Multiparameter Flow Cytometry Identification of Neoplastic Subclones: A New Biomarker in Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma.

Multiparameter flow cytometry (MFC)-based clonality assessment is a powerful method of diagnosis and follow-up in monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). However, the relevance of intraclonal heterogeneity in immunophenotypic studies remains poorly understood. The main objective of this work was to characterize the different immunophenotypic subclones in MGUS and MM patients and to investigate their correlation with disease stages. An 8-color MFC protocol with 17 markers was used to identify the subclones within the neoplastic compartment of 56 MGUS subjects, 151 newly diagnosed MM patients, 30 MM subjects in complete remission with detectable minimal residual disease, and 36 relapsed/refractory MM patients. Two or more clusters were observed in > 85% of MGUS subjects, 75% of stage I MM patients, and < 15% in stage III. Likewise, a significant correlation between the dominant subclone size, secondary cytogenetic features, and changes in the expression of CD27, CD44, and CD81 was detected. The loss of intraclonal equilibrium may be an important factor related with kinetics and risk of progression not well considered to date in MFC studies. The MFC strategy used in this work can provide useful biomarkers in MGUS and MM.

An Organic Mineral Adhesive Bone Graft: A Preclinical Study.

The development of a successful bone grafting technology with cohesive and adhesive properties has been an elusive goal for dental and orthopedic researchers. Tetracalcium phosphate combined with phosphoserine (TTCP-PS) is a synthetic, injectable, cohesive, self-setting, mineral-organic wet-field adhesive. The objective of this study was to evaluate four formulations of TTCP-PS in comparison to the conventional grafting materials, Bioglass and deproteinized cancellous bovine bone with a bioresorbable collagen membrane in standardized defects created in the angle of the rat mandible. Microcomputed tomography and histomorphometry were utilized to evaluate bone replacement with each of these materials after in vivo residence of either 4 or 12 weeks. The results of this study demonstrate that specific TTCP-PS formulations can form bone comparable to conventional materials in an osteopromotive mechanism but with the advantage of having cohesive and adhesive properties.

Prevalence of torus mandibularis in Rochester, New York, region.

The purpose of this study was to investigate the prevalence of torus mandibularis within a population residing in the Rochester, New York, region. During a comprehensive initial exam, utilizing clinical inspection and palpation, 1,323 subjects were examined for any tori in the mandibular area. Of the 1,323 subjects studied, 37.8% had tori mandibularis, with a higher frequency occurring in male patients (overall mean age: 40 years). In the Rochester, New York, area the observations noted a high prevalence of torus mandibularis (37.8%), with a mean population age of 40 years; 52% of the tori were observed in men.

Improving Titanium Implant Stability with Photobiomodulation: A Review and Meta-Analysis of Irradiation Parameters.

Objective: This analysis was designed to present a summary of available evidence that will inform practice and guide future research for photobiomodulation (PBM) after titanium implant placement procedures. Materials and methods: A systematic review was performed according to the Cochrane Collaboration and in line with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) criteria. Two investigators screened the titles and abstracts, and reviewed articles for risk of bias. Online databases searched included PubMed, Embase, Scopus, and Web of Science. Terms were specific to the effects of PBM on dental implant stability. Results: Eight hundred fifty-six studies were identified, and 15 studies fulfilled the inclusion criteria. Light sources included both laser and light emitting diode (LED) devices. Wavelengths ranged from 618 to 1064 nm. The meta-analysis concluded that all 15 published studies were able to safely apply PBM near dental implants without adverse events. Laser and LED wavelengths that reported significant results included 618, 626, 830, 940 (2 × ), and 1064 nm. Conclusions: The use of adjunctive PBM can be safely prescribed after surgical placement of titanium implants. Six groups reported statistical significance for improving implant stability (four laser diode, two LED) in wavelengths ranging from 618 to 1064 nm. The amount of time spent delivering PBM was not a variable that differentiated whether a study reported significant results.

Photobiomodulation in dental extraction therapy: Postsurgical pain reduction and wound healing.

BACKGROUND: This scoping review and analysis were designed to assess the amount of time spent delivering photobiomodulation (PBM) light therapy after dental extraction to improve postoperative pain and wound healing. TYPES OF STUDIES REVIEWED: The scoping review was performed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Publications were specific for human randomized controlled clinical trials, PBM after dental extraction therapy, and related clinical outcomes. Online databases searched included PubMed, Embase, Scopus, and Web of Science. Analyses were conducted to analyze the prescribed intervals of time (seconds) per application of PBM. RESULTS: Of the 632 studies initially identified, 22 studies fulfilled the inclusion criteria. Postoperative pain and PBM were reported in 20 articles for 24 treatment groups, with treatment times ranging from 17 through 900 seconds and wavelengths from 550 through 1,064 nm. Clinical wound healing outcomes were reported in 6 articles for 7 groups with treatment times ranging from 30 through 120 seconds and wavelengths from 660 through 808 nm. PBM therapy was not associated with adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: There is future potential to integrate PBM after dental extraction therapy to improve postoperative pain and clinical wound healing. The amount of time spent delivering PBM will vary by wavelength and the type of device. Further investigation is needed to translate PBM therapy into human clinical care.

Immune changes over time and survival in patients with cirrhosis treated with non-selective beta-blockers: A prospective longitudinal study.

BACKGROUND: Treatment with non-selective beta-blockers (NSBB) has been associated with anti-inflammatory and anti-cancer effects in patients with cirrhosis. This study aims to analyze the impact of chronic NSBB treatment on immune activation and disease progression in stable outpatients with cirrhosis. METHODS: In this prospective follow-up of 150 patients with cirrhosis, 39 received treatment with NSBB. Blood samples were taken every 6-9 months, and immune and adrenergic variables were measured. Mixed linear models were used to assess the effect of NSBB on these variables over time. Multivariate Cox regression was used to study associations with adverse clinical events (hepatocellular carcinoma, death, or liver transplant). RESULTS: Median follow-up was 1635 days. NSBB treatment was associated with significantly lower levels of IL-6 (ß - 4.7; 95% confidence interval [CI] -6.9, -2.6) throughout the study. During follow-up, 11 patients developed hepatocellular carcinoma, 32 died, and 4 underwent liver transplant. Patients with higher concentrations of IL-10, IL-6 and IFN-γ developed more clinical events. Event-free survival was significantly better in patients treated with NSBB (hazard ratio 0.36, 95% CI 0.18, 0.71) in a multivariate Cox regression adjusted for Child-Pugh-Score, esophageal varices, and platelets. CONCLUSION: Chronic treatment with NSBB in patients with stable cirrhosis gives rise to a different state of immune activation, characterized by lower concentrations of IL-6 over time, and it is associated with a reduced risk of adverse event (death, hepatocellular carcinoma, or transplant), after controlling for disease severity.

Measles outbreak in Venezuela: a new challenge to postelimination surveillance and control?

The circulation of wild measles virus was interrupted in Venezuela in February 2007 after the catch-up vaccination (1994) and monitoring (1998) and in response to the measles outbreak in 2001. Traditionally, the routine coverage with measles-mumps-rubella vaccine does not exceed 85%. In February 2006, a measles outbreak started by importation in the State Miranda; this extended to 7 states and lasted 50 weeks with an intermediate period of 17 weeks without reported cases. New cases were reported in the States Guarico and Amazon. The pattern of circulation of the silent period was determined through the use of retrospective search for measles; this showed that 57% of suspected cases did not enter the surveillance system. Molecular epidemiology made it possible to identify B3 as only genotype, which also circulated in Spain. The epidemiological and clinical characteristics of measles have been modified; these determine outbreaks identified late, of slow expansion, silent, and with limited case-fatality, compared with classical outbreaks. The outbreak spread by that behavior was not recognized and the classical control measures did not result. The beginning of a broader and intense vaccination was delayed, partly by weaknesses in the sensitivity of the system. It is crucial to recognize the new behavior of measles and the effectiveness of the classical control measures, and especially to establish criteria for interruption of the circulation to control an outbreak in this stage of elimination.

A Revised Peri-implantitis Classification Scheme: Adding Three-Dimensional Considerations to Facilitate Prognosis and Treatment Planning.

Historically, diagnosing peri-implantitis is done based on whether the disease is present, evaluated using the arbitrary thresholds of probing depths and bone loss. Using this approach as a tool to ascertain meaningful information regarding prevalence and treatment is limited. Efforts have been made to improve upon this, but to date, only one of these classifications has provided a simple method to communicate disease severity based on the amount of bone loss. A modified version of this simplified classification is proposed here, including information regarding the implant position, as emerging information suggests that this is a crucial factor in the etiology and prognosis of peri-implantitis. This enhancement to the classification better serves both researchers and clinicians in their discussion about peri-implantitis and helps to determine and recommend the most effective methods of management.

Flow cytometry detection of sustained humoral immune response (IgG + IgA) against native spike glycoprotein in asymptomatic/mild SARS-CoV-2 infection.

SARS-CoV-2 is the virus that causes the disease called COVID-19, which has caused the worst pandemic of the century. Both, to know the immunological status of general population and to evaluate the efficacy of the vaccination process that is taking place around the world, serological tests represent a key tool. Classic serological tests, based on colorimetric techniques, such as ELISA or CLIA, continue to be the most widely used option. However, a real improvement in results is still needed. We developed a highly sensitive and specific FCM assay that allows the detection of IgG and IgA antibodies, directed against the native and functional S-protein of SARS-CoV-2 exposed on the membrane of a transfected cell line, up to 8 months after infection.

A Modified Bilaminar Technique with the Use of a Fibrin-Fibronectin System for a Single Gingival Recession: A Case Report with a Follow-Up of 3 Years.

This case report described a modified bilaminar technique for treating a single gingival recession. Patient presented a gingival recession in a maxillary canine. Tooth was in a buccally prominent position and soft keratinized tissue apical to the recession was reduced but still present. A split-full-split thickness trapezoidal flap was designed. Root's surface was prepared with curettes. Epithelial-connective tissue graft was harvested from the palate with reduced dimension. After deepithelialization, the graft was placed with a fibrin-fibronectin system at the maximum root coverage level, and the flap coronally advanced and sutured. At 3-year follow-up control, the free gingival margin was still stable at the postsurgery position, with a thicker biotype corresponding to the grafted area, with no probing and a suitable aesthetic result.

Healed Edentulous Sites: Suitability for Dental Implant Placement, Need for Secondary Procedures, and Contemporary Implant Designs.

PURPOSE: The purpose of this retrospective computed tomography study was to evaluate bone availability for dental implant placement, frequency of bone augmentation procedures, frequency of anatomical structures that compromise implant placement, and frequency of implant dimensions, and to determine which edentulous sites would benefit from the use of a sloped implant versus a traditional flat design. MATERIALS AND METHODS: Recorded parameters included the width of the ridge, the buccal and lingual/palatal alveolar bone height in reference to different anatomical landmarks, determination of implant placement, selection of an implant with a flat or sloped top, and need for a secondary bone augmentation procedure. RESULTS: One thousand three hundred seventy edentulous sites were evaluated in 216 patients. Implants could be placed in 60.6% of the total sites, where the coronal portion would be sloped in 59% of sites and conventionally flat in 41%; 39.4% of sites were not adequate for implant placement, where 56.5% needed additional guided bone regeneration procedures and 43.5% required sinus augmentation procedures. The inferior alveolar canal was the most frequent anatomical structure limiting size and/or placement. CONCLUSION: The study indicates that implants can be placed in slightly over half of edentulous sites without a secondary grafting procedure. The possibility of dental implant placement varied according to the volume and morphology of alveolar bone and related anatomical structures. This decreased from anterior to posterior in both arches. The sloped implant design was beneficial. In addition, the sloped implant design resulted in the placement of a longer implant.

The Long-Term Evaluation of Two-Unit Fixed Partial Dentures on Short, Threaded Implants: Delayed Versus Immediate Loading.

Placement of short implants is a common approach to rehabilitate edentulous areas. The objective of this study was to evaluate the long-term survival of 7.0- and 8.5-mm implants placed in either a delayed or immediate loading protocol. Life table analysis revealed the implants treated with the delayed loading protocol had a 90.9% survival rate and the implants treated with the immediate loading protocol had a survival rate of 92.0%. The results of this 8-year prospective study demonstrate similar survival rates of short, cylindrical threaded implants placed by either a delayed or immediate loading protocol.

Peri-implant Mucosal Tissues and Inflammation: Clinical Implications.

PURPOSE: The purpose of this review was to explore the available literature and compile studies that discuss the relevance of the biofilm, onset and progression of disease, critical peri-implant pocket depth, frequency of supportive implant therapy, excess cement, and keratinized peri-implant tissues as related to peri-implant disease. MATERIALS AND METHODS: PubMed, Cochrane Oral Health Group Specialized Trial Register, and hand searches of related journals were performed in relationship to the focused question. Reports describing techniques, preclinical studies, and case reports were excluded. RESULTS: Due to the absence of controlled studies, a meta-analysis could not be performed. Summaries of relevant publications were completed for each topic area. Clinical recommendations were developed to provide guidance to the practitioner. CONCLUSION: The importance of proper diagnosis, planning, and clinical treatment cannot be overstated. Patient factors including systemic disease, periodontal status, and oral hygiene significantly impact peri-implant health. Clinician factors such as implant position, excess cement, and restorative design can contribute to development of peri-implant disease. Surveillance of implant status is essential and can be assisted by the assessment of risk factors, establishment of a proper recall program, and monitoring changes in bone and peri-implant pocket depths.

Surgical Alternatives for Treating Peri-implantitis.

The objective of this case series was to describe surgical approaches that can be used to efficiently and effectively treat peri-implantitis as measured by positive changes in clinical parameters. A total of 32 patients with 45 implants were treated surgically to eliminate peri-implantitis. Baseline clinical parameters measured prior to surgery were compared to those made 6 months postsurgery to evaluate the efficacy of each procedure. Implants demonstrating signs of peri-implantitis were treated by one of three approaches: (1) regenerative surgery, (2) osseous resective surgery, or (3) apically repositioned flap surgery. In all instances, the exposed implant surfaces were debrided and decontaminated. Relative to baseline values, regenerative surgery yielded statistically significant changes in probing depth (PD) (7.21 ± 0.27 mm to 4.09 ± 0.14 mm) and percentage of sites exhibiting bleeding on probing (BoP) (100.0% ± 0.0% to 10.6% ± 3.3%) as measured at the 6-month recall visit (P ≤ .05). The decrease in probing depth was not dependent on the type of graft material used (P ≤ .05). Resective surgery yielded statistically significant changes in PD (5.86 ± 0.23 mm to 3.63 ± 0.14 mm) and the percentage of sites exhibiting BoP (100.0% ± 0.0% to none) (P ≤ .05). Finally, the implants treated via apically repositioned flap surgery demonstrated statistically significant decreases (P ≤ .05) in both PD (6.79 ± 0.27 mm to 4.32 ± 0.16 mm) and BOP (100.0% ± 0.0% to 14.3% ± 6.7%) (P ≤ .05). Regenerative, resective, and apically positioned flap surgery can be utilized to successfully treat peri-implantitis.

Alveolar Ridge Augmentation with Three-Dimensional Printed Hydroxyapatite Devices: A Preclinical Study.

The objective of this study was to evaluate the effectiveness of precise three-dimensional hydroxyapatite printed micro- and macrochannel devices for alveolar ridge augmentation in a canine model. All grafts induced minimal inflammatory and fibrotic reactions. Examination of undecalcified sections revealed that both types of grafts demonstrated bone ingrowth. The majority of the bone growth into the block graft was into the channels, though a portion grew directly into the construct in the form of small bony spicules. In conclusion, bone ingrowth was readily demonstrated in the middle of the implanted printed devices.

The Use of Recombinant Human Platelet-Derived Growth Factor for Maxillary Sinus Augmentation.

The maxillary sinus augmentation procedure has become a predictable treatment to regenerate bone for implant placement. The purpose of this study was to evaluate the effect of recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with a deproteinized cancellous bovine bone graft for sinus augmentation. The lateral window approach was used for maxillary sinuses with minimal residual bone. After a healing period of 4 months, dental implants were placed and then restored following a 2-month osseointegration period. The result demonstrated increased bone height and ISQ values and a 100% survival rate. This study indicates that the addition of rhPDGF-BB to deproteinized cancellous bovine bone accelerated the healing period in maxillary sinuses with minimal native bone.

A Rare Case of Pure Erythroid Sarcoma in a Pediatric Patient: Case Report and Literature Review.

We describe an exceptional case of erythroid sarcoma in a pediatric patient as a growing orbital mass with no evidence of morphologic bone marrow involvement, who was finally diagnosed of pure erythroid sarcoma based on histopathology and flow cytometry criteria. We discuss the contribution of standardized eight-color flow cytometry as a rapid and reliable diagnostic method. The use of normal bone marrow databases allowed us to identify small aberrant populations in bone marrow and later confirm the diagnosis in the neoplastic tissue.

A Classification System for Peri-implant Diseases and Conditions.

Peri-implant bone levels are influenced by pathologic and nonpathologic conditions. The understanding of peri-implant disease has evolved over the past several decades, and the classification of peri-implantitis has been limited to descriptions of disease progression or those involving soft and/or hard tissues (peri-implant mucositis or peri-implantitis). However, no classification system has been established based on etiology. The objective of this study was to identify various etiologies for peri-implantitis and to establish a classification system based on the pathogenesis. The results indicate that the majority of bone loss was related to biofilm, followed by iatrogenic factors, exogenous irritants, absence of keratinized tissue, and extrinsic pathology. The proposed classification system will allow the clinician to properly diagnose peri-implant diseases in relation to etiology. These conditions may respond differently to applied therapies.

A Palatal Approach for a Sinus Augmentation Procedure.

The purpose of this article is to demonstrate an alternative method for sinus augmentation through a palatal approach when complications do not allow the use of traditional approaches. A 50-year-old male patient presented with multiple previous sinus augmentation attempts. A cone beam computed tomography scan revealed bone graft material had consolidated on the buccal aspect of the lateral sinus wall only, preventing implant placement while not allowing access via a conventional lateral window technique to improve the graft bulk. A palatal approach was adopted as an alternative method of sinus entry and is presented in this case report. The authors suggest that a palatal approach technique is a safe and effective method to complete a sinus augmentation where a buccal approach is impractical.