Does gender affect asthma control in adult asthmatics?

Several studies have shown gender differences in prevalence of asthma but there is little information about asthma control. In this study, we aimed to evaluate the effect of gender on asthma control in adult asthmatics. Medical records of 242 patients older than 18 years of age who regularly visited the allergy unit were evaluated. Standardized asthma questionnaires like the asthma control test (ACT) were performed. ACT scores, clinical characteristics, and demographic data such as smoking status, education, duration and severity of asthma, atopic status, family history of asthma, analgesic hypersensitivity, number of emergency visits, and hospitalization in the previous year were compared based on gender. In this study, 77.3% of the patients were female. Mean age, body mass index, and duration of asthma were 39.0 ± 0.7, 27.3 ± 0.3, and 6.6 ± 0.4 years, respectively. Of the total, 14.9% of the patients were smokers. Also, 55.8% of them were graduated from middle school, 22.7% from high school, and 14% from university. Atopy rate was 57%. Analgesic hypersensitivity was found in 18.6% of them. There was 30.2% family history of asthma. The asthma severity was mild in 45.5%, moderate in 40.9%, and severe in 13.6% of the patients. One-third of the patients were admitted to emergency room; 1/10th were hospitalized due to asthma in the previous year. ACT scores indicated complete control in 67.8%, partial control in 17.8%, and uncontrolled asthma in 14.5%. Comparing the results of males with females having asthma, there was no statistically significant difference between the two gender according to ACT scores and clinical characteristics. Finally, the results conclude that there was no effect of gender on asthma control assessed with standardized questionnaire in adult asthmatics.

Systematic review of prosthetic maintenance requirements for implant-supported overdentures.

PURPOSE: To evaluate prosthetic maintenance requirements for implant-retained/supported overdentures via a review of the literature. MATERIALS AND METHODS: Using the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand-searching. The initial search yielded 3,120 titles, and 287 articles were assigned to full-text analysis. Upon classification of the prosthetic complications with regard to the jaws treated and the attachment systems used, within- and between-group comparative frequency analyses were undertaken with the Kruskal-Wallis test or the Mann-Whitney U test at P < .05. RESULTS: A total of 49 articles were included. Within- and between-group evaluations with regard to jaw treated as well as the attachment systems used showed that the frequency of complications did not change over time (P > .05). The differences detected were more matrix replacements after 5 years in the maxilla and mandible and more matrix replacements and patrix fractures after the first year in the mandible (P < .05). Among the attachment systems, a dislodged, worn, or loose matrix or its respective housing was more common in the ball-attachment group after the first year (P < .05). Prosthetic complications for all types of attachments were comparable (P > .05), except for the differences in peri-implant or interabutment mucosal enlargement rates after 1 year. CONCLUSIONS: Prosthetic maintenance requirements for overdentures on both jaws seem to be comparable. The impact of attachment system on the prosthetic outcome is negligible.

A systematic review of marginal bone loss around implants retaining or supporting overdentures.

PURPOSE: To evaluate, through a systematic review of the literature, the effects of implant design and attachment type on marginal bone loss in implant-retained/supported overdentures. MATERIALS AND METHODS: With the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand searching. Marginal bone loss values with regard to time, attachment type, and implant system used were compared by Kruskal-Wallis tests. Means and standard deviations of data were combined using fixed- and random-effect models and evaluated using meta-analysis. RESULTS: Forty-six articles were included in the analyses; data extraction and meta-analysis were able to be conducted on eight studies. Data regarding maxillary overdentures could not be analyzed statistically. Bone loss around mandibular implants did not seem to be influenced by implant system or attachment design (bar, ball, magnet, and other types) in the first year, from 1 to = or < 5 years, and even after 5 years (P > .05). Meta-analysis could not detect differences in implant systems or attachment types (P > .05). CONCLUSIONS: Based upon a systematic review and meta-analysis of the literature that identified a total of 4,200 implants from 13 manufacturers, there was no difference in marginal bone loss around implants retaining/supporting mandibular overdentures relative to implant type or attachment designs.

Meta-analysis of methods used to assess implant stability.

PURPOSE: To evaluate correlations between Periotest, cutting torque or insertion torque, and/or the reverse torque test with resonance frequency analysis measurements. MATERIALS AND METHODS: The combined search terms dental implant, primary stability, resonance frequency analysis, removal torque, vibration analysis, torque, Periotest, cutting torque, and insertion torque and specific inclusion and exclusion criteria were used to retrieve eligible articles published between 1998 and 2008 (up to April 1) from PubMed, EMBASE, OVID, The Cochrane Library databases, and 10 journals by hand-searching. The pooled P value was calculated with the Fisher method. The correlation coefficients (r) were combined using fixed and random effect models. Heterogeneity of the studies was tested by performing the homogeneity test. RESULTS: Fifty articles were identified, but 3 studies were excluded because of limitations in study design. Studies that fulfilled the inclusion criteria fell into a variety of categories (11 human cadaver, 16 clinical, 15 animal, and 5 in vitro studies). Assessment of P values revealed that correlation between cutting torque or insertion torque and resonance frequency analysis was significant (6 studies; P = .0022). Correlation between Periotest and cutting torque or insertion torque was significant (1 study; P = .015), and correlations between resonance frequency analysis and reverse torque test values (1 study; P = .319; r = 0.405) and Periotest and resonance frequency analysis (P = .28) were insignificant. Nine articles provided r values, and cutting torque or insertion torque and resonance frequency analysis showed a statistically significant and direct relationship of 55.4% (P = .000). One study provided an r value of -0.149. A statistically significant and direct relationship of 87.6% was found between cutting torque or insertion torque and reverse torque (2 studies; P = .000). CONCLUSION: This meta-analysis of 47 studies showed a statistically significant correlation between cutting torque or insertion torque and resonance frequency analysis.

The expression of MMP-2, MMP-7, MMP-9, and TIMP-1 in chronic rhinosinusitis and nasal polyposis.

OBJECTIVES: To investigate the expression and clinical significance of MMP-2, MMP-7, MMP-9, and TIMP-1 in patients with nasal polyposis (NP) and chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: This study involved 54 patients. There were three groups: nasal polyposis group, chronic rhinosinusitis group, and control group. Specimens were collected during endoscopic sinus surgery. Each sample was immunohistochemically examined. RESULTS: Expression of MMP-2 was found significantly increased in NP, whereas MMP-7 expression was found significantly increased in CRS (P < 0.001). TIMP-1 was significantly high in control group compared to CRS and NP (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Different regulation type of activation of MMPs has been found in these two diseases. If MMP-2 expression is intense in the mucosa, then this ends with polyp formation; if MMP-7 expression is intense, it ends with CRS or stays as CRS.

Vascular endothelial growth factor (VEGF)-C, VEGF-D, VEGFR-3 and D2-40 expressions in primary breast cancer: Association with lymph node metastasis.

BACKGROUND: Two members of the vascular endothelial growth factor (VEGF) family, VEGF-C and -D, are known as lymphangiogenic growth factors and play an important role in tumor lymphangiogenesis via activation of the VEGF receptor (VEGFR)-3, which is expressed in lymphatic endothelial cells. D2-40 is a specific antibody for lymphatic vessel density (LVD). OBJECTIVES: In the present study, we have aimed to evaluate whether intraand peri-tumoral D2-40-positive lymphatic vessels affect lymph node metastasis and to investigate the relationship between LVD and lymph node metastasis in breast cancer. MATERIAL AND METHODS: We have evaluated the relationships between lymph node metastasis and VEGF-C, VEGF-D, VEGFR-3 and D2-40 expressions in breast cancer cells using immunohistochemistry. VEGF-C, VEGF-D and VEGFR-3 expression were found in tumor cells in the majority of the cases (83.75, 97.5 and 95%, respectively). RESULTS: There was a significant positive relationship between VEGF-D expression and lymph node metastasis (p < 0.05) however no significant association was found in VEGF-C and VEGFR-3 expressions. It was found that patients with high-expression of VEGF-D have a high level of both periand intra-tumoral LVD compared to those with low expression of VEGF-D (p < 0.05). CONCLUSIONS: Our results support that examination of VEGF-D expression in breast cancer cells may be beneficial in the identification of lymph node metastasis.

Thrombophilic polymorphisms are not associated with disease-free survival in breast cancer patients.

BACKGROUND: Thrombosis is one of the most common complications in cancer patients, however the effect of thrombophilic polymorphisms on cancer specific survival is still unclear. OBJECTIVES: The aims of the study were to analyze the effect of factor V Leiden (FVL), prothrombin (PT) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms on disease-free survival (DFS) in breast cancer and to evaluate the proportional odds model. METHODS: Relationship between thrombophilic polymorphisms and DFS was evaluated in 197 breast cancer patients. Data regarding patient's age, menopausal status, tumor size (T), lymph node status (N), cancer stage, tumor grade (G), estrogen and progesterone receptors, c-erbB2 expression, MTHFRC677T, FVL, and PTG20210A polymorphisms in DFS were examined by log-rank test and multivariate analyses. The proportional odds model was tested as an alternative to Cox model because of its insufficient proportional hazards assumption. RESULTS: According to log-rank test, T, N, G, tumor stage, and c-erbB2 were associated with DFS. T, N, G, and c-erbB2 were significantly related to DFS by log-normal regression model. PTG20210A, MTHFRC677T and FVL polymorphisms were not related to DFS in breast cancer (P>0.05). CONCLUSION: Our study suggests that thrombophilic polymorphisms are not associated with DFS when the proportional odds model is applied.

National practice in antibiotic prophylaxis in breast cancer surgery.

BACKGROUND: Although breast cancer surgery is regarded as a "clean" surgery, surgical site infection (SSI) rates are higher than expected. There is no consensus regarding the use of antibiotic prophylaxis in elective breast surgery. The nationwide survey was conducted to determine the trend of antibiotic prophylaxis in breast cancer among Turkish surgeons. METHODS: The survey was sent to surgeons who are member of Turkish Surgical Association (TSA) via e-mail from TSA web address. A 15 item web-based survey consisted of surgeon demographics and the use of prophylactic antibiotic in patients with risk factors related to SSI. RESULTS: The number of completed questionnaires was 245. The most common antibiotic used was first generation of cephalosporins. A majority of respondents indicated that prophylaxis was preferred in patients with high risk of SSI including preoperative chemotherapy or radiotherapy, older age, diabetes mellitus, immunodeficiency, immediate reconstruction (P < 0.05). However, the use of drain did not significantly influence antibiotic prophylaxis (P = 0.091). CONCLUSIONS: The use of prophylactic antibiotic was strongly dependent on the presence of some risk factors; however, the variation in current practice regarding antibiotic prophylaxis demonstrated a lack of its effect on preventing SSI after breast cancer surgery.

Load distribution in fixed space maintainers: a strain-gauge analysis.

PURPOSE: The purpose of this study was to compare the biomechanics of space maintainers supported by primary and permanent teeth. METHODS: Photoelastic models of permanent and primary teeth with a single missing tooth space were cast, and band-and-loop, direct-bonded, and fiber-reinforced space maintainers were fabricated. Linear strain-gauges were bonded next to the teeth and in the middle of the missing tooth space. Strain gauge signals were quantified during 50 N and 100 N static axial load applications on the molar, maintainer, and anterior support at 10 KHz using a data acquisition device and associated computer software. RESULTS: Regardless of the tooth being restored, strains around the molar teeth and the maintainer region were comparable between the groups under molar and maintainer loading (P>.05). Under 100 N loading on the anterior support, the highest strains were observed in the direct-bonded group (P<.01). Direct-bonded design led to higher strains than the band-and-loop design under 100 N maintainer loading, whereas the strain output of other designs were comparable. CONCLUSION: Load distribution of band-and-loop, direct-bonded, and fiber-reinforced space maintainers seem comparable, although direct-bonded maintainers could lead to higher strain concentrations in the buccal side due to bending moments.

Effects of laser treatment on endodontic pathogen Enterococcus faecalis: a systematic review.

OBJECTIVE: The effects of laser on eradication of Enterococcus faecalis in the root canal are unclear. The purpose of this review was to explore the antimicrobial effects of laser radiation on E. faecalis. METHODS: Using the combined search terms root canal, laser, antimicrobial, as inclusion and exclusion criteria, eligible articles were retrieved from PubMed, Embase, and OVID by hand searching. The initial search yielded 4192 titles, and 162 articles were assigned to full text analysis. Upon classification of the data with regard to laser source, laser energy level and watt, duration of application, initial and final bacterial count, and rate of decrease in bacteria, p values were pooled and data were calculated using Fisher's Z method. The initial and final bacterial count, the standard deviation of data, and data expressed in logarithm were pooled and calculated using standardized difference in means method. In the event homogeneity was found between studies, the outcome of the fixed effect model was used, and if heterogeneity was found, the result of the random effect model was used. RESULTS: A total of 12 articles were included. Er, Cr:YSGG, Nd:YAG, and KTP lasers and 1 and 1.5 W energy levels significantly reduced E. faecalis count. CONCLUSIONS: Despite the limited number of publications, the outcome of present meta-analytical assessment suggests that lasers are effective in eradication of E. faecalis.

Comparative assessments, meta-analysis, and recommended guidelines for reporting studies on histomorphometric bone-implant contact in humans.

PURPOSE: To evaluate factors that have an influence on histomorphometric bone-to-implant contact (BIC) of dental implants in humans. MATERIALS AND METHODS: Using inclusion/exclusion criteria, eligible studies were searched in five databases and handsearched in 11 journals. A total of 351 articles were assigned to full text analysis. The extracted data were assigned to comparative statistical assessments and meta-analysis. RESULTS: A total of 55 articles were included in the analysis. The mean BIC found in comparative assessments and meta-analysis of implants in the mandible (70.97 and 69.744 ± 3.304, respectively) was higher than those in the maxilla (53.24 and 56.692 ± 3.598; P = .000 and P = .008, respectively). The mean BIC in the anterior mandible (79.42) and maxilla (74.19) were higher than the posterior mandible (69.14) and maxilla (36.68) (P < .05). Differences were detected in BIC of commercially available implants and experimental micro-implants (P < .05). Comparative assessments and meta-analysis showed that conventionally loaded implants (75.70 and 75.786 ± 4.889, respectively) had higher BIC than unloaded (54.07 and 53.24 ± 4.971, respectively) and immediately loaded implants (58.53 and 68.831 ± 4.972; P = .000 and P = .004, respectively). CONCLUSIONS: Based upon a meta-analysis of the literature the following conclusions can be made: The BIC in the mandible is higher than the maxilla. The BIC is higher in the anterior than the posterior regions. The implant design coupled with the anatomical region affects the amount of BIC. Placement of experimental micro-implants with different surfaces in the posterior region always result in low and almost comparable BIC. The loading state and healing period seems to have an influence on BIC. Specific reporting guidelines are required to improve reporting of studies on human BIC.

Sneezing and runny nose: should allergy testing be routinely performed?

The need for routine determination of rhinitis subtypes by allergy testing and the relevance between symptoms and allergy were evaluated. A retrospective study at a tertiary hospital, ENT clinic. One hundred and twenty-seven adult patients with sneezing and runny nose for at least 6 months for the last two consecutive years were included. The age range was 16-60. Allergy testing was only positive in 43.4% of the patients. Excluding mixed rhinitis, persistent sneezing and runny nose were mostly related to anatomical deformities, mainly septal deviation followed by vasomotor rhinitis. Persistent sneezing and runny nose may be caused by different etiologies other than allergy. Determination of rhinitis subtypes is important for accurate treatment of patients with these symptoms. Taking appropriate medical history and performing a good physical exam with objective allergy testing are highly recommended.

Two-year follow-up of early- and conventionally-placed two-stage implants supporting fixed prostheses.

PURPOSE: The objective of this study was to compare the biologic and prosthetic outcomes of early- and conventionally-placed implants supporting fixed prostheses. MATERIALS AND METHODS: Using inclusion/exclusion criteria, early- and conventionally-placed implant patient groups, rehabilitated with Branemark System implants supporting fixed prostheses for 2 years, were selected from the patient archives. Kaplan-Meier survival estimates, time-dependent marginal bone loss, Plaque Index, peri-implant infection, Bleeding Index scores, and prosthetic complications data of the groups were compared. RESULTS: A total of 212 implants were placed in early-placed (n=42, 101 implants) and conventionally-placed (n=45, 111 implants) patient groups and 5 implants failed during the 2-year follow-up. The 1- and 2-year Kaplan-Meier survival probabilities of early-placed (0.98) and conventionally-placed (0.973) groups were comparable (P=.735). The 6-month to 2-year marginal bone loss in the conventionally-placed group was higher than in the early-placed group (P<.05). There were differences between groups on soft tissue scores between the 2 years of function (P<.05). The frequency of prosthetic complications was very low and comparable in both groups (P=.476). CONCLUSIONS: Early- and conventionally-placed implants supporting fixed prostheses showed comparable clinical outcomes during the 2-year follow-up, although the marginal bone loss was higher in the latter group.

A randomized, prospective, open-ended clinical trial of zirconia fixed partial dentures on teeth and implants: interim results.

PURPOSE: The aim of this randomized controlled clinical trial was to compare the outcomes of zirconia crowns and fixed partial dentures (FPDs) supported by teeth or implants. MATERIALS AND METHODS: Patients were recruited based on inclusion/exclusion criteria, and 59 eligible subjects were assigned randomly to treatment by one of four zirconia systems (Cercon, ZirkonZahn, Lava, and Katana). One hundred seven single-tooth and 160 three- to six-unit FPDs were fabricated on teeth and implants and cemented using composite resin cement. Californian Dental Association (CDA) quality evaluation, Plaque Index, and Gingival Index scores were recorded, and radiographic assessment of the restorations was performed using periapical and panoramic radiographs at baseline and annually up to 4 years. RESULTS: Five failures (1.9%) were recorded. The 4-year Kaplan-Meier survival probabilities of FPDs were higher than those of single-tooth restorations (P = .046). The highest survival probability for crowns was observed for Katana and the lowest for Cercon (P < .05). For FPDs, the survival probabilities of Lava restorations were similar to those of Cercon but lower than those of ZirkonZahn and Katana (P < .05). The 4-year survival probabilities of implant- and tooth-supported crowns were comparable (P = .182). Regarding CDA ratings, the slight marginal discrepancy scores for the Cercon restorations were higher than for the other systems at 1 year (P < .05). In FPDs, 94.5% of Katana FPDs had slight or gross color mismatch scores, and the difference between color and surface ratings among zirconia systems was significant (P < .05). FPDs had better periodontal scores than crowns over the 4-year observation period (P < .05). CONCLUSION: The 4-year interim results of this study suggest that zirconia systems used to fabricate FPDs have predictably high survival rates on teeth and implants and may exhibit differences, particularly in terms of mechanical failures, marginal adaptation, and color matching.

A randomized controlled clinical trial of feldspathic versus glass-infiltrated alumina all-ceramic crowns: a 3-year follow-up.

PURPOSE: The aim of this randomized controlled clinical trial was to compare the outcome of feldspathic porcelain (group 1) and glass-infiltrated alumina all-ceramic (group 2) crowns. MATERIALS AND METHODS: Patients were recruited based on inclusion/exclusion criteria, and 33 eligible subjects were assigned randomly to one of the two treatment groups. One hundred one crowns were placed predominantly in the anterior portion of the mouth and were cemented using resin cement. A baseline California Dental Association quality evaluation was completed, and Plaque and Gingival Index scores were recorded. Prosthetic and soft tissue scores were recorded for up to 3 years. RESULTS: Five restorations experienced mechanical failure. Kaplan-Meier analysis showed that the 3-year survival probabilities for group 1 (0.94) and group 2 (0.95) restorations were comparable (P = .484). Plaque and Gingival Index scores for both groups were similar at the 3-year recall (P > .999). Marginal integrity, anatomical form, and color and surface scores were also similar for both groups (P > .05). CONCLUSION: Feldspathic and glass-infiltrated alumina all-ceramic crowns placed predominantly in the anterior portion have comparable biologic and prosthetic outcomes, as well as survival probabilities.

The prevalence of aspirin hypersensitivity in patients with nasal polyposis and contributing factors.

BACKGROUND: Aspirin (acetylsalicylic acid [ASA]) hypersensitivity is frequent in patients with nasal polyps (NPs) and is called aspirin exacerbated respiratory disease, previously known as Samter's syndrome. However, studies evaluating the prevalence of ASA hypersensitivity in patients with NPs using the oral aspirin provocation test (APT) are quite limited. This study was designed to determine the prevalence of ASA hypersensitivity and factors associated with ASA hypersensitivity in patients with NPs. METHODS: Sixty-eight patients with NPs with or without asthma were recruited. Extension of NPs was evaluated by endoscopic examination/paranasal CT. A 2-day, single-blind placebo-controlled APT was used to detect ASA hypersensitivity. RESULTS: APT was performed in 53 (21 women/ 32 men) patients (mean age, 39.34 ± 1.76 years). APT resulted positive in 12 patients (22.6%) of whom 3 (25%) had no history of ASA hypersensitivity. Of the positive APTs, three were isolated rhinitis and nine had classic responses. APT was negative in 41 patients (77.4%) although three (7.3%) had a history of ASA hypersensitivity. History of ASA hypersensitivity and prolonged duration of NPs were associated with positive APT (p < 0.05). Advanced NP with multiple operations was also correlated with APT positivity but was not statistically significant. Presence of asthma was associated with age, female gender, NP duration, and ASA hypersensitivity history (p < 0.05), but not with smoking, atopy, NP extension, and positive APT. CONCLUSION: ASA hypersensitivity is quite common in patients with NP. Patients with extensive and long-term NP with multiple polyp operations require evaluation for the presence of ASA hypersensitivity in terms of chronic management and future risks of the disease.

Predicting outcomes of oral aspirin challenges in patients with asthma, nasal polyps, and chronic sinusitis.

BACKGROUND: A definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) requires a positive oral aspirin challenge (OAC), but predicting which patients will have positive challenges is often difficult. OBJECTIVE: To analyze information about historical aspirin- and nonsteroidal anti-inflammatory drug (NSAID)-associated respiratory reactions and clinical characteristics as potential markers to predict positive OACs. METHODS: A total of 243 patients underwent OACs. Data related to previous reactions and clinical characteristics of patients were correlated with the result of the OACs. RESULTS: Without prior exposure to aspirin or NSAIDs, the chance of a positive OAC was 5 in 12 (42%) but was 198 in 231 (86%) for those with a history of aspirin- and NSAID-associated asthma attacks. Sex, atopy, number of sinus infections per year, and number of sinus surgical procedures were not associated with positive OACs. Patients with 2 or more prior aspirin- and NSAID-associated respiratory reactions had an 89% chance of having a positive OAC vs single reactors (80%; P = .04). Mild or moderate prior reactions were associated with 84% or 80% positive OACs, whereas 100% of the 45 patients with severe prior reactions had positive OACs (P = .007). Except for hospitalizations, treatment locations of prior reactions (home or emergency department) did not seem to make any difference. Logistic regression identified age, sense of smell, and multiple prior reactions as independent risk factors associated with positive OACs. CONCLUSIONS: Age younger than 40 years, poor sense of smell, multiple prior respiratory reactions, and severe prior asthmatic reactions associated with aspirin and NSAIDs significantly increased the chances of a positive OAC.