Cardiovascular manifestations secondary to COVID-19: A narrative review.

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.

Survival Rate of CAD-CAM Endocrowns Performed by Undergraduate Students.

OBJECTIVES: This study aimed to evaluate the success of computer-aided design-computer-aided manufacturing (CAD-CAM) endocrown restorations of endodontically treated teeth (ETT) performed by supervised undergraduate students. The study also intended to identify possible factors that may lead to failures. METHODS AND MATERIALS: This observational open cohort study was based on clinical data from endocrown restorations performed by residents and undergraduate students in their 4th, 5th, and 6th year from July 2011 to May 2018. The presence of a tooth with an endocrown on the arch was the main criteria used to calculate the survival rate of restored teeth. The quality of the remaining endocrowns was evaluated referring to the FDI criteria. The cases of failure were categorized into either favorable or unfavorable. RESULTS: A total of 343 ETT were restored with endocrowns in 315 patients. Among them, 199 patients encompassing 225 endocrowns were followed during a 56 ± 26 month period. The survival rate of restored teeth was found to be 81.8%, the estimated Kaplan-Meier survival rate being 71.8% at 9 years. Among the 41 failed cases, 32 were favorable (debonding and/or ceramic fractures) and 9 were unfavorable. CONCLUSION: Endocrown restorations of posterior ETT using CAD-CAM technologies could be carried out by undergraduates with a low risk of failure. Teacher supervision could be reinforced, covering all steps of each endocrown procedure in order to avoid failures due to insufficient thickness or loss of retention.

[COVID-19 and venous thromboembolism]. / COVID-19 et pathologie thromboembolique veineuse.

Coronavirus disease 2019 (COVID-19) is associated with an increased incidence of venous thromboembolism (VTE). Frequently asymptomatic, VTE has a negative impact on patients clinical course. On top of traditional VTE risk factors encountered during COVID-19 such as prolonged bed rest, hypoxemia and intravascular material, main features of patients with severe forms (old age, obesity) explain in part the VTE frequency. In addition, COVID-19 causes an endothelial disease following endotheliitis after the direct invasion of endothelial cells and a prothrombotic state secondary to the strong inflammatory response to infection. Altogether, these mechanisms lead to an extensive immunothrombosis within the pulmonary vasculature. VTE risk stratification to prescribe adequate anticoagulation is an imperious requirement in the COVID-19 treatment. So far, guidelines are mainly based on observational data. Randomized controlled clinical trials are ongoing and will allow to precise the anticoagulant regiment of patients hospitalized for COVID-19.

The influence of oral health on patients' food perception: a systematic review.

Oral food perception depends on somatosensory information that includes taste and can be modified by oral components and/or functions such as mastication. The purpose of this study was to describe the interplay between oral health, mastication and taste. A review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was conducted on 615 publications found by both PubMed and backward research. Thirty-one studies have been included. The results showed that the decline in taste ability observed during the healthy ageing process could be potentiated by the deterioration of oral health and poor oral hygiene. Prosthetic treatment could modify taste ability and oral food perception. A palatal covering with removable dentures can have an impact on taste perception which may depend on taste modality. During the mastication sequence, taste is apparently scattered throughout the oral cavity, probably through saliva. The deterioration of masticatory function modifies taste perception. Oral health and oral care should consider factors influencing patients' food perception and relations between taste and mastication. Therefore, dentists may modulate these factors to improve food perception and patients' eating pleasure and quality of life.

Stabilization of mandibular complete dentures by four mini implants: Impact on masticatory function.

OBJECTIVES: The frequent instability of mandibular removable complete dentures causes an alteration of mastication. An innovative therapeutic strategy involves placing four symphyseal mini implants. This study aimed at assessing the development of masticatory parameters and the impact on quality of life in subjects that underwent this procedure. METHODS: Eleven edentulous subjects (mean age 72±11 years) with unstable mandibular complete dentures were followed-up before (T0) and two - three months after (T1) mini implant setting. Physiological parameters (number of cycles, duration of sequence and frequency of mastication) during the mastication of food models and the bolus median particle size (d50) of carrot were evaluated at each time. Quality of life was assessed at T0 and T1 using the Global Oral Health Assessment Index (GOHAI). Parametric tests were used to test relationships between mastication, quality of life variations and mini implant setting, and to compare each parameter mean value at times T0 and T1. RESULTS: More subjects were able to chew carrot after setting the mini implants (8 subjects compared to 4 at T0). This improvement was accompanied by changes in kinematic parameters when chewing carrots, soft and hard model food, and by an improvement of their quality of life. However, the particle size values observed in the bolus remained higher than for normal dentate subjects (9.2±2.8mm). CONCLUSIONS: These results indicated that the placement of mini implants as retentive elements for mandibular full dentures had a positive impact on patients' masticatory function and quality of life. CLINICAL SIGNIFICANCE: The placement of mini implants has a positive impact on the masticatory function and oral health quality of life. The results suggest that this alternative procedure can be used as a treatment option for patients unable to receive conventional implants.

Clonal B cells in Waldenström's macroglobulinemia exhibit functional features of chronic active B-cell receptor signaling.

Waldenström's macroglobulinemia (WM) is a B-cell non-Hodgkin's lymphoma (B-NHL) characterized by immunoglobulin M (IgM) monoclonal gammopathy and the medullary expansion of clonal lymphoplasmacytic cells. Neoplastic transformation has been partially attributed to hyperactive MYD88 signaling, secondary to the MYD88 L265P mutation, occurring in the majority of WM patients. Nevertheless, the presence of chronic active B-cell receptor (BCR) signaling, a feature of multiple IgM+ B-NHL, remains a subject of speculation in WM. Here, we interrogated the BCR signaling capacity of primary WM cells by utilizing multiparametric phosphoflow cytometry and found heightened basal phosphorylation of BCR-related signaling proteins, and augmented phosphoresponses on surface IgM (sIgM) crosslinking, compared with normal B cells. In support of those findings we observed high sIgM expression and loss of phosphatase activity in WM cells, which could both lead to signaling potentiation in clonal cells. Finally, led by the high-signaling heterogeneity among WM samples, we generated patient-specific phosphosignatures, which subclassified patients into a 'high' and a 'healthy-like' signaling group, with the second corresponding to patients with a more indolent clinical phenotype. These findings support the presence of chronic active BCR signaling in WM while providing a link between differential BCR signaling utilization and distinct clinical WM subgroups.

Safety and effectiveness of the association ezetimibe-statin (E-S) versus high dose rosuvastatin after acute coronary syndrome: the SAFE-ES study.

BACKGROUND: Statin therapy is a cornerstone therapy for secondary prevention after acute coronary syndrome (ACS). However, the use of these drugs can be limited by side effects, mainly muscular pain. Ezetimibe is a newer lipid-lowering agent, with fewer side effects. AIMS: The present study was designed to compare a commercially available association of ezetimibe and simvastatin (E-S) to high dose Rosuvastatin on cholesterol and muscular enzyme levels and occurrence of muscular pain. METHODS: All consecutive ACS statin-naïve patients with LDL cholesterol (LDL-C)>100mg/dL randomly received either high dose statin (Rosuvastatin 20mg) or E-S 10/40-mg. All patients had one-month follow-up with biological testing and clinical examination. We compared the two groups on the biological efficiency and incidence of muscular pain. RESULTS: One hundred and twenty-eight patients were randomized; 64 received E-S and 64 Rosuvastatin. In the two groups, the lowering of LDL-C level (Δ=51%) at one month was significant (P<0.01) without any difference in the rate of lowering on LDL-C or HDL-C suggesting that E-S is as effective as high dose Rosuvastatin (P=0.77 and P=0.99). The rate of patients reaching the objective of LDL-C<100mg/dL (45%) and LDL-C<70mg/dL (51%) was not different in the two clusters (P=0.65). Incidence of muscular pain was 15% higher in patients treated with Rosuvastatin (P=0.01) without any difference on CPK level (P=0.6). CONCLUSION: Using an association of E-S in an effective alternative strategy to high dose Rosuvastatin with a lower incidence of muscular pain, which might impact adherence to medication after ACS.

Bounds and correlation approximation for the effective conductivity of heterogeneous plates.

The size effect obtained when studying the effective properties of plates is investigated by producing a third-order correlation approximation and Hashin-Shtrikman bounds for the effective in-plane conductivity of heterogeneous plates. The boundary condition of the plates is taken into account by obtaining the exact Green operator for the boundary problem. Results are obtained for a two-dimensional (2D) random distribution of disks and a 3D distribution of spheres. All results recover those obtained for an infinite medium when the heterogeneity size becomes small compared to plate thickness. They show that the size effect is more significant in the case of a 2D distribution of heterogeneities than for a 3D distribution.

Dynamics of frequency shifted feedback lasers: simulation studies.

The operation of an intracavity frequency shifted feedback (FSF) laser exhibits a remarkable range of properties, some of which have been described previously. Here we report a more complete analysis of the dependence of the output power upon pump-laser power, based on simulations with an extended rate equation model and the use of phase space analysis. The effect of FSF is discussed in detail. The simulation of the operation of a titanium-sapphire laser with FSF reveals five separate regimes of operation, a superset of those observed in experiment. We predict the thresholds for each of these regimes for FSF-lasers with titanium-sapphire or neodymium doped crystals as gain medium.

Laparoscopic vertical banded gastroplasty for morbid obesity. Assessment of efficacy.

BACKGROUND: The advantages of treating morbidly obese patients via the laparoscopic approach have been demonstrated, in particular, for adjustable silicone gastric banding, but this operation is associated with a high rate of late complications. Gastric bypass and malabsorbitive procedures are feasible via the laparoscopic approach, but they entail a prolonged operating time and a consistently high morbidity rate. Laparoscopic vertical banded gastroplasty represents an effective alternative. METHODS: We performed 250 consecutive LVBG between November 1995 and February 2000. The procedure consisted of a personal technique designed to reproduce, by laparoscopy, MacLean's modification of the standard open Mason vertical-banded gastroplasty, with a calibrated transgastric window, a complete division between the staple lines, and a 5-cm-circumference polypropylene collar. RESULTS: The operative time was 95 min and the conversion rate was 0.8%. Operative mortality was nil; early and late complications, respectively, were 4.4% and 4%; the reoperation rate was 2%. Global results at 4 years were as follows: excess weight loss (EWL) 61%, success rate (excess weight <50%) 76.9%, body mass index (BMI) 29.4 kg/m2. In morbidly obese patients, the EWL at 4 years was 62.2%, with a 77.4% success rate and a 28.4 kg/m2 BMI; in superobese patients, the EWL at 4 years was 54.9% with a 50% success rate and a 35.5 kg/m2 BMI. The overall follow-up rate was 92%. CONCLUSIONS: LVBG is an effective and safe operation in morbidly obese patients, providing good weight loss with a low morbidity rate, no mortality, and minimum discomfort. However, in superobese patients, the weight loss results are disappointing; in these patients, LVBG is questionable and more complex procedures should be considered.

Sequence dependent rigidity of single stranded DNA.

Single stranded DNA (ssDNA) equilibrium dynamics are investigated using a fluorophore/quencher-labeled hairpin structure which thermally fluctuates between open and closed states. Temporal correlations of the fluorescence fluctuations are used to determine the energy barrier to conformational change. We find that ssDNA distortion is purely entropic for poly(T) but requires an additional enthalpy of +0.5 kcal x mol(-1) x base(-1) for poly(A), consistent with the disruption of base stacking. Such sequence dependent dynamics challenge the classical model of ssDNA as a completely flexible coil.

Genetic and epigenetic changes in human epithelial cells immortalized by telomerase.

Exogenous expression of hTERT, the catalytic component of telomerase, is sufficient for the immortalization of human fibroblasts but insufficient for the immortalization of human foreskin keratinocytes (HFKs) and human mammary epithelial cells (HMECs). These latter cell types can overcome senescence by coexpression of hTERT and human papillomavirus (HPV) E7 or by expression of hTERT and loss of p16(INK4a) expression, indicating that the retinoblastoma (Rb) pathway, along with a telomere maintenance pathway, plays a role in determining the life span of epithelial cells. In this study, we further characterize hTERT-immortalized HFKs and human adenoid epithelial cells (HAKs) for genotypic and phenotypic alterations that are associated with immortalization. Of five hTERT-immortalized HFK and HAK cell lines examined, four exhibited repression of p16(INK4a) expression by promoter methylation or specific large-scale deletion of chromosome 9p, the location of p16(INK4a). Interestingly, one cell line exhibited complete down-regulation of expression of p14(ARF), with only slight down-regulation of expression of p16(INK4a). Yet, all of the immortal cells lines exhibited hyperphosphorylated Rb. Cytogenetic analysis revealed clonal chromosome aberrations in three of the five cell lines. All of the cell lines retained a growth block response with the expression of mutant ras. When grown on organotypic raft cultures, however, the hTERT-immortalized cells exhibited a maturation delay on terminal differentiation. Our results indicate that immortalization of epithelial cells may require both activation of telomerase and other genetic and/or epigenetic alterations that abrogate normal differentiation.

Thermodynamic basis of the enhanced specificity of structured DNA probes.

Molecular beacons are DNA probes that form a stem-and-loop structure and possess an internally quenched fluorophore. When they bind to complementary nucleic acids, they undergo a conformational transition that switches on their fluorescence. These probes recognize their targets with higher specificity than probes that cannot form a hairpin stem, and they easily discriminate targets that differ from one another by only a single nucleotide. Our results show that molecular beacons can exist in three different states: bound to a target, free in the form of a hairpin structure, and free in the form of a random coil. Thermodynamic analysis of the transitions between these states reveals that enhanced specificity is a general feature of conformationally constrained probes.

Kinetics of conformational fluctuations in DNA hairpin-loops.

The kinetics of DNA hairpin-loop fluctuations has been investigated by using a combination of fluorescence energy transfer and fluorescence correlation spectroscopy. We measure the chemical rates and the activation energies associated with the opening and the closing of the hairpin for different sizes and sequences of the loop and for various salt concentrations. The rate of unzipping of the hairpin stem is essentially independent of the characteristics of the loop, whereas the rate of closing varies greatly with the loop length and sequence. The closing rate scales with the loop length, with an exponent 2.6 +/- 0.3. The closing rate is increased at higher salt concentrations. For hairpin closing, a loop of adenosine repeats leads to smaller rates and higher activation energies than a loop with thymine repeats.

An analysis of meiotic pairing in trisomy 21 oocytes using fluorescent in situ hybridization.

We report the use of chromosome 21-specific painting probes to analyze early stages of oogenesis in nine trisomy 21 fetuses. The proportion of cells in zygotene and pachytene in the trisomic ovaries ranged from 8 to 70% with a mean of 42% +/- 19 while the comparable values of euploid specimens ranged from 34 to 90% with a mean of 65% +/- 19. The low proportion of pairing cells may be the basis for the ovarian dysgenesis observed in some trisomy infants. Five percent of trisomic pachytene cells exhibited complete asynapsis which is an order of magnitude higher than that observed in euploid cells. A large fraction of the asynaptic cells were atretic which is consistent with the hypothesis of meiotic pairing as a signal for atresia. In addition, the asynaptic cells exhibited asynapsis of chromosomes other than 21, which we interpret as an interchromosomal effect of trisomy 21.

Disease profile of colon and rectum carcinoma at Pelonomi Hospital, Bloemfontein.

A retrospective study evaluated all new cases of colorectal cancer which presented over a 7-year period at Pelonomi Hospital, Bloemfontein. The aim of the study was to compare patients younger than 40 years with the group older than 40 years. Most patients presented late, with advanced disease. A high proportion of patients were younger than 40 years (32.4%). No significant differences in sex ratio, tumour position, differentiation or stage of tumour were detected between the two groups. Of note was a high proportion (45%) of right-sided colon cancer in both groups. The younger patients did not have more advanced disease at presentation than the older group. Their prognosis, when matched stage for stage, was similar.

A multicenter study of doxazosin in the treatment of essential hypertension in France.

This study was designed to assess the efficacy and tolerance of doxazosin in patients with mild, moderate, or severe essential hypertension in a general practice setting. Ninety-six adults of a mean age of 55 1/2 years took part in the 14-week study, consisting of a placebo phase (2 weeks), a dose-adjustment phase with doxazosin (8 weeks), and a maintenance phase (4 weeks). Doxazosin, at a final mean daily dose of 3.4 mg, produced a significant (p less than 0.05) reduction in blood pressure at all points of measurement during the study. The mean change in sitting blood pressure at the end of treatment was -15.4/-15.8 mm Hg. Of the 85 patients who could be categorized as a success or failure, 78 (92%) were considered a therapeutic success; 78 (89%) of the 88 efficacy-evaluable patients demonstrated an improvement in the severity category of their hypertension. Treatment with doxazosin produced a reduction in serum cholesterol (-3.1%) and triglyceride (-3.8%) levels, although these changes did not attain statistical significance. The calculated probability of developing coronary heart disease in 10 years (according to the Framingham equation) was significantly (p less than 0.001) reduced by 22%, from 16.7 chances per 100 (baseline) to 14.3 chances per 100 (final visit). Twenty-six patients (27.1%) reported side effects that were possibly related to treatment, the most prevalent of which were vertigo (7.3%) and headache (6.3%). In four (4.2%) patients the dose of doxazosin was reduced and two (2.1%) were withdrawn prematurely. The investigator's assessments of tolerance was reduced and two (2.1%) were considered to be excellent or good in 85 (88%) patients.

Supercoiled loop organization of genomic DNA: a close relationship between loop domains, expression units, and replicon organization in rDNA from Xenopus laevis.

Analysis of the organization of a specific chromosomal gene, the gene for rRNA in Xenopus laevis, has evidenced a close relationship between loop organization, replication organization, and expression units. The nontranscribed spacer appears to be involved in all three levels of organization. Furthermore the replication origin region appears to be involved in nuclear matrix anchorage and is closely related to the 40 S transcription promoter. This organization suggests how expression domains may be regulated and how this functional organization may be transmitted to daughter cells after DNA replication, thus allowing selected expression patterns not to be lost during development.

Evaluation of antihypertensive efficacy of lisinopril compared to metoprolol in moderate to severe hypertension.

A double-blind controlled, randomized, parallel, multicenter 12-week study was conducted to compare the antihypertensive efficacy of lisinopril with that of metoprolol in treatment of moderate to severe hypertension. Initially, 118 patients were recruited on lisinopril and 61 on metoprolol; and for the purpose of efficacy analysis at week 8, 115 patients on lisinopril and 60 on metoprolol were included. The doses of lisinopril or metoprolol were 40-80 mg/day and 100-200 mg/day, respectively. At week 4, the pretreatment diastolic blood pressure of 111 mm Hg was decreased to 97 mm Hg (p less than 0.01) with lisinopril: metoprolol decreased the diastolic blood pressure from 110 to 99 mm Hg (p less than 0.01). Similar decreases were noted at week 8; however, the drop in blood pressure with lisinopril was not significantly different from that with metoprolol. Systolic blood pressure also demonstrated a decrease of about 18 mm Hg with lisinopril and 12 mm Hg with metoprolol (p less than 0.01). This larger decrease in systolic blood pressure with lisinopril was statistically significant at week 4 (p less than 0.05). These decreases in systolic blood pressures were maintained at week 8, again with statistical significance (p less than 0.01). Of the 118 lisinopril-treated patients, four were discontinued from lisinopril therapy because of headache, dizziness, rash, flushing, or lymphadenopathy. Four patients out of 61 (9.8%) were discontinued from metoprolol therapy because of fatigue, somnolence, asthenia, weight gain, flatulence, tremor, or bronchospasm. In conclusion, lisinopril 40-80 mg once daily is as effective as metoprolol 100-200 mg once daily in reducing diastolic blood pressure in patients with moderate to severe hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)