Epidemiology and risk factors of peri-implantitis: A systematic review.

The purpose of this systematic review and meta-analysis was to assess the prevalence, incidence and risk factors of peri-implantitis in the current literature. An electronic search was performed to identify publications from January 1980 until March 2016 on 9 databases. The prevalence and incidence of peri-implantitis were assessed in different subgroups of patients and the prevalences were adjusted for sample size (SSA) of studies. For 12 of 111 identified putative risk factors and risk indicators, forest plots were created. Heterogeneity analysis and random effect meta-analysis were performed for selected potential risk factors of peri-implantitis. The search retrieved 8357 potentially relevant studies. Fifty-seven studies were included in the systematic review. Overall, the prevalence of peri-implantitis on implant level ranged from 1.1% to 85.0% and the incidence from 0.4% within 3 years, to 43.9% within 5 years, respectively. The median prevalence of peri-implantitis was 9.0% (SSA 10.9%) for regular participants of a prophylaxis program, 18.8% (SSA 8.8%) for patients without regular preventive maintenance, 11.0% (SSA 7.4%) for non-smokers, 7.0% (SSA 7.0%) among patients representing the general population, 9.6% (SSA 9.6%) for patients provided with fixed partial dentures, 14.3% (SSA 9.8%) for subjects with a history of periodontitis, 26.0% (SSA 28.8%) for patients with implant function time ≥5 years and 21.2% (SSA 38.4%) for ≥10 years. On a medium and medium-high level of evidence, smoking (effect summary OR 1.7, 95% CI 1.25-2.3), diabetes mellitus (effect summary OR 2.5; 95% CI 1.4-4.5), lack of prophylaxis and history or presence of periodontitis were identified as risk factors of peri-implantitis. There is medium-high evidence that patient's age (effect summary OR 1.0, 95% CI 0.87-1.16), gender and maxillary implants are not related to peri-implantitis. Currently, there is no convincing or low evidence available that identifies osteoporosis, absence of keratinized mucosa, implant surface characteristics or edentulism as risk factors for peri-implantitis. Based on the data analyzed in this systematic review, insufficient high-quality evidence is available to the research question. Future studies of prospective, randomized and controlled type including sufficient sample sizes are needed. The application of consistent diagnostic criteria (eg, according to the latest definition by the European Workshop on Periodontology) is particularly important. Very few studies evaluated the incidence of peri-implantitis; however, this study design may contribute to examine further the potential risk factors.

Outbreak of Salmonella enteritidis phage type 1B associated with frozen pre-cooked chicken cubes, Finland 2012.

In August to October 2012, a nationwide outbreak of Salmonella enteritidis phase type (PT) 1B with 53 cases occurred in Finland. Hypothesis generating interviews pointed toward ready-to-eat chicken salad from a Finnish company and at the same time Estonian authorities informed of a S. enteritidis PT 1B outbreak linked to chicken wrap prepared at an Estonian restaurant. We found that chicken salad was associated with the infection (odds ratio (OR) 16·1, 95% confidence interval (CI) 1·7-148·7 for consumption and OR 17·5. 95% CI 4·0-76·0 for purchase). The frozen pre-cooked chicken cubes used in Finnish salad and in Estonian wraps were traced back to a production plant in China. Great Britain made two Rapid Alert Systems for Food and Feed notifications on chicken cubes imported to the UK from the same Chinese production plant. Microbiological investigation confirmed that the patient isolates in Estonia and in Finland were indistinguishable from the strains isolated from chicken cubes in Estonia and in the UK. We recommend that despite certificates for tested Salmonella, food items should be analyzed when Salmonella contamination in outbreak investigations is suspected. In outbreak investigations, electronically implemented case-case study saves time, effort, and money compared with case-control study.

Estimating the burden of A(H1N1)pdm09 influenza in Finland during two seasons.

In Finland, the pandemic influenza virus A(H1N1)pdm09 was the dominant influenza strain during the pandemic season in 2009/2010 and presented alongside other influenza types during the 2010/2011 season. The true number of infected individuals is unknown, as surveillance missed a large portion of mild infections. We applied Bayesian evidence synthesis, combining available data from the national infectious disease registry with an ascertainment model and prior information on A(H1N1)pdm09 influenza and the surveillance system, to estimate the total incidence and hospitalization rate of A(H1N1)pdm09 infection. The estimated numbers of A(H1N1)pdm09 infections in Finland were 211 000 (4% of the population) in the 2009/2010 pandemic season and 53 000 (1% of the population) during the 2010/2011 season. Altogether, 1·1% of infected individuals were hospitalized. Only 1 infection per 25 was ascertained.

Outbreak of gastroenteritis caused by norovirus GII.4 Sydney variant after a wedding reception at a resort/activity centre, Finland, August 2012.

In August 2012, an outbreak of gastroenteritis occurred among 88 persons attending a wedding reception at a resort/activity centre in Ylöjärvi, Finland. Of 39 interviewed guests, 23 met the case definition. Two persons were hospitalized. Epidemiological, laboratory and environmental investigations were conducted to characterize the outbreak and to recommend control measures. Investigation confirmed the presence of a new strain of norovirus GII.4 Sydney variant in stool specimens obtained from two wedding guests and on several environmental surfaces in the centre. In the questionnaire study, none of the foods or beverages served during the reception were significantly associated with the illness. Additional cases of gastroenteritis that occurred at the centre before and after the wedding reception supported the hypothesis of environmental transmission of norovirus. After thorough cleansing and disinfection and 1 week's quarantine, no new cases with symptoms typical for norovirus infection were identified at the centre.

Investigation of increased listeriosis revealed two fishery production plants with persistent Listeria contamination in Finland in 2010.

In 2010, a marked increase in listeriosis incidence was observed in Finland. Listeria monocytogenes PFGE profile 96 was responsible for one-fifth of the reported cases and a cluster of PFGE profile 62 was also detected. Investigations revealed two fishery production plants with persistent Listeria contamination. It appears likely that the plants were at least partly responsible for the increase of listeriosis. Epidemiological investigation revealed that 57% (31/54) of cases with underlying immunosuppressive condition or medication reported eating gravad or cold-smoked fish. Two public notices were issued by THL and Evira informing which groups were most at risk from the effects of listeriosis and should therefore be cautious in consuming certain products. Systematic sampling of foods and adequate epidemiological investigation methods are required to identify the sources of Listeria infections. Continuous control measures at fishery production plants producing risk products are essential.

Raw grated beetroot linked to several outbreaks of sudden-onset gastrointestinal illness, Finland 2010.

In 2010, 7/44 (16%) reported foodborne outbreaks in Finland were linked with raw beetroot consumption. We reviewed data from the national outbreak registry in order to hypothesize the aetiology of illness and to prevent further outbreaks. In the seven outbreaks, 124 cases among 623 respondents were identified. Consumption of raw beetroot was strongly associated with gastrointestinal illness (relative risk 8∙99, 95% confidence interval 6∙06-13∙35). The illness was characterized by sudden onset of gastrointestinal symptoms; the median incubation time was 40 min and duration of illness 5 h. No common foodborne pathogens or toxins were found in either clinical or beetroot samples, but all tested beetroot samples were of poor quality according to total bacterial counts. Beta-haemolytic Pseudomonas fluorescens was detected in several beetroot samples but its effect on human health is unknown. No outbreaks were reported after the Finnish Food Safety Authority Evira advised against serving raw beetroot in institutional canteens.

Increased incidence of Mycoplasma pneumoniae infection in Finland, 2010-2011.

The number of cases of Mycoplasma pneumoniae infection detected by laboratory-based surveillance increased in Finland in late 2010. During 2011, the number of cases was four times higher than during the previous epidemic in 2005. The 2011 epidemic affected mostly school-age children. The increased number of cases was probably not due to changes in laboratory procedures, but public interest may have had an effect, since the number of Google queries followed closely the epidemic curve.

Macrophages, T cell receptor usage, and endothelial cell activation in the pancreas at the onset of insulin-dependent diabetes mellitus.

Current knowledge of the phenotype of mononuclear cells accumulating in pancreatic islets in insulin-dependent diabetes (IDDM) and factors determining their homing into the pancreas is limited. Therefore, a pancreas obtained at the onset of IDDM was studied in detail. Cryostat sections were stained for mononuclear cell types, T cell receptor subtypes, and adhesion molecules of vascular endothelium and studied by immunofluorescence microscopy, and peripheral blood mononuclear cells were phenotyped using flow cytometry. Monocytes/macrophages (lysozyme- or CD 14-reactive cells) were identified among other mononuclear cell types in islet infiltrates. V beta 8-positive T cells were overrepresented, but T cells with other V beta s studied (V beta 5, V beta 5.1, V beta 6, V beta 12) were also found. The vascular endothelium of the islets and many small vessels nearby islets strongly expressed intercellular adhesion molecule-1, whereas vascular cell adhesion molecule-1 and E-selectin were totally absent. We conclude: (a) that increased expression of intercellular adhesion molecule-1 on vascular endothelium may increase endothelial adhesion of mononuclear cells and enhance their accumulation in the pancreas during diabetic insulitis; (b) that T cells with certain T cell receptors can be enriched in infiltrated pancreatic islets; and (c) that macrophages and antigen-specific CD 8-positive T cells are involved in pancreatic beta cell destruction at the onset of IDDM.

Cured of breast cancer?

PURPOSE: That patients can be ultimately cured of breast cancer has been questioned, because late deaths from the disease have been observed even several decades after the diagnosis. The purpose of this study was to investigate late mortality caused by breast cancer. PATIENTS AND METHODS: Using the files of local hospitals and the Finnish Cancer Registry, we identified all patients with histologically diagnosed invasive breast cancer in a defined urban area (city of Turku, Finland) from 1945 to 1969 (n = 601). In 563 cases (94%), clinical data and histologic and autopsy slides could be reviewed, and these women had been monitored for a median of 29 years (range, 22 to 44; n = 66) or until death (n = 497). RESULTS: Mortality from breast cancer was observed even during the fourth follow-up decade, but if women who were diagnosed with contralateral breast cancer were excluded (n = 30), no deaths from breast cancer were identified after the 27th year of follow-up evaluation. The 30-year survival rates were 62% (95% confidence interval [CI], 54% to 70%), 19% (95% CI, 13% to 25%), and 0% for women with pN0 (node-negative) and pN1 or pN2 (node-positive) disease, respectively. High 30-year survival rates were found in small (pT1N0M0) unilateral cancers (80% alive; 95% CI, 66 to 94%), and in the lobular (45% alive; 95% CI, 31% to 59%) and the special histologic types (81% alive; 95% CI, 67% to 95%). These survival rates were obtained when correcting either for known intercurrent deaths or for mortality in the age- and sex-matched general population. CONCLUSION: Breast cancer, node-negative and node-positive, may be permanently cured even if treated with locoregional therapy only. The survival figures listed here may be considered as minimum values, because women with breast cancer diagnosed in the same area from 1970 to 1984 showed significantly improved short-term (< 20 years) survival rates over those diagnosed from 1945 to 1969.

Prognostic significance of HER-2 oncoprotein expression in breast cancer: a 30-year follow-up.

PURPOSE: To study retrospectively the long-term prognostic significance of HER-2 oncoprotein expression in breast cancer (BC). PATIENTS AND METHODS: Two hundred nine consecutive female patients with invasive operable BC from a defined urban population were observed for a median of 30 years. Tissue expression of HER-2 oncoprotein was demonstrated by using an immunoperoxidase procedure. RESULTS: Fifty-five (26%) patients had cancer and a positive HER-2 oncoprotein stain reaction. They had significantly worse 10- and 25-year survival rates than those patients who had a negative stain reaction in their cancer (31% v 48% and 31% v 39%, respectively; P = .004). HER-2 expression was also associated with a poorer survival among patients who had axillary nodal metastases (P = .003; n = 104), but not among those patients who did not have metastases. HER-2 expression was related to the ductal histologic type, poor histologic grade, and high mitotic count, but not to tumor size, axillary nodal status, DNA ploidy, or S-phase fraction (SPF). In a multivariate analysis among patients with nodal metastases, HER-2 expression was an independent prognostic factor (P = .04) that predicted poor survival. However, if the entire series was entered onto the analysis, it did not emerge as an independent factor. CONCLUSIONS: HER-2 oncoprotein expression has long-term prognostic significance for predicting poor survival in BC, and it has an independent prognostic value among patients who presented with axillary nodal metastases. This result is contradictory to the argument that HER-2 expression is only a marker for drug resistance because the patients were not given adjuvant drug therapy.

Cryptosporidium parvum Caused a Large Outbreak Linked to Frisée Salad in Finland, 2012.

Over 250 individuals fell ill in five outbreaks caused by Cryptosporidium parvum in Finland, October-November 2012. The cases were connected by lunch meals at restaurants in four different cities. In two outbreaks, the same C. parvumIIdA17G1 subtype was found in patients' stool samples which supports a single source of infection. Frisée salad was the only common food item served at the restaurants, and consumption of lunch salad containing the frisée salad was associated with the illness. Lunch customers who responded that they had eaten lunch salad were three times more likely to have become ill than those who had not answered whether they had eaten the salad or not (RR 2.66; 95% Cl 1.02-6.9, P-value <0.01). Cryptosporidiosis should be considered as a causal agent in long-lasting watery diarrhoea combined with abdominal cramps, and clinical samples should be tested for Cryptosporidium at the same time bacteria and viruses are tested. Measures to prevent contamination of 'ready-to-eat vegetables' with Cryptosporidium oocysts and methods to test frozen food samples should be developed.

Factors predicting late mortality from breast cancer.

Survival data of a cohort of 160 patients with breast cancer, who were still alive 10 years after the primary diagnosis, and who had been followed up for at least 22 years, were investigated to find out those factors that predict late mortality from breast cancer. The 13 factors investigated included age at diagnosis, histological type and grade, mitotic count, type of tumour margin, inflammatory cell reaction, extent of tumour necrosis, primary tumour size, axillary nodal status, DNA ploidy and index, S-phase fraction and occurrence of a second primary breast cancer. Advanced age at diagnosis (greater than 49 years, P = 0.002), occurrence of a second primary breast cancer during the follow-up (P = 0.01), and primary tumour size (T3-4, P = 0.03) were significantly associated with mortality from breast cancer after the 10th year of follow-up in a multivariate analysis, and the ductal invasive histological type (P = 0.03) and a large DNA index (greater than 1.2; P = 0.06) in univariate analyses.

Glycogen-rich clear-cell carcinoma of the breast: a clinicopathologic and flow cytometric study.

Six glycogen-rich clear-cell carcinomas (GCC) were found among 439 cases of breast cancer (BC) in a thorough search among a defined urban population. Five of these six patients had axillary lymph node metastases at diagnosis and all five died from their breast cancer within 7 years following the diagnosis. Tumors with histologic features of GCC were larger (P = 0.03), and they had a large DNA index (greater than 1.3) in flow cytometric DNA analysis more frequently than BCs in general (P = 0.04). All GCCs were nondiploid and had a high S-phase fraction (greater than 9%, mean 19.2%), which suggests that BCs with glycogen-rich cell features may be more aggressive than BCs in general.

Pure and mixed mucinous carcinomas of the breast: a clinicopathologic analysis of 61 cases with long-term follow-up.

Sixty-one mucinous carcinomas (MCs) of the female breast were followed-up for at least 18 years or until death (mean follow-up time, 26 years; median follow-up time, 23 years). The 61 MCs were compared with 441 unselected cases of breast carcinomas of all histologic types (reference carcinomas or RCs), which were follow-up for at least 21 years. When the MCs were divided into pure (PMCs) and mixed (MMCs) mucinous carcinomas, the 20-year cumulative corrected survival rate for operable cases in the PMC group was 79% +/- 11% (SE) and 28% +/- 13% for the MMC group. The difference is statistically significant (P less than .001). The PMCs had a significantly better survival rate (P less than .001) when compared with the RCs (20-year corrected survival rate, 41% +/- 3%). The survival rates for the MMCs and RCs did not differ significantly from each other. By Cox's multivariate analysis, pure histologic type and a tumor size less than 5cm were independent favorable prognostic factors in the MC group, but nodal status was closely related to the histologic type. Judging from the relative survival curves, no significant excess mortality of cancer occurred toward the end of the follow-up period in the PMC group.

Prognostic factors and long-term survival in breast cancer in a defined urban population.

During the years 1945-1965 461 women in the city of Turku, Southwestern Finland, were diagnosed as having a biopsy-verified breast cancer. Four-hundred and thirty-nine patients (95%) with complete clinicopathologic data have now been followed up for a mean of 28 years (range from 22 to 42 years) or until death. The survival rate corrected for intercurrent deaths was 44%, 35%, and 34% 10, 20, and 30 years after the diagnosis, respectively. Only 1.2% of all deaths caused by breast cancer occurred more than 20 years after the diagnosis, and therefore about one third of the patients are likely to be cured. Fifty-six (12.8%) patients developed a second primary breast cancer or cancer of other sites. Survival of the patients diagnosed in the 1960s was better than that of the patients diagnosed earlier (p = 0.02), but the relative percentage of prognostically unfavorable poorly differentiated (Gr III) cancers became smaller with time (p = 0.009). Axillary nodal status was the most important independent prognostic factor for the 342 patients with an operable, unilateral, and invasive breast cancer in Cox's multivariate analysis (p less than 0.001), followed by histologic grade, type of tumor margin, the primary tumor size (p less than 0.001), and the extent of tumor necrosis (p = 0.003). Histologic type, mitotic count, nuclear pleomorphism, extent of tubule formation, amount of elastin, and extent of intraductal tumor growth were also significant prognostic factors in a univariate analysis.

Long-term prognosis of scar and non-scar cancers of the breast.

The prognostic significance of histopathologic classification of ductal breast carcinoma as scar and non-scar types was studied among 311 patients with breast cancer, followed up for a minimum of 22 years after the diagnosis or until death. Ninety-six (31%) cancers were of scar type and they had a more favourable prognosis than the cancers of non-scar type (p = 0.0001). The scar cancers were more often well differentiated (p less than 0.0001), had more pronounced inflammatory cell reaction (p less than 0.0001), less nuclear pleomorphism (p less than 0.0001), less tumor necrosis (p less than 0.0001), and a lower mitotic rate (p less than 0.0001) than the non-scar cancers. It was less common for patients with scar cancer to have axillary lymph node metastases (p = 0.01) and their primary tumor was smaller (p = 0.006). In flow cytometric analysis the scar cancers were more often DNA diploid (p = 0.004) with S-phase fraction below the median (p = 0.0002). In a multivariate analysis the association of cancer with a scar did not appear as an independent prognostic factor, whereas histologic grade (p less than 0.001) and extent of tumor necrosis (p less than 0.001) did. We conclude that the classification of breast cancer as scar and non-scar types has less prognostic value than the conventional histopathologic grading.

Nuclear DNA content as a prognostic factor in T1-2N0 breast cancer.

One hundred fifteen patients with postsurgical stage T1-2N0 breast cancer with the minimum follow-up of 22 years and from a defined population were studied to find reliable prognostic factors predicting long-term survival rate. The 30-year survival rate corrected for intercurrent deaths was 75%, and no deaths of breast cancer occurred after the nineteenth year of follow-up. The 30-year crude survival rate was only 28%, indicating that the great majority of these patients ultimately die of other causes than breast cancer. The nuclear DNA content could be determined by flow cytometry in 95 of the 115 cases, and 52 (55%) of them were nondiploid. DNA ploidy (diploid vs. nondiploid, P = 0.11) did not have a significant influence on long-term survival rate, but cancers with the DNA index less than 1.2 had more favorable prognosis in a univariate analysis than those with the DNA index more than 1.2 (P = 0.02). The most important independent prognostic factor in Cox's multivariate analysis was the presence of lymphatic vessel invasion of cancer cells (P less than 0.001). Several other factors, including histologic grade and type, extent of necrosis, type of tumor margin, age at diagnosis, and primary tumor size could be shown to be of prognostic value in univariate and/or multivariate analyses.

Pure and mixed mucinous breast carcinomas: DNA stemline and prognosis.

The DNA stemline of 45 mucinous breast carcinomas was determined by flow cytometry using paraffin embedded archival tissue sections. The material consisted of 26 pure mucinous and 19 mixed mucinous carcinomas. The patients were followed up for at least 15 years or until death. Nearly all pure mucinous carcinomas had a normal DNA stemline (25 of 26) with only one aneuploid tumour. Mixed mucinous carcinomas had a DNA content resembling that of common ductal carcinoma with 11 aneuploid tumours. Aneuploid tumours tended to be of higher grade and stage than diploid tumours. The survival of patients with pure mucinous carcinoma was better than that of patients with mixed mucinous carcinoma. Mucinous carcinoma should be classified as such only if it is a pure mucinous carcinoma.

Determination of fat content of burbot (Lota lota) liver with low field MR imaging (0.04 T).

A reconstructed separate fat image was used for studying the fat content of the liver of 12 dead and six living fasting burbots (Lota lota) in a 0.04 T magnetic field with olive oil as a reference. The correlation between the MR intensities and the results of the cytological, histological and chemical fat measurements, as well as chemically measured water, collagen and total protein contents were examined. The MR signal intensity in reconstructed fat images correlated well with the changes in fat content of the liver in living fish (r = 0.69, P = 0.0014). Also the contents of water (r = -0.66, P = 0.003) and total protein (r = -0.91, P = 0.013) correlated significantly with the MR signal intensity. The reconstructed fat image is thus a reliable method for following the changes in tissue fat content. The living burbot is an applicable test animal for studying the hepatic fat content with MR.

Expression of estrogen receptor (ER) in oral mucosa and salivary glands.

OBJECTIVES: To assess the expression of estrogen receptor (ER) in oral mucosa and salivary glands, buccal mucosal biopsies from ten postmenopausal women (taken before and during the hormone replacement therapy), as well as, single biopsies from 20 healthy 19-year-old women were analyzed for ER expression. Salivary gland biopsies were taken from the minor labial salivary glands (n=6), submandibular glands (n=5) and parotid gland (n=1) from women at different ages. METHODS: total RNA extracted from the tissue samples was reverse-transcripted (RT) to single-stranded cDNA, and the RT-polymerase chain reaction (RT-PCR) product was subjected to nucleotide sequencing to confirm the match with ER cDNA. Immunohistochemistry (IHC) with a monoclonal ER antibody (ER-ICA, Abbott) and Western blot analysis with monoclonal antibody against ER-related antigen (ER-D5, Amersham) were performed on the biopsies taken from the postmenopausal women. RESULTS: ER mRNA was expressed in 18/20 (90%) and 20/20 (100%) of the mucosal biopsies in the postmenopausal and 19-year-old women, respectively. The expression of mRNA was detected in all the submandibular gland samples, in the single parotid gland, as well as, in 4/6 (67%) of the labial glands. ER expression could not be detected by IHC, indicating either a very low level of expressed protein or difficulties in recognizing the epitopes by IHC. However, Western blot demonstrated 8/8 (100%) of the mucosal biopsies of postmenopausal women positive for ER-related antigen. CONCLUSIONS: the presence of ER mRNA and immunoreactive ER protein suggests that estrogens have a biological role in oral mucosa and salivary glands.