Body Composition and Metabolic Dysfunction Really Matter for the Achievement of Better Outcomes in High-Grade Serous Ovarian Cancer.

Although obesity-associated metabolic disorders have a negative impact on various cancers, such evidence remains controversial for ovarian cancer. Here, we aimed to evaluate the impact of body composition (BC) and metabolism disorders on outcomes in high-grade serous ovarian cancer (HGSOC). METHODS: We analyzed clinical/genomic data from two cohorts (PUC n = 123/TCGA-OV n = 415). BC was estimated using the measurement of adiposity/muscle mass by a CT scan. A list of 425 genes linked to obesity/lipid metabolism was used to cluster patients using non-negative matrix factorization. Differential expression, gene set enrichment analyses, and Ecotyper were performed. Survival curves and Cox-regression models were also built-up. RESULTS: We identified four BC types and two clusters that, unlike BMI, effectively correlate with survival. High adiposity and sarcopenia were associated with worse outcomes. We also found that recovery of a normal BC and drug interventions to correct metabolism disorders had a positive impact on outcomes. Additionally, we showed that immune-cell-depleted microenvironments predominate in HGSOC, which was more evident among the BC types and the obesity/lipid metabolism cluster with worse prognosis. CONCLUSIONS: We have demonstrated the relevance of BC and metabolism disorders as determinants of outcomes in HGSOC. We have shone a spotlight on the relevance of incorporating corrective measures addressing these disorders to obtain better results.

Tuberculosis burden in immigrants and natives, adults and children, in Tuscany between 2000-2018.

BACKGROUND: Updated data on epidemiology of tuberculosis are needed in Italy. The aim of this study is to evaluate trends in incidence and associated lethality of tuberculosis in immigrants compared with Italians. METHODS: All tuberculosis cases diagnosed from 2000 to 2018 in 31 Tuscan hospitals were retrospectively identified. RESULTS: In 10,827 tuberculosis cases 6715 were males (62%), 4312 (60%) were Italian-born. Hospitalization rate was 15.37/100,000 population/year. The most common comorbidity were liver disease (832/10,827; 7.7%), COPD (675/10,827; 6.2%), cancer (614/10,827; 5.7%). HIV was more frequent in the immigrants (p < 0.001). Extra-pulmonary tuberculosis cases (EPTB) were mainly localized in pleura (740/3,894, 19%) and lymph nodes (449/3,894, 11,5%). HIV was associated with an increased risk of EPTB (OR 3.51 95% CI 2.92-4.23, p < 0.0001). EPTB risk was increased in South Asian-born patients (OR 1.77, 95% CI 1.46-2.15, p < 0.0001) as well in African-born patients (OR 1.13, 95% CI 1.03-1.24, p = 0.0091), who were at risk for gastroenteric tuberculosis (OR 3.74, 95% CI 2.69-5.22, p < 0.0001). Overall mortality rate was 0.006 per 1000. Most of death cases (89%) were Italians (p < 0.02) and mainly affected by pulmonary tuberculosis (PTB). CONCLUSIONS: In Tuscany, tuberculosis is still a health concern in terms of both morbidity and mortality.

Sistema de evacuación seguro de neumoperitoneo y humo quirúrgico en cirugía laparoscópica mediante trampa de agua en tiempos de COVID-19 / Safe evacuation system for pneumoperitoneum and surgical smoke in laparoscopic surgery using a water trap in times of COVID-19

INTRODUCCIÓN: La reciente pandemia por SARS-CoV-2 (COVID-19) ha hecho resurgir preocupación sobre la exposición inadvertida del equipo quirúrgico a agentes infecciosos transmisibles por vía aérea durante el acto quirúrgico. El objetivo de este trabajo es describir la confección de un sistema de filtrado simple y de bajo costo que permite reducir el riesgo de exposición al virus, particularmente en el proceso de aspiración, recambio y remoción del neumoperitoneo en cirugía laparoscópica. MATERIALES Y MÉTODO: Se diseñó e implementó un circuito cerrado de evacuación y de filtrado del neumoperitoneo en cirugías ginecológicas laparoscópicas en un centro de salud terciario. El circuito incluye un filtro HEPA (High Efficiency Particulate Air) y una trampa de vacío que contiene una solución de inactivación en base a amonio cuaternario o hipoclorito de sodio. RESULTADOS: Desde su implementación se han realizado 17 cirugías laparoscópicas ginecológicas por diversas patologías. Dos de ellas fueron en pacientes Covid-19 (+). A la fecha no se han reportado contagios en el equipo médico que participó en la cirugía. CONCLUSIONES: Es posible implementar un sistema de evacuación del neumoperitoneo en cirugía laparoscópica presumiblemente eficaz en minimizar el riesgo de exposición al virus SARS-COV-2 (Covid-19). Su bajo costo lo hace especialmente recomendable en países en vías de desarrollo.

INTRODUCTION: The recent SARS-CoV-2 (COVID-19) pandemics has raised concern on the incidental exposition of health team to air transmissible infectious agents during surgeries. The main goal of this work is to communicate a simple and low-cost filtering system allowing to reduce the risk of contagion related to the virus, associated with pneumoperitoneum removal during surgical laparoscopy. METHODS: A closed circuit of gas removal and filtering was developed and implemented in laparoscopic gynecologic procedures at a tertiary teaching hospital. The circuit included an HEPA (High Efficiency Particulate Air) filter and a vacuum trap containing an inactivating solution based on quaternary ammonium or sodium hypochlorite. RESULTS: Since its introduction, seventeen laparoscopic surgeries have been carried out for different gynecologic pathologies. Two of them in Covid (+) cases. To date, no contagion has been reported among health teammates participating in these surgeries. CONCLUSIONS: It is possible to implement a pneumoperitoneum evacuation system in laparoscopic surgery presumably effective in minimizing the risk of exposure to the SARS-COV-2 virus (Covid-19). Its low cost makes it especially recommended in developing countries.

Increasing imported malaria in children and adults in Tuscany, Italy, (2000 to 2017): A retrospective analysis.

BACKGROUND: Updated data regarding the epidemiology of imported malaria in Italy are needed. The aim of this study is to evaluate trends in incidence and associated lethality of malaria episodes and to consider if there has been an increase in paediatric cases in the region of Tuscany. METHODS: All malaria cases diagnosed from 2000 to 2017 in 31 Tuscan hospitals were retrospectively identified. Epidemiological data regarding hospitalization rates and lethality for malaria in paediatric and adult population were described. RESULTS: Among the 1102 retrieved cases of malaria (134 children and 968 adults). Plasmodium falciparum was the most commonly reported species (67%). The overall hospitalization rate was of 1.69 cases per 100,000 population/year. Hospitalization rate in the total population decreased from 2000 to 2009 (p < 0.01) and increased from 2009 to 2017 (p < 0.01), similar trends were observed in adults and children. However, in 2010-2017, the cumulative child group incidence of 1.78 per 100,000 surpassed that of the adult group of 1.53 per 100,000 (p < 0.01). Fifteen deaths occurred, all of them in adults, giving a crude lethality rate of 1.36%. CONCLUSIONS: In Tuscany, malaria is still a health concern in terms of both morbidity and mortality. Educational actions and pre-travel advice must be promoted.

Hospitalization rates and outcome of invasive bacterial vaccine-preventable diseases in Tuscany: a historical cohort study of the 2000-2016 period.

BACKGROUND: Invasive bacterial diseases (IBD) are a serious cause of hospitalization, sequelae and mortality. Albeit a low incidence, an increase in cases due to H. influenzae was registered in the past 4 years and, in the Tuscany region, an excess of cases due to N. meningitidis since 2015 is alarming. The purpose of this study is to deepen the knowledge of IBD epidemiology in Tuscany with particular attention to temporal trends. METHODS: Tuscan residents hospitalized for IBD from January 1st 2000 to March 18th 2016 were selected from the regional hospital discharge database based on ICD-9-CM codes. Age-specific and standardized hospitalization rates were calculated together with case-fatality rates (CFRs). A time-trend analysis was performed; whereas, prognostic factors of death were investigated through univariable and multivariable analyses. RESULTS: The average standardized hospitalization rates for invasive meningococcal diseases (IMD), invasive pneumococcal diseases and invasive diseases due to H. influenzae from 2000 to 2016 were 0.6, 1.8, and 0.2 per 100,000, respectively. The average CFRs were 10.5%, 14.5% and 11.5% respectively with higher values in the elderly. Older age was significantly associated with higher risk of death from all IBD. A significant reduction in hospitalization rates for IMD was observed after meningococcal C conjugate vaccine introduction. The Annual Percentage Change (APC) was -13.5 (95% confidence interval (CI) -22.3; -3.5) in 2005-2013 but has risen since that period. Furthermore, a significant increasing trend of invasive diseases due to H. influenzae was observed from 2005 onwards in children 1-4 years old (APC 13.3; 95% CI 0; 28.3). CONCLUSIONS: This study confirms changes in the epidemiology of invasive diseases due to H. influenzae and IMD. Furthermore, attention is called to the prevention of IBD in the elderly because of the age group's significantly higher rate of hospitalizations and deaths for all types of IBD.

The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease.

OBJECTIVE: To evaluate the usefulness of endocervical curettage (ECC) during loop electrosurgical excision procedures (LEEPs) in predicting the risk of persistence/recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and informing clinical decision-making after LEEP. METHODS: The present retrospective study included women undergoing LEEP for CIN2+ at a teaching hospital in Chile between January 1, 2007, and December 31, 2014. Demographic, pathologic, and follow-up data were collected. Associations between predictors and treatment failure (persistent/recurrent disease) were examined; a Cox model was used to assess the effects of different variables on the failure rate. RESULTS: The analysis included 330 women with a mean follow-up of 29.4 months; 188 women underwent ECC at the time of LEEP. On multivariate analysis, a positive ECC was the only variable significantly associated with persistence/recurrence (P=0.001). In the Cox model, positive ECC (P=0.001) and positive margins (P=0.009) were independently associated with higher failure rates. When faced with positive ECC findings, clinicians tended to perform additional treatment instead of advising follow-up. CONCLUSION: Positive findings from ECC performed during LEEP were a better predictor of persistent/recurrent disease than margin status, after adjusting the individual variable effect in the Cox modelling. The performance of ECC is recommended during any LEEP performed for CIN2+; in particular, it should never be omitted if endocervical disease is suspected.

El método CONO-UC: un protocolo integrado de toma de decisión y manejo de lesiones pre-invasoras del cuello uterino útil para especialistas jóvenes / The CONO-UC method: an integrated protocol for decision-making and management of pre-invasive cervical lesions useful for young specialists

OBJETIVOS: En la actualidad, existe una alta tasa de sobre-tratamiento de lesiones precursoras cervicales, la cual, en su causalidad, depende de la inexperiencia del operador que toma las decisiones. El objetivo del presente trabajo fue desarrollar un método estandarizado de ponderación/juicio de variables diagnósticas y tratamiento útiles de ser usadas por especialistas jóvenes a fin de minimizar el riesgo de manejo inadecuado. MATERIALES Y MÉTODOS: Se incluyeron 471 pacientes referidos por citología anormal y tratados mediante asa de LEEP. Se calcularon la sensibilidad, la especificidad, los valores predictivos y las relaciones de probabilidad para el diagnóstico de NIE2+ para cada uno de los métodos de diagnóstico. A cada residente se le enseñó un protocolo estandarizado de tratamiento mediante asa. Una vez identificados los mejores predictores, se construyó una escala de puntaje que ponderaba las variables y se definió mediante curva ROC el major punto de corte para la predicción de NIE2+. Las diferencias entre los grupos se compararon mediante Chi-cuadrado, ANOVA o t-test. Se construyó curva de fallas mediante el método de 1-Kaplan Meier. RESULTADOS: La prevalencia de NIE2+ en esta cohorte fue 66%. La concordancia entre las pruebas diagnósticas fue baja, teniendo la colposcopia el peor valor predictivo positivo y el mayor riesgo de sobre-tratamiento. Para la escala de puntaje se incluyeron la edad, la citología, la colposcopia (estratificación basada en la extensión de compromiso por cuadrantes), la biopsia por mascada y la concordancia entre pruebas diagnósticas. Un puntaje≥ 9 asociado al uso de un protocolo estandarizado, obtuvo tasas de sobre-tratamiento <15%, de recurrencias de NIE2+ <5% a 5 años y una baja tasa de procedimientos sub-óptimos o con complicaciones (<2 %). CONCLUSIONES: El método CONO-UC al combinar un sistema de puntaje integrado (punto de corte) con un protocolo estandarizado de excisión, permite minimizar el riesgo de sobretratamiento o tratamiento inadecuado, por parte de especialistas jóvenes, de lesiones preinvasoras del cuello uterino, reduciendo además el número de procedimientos indicados innecesariamente y manteniendo una alta tasa de éxito terapéutico.

GOALS: Currently, there is a high rate of over-treatment of precursor cervical lesions, which, in their causality, depends on the inexperience of the decision-making operator. The objective of the present study was to develop a standardized method of weighting / judgment of diagnostic variables and treatment useful to be used by young specialists in order to minimize the risk of improper handling. MATERIAL AND METHODS: We included 471 patients referred by abnormal cytology and treated by LEEP. Sensitivity, specificity, predictive values and likelihood ratios for the diagnosis of CIN2+ were calculated for each of the diagnostic methods. Each resident was taught a standardized protocol to carry out a LEEP procedure. Once the best predictors were identified, a scoring scale was constructed that weighted the variables and the best cut-off point for the prediction of CIN2+ was defined by ROC curve. Differences between groups were compared using Chi-square, ANOVA or t-test. Failure curves were built up using the 1-Kaplan Meier method. RESULTS: The prevalence of CIN2+ in this cohort was 66%. The agreement between the diagnostic tests was low, with colposcopy having the worst positive predictive value and the highest risk of over-treatment. Age, cytology, colposcopy (stratification based on the extent of compromise by quadrants), punch biopsy, and agreement between diagnostic tests were included for building the scoring scale. A score ≥ 9 in association with the use of a standardized protocol obtained rates of over-treatment <15%, recurrences of CIN2+ <5% at 5-year follow-up and a low rate of suboptimal procedures or complications (<2%). CONCLUSIONS: The UC-CONE method, by combining an integrated scoring system with a standardized excision protocol, minimizes the risk of over-treatment or inadequate treatment of pre-invasive cervical lesions by young specialists, reducing the number of procedures indicated unnecessarily and maintaining a high rate of therapeutic success.

Sexual dimorphism in tuberculosis incidence: children cases compared to adult cases in Tuscany from 1997 to 2011.

BACKGROUND: In most countries, men seem to be more susceptible to tuberculosis (TB) than women, but only few studies have investigated the reasons of this gender incidence difference. The effect of sexual hormones on immunity is possible. METHODS: Data from children and adults, living in Tuscany, hospitalized for TB in all the thirty-one regional hospitals from January 1st 1997 to December 31st 2011, were analyzed using the International Classification of Disease, 9th Revision, Clinical Modification. RESULTS: During the study period, 10,744 patients were hospitalized with TB diagnosis, precisely 279 (2.6%) children [0-14 years], 205 (1.9%) adolescents [15-18 years] and 10,260 (95.5%) adults [≥ 18 years]. The male population ranged from 249 patients (51.4%) in children and adolescents, to 6,253 (60.9%) in adults. Pulmonary TB was the most common form both in children and adults. Men were more likely than women to have pulmonary TB after puberty, while no significant differences were found between males and females in the hospitalized children. The male gender also resulted the most affected for the extra-pulmonary disease sites, excluding the lymphatic system, during the reproductive age. CONCLUSIONS: Our findings suggest a possible role of sexual hormones in the development of TB. No significant male-female difference was found in TB incidence among children, while a sex ratio significantly different from 1:1 emerged among reproductive age classes. An increased incidence difference also persisted in older men, suggesting that male-biased risk factors could influence TB progression. Some limitations of the study are the sample size, the method of discharge diagnosis which could be deficient in accuracy in some cases, the increasing number of immigrants and the lack of possible individual risk factors (smoke and alcohol). Further studies are needed to investigate the possible hormone-driven immune mechanisms determining the sexual dimorphism in TB.

Pertussis is still common in a highly vaccinated infant population.

AIM: To provide epidemiological data on pertussis in a highly vaccinated paediatric population, focusing on the age of the infected children. METHODS: We analysed data from the regional hospital discharge database on children hospitalised for pertussis in Tuscany, Italy, from January 2000 to December 2012. RESULTS: A total of 279 cases were recorded. The majority of hospitalised children were infants (75.6%), who had the highest rate of complications (24.2%) of any age group and a crude mortality rate of 9.47 per 1000. The overall hospitalisation rate decreased significantly during the study period, from 4.23 to 2.82 per 100 000, but when we analysed the data by age groups, we found notable differences. Hospitalisation rates in the 1- to 4-year-old age group decreased significantly from 2.82 in the year 2000 to zero per 100 000 in 2012 and decreased significantly in the 5- to 9-year-old age group over the same period, from 6.58 to 0.63 per 100 000. Overall hospitalisation rates in the infant group remained high at 53.14 per 100 000, with three peaks due to periodic pertussis outbreaks. CONCLUSION: Pertussis is still a relevant health concern in infants who are unvaccinated or incompletely immunised, both in terms of morbidity and mortality.

Increasing incidence of tuberculosis in Tuscan youth, 1997 to 2011.

Data from 484 children (median age: 6 years; 46.5% immigrants) hospitalized for tuberculosis in 31 Tuscan hospitals in 1997-2011 were analyzed. Incidence increased from 7.3 (95% confidence interval: 4.9-9.4) to 12.5 (95% confidence interval: 9.6-15.4) per 100,000 (P=0.009). Increases were particularly profound in children<5 years of age, reaching 13.3 (95% confidence interval: 7.8-18.9; P<0.0001 for 2011 vs.1997) per 100,000. Pediatric tuberculosis is a major issue in Tuscany.

Evaluación prospectiva de la venografía mediante angioTC en el diagnóstico de enfermedad tromboembólica / Diagnostic yield of CT pulmonary angiography and venography for thromboembolic disease

Background: CT pulmonary angiography is the diagnostic procedure of choice for non-massive pulmonary embolism. Aim: To assess the diagnostic yield for thromboembolic disease of CT pulmonary angiography and venography using a 64- slice multidetector tomography. Material and Methods: Prospective study of patients with a clinical suspicion of thromboembolic disease, subjected to CT pulmonary angiography and venography. The presence and location of pulmonary thromboembolism, of isolated or concomitant deep venous thrombosis and of other significant radiological findings, were registered. Results: A 64-MDCT scanner was performed to 893 patients and thromboembolic disease was demonstrated in 240. Pulmonary thromboembolism was diagnosed in 218 patients. It was concomitant with deep venous thrombosis in 79 patients (36 percent) and isolated in the rest. Thirty fve of the 218 patients with pulmonary thromboembolism had radiological evidence of right ventricular overload. Twenty two patients (10 percent) had an isolated deep venous thrombosis. In 65 patients with pulmonary thromboembolism (30 percent) a possibly new or old malignant lesion, was observed. Seventy one of 653 patients without evidence of thromboembolic disease had potentially pathological findings on CT. Conclusions: The combined use of CT pulmonary arteriography and venography using a 64 MDCT scanner increases the diagnostic yield of the procedure for thromboembolic disease. It also allows the diagnosis of other related conditions, specially malignant tumors.

Pharmacological treatment of hip fractured patients in Italy: a simulation based on Tuscany regional database for the TARGET project.

BACKGROUND: Italy is the Country with the highest life expectancy in the world, and over 75,000 elderly people experience a hip fracture each year. OBJECTIVE: following the Tuscany TARGET protocol, we aimed to estimate the costs of pharmacological treatment in the hypothesis of treating all elderly Italian people with hip fractures. METHODS: we analyzed the Tuscany healthcare system databases at the beginning of the Tuscany TARGET project for the prevention of hip fractures in elderly patients, and the Italian national hospitalizations records and DRGs databases concerning hip fractures occurred between 2000 and 2005. RESULTS: costs sustained for pharmacological treatments effective in reducing the risk of subsequent hip fractures all over Italy would account for 17.5 million Euros, representing only 0.18% of the overall national pharmaceuticals expenditures, while the national healthcare service is currently spending more than 30% of the overall pharmaceuticals expenditures in providing cardiovascular-active drugs. CONCLUSIONS: The burden of hip fractures in the Italian elderly population is substantial and must be acknowledged as an important health problem. Specific preventive strategies, such as the Tuscany TARGET project should be implemented in all Italian regions.

[Diagnostic yield of CT pulmonary angiography and venography for thromboembolic disease]. / Evaluación prospectiva de la venografía mediante angioTC en el diagnóstico de enfermedad tromboembólica.

BACKGROUND: CT pulmonary angiography is the diagnostic procedure of choice for non-massive pulmonary embolism. AIM: To assess the diagnostic yield for thromboembolic disease of CT pulmonary angiography and venography using a 64-slice multidetector tomography. MATERIAL AND METHODS: Prospective study of patients with a clinical suspicion of thromboembolic disease, subjected to CT pulmonary angiography and venography. The presence and location of pulmonary thromboembolism, of isolated or concomitant deep venous thrombosis and of other significant radiological findings, were registered. RESULTS: A 64-MDCT scanner was performed to 893 patients and thromboembolic disease was demonstrated in 240. Pulmonary thromboembolism was diagnosed in 218 patients. It was concomitant with deep venous thrombosis in 79 patients (36%) and isolated in the rest. Thirty five of the 218 patients with pulmonary thromboembolism had radiological evidence of right ventricular overload. Twenty two patients (10%) had an isolated deep venous thrombosis. In 65 patients with pulmonary thromboembolism (30%) a possibly new or old malignant lesion, was observed. Seventy one of 653 patients without evidence of thromboembolic disease had potentially pathological findings on CT. CONCLUSIONS: The combined use of CT pulmonary arteriography and venography using a 64 MDCT scanner increases the diagnostic yield of the procedure for thromboembolic disease. It also allows the diagnosis of other related conditions, specially malignant tumors.

[Thrombophilia risk factors evaluation in a group of Italian patients with deep venous thrombosis]. / Valutazione del rischio trombofilico in una coorte di pazienti con trombosi venosa profonda.

UNLABELLED: Venous thrombosis usually results from coexistence of multiple genetic and acquired risk factors with a trigger condition. In this study the authors report their experience in a cohort of Italian patients with previous venous thrombosis. MATERIAL AND METHODS: We considered 292 consecutive patients. Each patient was studied by using a panel of functional and genetic tests to detect some of the most relevant thrombophilia risk factors. RESULTS: The single most frequent thrombophilia risk factor was activated C protein resistance due to FV Leiden. Tests for anti phospholipids auto antibodies showed reactivity in 62 subjects. CONCLUSION: The great majority (80%) of patients showed almost one thrombophilia risk factor. Presence of multiple risk factors was demonstrated in 128 (44%) patients.

What is the role of serology for the study of chronic hepatitis B virus infection in the age of molecular biology?

To assess quantitative serology in chronic hepatitis B virus (HBV) infection, testing by novel immunoassays has been carried out on 202 specimens from untreated patients and in 83 samples from 10 patients with chronic hepatitis B treated with lamivudine. Serum samples were assayed for quantitative HBsAg, in comparison with quantitative HBV-DNA, and for anti-HBc IgM and the avidity index (AI) of total anti-HBc antibodies. The AI was high (mean: 0.93 +/- 0.19) in all groups, confirming the consistency of this procedure in chronic HBV infections. A low-level positivity (2-28 Paul-Ehrlich units/ml) for IgM anti-HBc was detectable both in HBeAg-positive and in HBeAg-negative untreated chronic hepatitis cases (mean S/CO values by the Abbott Architect assay: 0.51 +/- 0.12 and 0.48 +/- 0.10, respectively; correlation between assays: r = 0.685), while treated patients (mean: 0.20 +/- 0.15) and inactive carriers (mean: 0.17 +/- 0.21), were generally negative for IgM. The levels of HBsAg (IU/ml) showed a weak correlation with HBV-DNA (IU/ml). A difference in HBsAg levels was found between inactive carriers (1,935 +/- 2,887 IU/ml) and chronic hepatitis B cases, either treated (5,199 +/- 9,259 IU/ml) or untreated (14,596 +/- 15,227 IU/ml). Pre-treatment levels of HBsAg in patients undergoing lamivudine treatment were correlated with a sustained response to therapy over 13-33 months (mean: 27.3) of follow-up: mean HBsAg values were 1,576 + 1,487 IU/ml in five responders and 6,063 + 5,142 in five nonresponders or breakthrough responders (P < 0.05). The availability of standardized quantitative immunoassays for HBsAg and anti-HBc IgM may be considered in addition to quantitative HBV-DNA in the staging and monitoring of chronic HBV infection.

Modulation of clinical expression of plaque-induced gingivitis. II. Identification of "high-responder" and "low-responder" subjects.

AIM: The aims of this study were to validate a randomized, split-mouth, localized experimental gingivitis model and to identify subjects with different gingivitis susceptibility. MATERIAL AND METHODS: In each of 96 healthy subjects, one maxillary quadrant was randomly assigned as "test" (experimental gingivitis) and the contralateral quadrant as "control". Plaque index (PlI), gingival index (GI), gingival crevicular fluid volume (GCF), and angulated bleeding score (AngBS) were recorded in both quadrants at days 0, 7, 14, and 21. Cumulative plaque exposure (CPE), i.e. PlI over time, was calculated. Day-21 GCF was standardized according to CPE, and residuals of GCF on CPE were calculated. Two subpopulations were then defined, based on upper and lower quartiles of GCF-residual distribution and were, respectively, identified as "high-responder" (HR; n=24) and "low-responder" (LR; n=24). RESULTS: At test quadrants, all parameters significantly increased throughout the trial, while in control quadrants, PlI, GI, and AngBS remained low. Significant differences were noted between test and control quadrants on days 7, 14, and 21 for all parameters. Significant increases in GI, AngBS, and GCF were observed in test quadrants over the course of the study in both HR and LR groups. Significant differences were noted between HR and LR groups for all gingivitis parameters on day 21 in test quadrants, without any significant differences in PlI or CPE between the groups. CONCLUSIONS: We identified two subpopulations characterized by significant differences in clinical parameters of plaque-induced gingival inflammation, despite similar amounts of plaque deposits and plaque accumulation rates.

Modulation of clinical expression of plaque-induced gingivitis. III. Response of "high responders" and "low responders" to therapy.

AIM: The aim of the present study was to characterize the subject-based clinical behavior of the gingiva in response to a tooth-cleaning regimen in two subpopulations, "high-responder" (HR) and "low-responder" (LR) groups, presenting a different inflammatory response to plaque accumulation. MATERIAL AND METHODS: The study population comprised of 96 systemically and periodontally healthy subjects, 46 males and 50 females, non-smokers, enrolled in an experimental gingivitis trial. At completion of the experimental gingivitis period (day 21), all subjects were prescribed the same 21-day treatment regimen of amine/stannous fluoride (AmF/SnF(2))-containing toothpaste and mouthrinse. Plaque index (PlI), gingival index (GI), gingival crevicular fluid volume (GCF), and angulated bleeding score (AngBS) were recorded on three selected teeth. Treatment efficacy was evaluated in the overall population as well as in HR and LR groups, separately. RESULTS: A statistically significant decrease of PlI was observed after treatment (p<0.001), with PlI reversing to baseline levels. Changes in PlI revealed the same trend in both HR and LR groups, without differences between groups. Treatment also resulted in a significant decrease of all gingivitis parameters (p<0.001 for all comparisons). After treatment, GI, AngBS, and GCF were comparable with baseline condition. However, when the two groups were compared, day 42-GCF was significantly higher in the HR group than the LR group. CONCLUSIONS: A treatment regimen based on mechanical plaque control supplemented with AmF/SnF(2)-containing toothpaste and mouthrinse is effective in reducing plaque accumulation and re-establishing healthy gingival conditions after experimentally induced gingivitis, even in subjects with different inflammatory response to plaque accumulation.