Bundled preparation of skin antisepsis decreases the risk of cardiac implantable electronic device-related infection.

AIMS: To evaluate the efficacy of bundled skin antiseptic preparation to prevent cardiac implantable electronic device (CIED) infections. METHODS AND RESULTS: From January 2010 to November 2013, 665 consecutive patients were divided into two groups according to the strategy of skin preparation. In Period 1 (January 2010 to June 2012), 395 patients received the standard skin antiseptic preparation. In Period 2 (July 2012 to November 2013), 270 patients received a triple-step skin antiseptic preparation, 'bundled skin antiseptic preparation', consisting of applying 75% alcohol over anterior chest on the night before the index day, povidone-iodine 10 min before operation, and the standard skin antiseptic preparation before incision. During follow-up, the occurrence of CIED infection was recorded. Multiple logistic regression analysis was used to determinate the risk factors of CIED infection. During a mean follow-up of 26.9 ± 16.2 months, 20 episodes of CIED infection developed in 19 patients (2.9%), and the incidence of minor and major infection episodes was 2.2% and 0.8%, respectively. Patients with the bundled skin antiseptic preparation had a significantly lower incidence of CIED infection, compared with patients with the standard preparation (0.7 vs. 4.3%, P = 0.007). In multivariate analysis, pocket haematoma (P = 0.020), atrial fibrillation (P = 0.033), and complex procedures (P = 0.047) were independent predictors for CIED infection. In contrast, the bundled skin antiseptic preparation was a significant predictor against CIED infection (P = 0.014). CONCLUSION: Pocket haematoma was the most important risk factor for CIED infection. The bundled skin antiseptic preparation strategy significantly reduced the risk of minor CIED infection.

Endodontic apical surgery with novel endoscope: Three-case series.

Successful apical surgery relies on effective magnification and illumination. In the field of endodontics, the microscope has emerged as the predominant tool for meeting these requirements. The rigid endoscope is also a valuable instrument in apical surgery. This study introduces three cases demonstrating the application of endoscope technology in endodontic apical surgery. The first case employs a soft endoscope for treating an anterior tooth with apical periodontitis, the second integrates an endoscope with new attachments for a premolar, and the third combines an endoscope, attachments and navigation for the lower first molar surgery. It revealed that endoscopes offer certain advantages that are not achievable with microscope-assisted surgery, these cases had a great outcome. In the future, a broader application of endoscopic technology in various procedures is anticipated.

The effect of pilocarpine on dental caries in patients with primary Sjögren's syndrome: a database prospective cohort study.

BACKGROUND: Primary Sjögren's syndrome (pSS) is associated with dental caries. Pilocarpine, a salivary stimulant, can improve the amount and flow rate of saliva in patients with pSS. This study aimed to assess whether the risk of dental caries decreases with the use of pilocarpine in patients with pSS. METHODS: For this prospective cohort study, we identified pSS patients from the catastrophic illnesses registry of the National Health Insurance Research Database of Taiwan between 2009 and 2013. We divided participants into pilocarpine and non-user groups based on the pilocarpine prescriptions available during the first 3-month follow-up. The primary endpoint was dental caries. The secondary endpoints were periodontitis and oral candidiasis. We compared the risk of these oral manifestations using the Cox proportional hazard model. RESULTS: A total of 4973 patients with new-onset pSS were eligible for analysis. After propensity score matching, we included 1014 patients in the pilocarpine group and 2028 patients in the non-user group. During the mean follow-up of 2.6 years, the number of events was 487 in the pilocarpine group (48.0%) and 1047 in the non-user group (51.6%); however, the difference was not significant (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.82 to 1.06). Furthermore, there was no significant difference between groups regarding risk of periodontitis (HR 0.91, 95% CI 0.81 to 1.03) and oral candidiasis (HR 1.16, 95% CI 0.70 to 1.94). CONCLUSION: Pilocarpine may have no protective effect on dental caries, periodontitis, or oral candidiasis in patients with pSS.

Morphology and electrochemical behavior of Ag-Cu nanoparticle-doped amalgams.

The aim of this study was to introduce Ag-Cu phase nanopowder as an additive to improve the corrosion behavior of dental amalgams. A novel Ag-Cu nanopowder was synthesized by the precipitation method. An amalgam alloy powder (World-Cap) was added and mixed with 5 wt.% and 10 wt.% of Ag-Cu nanopowders, respectively, to form experimental amalgam alloy powders. The original alloy powder was used as a control. Alloy powders were examined using X-ray diffraction, transmission electron microscopy (TEM), scanning electron microscopy and electron probe microanalysis. Amalgam disk specimens of metallurgically prepared were tested in 0.9% NaCl solution using electrochemical methods. The changes in the corrosion potential and anodic polarization characteristics were determined. Corrosion potential data were analyzed statistically (n=3, analysis of variance, Tukey's test, p<0.05). The diameters of lamellar structure Ag-Cu nanoparticles were measured to be approximately 30 nm. The composition of the Ag-Cu nanoparticles determined by TEM-energy-dispersive spectroscopy was 56.28 at.% Ag-43.72 at.% Cu. A light-shaded phase was found mixing with dark Cu-Sn reaction particles in the reaction zones of Ag-Cu nanoparticle-doped amalgams. The Ag-Cu nanoparticle-doped amalgams exhibited zero current potentials more positive than the control (p<0.05) and no current peak was observed at -325mV that related to Ag-Hg phase and Cu6Sn5 phase in anodic polarization curves. The results indicated that the corrosion resistance of high-copper single-composition amalgam could be improved by Ag-Cu nanoparticle-doping.

Dental Procedures and the Risk of Infective Endocarditis.

Infective endocarditis (IE) is an uncommon but potentially devastating disease. Recently published data have revealed a significant increase in the incidence of IE following the restriction on indications for antibiotic prophylaxis as recommended by the revised guidelines. This study aims to reexamine the basic assumption behind the rationale of prophylaxis that dental procedures increase the risk of IE.Using the Longitudinal Health Insurance Database of Taiwan, we retrospectively analyzed a total of 739 patients hospitalized for IE between 1999 and 2012. A case-crossover design was conducted to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no IE developed.In the unadjusted model, the odds ratio (OR) was 0.93 for tooth extraction (95% confidence interval [CI] 0.54-1.59), 1.64 for surgery (95% CI 0.61-4.42), 0.92 for dental scaling (95% CI 0.59-1.42), 1.69 for periodontal treatment (95% CI 0.88-3.21), and 1.29 for endodontic treatment (95% CI 0.72-2.31). The association between dental procedures and the risk of IE remained insignificant after adjustment for antibiotic use, indicating that dental procedures did not increase the risk of IE.Therefore, this result may argue against the conventional assumption on which the recommended prophylaxis for IE is based.

Major Adverse Cardiovascular Events in Treated Periodontitis: A Population-Based Follow-Up Study from Taiwan.

BACKGROUND: The aim of the present study was to identify the long-term major adverse cardiovascular events (MACE) in treated periodontitis patients in Taiwan. METHODS: From the National Health Insurance Research Database (2001-2010), adult patients (≥ 18 years) with treated periodontitis were identified. Comparison was made between patients with mild form and severe form of treated periodontitis after propensity score matching. The primary end point was the incidence of MACE. RESULTS: A total of 32,504 adult patients with treated periodontitis were identified between 2001 and 2010. After propensity score matching, 27,146 patients were preserved for comparison, including 13,573 patients with mild form and 13,573 patients with severe form of treated periodontitis. During follow-up, 728 individuals in mild treated periodontitis group and 1,206 individuals in severe treated periodontitis group had at least 1 MACE event. After adjustment for gender, hyperlipidemia, hypertension and diabetes mellitus, severe treated periodontitis was associated with a mildly but significantly increased risk of MACE among older patients > 60 years of age (incidence rate ratio, 1.26; 95% confidence interval, 1.08-1.46). No association was found among younger patients ≤ 60 years of age. CONCLUSIONS: Severe form of treated periodontitis was associated with an increased risk of MACE among older Taiwanese patients, but not among younger Taiwanese patients. We should put more efforts on the improvement of periodontal health to prevent further MACE.

Immobilization of cellulase onto electrospun polyacrylonitrile (PAN) nanofibrous membranes and its application to the reducing sugar production from microalgae.

This study demonstrates a method to prepare an immobilized cellulase by using an electrospun polyacrylonitrile (PAN) nanofibrous membrane as the support. To obtain an immobilized cellulase with high hydrolytic activity, the immobilization conditions including activation time, enzyme concentration, immobilization time, and temperature were optimized. Under those conditions, the immobilized cellulase possessed a protein loading of 30 mg/g-support and a specific activity of 3.2U/mg-protein. After immobilization, the enzymatic stability of cellulase against pH and thermal stresses was improved. Fourier transform infrared spectroscopy (FTIR) measurements also revealed that the cellulase was covalently bonded to the supports. The immobilized cellulase was then used to hydrolyze cell wall of microalgae for the production of reducing sugars. Analyses using response surface methodology (RSM) show that the hydrolysis yield was affected by the reaction temperature, pH, and substrate/cellulase mass ratio, and a hydrolysis yield of 60.86% could be obtained at 47.85°C, pH 5.82, and a substrate/cellulase mass ratio of 40 g-substrate/g-cellulase. This result suggests that the proposed scheme for the cellulase immobilization has great potential for the application to the reducing sugar production.

Synthesis and characterization of poly(vinyl alcohol) membranes with quaternary ammonium groups for wound dressing.

2-[(acryloyloxy)ethyl]Trimethylammonium chloride (AETMAC) was grafted onto poly(vinyl alcohol) (PVA) using ceric ammonium nitrate (CAN) as a redox initiator. A series of graft co-polymer (PVA-g-PAETMAC) membranes with different contents of AETMAC were prepared with a casting method. The incorporation of AETMAC into PVA chains was confirmed by element analysis and Fourier transform infrared spectroscopy. The effects of grafting on the thermal properties, water take, water vapor transmission rate (WVTR), contact angle, antibacterial activity and cytotoxicity of PVA-g-PAETMAC membranes were investigated. The experiment results showed that PVA-g-PAETMAC membrane has a higher equilibrium swelling ratio, surface hydrophilicity and WVTR than pure PVA membrane. Moreover, the higher the content of AETMAC, the higher were equilibrium swelling ratio, surface hydrophilicity and WVTR. In vitro bacterial adhesion study demonstrated a significantly reduced number of Staphylococcus aureus and Escherichia coli on PVA-g-PAETMAC surfaces when compared to PVA surface. In addition, no significant difference in the in vitro cytotoxicity was observed between PVA and PVA-g-PAETMAC membranes. The presence of quaternary ammonium groups did not reduce L929 cell growth. Therefore, the PVA-g-PAETMAC membranes have the potential for wound-dressing application.