Clinical Outcomes of Periodontal Regenerative Therapy Using rhFGF-2 with a Modified Minimally Invasive Surgical Technique for Intrabony Defects: Case Series with a 12-Month Follow-up.

The Modified Minimally Invasive Surgical Technique (M-MIST) was designed to improve wound stability and reduce patient morbidity. This case series aimed to evaluate clinical outcomes of periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 with M-MIST for the treatment of intrabony defects. Following initial periodontal therapy, nine intrabony defects in seven patients received rhFGF-2 therapy. Using M-MIST, a buccal incision was made to gain access to the defect without interdental and lingual incisions. After debridement, rhFGF-2 was applied to the defect. Periodontal parameters were evaluated at baseline and at 3, 6, and 12 months postoperatively. Composite Outcome Measure (COM) and patient-reported outcome measure (PROM, recorded using an oral health-related quality of life [QoL] instrument) were also used for evaluation. At 12 months postoperative, mean probing depth reduction was 4.2 ± 0.8 mm and clinical attachment gain was 4.7 ± 0.7 mm. The mean value for gingival recession was -0.3 ± 0.5 mm. According to COM, the outcomes of the treated sites were successful. An improvement in oral health-related QoL was noted at 12 months compared to after the initial periodontal therapy. This case series shows that rhFGF-2 therapy with M-MIST yields favorable clinical outcomes in the treatment of intrabony defects.

Gender difference in heart failure with preserved ejection fraction: clinical profiles, examinations, and prognosis.

Heart failure with preserved ejection fraction (HFpEF) has currently become a major concern in the aging society owing to its substantial and growing prevalence. Recent investigations regarding sacubitril/valsartan have suggested that there is a gender difference in the efficacy of the medication in HFpEF cohort. However, information of gender difference in clinical profiles, examination, and prognosis have not been well investigated. The present study aimed to evaluate the differences in baseline characteristics and outcomes between women and men in a Japanese HFpEF cohort. We analyzed the data from our prospective, observational, and multicenter cohort study. Overall, 1036 consecutive patients hospitalized for acute decompensated heart failure were enrolled. We defined patients with an ejection fraction (EF) of ≥ 50% as HFpEF. Patients with severe valvular disease were excluded; the remaining 379 patients (women: n = 201, men: n = 178) were assessed. Women were older than men [median: 85 (79-89) years vs. 83 (75-87) years, p = 0.013]. Diabetes mellitus, hyperuricemia, and coronary artery disease were more prevalent in men than in women (34.8% vs. 23.9%, p = 0.019, 23.6% vs. 11.4%, p = 0.002, and 23.0% vs. 11.9%, p = 0.005, respectively). EF was not significantly different between women and men. The cumulative incidence of cardiovascular death or hospitalization for congestive heart failure (CHF) was significantly lower in women than in men (log-rank p = 0.040). Women with HFpEF were older and less often exhibited an ischemic etiology; further, they were associated with a lower risk for cardiovascular death or hospitalization for CHF compared with men in the Japanese population.

Comparison of prognostic impact of anticoagulants in heart failure patients with atrial fibrillation and renal dysfunction: direct oral anticoagulants versus vitamin K antagonists.

Although high thromboembolic risk was assumed in elderly patients with heart failure (HF) and atrial fibrillation (AF), inadequate control of prothrombin time/international normalized ratio was often observed in patients using vitamin K antagonists (VKAs). We hypothesized that patients treated with direct oral anticoagulants (DOAC) would have a better outcome than those treated with VKAs. The aim of this study was to compare the efficacies of DOACs and VKAs in elderly patients with HF and AF. We retrospectively analyzed data from a multicenter, prospective observational cohort study. A total of 1036 patients who were hospitalized for acute decompensated HF were enrolled. We assessed 329 patients aged > 65 years who had non-valvular AF and divided them into 2 groups according to the anticoagulant therapy they received. A subgroup analysis was performed using renal dysfunction based on estimated glomerular filtration rate (eGFR; mL/min/1.73 m2). The primary outcome was all-cause mortality, and the secondary outcomes were non-cardiovascular death or stroke. The median follow-up period was 730 days (range 334-1194 days). The primary outcome was observed in 84 patients; non-cardiovascular death, in 25 patients; and stroke, in 14 patients. The Kaplan-Meier analysis revealed that all-cause mortality was significantly lower in the DOAC group than in the VKA group (log-rank p = 0.033), whereas the incidence rates of non-cardiovascular death (log-rank p = 0.171) and stroke (log-rank p = 0.703) were not significantly different in the crude population. DOAC therapy was not associated with lower mortality in the crude population (log-rank p = 0.146) and in the eGFR ≥ 45 mL/min/1.73 m2 subgroup (log-rank p = 0.580). However, DOAC therapy was independently associated with lower mortality after adjustments for age, diabetes mellitus, and albumin level (hazard ratio, 0.55; 95% confidence interval, 0.30-0.99; p = 0.045) in the eGFR < 45 mL/min/1.73 m2 subgroup. Compared with VKA therapy, DOAC therapy was associated with lower risk of all-cause mortality in the elderly HF patients with AF and renal dysfunction.

Inflammation-based assessment for the risk stratification of mortality in patients with heart failure.

The Glasgow Prognostic Score (GPS) has been established as a useful resource to evaluate inflammation and malnutrition and predict prognosis in several cancers. However, its prognostic significance in patients with heart failure (HF) is not well established. To investigate the association between the GPS and mortality in patients with HF, we assessed 870 patients who were 20 years old and more and had been admitted for acute decompensated HF. The GPS ranged from 0 to 2 points as previously reported. Over the 18-month follow-up (follow-up rate, 83.9%), 143 patients died. Increasing GPS was associated with higher HF severity assessed by New York Heart Association functional class and B-type natriuretic peptide (BNP) levels. Kaplan-Meier analysis showed significant associations for mortality and increased GPS. In multivariate analysis, compared to the GPS 0 group, the GPS 2 group was associated with high mortality (hazard ratio 2.92, 95% confidence interval 1.77-4.81, p < 0.001) after adjustment for age, sex, blood pressure, HF history, HF severity, hemoglobin, renal function, sodium, BNP, left ventricular ejection fraction, and anti-HF medications. In conclusion, high GPS was significantly associated with worse prognosis in patients with HF. Inflammation-based assessment by the GPS may enable simple evaluation of HF severity and prognosis.

Body composition and mortality in patients undergoing endovascular treatment for peripheral artery disease.

An inverse correlation between body mass index and mortality in patients with peripheral artery disease (PAD) has been reported. However, little information is available regarding the impact of body composition on the clinical outcomes in patients with PAD. This study evaluated the relationships between the lean body mass index (LBMI), body fat % (BF%), and mortality and major amputation rate in patients with PAD. We evaluated 320 patients with PAD after endovascular treatment (EVT) enrolled from August 2015 to July 2016 and divided them into low and high LBMI and BF% groups based on their median values (17.47 kg/m2 and 22.07%, respectively). We assessed 3-year mortality and major amputation for the following patient groups: Low LBMI/Low BF%, Low LBMI/High BF%, High LBMI/Low BF%, and High LBMI/High BF%. During the median 3.1-year follow-up period, 70 (21.9%) patients died and 9 (2.9%) patients experienced major amputation. The survival rate was lower in the Low LBMI than in the High LBMI group, and was not significantly different between the Low and High BF% groups. Survival rates were lowest in the Low LBMI/Low BF% group (57.5%) and highest in the High LBMI/High BF% group (94.4%). There were no significant differences in major amputation rate between the Low LBMI and High LBMI groups, and between the Low BF% and High BF% groups. The Low LBMI and Low BF% groups were associated with an increased risk of mortality after adjustment for age, sex, frailty and conventional risk factors [hazard ratio (HR): 4.02; 95% confidence interval (CI) 2.10-7.70; p < 0.001 and HR: 4.48; 95% CI 1.58-12.68, p = 0.005, respectively], for age, sex, hemodialysis, and prior cerebral cardiovascular disease (HR: 3.63; 95% CI 1.93-6.82; p < 0.001 and HR: 4.03; 95% CI 1.43-11.42, p = 0.009, respectively) and for age, sex, and laboratory date (HR: 3.97; 95% CI 1.88-8.37; p < 0.001 and HR: 3.31; 95% CI 1.15-9.53, p = 0.026, respectively). In conclusion, Low LBMI and Low BF% were associated with poor prognosis in patients undergoing EVT for PAD, and mortality was the lowest in the High LBMI/High BF% group compared with other body composition groups.

Predictive Value of Abdominal Fat Distribution on Coronary Artery Disease Severity Stratified by Computed Tomography-Derived SYNTAX Score.

This study aimed to evaluate the association between abdominal fat distribution (AFD) and coronary artery disease (CAD) complexities using the computed tomography (CT)-derived SYNTAX score (CT-SXscore). Coronary computed tomographic angiography (CCTA) was performed in patients with suspected CAD. Plain abdominal CT was performed to measure visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas. To assess AFD, VAT/SAT (V/S) ratios were calculated. The CT-SXscore was calculated in patients with significant stenoses assessed by CCTA. Of 942 enrolled patients, 310 (32.9%) had 1 or more significant stenoses. The CT-SXscore showed a positive correlation with the V/S ratio (r = 0.33, p < 0.001). In the multivariate regression analysis, the V/S ratio was the only independent predictor for CAD severity based on the CT-SXscore (ß = 0.25; t = 4.14; p < 0.001), even though the absolute SAT and VAT areas showed no relationship to the CT-SXscore. Regarding the 4 CAD-patient groups divided according to their median VAT and SAT areas, the CT-SXscore was significantly higher for the high VAT/low SAT group than for any other group (19.6 ± 11.5 vs 13.3 ± 9.6 in the low VAT/low SAT, 10.1 ± 8.5 in the low VAT/high SAT, and 12.2 ± 8.7 in the high VAT/high SAT groups; p < 0.001 for all). In conclusion, it was found that the V/S ratio is a useful index for predicting CAD severity and that AFD may be a more important risk factor for CAD than the absolute amount of each abdominal fat.

Treatment of Chronic Periodontitis with Recombinant Human Fibroblast Growth Factor-2 and Deproteinized Bovine Bone Mineral in Wide Intrabony Defects:12-month Follow-up Case Series.

Clinical use of 0.3% recombinant human fibroblast growth factor (rhFGF)-2 for periodontal regeneration received formal approval in Japan in 2016. The combination of growth factor and bone graft material is used to enhance periodontal healing in regenerative therapy. The exact effects of combination therapy on periodontal healing remain unknown, however. Here, we report three cases of chronic periodontitis treated with the combination of rhFGF-2 and deproteinized bovine bone mineral (DBBM). Following initial periodontal therapy, periodontal regenerative therapy using rhFGF-2 in combination with DBBM was performed to treat wide intrabony defects. Periodontal parameters and radiographic bone fill were reevaluated at 3 months, 6 months, and 1 year postoperatively. Oral health-related quality of life (OHRQL) was assessed as a patient-reported measure of outcome. At 1 year postoperatively, probing pocket depth and clinical attachment level showed a significant improvement in comparison with at baseline. An improvement was also noted in radiographic evidence of bone fill and total OHRQL scores. Combination therapy yielded clinically favorable results in the present cases.

Determining Surface Terminations and Chirality of Noncentrosymmetric FeGe Thin Films via Scanning Tunneling Microscopy.

Scanning tunneling microscopy was used to study the surfaces of 20-100 nm thick FeGe films grown by molecular beam epitaxy. An average surface lattice constant of ∼6.8 Å, in agreement with the bulk value, was observed via scanning tunneling microscopy, low energy electron diffraction, and reflection high energy electron diffraction. Each of the four possible chemical terminations in the FeGe films were identified by comparing atomic-resolution images, showing distinct contrast with simulations from density functional theory calculations. A detailed study of the atomic layering order and registry across step edges allows us to uniquely determine the grain orientation and chirality in these noncentrosymmetric films.

Reimplantation of a Pacemaker into a Subpectoral Pocket Via the Lateral Approach in Collaboration with Plastic Surgeons.

An 86-year-old woman had a pacemaker implanted into a subfascial pocket. After four months, the generator became exposed, and the pacemaker was removed. She exhibited a lack of prepectoral tissue. We therefore performed reimplantation in collaboration with plastic surgeons. We placed the leads via the extrathoracic subclavian venous approach, and plastic surgeons created a subpectoral pocket from the low lateral side of the pectoralis major muscle. General cardiologists rarely create subpectoral pockets and they are unable to implant leadless pacemakers at their hospital due to lack of sufficient skill. Our case showed that creating a subpectoral pocket in collaboration with plastic surgeons is quick and safe.

Treatment of intrabony periodontal defects using rhFGF-2 in combination with deproteinized bovine bone mineral or rhFGF-2 alone: A 6-month randomized controlled trial.

AIM: To evaluate the use of recombinant human fibroblast growth factor (rhFGF)-2 in combination with deproteinized bovine bone mineral (DBBM) compared with rhFGF-2 alone, in the treatment of intrabony periodontal defects. MATERIALS AND METHODS: Patients with periodontitis who had received initial periodontal therapy and had intrabony defects of ≥ 3 mm in depth were enrolled. Sites were randomly assigned to receive a commercial formulation of 0.3% rhFGF-2 + DBBM (test) or rhFGF-2 alone (control). Clinical parameters and a patient-reported outcome measure (PROM) were evaluated at baseline and at 3 and 6 months postoperatively. RESULTS: Twenty-two sites in each group were evaluated. A significant improvement in clinical attachment level (CAL) from baseline was observed in both groups at 6 months postoperatively. CAL gain was 3.16 ± 1.45 mm in the test group and 2.77 ± 1.15 mm in the control group, showing no significant difference between groups. Radiographic bone fill was significantly greater in the test group (47.2%) than in the control group (29.3%). No significant difference in PROM between groups was observed. CONCLUSIONS: At 6 months, no significant difference in CAL gain or PROM between the two treatments was observed, although combination therapy yielded an enhanced radiographic outcome.

Single-center experience with percutaneous lead extraction of cardiac implantable electric devices.

BACKGROUND: The estimated incidence of infected cardiac implantable electric devices (CIED) has recently increased to 1-2% in Japan. Extraction of long-term implanted devices is generally difficult. There are few reports about lead extraction in Japan. We describe our experience with and outcomes of lead extraction using excimer lasers, mechanical sheaths, and manual extraction. METHODS: We retrospectively analyzed the characteristics, types of devices, and indications for extraction in 29 patients with 67 leads who required CIED lead extraction at Shinshu University Hospital between April 2014 and October 2016. Mean patient age was 71 years and 25 patients were male. The indications for device extraction were infections (n=25) and non-functioning leads (n=4). RESULTS: A total of 67 leads (active fixation lead, n=28; passive fixation lead, n=39) had been implanted for a median duration of 6.3±5.6 years. Extractions were performed using an excimer laser sheath (n=26), laser with mechanical sheath (n=7), only mechanical sheath (Cook Vascular Inc., Leechburg, PA, USA) (n=1), and manually (n=1). The procedure was successful in all patients. There were no major or minor complications during extraction. There was no recurrence of infection after infected device extraction. Two patients were implanted with subcutaneous implantable defibrillators after extraction of the implantable cardioverter defibrillator (ICD). CONCLUSIONS: CIED lead extraction, especially of those that are adherent to the subclavian vein, can be successfully performed in Japanese subjects using an excimer laser and mechanical sheath, without complications.

Periodontal regenerative therapy with enamel matrix derivative in the treatment of intrabony defects: a prospective 2-year study.

OBJECTIVE: To date, enamel matrix derivative (EMD) has been considered to be one of the few biomaterials for clinical use capable of demonstrating true periodontal regeneration. The aim of this two-center prospective clinical study was to evaluate 2-year outcome of periodontal regenerative therapy using EMD in the treatment of intrabony defects, performed as an 'advanced medical treatment' under the national healthcare system in Japan. RESULTS: Patients with chronic periodontitis who have completed initial periodontal therapy at either of the two dental school clinics were enrolled. Each contributed at least one intrabony defect of ≥3 mm in depth. During surgery, EMD was applied to the defect following debridement. Twenty-two participants (mean age 55.2 years old, 9 men and 13 women) completed 2-year reevaluation, and a total of 42 defects were subjected to data analysis. Mean gains in clinical attachment level (CAL) at 1 and 2 years were 2.9 mm (38% of baseline CAL) and 3.1 mm (41%), respectively, both showing a significant improvement from baseline. There was also a significant reduction in probing depth (PD): mean reductions at 1 and 2 years were 3.2 and 3.3 mm, respectively. There was a progressive improvement in the mean percentages of bone fill from 26% at 1 year to 36% at 2 years. No significant difference in CAL gain at 2 years was found between 3-wall bone defects and other defect types combined. In multiple regression analysis, the baseline PD was significantly associated with CAL gain at 2 years. In this population of patients, the treatment of intrabony defects with EMD yielded clinically favorable outcomes, as assessed by periodontal and radiographical parameters, over a period of 2 years.

Cardiac hyaluronan may be associated with the persistence of atrial fibrillation.

Hyaluronan (HA), a primary component of the extracellular matrix, is associated with several cardiovascular diseases. However, its precise cardiac origin and role in atrial fibrillation (AF) remain unclear. We investigated chamber-specific HA levels in patients with paroxysmal AF (PAF) or persistent AF (PSAF). The levels of HA, a diacron-reactive oxygen metabolite (dROM) as a marker for oxidative stress, at different cardiac sites, and peripheral brain natriuretic peptide (BNP) levels were measured in patients with PAF (n = 50) or PSAF (n = 35). HA levels in the coronary sinus (CS-HA) were significantly higher than those other sites, in both PAF and PSAF patients, and CS-HA levels were significantly higher in PSAF patients than in PAF patients [37.1 (interquartile range, 31.2-48.3) vs. 30.6 (23.7-40.2) pg/mL, P < 0.01]. CS-HA levels were correlated with CS-dROM levels and peripheral BNP levels in PSAF patients (r = 0.417, P = 0.03 and r = 0.579, P < 0.001, respectively), but not in PAF patients (r = -0.115, P = 0.421 and r = 0.048, P = 0.740, respectively). CS-HA levels were elevated in both PAF and PSAF patients and were correlated with cardiac oxidative stress and BNP levels in PSAF patients. Cardiac HA may be associated with the persistence of AF.

Clinical outcome of periodontal regenerative therapy using collagen membrane and deproteinized bovine bone mineral: a 2.5-year follow-up study.

BACKGROUND: This study aimed to evaluate, longitudinally, the outcome of periodontal regenerative therapy using a deproteinized bovine bone mineral (DBBM) in combination with a collagen barrier (CB) for the treatment of intrabony defects. RESULTS: Patients with chronic periodontitis who have completed initial periodontal therapy participated in this study. They had at least one 2- or 3-wall intrabony periodontal defect of ≥3 mm in depth. During surgery, defects were filled with DBBM and covered with CB. Ten patients completed 2.5-year reevaluation. At baseline, mean clinical attachment level (CAL) of the treated site was 8.0 mm and mean probing depth (PD) was 7.5 mm. Mean depth of intrabony component was 4.6 mm. Mean gains in CAL at 6 months and 2.5 years were 2.8 ± 1.0 and 1.4 ± 1.5 mm, respectively, both showing a significant improvement from baseline. CAL gains at 1 and 2.5 years were significantly reduced from that at 6 months. A significant improvement in PD was also noted: mean reductions in PD at 6 months and 2.5 years were 4.0 ± 0.8 and 3.2 ± 0.8 mm, respectively. CONCLUSIONS: The combination therapy using DBBM and CB yielded statistically significant effects such as CAL gain and PD reduction, up to 2.5 years in the treatment of intrabony defects. However, the trend for decrease in CAL gain over time calls for the need for careful maintenance care.

Periodontal Regenerative Therapy of Intrabony Defects Using Deproteinized Bovine Bone Mineral in Combination with Collagen Barrier Membrane: A Multicenter Prospective Case-Series Study.

This multicenter prospective case series study aimed to evaluate the outcome of periodontal regenerative therapy using a deproteinized bovine bone mineral (DBBM) in combination with a collagen barrier (CB) in the treatment of intrabony defects. A total of 36 nonsmoking patients with chronic periodontitis were recruited in five centers in Japan. All patients had at least one intrabony defect of ≥ 3 mm. The surgical procedures included access for debridement using a papilla preservation technique. Defects were filled with DBBM and covered with CB. Clinical evidence after 6 months supported the effectiveness of the combination therapy in the treatment of intrabony defects.

Failure of steroid withdrawal guided by 18F-FDG PET in a patient with cardiac sarcoidosis.

A 71-year-old man diagnosed with cardiac sarcoidosis (CS) 11 years previously underwent implantation of an implantable cardioverter defibrillator due to sustained ventricular tachycardia. Over past decade, his condition of CS did not progress on the maintenance steroid dose of 7.5 mg per day. We attempted to taper and discontinue steroids according to the results of fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET). On the basis of the results, we reduced the oral steroid dose slowly. In spite of no abnormal 18F-FDG uptake in the myocardium, advanced atrioventricular conduction block and deterioration of the ventricular pacing threshold occurred during the course of steroid withdrawal. Plasma brain natriuretic peptide (BNP) increased from 94 to 842 pg/ml. It was necessary to add new ventricular and atrial leads to synchronize atrial and ventricular contractions, and the pacing mode for bradycardia was changed to dual-chamber DDD-60 ppm. Fatigue disappeared, and BNP levels decreased to 147 pg/ml. 18F-FDG PET might have a limit to detect small scattered inflammatory foci. This case highlights the need for caution when reducing steroid doses in CS patients, guided by 18F-FDG PET only. .

Effect of poly (lactide-co-glycolide) (PLGA)-coated beta-tricalcium phosphate on the healing of rat calvarial bone defects: a comparative study with pure-phase beta-tricalcium phosphate.

OBJECTIVES: To investigate the effect of poly (lactide-co-glycolide) (PLGA)-coated ß-tricalcium phosphate (TCP) as a scaffold on bone regeneration in rat calvaria. MATERIAL AND METHODS: Bilateral critical-sized defects were created in the calvaria of 20 Sprague Dawley rats. Defects of each rat were filled with pure-phase ß-TCP or PLGA/ß-TCP, or left as unfilled control. The healing was evaluated by micro-computed tomography, histological, and immunohistochemical analyses. Tartrate-resistant acid phosphatase (TRAP) staining was also performed to assess the resorption activity. RESULTS: At 4 weeks, ingrowth of cells from the surrounding tissue into the ß-TCP and PLGA/ß-TCP biomaterials were observed in the defect area, and new bone formation had started. At 6 weeks, the value for defect closure in the ß-TCP group was significantly greater than that in the unfilled control (P < 0.01). A significantly greater level of new bone formation was found in the ß-TCP group (P < 0.01) and PLGA/ß-TCP group (P < 0.05) than that in the control group, while no significant difference was found between the ß-TCP and PLGA/ß-TCP groups. At both time points, the height of new tissue/biomaterial in the central third of the defect was significantly increased when the ß-TCP or PLGA/ß-TCP was used. Proliferating cell nuclear antigen -positive cells were observed around and inside the ß-TCP or PLGA/ß-TCP, and TRAP-positive cells were found at the surface of the biomaterials, suggesting that remodeling was occurring. CONCLUSION: The application of PLGA-coated ß-TCP could promote bone regeneration to similar extent as the ß-TCP biomaterial in this in vivo model.

Enhanced healing of surgical periodontal defects in rats following application of a self-assembling peptide nanofibre hydrogel.

AIM: The aim of this study was to investigate the effects of a self-assembling peptide (SAP) nanofibre hydrogel on healing of surgical periodontal defects in rats. MATERIALS AND METHODS: In vitro interactions between rat periodontal ligament (PDL) cells and SAP hydrogel (2.5% RADA16) were assessed by cell proliferation assays. In vivo, maxillary first molars of 45 Wistar rats were extracted and after healing, bilateral periodontal defects were surgically created mesially in second molars. Defects were treated with RADA16, Matrigel, or left unfilled. After 2 and 4 weeks, defect healing was evaluated by microcomputed tomography, histological and immunohistochemical analyses. RESULTS: Periodontal ligament cells grown on RADA16 showed an gradual increase in proliferation up to 72 h. At 4 weeks post surgery, the bone volume fraction and trabecular thickness of defect areas in the RADA16 group were significantly greater than those in other groups. Histologically, enhanced new bone formation was observed in the RADA16 group. At 4 weeks, PDL-like collagen bundles ran oblique to the root surface in the RADA16 group. Expression levels of PCNA-positive cells, vascular endothelial growth factor and osteopontin in the RADA16 group were significantly greater than those in other groups. CONCLUSIONS: Within the limitations of the study, application of the SAP hydrogel promoted healing of surgical periodontal defects by enhancing cell recruitment and possibly angiogenesis.

Characterization of cardiac oxidative stress levels in patients with atrial fibrillation.

Atrial fibrillation (AF) is associated with oxidative stress and elevated brain natriuretic peptide (BNP) levels. However, the exact cardiac origin of oxidative stress and its association with BNP levels in AF patients remain unclear. Therefore, we investigated the chamber-specific plasma oxidative stress levels in patients with paroxysmal AF (PAF) and persistent AF (PSAF). Diacron-reactive oxygen metabolite (dROM) levels were measured in patients with PAF (n = 50) and PSAF (n = 35) at different cardiac sites before ablation and in peripheral vein 3 months after ablation. For all sites, dROM levels were higher in PSAF patients than in PAF patients; the levels were the highest in the coronary sinus at 429.0 (interquartile range: 392.0-449.0) vs. 374.0 (357.0-397.8) Carratelli units (P < 0.05). dROM levels in the coronary sinus were related to the BNP levels (r = 0.436, P < 0.001). Furthermore, the reduction in the peripheral dROM levels was related to that in the peripheral BNP levels in patients with symptomatic improvement (r = 0.473, P < 0.001). Cardiac oxidative stress may either be a cause or consequence of prolonged AF, and cardiac oxidative stress levels correlated with BNP levels, though a possible source of oxidative stress in AF patients may be systemic circulation.