Transitioning from Da Vinci Si to Xi: assessing surgical outcomes at a high-volume robotic center.

PURPOSE: In the emerging field of robotics, only few studies investigated the transition between different robotic platforms in terms of surgical outcomes. We aimed at assessing surgical outcomes of patients receiving robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN) at a high-volume robotic center during the transition from Si to Xi Da Vinci surgical systems. METHODS: We analyzed data of 1884 patients undergoing RARP (n = 1437, 76%) and RAPN (n = 447, 24%) at OLV hospital (Aalst, Belgium) between 2011 and 2021. For both procedures, we assessed operative time, estimated blood loss, length of stay, and positive surgical margins. For RARP, we investigated length of catheterization and PSA persistence after surgery, whereas warm ischemia time, clampless surgery, and acute kidney injury (AKI) were assessed for RAPN. Multivariable analyses (MVA) investigated the association between robotic platform (Si vs. Xi) and surgical outcomes after adjustment for patient- and tumor-related factors. RESULTS: A total of 975 (68%) and 462 (32%) patients underwent RARP performed with the Si vs. Xi surgical system, respectively. Baseline characteristics did not differ between the groups. On MVA, we did not find evidence of a difference between the groups with respect to operative time (estimate: 1.07) or estimated blood loss (estimate: 32.39; both p > 0.05). Median (interquartile range [IQR]) length of stay was 6 (3, 6) and 4 (3, 5) days in the Si vs. Xi group, respectively (p < 0.0001). On MVA, men treated with the Xi vs. Si robot had lower odds of PSM (Odds ratio [OR]: 0.58; p = 0.014). A total of 184 (41%) and 263 (59%) patients received RAPN with the Si and Xi robotic system, respectively. Baseline characteristics, including demographics, functional data, and tumor-related features did not differ between the groups. On MVA, operative time was longer in the Xi vs. Si group (estimate: 30.54; p = 0.006). Patients treated with the Xi vs. Si system had higher probability of undergoing a clampless procedure (OR: 2.56; p = 0.001), whereas the risk of AKI did not differ between the groups (OR: 1.25; p = 0.4). On MVA, patients operated with the Xi robot had shorter length of stay as compared to the Si group (estimate: - 0.86; p = 0.003), whereas we did not find evidence of an association between robotic system and PSM (OR: 1.55; p = 0.3). CONCLUSION: We found that the Xi robot allowed for improvements in peri-operative outcomes as compared to the Si platform, with lower rate of positive margins for RARP and higher rate of off-clamp procedures for RAPN. Hospital stay was also shorter for patients operated with the Xi vs. Si robot, especially after robot-assisted partial nephrectomy. Awaiting future investigations-in particular, cost analyses-these results have important implications for patients, surgeons, and healthcare policymakers.

Robot-assisted Radical Prostatectomy Performed with Different Robotic Platforms: First Comparative Evidence Between Da Vinci and HUGO Robot-assisted Surgery Robots.

BACKGROUND: In the field of robotic surgery, there is a lack of comparative evidence on surgical and functional outcomes of different robotic platforms. OBJECTIVE: To assess the outcomes of patients receiving robot-assisted radical prostatectomy (RARP) at a high-volume robotic center with daVinci and HUGO robot-assisted surgery (RAS) surgical systems. DESIGN, SETTING, AND PARTICIPANTS: We analyzed the data of 542 patients undergoing RARP ± extended pelvic lymph node dissection at OLV hospital (Aalst, Belgium) between 2021 and 2023. All procedures were performed by six surgeons using daVinci or HUGO RAS robots; the use of one platform rather than the other did not follow any specific preference and/or indication. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable analyses investigated the association between robotic system (daVinci vs HUGO RAS) and surgical outcomes after adjustment for patient- and tumor-related factors. Urinary continence recovery was defined as the use of no/one safety pad. RESULTS AND LIMITATIONS: A total of 378 (70%) and 164 (30%) patients underwent RARP with daVinci and HUGO RAS surgical systems, respectively. Despite a higher rate of palpable disease in the HUGO RAS group (34% vs 25%), baseline characteristics did not differ between the groups (all p > 0.05). After adjusting for confounders, we did not find evidence of a difference between the groups with respect to operative time (estimate: 16.71; 95% confidence interval [CI]: -6.35, 39.78; p = 0.12), estimated blood loss (estimate: 3.12; 95% CI: -67.03, 73.27; p = 0.9), and postoperative Clavien-Dindo ≥2 complications (odds ratio [OR]: 1.66; 95% CI: 0.34, 8.15; p = 0.5). On final pathology, 55 (15%) and 20 (12%) men in, respectively, the daVinci and the HUGO RAS group had positive surgical margins (PSMs; p = 0.5). On multivariable analyses, we did not find evidence of an association between a robotic system and PSMs (OR: 1.08; 95% CI: 0.56, 2.07; p = 0.8). Similarly, the odds of recovering continence did not differ between daVinci and HUGO RAS cases after both 1 mo (OR: 0.78; 95% CI: 0.45, 1.38; p = 0.4) and 3 mo (OR: 1.17; 95% CI: 0.49, 2.79; p = 0.7). CONCLUSIONS: Among patients receiving RARP with daVinci or HUGO RAS surgical platforms, we did not find differences in surgical and functional outcomes between the robots. This may be a result of a standardized surgical technique that allowed surgeons to transfer their skills between robotic systems. Awaiting future investigations with longer follow-up, these results have important implications for patients, surgeons, and health care policymakers. PATIENT SUMMARY: We compared surgical and functional outcomes of patients receiving robot-assisted radical prostatectomy with daVinci versus HUGO robot-assisted surgery (RAS) robots. The two platforms were able to achieve similar outcomes, suggesting that the introduction of HUGO RAS is safe and allows for optimal outcomes after radical prostatectomy.

Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique

ABSTRACT Introduction: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5-7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). Surgical Technique: We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane - virtually until the seminal vesicles - prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. Conclusions: Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention.

Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique.

INTRODUCTION: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5-7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). SURGICAL TECHNIQUE: We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane - virtually until the seminal vesicles - prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. CONCLUSIONS: Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention.

Outcomes of Robot-assisted Radical Prostatectomy with the Hugo RAS Surgical System: Initial Experience at a High-volume Robotic Center.

Clinical data on robot-assisted radical prostatectomy (RARP) performed with the new Hugo robot-assisted surgery (RAS) system are scarce. We described surgical outcomes of 112 consecutive patients who underwent RARP ± extended pelvic lymph-node dissection (ePLND) at OLV Hospital (Aalst, Belgium) between February and November 2022. The median age was 65 yr (interquartile range [IQR] 60-70) and median preoperative prostate-specific antigen (PSA) was 7.9 ng/ml (5.8-10.7). Thirty-eight patients (34%) had International Society of Urological Pathology grade group ≥3 tumor on prostate biopsy. On preoperative magnetic resonance imaging, 26 (23%) patients had a suspicion of extraprostatic disease. The median operative time was 180 min (IQR 145-200) and 27 men (24%) underwent ePLND. On final pathology, 34 patients (31%) had extraprostatic disease and ten (9%) had positive surgical margins. The median number of nodes removed was 15 (IQR 9-19). Among men with data available on the first PSA after surgery, 88% (60/68) had undetectable PSA (<0.1 ng/ml). The probability of urinary continence (UC) recovery was 36% (95% confidence interval [CI] 28-47%) at 1 mo and 81% (95% CI 72-89%) at 3 mo. The median time to UC recovery was 36 d (95% CI 34-44). This is the first report of data on UC recovery and surgical pathology for patients undergoing RARP for prostate cancer performed with the Hugo RAS robotic system. Future investigations with longer follow-up are awaited. PATIENT SUMMARY: We describe surgical outcomes of patients undergoing robot-assisted surgical removal of the prostate for cancer performed with the Hugo RAS robotic system at our institution. In our experience this platform provided adequate results in terms of surgical results and early recovery of urinary continence. Studies with longer follow-up are awaited.

Long-term oncologic outcomes of robot-assisted radical cystectomy: update series from a high-volume robotic center beyond 10 years of follow-up.

Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) for non-metastatic bladder cancer (BCa) are limited. The purpose of this study is to describe long-term oncologic outcomes of patients receiving robotic radical cystectomy at a high-volume European Institution. We analyzed data of 107 patients treated with RARC between 2003 and 2012 at a high-volume robotic center. Clinical, pathologic, and survival data at the latest follow-up were collected. Clinical recurrence (CR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) were plotted using Kaplan-Meier survival curves. Cox proportional hazard models investigated predictors of CR and CSM. Competing-risk regressions were utilized to depict cumulative incidences of death from BCa and death from other causes after RARC at long term. Pathologic nonorgan-confined BCa was found in 40% of patients, and 7 (7%) patients had positive soft tissue surgical margins. Median (interquartile range [IQR]) number of nodes removed was 11 (6, 14), and 26% of patients had pN + disease. Median (IQR) follow-up for survivors was 123 (117, 149) months. The 12-year CR-free, CSM-free and overall survival were 55% (95% confidence interval [CI] 44%, 65%), 62% (95% CI 50%, 72%), and 34% (95% CI 24%, 44%), respectively. Nodal involvement on final pathology was associated with poor prognosis on multivariable competing risk analysis. The cumulative incidence of non-cancer death exceeded that of death from BCa after approximately ten years after RARC. We provided relevant data on oncologic outcomes of RARC at a high-volume robotic center, with acceptable rates of clinical recurrence and cancer-specific survival at long-term. In patients treated with RARC, the cumulative incidence of death from causes other than BCa is non-negligible, and should be taken into consideration for post-operative follow-up.

What Donation Features are Related to Complications in Donation after Circulatory Death Kidney Transplant? Analysis of Risk Factors for Complication after Circulatory Death Kidney Transplant.

OBJECTIVE: Complications in donation after circulatory death (DCD) kidney transplants (KT) are barely described, while in some urological complications the cause is unknown. The aim of this study is to describe surgical and urological complications and analyze what donation features could be involved. METHODS: A prospective, single center study was performed from 2016 to 2019 including all KT from controlled cardiac death donors (cDCD). RESULTS: A total of 86 cDCD KT were included in the study. Recipient BMI, residual urine output (RUO) <500 mL/day, delayed graft function (DGF), and wound complication were related to UTI (p = 0.020, p = 0.008, p = 0.016, and p = 0.004, respectively). Features related to early graft nephrectomy were recipient BMI and recipients with diabetes mellitus (DM) (p = 0.025 and p = 0.036, respectively). DM in recipients was significantly associated with hematuria (p = 0.046). Urinary leak (UL) was associated to vascular complication and ureteral stricture (US) (p = 0.029 both). UL and lymphocele were associated to US (p = 0.029 both). Features related to lymphocele were recipient BMI and US (p = 0.028 and p = 0.029, respectively). History of previous transplant, time from cardiac arrest (CA) to cold flush, and DGF, were associated to wound complication (p = 0.040, p = 0.011 and p = 0.016, respectively). CONCLUSIONS: Surgical and urological complications after KT are an important issue to resolve. Our data revealed an association between RUO <500 mL/day, DGF, and wound complication with urinary infection, as well as between recipient DM and hematuria. Recipient BMI and DM were related to early graft nephrectomy. Vascular complications were associated with urinary leak, and lymphocele with US. Finally, wound complication was related to previous transplant, DGF, and time from CA to cold flush. This data revealed interesting associations between donor and recipient features and cDCD KT complications, providing more information to improve prevention and management.

Effect of Ischemia Times and Donor and Recipient Features on Maastricht Category III Kidney Transplant Outcomes.

OBJECTIVE: Expansion of the donor pool has been enabled by the use of donation after circulatory death (DCD). The aim of this study is to identify what donation features are able to predict kidney transplant (KT) outcomes from DCD. MATERIALS AND METHODS: A prospective analysis of all DCD KT from June 2016 to November 2019 was conducted. Association between donor and recipient features, and ischemia times with delayed graft function (DGF) and serum creatinine (Cr) at discharge, and at three and twelve months were analysed. RESULTS: A total of 86 KT were performed. The results revealed a relationship between donor age (p = 0.014) and receptors on haemodialysis (p = 0.001) with DGF. There was no association between different ischemia times and DGF. Residual urine output greater than 500mL/day and being on peritoneal dialysis were found to be protective factors for DGF. Correlation analysis illustrated a significant correlation between donor age and Cr at discharge and at 3 months. CONCLUSION: Higher donor age and being on haemodialysis were risk factors for DGF. Likewise, donor age did not show a significant association with 12-month serum Cr. These results demonstrate that donor age is a risk factor for DGF but does not affect long term graft function.

Effect of Ischemia Times and Donor and Recipient Features on Maastricht Category III Kidney Transplant Outcomes

Objective: Expansion of the donor pool has been enabled by the use of donation after circulatory death (DCD). The aim of this study is to identify what donation features are able to predict kidney transplant (KT) outcomes from DCD. Materials and Methods: A prospective analysis of all DCD KT from June 2016 to November 2019 was conducted. Association between donor and recipient features, and ischemia times with delayed graft function (DGF) and serum creatinine (Cr) at discharge, and at three and twelve months were analysed. Results: A total of 86 KT were performed. The results revealed a relationship between donor age (p = 0.014) and receptors on haemodialysis (p = 0.001) with DGF. There was no association between different ischemia times and DGF. Residual urine output greater than 500mL/day and being on peritoneal dialysis were found to be protective factors for DGF. Correlation analysis illustrated a significant correlation between donor age and Cr at discharge and at 3 months. Conclusion: Higher donor age and being on haemodialysis were risk factors for DGF. Likewise, donor age did not show a significant association with 12-month serum Cr. These results demonstrate that donor age is a risk factor for DGF but does not affect long term graft function (AU)

What Donation Features are Related to Complications in Donation after Circulatory Death Kidney Transplant? Analysis of Risk Factors for Complication after Circulatory Death Kidney Transplant

Objective: Complications in donation after circulatory death (DCD) kidney transplants (KT) are barely described, while in some urological complications the cause is unknown. The aim of this study is to describe surgical and urological complications and analyze what donation features could be involved. Methods: A prospective, single center study was performed from 2016 to 2019 including all KT from controlled cardiac death donors (cDCD). Results: A total of 86 cDCD KT were included in the study. Recipient BMI, residual urine output (RUO) <500 mL/day, delayed graft function (DGF), and wound complication were related to UTI (p = 0.020, p = 0.008, p = 0.016, and p = 0.004, respectively). Features related to early graft nephrectomy were recipient BMI and recipients with diabetes mellitus (DM) (p = 0.025 and p = 0.036, respectively). DM in recipients was significantly associated with hematuria (p = 0.046). Urinary leak (UL) was associated to vascular complication and ureteral stricture (US) (p = 0.029 both). UL and lymphocele were associated to US (p = 0.029 both). Features related to lymphocele were recipient BMI and US (p = 0.028 and p = 0.029, respectively). History of previous transplant, time from cardiac arrest (CA) to cold flush, and DGF, were associated to wound complication (p = 0.040, p = 0.011 and p = 0.016, respectively). Conclusions: Surgical and urological complications after KT are an important issue to resolve. Our data revealed an association between RUO <500 mL/day, DGF, and wound complication with urinary infection, as well as between recipient DM and hematuria. Recipient BMI and DM were related to early graft nephrectomy (AU)

A prioritization score for elective urological surgery during the COVID-19 pandemic: The Medically Necessary Time-Sensitive (MeNTS) score system.

PURPOSE: The COVID19 pandemic has caused a redistribution of hospital resources. Prioritization strategies are needed in order to organize elective surgeries. We compared the new Medically Necessary Time-Sensitive score (MeNTS) and its factors (disease, procedure, and patient factors) between operated and deferred cases, and also to a subjective priority scale in the Urology department. METHODS: The MeNTS score and a subjective prioritization scale were prospective applied to all patients included on the surgical waiting list from March 10 to September 9, 2020. Mann-Whitney U test was used to compare MeNTS scores between operated and non-operated groups. Kruskal-Wallis test was used to compare MeNTS scores between three subjective priority groups. RESULTS: A total of 150 cases were operated while 100 were deferred. Median total MeNTS score in the operated group was 39.5 whereas in the non-operated group it was 38 (p = 0.135). Median disease factors score was 9.5 in the operated group and 11 in the non-operated group(p = 0.033). Median procedure factors score was 10 in both groups (p = 0.02). Median patient factors score was 17 in the operated group and 18 in the non-operated group (p = 0.210). Disease factors displayed a significant difference between the three subjective priority groups. CONCLUSIONS: Total MeNTS score does not show significant differences between operated and non-operated patients. However, we demonstrate a relationship between MeNTS disease factors and the operated group as well as with the subjective priority scale.

Adipokines as New Biomarkers of Immune Recovery: Apelin Receptor, RBP4 and ZAG Are Related to CD4+ T-Cell Reconstitution in PLHIV on Suppressive Antiretroviral Therapy.

A significant proportion of people living with HIV (PLHIV) who successfully achieve virological suppression fail to recover CD4+ T-cell counts. Since adipose tissue has been discovered as a key immune organ, this study aimed to assess the role of adipokines in the HIV immunodiscordant response. This is a multicenter prospective study including 221 PLHIV starting the first antiretroviral therapy (ART) and classified according to baseline CD4+ T-cell counts/µL (controls > 200 cells/µL and cases ≤ 200 cells/µL). Immune failure recovery was considered when cases did not reach more than 250 CD4+ T cells/µL at 144 weeks (immunological nonresponders, INR). Circulating adipokine concentrations were longitudinally measured using enzyme-linked immunosorbent assays. At baseline, apelin receptor (APLNR) and zinc-alpha-2-glycoprotein (ZAG) concentrations were significantly lower in INRs than in immunological responders (p = 0.043 and p = 0.034), and they remained lower during all ART follow-up visits (p = 0.044 and p = 0.028 for APLNR, p = 0.038 and p = 0.010 for ZAG, at 48 and 144 weeks, respectively). ZAG levels positively correlated with retinol-binding protein 4 (RBP4) levels (p < 0.01), and low circulating RBP4 concentrations were related to a low CD4+ T-cell gain (p = 0.018 and p = 0.039 at 48 and 144 weeks, respectively). Multiple regression adjusted for clinical variables and adipokine concentrations confirmed both low APLNR and RBP4 as independent predictors for CD4+ T cells at 144 weeks (p < 0.001). In conclusion, low APLNR and RBP4 concentrations were associated with poor immune recovery in treated PLHIV and could be considered predictive biomarkers of a discordant immunological response.

Masticatory rhythm 3 months after treatment with unilateral implant-supported fixed partial prosthesis: A clinical study.

STATEMENT OF PROBLEM: Whether treatment with an implant-supported fixed partial prosthesis (ISFPP) affects the masticatory rhythm in patients with unilateral posterior missing teeth is unclear. PURPOSE: The purpose of this prospective clinical study was to determine the change in masticatory rhythm in participants with unilateral posterior missing teeth 3 months after treatment with an ISFPP and to assess whether treatment influenced the stability of the masticatory rhythm. MATERIAL AND METHODS: Thirty participants (mean age 59 years; 17 women) with unilateral posterior missing teeth were treated with 1-, 2-, or 3-unit ISFPPs. Ten healthy individuals (mean age 36 years; 8 women) with a complete natural dentition were included in a control group. In this prospective study, each participant performed 3 masticatory assays (freestyle, unilateral right, and unilateral left) at baseline and at the 3-month follow-up. Each assay comprised 5 trials of 20 cycles masticating pieces of silicone placed in a latex bag. The time needed to complete the 20 masticatory cycles per trial was measured, and the mean masticatory frequency was calculated for each assay. Coefficients of variation were then calculated from the 5 mean values of the masticatory trials. Differences in the data at 3 months and baseline were analyzed by using the Wilcoxon or paired t tests. The control and treated groups were compared by analysis of variance or Mann-Whitney U tests (α=.05). RESULTS: After 3 months, participants treated with ISFPPs showed an increase of 8.7% in masticatory frequency during freestyle mastication (P<.001) and an 8.0% increase during unilateral mastication on the treated side (P<.01). At baseline, the coefficient of variation of masticatory frequency on the treated side was higher in the ISFPP group than in the control group during unilateral mastication (P=.033). Three months after treatment, there was a significant reduction in the coefficient of variation during unilateral mastication on the treated side of the ISFPP group (P<.001). The treatment group also reached a masticatory frequency similar to that of the control group (75 and 78 cycles per minute, respectively). CONCLUSIONS: Treatment with ISFPPs accelerated the masticatory rhythm of individuals with unilateral posterior missing teeth, who achieve similar rhythms to those with complete natural dentitions. The stability of the masticatory rhythm was also restored, indicating an improvement in masticatory function.

High circulating SDF-1and MCP-1 levels and genetic variations in CXCL12, CCL2 and CCR5: Prognostic signature of immune recovery status in treated HIV-positive patients.

BACKGROUND: The underlying mechanisms of incomplete immune reconstitution in treated HIV-positive patients are very complex and may be multifactorial, but perturbation of chemokine secretion could play a key role in CD4+T-cell turnover. METHODS: We evaluated the circulating baseline and 48-week follow-up concentrations of SDF-1/CXCL12, fractalkine/CX3CL1, MCP-1/CCL2, MIP-α/CCL3, MIP-ß/CCL4 and RANTES/CCL5, and we estimated their association with CXCL12, CX3CR1, CCR2, CCL5 and CCR5 single nucleotide polymorphisms (SNPs) to investigate multiple chemokine-chemokine receptor signatures associated with immune dysregulation preceding poor immune recovery. FINDINGS: The circulating concentrations and gene expression patterns of SDF-1/CXCL12 (CXCL12 rs1801157) and MCP-1/CCL2 (CCR2 rs1799864_814) were associated with immune recovery status. CCR2 rs1799864_814 and CCR5 rs333_814 (Δ32) determine the baseline plasma RANTES and MIP-α concentrations, respectively, in participants with poor immune response. INTERPRETATION: SDF-1/CXCL12 and MCP-1/CCL2 could be considered prognostic markers of immune failure despite suppressive antiretroviral therapy. The strong linkage disequilibrium (LD) between CCR2 rs1799864_814 and CCR5 rs1800024 indicated that the alleles of each gene are inherited together more often than would be expected by chance. FUNDING: This work was supported by Fondo de Investigacion Sanitaria and SPANISH AIDS Research Network (ISCIII-FEDER); AGAUR and Gilead Fellowship. FV and YMP are supported by grants from the Programa de Intensificación (ISCIII) and Servicio Andaluz de Salud, respectively. JVG,EY and LR are supported by the Instituto de Salud Carlos III (ISCIII). AR is supported by Departament de Salut, Generalitat de Catalunya and by the Instituto de Salud Carlos III (ISCIII).

Changes in masticatory laterality 3 months after treatment with unilateral implant-supported fixed partial prosthesis.

OBJECTIVE: This study assessed changes in masticatory laterality in patients with unilateral posterior missing teeth 3 months after treatment with an implant-supported fixed partial prosthesis (ISFPP). METHODS: Thirty patients with unilateral posterior missing teeth participated in this prospective study. They were treated with one-, two- or three-unit ISFPPs. The control group comprised 10 healthy individuals with complete natural dentition. Each participant performed masticatory assays at baseline and at 3-month follow-up, chewing pieces of silicon inside a latex bag. Masticatory laterality was determined using three different methods: assessment of the first chewing cycle, of all cycles and application of a visual analogue scale. Data were compared using the Kruskal-Wallis or the Mann-Whitney U test as appropriate. RESULTS: Three months after treatment, a significant change in the asymmetry index towards the treated side and a significant reduction in the Unilateral Chewing Index were observed in the ISFPP group. No significant differences in masticatory laterality between groups were detected at 3-month follow-up, regardless of the method assessed. CONCLUSION: Treatment with ISFPPs alters the masticatory laterality, moving it to the treated side and increasing the degree of bilateral chewing in patients with unilateral posterior missing teeth.

IL-7/IL-7R gene variants impact circulating IL-7/IL-7R homeostasis and ART-associated immune recovery status.

A relationship between polymorphisms in genes encoding interleukin 7 (IL-7) and its cellular receptor (IL-7R) and antiretroviral therapy (ART)-associated immune recovery in HIV subjects has been previously reported. However, details of this relationship remain unclear, and the association of these polymorphisms with circulating IL-7/IL-7R levels is scarce. Here, we explored whether IL-7/IL-7R axis was associated with quantitative CD4+ T-cell recovery in HIV-infected subjects. IL-7/IL-7R polymorphisms were assessed by genotyping, and multiple inheritance models were used to estimate both, their association with low pre-ART CD4+ T-cell counts and incomplete immune recovery status after 48 weeks of suppressive ART. Integrated data from genetic variants association and soluble plasma IL-7/IL-7R quantification suggest that IL-7/IL-7R genotype expression could alter the homeostatic balance between soluble and membrane-bound receptors. The haplotype analyses indicates that allele combinations impacts pre-ART circulating CD4+ T-cell counts, immune recovery status and the absolute increment of CD4+ T-cell counts. The knowledge about how IL-7/IL-7R axis is related to quantitative CD4+ T-cell recovery and immune recovery status after initiating ART could be useful regarding T-cell reservoirs investigations in HIV subjects.

Do implant-supported fixed partial prostheses improve masticatory performance in patients with unilateral posterior missing teeth?

OBJECTIVES: The purpose of this study was to determine the improvement in masticatory performance and satisfaction with chewing ability in partially edentulous patients after treatment with an implant-supported fixed partial prosthesis (ISFPP). MATERIAL AND METHODS: This prospective study included 30 patients (mean age 59 years; 17 women) with unilateral posterior missing teeth treated with one-, two- or three-unit ISFPPs and 10 healthy individuals (mean age 36 years; 8 women) with complete natural dentition to establish the normal levels of mastication. Three variables were determined at baseline and at 3-months' follow-up in all participants: masticatory performance according to the median particle size (MPS) during freestyle mastication and unilateral mastication on each side, and satisfaction with chewing ability using a visual analog scale. Paired samples t test and Kruskal-Wallis test were used for intra-group and inter-group comparisons. RESULTS: The MPS following freestyle mastication decreased significantly at 3 months in both groups. Significant reductions of 21%, 30%, and 42% in the MPS were obtained from unilateral mastication on the treated side after treatment with 1, 2, or 3 restorative units, respectively. Three months after ISFPP, satisfaction with chewing ability improved by 40% in the treatment group. CONCLUSIONS: Freestyle masticatory performance may improve slightly within three months of treatment with an ISFPP and may be similar to that of subjects with complete natural dentition. Patients may obtain a 21%-38% improvement in unilateral mastication on the treated side and a 26%-54% improvement in satisfaction with chewing ability.

Satisfaction of patients with amyotrophic lateral sclerosis with an oral appliance for managing oral self-biting injuries and alterations in their masticatory system: A case-series study.

STATEMENT OF PROBLEM: About 10% of patients with amyotrophic lateral sclerosis (ALS) are candidates for oral treatment specifically because of traumatic injuries in the lips, cheeks, or tongue due to self-biting. However, patients with ALS have a prevalence of temporomandibular disorder (TMD) similar to that in the general population. PURPOSE: The purpose of this case-series study was to determine the degree of satisfaction of patients with ALS with an oral appliance for managing oral self-biting lesions or symptoms related to TMDs. This study also assessed the degree of improvement of the chief complaint and the compliance with and adverse effects of this treatment. MATERIAL AND METHODS: Eleven patients with ALS who sought oral treatment because of oral self-biting or TMD-related symptoms were included. A custom complete-coverage acrylic resin device was fabricated and fitted to each participant. A follow-up visit was planned for 3 months after the placement of the oral appliance, at which point the patients would rate the degree of improvement or worsening of the chief complaint and their degree of satisfaction with the treatment. A 1-sample t test was used to assess whether the degree of improvement of the chief complaint was significant. RESULTS: Participants reported a mean of 61% (95% confidence interval [CI] 38% to 84%) improvement of the chief complaint and a mean of 84% (95% CI 72% to 97%) satisfaction with the treatment. The mean rate of compliance was 62% (95% CI 40% to 84%) of the recommended time, and only a few adverse effects were reported. CONCLUSIONS: Participants with ALS were highly satisfied with the use of an oral appliance to manage oral self-biting or TMD-related symptoms. Adherence to this treatment was high, and no major adverse effects were observed.