Maxillary Sinus Augmentation with Anorganic Bovine Bone Mineral of Different Particle Sizes: A Split-Mouth Study with Histomorphometric, Radiographic, and Clinical Analyses.

PURPOSE: The aim of the present study was to compare the histomorphometrically evaluated new bone formation (NB), the radiographically measured graft stability, and the clinical implant outcome for maxillary sinus augmentation grafted with deproteinized bovine bone mineral (DBBM) with either small (Bio-Oss-S, Geistlich) or large (Bio-Oss-L, Geistlich) particles. MATERIALS AND METHODS: Using a split-mouth study design, bilateral maxillary sinus augmentation was performed in 13 patients either with Bio-Oss-S particles (0.25 to 1 mm) or Bio-Oss-L particles (1 to 2 mm). After a healing period of 6 months, bone biopsies were axially retrieved in the molar region for histologic/histomorphometric analysis of NB, including subsequent staged implant placement. To determine graft stability, the maxillary sinus augmentation vertical graft heights were radiographically measured immediately after sinus augmentation, at implant placement, and at the 2- and 4-year post-augmentation follow-ups. In addition, the clinical implant-prosthodontic outcome (survival/ success/marginal bone loss) was assessed at 1 and 3 years post-loading. RESULTS: A total of 22 sinuses from 11 patients with split-mouth evaluation were ultimately available for data and statistical analysis. Histomorphometric analysis of the axially retrieved bone biopsies revealed the presence of NB (S: 25.5% ± 7.0% vs L: 23.6% ± 11.9%; P = .640), residual graft particles (S: 19.6% ± 9.2% vs L: 17.5% ± 6.3%; P = .365) as well as connective tissue (S: 54.9% ± 9.2% vs L: 58.9% ± 12.5%; P = .283), without significant differences between the use of small (Bio-Oss-S) and large (Bio-Oss-L) particles. However, there was significantly (P = .021) higher bone-to-graft contact (BGC) for the small-particle graft sites (27.9% ± 14.8%) compared to the large-particle graft sites (19.9% ± 12.9%), representing a significantly higher osteoconductivity. Both particle sizes showed significant (P < .01) vertical graft height reduction over time (4 years) of about 10%, with predominant graft reduction in the time period between sinus augmentation and implant placement compared to any follow-up periods after implant placement. At the 3-year post-loading implant evaluation, all implants and prostheses survived (100%), and the peri-implant marginal bone loss (S: 0.52 ± 0.19 mm; L: 0.48 ± 0.15 mm) as well as the peri-implant health conditions (S: 87.5%, L:81.2%) did not differ between implants inserted with the two different xenograft particles used. CONCLUSIONS: The use of small and large bovine xenograft particles for maxillary sinus augmentation provides for comparable bone formation, ensuring stable graft dimensions combined with high implant success and healthy peri-implant conditions. However, small particle size resulted in a higher BGC, providing for higher osteoconductivity than with the larger particle size.

Endothelial receptor proteins in acute venous thrombosis and delayed thrombus resolution in cerebral sinus vein thrombosis.

BACKGROUND AND PURPOSE: Cerebral sinus venous thrombosis (CSVT) is a rare but life-threatening disease and its diagnosis remains challenging. Blood biomarkers, including D-Dimer are currently not recommended in guidelines. Soluble endothelial receptor proteins (sICAM-1, sPECAM-1 and sVCAM-1) have been shown to be promising diagnostic biomarkers in deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, we examined endothelial receptor proteins as potential biomarkers for detecting CSVT. METHODS: In this bi-centre, prospective study, we quantified D-Dimer as well as sICAM-1, sPECAM-1 and sVCAM-1 in plasma of patients with clinically suspected CSVT managed in the neurological emergency department (ED) of a tertiary care hospital. All patients underwent cerebral magnetic resonance imaging (MRI) and were followed up after 3, 6 and 12 months to detect thrombus resolution. RESULTS: Twenty-four out of 75 (32%) patients with clinically suspected CSVT presenting with headache to the ED were diagnosed with acute CSVT. These patients had a mean age of 45 ± 16 years and 78% were female. In patients with CSVT, mean baseline D-dimer (p < 0.001) and sPECAM-1 (p < 0.001) were significantly higher compared to patients without CSVT. The combination of D-Dimer and sPECAM-1 yielded the best ROC-AUC (0.994; < 0.001) with a negative predictive value of 95.7% and a positive predictive value of 95.5%. In addition, higher baseline sPECAM-1 levels (> 198 ng/ml) on admission were associated with delayed venous thrombus resolution at 3 months (AUC = 0.83). CONCLUSION: sPECAM-1 in combination with D-Dimer should be used to improve the diagnostic accuracy of acute CSVT and sPECAM-1 may predict long-term outcome of CSVT. Confirmatory results are needed in other settings in order to show their value in the management concept of CSVT patients.

Transsinusoidal lateral nasal floor augmentation for implant placement in the atrophic premaxilla: A within-patient, 5-year, prospective comparative study.

OBJECTIVES: To evaluate the clinical outcome for implants placed with transsinusoidal-lateral nasal cavity augmentation (NA) compared to implants placed in maxillary sinus augmentation (SA). MATERIALS AND METHODS: In 28 atrophic edentulous maxillary regions (14 patients bi-maxillary), a lateral window approach was used to perform transsinusoidal-lateral NA (TSLNA) combined with maxillary SA. After healing period of about 6 months, each patient received bimaxillary one anterior implant located in the pre-maxilla having lateral NA and 2-3 implants in the maxillary posterior region with SA. In a prospective follow-up evaluation, clinical implant outcome (survival/success rates) and peri-implant health (mucositis/peri-implantitis) were assessed and compared between implants placed in TSLNA (n = 28) and SA (n = 58). RESULTS: At the year-1, year-3, and year-5 evaluation, neither patient-based nor implant-based comparisons revealed differences for marginal bone level reduction between implants placed in TSLNA (5-year overall: 1.11 ± 0.26 mm) and SA (5-year overall: 1.07 ± 0.30 mm), although with a significant (p < .001) continuous reduction over the observation time. At the year-5 evaluation, all implants (n = 86) and restorations (n = 14) were still in situ (survival 100%) and showed an implant-based incidence of peri-implant mucositis/peri-implantitis of 14.3%/0% in TSLNA and 6.9%/3.4% in SA corresponding to 21.4%/0% and 28.6%/7.1% for implant-based evaluation. In addition, the implant success rate did not differ between NA and SA at implant- (100%/ 98.8%) and patient-based (100%/97.6%) evaluation. CONCLUSION: The findings obtained show TSLNA as an effective method for implant placement of adequate length and direction in the atrophic premaxilla providing for success rates comparable to those of implants placed in SA.

Immediately loaded implants simultaneously placed in fresh extraction and healed sites supporting four-implant-supported fixed mandibular prostheses using the all-on-4 concept: A 5-year prospective study.

OBJECTIVES: To evaluate the peri-implant marginal bone level for immediately loaded implants placed simultaneously in both fresh extraction sites (FES) and healed sites (HS) supporting a 4-implant supported mandibular fixed prosthesis (4-ISFMP) using the all-on-4 concept. MATERIAL AND METHODS: A 5-year prospective study was conducted in 24 patients (96 implants) treated with 4-ISFMP including 55 implants inserted in FES and 41 implants in HS. At implant placement (baseline) and at the 1st -, 3rd - and 5th -year follow-up examinations, peri-implant marginal bone level was evaluated radiographically and compared between placement in FES and HS. Marginal bone loss was calculated as the difference in the marginal bone level evaluated at the follow-up periods. Additionally, implant and prosthesis survival rates as well as the presence of peri-implant mucositis (bleeding on probing+[BOP]) and peri-implantitis (BOP+ >2 mm MBL) were evaluated. RESULTS: 22/24 patients with 88/96 implants (dropout rate: 8.3%) were continually followed for 5 years (survival rate: 100%). Radiographically measured marginal bone level differed significantly between FES and HS at implant placement (1.46 ± 0.80 mm vs. 0.60 ± 0.70 mm; p < .001), at the 1-year (-0.04 ± 0.14 mm vs. -0.18 ± 0.20 mm; p = .002) and 3-year (-0.26 ± 0.49 mm vs. -0.58 ± 0.48 mm, p = .049), but not at the 5-year evaluation (-0.90 ± 0.66 mm vs. -1.00 ± 0.59 mm, p = .361). The marginal bone loss differed significantly (p < .001) between FES and HS between implant placement and the 1-year evaluation but not for the 1- to 3-year (p > .99) and the 3- to 5-year period (p = .082). At the 5-year follow-up evaluation, no implant/prosthesis failed (100% survival) and peri-implant mucositis and peri-implantitis were noted in 41.2% and 11.7% at patient level and in 17.6% and 4.5% at implant level respectively. CONCLUSION: Implants placed in FES showed a prolonged peri-implant remodelling process but provided for similar peri-implant marginal bone levels as implants placed in HS at the 5-year evaluation for immediately loaded 4-ISFMP.

The influence of different forms of sinus membrane perforation on the prevalence of postoperative complications in lateral window sinus floor elevation: A retrospective study.

BACKGROUND: Maxillary sinus membrane perforation (SMP) during lateral window sinus floor elevation (SFE) might be associated with postoperative complications (PC). OBJECTIVES: To evaluate the prevalence of PC and clinical implant outcome for different forms of SMP with lateral window SFE. MATERIAL AND METHODS: The prevalence of PC such as maxillary sinusitis, graft necrosis and wound infection was retrospectively evaluated for 434 lateral window SFE (334 patients) with 331 SFE (241 patients) without and 103 SFE (93 patients) with SMP. SMP was additionally classified into four subgroups regarding to membrane perforation size (small-moderate [<10 mm] vs. large [>10 mm]) and membrane biotype ([BT] thin vs. thick). Additionally, patient- and surgery-related risk factors affecting PC and the 1-year implant survival rate were evaluated for SFE without and with SMP and subgroups. RESULTS: A significantly higher prevalence including significant odds ratios of PC such as maxillary sinusitis (10/103 [9.7%] vs. 4/331 [1.2%]; p < 0.021; OR: 8.85; p < 0.021) and graft necrosis (7/103[6.8%] vs. 1/103[0.3%]; p < 0.017; OR:7.43; p < 0.017) was found for SFE with than without SMP. The SMP subgroup with large size and thin BT involved significantly (p < 0.005) more PC (15/20[75%]) than all other SMP subgroups (5/20[25%]). For the risk factors evaluated the univariate analysis demonstrated differences of PC for the presence versus absence of SMP (p < 0.001) and for thin versus thick sinus mucosa (p < 0.038; p < 0.006) but not for sex, smoking, sinus septa and surgical stage. In the multivariate risk factors analysis, PC were significantly related to risk factors such as large size with thin BT (OR:18.049; p < 0.007). The 1-year implant survival rate did not differ between SFE without (99.5%) and with SMP (99.1%), regardless of successfully repaired subtype of SMP. CONCLUSION: The synopsis of perforation size and membrane biotype is crucial in differentiating different forms of SMP assessing and anticipating different prevalences of PC in lateral window SFE.

Caregiver strain in progressive supranuclear palsy and corticobasal syndromes.

Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) progress relentlessly and lead to a need for care. Caregiving is often burdensome. Little is known about the course of caregiver burden (CB) in PSP and CBS patients. Longitudinal analysis of CB in family members caring for PSP and CBS patients. Single-center longitudinal pilot study in 68 newly diagnosed patients with probable PSP and CBS (52 Richardson's syndrome; 1 progressive gait freezing of PSP; 15 CBS). Demographic, educational, occupational parameters, family status, motor functions (UPDRSIII, Hoehn and Yahr Score, Tinetti) and neuropsychological performance (CERAD Plus, Frontal Assessment Battery) were assessed, as well as behavioral and neuropsychiatric impairments (Frontal Behavioral Inventory, Neuropsychiatric Inventory), activities of daily living (ADL) and caregiver burden using the Caregiver Strain Index (CSI), in most patients also the Zarit Burden Interview (ZBI). Patients were followed up every 6 months for up to 2 years. Caregivers reported mild to moderate CB at baseline, which increased by 25-30% in 2 years and was significantly greater in PSP than in CBS. Risk for mental health problems increased over time, especially in female caregivers (depression). Important patient-related factors were apathy, aspontaneity, depression, irritability, disorganization, poor judgment, impairment of language, impairments in ADL, a high educational level of the patient and close family relationship. Behavioral symptoms and impaired ADL are the main patient-related factors of CB in PSP and CBS. CB can be severe and needs to be assessed repeatedly from the time of diagnosis to provide comprehensive support.

Caregiver burden in patients with behavioural variant frontotemporal dementia and non-fluent variant and semantic variant primary progressive aphasia.

Studies on caregiver burden in patients with frontotemporal lobar degeneration are rare, differ methodologically and show variable results. Single center longitudinal pilot study on caregiver burden and potential risk factors in patients with behavioural variant frontotemporal dementia (bvFTD) and semantic (svPPA) and non-fluent variants (nfvPPA) primary progressive aphasia. Forty-six bvFTD, nine svPPA, and six nfvPPA patients and caring relatives were analysed for up to 2 years using the Mini-Mental State Examination as global measure for cognitive performance, Frontal Assessment Battery (frontal lobe functions), Frontal Behavioural Inventory (personality and behaviour), Neuropsychiatric Inventory (dementia-related neuropsychiatric symptoms), Barthel Index and Lawton IADL Scale (basic and instrumental activities of daily living), the Caregiver Strain Index (CSI), and in most participants also the Zarit Burden Interview (ZBI). CSI baseline sum scores were highest in bvFTD (mean ± SD 5.5 ± 3.4, median 5, IQR 6), intermediate in svPPA (2.9 ± 2.3; 3; 3.5) and low in nfvPPA (1.6 ± 2.1; 1; 2). Similar differences of caregiver burden were found using the ZBI. During follow-up, CSI and ZBI sum scores deteriorated in svPPA, not in bvFTD and nfvPPA, and correlated significantly with personality and behaviour, neuropsychiatric symptoms, caregiver age, and instrumental, but not basic activities of daily living, Mini-Mental State Examination scores or frontal lobe functions. This study reveals differences in caregiver burden in variants of frontotemporal lobar degeneration. Caregivers should be systematically asked for caregiver burden from the time of the diagnosis to provide comprehensive support in time.

Design of Paper-Based Visual Analogue Scale Items.

Paper-based visual analogue scale (VAS) items were developed 100 years ago. Although they gained great popularity in clinical and medical research for assessing pain, they have been scarcely applied in other areas of psychological research for several decades. However, since the beginning of digitization, VAS have attracted growing interest among researchers for carrying out computerized and paper-based data assessments. In the present study, we investigated the research question "Which different design characteristics of paper-based VAS items are preferred by women and men?" Based on a sample of 115 participants (68 female), our results revealed that the respondents preferred a paper-based VAS item with a horizontal, 8-cm long, 3 DTP ("desktop publishing point") wide, black line, with flat line endpoints, and the ascending numerical anchors "0" and "10", both for women and men. Although we did not identify any gender difference in these characteristics, our findings uncovered clear preferences on how to design paper-based VAS items.

Risk Factor Analysis Affecting Sinus Membrane Perforation During Lateral Window Maxillary Sinus Elevation Surgery.

PURPOSE: To analyze risk factors affecting sinus membrane perforation (SMP) during sinus floor elevation (SFE) procedures using the lateral window technique (LWT). MATERIALS AND METHODS: For patients with SFEs using the LWT, patient-related risk factors (age/sex/smoking/diabetes) and surgical-anatomical-related risk factors (stage approach/sinus side/residual ridge height/sinus membrane thickness/previous surgical interventions) were compared between perforated and nonperforated sites and were evaluated for their influence affecting SMP. Additionally, SMPs were further subdivided into small/moderate (< 10 mm) or large (≥ 10 mm) in dimension, which were also analyzed for risk factors and consecutively for their influence on perforation. RESULTS: The study sample comprised 434 SFE procedures in 355 patients; 94/355 patients (26.5%) presented SMP in 103 of 434 SFE procedures (23.8%). SFE procedures with (n = 103) and without (n = 331) SMP did not differ for patient-related risk factors but differed significantly (P = .001) for surgical-anatomical factors as follows: residual ridge height (3.05 ± 1.35 mm vs 4.15 ± 1.46 mm), sinus membrane thickness (1.2 ± 0.5 mm vs 2.6 ± 1.1 mm), prevalence of staged procedures (78.6% vs 57.7%), presence of maxillary sinus septa (75.7% vs 14.2%), presence of thin (< 1.5 mm) mucosa biotype (62.1% vs 29%), and previous oral surgical interventions (37.9% vs 16.3%). In the multivariate analysis, significant associations of SMP were found with the presence of sinus septa (odds ratio [OR] = 31.992; P = .001), residual ridge height (OR = 1.563; P = .007), sinus membrane thickness (OR = 1.057; P = .001), presence of thin (< 1.5 mm) sinus biotype (OR = 8.883; P = .001), previous surgical interventions (OR = 4.689; P = .002), and smoking habits (OR = 2.238; P = .030). For inducing a large (≥ 10 mm) SMP, the presence of thin sinus membrane thickness/thin sinus membrane biotype (OR = 5.319; P = .006; OR = 22.222; P = .001) and reduced alveolar ridge height (OR = 0.629; P = .026) were assessed as being significant risk factors. CONCLUSION: In general, the presence of sinus septa, thin sinus mucosa, staged procedures, and previous surgical interventions are the main risk factors inducing SMP for SFE using the LWT. In particular, the presence of thin sinus membrane in conjunction with a staged procedure significantly increases the risk for a large SMP.

Implant health and factors affecting peri-implant marginal bone alteration for implants placed in staged maxillary sinus augmentation: A 5-year prospective study.

PURPOSE: Evaluating the extent of and the factors affecting marginal bone level (MBL) alterations and consecutively implant success and implant health for implants placed in staged maxillary sinus floor (SF) augmentation. MATERIALS AND METHODS: A 5-year prospective, cohort study was conducted on 85 patients with 124 maxillary sinus augmentation procedure and 295 implants placed. Peri-implant MBL alterations (reductions) were evaluated radiographically at the first year, third year, and fifth year postloading follow-ups and were considered to patient-related risk factors (age, gender, diabetes mellitus, smoking, rheumatic disorders, and history of periodontal disease [PD]), to clinican/surgically related risk factors (membrane perforations, sinus site, and residual ridge height), to implant/prosthesis-related features (implant length, diameter, location, keratinized gingiva, and restoration gap), and to the plaque score. Additionally, implant and prostheses survival/success rate and peri-implant health (mucositis/peri-implantitis) were assessed. RESULTS: About 267/295 implants (drop-out:n9 pat; 28 implants: 9%) were followed for 5 years (survival/success: 99.3%/96.5%), presenting significant (P < .001) differences of MBL alterations (-1.45 ± 0.38 mm) over time. The univariate analysis demonstrated differences of MBL alterations for smokers versus nonsmokers (P = .005), for patients with versus without history of PD (P = .001), and presence versus absence of plaque (P = .041). In the 5-year multivariate analysis, MBL alteration was influenced by time (P = .001) and was related to risk factors as smoking (P = .001; odds ratio [OR] = 6.563) and history of PD (P = .015; OR = 4.450). Significant ORs for MBL alterations were also found for a restoration gap used for a full-arch dentures (P = .001; OR = 8.275) associated with reduced (≤3 mm) residual ridge height (P = .015; OR = 1.365). The overall 5 year incidence of peri-implant mucositis and peri-implantitis was 25.3% and 3.7% at implant level and 30.3% and 6.6% at patient level, respectively. CONCLUSIONS: Apart from the high success rate and healthy status of implant placed in staged SF seen, MBL alteration increased over time and was negatively affected predominately by patient-specific risk factors such as smoking status and previous history of periodontitis.

Clinical Outcome of Implants Placed in Staged Maxillary Sinus Augmentation Using Bovine Bone Mineral Mixed with Autogenous Bone at Three Different Ratios: A 5-Year Prospective Follow-up Study.

PURPOSE: To evaluate the 5-year clinical outcomes for implants placed in a staged sinus floor elevation (SFE) procedure and to compare three patient groups with sinus grafts with three different ratios of bovine bone mineral (BBM) and autogenous bone (AB) mixture. MATERIALS AND METHODS: A 5-year prospective cohort study was conducted on 81 patients with 119 staged SFEs non-randomly distributed to three groups based on the origin of the AB and the mixture ratio with BBM: group 1 (locally harvested AB [LHB] from osteotomy sites + BBM, ratio: 1:10), 31 patients, 37 SFEs; group 2: (LHB + intraorally harvested peripheral AB [IHPB] from retromolar/chin region + BBM, ratio: 1:4), 22 patients, 29 SFEs; and group 3 (LHB + extraorally harvested peripheral AB [EHPB] from iliac crest/tibia + BBM, ratio 1:1), 28 patients, 53 SFEs. After graft healing (5 to 7 months), 284 dental implants (group 1: 76, group 2: 61, group 3: 147 [overall: 2.3 implants/sinus]) were placed. After an additional healing period (5 to 7 months), all implants placed were functionally loaded and prospectively followed by clinical and radiographic evaluations assessing implant survival/success rate as well as peri-implant marginal bone level (MBL) alteration at 1, 3, and 5 years postloading. RESULTS: A total of 76/81 patients with 267/284 implants were followed for up to 5 years (dropouts: 5 patients/15 implants; implant loss = 2). The 5-year implant survival and implant success rate (group 1: 100%/98.6%; group 2: 98.3%/96.6%; group 3: 99.3%/95.7%) did not differ between the three graft mixture groups. The peri-implant marginal bone alteration (reduction) averaged over all 5 years was 1.40 ± 0.29 mm for group 1, 1.41 ± 0.22 mm for group 2, and 1.46 ± 0.46 mm for group 3 (P = .187). However, over time, a continual and significant MBL reduction (P = .045) was noted for all groups presenting peri-implant MBL changes between 1 year and 5 years of -0.17 mm (group 1), -0.12 mm (group 2), and -0.24 mm (group 3), respectively. CONCLUSION: According to the clinical results obtained, dental implants inserted in grafted (staged) SFE using a mixture of BBM with a minimal amount of AB harvested from local sites provide for similarly high 5-year implant/augmentation success rates as graft mixtures with AB harvested from peripheral intraoral or extraoral donor sites, confirming no need for additional bone harvesting.

Changes in renal artery dimensions are associated with clinical response to radiofrequency renal denervation: a series of studies using quantitative angiography and intravascular ultrasound.

OBJECTIVE: Renal denervation (RDN) can cause focal (notches) and global (spasms) changes in renal artery dimensions. We quantified these changes and related them to renal norepinephrin tissue content in animals and to blood pressure (BP) changes in patients. METHODS: We measured renal artery dimensions pre-RDN and post-RDN, utilizing quantitative renal angiography (QRA) in a porcine model and in a retrospective patient cohort, and intravascular ultrasound (IVUS) in a prospective patient cohort. Focal and global measurements were minimum and mean diameter/area/volume with QRA, minimum lumen/vessel/wall area and volume with IVUS. BP was assessed with 24-h ambulatory monitoring, norepinephrin content with liquid chromatography. RESULTS: In 36 pigs treated unilaterally with RDN, norepinephrin content of the treated right kidney was 48.2% of the untreated left kidney. QRA measurements following RDN were associated with norepinephrin content only of the (treated) right kidney. In the human QRA study (n = 43 patients), mean 24-h BP fell by 8/4 and 12/6 mmHg at 1 and 12 months, respectively. More pronounced changes in QRA measurements were associated with a more pronounced BP drop. In multiple regression models, the change in minimum diameter was independently associated with BP changes at 12 months. In the prospective IVUS study (n = 17 patients), a larger decrease in minimum lumen/vessel area and larger increase of wall area/volume were associated with a larger BP drop. CONCLUSION: Focal and global changes in renal arteries following RDN can be quantified, using QRA or IVUS, and may serve as markers of a successful procedure.

Mandibular Full-Arch Fixed Prostheses Supported on 4 Implants with Either Axial Or Tilted Distal Implants: A 3-Year Prospective Study.

PURPOSE: This prospective study evaluated the clinical and radiographic outcome of distally cantilevered 4-implant-supported fixed mandibular prostheses (4-ISFMP) with distal implants either in axial or distally tilted direction. MATERIAL AND METHODS: Forty-one mandibulary edentulous patients received acrylic veneered 4-ISFMP with casted framework. Based on distal implant placement direction patients were assigned to 2 groups: 21 patients with four (2 anterior/2 posterior) axial implants (axial-group I) and 20 patients with 2 anterior axial/2 distal tilted implants (tilted-group II). Patients were prospectively followed for 3 years by annual examinations of implants and prosthetic survival rates including assessment for biological and mechanical complications. Additionally, peri-implant marginal bone resorption [MBR], pocket depth [PD], plaque index [PI], bleeding index [BI] and gingival index [GI], and calculus index [CI] were evaluated at each annual follow-up. RESULTS: 37/41 patients (19 axial-group I, 18 tilted-group II) and 148/164 implants were followed at the 1-, 2-, and 3-year evaluation (dropout rate: 11.8%) presenting no implant and denture loss (100% survival). The overall, MBR at year 1, 2, and 3 was 1.11 ± 0.4 mm, 1.26 ± 0.42 mm, and 1.40 ± 0.41 mm, respectively, representing a significant (p < .001) continuing time depending annual reduction. MBR and PD did not differ between anterior and posterior regions in both groups or for anterior and posterior regions between the groups. PI and CI were significantly (p < .001) higher for implants in anterior regions than for posterior regions in both groups. Moreover, posterior implant regions showed significantly (p < .001) higher PI and CI for axial-group I than for tilted-group II over time. Biological and mechanical complications as well as GI and BI did not differ between the groups over a 3-year follow-up period. CONCLUSION: For clinical implant and prosthesis outcome no statistical significant mean differences were noted for distally cantilevered 4-ISFMP supported by distal implants placed in tilted or axial direction.

MR arthrography of the hip with and without leg traction: Assessing the diagnostic performance in detection of ligamentum teres lesions with arthroscopic correlation.

OBJECTIVES: To retrospectively assess the diagnostic performance of hip MR arthrography with and without traction in detecting ligamentum teres (LT) lesions with arthroscopic correlation and to evaluate the effect of traction on the imaging appearance of the LT. METHODS: 73 MR arthrograms (73 consecutive patients, mean age, 34.5 years; range, 14-55 years) obtained without and with leg traction (application of 15-23 kg, use of a supporting plate for the contralateral leg) were included. Two blinded readers independently evaluated LT lesions on MR arthrograms on separate occasions: coronal images without traction; coronal images with traction; a multiplanar traction protocol. MR findings were correlated with arthroscopic records. Sensitivity/specificity of traction and non-traction imaging was compared on coronal images with the exact McNemar test. Imaging appearance of the LT with and without traction was assessed in consensus and compared on coronal images using McNemar and McNemar-Bowker tests. (p<0.05, * corrected for type I error). RESULTS: With arthroscopy 29 (40%) LT lesions were identified in 73 patients. Sensitivity was 72%/90% (without traction/with traction; p=0.25*), specificity was 89%/77% (p=0.25*) for reader 1 in assessing coronal images and for reader 2 sensitivity was 59%/86% (p=0.044*) and specificity was 93%/82% (p=0.25*). Alterations in fiber orientation, signal intensity, surface, dimension, fiber continuity after application of traction were observed in 33/73 (45%, p=0.002*), 6/73 (8%, p=0.223), 9/73 (12%, p=0.36*), 6/73 (8%, p=0.031) respectively 9/73 (12%, p=0.003) cases. Traction-related alterations in at least one criterion were observed in 41/73 (56%) cases. CONCLUSION: Application of traction can considerably alter the imaging appearance of the LT and resulted in higher rates of true-positive and false-positive findings compared to conventional MR arthrography.

Factors affecting peri-implant bone resorption in four Implant supported mandibular full-arch restorations: a 3-year prospective study.

BACKGROUND: Peri-implant marginal bone-level (MBL) alteration represents one of the parameters included in the criteria for determining implant health. OBJECTIVE: Factors affecting peri-implant MBL alteration for 4-implant-supported fixed mandibular prostheses (4-ISFMP) were assessed. MATERIAL & METHODS: A 3-year prospective, cohort study was conducted on 44 mandibularly edentulous patients treated with 4-ISFMP. Peri-implant MBL alteration was evaluated radiographically at the 12-, 24- and 36-month follow-ups considering to patient-related risk factors [age, gender, diabetes mellitus, smoking, cardiovascular disease (CVD), rheumatic disorders (RD)] and implant/prosthesis-related features (implant location, keratinized gingiva, denture cantilever length, prosthesis supporting zone, opposing dentition) as well as to peri-implant biological parameters (plaque-, bleeding-, calculus index). RESULTS: 148/176 implants (37 patients, drop-out: 15%) were followed for 3 years showing significant (p < 0.001) annual differences of MBL alterations over time. The univariate analysis demonstrated differences of MBL alterations for smokers (p = 0.014), for patients with CVD (p = 0.001) and RD (p = 0.011). In the 3-year multivariate analysis, MBL alteration was influenced by time (p < 0.001) and showed relationship with risk factors as smoking (p < 0.002; OR = 18.965), CVD (p < 0.021; OR = 5.172), RD (p < 0.006; OR = 50.171) and plaque-index (p = 0.034; OR = 3.252). CONCLUSIONS: Although peri-implant MBL alteration increased annually, significant odds ratios, were found for patients-related risk factors identifying them potentiating the alterations.

Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison.

OBJECTIVES: To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. METHODS: Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. RESULTS: No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. CONCLUSION: Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. KEY POINTS: • The used traction technique was well tolerated by most patients. • The used traction technique almost consistently achieved separation of cartilage layers. • Traction MR arthrography enabled accurate detection of chondral and labral lesions.

Improving visualization of the central compartment of the hip with direct MR arthrography under axial leg traction: a feasibility study.

RATIONALE AND OBJECTIVES: To evaluate the feasibility of a modified approach for direct magnetic resonance (MR) arthrography of the hip under leg traction in achieving a sufficient femoroacetabular interface and improving the visualization of the ligamentum teres. MATERIALS AND METHODS: Forty-six MR arthrograms of 44 patients who underwent MR arthrography with and without leg traction were included into the study. Traction approach included injection of 18-27 mL of fluid (local anesthetic, contrast agent), application of weight-adapted traction load (15-23 kg), and the use of a supporting plate. Patients were instructed to report on pain and complications with an integer pain scale. Joint distraction was measured on coronal images obtained with and without traction, and two radiologists independently evaluated whether femoroacetabular cartilage layers and the ligamentum teres could be seen as distinct entities. McNemar test was used and interobserver agreement was assessed. RESULTS: No patient asked for termination of the examination. There were no cases of neuropraxia. Mean difference in distraction was 3.7 mm/3.6 mm (reader 1/reader 2). Cartilage layers could be seen as distinct entities in 43/43 (93.5%/93.5%) and 6/8 (13%/17.4%) of the joints with/without traction (P < .001/P < .001), respectively. The ligamentum teres could be differentiated in 33/30 (71.7%/65.2%) cases with traction, in 33/30 (71.7%/65.2%) cases without traction (P < .999/P < .999), and in 40/37 (87%/80.4%) cases with both the techniques combined. CONCLUSIONS: Traction MR arthrography is safe and technically feasible. It enabled the differentiation between femoroacetabular cartilage layers in most cases. Visualization of the ligamentum teres was optimal by combining imaging with both modalities.

Medication adherence in patients with dementia: an Austrian cohort study.

Sustained treatment with effective doses of cholinesterase inhibitors or memantine is crucial to transfer treatment effects in dementia. Numerous studies, with often small samples sizes, describe low adherence rates. The purpose of current study was to examine the medical adherence of antidementia therapy in Austria. We analyzed the data of 10 Austrian Health Insurance Funds, including treatment-naive dementia patients. Study outcome measures were discontinuation, switching, number of days on therapy, Medication-Possession-Ratio, and compliance. A total of 15,809 patients (mean age: 79.9 y, female: 67.3%) met the study's inclusion criteria. After stratification by index medication there were 40.3% on donepezil (n=6371); 26.6% on rivastigmine (n=4206); 15.3% on galantamine (n=2424); and 17.8% on memantine (n=2808). After 6 and 12 months on therapy, 5376 (34.0%) and 9243 (58.5%) patients stopped the initially prescribed antidementia therapy; after 12 months the highest discontinuation rate was seen for patients taking rivastigmine (67.3%), whereas patients on memantine (45.0%) had the lowest. After 12 months, a total of 1874 (11.9%) patients switched from their index medication to another cholinesterase inhibitor or memantine. A total of 6163 patients (39.0%) were compliant (Medication-Possession-Ratio >80%) during the first 6 months and 5366 patients (33.9%) during 12 months of the study. Our study shows that memantine-treated patients adhere significantly better to treatment. Specifically, after 12 months, 45.0% discontinued medication, 7.9% switched, and 50.8% of patients on therapy were compliant.

Pregnancy-associated plasma protein-A as a marker for long-term mortality in patients with peripheral atherosclerosis: inconclusive findings from the Linz Peripheral Arterial Disease (LIPAD) study.

BACKGROUND: Pregnancy-associated plasma protein-A (PAPP-A) has been associated with peripheral artery disease (PAD). The aim of this study was to evaluate the utility of PAPP-A as a marker for long-term mortality in patients with atherosclerotic PAD. METHODS: PAPP-A serum concentrations were measured using an enzymatically amplified two-step sandwich-type immunoassay in 487 consecutive patients admitted to a tertiary care hospital with symptomatic PAD. The main outcome measure was all-cause mortality at 5 years. RESULTS: During follow-up, 114 patients died and 373 survived. The median PAPP-A concentration was higher among decedents compared with survivors (0.96 vs. 0.78 mU/L, p=0.024). The area under the receiver operating characteristic curve for the prediction of 5-year mortality by PAPP-A was 0.57 [95% confidence interval (CI), 0.53-0.61; p=0.026]. Survival probability was not significantly associated with PAPP-A concentrations using Kaplan-Meier curve analysis. However, univariate Cox proportional-hazards regression analysis revealed that PAPP-A was associated with 5-year mortality [risk ratio 1.25; 95% CI, 1.05-1.50; p=0.013 per one standard deviation (SD) increase in log transformed values]. In the multivariate model using a bootstrapping method, the predictive value of PAPP-A remained significant (risk ratio 1.31; 95% CI, 1.01-1.73; p=0.024 per 1 SD increase in log transformed values), even after adjustment for clinical confounders and other biomarkers, such as high-sensitivity C-reactive protein and amino terminal pro-B-type natriuretic peptide. CONCLUSIONS: In this study, PAPP-A was an independent predictor of 5-year all-cause mortality in patients with symptomatic PAD. However, based on the weak association between PAPP-A and outcome in our cohort, we consider PAPP-A measurements to not be useful in clinical practice for prognostic purposes in patients with PAD.