Physical and Psychosocial Symptoms of Young Adult Patients Referred to the Supportive Care Mobile Team.

Young adult (YA) aged cancer patients have unique psychosocial needs with studies indicating more symptoms and emotional distress compared to older patients. Our study aimed to compare clinical characteristics and symptom distress between YAs and older adults. We retrospectively studied 896 randomly selected patients across 3 age groups: 18-39 YAs (n = 297), 40-64 (n = 300), and 65 and older (n = 299). We compared medical, psychosocial history, Morphine Equivalent Daily Dose (MEDD), Edmonton Symptom Assessment Scale (ESAS) scores, and Eastern Cooperative Oncology Group (ECOG) scores at the time of initial inpatient consultation with supportive care. YAs were more frequently female and white, with higher ECOG scores, had more self-reported psychiatric history and worse ESAS sleep scores compared to the other age cohort groups. YAs had higher pain expression than those of 65 years and older. YAs were more likely to have children younger than 18 years old, which was associated with worse pain, sleep, and financial distress. In general, YAs did not report higher symptoms distress, with the exception of insomnia and self-reported psychiatric history. Importantly, YAs with children was associated with higher ratings of pain, sleep difficulties, and financial distress. Overall, results suggest YAs may benefit from specialized services to address their unique psychosocial needs.

Frequency and Prediction of Burnout Among Physicians Who Completed Palliative Care Fellowship Training - A 10 Year Survey.

CONTEXT: Palliative Care (PC) physicians are vulnerable to burnout given the nature of practice. Reports suggest that burnout frequency is variable across different countries. OBJECTIVE: The main objective of our study was to determine knowledge, attitudes and frequency of burnout among Hospice and Palliative Medicine (HPM) Fellowship graduates trained at a comprehensive cancer center. METHODS: We conducted a survey to determine the knowledge, attitudes, and frequency of burnout in former fellows, consisting of the Maslach Burnout Inventory (MBI) and 41 custom questions. Palliative care fellows who trained at a Comprehensive Cancer Center from 2008 to 2018 were included in the survey. RESULTS: Eighty-four percent of the 52 eligible physicians completed surveys. Median age was 38 years, with 68% females. Seventy-seven percent practiced PC more than 50% of time. Median practice duration was four years, and 84% were board certified. Most common disease types treated were cancer (89%), cardiac (43%) and pulmonary (43%). Burnout rate was high at 52% (n=20). The median scores for emotional exhaustion were 25.5, depersonalization 9, and personal accomplishment 48. Female gender (P=0.07) and having administration as a component in the job description (P=0.044) were associated with risk of burnout. Clinical care setting, work hours/week, frequency of weekend calls, and size of team were not significantly associated with burnout. CONCLUSION: Burnout among former fellows trained in HPM between 2008 and 2018 is high. More research is needed to develop strategies to better prevent and manage burnout among HPM fellowship trained PC physicians.

Immunomodulatory effect of metabolites from digested and fermented fractions from irradiated pineapple (Annanas comosus L.) snack-bars.

Phenolic compounds (PC), can modulate the immune response. UV-C irradiation, commonly used as a minimal processing method in fresh-foods to reduce the microbial load, increase shelf-life, provide a minimal processing and facilitate the release of PC. This study aimed to evaluate the effect of intestinal (IF) and fermented (FF) fractions of non-irradiated (NIPB) and irradiated (IPB) pineapple snack-bars on the production of nitric oxide (NO), interleukin 6 (IL-6), cyclooxygenase 2 (COX-2), and tumor necrosis factor-alpha (TNF-α) in mice macrophages. IF of NIPB and IPB exerted an immunomodulatory effect by promoting the production of NO (26 pg/mL) in both treatments, COX-2 (438 and 399 pg/mL), and TNF-α (778 and 802 pg/mL) for NIPB and IPB respectively. The TNF-α increased in IF of NIPB and IPB approximately 371 %, and in FF, only increased 132 %. The NO production was not different between IF and FF. COX-2 production was higher in FF.

Relationship of the XRCC1 rs25487 polymorphism with demographic, behavioral, clinical, and histological parameters in oral potentially malignant disorders and oral squamous cell carcinoma in a Colombian population.

OBJECTIVES: To evaluate the salivary detection of XRCC1 rs25487 single-nucleotide polymorphism (SNP), its relationship with clinicopathological characteristics, and the interactions with demographic/behavioral variables in the etiopathogenesis of oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) in a Colombian population. METHODS: Demographic/behavioral data and saliva samples were obtained from patients with oral leukoplakia (OL, n = 17) and oral lichenoid lesions with epithelial dysplasia (OLL-ED, n = 10), or OSCC (n = 45), along with healthy controls (n = 40). Tissue biopsies were obtained for histological assessment and genetic analysis was performed using polymerase chain reaction-restriction fragment length polymorphism. Descriptive analyses were used to compare the distribution of genotypes/alleles between study groups alongside an analysis of the interaction between genetic findings and demographic/behavioral variables. RESULTS: No association was observed between the genotype and allele frequencies in OPMD or OSCC. The AG genotype was significantly more frequent in OL with high-grade dysplasia, acanthotic epithelial lining, moderate-to-severe mitotic count, and negative-to-mild apoptotic count; and in OSCC cases with stage III/IV, poorly differentiated, perineural/lymphovascular invasion, severe cellular atypia, moderate-to-severe mitotic count, and negative-to-mild apoptotic counts. Significant interaction effects were detected in the AG genotype with regard to ageing, smoking habits, and alcohol consumption in both OL and OSCC. CONCLUSION: Although rs25487 SNP appeared to not modulate the risk of OPMD/OSCC independently, its significant association with clinicopathological characteristics in OL and OSCC, and the synergistic interaction between ageing and smoking/alcohol consumption, might play a role in these two diseases.

Effective Wavelength Range in Photobiomodulation for Tooth Movement Acceleration in Orthodontics: A Systematic Review.

Objective: The present systematic review aims to establish an effective range of low-level laser therapy wavelengths to accelerate tooth movement in orthodontic treatments. Materials and methods: The electronic literature search was carried out in the following databases: PubMed, ISI Web of Science, Scopus, and Cochrane randomized controlled trials (RCTs). The protocol (CRD42019117648) was registered in PROSPERO. Results: According to PRISMA guidelines and after applying the inclusion criteria, nine RCTs were included. Three blind reviewers independently assessed the methodological quality and evidence level of selected articles. Evidence level classification was established according to the recommendations of SIGN 50 (Scottish Intercollegiate Guidelines Network 2012) and was high quality being ++, acceptable +, low quality -, unacceptable -, reject 0. Conclusions: The majority of RCTs related to accelerating the tooth movement in orthodontic treatments are ideally between 780 and 830 nm wavelengths. The average increase in speed movement calculated as a percentage of the control group in nine studies is 24%. Further studies are necessary to establish the exact dosimeter in photobiomodulation during orthodontic movement.

Analysis of salivary detection of P16INK4A and RASSF1A promoter gene methylation and its association with oral squamous cell carcinoma in a Colombian population.

BACKGROUND: Epigenetic factors play a fundamental role in the etiopathogenesis of oral squamous cell carcinoma (OSCC). This study evaluated if salivary detection of P16INK4A/RASSF1A gene promoter methylation might be linked to the clinical/histological features of OSCC in a Colombian population. MATERIAL AND METHODS: Methylation-specific polymerase chain reaction (MSP-PCR) was used to detect the methylation frequency of P16INK4A/RASSF1A genes in DNA obtained from whole saliva collected of 40 healthy controls (HC) and 43 OSCC patients. Determination of the clinical performance of MSP-PCR assay was based on standard algorithms derived from two-way contingency table analysis. The association of methylation status of targeted genes with OSCC was analyzed in a multivariate binary logistic regression model. RESULTS: There were significantly higher proportions of promoter methylation of these target genes in OSCC patients when compared with HC. The analysis of single methylated genes showed high specificity, good positive and negative predictive values, but was accompanied by a low sensitivity. OSCC cases with clinical stage III/IV, poorly differentiated, and severe cellular atypia showed a significantly greater proportion of methylated than that of unmethylated targeted genes in saliva samples. Logistic regression analysis indicated an independent association of P16INK4A and RASSF1A promoter methylation with OSCC diagnosis. A significant interaction effect between ageing and P16INK4A promoter methylation was also detected. CONCLUSIONS: Salivary detection of P16INK4A and RASSF1A promoter methylation appears to be independently associated with OSCC and may be linked to the tumor activity in the present population. Consequently, the targeting of these genes in saliva samples might constitute an important tool for diagnosis and prognosis purposes. Key words:Gene methylation, oral squamous cell carcinoma, P16INK4A, RASSF1A, saliva.

Caracterización de pacientes con lupus y fiebre: actividad, infección o ambas / Characterisation of patients with lupus and fever: Activity, infection or both

RESUMEN Objetivo: Describir las características clínicas y de laboratorio en pacientes mayores de 15 arios con diagnóstico de lupus eritematoso sistémico (LES) hospitalizados por fiebre, cuyo diagnóstico final fue infección, actividad lúpica o ambas (actividad e infección). Métodos: Se realizó un estudio descriptivo retrospectivo en el que se incluyeron pacientes con diagnóstico de LES admitidos por fiebre en el servicio de urgencias del Hospital Universitario Clínica San Rafael; se estudiaron variables clínicas y paraclínicas, dividiéndose en 3 grupos de interés: pacientes con actividad de la enfermedad, de la infección o de ambas, de acuerdo con el diagnóstico definitivo una vez se daba el alta hospitalaria. Se estudiaron variables clínicas y de laboratorio, realizándose una descripción de la población en los 3 estados. Resultados: Se evaluaron en total 115 pacientes, incluyéndose en el análisis final 108 pacientes. La mediana de edad fue de 36 años y el 86% fueron mujeres. La mediana del puntaje del Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) en toda la población fue de 6 (R 1-15), en los pacientes con infección y actividad el puntaje mostró una mediana de 9,5 (R 6-15). No hubo diferencias significativas entre los síntomas clínicos y los hallazgos de laboratorio en los diferentes grupos. El uso de prednisolona en los últimos 3 meses fue mayor en el grupo de infección (p = 0,001), pero sin diferencias significativas entre las otras terapias de inmunosupresión. Conclusión: El uso de esteroides en los últimos 3 meses, el puntaje de la escala SLEDAI y el tiempo transcurrido desde el diagnóstico de LES podrían ser variables que pueden ayudar a discriminar entre infección y actividad en pacientes con historia de LES y fiebre. Los hallazgos clínicos y paraclínicos no discriminan entre estas condiciones de enfermedad.

ABSTRACT Objective: To describe clinical characteristics and laboratory findings of patients older than 15 years of age diagnosed with Systemic Lupus Erythematosus (SLE) that were admitted to hospital with fever and with a final diagnosis of infection, disease flare-up, or both. Methods: A retrospective chart review of medical charts was performed to identify patients with a diagnosis of SLE with a fever, admitted to the Emergency Department of Hospital Universitario Clinica San Rafael. The data collected included demographics, SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) scores, clinical symptoms, laboratory findings, and steroid use. Results analysis was based on three groups (according to final diagnosis at discharge): patients diagnosed with SLE and infection, SLE and disease flare-up, and SLE with both infection and disease flare-up. Results: This study included 108 patients with a mean age of 36, of whom 86% were female. The mean SLEDAI score of all patients analysed was 6 (R 1-15), and for patients with SLE with both infection and disease flare-up was 9.5 (R 6-15). No significant differences were found with clinical symptoms and laboratory findings for any group analysed. SLE patients diagnosed with infections took significantly more prednisolone in the last three months before admission (P = .001). No differences were found with other immunosuppressants. Conclusion: The use of steroids in the last three months, the SLEDAI score, and time since a SLE diagnosis may be variables used to distinguish between infection and disease flare-up in SLE patients presenting with fever. Clinical symptoms and laboratory results are not useful markers to make this distinction.

Frequency of Burnout Among Palliative Care Physicians Participating in a Continuing Medical Education Course.

CONTEXT: Palliative care (PC) physicians are vulnerable for burnout given the nature of practice. The burnout frequency may be variable and reported between 24% and 38% across different countries. OBJECTIVE: The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC continuing medical education course. METHODS: A survey including the Maslach Burnout Inventory-General along with 41 custom questions were administered to determine the frequency of burnout among physicians attending the 2018 Hospice and Palliative Medicine Board review course. RESULTS: Of 110 physicians, 91 (83%) completed the survey. The median age was 48 years with 65% being females, 81% married, 46% in community practice, 38% in practice for 6-15 years. PC was practiced ≥50% of the time by 62%, and 76% were doing clinical work. About 73 (80%) reported that PC is appreciated at their work, 58 (64%) reported insurance to be a burden, and 58 (64%) reported that the electronic medical record was a burden. About 82 (90%) felt optimistic about continuing PC in future. Maslach Burnout Inventory results suggest that 35 (38%) participants reported at least one symptom of burnout. Only being single/separated showed trend toward significance with burnout (P = 0.056). CONCLUSION: Burnout among PC physicians who attended a board review course was 38%. Being single/separated showed trend toward association with burnout. Physicians who choose to attend continuing medical education may have unique motivating characteristics allowing them to better cope with stress and avoid burnout.

Enhancing palliative care patient access to psychological counseling through outreach telehealth services.

CONTEXT: Palliative care encompasses an interdisciplinary team, including mental health care professionals, to address psychological distress of cancer patients. OBJECTIVES: To present the implementation of an outreach counseling program via videoconferencing or telephone to patients receiving care in an outpatient palliative care clinic and to compare patients using this service to those who only received psychological counseling in our outpatient clinic. METHODS: We conducted a retrospective chart review of cancer patients seen for psychology counseling services in an outpatient supportive care center between June 2015 and March 2017. RESULTS: We reviewed 2072 unique patients (52% of the total patients seen at the outpatient Supportive Care Center), who had 4567 total counseling encounters across outreach and outpatient settings. A total of 452 (22%) patients participated in a combination of outpatient and outreach counseling services. Patients who participated in outreach services had significantly more encounters (311 [69%] had two to five sessions) compared with those who had outpatient services only (1137 [70%] had one session only) (P < .001). Outreach patients also had shorter times between the initial and follow-up encounters (median 14 days) compared with those who had outpatient services only (median 30 days) (P < .0001). CONCLUSIONS: Outreach telehealth counseling services was found to enhance palliative care patient access to psychological counseling. These services represent an additional modality for providing continuous psychological care.

Assessment of adherence to preventive treatment of plaque-induced oral diseases using sugar-free gums: a controlled clinical trial / Evaluación de la adhesión al tratamiento preventivo de enfermedades bucales inducidas por placa bacteriana mediante el uso de gomas de mascar sin azúcar: ensayo clínico controlado

Abstract Introduction: the aim of this study was to assess the adherence to a preventive treatment of plaque-induced oral diseases using two sugar-free gums, establishing their effect on cariogenic bacteria counts as a biological marker of treatment response. Methods: a double-blind, randomized, parallel-group, controlled intervention study was conducted in 96 young adult university students in an experimental period of 30 days. Participants were distributed into two groups and given a chewing gum with either pentitol or hexitol + CPP-ACP complex to be taken three times a day for 20 minutes after conventional oral hygiene. Saliva samples were collected at baseline to evaluate counts of Streptococcus mutans (SM) and Lactobacillus spp. A survey was conducted at the end of the experimental period to assess the levels of adherence to treatment, remeasuring bacterial counts. Results: SM counts showed statistically significant differences between the study groups at the end of the experimental period, with a decreasing tendency in both groups. Intragroup difference was observed in patients who took pentitol gum with a marked reduction in SM counts. Conclusion: the final estimate of adherence to treatment showed that the type of chewing gum patients were given had no influence and therefore such gums can be used, considering the therapeutic agents that most contribute to patient's particular case and preferences.

Resumen Introducción: el objetivo consistió en evaluar la adherencia a un tratamiento preventivo de enfermedades bucales inducidas por placa bacteriana, utilizando dos gomas de mascar sin azúcar y establecer su efecto sobre recuentos de bacterias cariogénicas como indicador biológico de los efectos del tratamiento. Métodos: se realizó un estudio de intervención, doble ciego, de grupos paralelos, aleatorizado controlado, en 96 adultos jóvenes universitarios, en un período experimental de 30 días. Los participantes fueron distribuidos en dos grupos con asignación de una goma de mascar con pentitol o con hexitol + complejo CPP-ACP que debían ser consumidas 20 minutos/tres veces al día después de la higiene oral convencional. Al inicio del studio fueron recolectadas muestras de saliva para evaluar recuentos de Estreptococos del grupo mutans (SM) y Lactobacillus spp. Al finalizar el período experimental, se realizó una encuesta para evaluar los niveles deadherencia al tratamiento y los recuentos bacterianos fueron medidos nuevamente. Resultados: Los recuentos de SM mostraron diferencias estadísticamente significativas entre los grupos de estudio al final del período experimental, con tendencia hacia la disminución en ambos grupos. Se observó diferencia intragrupo en los pacientes que consumieron la goma de mascar con pentitol, con marcada reducción de los recuentos de SM. Conclusión: la estimación final de la adherencia al tratamiento mostró que el tipo de goma de mascar asignada al paciente no tuvo influencia y, por lo tanto, estas pueden ser utilizadas teniendo en cuenta los agentes terapéuticos que más aporten al caso particular del paciente y las preferencias del mismo.

Crecimiento de Centrosema pubescens Benth bajo fertilización nitrogenada más azufre en Ecuador / Centrosema pubescens Benth growth under nitrogen and sulfur fertilization more sulfur in Ecuador

RESUMEN La calidad y disponibilidad del forraje, principalmente de las gramíneas, disminuye en las regiones tropicales durante la época seca, ya que al madurar incrementa el contenido de carbohidratos estructurales y disminuye el de proteínas y la digestibilidad. El objetivo de este trabajo fue evaluar el crecimiento inicial de Centrosema pubescens Benth, bajo fertilización nitrogenada y azufrada. La siembra de C. pubescens se realizó en bolsas negras de polietileno. Se evaluaron dos tratamientos de fertilización nitrogenada 0 kg/Nha-1 (-NS) y 44 kg/N-ha-1 (+NS), utilizando como fuente de nitrógeno sulfato de amonio. La fertilización se hizo al momento de la siembra, a los 15 d, 30 d y 60 d después de la siembra. El ensayo duró 12 semanas y se realizaron muestreos semanales de las siguientes variables: número de nódulos (NN), peso de nódulos (PN), longitud de raíz (LR), materia seca parcial (MSP), altura de planta (AP), índice de área foliar (IAF), tasa de acumulación neta (TAN), tasa de crecimiento del cultivo (TCC), tasa relativa de crecimiento (TRC) y área foliar específica (AFE). Se utilizó un análisis de regresión para estimar curvas de crecimiento y líneas de tendencia. El tratamiento +NS provocó la disminución significativa de NN (- 10) y PN (- 0.72 g) (P < 0.05). Resultados no significativos (P > 0.05) fueron observados en LR con 42.0 cm y 42.8 cm para +NS y -NS, respectivamente. Mientras que para MSP y AP, los tratamientos afectaron positivamente, el comportamiento (P < 0.05). El resto de las variables (IAF, TAN, TCC, TRC y AFE) no fueron afectadas por los tratamientos (P > 0.05). La fertilización con nitrógeno más azufre mejoró el establecimiento de C. pubescens con fines forrajeros.

ABSTRACT The quality and availability of forage, mainly from grasses, decreases in the tropical regions during the dry season, since when it matures it increases the content of structural carbohydrates and decreases the protein and the digestibility. The objective of this study was to evaluate the initial growth of Centro-sema pubescens Benth, under nitrogen and sulfur fertilization. The planting of C. pubescens was carried out in black polyethylene bags. Two treatments of nitrogen fertilization 0 kg/Nha-1 (-NS) and 44 kg/Nha-1 (+NS) were evaluated using ammonium sulfate as the nitrogen source. Fertilization was done at the time of planting, at 15 d, 30 d and 60 d after sowing. The experiment lasted 12 weeks and weekly sampling of the following variables was done: number of nodules (NN), nodule weight (NW), root length (RL), partially dry matter (PDM), plant height (PH), leaf area index (LAI), net accumulation rate (NAR), crop growth rate (CGR), relative growth rate (RGC) and specific leaf area (SLA). A regression analysis was used to estimate growth curves and trend lines. The +NS treatment caused a significant decrease of NN (- 10) and NW (- 0.72 g) (P < 0.05). Nonsignificant result was observed in RL (P > 0.05) with 42.0 cm and 42.8 cm for +NS and -NS, respectively. However, for PDM and PH the treatments affected positivity their behavior (P < 0.05). The rest of the variables (LAI, NAR, CGR, RGR and SLA) were not affected by the treatments (P > 0.05). Fertilization with nitrogen plus sulfur improved the establishment of C. pubescens for fodder purposes.

Salivary Levels of NLRP3 Inflammasome-Related Proteins as Potential Biomarkers of Periodontal Clinical Status.

BACKGROUND: Emerging evidence suggests that activation of inflammasomes plays a central mechanism in pathogenesis of periodontitis. This study aims to compare salivary levels of nod-like receptor family pyrin domain containing protein (NLRP) 3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), cysteine aspartase (caspase)-1, and interleukin (IL)-1ß from individuals with aggressive (AgP) or chronic periodontitis (CP) and healthy controls (HC), as well as elucidate its association with periodontal clinical status. METHODS: Saliva samples from individuals with CP (n = 75), AgP (n = 20), and HC (n = 69) were collected. Periodontal status was assessed by measurement of probing depth, clinical attachment level, and extent and severity of disease. Salivary levels of analytes were analyzed by enzyme-linked immunosorbent assay. Association between biomarkers with CP or AgP was analyzed using multivariate binary logistic regression models. RESULTS: Significantly higher levels of NLRP3, ASC, and IL-1ß were detected in periodontitis groups in comparison to the periodontally HC group. However, no significant differences were observed for caspase-1 levels between clinical groups, and only NLRP3 salivary concentration was significantly higher in AgP compared with CP patients. Also, positive significant correlations among NLRP3, ASC, and IL-1ß salivary concentrations and clinical parameters were observed. Logistic regression analyses revealed a strong/independent association of NLRP3, ASC, and IL-1ß salivary levels with CP and AgP. CONCLUSION: Although the concentration of caspase-1 in saliva samples makes its determination useless for detection of periodontal disease and/or its severity, salivary levels of NLRP3, ASC, and IL-1ß may act as strong/independent indicators of amount and extent of periodontal breakdown in both CP and AgP and could potentially be used for prevention and therapy of this group of diseases.

Transformaciones del Sistema de Salud Ecuatoriano / Transformations of health system in Ecuador

Resumen Objetivo: Describir las transformaciones de la estructura del Sistema de Salud Ecuatoriano, teniendo en cuenta el contexto constitucional y normativo de dicho país, y reflexionar sobre el contexto histórico en que acaecieron y sus implicaciones en el bienestar de los ecuatorianos. Materiales y métodos: Se realizó una revisión bibliográfica, analizando la normatividad de Ecuador desde la Constitución de 1979, en donde se empieza hablar de la salud como un derecho, pasando por la Ley Orgánica de Salud, la Ley de Seguridad Social, entre otras, incluyendo la última reforma de la Constitución en 2008. Resultados: La transformación del Sistema de Salud del Ecuador es el resultado de la acción de fuerzas políticas y económicas tanto internas como externas que han afectado a este país a lo largo del periodo estudiado.

Abstract Objective: To describe the transformations of the structure of the health system in Ecuador, taking into account the constitutional and policy context of that country, and to reflect on the historical context in which it occurred and its implications for the welfare of the people from Ecuador. Materials and methods: A bibliographic review was made, beginning with the regulations of Ecuador since the Constitution of 1979, where health is considered as a right, passing by the Organic Law of Health, the Social Security Act, among others, including the last reform of the Constitution in 2008. Results: The transformation of the Health System of Ecuador is the result of the action of economic and political forces, both internal and external, that have affected this country throughout the studied period.

Determination of NLRP3 (rs4612666) and IL-1B (rs1143634) genetic polymorphisms in periodontally diseased and healthy subjects.

OBJECTIVE: The focus of the current study was to identify if a possible association between NLRP3 (rs4612666) and IL-1B (rs1143634) single-nucleotide polymorphisms (SNPs) may be implicated in the etiopathogenesis of chronic periodontitis (CP) in a Colombian population. DESIGN: One hundred and twenty-four CP subjects and 81 periodontally healthy controls (HC) were recruited. Periodontal status was assessed by criteria based on probing depth, clinical attachment level, extent, and severity of periodontal breakdown. Human genomic DNA was obtained from saliva samples of the study subjects. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to identify the NLRP3 (rs4612666) and IL-1B (rs1143634) SNPs. The association of polymorphisms with CP was assessed individually and adjusted for confounding using a multivariate binary logistic regression model. RESULTS: Bivariate analysis showed a weak association between CT genotype of NLRP3 (rs4612666) SNP and CP, however after logistic regression analysis, neither NLRP3 (rs4612666) nor IL-1B (rs1143634) polymorphisms were strongly/independently associated with disease status. Even so, an interaction effect was significantly detected not only among CT/CC genotypes of NLRP3 gene regarding to the age stratum ≥ 48 years, but also between CC genotype of the same gene and smoking habit. CONCLUSION: Although the present results do not support that IL-1B (rs1143634) SNP could be identified as a risk predictor for CP in the present population, the synergistic interaction of the CT/CC genotypes of NLRP3 (rs4612666) SNP with ageing and/or smoking habit potentially might play a significant role in the pathogenic pathways of periodontal disease.

Prognostic Value of 8-Hydroxy-2'-Deoxyguanosine and Human Neutrophil Elastase/α1-Proteinase Inhibitor Complex as Salivary Biomarkers of Oxidative Stress in Chronic Periodontitis.

BACKGROUND: 8-Hydroxy-2'-deoxyguanosine (8-OHdG) and human neutrophil elastase/α1-proteinase inhibitor (HNE/α1-PI) complex have been regarded as reliable biomarkers of oxidative stress in inflammatory conditions. This study investigates whether the salivary levels of these two analytes may be linked with periodontal health status. METHODS: One hundred ten patients with chronic periodontitis (CP) and 50 healthy controls were selected. Periodontal status was assessed by criteria based on probing depth, clinical attachment level, and extent and severity of periodontal breakdown. 8-OHdG and HNE/α1-PI salivary levels were analyzed by enzyme-linked immunosorbent assay. The association of these analytes with CP was analyzed individually and adjusted for confounding factors using a multivariate binary logistic regression model. RESULTS: Significantly higher levels of both markers were detected in the CP group in comparison to controls. Weak-to-moderate positive significant correlations between salivary biomarkers and clinical parameters were observed. After binary logistic regression analysis, salivary levels of 8-OHdG >17.35 ng/mL and HNE/α1-PI complex >158.28 ng/mL were independently associated with disease status. Interaction effects among candidate prognostic variables were also noted. CONCLUSIONS: Increased salivary levels of 8-OHdG and HNE/α1-PI complex may be strong, independent prognostic indicators of the amount and extent of oxidative stress-induced periodontal breakdown. In addition, unstimulated whole saliva samples might reflect a synergistic biologic interactive effect of HNE/α1-PI associated with the aging and smoking cumulative characteristics of periodontal damage.

Immunoexpression of NF-ĸB and their inhibitory subunits IĸBα and IĸBß in giant cell lesions of the jaws: implications for their clinical behavior.

BACKGROUND: The unpredictable behavior of giant cell lesions (GCLs) of the jaws parallels its controversial histogenesis. This study evaluated a possible association between the immunohistochemical expression of NF-ĸB, the inhibitory subunits IĸBα/IĸBß, and clinicopathological variables with the behavior of central and peripheral GCLs of the jaws. MATERIALS AND METHODS: Paraffin-embedded samples of GCLs of the jaws (n = 68) were prepared for histological/immunohistochemical assessment. Demographic and clinicopathological parameters were assessed to determine the behavior of the lesions. A staining-intensity-distribution (SID) score was used to assess the immunomarkers reactivity. The association between significant candidate immunohistochemical predictor variables regarding clinical behavior was analyzed individually and adjusted for confounding using a binary logistic regression model. RESULTS: While univariate analysis revealed a positive association of NF-ĸB SID score, NF-ĸB nuclear expression, IĸBα SID score, and NF-ĸB to inhibitors average ratio with the aggressive status of GCLs, after bivariate logistic regression analysis, only NF-ĸB nuclear expression, IĸBα SID score, and NF-ĸB to inhibitors average ratio remained as robust predictors of aggressiveness. Confounding and interaction effects regarding clinicopathological candidate predictor variables were also noted. CONCLUSION: It looks that clinical behavior of GCLs of the jaws may be strong/independently linked to the increased nuclear expression of NF-ĸB, higher NF-ĸB to inhibitors average ratio, and decreased IĸBα SID score. Notwithstanding, there are simultaneously synergistic and opposing interactive effects with respect to age stratum, growth rate, multinucleated giant cells count, and mononuclear stromal cells density in the susceptible host that may increase the tissue destruction observed in aggressive GCLs.

Association study between clinicopathological variables and periodontal breakdown in gingival pyogenic granuloma.

OBJECTIVE: The aim was to investigate a possible association between the immunoexpression of interleukin (IL)-4 and clinicopathological parameters with the periodontal breakdown observed in gingival pyogenic granuloma (PG). MATERIALS AND METHODS: Paraffin-embedded samples of gingival PG (n = 46) were prepared for histological and immunohistochemical assessment. Demographic and clinical parameters were assessed by criteria based on age stratum, gender, smoking habit, evolution course, location, lesion size, macroscopic appearance, predisposing factors, recurrence, and periodontal breakdown. Histological assessment included the appearance of epithelial lining, microvessel density, inflammatory infiltrate density, interstitial fibrosis, and histological arrangement. A staining intensity distribution (SID) score was used to assess IL-4 immunoreactivity. The association between candidate predictor variables and periodontal breakdown was analyzed individually and adjusted for confounding using a bivariate binary logistic regression model. RESULTS: Mean IL-4 SID values were significantly increased for long-standing and large lesions, presence of periodontal breakdown, high microvessel density, and moderate-to-severe inflammatory infiltrate density. While bivariate and univariate analyses revealed a positive association of the evolution course ≥12 months, lesion size >1 cm, high microvessel density, moderate-to-severe inflammatory infiltrate density, and IL-4 SID score ≥8.04 with periodontal breakdown, after bivariate logistic regression analysis, only the evolution course ≥12 months, moderate-to-severe inflammatory infiltrate density, and IL-4 SID score ≥8.04 remained as robust predictors of periodontal damage. Confounding and interaction effects between candidate predictor variables were also noted. CONCLUSION: These findings suggest that while evolution course, inflammatory infiltrate density, and the overexpression of IL-4 may act as predictors of periodontal breakdown in gingival PG, there are mutual confounding and synergistic biological interactive effects with respect to the lesion size and microvessel density in the susceptible host that may be also associated with the bone resorption and tissue destruction. CLINICAL RELEVANCE: Although the first-line therapy of gingival PG continues to be the surgical excision, this approach poses unwanted complications such as severe mucogingival defects and recurrence. Hence, early diagnosis and detection of these three significant predictor variables as well as timely surgical excision might help prevent the periodontal tissue destruction observed in some of these lesions.

Time-related changes in salivary levels of the osteotropic factors sRANKL and OPG through orthodontic tooth movement.

INTRODUCTION: In this study, we aimed to determine whether the variations in salivary concentrations of soluble receptor activator of nuclear factor kappa B ligand (sRANKL) and osteoprotegerin (OPG), and their ratios, might be linked with the different phases of orthodontic tooth movement. METHODS: Twenty healthy subjects who required fixed appliance therapy not involving tooth extractions or surgical procedures were selected. Unstimulated whole saliva samples were collected from each patient before fitting the orthodontic appliances, and at 24 to 48 hours, 2 weeks, 5 weeks, and 8 weeks after the activation. Salivary sRANKL and OPG concentrations were determined by enzyme-linked immunosorbent assays. The data were analyzed by using nonparametric statistics. RESULTS: Overall, median values of sRANKL showed significant increases, median OPG salivary values showed a significant downward trend, and the sRANKL/OPG ratio tended to increase significantly over time after the activation visit. However, clear fluctuations in the immunoenzymatic findings were noted at the different sampling times, indicating nonlinear trends in the levels of the biomarkers through time. Post-hoc pairwise comparisons showed significant differences between (1) all sRANKL values relative to those of the 8-week sampling time; (2) baseline/8-week OPG salivary levels; and (3) baseline, 24 to 48 hours, and 2-week sRANKL/OPG ratios compared with those of the 8-week test. CONCLUSIONS: The findings indicate that variations in salivary concentrations of sRANKL and OPG and their ratios might be linked to the different phases of orthodontic tooth movement. Hence, these analytes might serve in a panel of salivary functional biomarkers that could assist in the screening of orthodontic treatment in clinical practice.