Prediction Model of Cardiac Risk for Dental Extraction in Elderly Patients with Cardiovascular Diseases.

BACKGROUND: With the rapidly increasing population of elderly people, dental extraction in elderly individuals with cardiovascular diseases (CVDs) has become quite common. The issue of how to assure the safety of elderly patients with CVDs undergoing dental extraction has perplexed dentists and internists for many years. And it is important to derive an appropriate risk prediction tool for this population. OBJECTIVES: The aim of this retrospective, observational study was to establish and validate a prediction model based on the random forest (RF) algorithm for the risk of cardiac complications of dental extraction in elderly patients with CVDs. METHODS: Between August 2017 and May 2018, a total of 603 patients who fulfilled the inclusion criteria were used to create a training set. An independent test set contained 230 patients between June 2018 and July 2018. Data regarding clinical parameters, laboratory tests, clinical examinations before dental extraction, and 1-week follow-up were retrieved. Predictors were identified by using logistic regression (LR) with penalized LASSO (least absolute shrinkage and selection operator) variable selection. Then, a prediction model was constructed based on the RF algorithm by using a 5-fold cross-validation method. RESULTS: The training set, based on 603 participants, including 282 men and 321 women, had an average participant age of 72.38 ± 8.31 years. Using feature selection methods, 11 predictors for risk of cardiac complications were screened out. When the RF model was constructed, its overall classification accuracy was 0.82 at the optimal cutoff value of 18.5%. In comparison to the LR model, the RF model showed a superior predictive performance. The AUROC (area under the receiver operating characteristic curve) scores of the RF and LR models were 0.83 and 0.80, respectively, in the independent test set. The AUPRC (area under the precision-recall curve) scores of the RF and LR models were 0.56 and 0.35, respectively, in the independent test set. CONCLUSION: The RF-based prediction model is expected to be applicable for preoperative clinical assessment for preventing cardiac complications in elderly patients with CVDs undergoing dental extraction. The findings may aid physicians and dentists in making more informed recommendations to prevent cardiac complications in this patient population.

miR-146a and miR-155 expression in PBMCs from patients with Sjögren's syndrome.

BACKGROUND: An increasing number of studies have revealed that microRNA (miRNA) contributes to the pathogenesis of autoimmune diseases. The objective of this study is to investigate the miR-146a and miR-155 levels in peripheral mononuclear blood cells from patients with primary Sjögren's syndrome (pSS) who were not receiving medications and to examine the correlations between these miRNA levels and the clinical features of the disease. METHOD: Using real-time polymerase chain reaction analysis of miRNAs, the miR-146a and miR-155 expression levels were assessed in peripheral mononuclear blood cells from 27 patients with pSS and 22 healthy controls, and the relationships between these miRNA levels and the visual analog scale (VAS) scores for dry mouth, dry eyes, and parotid gland swelling were investigated. RESULTS: Compared with the healthy controls, the miR-146a expression level was significantly increased in the patients with pSS (P = 0.0182) and was positively correlated with the VAS scores for parotid swelling (r = 0.4475, P = 0.0192) and dry eyes (r = 0.4051, P = 0.0361). Although the miR-155 expression level was significantly decreased in the patients with pSS (P = 0.0131), the miR-155 expression positively correlated with the VAS score for dry eyes (r = 0.4894, P = 0.0096). CONCLUSION: Our results demonstrated miR-146a overexpression and miR-155 underexpression in the peripheral mononuclear blood cells of the patients with pSS. Furthermore, the expression levels of these miRNAs correlated with the patients' clinical features. Our data suggest that miR-146a and miR-155 might play important roles in the pathogenesis of pSS and that their expression levels may be useful for diagnosing pSS and for predicting disease activity and therapeutic responses.

Activation of TLR9-dependent p38MAPK pathway in the pathogenesis of primary Sjögren's syndrome in NOD/Ltj mouse.

OBJECTIVE: The objective of this study was to investigate the potential role of Toll-like receptor 9-dependent p38 MAPK signaling pathway in the pathogenesis of primary Sjögren's syndrome (pSS) in NOD/Ltj mouse, aiming to identify an ideal target therapy model for human pSS. METHODS: NOD/Ltj mice were chosen as a model of pSS. The Toll-like receptor 9 and p-p38 MAPK double-positive peripheral blood mononuclear cells (PBMCs) of 4-, 5-, 8-, 10-, and 15-week-old NOD/Ltj mouse were analyzed by flow cytometry. The expressions of Toll-like receptor 9 and p-p38 MAPK in the submandibular gland (SMG) were also examined by immunohistochemistry. The change of stimulated salivary flow rate was dynamically measured, and the histopathology of SMG was evaluated by hematoxylin and eosin stain. RESULTS: The stimulated salivary flow rate in NOD/Ltj was reduced to 50-60% of the flow rate of control mice since the fifth week onwards. The Toll-like receptor 9 and p-p38 MAPK double-positive PBMCs in both groups increased gradually from 5 weeks, peaked at 8 weeks and then gradually decreased at 10 weeks, yet the percentage of Toll-like receptor 9 and p-p38MAPK double-positive PBMCs in 5-, 8-, and 10-week-old NOD/Ltj mouse was significantly increased compared with those in control subjects. After the 10th week onwards, there were no significant differences in the Toll-like receptor 9 and p-p38 MAPK double-positive PBMCs between NOD/Ltj mice and controls. Immunohistochemical staining showed that Toll-like receptor 9 was positive in the acinar epithelium cells and infiltrating lymphocytes in NOD/Ltj mice. p-p38 MAPK was detected in infiltrating lymphocytes and few ductal or acinar epithelium cells adjacent to infiltrating lymphocytes in NOD/Ltj mice. CONCLUSIONS: From the fifth week till the tenth week, Toll-like receptor 9 and p-p38 MAPK double-positive PBMCs were significantly increased in NOD/Ltj mice, accompanied with reduced stimulated salivary flow rate and Toll-like receptor 9 or p-p38 MAPK positive infiltrating lymphocytes observed in the SMG of NOD/Ltj mouse. Our results indicated that activation of Toll-like receptor 9-depended p38 MAPK signal pathway in PBMCs was an early event in pSS which made NOD/Ltj as an ideal therapy model to test the treatment effects of p38 MAPK or Toll-like receptor 9 inhibitors on pSS.

Bilateral aplasia of the major salivary glands and unilateral atresia of lacrimal duct.

Aplasia of the major salivary glands, especially the parotid gland, is a rare disorder. Up to now, few cases have been reported. Clinically, patients may present with xerostomia, irritable eyes, severe dental caries, or asymptomatic manifestations.According to clinical and radiologic findings, we reported a case of a 20-year-old girl with bilateral aplasia of the major salivary glands and unilateral atresia of the lacrimal duct and made telephone follow-up 1 year later.

Clinicopathologic features of dentigerous cysts in the maxillary sinus.

Dentigerous cyst (DC) in the maxillary sinus is extremely rare. This study evaluated the clinical features, etiologic factors, imaging, treatment, and signs and symptoms of this type of DC. Clinical symptoms, radiographic findings, surgical methods, and histopathologic findings of 4 patients with DCs in the maxillary sinus were evaluated. In addition, we reviewed the literature reports of DCs in the maxillary sinus over the past 40 years. Our 4 patients with DC in the maxillary sinus showed the following results: (1) all the patients were males at first 3 decades of age, (2) swelling and/or yellow-green pus discharges from pharyngeal cavity were common symptoms, (3) the involved teeth in the DC were the maxillary third molar teeth and supernumerary teeth, and (4) Caldwell-Luc approach was performed in these 4 patients. The patients with DC in the maxillary sinus should be evaluated thoroughly by extraoral and intraoral examinations, proper diagnostic imaging procedures, and pathologic examination to avoid misdiagnosis of maxillary sinusitis. The standard treatment for DC in the maxillary sinus is often removed by Caldwell-Luc approach. Furthermore, marsupialization or functional endoscopic sinus surgery may be performed because of the size, location of the cysts, or the age of the patients.

Function of the parotid gland in juvenile recurrent parotitis: a case series.

Our aim was to find out how the parotid gland functions in 44 patients with juvenile recurrent parotitis, and to assess the value of measuring the serum amylase activity. Clinical and personal details were recorded, and all patients had their serum amylase activity measured together with sialography during the chronic phase. The function of the gland was classified by sialographic images. The chi square test and Spearman's rank correlation coefficient were used in the statistical analyses. There was a significant association between the degree of glandular function and serum amylase activity (p=0.014). The patients with unilateral and bilateral disease differed significantly in their degree of glandular function (p=0.020), those with bilateral disease having poorer function. There were no significant correlations between other clinical variables and glandular function. Serum amylase activity is an important diagnostic variable in juvenile recurrent parotitis, and poor parotid function reflects the severity of the disease.

[Clinical study of SS syrup in treating xerostomia].

OBJECTIVE: To compare the clinical efficacy of SS syrup, a Chinese medicine, and pilocarpine in treating patients with xerostomia. METHODS: Thirty-eight patients conformed to the inclusive criteria were randomly divided into two groups, they were treated by SS syrup (SS group) and pilocarpine (control group) respectively. Three indexes, i.e. questionnaire of dryness in mouth, total static salivary flow and dynamic salivary flow, before treatment, 1, 2 and 4 weeks after treatment were recorded and statistically analyzed. RESULTS: Significant difference was shown in the 3 indexes in the SS group between before treatment and 1, 2 and 4 weeks after treatment (P < 0.05), while in the control group significant difference was shown between before treatment and 1, 2, and 4 weeks after treatment except for total dynamic salivary flow after I weck treatment (P < 0.05). CONCLUSION: SS syrup, which has no adverse reaction, no contraindication, could be taken chronically, and shows good efficacy in improving the symptoms of xerostomia.

Anatomic relationship between impacted third mandibular molar and the mandibular canal as the risk factor of inferior alveolar nerve injury.

Our aim was to explore the relation between the site of the mandibular canal and neurosensory impairment after extraction of impacted mandibular third molars. We organised a retrospective study of 537 extractions in 318 patients in which the affected tooth was intersected by the mandibular canal. This was verified by cone-beam computed tomography (CBCT), and we analysed the relation between the site of the canal and the likelihood of injury to the inferior alveolar nerve (IAN) after extraction of the third molar. The relation between the position of the root of the tooth and the mandibular canal was categorised into 4 groups: I=root above the canal; II=on the buccal side; III=on the lingual side; and IV=between the roots. The overall rate of neurosensory impairment after extraction was 6% (33/537). It occurred in 9/272 patients (3%) in group 1, 16/86 (19%) in group II, and in 8/172 (5%) in group III. There was no neurosensory impairment in group IV where the canal was between the roots. There were significant differences between group II and groups I and III (p<0.01), but not between groups I and III (p=0.32). The risk of damage to the inferior alveolar nerve is increased if third molars intersect with the mandibular canal, particularly on its buccal side.

Dentigerous cysts associated with impacted supernumerary teeth in the anterior maxilla.

Dentigerous cysts are thought to be caused by a developmental abnormality derived from the reduced enamel epithelium of the tooth forming organ. Most typical dentigerous cysts are those associated with the third molar teeth of the mandible, but rarely involve impacted supernumerary teeth in the anterior maxilla. Swelling and/or pain may be the major complaints of the patients. Herein, we review the literature spanning the past 22 years concerning dentigerous cysts associated with supernumerary teeth in the anterior maxilla, and present four additional cases with emphasis given to the clinicopathological characteristics of this type of dentigerous cyst.

[Diagnostic value of magnetic resonance sialography for submandibular sialolithiasis].

PURPOSE: To evaluate the role of MR Sialography(MRS) in diagnosis of submandibular sialolithiasis. METHODS: Twenty-one patients with submandibular sialolithiasis were scanned by MRS, the results of MRS were compared with those after proper treatment. RESULTS: The results of MRS were consistent with those after proper treatment. CONCLUSION: MRS has high diagnostic accuracy in diagnosis of sialolithiasis including submandibular sialadenitis.

[The value of MRS in diagnosis of Sjoigren's syndrome in parotid gland].

PURPOSE: The purpose of this study is to evaluate the value of MR sialography in diagnosis of Sjoigren's syndrome in parotid gland. METHODS: MRI and MRS were used to diagnose Sjoigren's symdrome and differentiate with other disease combined with clinical, serologic and histopathologic result. Meanwhile, the result of MRS was compared with sialograph. RESULTS: 25 cases were ultimately diagnosed as Sjoigren's syndrome among 32 cases by clinical, serologic, histopathologic and sialography or MRS method. 23 cases were presented typical image in MRS, and sensitivity was 92%; specificity 71.4% and accuracy 87.5%. Other different manifestations were found in 25 cases, such as: autoantibody 68%, focui lymphocytic infiltration 72%. 18 cases have the positive results between MRS and sialography and 15 cases (83.3%) have the same manifestations by degree classification. CONCLUSION: The Sjoigren's syndrome can be confirmed by clinical, serologic, histopathologic, and MRS or sialography. MRS is a reliable method to diagnosis and differentiated diagnose Sjoigren's syndrome with other disease.

[The diagnostic value of magnetic resonance sialography for chronic obstructive parotitis].

PURPOSE: To evaluate the diagnostic value of magnetic resonance sialography (MRS) for chronic obstructive parotitis (COP). METHODS: 18 patients with COP underwent both conventional sialography and MRI sialography. A new magnetic resonance technique was applied. In addition to the usually performed T1 and T2 cross-sectional sequence, a heavy T2-weighted sequence (TR=4000 msec,TE=250 msec)was performed that allowed depiction of the fluid-filled parotid duct system. The MRI sialographic findings were compared with that of conventional sialography. The overall accuracy of diagnosis and ductal stenosis were assessed. RESULTS: The main duct of the parotid gland as well as primary branching ducts could be reliably depicted. Compared with the conventional sialography, the diagnostic accuracy of MRS was 94.4%(17/18) and stenosis diagnosis reached 100%(17/17). CONCLUSIONS: Initial experience indicates that magnetic resonance sialography can be applied successfully to investigate the duct system of the parotid gland. It is completely noninvasive and a promising alternative to radiographic sialography.