolve several of its limitations. A systematic review has been carried out to compare the physicochemical properties of Biodentine® versus MTA® as root-end filling material in periapical surgery.

Material and Methods

An electronic search was conducted by two independent examiners during March 2020 in the Cochrane, PubMed-MEDLINE and Scopus databases. In addition, a manual search was made in specialized journals. Comparative human or in vitro studies that evaluated bond strength, the presence of marginal gap and sealing ability were included. No restriction on publication date was applied. Animal studies, clinical cases, cases series and expert opinions were excluded.

Results

After analyzing 147 initially selected studies, 13 publications were included. Regarding bond strength, the studies seemed to evidence better performance of Biodentine® in both acidic and blood contaminated environments. In relation to the presence of marginal gap and sealing ability, the studies yielded contradictory results. According to some authors, the sealing ability of Biodentine® is greater than that of MTA® during the first 24 hours, though both materials prove equal after one week. Other authors recorded no significant differences.

Conclusions

Considering the limitations and heterogeneity of the studies included, there is not sufficient evidence to confirm the clinical superiority of Biodentine® as a root-end filling material in periapical surgery.

Key words:Biodentine, MTA, retrograde filling, periapical surgery.

A polydiagnostic approach to cognitive deficits in schizophrenia

Introduction

Cognitive deficits are common, clinically relevant and closely linked to poor functional outcomes in everyday functioning in patients with schizophrenia and other psychoses.

Objectives

To ascertain to which extent a polydiagnostic assessment of schizophrenia is associated with clinically-derived criteria of cognitive impairment and gold-standard neuropsychological assessment.

Methods

We assessed 98 patients with a psychotic disorder. We tested if patients met criteria for schizophrenia according to five diagnostic classifications: Krapelin, Bleuler, Schneider, ICD-10 and DSM-IV. Also, we applied a set of clinically-derived criteria to assess cognitive impairment associated with psychosis (CIAPs). Gold-standard neuropsychological assessment was administered, covering the cognitive domains included in the MATRICS Cognitive Battery: attention, processing speed, verbal memory, visual memory, working memory, executive function and social cognition. MANOVAs were performed to test the association between polydiagnostic and clinically-derived criteria and neuropsychological assessment.

Results

MANOVA profile analyses revealed that patients who met CIAPs criteria showed cognitive impairment in all the cognitive domains except for social cognition. Patients diagnosed with Kraepelin’s criteria showed significant differences in processing speed, visual memory, working memory and GCI. Patients fulfilling Bleuler and DSM-IV criteria showed significant deficits in processing speed and verbal memory, respectively. Schneider and ICD-10 diagnostic criteria did not reveal differences in cognition between patients who fulfilled these criteria.

Conclusions

CIAPs criteria were the most accurate classifying patients with cognitive impairment, followed by Kraepelin’s criteria, which were the ones among diagnostic criteria which better differentiated patients regarding cognitive impairment. These criteria take into consideration the outcome in addition to symptoms.

Disclosure

This work was supported by the Government of Navarra (grants 17/31, 18/41, 87/2014) and the Carlos III Health Institute (FEDER Funds) from the Spanish Ministry of Economy and Competitivity (14/01621 and 16/02148). Both had no further role in the study des

Childhood trauma in a sample of patients with psychosis and healthy brothers

Introduction

Psychosis are complex disorders due to their symptomatic and evolutionary heterogeneity. The genetic-environmental interaction model is the most accepted etiopathogenic model, in which neurobiological processes (genetic factors, connectivity and brain structure) and environmental factors (for example: childhood trauma) are studied. The association between suffering traumatic events in childhood and the subsequent development of a Mental Disorder is of increasing interest.

Objectives

Analyze if a childhood trauma is a modulating factor of psychotic symptoms in patients with Mental Disorder. Analyze the implication of childhood trauma in long-term functionality.

Methods

The sample is made up of 37 patients with psychosis and their healthy brothers. Different sociodemographic, clinical and evolutionary variables were collected in all groups. The sample was evaluated using the semi-structured interview CASH, the WHODAS scale and the self-applied questionnaire CTQ.

Results

We did not find significant differences between the scores of CTQ between patients with psychosis and their healthy brothers. Sexual abuse is significantly correlated with the presence of hallucinations, inappropriate affect, formal thought disorders and catatonic symptoms. Emotional neglect is significantly correlated with the presence of hallucinations, inappropriate affect, affective blunting, and anhedonia. Physical neglect is significantly correlated with flattery and blunt affection. Sexual abuse is correlated with poorer personal care. Emotional neglect is correlated with poorer personal care, poorer family functioning, and worse overall functioning in the last year.

Conclusions

The intensity of traumatic experiences throughout childhood could be considered a modulating factor of psychotic symptoms (positive, negative, disorganized and catatonic) and overall functioning (occupational, family, social and personal care).

Cognitive impairment associated with psychosis (CIAPS): Validity of clinical criteria to detect cognitive impairment

Introduction

Even though cognitive impairment is considered a hallmark of schizophrenia, it has not been included as a criterion into major diagnostic systems.

Objectives

To test whether a set of clinical-defined cognitive impairment criteria can have utility in the assessment of psychosis patients in clinical practice.

Methods

We assessed 98 patients with a psychotic disorder, diagnosed using DSM 5 criteria. We developed a set of cognitive impairment associated with psychosis (CIAPs) criteria following the format of current DSM criteria and based on previous literature. The CIAPs criteria include: A) criterion for evidence of cognitive impairment after the beginning of illness; B) cognitive impairment clinically evidenced, affecting functioning in everyday activities in at least two out of six cognitive domains; C) and D) exclusion criterion for either delirium or other neurocognitive disorders, respectively, as causal agents of the cognitive impairment. The psychosis patients dichotomized by the CIAPs criteria were tested regarding the neuropsychological performance in attention, speed of processing, verbal memory, visual memory, working memory, executive function and social cognition tasks. Also a Global Cognitive Index was calculated.

Results

Forty-three patients with psychosis fulfilled the CIAPs criteria (43.9%). MANOVA profile analyses revealed a pattern of statistically significant deficits in all the cognitive dimensions except for social cognition in CIAPs+ patients regarding CIAPS-, with prominent deficits in processing speed and memory functions.

Conclusions

The CIAPs criteria could be an auxiliary method for clinicians to assess cognitive impairment. It may also permit clinical estimation of the influence of cognitive deficits on the ecological functioning of patients.

Conflict of interest

This work was supported by the Government of Navarra (grants 17/31, 18/41, 87/2014) and the Carlos III Health Institute (FEDER Funds) from the Spanish Ministry of Economy and Competitivity (14/01621 and 16/02148). Both had no further role in the study des

Empirical validation of the wcst network structure in patients

Introduction

Cognitive impairment is a core feature of schizophrenia and other psychotic disorders and executive deficits are within the most impaired cognitive functions The Wisconsin Card Sorting test (WCST) has been extensively used in literature on schizophrenia and psychosis. The underlying structure of executive impairment may have important implications for our understanding of the complex connections between executive dysfunction and the psychopathology and neurofunctional basis of psychosis.

Objectives

The objective was to empirically validate the dimensions of the WCST network structure of patients regarding antecedent, concurrent and outcome variables.

Methods

Subjects were 298 patients with a DSM 5 diagnosis of psychotic disorder. To assess the empirical validation of network structure of the WCST antecedent, concurrent and outcome variables were selected from the CASH interview and other scales of patients.

Results

Pearson coefficient correlations between the 4 network loadings (NL) of WCST, namely perseveration, inefficient sorting, failure to maintain the set and learning, and antecedent, concurrent and outcome validators are shown in the table. PER and IS showed common and strong associations with antecedent, concurrent and outcome validators. LNG dimension was also moderately associated and FMS did not show significant associations.

Conclusions

‘Perseveration’ and ‘Inefficient sorting’ dimensions achieve and share common antecedent, concurrent and outcome validators. While ‘Learning’ dimension achieves partial validation in terms of antecedent and outcome validators and ‘Failure to maintain the set’ dimension was not associated with external validators. These four underlying dysfunctions might help to disentangle the neurofunctional basis of executive deficits in psychosis.

Social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis

Introduction

Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear.

Objectives

The aim of the study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.

Methods

The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.

Results

At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).

Conclusions

Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

Disclosure

This work was supported by the Carlos III Institute of Health and European Fund for Regional Development (PI08/1213, PI11/ 01977, PI14/01900, PI08/01026, PI11/02831, PI14/01621, PI08/1161, PI16/ 00359, PI16/01164, PI18/00805), the Basque Foundation for He

A network analysis of executive deficits in patients with psychosis and their healthy siblings

Introduction

Psychopathological symptoms and cognitive impairment are core features of patients with psychotic disorders. Executive dysfunctions are within the most commonly observed deficits and the Wisconsin Card Sorting Test (WCST) is the test most extensively used for their assessment. Yet, the structure of executive deficits remains unclear, as there may be different underlying processes.

Objectives

The study’s aims were to explore and compare the network structure of the WCST measures in psychosis and their unaffected siblings.

Methods

Subjects were 298 patients with a DSM 5 diagnosis of psychotic disorder and 89 of their healthy siblings. The dimensionality and network structure of the 13 WCST measures were examined by means of the Exploratory Graph Analysis (EGA) and centrality parameters.

Results

The WCST network structure comprised 4 dimensions: Perseveration (PER), Inefficient sorting (IS), Failure to maintain set (FMS) and Learning (LNG). Patient and sibling groups showed a similar network structure and in both cases the network structure was reliably estimated.

Conclusions

Perseveration measures reflect the inability to switch sorting rules when necessary. Scores for the IS dimension can occur when the subject ineffectively tries to test different sorting hypotheses, changing at random the response. FMS reflects the subject’s strategy when he/she is able to find out the sorting rule, but is unable to keep applying that rule long enough. LNG comprised conceptual ability and learning items. The lack of significant difference between network structures is in keeping with results from exploratory and confirmatory studies demonstrating an invariant cognitive factor structure between schizophrenia patients and their unaffected siblings.

THU0316 VALIDATION OF ACR/EULAR PROVISIONAL CLASSIFICATION CRITERIA FOR ANCA-ASSOCIATED VASCULITIS IN A LATIN-AMERICAN TERTIARY CENTER

Background:

There is lack studies about performance of new criteria set for ANCA-Associated Vasculitis (AAV) in Latin-America.

Objectives:

To validate the new classification criteria for AAV in a real-life cohort of patients with these conditions.

Methods:

We performed a review of medical records from January 1990 to December 2019 at Hospital Nacional Guillermo Almenara Irigoyen from Peru. AAV was diagnosed by experienced rheumatologists based on the ACR 1990 criteria, Chapel Hill 2012 consensus, EMEA criteria and their experience and clinical acumen. Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) were diagnosed. Renal limited vasculitis was considered as MPA. To evaluate the performance of the new criteria, we classified all patients using “former criteria set” (including the 1990 ACR criteria for GPA and EGPA and the 1994 Chapel Hill Consensus Conference for MPA) and the EMEA (European Medicines Agency) criteria set. At the same time, we classified all patients using the ACR/EULAR Provisional criteria (new criteria set). The values for sensitivity, specificity and level of agreement (using Cohen’s kappa) of all sets of criteria were calculated using the clinical diagnosis as gold standard.

Results:

Two hundred twelve patients were identified; 12 of them were excluded (eight did not have ANCA and four had incomplete data). Female/male ratio was 1.9:1 [130 (65%)/70 (35%)] and their mean (SD) age at diagnosis was 59.3 (12.6) years. One hundred fifty-four (77%) had MPA, 41 (20.5%) GPA and 5 (2.5%) EGPA. One hundred ninety-six patients had ANCA-IIF results [p-ANCA: 131 (66.8%), c-ANCA: 43 (21.9%), negative-ANCA: 22 (11.3%)] and 190 patients had ANCA-ELISA results [MPO: 129 (67.9%), PR3: 37 (19.5%), negative-ANCA: 24 (12.6%)]. Type of diagnosis according to criteria set used is depicted in Table 1. The new criteria set had better agreement (kappa: 0.653) than the EMEA criteria (kappa: 0.506) and the former criteria set (kappa: 0.305). Performance of the criteria sets is depicted in Table 2.

Table 1.

Type of AAV according to criteria set used.

TYPE OF AAVClinical diagnosisFormer criteriaNew criteriaEMEAcriteriaMPA, n (%)154 (77)76 (38)137 (68.5)110 (56.0)GPA, n (%)41 (20.5)30 (15)39 (19.5)39 (19.5)EGPA, n (%)5 (2.5)2 (1)4 (2)2 (1.0)Not classifiable, n (%)NA92 (46)20 (10)44 (22.0)PAN5 (2.5)

PAN: Polyarteritis nodosa. NA: Not applicable.

Table 2.

Performance of the different criteria sets in AAV patients.

DIAGNOSISCRITERIA SETSESPKappaMPAFormer49.4100.00.309EMEA69.993.90.471New87.093.50.713GPAFormer68.398.70.744EMEA92.799.40.938New80.596.20.781EGPAFormer40.0100.00.565EMEA40.0100.00.565New60.099.50.659

SE: Sensitivity. SP: Specificity.

Conclusion:

The ACR/EULAR Provisional Criteria for AAV have better agreement with the clinical diagnosis of AAV in Latin-American patients from a real-life cohort.

Disclosure of Interests:

Victor Pimentel-Quiroz: None declared, Alfredo Sánchez-Torres: None declared, Cristina Reategui Sokolova: None declared, Rocío Violeta Gamboa Cárdenas Grant/research support from: Pfizer, César Sánchez-Schwartz: None declared, Mariela Medina Chinchon: None declared, Francisco Zevallos Miranda: None declared, Erika Noriega: None declared, Jose Alfaro Lozano Speakers bureau: Lilly, Jorge-M Cucho-V: None declared, Zoila Rodriguez Bellido: None declared, Cesar Pastor Asurza: None declared, Eduardo Acevedo-Vásquez: None declared, Risto Perich Campos Consultant of: Pfizer, Speakers bureau: Pfizer, Graciela S Alarcon: None declared, Manuel F. Ugarte-Gil Grant/research support from: Jannsen, Pfizer

Which is the most suitable local anaesthetic when inferior nerve blocks are used for impacted mandibular third molar extraction? A network meta-analysis

The aim of this study was to compare the efficacy and safety of the different local anaesthetic agents for the extraction of impacted lower third molars. A network meta-analysis was performed of all published reports of randomized controlled clinical trials assessing efficacy (anaesthetic success and absence of need for supplementary anaesthesia during the surgical procedure) and/or safety (number of adverse events) of anaesthetic agents. Three electronic databases were searched, from their earliest records up to April 2019. Additionally, the grey literature was searched to identify further potential candidates for inclusion. Anaesthesia had to be delivered by an inferior alveolar nerve block, complemented with infiltration anaesthesia of the buccal nerve. The quality of the studies was assessed using the Cochrane Collaboration tool. This study included a total of 21 trials (2021 molars) assessing the efficacy and 19 trials (1977 molars) assessing the safety of 11 anaesthetic solutions. Seven of the studies included were considered to have a high risk of bias. The most effective local anaesthetic for the extraction of impacted mandibular third molars appeared to be 4% articaine, with significant differences when compared with 2% lidocaine, 0.5% bupivacaine, and 1% ropivacaine. Lidocaine is the safest local anaesthetic, although all investigated solutions can be used safely.

Influence of information concerning a computerized anesthesia system on dental anxiety: a randomized controlled clinical trial

BACKGROUND

A single-blinded randomized controlled trial among patients requiring an upper third molar extraction was performed to evaluate the anxiety degree after receiving information or not about the functioning of The Wand system. Secondarily, perceived pain and the need of re-anesthesia were assessed.

MATERIAL AND METHODS

Patients were randomly assigned to the experimental group (detailed explanation about The Wand) or control group (no specific information). Local anesthesia with The Wand consisted in a supraperiosteal infiltrative technique injection 1.6 mL at the buccal and 0.2 mL at the palatal side. Distinct questionnaires for assessing dental anxiety and 100-mm visual analog scales to assess pain were delivered. Demographic data, radiological parameters, operative time and type of intervention were also registered. A descriptive bivariate analysis by non-parametric tests to detect differences in anxiety, pain and re-anesthesia was performed by SPSS 22.0 (SPPS Inc. Chicago, USA).

RESULTS

A total of 85 patients were assessed for eligibility but 17 participants were lost due to the cancellation of the visit for the surgical intervention. Finally, sixty-eight patients were included (34 participants in each group), 47 women (69.1%) and 21 men (30.9%), with an average age of 28.8 (± 9.3) years.

CONCLUSIONS

Patients that received a detailed explanation of The Wand did not have a significant reduction of the anxiety degree and perceived pain during the anesthetic act compared to patients that received no information. The need of re-anesthesia was not related to the anxiety level but was significantly related to increasing operative time.

Patient, radiological, and operative factors associated with surgical difficulty in the extraction of third molars: a systematic review

The aim of this systematic review was to determine the patient, radiological, and operative variables associated with surgical difficulty in the extraction of third molars, according to a visual analogue scale completed by the surgeon, operative time, or surgical technique. Searches of the PubMed (MEDLINE), Scopus, and Cochrane Library databases were conducted by two independent reviewers. Randomized and non-randomized clinical trials and prospective cohort studies evaluating surgical difficulty in the extraction of impacted mandibular or maxillary third molars according to patient, radiological, and operative variables were included. The full texts of 21 of the 859 articles initially retrieved were analysed, and 15 articles were included in the final systematic review. All 15 reported prospective cohort studies. The following variables were found to be on the spectrum of highly difficult or complex cases: older patient age and being overweight (patient variables), surgeons with little experience and the use of complex surgical techniques requiring tooth sectioning linked to hard tissue impaction (operative variables), and adverse radiological factors such as deep impaction, unfavourable angulation and root morphology, and a close relationship with the second molar, maxillary sinus, or the inferior alveolar nerve canal (radiological variables).

Recurrence rate of oral squamous cell papilloma after excision with surgical scalpel or laser therapy: A retrospective cohort study

Background

The aim was to describe the recurrence rates of Oral Squamous Cell Papilloma (OSCP) following surgical treatment with surgical scalpel and two different lasers (CO2 or Er,Cr;YSGG) and to determine the clinical and histopathologic features of these lesions.

Material and Methods

A retrospective cohort study covering a period of 12 years (1997-2009) that included patients diagnosed of OSCP treated with surgical excision was performed. Data was processed using SPSS 22.0 (SPPS Inc. Chicago, USA) and a descriptive and bivariate analysis were conducted.

Results

A total of 37 histopathologically confirmed OSCP in 36 patients, 19 women (52.7%) and 17 men (47.2%) with an average age of 33.4 years (14-86 years) were included. Twenty-two cases were treated by excision with surgical scalpel excision, 11 with CO2 laser and 3 with Er,Cr:YSGG laser. The mean age was 35.4 years (14-86 years) and the distribution by gender was 19 women (52.7%) and 17 men (47.2%). The most common locations were the palate in 14 cases (37.8%), followed by the tongue in 11 cases (29.7%) and gingiva with 5 cases (13.5%). The average size of the lesions was 4.25 mm in diameter, with a mean evolution time of 5.9 months. The recurrence rate was slightly higher with the CO2 laser (14.3 %) in comparison with the conventional scalpel (10%). No recurrences for Er,Cr:YSGG were found.

Conclusions

No differences for recurrence rates for OSCP between groups were found. The recurrence rate is low, happening usually before 15 months of follow-up. OSCPs are lesions usually appearing in patients between 30 and 50 years of both genders and located predominantly on the palate, tongue and gingiva.

Key words:Oral squamous cell papilloma, squamous cell papilloma, CO2 laser, recurrence.

Alveolar distraction osteogenesis for dental implant treatments of the vertical bone atrophy: A systematic review

BACKGROUND

To determine if alveolar vertical distraction osteogenesis obtains better results compared to other bone regeneration treatments (guided bone regeneration with membranes and / or filling material, or autogenous bone graft) in terms of bone gain, complications, and implant survival and success rates.

MATERIAL AND METHODS

An electronic search was performed in Pubmed (MEDLINE), Cochrane Library and Scopus databases in March 2017. Besides, a manual search was carried out. Inclusion criteria were randomized controlled trials published within the last 10 years with at least 1 year of follow-up after implant placement. No language restriction was applied. Exclusion criteria were studies in patients with bone defects produced by trauma, congenital malformation or oncologic surgical treatment. The methodological quality of the selected studies was evaluated by means of the Cochrane Collaboration's Tool for assessing risk of bias. The reports were classified into different levels of recommendation according to the "Strength of Recommendation Taxonomy ".

RESULTS

Out of 221 articles, two randomized controlled trials were finally selected for the inclusion in the systematic review. Bone gain and complications were higher with the alveolar vertical distraction osteogenesis compared to the autologous bone graft. There was higher bone resorption with the autologous bone graft. Implant survival and success rates were similar between studies, despite of the used technique.

CONCLUSIONS

Both alveolar distraction osteogenesis and autogenous bone graft are effective bone regeneration techniques for the treatment of mandibular vertical bone atrophy. A level B recommendation can be established for the use of alveolar vertical distraction osteogenesis for the treatment of the mandibular vertical bone atrophy.

Bifid mandibular condyles: A systematic review

Background

Bifid mandibular condyle (BMC) constitutes an extremely rare disorder characterized by a duplication of the head of the mandibular condyle. Its prevalence ranges from 0.31% to 1.82% in the published literature.

Objectives

The primary objective was to describe the main etiological, clinical and radiological characteristics of patients with BMCs and the existent treatment options. The secondary objective was to simultaneously include the characteristics of two new cases of BMC.

Material and Methods

An electronic search in Pubmed (MEDLINE), Scopus and The Cochrane Library was carried out by two independent reviewers until April 2018. Prospective or retrospective cohort studies, case series and case reports describing clinical and/or radiological characteristics of patients with BMC were included. Registered variables were demographic, etiological factors, diagnostic exam, clinical characteristics and treatment options. The results from the articles selected were organized in a Table along with the characteristics of two new cases of BMC provided by the authors.

Results

From a total of 431 articles found in the initial search, 68 articles were finally included. This systematic review included 216 patients and 270 BMC with an average age of 30.6 (SD=14.7) years and a women:men ratio of 1.4:1. Mediolateral condylar orientation was the most prevalent position (80.1%). Among cases with known etiology, 40.8% of cases had a history of traumatism, while 55.9% did not present any relevant medical background. Half of the symptomatic cases had history of trauma. The most common symptoms were hypomobility (22.7%), arthralgia (18.1%), articular noise (17.2%) and ankylosis (17.6%). Active monitoring and manufacturing an occlusal splint were the most frequent treatment options.

Conclusions

BMC may have congenital or traumatic etiology. Hypomobility and arthralgia are the most frequent symptoms and treatment options are often conservative.

Key words:Bifid mandibular condyle, trifid condyle, tetrafid condyle, condylar orientation, ankyloses.

Affective versus non-affective first episode psychoses: A longitudinal study

OBJECTIVE

This study aimed to assess (1) whether there were clinical, neuropsychological and functional differences between and within affective and non-affective psychoses at baseline and two years-follow-up and (2) to explore clinical and neuropsychological predictors of psychosocial functioning in the whole sample.

METHOD

This is a subanalysis from a multicentre, naturalistic, longitudinal prospective study ('Phenotype-genotype and environmental interaction. Application of a predictive model in first psychotic episodes'). The sample consisted of 192 patients with a first psychotic episode (FEP): 142 with non-affective psychoses and 50 with affective psychoses. Student t-tests, paired t-tests, Pearson correlations, ANOVAs and regression analyses were performed.

RESULTS

At baseline, the groups differed in perseverative errors (WCST), Premorbid Adjustment Scale (PAS), family history of psychiatric disorder, negative (PANSS) and manic symptoms (YMRS). At two years follow-up, the groups differed in all the PANSS subscales and in depressive symptoms assessed by the MADRS. When the whole sample was considered, the regression model which best explained the estimated variance in functioning at follow-up (41%) was composed by PANSS total score and verbal fluency assessed by the FAS (COWAT).

CONCLUSIONS

We found clinical and neurocognitive differences at baseline which decreased in the follow-up. Reduced performances at baseline in executive functions in combination with symptom severity (PANSS) were predictors of FEP patients' poor functional outcome.

Role of Carnoy's solution in the treatment of keratocystic odontogenic tumor: A systematic review

Introduction and Objective

The keratocystic odontogenic tumor is a benign but aggressive neoplasm. As enucleation alone obtains high recurrence rates, some adjuvant treatments such as Carnoy’s solution have been proposed. The aim of this study is to evaluate the reduction of recurrences with the use of Carnoy’s solution as adjuvant in the treatment of keratocystic odontogenic tumors.

Material and Methods

An electronic search in Pubmed (MEDLINE), ScienceDirect and Cochrane databases was conducted with the key words “odontogenic keratocyst”, “keratocystic odontogenic tumor”, “carnoy’s solution”, “treatment” and “enucleation”. The inclusion criteria were clinical studies using Carnoy’s solution as adjuvant for the treatment of keratocystic odontogenic tumors, published in English, including at least 10 patients. Articles with an unclear reporting of the treatment applied, nonhuman studies, case reports and lesions associated to Gorlin-Goltz syndrome were excluded.

Results

All the studies included were case series. The recurrence rate of enucleation ranged from 0% to 58.8%. With the only use of Carnoy’s solution as adjuvant treatment to the enucleation, recurrences varied from 0% to 100%. The use of ≥ 2 adjuvant treatments reduced the range between 0% and 7.9%.

Conclusions

The use of Carnoy’s solution as adjuvant therapy for the treatment of keratocystic odontogenic tumor has a grade C recommendation.

Key words:Carnoy’s solution, keratocystic odontogenic tumor, treatment, recurrence.

Assessment of cognitive impairment with the cognitive assessment interview (CAI) was useful for identifying poor psychosocial functioning outcome in patients with psychosis

Introduction

Cognitive impairments clearly impact the daily functioning of patients with psychosis.

Objectives

To assess cross-sectionally whether there are differences in the cognitive domains assessed with the CAI, for considering the real-world functioning of a sample of patients with psychosis.

Methods

The sample consisted of 76 patients with a DSM-IV psychotic disorder. Patients were assessed with the cognitive assessment interview (CAI), which is an interview-based measure of cognitive functioning that is intermediate between cognitive functioning and daily functioning, and three subscales of the specific levels of functioning (SLOF), an informant-rated measure of functioning. The CAI was used to assess the patient and an informant, and these scores were integrated into a rater composite score. We divided the sample by a median-split procedure for each of the three functional domains, and then applied ANOVAs to compare the two groups (impaired/not impaired) in the six cognitive domains of the CAI: working memory, attention, verbal memory, problem solving, processing speed, and social cognition.

Results

We found significant differences between the impaired vs. non-impaired groups in most of the cognitive domains assessed with the CAI (Fig. 1).

Conclusions

Interview-based assessment of cognition with the CAI allows for the prediction of everyday functioning in patients with psychosis. Impairment in almost all CAI cognitive domains, except for social cognition, was associated with poorer psychosocial functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Pro- and anti-inflammatory cytokine gene single-nucleotide polymorphisms in inflammatory bowel disease

Anti-inflammatory cytokines have an important role in disease, tumour and transplant processes. Alterations in the regulation of several cytokines have been implicated in a variety of inflammatory disorders, including IBD (inflammatory bowel disease) [Crohn's disease (CD) and ulcerative colitis (UC)]. Cytokine polymorphisms are also known to affect the level of gene expression. Thus, the aim of this study was to determine the relationship between cytokine polymorphisms and the IBD pathologies in a Spanish population. Polymorphisms analysis was performed using PCR-SSOP using a microbeads luminex assay. The following polymorphisms were determined: TNFα [-238G/A (rs361525) and -308G/A (rs1800629)], IFNγ [+874A/T (rs62559044)], TGFβ [+869C/T (rs1982073) and +915G/C (rs1800471)], IL10 [-1082A/A (rs1800896), -592A/C (rs1800872), -819C/T (rs1800871)], IL6 [-174C/G (rs1800795)], IL12p40 [3'UTR -1188A/C (rs3212227)], IL1α [-889C/T (rs1800587)], IL1β [-511C/T (rs1143634) and +3962C/T (rs1143633)], IL1R [Pst-1 1970C/T] and IL1RA [Mspa-1 11100C/T]. No statistical differences in TNFα, IFNγ, TGFβ, IL10, IL6, IL1α, IL1β, IL1R and IL1Ra genotypes and allele distributions between the IBD groups and healthy controls were found. However, we observed significant differences in the 3'UTR -1188A/C polymorphism of IL12p40. So -1188A allele was increased in patients with UC and the -1188C allele (high IL12p40 production) was increased in patients with CD with respect to controls. These data are in concordance with the fact that CD has been shown to be associated with a Th1 T-cell-mediated inflammation model and high IL12/IFNγ production at histological affected sites. These data suggest that cytokine polymorphisms in TNFα, IFNγ, TGFβ, IL10, IL6 and IL1α, IL1β, IL1R and IL1Ra cytokine gene do not seem to be relevant in IBD susceptibility and IL12p40 3'UTR -1188A/C polymorphism seems to be associated with a differential IBD development.

Genetic polymorphisms of tumour necrosis factor alpha (TNF-α) promoter gene and response to TNF-α inhibitors in Spanish patients with inflammatory bowel disease

Tumour necrosis factor alpha (TNF-α) has an important role in inflammatory response. Alterations in the regulation of TNF-α have been implicated in a variety of inflammatory disorders, including Inflammatory bowel disease (IBD). Indeed, a common treatment for IBD is the use of TNF-α inhibitors. Polymorphisms in the TNF-α promoter region are known to affect the level of gene expression. Our aim was to investigate the influence of these single nucleotide polymorphisms (SNPs) in TNF-α promoter gene play in the risk of IBD in a Spanish population and their individual response to anti-TNF-α treatment. DNA samples from patients with IBD and controls were screened for TNF-α -238G/A (rs361525) and -308G/A (rs1800629) SNPs by PCR-SSOP using a microbeads luminex assay and compared with response to TNF-α inhibitors. There were not statistical differences in -238G/A and -308G/A allele and genotype frequencies between patients. However, we found an increased frequency of -308A allele and -308GA genotype in these nonresponders patients to TNF-α inhibitors with respect to responders patients (Pc < 0.05). This -308GA genotype has been classified as high producer of this cytokine. This fact could actually be interesting to explain the different response of patients with IBD with respect to TNF-α inhibitors. TNF-α promoter gene polymorphism does not seem to play a role in IBD susceptibility, but particular TNF-α genotypes may be involved in the different responses to TNF-α inhibitor treatment in Spanish patients with IBD.

Adenocarcinoma of the rectum and anus in a patient with Crohn's disease treated with infliximab

In the present paper, we report the case of a patient with long-standing Crohn s disease and multiple complications that, after receiving treatment with infliximab, was diagnosed with an adenocarcinoma of the rectum and anus that required radical surgery, later presenting multiple metastases. In the discussion, characteristics and major risk factors for colorectal cancer in patients with inflammatory bowel disease will be largely reviewed, and current studies will be analyzed in connection with the appearance of neoplasms in patients being treated with biologics.

Attenuated response to purified protein derivative in patients with rheumatoid arthritis: study in a population with a high prevalence of tuberculosis

BACKGROUND

The purified protein derivative (PPD) skin test is the only widely used method which detects latent tuberculosis infection (LTBI) and is dependent on a normal T cell function. In rheumatoid arthritis (RA) the T cell function is altered, which may result in an inability to develop an adequate PPD reaction.

OBJECTIVES

To evaluate the response to PPD in patients with RA and to compare it with that of control subjects.

METHODS

112 patients with RA and 96 healthy controls were studied. PPD 5 U was applied using the Mantoux method, and skin reaction was measured at 72 hours. The reaction was considered negative for PPD <5 mm.

RESULTS

There were no significant differences in age, sex, history of bacille Calmette-Guerin vaccination, or tuberculosis contact between the two groups. The median size of the PPD induration in the patients with RA was significantly less than that in the control group (4.5 v 11.5 mm, p<0.01). 79 (70.6%) patients with RA compared with 25 (26%) of the control group had a negative reaction to PPD (p<0.01), a response not influenced by disease activity or duration of disease in the patients with RA.

CONCLUSION

A PPD skin test is not an appropriate test for recognising LTBI in patients with RA in our population.