Non-submerged reconstructive approach for peri-implantitis osseous defect with removal of implant crowns: One-year outcomes of a prospective case series study.

BACKGROUND: The aim of this study was to test a non-submerged reconstructive approach for peri-implantitis osseous defects, by removing the prosthetic components, augmenting of the infraosseous bony compartment, and flap readaptation around the replaced healing abutments, without obtaining a primary wound closure. METHODS: Twenty-nine implants in 24 patients were treated. Implant suprastructures were removed at the time of the intervention, to aid with the debridement process which included curettage, implantoplasty, air-power driven devices, and locally delivered antibiotics. The infraosseous part of peri-implant defects were augmented using a composite bone graft and an absorbable membrane to be secured around the replaced healing abutments without attempting to submerge the implants. After 8 months, direct peri-implant defect measurements were obtained to serve as the primary outcome. Secondary outcomes included of radiographic bone changes, and probing depth (PD) and bleeding on probing (BOP) changes at 12 months. RESULTS: At the time of the surgical re-entry (8 months), a statistically significant clinical and radiographic defect fill was observed (average of 2.33 and 1.63 mm, respectively). Approximately 3 months after crown replacement, 12 months from the surgical intervention, a significant PD (1.51 mm) and BOP (65%) reduction were also noted. CONCLUSIONS: Considering its limitations, the use of a non-submerged approach (with removal of implant crowns) led to significant improvements in clinical (defect fill, PD, BOP) and radiographic outcomes.

Surgical reconstructive treatment for infraosseous peri-implantitis defects with a submerged healing approach: A prospective controlled study.

BACKGROUND: The aim of this study was to assess the reconstructive potential of a submerged healing approach for the treatment of infraosseous peri-implantitis defects. METHODS: Patients with a diagnosis of peri-implantitis were recruited. Implant suprastructures were removed before the surgical treatment, which included implant surface and defect detoxification using implantoplasty, air-power driven devices, and locally delivered antibiotics. The augmentation procedure included a composite bone graft and a non-resorbable membrane followed by primary wound coverage and a submerged healing of 8 months, at which point membranes were removed, and peri-implant defect measurements were obtained as the primary outcome. Secondary endpoints included assessment of cone-beam computed tomography (CBCT) and probing depth (PD) reductions. RESULTS: Thirty implants in 22 patients were treated. A significant clinical bone gain of 3.22 ± 0.41 mm was observed at 8 months. Radiographic analysis also showed an average gain of 3.47 ± 0.41 mm. Three months after installment of new crowns, final PD measures showed a significant reduction compared to initial examinations and a significant reduction in bleeding on probing compared to examinations at the pre-surgical visit. CONCLUSIONS: Reconstruction of infraosseous peri-implantitis defects is feasible with thorough detoxification of implant sites, and a submerged regenerative healing approach.

Time analysis of alveolar ridge preservation using a combination of mineralized bone-plug and dense-polytetrafluoroethylene membrane: A histomorphometric study.

BACKGROUND: The objective of this study was to histologically evaluate and compare vital bone formation, residual graft particles, and fraction of connective tissue (CT)/other tissues between three different time points at 2-month intervals after alveolar ridge preservation with a cancellous allograft and dense-polytetrafluoroethylene (d-PTFE) membrane. METHODS: Ridge preservation with a cancellous allograft and d-PTFE membrane was performed at 49 extraction sockets (one per patient). Volunteers were assigned to implant placement at three different time points of 2, 4, and 6 months, at which time core biopsies were obtained. Histomorphometric analysis was performed to determine the percentages of vital bone, residual graft particles, and connective tissue/other non-bone components, and subjected to statistical analyses. RESULTS: There was a statistically significant difference in the amount of vital bone at every time point from 28.31% to 40.87% to 64.11% (at 2-, 4-, and 6-month groups, respectively) (P < 0.05). The percentage of residual graft particles ranged from 44.57% to 36.16% to 14.86%, showing statistical significance from 4 to 6 months (21.29%, P < 0.001), and 2 to 6 months (29.71%, P < 0.001), while there were no significant differences for the amount of CT/other tissue among the different time points. CONCLUSIONS: This study provided the first histologic comparison of alveolar ridge preservation using a cancellous allograft and d-PTFE membrane at three different time points. Extraction sockets that healed for 6 months produced the highest amount of vital bone in combination with the least percentage of residual graft particles, while similar results were observed for the fraction of CT/other tissues between the three time points.

The risk of stroke and associated risk factors in a health examination population: A cross-sectional study.

Health examination is an important method for early detection of people with different risk of stroke. This study estimates the risk of stroke and identify risk factors for people who underwent health examinations at the Health Examination Center at West China Hospital, Sichuan University from July 2014 to February 2018.A total of 31,464 people were recruited in this study and divided into 3 groups (low risk, moderate risk, and high risk) according to risk of stroke. We explored possible factors associated with the risk of stroke by using multivariable stepwise logistic regression analysis.Among the participants, 17,959 were at low risk, 11,825 were at moderate risk, and 1680 were at high risk. Age, smoking, alcohol consumption, body mass index, uric acid, diastolic pressure, systolic pressure, triglycerides, low-density lipoprotein cholesterol, glucose, and brachial-ankle pulse wave velocity (baPWV) were independent significant risk factors for stroke, whereas high-density lipoprotein cholesterol was an independent protective factor for stroke. Interestingly, with increasing age, the percentage of people at moderate or high risk of stroke was increased. The percentages of people at moderate and high risk of stroke were also increased with respect to the stages of baPWV.This study showed that >40% of the participants were at moderate or high risk of stroke, especially the older participants. Several factors were related to the risk of stroke, especially baPWV. Some preventive action may be adopted early, and more attention can be paid to the health examination population.

Regeneration of Peri-implantitis Infrabony Defects: Report on Three Cases.

This paper presents a surgical treatment protocol known as EP-DDS (etiology identification, primary wound closure, debridement, decontamination, and stability of wound). The treatment protocol can be achieved in five steps. First, identify etiologic factors associated with peri-implantitis to determine whether or not the defects can be treated with this protocol. Second, in order to achieve primary wound coverage, ensure there is undisturbed wound healing, which may involve using procedures such as removing an existing prosthesis and performing tension-releasing flap design. Third, perform proper debridement of the inflamed granulomatous tissues to ensure the wound is free of any inflamed remnants. Fourth, conduct implant-surface decontamination by using a titanium brush or lasers. And finally, place appropriate space fillers (bone grafts and membrane) for wound stability. The three cases that have been successfully treated with the EP-DDS surgical protocol suggest it is a feasible surgical approach to obtain good infrabony defect bone fill (5.5-mm average) around the defects (buccal, mesial, lingual, and distal). Nonetheless, future randomized clinical trials with larger sample sizes and longer follow-ups are needed to further validate this treatment protocol.

Classification tree analysis of the factors influencing injury-related disability caused by the Wenchuan earthquake.

OBJECTIVE: To identify the factors that influenced the risk of injury-related disability caused by the Wenchuan earthquake. METHODS: A chi-squared automatic interaction detection (CHAID) classification tree analysis was used to retrospectively analyse clinical data from patients who underwent surgical treatment for earthquake-related injuries in the first 5 days after the earthquake. The CHAID classification tree explored the relationships between the development of disability and potential influencing factors including sex, age, time interval between injury and treatment, wound type, preoperative and postoperative haemoglobin levels, and operation time. RESULTS: A total of 334 patients underwent surgery; of these, 113 (33.8%) were discharged with varying degrees of permanent disability. The CHAID classification tree showed that children (≤ 17 years old), a long time interval between injury and treatment, an open wound and a low preoperative haemoglobin level were significant risk factors for disability. CONCLUSION: The results of this study can help to stratify patients according to their medical needs and to help allocate the available resources efficiently to ensure the best outcomes for injured patients during future earthquakes.

[The influence of Qi-lan granulates on the variation of proliferating cell nuclear antigen during the course of SD rat tongue carcinogenesis].

PURPOSE: To study the cancer blocking effect of the Qi-lan granulates in SD rats. METHODS: A total of 150 SD rats were divided into five groups A,B,C,D,E. Rats in group A, B, C, D were fed with 0.002% 4NQO dissolved in drinking water to induce tongue carcinogenesis in rats. Different concentration of the herb Qi-lan granulates was given to the rats of group B, C, D during oral carcinogenesis. Group A was model group, group E was normal group. The rats were sacrificed at 9, 18, 27 and 36 weeks respectively from the beginning of the experiment. The samples were collected for histophology and PCNA immunohistochemistry. The date was analyzed by Chi-square test and Kruskal-Wallis test using SPSS13.0 software package. RESULTS: The overall canceration rate of group B (14.29%), C (3.57%), D (14.29%) was significantly lower than group A (39.29%) (P<0.05), the effect of Qi-lan granulates in group C was the best. Immunohistochemistry result showed that 6 cases of normal oral mucosa in group A had positive expression of PCNA. In 11 cases of dysplasia, 8 had positive express of PCNA, 11 rats with oral cancerous tissues had positive expression of PCNA.In group A, the expression of PCNA was normal tissue0.05). In general, the expression of PCNA in group A was significantly higher than the Qi-lan granulates group, the difference was statistically significant (P<0.05). The expression of PCNA in group E was negative. CONCLUSIONS: Qi-lan granulates have significant inhibitory effect on tongue cancer, through blocking cell proliferation.

[Multicenter phase II clinical trial of uroacitides injection in the treatment for advanced malignant tumors].

OBJECTIVE: To investigate the efficacy, safety and the life quality improvement of uroacitides injection in the treatment for patients with advanced malignant tumors. METHODS: A total of 160 patients with advanced stage cancers were enrolled into this multicenter, open and non-randomized phase II clinical trial, including cancers of the lung (33 cases), liver (45 cases), breast (17 cases), esophagus (11 cases), stomach (18 cases), colon (19 cases), pancreas (3 cases) and kidney (4 cases), and glioma (10 cases). Uroacitides was administrated in a dose of 300 ml daily via the superior vena cava catheter for consecutive 4-8 weeks. RESULTS: Of the 160 patients, 21 dropped out and one patient died during the trial. Efficacy could be evaluated in 138 patients and safety in 160. The total objective response rate (ORR, CR + PR)) and tumor control rate (CR + PR + MR + SD) of the 138 evaluable patients were 5.8% and 65.2%, respectively. Clinical benefit response (CBR) rate was 57.2%. Major adverse effects were grade I - II and reversible nausea/vomiting (21.9%) and pain (6.3%). CONCLUSION: Uroacitides injection is effective in the control for various kinds of advanced cancers with mild, reversible and tolerable adverse effects, and can also improve the patient's quality of life. It is worth being studied further.

[The development and in vitro experiment study of a bio-type root canal filling sealer using calcium phosphate cement].

PURPOSE: The purpose of this study is to develop a novel root canal filling sealers based on calcium phosphate cement (CPC), and to evaluate its physical-chemical properties and in vitro antibacterial activity on the predominant bacteria infecting root canal. METHODS: The fluidity and the setting time of the sealer were tested according to ISO 6876:2001(E) standards. The crystal size of the final product was determined. Its opacification with different composition were measured. The in vitro antibacterial property of the sealer was tested according to the Antimicrobial Susceptibility Testing of Anaerobes recommended by National Committee for Clinical Laboratory Standards (NCCLs). The involved bacteria included Actinomyces naeslundii(A. naeslundii), Peptostreptococcus anaerobius (P. anaerobius), Porphyromonas gingivalis (P. gingivalis), Porphyromonas endodpntalis (P. endodpntalis) and Fusobacterium nucleatum (F. nucleatum). Twenty single-rooted human extracted teeth were selected to evaluate the sealing ability using dye microleakage technology. Dye penetration was measured and the results were statistically analyzed using SPSS12.0 software package. RESULTS: The new root canal filling sealer was primarily composed of hydroxyapatite in 279 nm after setting. Its liquidity was suitable, the operating time was over 30 minutes, and the controlled setting time was (1.0+/-0.5) hours. The opacification was acceptable. MIC

[Experimental study on effects of shengmai injection: enhancing 5-FU anti-tumor efficacy and reducing its toxicity].

OBJECTIVE: To observe the effects of Shengmai Injection on enhancing efficacy and reducing toxicity of 5-fluorouracil (5-FU). METHODS: Fifty hepatoma 22 bearing mice were randomly divided into five groups: control group, 5-Fu group, Shengmai Injection (low, medium and high dose) combined with 5-FU groups. There were 10 mice in each group. Mice in the five groups were injected introperitoneally the same amount of normal saline, 5-FU (20 mg.kg(-1).d(-1)) and Shengmai Injection (3.5 ml.kg(-1).d(-1), 7 ml.kg(-1).d(-1) and 14 ml.kg(-1).d(-1)) combined with 5-FU respectively, once a day for 14 days. After that, all mice were killed and the tumor inhibiting rates, index of immunological function, liver and kidney function and the blood cells in the peripheral blood were observed. RESULTS: The tumor inhibiting rates were higher in each Shengmai Injection combined with 5-FU group than that in the 5-FU group (P<0.05). The levels of CD3, CD4, CD4/CD8, IgG, IgM in 5-FU group were lower (P<0.05), while those in the three Shengmai Injection combined with 5-FU groups were higher than those in the control group (P<0.05). The level of serum alanine aminotransferase (ALT) was higher and the WBC and PLT counts in the peripheral blood were lower in 5-FU group than those in the control group (P<0.05). But the levels of serum ALT in the three Shengmai Injection combined with 5-FU groups were consistent with that in the control group and the amounts of WBC decreased slightly. CONCLUSION: Shengmai Injection can enhance the anti-tumor effect of 5-FU. It can also improve the immunological function and reduce the adverse reactions of chemotherapy.

Current preventive treatment for recurrence after curative hepatectomy for liver metastases of colorectal carcinoma: a literature review of randomized control trials.

To review the preventive approaches for recurrence after curative resection of hepatic metastases from colorectal carcinoma, we have summarized all available publications reporting randomized control trials (RCTs) covered in PubMed. The treatment approaches presented above include adjuvant intrahepatic arterial infusion chemotherapy, systemic chemotherapy, neoadjuvant chemotherapy, and immunotherapy. Although no standard treatment has been established, several approaches present promising results, which are both effective and tolerable in post-hepatectomy patients. Intrahepatic arterial infusion chemotherapy should be regarded as effective and tolerable and it increases overall survival (OS) and disease-free survival (DFS) of patients, while 5-fluorouracil-based systemic chemotherapy has not shown any significant survival benefit. Fortunately chemotherapy combined with hepatic arterial infusion and intravenous infusion has shown OS and DFS benefit in many researches. Few neoadjuvant RCT studies have been conducted to evaluate its effect on prolonging survivals although many retrospective studies and case reports are published in which unresectable colorectal liver metastases are downstaged and made resectable with neoadjuvant chemotherapy. Liver resection supplemented with immunotherapy is associated with optimal results; however, it is also questioned by others. In conclusion, several adjuvant approaches have been studied for their efficacy on recurrence after hepatectomy for liver metastases from colorectal cancer (CRC), but multi-centric RCT is still needed for further evaluation on their efficacy and systemic or local toxicities. In addition, new adjuvant treatment should be investigated to provide more effective and tolerable methods for the patients with resectable hepatic metastases from CRC.

Concurrent hyperglycemia does not influence the long-term prognosis of unresectable hepatocellular carcinomas.

AIM: The association has been established between the disorder of carbohydrate metabolism and liver cancer. However, little is known regarding the impact of concurrent hyperglycemia on prognosis of hepatocellular carcinoma (HCC). The present study aimed at solving this problem. METHODS: A total of 225 patients included in this study, were admitted from January 1998 to December 2001 for an unresectable HCC proven by histological and imaging examinations. Most of the patients received interventional treatment, radiation and biotherapy. Response was evaluated by computerized tomography (CT) scan conducted 4-6 weeks following completion of the treatment, and then every 3 months. Survival was calculated from the beginning of treatment using the Kaplan-Meier method. Pretreatment, treatment and follow-up variables with possible prognostic significance were analyzed. A stepwise multivariate analysis was performed using the Cox regression model, and a prognostic index was obtained. RESULTS: No differences were observed in survival parameters between the patients with and without hyperglycemia, median survival times of the patients were being 26+/-3.46 months and 29.5+/-2.04 months, respectively, and the 3-year survival rate was 8.36 % and 9.62 %, respectively. The univariate analysis indicated that there were several survival-associated variables including serum AFP level, clinical stage, Child-Pugh grade, method of treatment, size and number of tumor nodule (s). However, only the clinical stage, Child-Pugh grade and the treatment procedure were proved to be independent prognostic factors in the multivariate analysis. CONCLUSION: This study indicates that hyperglycemia does not influence the long-term prognosis of HCC, and concurrent hyperglycemia should not be considered as an unfavorable prognostic factor during the treatment of patients with HCC.

[Clinical evaluation of integration of transcatheter arterial chemoembolization and traditional Chinese medicine in treating metastatic liver cancer].

OBJECTIVE: To evaluate the treatment effect, quality of life and side-effect of transcatheter arterial chemoembolization (TACE) and traditional Chinese medicine (TCM) in treating metastatic liver cancer. METHODS: Thirty-nine cases of colon metastatic liver cancer were randomly divided into two groups. Both TACE and TCM were used in the treatment group, while only TACE was used in the control group. The drug used in TACE included floxuridine, pirarubicin, cisplatin, and the herbs for strengthening the spleen and regulating Qi were used in TCM. RESULTS: The response rate in the treatment group was 30% (45% including minor remission patients), and the median survival time was 18.6 months. While in the control group the response rate was 15.8% (36.8% including minor remission patients), and the median survival time was 14.3 months. The 1-, 2-, 3- year survival rates of treatment group and the control group were 70.2%, 40.3%, 13.0% and 68.7%, 29.5%, 10.3% respectively. There were fewer other organ metastases in the treatment group. The score from the EORTC quality of life questionnaire QLQ-C30 in treatment group was higher than that in the control group. CONCLUSION: Integration of TACE and TCM in treating colon metastatic liver cancer has better results.

[Evaluation of therapeutic effects of traditional Chinese medicine combined with western medicine on breast cancer after resection: analysis of 71 cases].

OBJECTIVE: To evaluate the effectiveness of traditional Chinese medicine (TCM) combined with western medicine on breast cancer after surgical resection. METHODS: Seventy-one patients with breast cancer received chemotherapy, radiotherapy, endocrine therapy and TCM following resection. RESULTS: None of the patients died during the follow-up period. Fifty-seven patients were treated with TCM shortly after undergoing resection. Two recurrences (3.5%) and 6 metastases (10.5%) were observed in 8 patients, whose median disease free survival was 5.9 years. Fourteen patients didn't receive TCM until recurrence or metastasis emerged, with a median disease free survival of 3.5 years. There was significant difference between the two groups (P=0.033). CONCLUSION: TCM combined with western medicine is efficient in preventing and delaying recurrence and metastasis.