Safety and efficacy of nivolumab therapy in patients with metastatic renal cell carcinoma and impaired kidney function.

INTRODUCTION: Patients with renal insufficiency, usually defined as those with creatinine clearance < 40 mL/min, were excluded from pivotal clinical trials, especially in studies involving nivolumab therapy in patients with renal cell carcinoma (RCC). The aim of the study is to evaluate the efficacy and safety of nivolumab in patients with metastatic RCC (mRCC) stratified according to creatinine clearance. MATERIAL AND METHODS: Data from mRCC patients treated with nivolumab were retrospectively analyzed. Patients were classified into two categories according to their estimated glomerular filtration rate (eGFR); the first category (C1) included patients with eGFR < 40 mL/min/1.73 m2 and the second category (C2) included those with eGFR ≥ 40 mL/min/1.73 m2. RESULTS: Of the 95 patients enrolled, 1. group included 26 patients (27.4%) and 2. group included 69 patients (72.6%). None of the pts in category 1 were on hemodialysis. Overall incidence of adverse events was not statistically different between the two groups (P = .469). The overall response rate ORR was 50% in the first group and 42.0% in the second group (P = .486). Median overall survival (OS) was longer with 23.3 months in the 2. group versus 11 months in the 1. group (P = .415). CONCLUSION: Renal insufficiency is a common problem in patients with advanced renal cancer since they often undergo nephrectomy and their renal function may also worsen while receiving tyrosine kinase inhibitor therapy. We found that there is no significant difference in the safety and efficacy of nivolumab treatment between two groups. Nivolumab appears to be a safe and effective agent in patients with renal impairment.

Mask-Associated Dry Eye (MADE) in healthcare professionals working at COVID-19 pandemic clinics.

Background: Healthcare professionals working at COVID-19 pandemic clinics have to work with masks during long hours. After the widespread use of masks in the community, many mask-related side effects were reported to clinics. The increase in the number of applicants with dry eye symptoms due to mask use in ophthalmology clinics has led to the emergence of the concept of mask-associated dry eye (MADE). We think that it would be valuable to evaluate ocular surface tests with a comparative study using healthcare professionals working in pandemic clinics, which we think is the right study group to examine the effects of long-term mask use. Aims: We aimed to evaluate the mask-associated dry eye (MADE) symptoms and findings in healthcare professionals who have to work prolonged time with face masks in coronavirus disease 2019 (COVID-19) pandemic clinics. Patients and Methods: In this prospective, observational comparative clinical study, healthcare professionals who use the mask for a long time and work in COVID-19 pandemic clinics were compared with an age and sex-matched control group consisting of short-term masks users, from April 2021 to November 2021. All participants underwent the Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (T-BUT), Oxford staining score, Schirmer's test I, and meibography with infrared transillumination. Results: The long-term mask user group consisted of 64 people, while the short-term mask user group consisted of 66 people (260 eyes, total). The OSDI score and Schirmer I measurement were not statistically different between the two groups. T-BUT was statistically significantly shorter in the long-term group (P: 0.008); lid parallel-conjunctival fold, Oxford staining score, and upper and lower lid meibography score were found to be significantly higher in the long-term group (P < 0.001, P: 0.004, P: 0.049, P: 0.044, respectively). Conclusion: Healthcare professionals with longer mask-wearing times are at greater risk of ocular surface damage. It may be considered to prevent this damage by blocking airflow to the ocular surface, such as by wearing a face mask properly or fitting it over the nose with surgical tape. Those who have to work with a mask for a long time during the COVID-19 pandemic should keep in mind the ophthalmology follow-up for eye comfort and ocular surface health.

Comparison of post-mortem vitreous fluid and blood glucose levels in diabetes-induced rabbit models.

Background: Diabetes is a common systemic disease in the world. Acute complications of diabetes may cause sudden unexpected deaths. Analysis done in vitreous fluid which is more protected and less contaminated by bacteria comparing to blood will produce more accurate results. Aim: Thus, we aimed to diagnose diabetes by comparing glucose levels of post mortem blood and vitreous fluid in death cases. Materials and Methods: A total of 17 New Zealand-type rabbits were divided into hyperglycemia (8), hypoglycemia (8), and control group (1). Rabbits were monitored for 5 days after experimental diabetes induction, and samples were taken at the point of death. Later rabbits were left in their environment, and samples were taken again at the post mortem first day. Mean blood glucose levels of hyperglycemia and hypoglycemia group were in diabetic range. Results: Blood glucose levels of hyperglycemic rabbits were measured as 512 ± 52,1 mg/dl, while vitreous glucose levels were 518,3 ± 76,8 mg/dl at the point of death. After one day, levels were measured as 433,9 ± 59,3 mg/dl and 329,8 ± 86,6 mg/dl. Blood glucose levels of hypoglycemic rabbits were measured as 39 ± 3,8 mg/dl, while vitreous glucose levels were 53,4 ± 13,9 mg/dl at the point of death. After one day, levels were measured as 36 ± 4,2 mg/dl and 1,6 ± 0,6 mg/dl. After analysis, there was a statistically significant difference between day 0 and 1 vitreous levels of hypoglycemia group. Conclusion: It can be clearly seen that vitreous fluid samples should be taken in judicial cases with sudden unexpected deaths like diabetes. This will contribute to identification cause of death.

[Status and recommendations for interventional radiological procedures in COVID-19 patients]. / Status und Empfehlungen zur interventionell-radiologischen Versorgung bei COVID-19-PatientInnen.

BACKGROUND: Particularly at the beginning, the COVID-19 (coronavirus disease 2019) pandemic caused a reduction in the number of interventions in interventional radiology. At the same time, interventional training became more challenging. Infectious patients and disease transmission within interventional radiology departments continue to pose significant challenges. OBJECTIVES: This article describes the status and recommendations for interventional radiological procedures in COVID-19 patients. MATERIALS AND METHODS: Guidelines and recommendations from international and national societies as well as original works and reviews were evaluated. RESULTS: Interventional radiological care of COVID-19 patients with complicated courses of infection has become established during the course of the pandemic. To protect patients and staff, interventions in COVID-19 patients should be prioritized, performed in separate procedure rooms if possible, and patients should be tested before interventions. Logistics, staff planning, and hygiene measures should be continuously optimized. CONCLUSIONS: Structured workflows within interventional radiology in dealing with COVID-19 patients appear necessary to minimize infection risks and to guarantee the staff's work capability and health. In order to develop concepts for the handling of COVID-19 patients and to be prepared for potential upcoming waves of infections, recommendations of the Robert Koch Institute (RKI) and (inter-)national professional societies are helpful.

Treatment of Proximal Posterior Inferior Cerebellar Artery Aneurysms by Intrasaccular Flow Disruption: A Multicenter Experience.

BACKGROUND AND PURPOSE: Treatment of PICA aneurysms can be technically challenging by either surgical or endovascular means. Our aim was to report our preliminary experience with intrasaccular flow disruption using the Woven EndoBridge (WEB) for the treatment of proximal PICA aneurysms. MATERIALS AND METHODS: Sixteen PICA aneurysms treated with the WEB at 3 institutions were retrospectively reviewed. Baseline patient and aneurysm characteristics, procedural specifics, clinical outcomes, and angiographic results were evaluated. RESULTS: All aneurysms were located at the proximal, anteromedullary segment of the PICA. Seven aneurysms were ruptured. The median aneurysm size was 3.9 mm (range, 2-12 mm), and all aneurysms were wide-neck. WEB deployment failed in 1 case due to WEB protrusion in a small PICA aneurysm. Additional stent implantation was required for 2 aneurysms to improve intra-aneurysmal WEB positioning. One patient developed a partial posterior cerebral artery territory infarction with transient hemianopsia. Intraoperative rerupture of a ruptured aneurysm could be immediately stopped by WEB deployment due to intrasaccular stasis; however, it might have contributed to a slight disability of the patient. At last angiographic follow-up, 12/15 aneurysms (80%) were completely occluded and 3/15 (20%) had a neck remnant. CONCLUSIONS: The preliminary results indicate that WEB treatment of proximal PICA aneurysms is feasible with a reasonable safety and efficacy profile. The advantages of intrasaccular flow disruption include preservation of the PICA, durable aneurysm occlusion, and omission of antiplatelet therapy. The low-profile WEB 17 delivery system might enable navigation to distal PICA aneurysms, which needs to be addressed further.

Effects of mastoid and middle-ear volume on graft success and hearing outcomes in paediatric tympanoplasty.

OBJECTIVE: To examine the effects of mastoid and middle-ear volume on the anatomical and functional success of type 1 tympanoplasty in paediatric patients. METHODS: This study included 45 paediatric patients who underwent type 1 cartilage tympanoplasty. Patients' demographic data, pre- and post-operative audiological evaluation results, and post-operative graft status were evaluated. Middle-ear and mastoid cavity volumes were calculated (in cubic centimetres) using temporal bone high-resolution computed tomography. Middle-ear and mastoid cavity volume values were compared between patients with and without post-operative anatomical and functional success. RESULTS: Anatomical success was achieved in 82.2 per cent of patients (n = 37), and functional success in 68.9 per cent (n = 31). When anatomical success and failure groups were compared, a statistically significant difference was found in mean mastoid volume (p = 0.037), while there was no significant difference in relation to mean middle-ear volume (p = 0.827). The comparison of functional success and failure groups revealed no significant difference in mean mastoid volume (p = 0.492) or middle-ear volume (p = 0.941). CONCLUSION: The study showed that mastoid pneumatisation volume affects surgical success in paediatric tympanoplasty.

True first-pass effect in basilar artery occlusions: First-pass complete reperfusion improves clinical outcome in stroke thrombectomy patients.

BACKGROUND: Complete reperfusion (mTICI 3) in anterior circulation ischemic stroke patients after a single mechanical thrombectomy (MT) pass has been identified as a predictor of favorable outcome (modified Rankin Score 0-2) and defined as true first-pass effect recently. This effect has not yet been demonstrated in posterior circulation ischemic stroke. We hypothesized a true first-pass effect for the subgroup of acute basilar artery occlusions (BAO). METHODS: Consecutive patients with acute thromboembolic occlusions in the posterior circulation, treated between 2010 and 2017, were screened and all BAO patients with complete angiographic reperfusion and known symptom onset included for unmatched and matched analysis after adjustment for multiple confounding factors (demographics, time intervals, stroke severity, posterior circulation Alberta Stroke Program early computed tomography Score and comorbidity. The primary objective was outcome at 90 days between matched cohorts of single pass vs. multi pass complete reperfusion patients. RESULTS: 90 MTs in BAO were analyzed, yielding 56 patients with known symptom onset, in whom we achieved complete reperfusion (mTICI 3), depending on whether complete reperfusion was achieved after a single pass (n = 28) or multiple passes (n = 28). Multivariable analysis of 56 non-matched patients revealed a significant association between first-pass complete reperfusion and favorable outcome (p < 0.01). In matched cohorts (n = 7 vs. n = 7), favorable outcome was only seen if complete reperfusion was achieved after a single pass (86% vs. 0%). CONCLUSION: Single pass complete reperfusion in acute basilar artery occlusion is an independent predictor of favorable outcome. Achieving complete reperfusion after multiple passes might impair favorable patient recovery.

[Brain metastases-Interdisciplinary approach towards a personalized treatment]. / Hirnmetastasen ­ interdisziplinär zu einer personalisierten Behandlung.

The incidence, treatment and prognosis of patients with brain metastases have substantially changed during the last decades. While the survival time after diagnosis of cerebral metastases was on average a maximum of 3-6 months only 10 years ago, the survival time could be significantly improved due to novel surgical, radiotherapeutic and systemic treatment modalities. Only a few years ago, the occurrence of brain metastases led to a withdrawal from systemic oncological treatment and the exclusion of drug therapy studies and to a purely palliatively oriented treatment in the sense of whole brain radiation therapy (WBRT) with or without surgery. The increasing availability of targeted and immunomodulatory drugs as well as adapted radio-oncological procedures enable increasingly more personalized treatment approaches. The aim of this review article is to demonstrate the progress and complexity of the treatment of brain metastases in the context of modern comprehensive interdisciplinary concepts.

Effect of Aging on Surface Roughness and Color Stability of a Novel Alkasite in Comparison with Current Direct Restorative Materials.

AIM: To compare the surface roughness and color stability of a novel alkasite with current direct restorative materials with and without an aging step. METHODS AND MATERIALS: Twenty-six specimens of each of the following materials were prepared: alkasite, ormocer, giomer, high-viscosity glass ionomer, glass carbomer, and nanohybrid composite (control). Half of the specimens in each group were stained, the other half of the specimens were aged and then stained. Color and surface roughness evaluations were conducted at baseline, after aging and after staining, using a dental spectrophotometer, and a three-dimentional (3D) noncontact optical profilometer, respectively. Statistical analyses were completed using one-way analysis of variance, post hoc Tukey test, and paired samples t-test. RESULTS: At baseline and after aging, the surface of alkasite was found to be rougher than nanohybrid composite and ormocer surfaces (p<0.05). However, in terms of roughness increase caused by aging, ormocer, nanohybrid composite, and alkasite were affected in a similar way (p>0.05). In terms of color stability, alkasite was more colored than nanohybrid composite and ormocer (p<0.05), and performed similar to giomer (p>0.05). CONCLUSIONS: The surface roughness and color stability characteristics of alkasite material was between composite resins and glass ionomer-based materials after aging.

The impact of propranolol on apoptosis in cutaneous squamous cell carcinomas.

OBJECTIVES: Cutaneous squamous cell carcinoma (cSCC) is a common cancer in Caucasian populations. Treatments registered for high-risk cSCC are still undetermined. Experimental data have demonstrated possibly useful effects of a combined application of beta­blockers in cancer therapy. The goal of this study was to examine the efficacy of propranolol in the treatment of cSCC and its impact on apoptosis. Thus, we aimed to investigate the apoptotic pathway protein levels and activity in beta­blocker­treated cSCC cells. MATERIALS AND METHODS: The study was performed on human cSCC cancer cell line culture. One of the cSCC cell lines was treated with propranolol, whereas no treatment was given to the other group. Then, the levels of apoptotic pathway proteins were determined by ELISA test in both groups. RESULTS: The propranolol treatment group exhibited a remarkable difference as compared with the other group. It was found that propranolol treatment enhanced the activity of caspase-3 while the expression of bax, wee1, gadd153, grp78 and AIF decreased bcl-2 which is antiapoptotic protein in cSCC cell lines. CONCLUSION: Our results suggest that propranolol treatment has anti-cancer properties with an effect on various apoptotic pathways in cSCC. These data are important because propronalol may be involved in future cSCC treatment (Tab. 1, Fig. 3, Ref. 22).

Subclinical atherosclerosis and impaired cardiac autonomic control in pediatric patients with Vitamin B12 deficiency.

OBJECTIVE: Homocysteine (Hcy) is an independent risk factor for predisposing to atherosclerosis and endothelial dysfunction. Hcy levels increase with Vitamin B12 deficiency. The aim of this study was to investigate the association between carotid intima-media thickness (CIMT) and the autonomic modulation of heart rate variability (HRV) in early detection of atherosclerosis and impaired cardiac autonomic control in pediatric patients with Vitamin B12 deficiency. MATERIALS AND METHODS: Sixty patients with Vitamin B12 deficiency (14.4 ± 1.72 years, 36 female) and 40, age, sex, and body mass index-matched healthy controls (13.4 ± 1.86 years, 24 female) had performed 24-h Holter monitoring, carotid ultrasonography, and echocardiography. Linear regression models assessed associations between to HRV parameters and CIMT and the blood markers. RESULTS: We defined Vitamin B12 deficiency as a serum level, 200 pg/mL. Hcy (P < 0.001) and CIMT (P < 0.001) levels were significantly higher in the patient group compared with the control group. Hcy level was found to be the most important independent variable affecting CIMT. Each 1 degree increase in Hcy, it was observed that the CIMT value increased by 0.01 mm (B = 0.01; t = -2.39; P < 0.05). Low-frequency power (LF), high-frequency power (HF) (P < 0.001), and the square root of the mean of the squared differences of two consecutive RR intervals (rMSSd) (P = 0.04) were significantly lower in the B12 deficient patients. Furthermore, Hcy level was found to be the most important independent variable affecting LF, HF, and rMSSd. CONCLUSIONS: Subclinical atherosclerosis was associated with cardiovascular autonomic imbalance in pediatric patients with Vitamin B12 deficiency. Homocysteinemia may be an important marker for the prediction of future cardiovascular disease.

Influence of visual information on consent for invasive procedures in intensive care unit.

OBJECTIVE: Patients hospitalized in Intensive Care Units (ICU) are critically ill. Sometimes informed consent for invasive procedures cannot be obtained from patients or relatives due to insufficient information. METHODOLOGY: Relatives of the patients who were being hospitalized in ICUs of state hospitals in 3 provinces in Eastern part of Turkey during year 2015, who were planned to undergo central venous catheter insertion, tracheostomy, and percutaneous gastroenterostomy (PGE) were asked to sign consent forms and these relatives were included in the study. The study groups were allocated as verbal (VeIG) and verbal-visual information groups (ViIG). The next of kin who had the right for signing was included in the study. RESULTS: Relatives of patients were interviewed for 512 invasive procedures. For the central venous catheterization, 91.6% of the VeIG (n = 166) and 97.6% of the ViIG (n = 166) accepted the central venous catheterization interventions (n = 332), for the tracheostomy, 65.3% of the VeIG (n = 49), 85.4% of the ViIG (n = 48) accepted the tracheostomy interventions (n = 97), and for the PGE, 23.8% of the VeIG (n = 42) and 48.8% of the ViIG (n = 41) accepted the PGE interventions (n = 83). A statistically significant difference was detected between VeIG and ViIG with regard to approval and refusal rates for different interventions. When approval-refusal rates were compared with regard to education level, statistically significant difference was not detected between VeIG and ViIG with regard to approval and refusal rates. CONCLUSIONS: Using visual materials such as video in addition to verbal information provided an improvement in consent ratios regardless of education levels.

Effects of artificial tear treatment on corneal epithelial thickness and corneal topography findings in dry eye patients.

PURPOSE: To investigate the effects of artificial tear treatment on central corneal epithelial thickness, and central, mid-peripheral and peripheral corneal thicknesses in patients with dry eye disease (DED). MATERIAL-METHODS: Patients with DED underwent ocular examinations, including Schirmer-2 test, slit lamp examination for tear break-up time (BUT), corneal topography (CT) for measuring mean central, mid-peripheral and peripheral corneal thickness values and anterior segment optic coherence tomography (AS-OCT) for obtaining central corneal epithelial thickness. After artificial tear treatment (carboxymethylcellulose and sodium hyaluronate formulations) for one month, patients were examined again at a second visit and the results were compared. RESULTS: Sixty-one eyes of 33 female dry eye patients (mean age: 38.3±5.7 years) were enrolled. The mean follow-up time was 36.4±3.3 days. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment (P=0.000, P=0.000, respectively). Central corneal epithelium and mean mid-peripheral corneal thicknesses measured significantly higher after treatment (P=0.001, P=0.02). Changes in central and peripheral corneal thicknesses were not statistically significant. CONCLUSION: Artificial tear treatment in dry eye patients seems to increase central corneal epithelial and mid-peripheral corneal thicknesses. Measurement of corneal epithelial thickness can be a useful tool for evaluation of treatment response in dry eye patients. Further long-term prospective studies are needed to investigate this item.

Clinical performance of a combined approach for the esthetic management of fluorosed teeth: Three-year results.

OBJECTIVE: The long-term clinical performance of combined therapy including enamel microabrasion and vital bleaching is debatable due to the abrasion of outer enamel surface. The aim of this longitudinal cohort study was to evaluate the 3-year clinical performance of enamel microabrasion in combination with vital tooth bleaching for the esthetic management of fluorosed teeth. MATERIALS AND METHODS: Fifteen patients with 176 fluorosed incisors and canines were included in this study. All the teeth were treated with enamel microabrasion (Opalustre, Ultradent), and at-home bleaching technique (10% Opalescence PF, Ultradent). Fluorosed teeth were evaluated at baseline, after microabrasion, after combined therapy, and at 3-year follow-up in terms of esthetic criteria (esthetic appearance, brown stains, and opaque white areas), side effects, and patient satisfaction using visual analog scales. The data were statistically analyzed (α = 0.05). RESULTS: Fluorosed teeth revealed significantly better esthetic appearance after microabrasion and combined therapy and at 3-year follow-up compared to those at baseline (P P Conclusions: The combined therapy was effective in the esthetic management of fluorosed teeth. However, a significant relapse was observed in the esthetic appearance and brown stains of these patients after 3 years, which also reduced patient satisfaction.

Neoadjuvant chemotherapy or chemoradiation for patients with advanced adenocarcinoma of the oesophagus? A propensity score-matched study.

BACKGROUND: Multimodal therapies are the standard of care for advanced adenocarcinomas of the oesophagus and gastro-oesophageal junction (AEG Types I and II). Only three randomised trials have compared preoperative chemotherapy with and without radiation. The results showed a small benefit for combined chemoradiation. In the meantime, newer therapy protocols are available. AIM: In a propensity-score matched study, we analysed patients with locally advanced AEG type I or II, treated with chemotherapy (FLOT-protocol) or chemoradiation (CROSS-protocol), followed by oesophagectomy, in a single high-volume centre. PATIENTS AND METHODS: Between 2011 and 2015, 137 patients with advanced (cT3NxcM0) adenocarcinoma received pre-operative therapy; 70% had chemoradiation (CROSS-protocol) and 30% had chemotherapy (FLOT-protocol). After propensity-score matching, 40 patients from the CROSS-group were selected for analysis. Postoperative histopathological response and prognosis were analysed. RESULTS: The two groups were comparable according to the matching criteria age, gender, tumour location, and year of surgery. R0-resection was achieved in 97% of patients in the CROSS-group and 85% of the FLOT-group (p = 0.049). Major response of the primary tumour was evident more often in the CROSS-group (17/40 pts. 43%) versus FLOT-group (11/40 pts. 27%) as well no lymph node metastasis (ypN0 = 68% versus ypN0 = 40%) (p = 0.014). Prognosis were not significantly different between the two groups. In multivariate analysis, only ypN-category was an independent prognostic factor. CONCLUSION: Compared to FLOT-chemotherapy, neoadjuvant chemoradiotherapy with the CROSS-protocol in locally advanced adenocarcinoma AEG types I and II resulted in better response by the primary tumour and less lymph node metastasis but without superior survival.

Influence of blood contamination during multimode adhesive application on the microtensile bond strength to dentin.

OBJECTIVES: The present study evaluated the effects of blood contamination performed at different steps of bonding on the microtensile bond strength (µTBS) of multimode adhesives to dentin when using the self-etch approach. MATERIALS AND METHODS: Seventy-five molars were randomly assigned to three adhesive groups comprising 25 specimens each: two multimode adhesives [Single Bond Universal (SBU) and All-Bond Universal (ABU)] and a conventional one-step self-etch adhesive [Clearfil S3 Bond Plus (CSBP)]. Each group was subdivided as follows: (1) uncontaminated (control): bonding application/light curing as a positive control; (2) contamination-1 (cont-1): bonding application/light curing/blood contamination/dry as a negative control; (3) contamination-2 (cont-2): bonding application/light curing/blood contamination/rinse/dry; (4) contamination-3 (cont-3): bonding application/blood contamination/dry/bonding re-application/light curing; and (5) contamination-4 (cont-4): bonding application/blood contamination/rinse/dry/bonding re-application/light curing. Dentin specimens were prepared for µTBS testing after the composite resin application. Data were analyzed with two-way ANOVA and post-hoc tests (α = 0.05). RESULTS: µTBS values were similar in cont-3 groups, and ABU/cont-4 and corresponding control groups, but were significantly lower in the other groups than in their control groups (P < 0.05). Cont-1 groups showed the lowest µTBS values (P < 0.05). CONCLUSIONS: Neither decontamination method prevented the decrease in µTBS when contamination occurred after light curing. Drying the blood contaminants and reapplying the adhesive may regain the dentin adhesion when contamination occurs before light curing. Alternatively, rinsing and drying contaminants followed by adhesive re-application may be effective depending on adhesive type.

Can N-terminal pro B-type natriuretic peptide, neutrophil-to-lymphocyte ratio, C-reactive protein help to predict short and long term mortality?

BACKGROUND: There is limited data about ICU, short and long-term mortality prediction of severe CAP with neutrophil-to-lymphocyte ratio (NLR): N-terminal proB- type natriuretic peptide (NT-proBNP): C-reactive protein (CRP). AIM: Besides the known severity indexes of ICU, can NLR, NT-proBNP, CRP predict ICU, short and long term mortality? METHODS: A retrospective cohort study was carried out in a level III ICU of a tertiary training hospital for chest diseases and thoracic surgery. RESULTS: Over the study period, a total of 143 patients were enrolled in the study. The APACHE II scoring showed a significantly higher predicting performance for ICU mortality (p = 0.002). The performance for predicting short term mortality NLR (p = 0.039) and long term mortality NTproBNP (p = 0.002) had a significantly higher performance. The survival analysis revealed that mortality was significantly higher in patients with CURB65 score ≥ 4 (p = 0.047). CONCLUSION: NLR, NTproBNP > 2000pg/mL can be used to predict pneumonia severity in ICU alike CURB65 and PSI. Higher NLR, APACHE II and atrial fibrillation can cause an important mortality factor in long term. Consequently, clinicians should take an attention for good cardiac evaluation and cardiac follow-up of patients with CAP (Tab. 4, Fig. 3, Ref. 36).

Efficacy of a casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste in preventing white spot lesions in patients with fixed orthodontic appliances: A prospective clinical trial.

AIM: The aim of this prospective study was to test the efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste applied in-office to prevent white spot lesions (WSL) in patients undergoing fixed orthodontic treatment. MATERIALS AND METHODS: Study design: this study was designed as a randomised controlled clinical trial. Fifty-seven patients undergoing nonextraction fixed orthodontic treatment were enrolled and divided randomly into two groups (control n = 28, experimental n = 29). The pretreatment plaque, gingival and bleeding indices, and oral hygiene habits were recorded. One group received CPP-ACP paste (GC Tooth Mousse) at each monthly orthodontic follow-up examination; the control group received routine orthodontic treatment. The mean patient age was 16.9 years in the experimental group and 17.1 years in the control group. The periodontal indices, decayed, missing, and filled teeth (DMFT), decayed, missing, and filled surfaces (DMFS), and the WSL prevalence pre- and post-treatment were measured and compared between the groups. STATISTICS: differences between groups in normally distributed data between groups were assessed by the paired-t test, and the Wilcoxon Signed Rank test was used to compare variables that were not normally distributed. RESULTS: There was a lower incidence of WSL in the experimental group compared to the control group. Most of the WSL occurred at the maxillary incisors, mandibular canines and premolars. CONCLUSION: The in-office application of CPP-ACP paste did not prevent WSL development completely; however, it did significantly decrease the number of WSL compared to the control patients.