Laparoscopic Anterior Resection with Anastomosis of Mid-Transverse to Distal Rectum with Deloyers Procedure Under Indocyanine Green fluorescence Guidance: A Video Case Report.

BACKGROUND: Reconstruction with transverse colon-rectal anastomosis after an extended left hemicolectomy can be challenging. The Deloyers procedure, first described in 1964,1 comprises complete mobilization and rotation of the right colon, while maintaining the ileocolic artery, to achieve a well vascularized, tension-free colorectal anastomosis. We present a video of a laparoscopic Deloyers procedure with Indocyanin green (ICG) fluorescence as a useful adjunct. METHODS: A middle-aged female underwent a laparoscopic anterior resection with anastomosis of mid-transverse to distal rectum with Deloyers procedure for synchronous splenic flexure adenocarcinoma and mid-rectal malignant polyp. Proximal transection was performed at mid-transverse colon while distal transection was performed at lower rectum. Tension-free mid-transverse colon-low rectal anastomosis was performed with Deloyers procedure. ICG fluorescence was performed for the colonic conduit, proximal, and distal transection margins to confirm perfusion just prior to anastomosis. Defunctioning loop ileostomy was then created 40 cm from the ileocecal valve. RESULTS: Patient recovered uneventfully with functioning stoma on postoperative Day 1. Intraoperative use of ICG fluorescence has been proven to be an accurate tool assess anastomotic perfusion and has been associated with a lower anastomotic leak rate after colorectal resection.2 To our knowledge, this is the first report in which laparoscopic Deloyers procedure was performed under ICG guidance. Open Deloyers procedure with ICG was first reported by Okamoto et al.3 in April 2021 and remains the only other case report of Deloyers with ICG to date. CONCLUSIONS: The Deloyers procedure can be safely performed laparoscopically and ICG fluorescence is a recommended adjunct to assess such unorthodox colorectal anastomosis.

Effect of oral hygiene programmes on oral opportunistic pathogens during stroke rehabilitation.

OBJECTIVES: This study was to assess the effectiveness of a conventional oral hygiene care programme (COHCP) and an advanced oral hygiene care programme (AOHCP) on prevalence and viable counts of oral opportunistic pathogens among patients undergoing stroke rehabilitation. METHODS: A total of 94 patients were randomized to two groups. Subjects were block randomized to either (a) COHCP: manual toothbrushing with oral hygiene instruction (OHI); or (b) AOHCP: powered toothbrushing, mouthrinsing with chlorhexidine and OHI. Prevalence and viable counts of oral opportunistic pathogens including yeasts, aerobic and facultative anaerobic gram-negative bacilli, Staphylococcus aureus, were assessed at baseline, the end of 3 and 6 months. RESULTS: No significant difference was observed in the prevalence of oral opportunistic pathogens within each group over the clinical trial period. A significant decrease in the viable counts of S. aureus was found over the clinical trial period within AOHCP group (p < 0.05), while the viable counts of yeasts and anaerobic gram-negative bacillus (AGNB) remained stable within each group. Regression analysis failed to detect an association between intervention and the prevalence/viable counts of oral opportunistic pathogens. CONCLUSIONS: Neither oral healthcare programme significantly affects AGNB, yeast or S. aureus over the study period in terms of prevalence and viable counts.

Oral Health Interventions Using Chlorhexidine-Effects on the Prevalence of Oral Opportunistic Pathogens in Stroke Survivors: A Randomized Clinical Trial.

OBJECTIVE: To evaluate the presence of oral opportunistic pathogens among stroke survivors, both before and after oral health care interventions. METHODS: A multicenter randomized clinical trial was conducted on hospitalized stroke survivors. Those in the control group were given standard care of oral hygiene (a manual toothbrush and toothpaste), whereas those in the test group were given intense care of oral hygiene (a powered toothbrush and 1% chlorhexidine oral gel). Oral clinical assessments were carried out, and microbiological samples were collected, using concentrated oral rinse samples at 3 time points: baseline, 3 months, and 6 months. RESULTS: The prevalence of oral yeast was significantly reduced in the test group at 6 months (P < .05), but no significant difference was observed over time. A significant reduction was observed in the prevalence of Staphylococcus aureus (P < .01) and aerobic and facultative gram-negative bacilli over time (P < .05), but there were no significant differences noted between groups at 6 months. Candida albicans and Klebsiella pneumoniae were the prominent pathogens determined throughout the trial. Kluyvera strains have also been isolated from this cohort. CONCLUSION: Oral hygiene intervention using a powered tooth brush and 1% chlorhexidine oral gel was effective in reducing the prevalence of oral opportunistic pathogens.

Performance of A-stage process treating combined municipal-industrial wastewater.

A biosorption column and a settling tank were operated for 6 months with combined municipal and industrial wastewaters (1 m3/hr) to study the effect of dissolved oxygen (DO) levels and Fe3+ dosage on removal efficiency of dissolved and suspended organics prior to biological treatment. High DO (>0.4 mg/L) were found to be detrimental for soluble chemical oxygen demand (COD) removals and iron dosing (up to 20 ppm) did not improve the overall performance. The system performed significantly better at high loading rate (>20 kg COD.m-3.d-1) where suspended solids and COD removals were greater than 80% and 60%, respectively. This is a significant improvement compared to the conventional primary sedimentation tank, and the process is a promising alternative for the pre-treatment of industrial wastewater.

Characterization and biodegradability of sludge from a high rate A-stage contact tank and B-stage membrane bioreactor of a pilot-scale AB system treating municipal wastewaters.

In light of global warming mitigation efforts, increasing sludge disposal costs, and need for reduction in the carbon footprint of wastewater treatment plants, innovation in treatment technology has been tailored towards energy self-sufficiency. The AB process is a promising technology for achieving maximal energy recovery from wastewaters with minimum energy expenditure and therefore inherently reducing excess sludge production. Characterization of this novel sludge and its comparison with the more conventional B-stage sludge are necessary for a deeper understanding of AB treatment process design. This paper presents a case study of a pilot-scale AB system treating municipal wastewaters as well as a bio- (biochemical methane potential and adenosine tri-phosphate analysis) and physico-chemical properties (chemical oxygen demand, sludge volume index, dewaterability, calorific value, zeta potential and particle size distribution) comparison of the organic-rich A-stage against the B-stage activated sludge. Compared to the B-sludge, the A-sludge yielded 1.4 to 4.9 times more methane throughout the 62-week operation.

Combined ultrasonication and thermal pre-treatment of sewage sludge for increasing methane production.

This article focuses on the combination of ultrasonic and thermal treatment of sewage sludge (SS). The combination involved ultrasonicating a fraction of the sludge and thermal treatment at various temperatures and this resulted in solubilization of proteins and carbohydrates, and so contributing to increased COD solubilization. During the treatment, SCOD, soluble proteins and carbohydrates increased from 760 mg L(-1) to 10,200 mg L(-1), 110 mg L(-1) to 2,900 mg L(-1) and 60 mg L(-1) to 630 mg L(-1), respectively. It was found ultrasonication of only a fraction of the sludge (>20%) followed by thermal treatment led to significant improvement compared to thermal and ULS treatments applied on their own. At 65°C, the kinetic of solubilization was improved and the hyper-thermophilic treatment time could be reduced to a few hours when ultrasonication was used first. A linear correlation (R(2) = 95%) was found between the SCOD obtained after ultrasonication pre-treatment and anaerobic biodegradability. The combined treatment resulted in 20% increase in biogas production during the anaerobic digestion of the pre-treated sludge.

Impact of ozone assisted ultrasonication pre-treatment on anaerobic digestibility of sewage sludge.

Impact of ultrasonication (ULS) and ultrasonication-ozonation (ULS-Ozone) pre-treatment on the anaerobic digestibility of sewage sludge was investigated with semi-continuous anaerobic reactors at solid retention time (SRT) of 10 and 20 days. The control, ULS and ULS-Ozone reactors produced 256, 309 and 348 mL biogas/g CODfed and the volatile solid (VS) removals were 35.6%, 38.3% and 42.1%, respectively at SRT of 10 days. At SRT of 20 days, the biogas yields reached 313, 337 and 393 mL biogas/g CODfed and the VS removal rates were 37.3%, 40.9% and 45.3% in the control, ULS and ULS-Ozone reactors, respectively. ULS-Ozone pre-treatment increased the residual organic amount in the digested sludge. These soluble residual organics were found to contain macromolecules with molecular weights (MW) larger than 500 kDa and smaller polymeric products with MW around 19.4 and 7.7 kDa. These compounds were further characterized to be humic acid-like substances with fluorescent spectroscopy analysis.

A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression.

BACKGROUND: Our previous studies have demonstrated the treatment benefits of dense cranial electroacupuncture stimulation (DCEAS), a novel brain stimulation therapy in patients with major depression, postpartum depression and obsessive-compulsive disorder. The purpose of the present study was to further evaluate the effectiveness of DCEAS combined with body acupuncture and selective serotonin reuptake inhibitors (SSRIs) in patients with post-stroke depression (PSD). METHODS: In a single-blind, randomized controlled trial, 43 patients with PSD were randomly assigned to 12 sessions of DCEAS plus SSRI plus body electroacupuncture (n = 23), or sham (non-invasive cranial electroacupuncture, n-CEA) plus SSRI plus body electroacupuncture (n = 20) for 3 sessions per week over 4 weeks. Treatment outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), the Clinical Global Impression - Severity scale (CGI-S) and Barthel Index (BI), a measure used to evaluate movement ability associated with daily self-caring activity. RESULTS: DCEAS produced a significantly greater reduction of both HAMD-17 and CGI-S as early as week 1 and CGI-S at endpoint compared to n-CEA, but subjects of n-CEA group exhibited a significantly greater improvement on BI at week 4 than DCEAS. Incidence of adverse events was not different in the two groups. CONCLUSIONS: These results indicate that DCEAS could be effective in reducing stroke patients' depressive symptoms. Superficial electrical stimulation in n-CEA group may be beneficial in improving movement disability of stroke patients. A combination of DCEAS and body acupuncture can be considered a treatment option for neuropsychiatric sequelae of stroke. TRIAL REGISTRATION: http://www.clinicaltrials.gov, NCT01174394.

Botulinum toxin A injection for post-stroke upper limb spasticity and rehabilitation practices from centers across Asian countries.

Purpose: Describe real-life practice and outcomes in the management of post-stroke upper limb spasticity with botulinum toxin A (BoNT-A) in Asian settings. Methods: Subgroup analysis of a prospective, observational study (NCT01020500) of adult patients (≥18 years) with post-stroke upper limb spasticity presenting for routine spasticity management, including treatment with BoNT-A. The primary outcome was goal attainment as assessed using goal-attainment scaling (GAS). Patients baseline clinical characteristics and BoNT-A injection parameters are also described. Results: Overall, 51 patients from Asia were enrolled. Rates of comorbid cognitive and emotional problems were relatively low. Patients tended to have more severe distal limb spasticity and to prioritize active over passive function goals. Most (94.1%) patients in the subgroup were treated with abobotulinumtoxinA. For these patients, the median total dose was 500 units, and the most frequently injected muscles were the biceps brachii (83.3%), flexor carpi radialis (72.9%), and flexor digitorum profundus (66.7%). Overall, 74.5% achieved their primary goal and the mean GAS T score after one treatment cycle was 56.0 ± 13.0, with a change from baseline of 20.9 ± 14.3 (p < 0.001). The majority (96.1%) of Asian patients were rated as having improved. Conclusion: In the Asian treatment setting, BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper limb spasticity following stroke.

Randomized clinical trial of oral health promotion interventions among patients following stroke.

OBJECTIVE: To evaluate the effectiveness of oral health promotion interventions on clinical oral health. DESIGN: Single-blind randomized controlled trial conducted over 3 weeks of in-hospital rehabilitation. SETTING: Stroke rehabilitation ward in Hong Kong. PARTICIPANTS: Patients with stroke (N=102) admitted to the rehabilitation ward. INTERVENTIONS: Patients were randomly assigned either: (1) oral hygiene instruction, (2) oral hygiene instruction and chlorhexidine mouthrinse, or (3) oral hygiene instruction, chlorhexidine mouthrinse, and assisted brushing. MAIN OUTCOME MEASURES: Dental plaque, gingival bleeding, and oral functional status were assessed at baseline and review. Development of infectious complications were also monitored during the clinical trial. RESULTS: Poor oral hygiene and an overall neglect of oral hygiene practices were observed at baseline. Reductions in dental plaque were significantly greater in the 2 groups receiving chlorhexidine compared with the group receiving oral hygiene instruction alone (P<.001). Reductions in gingival bleeding scores were 3- to 4-fold greater in groups receiving chlorhexidine. No cases of pneumonia were observed during the course of the clinical trial. CONCLUSIONS: The oral health condition of patients may be safeguarded after acute stroke with the use of chlorhexidine mouthrinse in conjunction with a standard mechanical plaque removal tool, such as an electric toothbrush. These interventions are acceptable to the majority of patients, and their administration poses a minimal burden to rehabilitation ward staff.

Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with type 2 diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) patients are at increased risk of developing cardiovascular events. Unfortunately traditional risk assessment scores, including the Framingham Risk Score (FRS), have only modest accuracy in cardiovascular risk prediction in these patients. METHODS: We sought to determine the prognostic values of different non-invasive markers of atherosclerosis, including brachial artery endothelial function, carotid artery atheroma burden, ankle-brachial index, arterial stiffness and computed tomography coronary artery calcium score (CACS) in 151 T2DM Chinese patients that were identified low-intermediate risk from the FRS recalibrated for Chinese (<20% risk in 10 years). Patients were prospectively followed-up and presence of atherosclerotic events documented for a mean duration of 61 ± 16 months. RESULTS: A total of 17 atherosclerotic events in 16 patients (11%) occurred during the follow-up period. The mean FRS of the study population was 5.0 ± 4.6% and area under curve (AUC) from receiver operating characteristic curve analysis for prediction of atherosclerotic events was 0.59 ± 0.07 (P = 0.21). Among different vascular assessments, CACS > 40 had the best prognostic value (AUC 0.81 ± 0.06, P < 0.01) and offered significantly better accuracy in prediction compared with FRS (P = 0.038 for AUC comparisons). Combination of FRS with CACS or other surrogate vascular markers did not further improve the prognostic values over CACS alone. Multivariate Cox regression analysis identified CACS > 40 as an independent predictor of atherosclerotic events in T2DM patients (Hazards Ratio 27.11, 95% Confidence Interval 3.36-218.81, P = 0.002). CONCLUSIONS: In T2DM patients identified as low-intermediate risk by the FRS, a raised CACS > 40 was an independent predictor for atherosclerotic events.

Oral health promotion interventions on oral yeast in hospitalised and medically compromised patients: a systematic review.

Yeast are major aetiological agents of localised oral mucosal lesions, and are also leading causes of nosocomial bloodstream infections. The purpose of this systematic review was to examine the effectiveness of oral health promotion interventions on the prevalence and incidence of these opportunistic oral pathogens in hospitalised and medically compromised patients. The PubMed, ISI Web of Science and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral yeast. Chlorhexidine delivered in a variety of oral hygiene products appeared to have some effect on oral yeast, although some studies found equivocal effects. Although a wide array of other compounds have also been investigated, their clinical effectiveness remains to be substantiated. Likewise, the utility of mechanical oral hygiene interventions and other oral health promotion measures such as topical application of salivary substitute, remains unsettled. Although many chemical agents contained in oral hygiene products have proven in vitro activity against oral yeast, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remains to be confirmed by further high-quality randomised controlled trials. This is pertinent, given the recent emergence of yeast resistance to conventional antifungal agents.

The Effect of Mirror Visual Feedback on Spatial Neglect for Patients after Stroke: A Preliminary Randomized Controlled Trial.

We investigated the effects of mirror visual feedback (MVF), with reference to using a glass wall or a covered mirror, on the reduction of spatial neglect for patients with stroke. A total of 21 subacute patients with left spatial neglect after right-hemispheric stroke were randomly assigned to 3 groups: MVF, sham 1 (viewing the hemiparetic arm through the transparent glass during bilateral arm movement) and sham 2 (using a covered mirror). The 3-week treatment program for all groups consisted of 12 sessions of movement tasks for the hemiparetic arm graded according to the severity of arm impairments. Blinded assessments were administered at pre/post and a three-week follow-up. The results showed that there was no significant advantage for MVF than sham 1; however, MVF was more beneficial than sham 2, as shown by the line crossing (p = 0.022). Improvement in discriminating the left-gap figures on the left and right side of the page in the Gap Detection Test was greater in MVF than using the covered mirror (p = 0.013; p = 0.010), showing a slight advantage of MVF in alleviating allocentric symptoms. Our study confirms that MVF was superior to using a covered mirror as a method for reducing spatial neglect and in alleviating its allocentric symptoms, but no significant advantage over bilateral arm movement through transparent glass was found. Further research in comparing their therapeutic effects is warranted.

Effect of periodontal treatment on circulating CD34(+) cells and peripheral vascular endothelial function: a randomized controlled trial.

AIM: periodontal disease is associated with endothelial dysfunction and increased circulating progenitor cell (CPC) count. This study sought to investigate the effect of periodontal treatment on CPC count and vascular endothelial function. MATERIALS AND METHODS: a single-blind, randomized controlled trial was conducted in 50 otherwise healthy subjects with moderate-to-severe chronic periodontitis. They were randomly assigned into Treatment group (n=25), in whom periodontal treatment was conducted immediately, and Control group (n=25), in whom periodontal treatment was postponed until the completion of this 3-month study. CPCs and peripheral endothelial function were evaluated at baseline and 3-month follow-up using flow cytometry and peripheral arterial tonometry, respectively. RESULTS: based on the intention-to-treat analysis, periodontal treatment exhibited neutral effects on endothelial function [treatment effect: 0.03, 95% confidence interval (CI): -0.29 to 0.35, p=0.85]. However, circulating CD34(+) cells count significantly decreased in the Treatment group compared with the controls (treatment effect: -29.85 cells/µl, 95% CI: -52.62 to -7.08, p=0.011). The reduction of circulating CD34(+) count was positively correlated with the decrease in sites% with bleeding on probing or periodontal pockets 4 mm. CONCLUSIONS: this study suggests that treatment of periodontitis has neutral effects on peripheral endothelial function but significantly decreases circulating CD34(+) cell count.

Event-Related Desynchronization During Mirror Visual Feedback: A Comparison of Older Adults and People After Stroke.

Event-related desynchronization (ERD), as a proxy for mirror neuron activity, has been used as a neurophysiological marker for motor execution after mirror visual feedback (MVF). Using EEG, this study investigated ERD upon the immediate effects of single-session MVF in unimanual arm movements compared with the ERD effects occurring without a mirror, in two groups: stroke patients with left hemiplegia and their healthy counterparts. During EEG recordings, each group performed one session of mirror therapy training in three task conditions: with a mirror, with no mirror, and with a covered mirror. An asymmetry index was calculated from the subtraction of the event-related spectrum perturbations between the C3 and C4 electrodes located over the sensorimotor cortices contralateral and ipsilateral to the moved arm. Results of the effect of task versus group in contralateral and ipsilateral motor areas showed that there was a significant effect of task condition at the contralateral motor area in the high beta band (17-35 Hz) at C3. High beta ERD showed that the suppression was greater over the contralateral hemisphere than it was over the ipsilateral hemisphere in both study groups. The magnitude of low beta (12-16 Hz) ERD in patients with stroke was more suppressed in contralesional C3 under the no mirror compared to that of the covered mirror and similarly more suppressed in ipsilesional C4 ERD under the no mirror compared to that of the mirror condition. The correlation analysis revealed that the magnitude of ERSP power correlated significantly with arm severity in the low and high beta bands in patients with stroke, and a higher asymmetry index in the low beta band was associated with higher arm functioning under the no-mirror condition. There was a shift in sensorimotor ERD toward the contralateral hemisphere as induced by MVF accompanying unimanual movement in both stroke patients and healthy controls. The use of ERD in the low beta band as a neurophysiological marker to indicate the relationships between the amount of MVF-induced ERD attenuation and motor severity, and the outcome indicator for improving stroke patients' neuroplasticity in clinical trials using MVF are warranted to be explored in the future.

Relation between rich-club organization versus brain functions and functional recovery after acute ischemic stroke.

Studies have shown the brain's rich-club organization may underpin brain function and be associated with various brain disorders. In this study, we aimed to investigate the relation between poststroke brain functions and functional recovery versus the rich-club organization of the structural brain network of patients after first-time acute ischemic stroke. A cohort of 16 acute ischemic stroke patients (11 males) was recruited. Structural brain networks were measured using diffusion tensor imaging within 1 week and at 1, 3 and 6 months after stroke. Motor impairment was assessed using the Upper-Extremity Fugl-Meyer motor scale and activities of daily living using the Barthel Index at the same time points as MRI. The rich-club regions that were stable over the course of stroke recovery included the bilateral dorsolateral superior frontal gyri, right supplementary motor area, and left median cingulate and paracingulate gyri. The network properties that correlated with poststroke brain functions were mainly the ratio between communication cost ratio and density ratio of rich-club, feeder and local connections. The recovery of both motor functions and activities of daily living were correlated with higher normalized rich club coefficients and a shorter length of local connections within a week after stroke. The communication cost ratio of feeder connections, the length of rich-club and local connections, and normalized rich club coefficients were found to be potential prognostic indicators of stroke recovery. Our results provide additional support to the notion that different types of network connections play different roles in brain functions as well as functional recovery.

Minimally invasive complete mesocolic excision and central vascular ligation (CME/CVL) for right colon cancer.

Total mesorectal excision (TME) is the standard of care in rectal cancer surgery. Complete mesocolic excision and central vascular ligation (CME and CVL) are surgical concepts that are extrapolated from the principles of TME. Increasingly adopted by surgical units worldwide, laparoscopic CME/CVL for right sided colon cancer is a challenging procedure that requires meticulous dissection by the surgeon and detailed knowledge of the colonic vascular anatomy. This review article addresses the main issues pertaining to this surgical technique and also discusses steps on how to perform this operation safely.

A randomized controlled trial of mental imagery augment generalization of learning in acute poststroke patients.

BACKGROUND AND PURPOSE: Our previous studies demonstrated that mental imagery intervention enhanced poststroke patients relearning daily task performance. This study aimed to test the efficacy of mental imagery for promoting generalization of the task skills learned in a training environment to trained and untrained tasks carried out in a novel environment. METHODS: Thirty-five acute poststroke patients were randomly assigned to the mental imagery (MI; n=18) or conventional functional rehabilitation (FR; n=17) group. The MI intervention was 3-week standardized practices and daily tasks using the chunking-regulation-rehearsal strategies. Outcome measurements were the performances on trained and untrained tasks in the training and novel environments. RESULTS: The MI patients showed significantly better performances on 4 of 5 trained tasks (P=0.001 to 0.026) versus only 1 task in the FR patients (P=0.021). The MI patients also outperformed their FR counterpart on the 3 (of 5) (P=0.025 to 0.049) trained and 2 (of 3) untrained tasks (P=0.042 to 0.045) carried out in the novel environment. CONCLUSIONS: The mental imagery intervention was useful for improving patients' ability on performing the tasks which they did not previously trained on and in places different from the training environments. These involved generalization of the skills learned at the task performance level. Our findings are limited to poststoke patients who share similar characteristics with those in this study.

Selective attention biases of people with depression: positive and negative priming of depression-related information.

Selective attention biases are believed to be one of the cognitive vulnerabilities to depression. This study examined two types of attention biases, namely attention facilitation and attention disinhibition, towards mood-congruent words in 40 clinically depressed outpatients and 40 never-depressed healthy controls. Measures were differential reaction time towards neutral and depressive words in the positive and negative priming paradigms that were used to assess attention facilitation and attention disinhibition, respectively. Results showed that the depressed group exhibited enhanced attention facilitation to depressive words relative to neutral words, whereas the control group did not. The differential reduction of reaction time of the depressed group to the previously presented depressive words relative to the previously presented neutral words was greater than that in the control group. On the other hand, both groups showed similar attention disinhibition to depressive words relative to neutral words. The differential increase in reaction time to previously ignored depressive words relative to the previously ignored neutral words was similar in both groups. The above results suggest that major depressive disorder is characterized by attention facilitation by mood-congruent information, but inhibition difficulties in attention to depression-related information is not specific to depressive disorder.

Increased levels of circulating endothelial progenitor cells in subjects with moderate to severe chronic periodontitis.

AIM: Emerging evidence shows that periodontal disease is associated with endothelial dysfunction. The purpose of this study was to determine the association between chronic periodontitis (CP) and circulating endothelial progenitor cells (EPC). MATERIALS AND METHODS: Eighty-six non-smoking subjects (36 males and 50 females, aged 35-80 years) were recruited, including 23 subjects with no or mild CP and 63 subjects with moderate to severe CP. The levels of circulating EPC were quantitatively determined by fluorescence-activated cell analysis, including CD34+/kinase insert domain-containing receptor (KDR)+ (more mature EPC) and CD133+/KDR+ (less mature EPC). Periodontal conditions, the intima-media thickness of carotid arteries and circulating biomarkers were examined. RESULTS: Subjects with moderate to severe CP exhibited an increased risk of high EPC count, compared with those with no or mild CP: CD34+/KDR+ EPC [odds ratio (OR)=9.5, 95% confidence interval (95% CI) 1.5-61.0, p=0.018; CD133+/KDR+ EPC, OR=4.6, 95% CI 1.1-19.5, p=0.039]. C-reactive protein was significantly associated with high CD34+/KDR+ EPC count and age was inversely related with high EPC count. Age, gender and CD34+/KDR+ EPC were independent variables of increased carotid intima-media thickness (p<0.05). CONCLUSION: This study shows for the first time that moderate to severe CP is associated with an increased level of circulating EPC.