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STATEMENT OF PROBLEM: Evidence on the long-term clinical assessment and longevity of ceramic veneers bonded to different substrates is limited. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the effect of various substrates, including enamel, dentin, or an existing composite resin restoration, on the clinical survival and complication rates of ceramic veneers. MATERIAL AND METHODS: The PubMed, Scopus, and the Cochrane Library electronic databases were searched, and related journals were hand searched without time or language restrictions to identify clinical trials that compared the survival rate and clinical complication rates when bonding ceramic veneers to different tooth substrates. The success rate of the included participants was estimated by the number of veneers that did not require a clinical intervention, and the survival rate by all veneers that did not fail absolutely. The risk difference (RD) with 95% confidence intervals (CIs) for dichotomous outcomes was used to quantify the intervention effect. RESULTS: Of 973 screened articles, 6 clinical studies were included. The survival and success rates varied depending on the bonding substrate. Enamel-bonded veneers had almost perfect rates of survival (99% with a range of 98% to 100%) and success (99% with a range of 98% to 100%). Veneers bonded to composite resin or surfaces with minimal dentin exposure had slightly lower survival rates (94% with a range of 91% to 97% and 95% with a range of 91% to 100%, respectively) and success rates (70% with a range of 60% to 80% and 95% with a range of 90% to 99%). Severe dentin exposure significantly decreased both survival rates (91% with a range of 84% to 98%) and success rates (74% with a range of 64% to 85%). The combined findings suggested that ceramic veneers bonded to enamel had fewer clinical complications (RD: -0.04; 95% CI: -0.09 to 0.02) and lower failure rates (RD: -0.13; 95% CI: -0.32 to 0.07) compared with those bonded to exposed dentin. Additionally, veneers attached to teeth with minimal dentin exposure were significantly less likely to require clinical interventions (RD: -0.16; 95% CI: -0.31 to -0.01) and had a reduced incidence of failure (RD: -0.08; 95% CI: -0.17 to 0.01) compared with those with severe dentin exposure. CONCLUSIONS: Ceramic veneers bonded to enamel showed higher survival and success rates with lower clinical incidences of complications and failure than those bonded to dentin or teeth with existing composite resin restorations.
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OBJECTIVES: Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary. DESIGN: Prospective observational cohort study. SETTING: Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed. PARTICIPANTS: Children (≥4 years, ≤16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology. MAIN OUTCOME MEASURES: Frequency and severity of post-operative bleeding. Intensity and pattern of post-operative pain. RESULTS: In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008). CONCLUSION: A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.
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Tonsilectomia , Criança , Humanos , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Estudos de Coortes , Estudos Prospectivos , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologiaRESUMO
Background and Objectives: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric twisting without the anatomical constriction of the gastric lumen. During endoscopic examination, the staple line is deviated with a clockwise rotation, and the stenosis requires additional endoscopic manipulations for its transposition. Upper gastrointestinal series show the gastric twist with an upstream dilatation of the gastric tube in some patients. Data on its management have remained scarce. The objective was to assess the efficacy and safety of endoscopic balloon dilatation in the management of functional post-sleeve gastrectomy stenosis. Patients and Methods: Twenty-two patients with functional post-primary-sleeve-gastrectomy stenosis who had an endoscopic balloon dilatation between 2017 and 2023 were included in this retrospective study. Patients with alternative treatment plans and those undergoing endoscopic dilatation for other forms of gastric stenosis were excluded. The clinical outcomes were used to evaluate the efficacy and safety of balloon dilatation in the management of functional gastric stenosis. Results: A total of 45 dilatations were performed with a 30 mm balloon in 22 patients (100%), a 35 mm balloon in 18 patients (81.82%), and a 40 mm balloon in 5 patients (22.73%). The patients' clinical responses after the first balloon dilatation were a complete clinical response (4 patients, 18.18%), a partial clinical response (12 patients, 54.55%), and a non-response (6 patients, 27.27%). Nineteen patients (86.36%) had achieved clinical success at six months. Three patients (13.64%) who remained symptomatic even after achieving the maximal balloon dilation of 40 mm were considered failure of endoscopic dilatation, and they were referred for surgical intervention. No significant adverse events were found during or following the balloon dilatation. Conclusions: Endoscopic balloon dilatation is an effective and safe minimally invasive procedure in the management of functional post-sleeve-gastrectomy stenosis.
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Dilatação , Gastrectomia , Humanos , Masculino , Feminino , Gastrectomia/métodos , Gastrectomia/efeitos adversos , Pessoa de Meia-Idade , Estudos Retrospectivos , Dilatação/métodos , Dilatação/instrumentação , Dilatação/efeitos adversos , Adulto , Resultado do Tratamento , Constrição Patológica/terapia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/etiologiaRESUMO
Background and Objectives: Endoscopic biliary plastic stenting is a safe and effective temporary therapeutic modality used in various benign biliary disorders. Long-term indwelling stents for more than one year without retrieval are termed "forgotten biliary stents". In clinical practice, the forgotten stents are underestimated and the majority of data were obtained from case reports. The aim of this study was to determine the forgotten-biliary-plastic-stent-related complications, their management, and the patients' clinical outcomes. Materials and Methods: This retrospective study was performed at three hospitals during the period from January 2021 to December 2023. In total, 577 patients with biliary plastic stents-inserted for a variety of benign biliary conditions-were included. They were divided into two groups, as follows: group 1 included 527 patients who had biliary stents removed within 3 months, and group 2 included 50 patients with biliary stents retrieved after one year of their deployment. The stent-related complications (e.g., acute cholangitis, stent clogging, distal stent migration, new common bile duct (CBD) stone formation, and proximal stent migration) and the endoscopic management success rate were evaluated. Results: Irretrievable CBD stones were the main indication for biliary plastic stenting in both groups. The stent-related complications, number of endoscopic sessions, and hospital admissions were significantly higher in the patients with forgotten biliary stents than those with stent removal within 3 months. All the study patients were successfully managed endoscopically with uneventful outcomes. Conclusions: Based on this retrospective study, non-adherence to the endoscopists' instructions is the main reason for retained biliary stents for more than one year. The patients with forgotten stents had significantly higher complication rates, a higher number of endoscopic sessions, and a higher number of hospital admissions than those with stents that were retrieved in the scheduled time. All patients were managed endoscopically with a technical success rate of 100%, and with no complication-related mortality.
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Stents , Humanos , Masculino , Estudos Retrospectivos , Stents/efeitos adversos , Stents/normas , Stents/estatística & dados numéricos , Feminino , Pessoa de Meia-Idade , Idoso , Plásticos , Adulto , Idoso de 80 Anos ou mais , Resultado do Tratamento , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Remoção de Dispositivo/estatística & dados numéricos , Remoção de Dispositivo/métodos , Complicações Pós-Operatórias/etiologiaRESUMO
PMEPA1 (prostate transmembrane protein, androgen-induced 1)/TMEPAI (transmembrane prostate androgen-induced protein) is highly expressed in diverse cancers, including breast, lung and prostate cancers. It consists of four isoforms with distinct extracellular regions (isoforms a-d). The expression and function of these isoforms are still poorly understood. Hence, we aimed to identify the preferentially expressed isoforms in breast cancer cells and analyze possible differences in tumorigenic functions. In this study, we used 5' Rapid Amplification of cDNA Ends (RACE) and Western blot analyses to identify the mRNA variants and protein isoforms of TMEPAI and found that TMEPAI isoform d as the major isoform expressed by TGF-ß stimulation in breast cancer cells. We then generated CRISPR/Cas9-mediated TMEPAI knockout (KO) breast cancer cell lines and used a lentiviral expression system to complement each isoform individually. Although there were no clear functional differences between isoforms, double PPxY (PY) motifs and a Smad-interaction motif (SIM) of TMEPAI were both essential for colony and sphere formation. Collectively, our results provide a novel insight into TMEPAI isoforms in breast cancer cells and showed that coordination between double PY motifs and a SIM of TMEPAI are essential for colony and sphere formation but not for monolayer cell proliferation.
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Neoplasias da Mama/metabolismo , Regulação Neoplásica da Expressão Gênica/genética , Proteínas de Membrana/metabolismo , Proteínas Smad/metabolismo , Motivos de Aminoácidos , Animais , Neoplasias da Mama/genética , Células COS , Carcinogênese/genética , Proliferação de Células/genética , Chlorocebus aethiops , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Técnicas de Inativação de Genes , Células HEK293 , Humanos , Proteínas de Membrana/genética , Organoides/metabolismo , Fosfatidilinositol 3-Quinase/metabolismo , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Proteínas Smad/genética , Fator de Crescimento Transformador beta/farmacologiaRESUMO
Alzheimer's disease (AD) is a severe irreversible neurodegenerative disease that has great sufferings on patients and eventually leads to death. Early detection of AD and its prodromal stage, mild cognitive impairment (MCI) which can be either stable (sMCI) or progressive (pMCI), is highly desirable for effective treatment planning and tailoring therapy. Recent studies recommended using multimodal data fusion of genetic (single nucleotide polymorphisms, SNPs) and neuroimaging data (magnetic resonance imaging (MRI) and positron emission tomography (PET)) to discriminate AD/MCI from normal control (NC) subjects. However, missing multimodal data in the cohort under study is inevitable. In addition, data heterogeneity between phenotypes and genotypes biomarkers makes learning capability of the models more challenging. Also, the current studies mainly focus on identifying brain disease classification and ignoring the regression task. Furthermore, they utilize multistage for predicting the brain disease progression. To address these issues, we propose a novel multimodal neuroimaging and genetic data fusion for joint classification and clinical score regression tasks using the maximum number of available samples in one unified framework using convolutional neural network (CNN). Specifically, we initially perform a technique based on linear interpolation to fill the missing features for each incomplete sample. Then, we learn the neuroimaging features from MRI, PET, and SNPs using CNN to alleviate the heterogeneity among genotype and phenotype data. Meanwhile, the high learned features from each modality are combined for jointly identifying brain diseases and predicting clinical scores. To validate the performance of the proposed method, we test our method on 805 subjects from Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. Also, we verify the similarity between the synthetic and real data using statistical analysis. Moreover, the experimental results demonstrate that the proposed method can yield better performance in both classification and regression tasks. Specifically, our proposed method achieves accuracy of 98.22%, 93.11%, and 97.35% for NC vs. AD, NC vs. sMCI, and NC vs. pMCI, respectively. On the other hand, our method attains the lowest root mean square error and the highest correlation coefficient for different clinical scores regression tasks compared with the state-of-the-art methods.
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Doença de Alzheimer , Disfunção Cognitiva , Doenças Neurodegenerativas , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/genética , Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/genética , Humanos , Imageamento por Ressonância Magnética , Redes Neurais de Computação , NeuroimagemRESUMO
STATEMENT OF PROBLEM: Evidence relating to the choice of materials for single implant-supported crowns is sparse. PURPOSE: The purpose of this systematic review and meta-analysis was to assess articles that compared the clinical performance of ceramic and metal-ceramic (MC) implant-supported single crowns with regard to prosthesis failure, complication rate, and patient satisfaction. MATERIAL AND METHODS: A comprehensive search of databases (PubMed/MEDLINE, Scopus, and Cochrane Library) was performed. The last search was conducted in December 2019. Randomized clinical trials comparing ceramic and MC implant-supported single crowns with at least a 12-month follow-up were included, all of which were published in English. The pooled effects were presented as both a risk difference (RD) and mean difference according to the type of data with 95% confidence intervals (CIs). RESULTS: Seven randomized clinical trials fulfilled the eligibility criteria and were included in the meta-analysis. The pooled data did not show any statistically significant differences concerning prosthesis failure (RD: 0.000, 95% CI: -0.05 to 0.06), marginal bone loss (mean difference [MD]: -0.02, 95% CI: -0.75 to 0.35), mechanical complications (RD: -0.06, 95% CI: -0.18 to 0.07), biological complications (RD: 0.02, 95% CI: -0.07 to 0.11), or patient satisfaction (MD: 4.86, 95% CI: -2.86 to 12.58). CONCLUSIONS: Ceramic and MC crowns had similar outcomes with regard to prosthesis failure, mechanical and biological complication rates, and patient satisfaction. As a result, the selection of single implant crown material depends on the preference of the dentist and patient.
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Implantes Dentários , Falha de Restauração Dentária , Cerâmica , Coroas , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Herpesviruses have acquired numerous genes from their hosts. Although these homologs are not essential for viral replication, they often have important immunomodulatory functions that ensure viral persistence in the host. Some of these viral molecules are called virokines as they mimic cellular cytokines of their host such as interleukin-10 (cIL-10). In recent years, many viral homologs of IL-10 (vIL-10s) have been discovered in the genome of members of the order Herpesvirales. For some, gene and protein structure as well as biological activity and potential use in the clinical context have been explored. Besides virokines, herpesviruses have also captured genes encoding membrane-bound host immunomodulatory proteins such as major histocompatibility complex (MHC) molecules. These viral MHC mimics also retain many of the functions of the cellular genes, in particular directly or indirectly modulating the activity of natural killer cells. The mechanisms underlying capture of cellular genes by large DNA viruses are still enigmatic. In this review, we provide an update of the advances in the field of herpesviral gene piracy and discuss possible scenarios that could explain how the gene transfer from host to viral genome was achieved.
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Herpesviridae/genética , Interações Hospedeiro-Patógeno/genética , Fatores Imunológicos/genética , Imunomodulação/genética , Animais , Citocinas/genética , Humanos , Proteínas Virais/genéticaRESUMO
OBJECTIVES: To evaluate how various tooth preparation designs impact the adaptation-both at the margins and internally-and the retentive strength of computer-aided design and computer-aided manufacturing (CAD/CAM) produced endocrowns. MATERIALS AND METHODS: 60 extracted human mandibular first molars were endodontically treated and assigned into three groups (n = 20) according to the tooth preparation design: Group N: butt joint design, Group F and F1 received 1- and 2-mm circumferential ferrule preparation, respectively. Endocrowns were milled using either lithium disilicate glass-ceramic (IPS emax ceramic) or monolithic zirconia. The internal and marginal adaptation of the endocrowns were evaluated using the replica technique. After cementation, the endocrowns of all test groups were dislodged axially at 0.5 mm/min using a universal testing machine. A 2-way ANOVA and the independent samples t-test (α = .05) were performed to statistically analyze the data. RESULTS: The effect of changing the design of the tooth preparation (butt joint, ferrule) on the marginal and internal gap was shown to be statistically significant (p < .05); the lower gap values were recorded at the axial followed by cervical, marginal, and pulpal floor walls in both ceramic groups regardless of the teeth preparation design. The ANOVA test revealed similar average removal forces and stresses for the two types of tested ceramic materials. CONCLUSION: IPS emax ceramic adapted better than monolithic zirconia ceramic, regardless of the preparation design. Ferrule preparation design is more retentive than butt joint preparation, regardless of the type of ceramic material used.
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Coroas , Planejamento de Prótese Dentária , Zircônio , Humanos , Planejamento de Prótese Dentária/métodos , Teste de Materiais , Cerâmica , Preparo do Dente , Desenho Assistido por ComputadorRESUMO
OBJECTIVES: The study aimed to evaluate the debonding resistance of three different endocrown designs on molar teeth, using three different zirconia surface pretreatments. MATERIAL AND METHOD: Ninety human mandibular first molars were divided into three main groups: endocrowns without ferrule, with 1 mm ferrule, and with 2 mm ferrule. The subgroups were defined by their surface pretreatment method used (n = 15): 50 µm alumina air-particle abrasion, silica coating using 30 µm Cojet™ particles, and Zircos-E® etching. The endocrowns were fabricated using multilayer zirconia ceramic, cemented with self-adhesive resin cement, and subjected to 5000 thermocycles (5-55°C) before debonding. The data obtained were analyzed using a two-way ANOVA. RESULTS: All test specimens survived the thermocyclic aging. The results indicated that both the preparation design and the surface treatment had a significant impact on the resistance to debonding of the endocrowns (p < .001). The 2 mm ferrule followed by the 1 mm ferrule designs exhibited the highest debonding resistance, both were superior to the endocrown without ferrule. Zircos-E® etching and silica coating yielded comparable debonding resistance, which were significantly higher than alumina air-particle abrasion. All endocrowns demonstrated a favorable failure mode. CONCLUSIONS: All designs and surface treatments showed high debonding resistance for a single restoration. However, ferrule designs with Zircos-E® etching or silica coating may represent better clinical options compared to the nonferrule design or alumina airborne-particle abrasion. Nonetheless, further research, including fatigue testing and evaluations with different luting agents is recommended.
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Óxido de Alumínio , Dióxido de Silício , Propriedades de Superfície , Zircônio , Óxido de Alumínio/química , Humanos , Dióxido de Silício/química , Zircônio/química , Dente Molar , Teste de Materiais , Abrasão Dental por Ar/métodos , Cimentos de Resina/química , Corrosão Dentária/métodos , Análise do Estresse Dentário , Planejamento de Prótese DentáriaRESUMO
The study aimed to assess the marginal, axial, and internal adaptation, as well as the fracture resistance of zirconia-reinforced lithium silicate (ZLS) endocrowns with varying pulpal inlay extensions and marginal geometry. Sixty extracted maxillary first molar teeth were divided into six groups (n = 10) according to pulpal inlay extension and marginal configuration. The first three groups (J2, J3, and J4) utilized prepared teeth for endocrowns without ferrule design and 2 mm, 3 mm, and 4 mm pulpal extensions, respectively. The second three groups (F2, F3, and F4) utilized prepared teeth with 1 mm shoulder margins and 2 mm, 3 mm, and 4 mm pulpal extensions. The endocrowns were fabricated from ZLS blocks using CAD/CAM milling technology. After cementation, the specimens underwent thermal aging for 5000 cycles and were evaluated for marginal adaptation. Using a universal testing machine, the fracture resistance was tested under quasistatic loading (1 mm/min). Two-way ANOVA and the Tukey's post hoc test were employed for data analysis (p ≤ 0.05). The results of this study revealed that endocrowns without ferrule exhibited superior fracture strength than a 1 mm ferrule design p < 0.05, irrespective of the inlay depth. All designs with and without ferrule and all inlay depths showed clinically acceptable marginal and internal fit. The conventional endocrown design without ferrule and 2 mm inlay depth showed the lowest surface gap. The pulpal surface showed the highest discrepancy among all groups compared to the other surfaces. Endocrowns without ferrule are more conservative and have higher fracture strength than 1 mm ferrule designs; extending the inlay depth showed a significant increase in fracture resistance of the 1 mm ferrule design, but not for the conventional design without ferrule and 2 mm inlay depth. All groups exhibited a high auspicious fracture strength value for molar endocrown restorations.
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BACKGROUND: The neutrophil percentage-to-albumin ratio (NPAR) is a novel measure of systemic inflammation and infection. Low albumin levels increase the risk of infection, while high neutrophil counts indicate the presence of infection. Spontaneous bacterial peritonitis (SBP) is a serious infection in cirrhotic ascites, and the potential of NPAR in diagnosing SBP is not yet established. OBJECTIVE: The objective of this study is to determine the diagnostic value of NPAR in identifying SBP. PATIENTS: This prospective multicenter study included 465 patients diagnosed with cirrhotic ascites and SBP according to international guidelines. Demographic, clinical, and laboratory data were collected. The sensitivity and specificity of NPAR values for diagnosing SBP were assessed using the receiver operating characteristic curve. RESULTS: For SBP diagnosis in the total cohort, NPAR of > 17 had a sensitivity of 85.71%, specificity of 66.67%, and 95% CI (42.1-99.6). In culture-positive SBP, the NPAR at a cut-off > 5.2 had a sensitivity of 85.71%, specificity of 83.33%, and 95% CI (0.709 to 0.979), while in culture-negative SBP, the NPAR at a cut-off > 2.1 had a sensitivity of 92.86%, specificity of 33.33% and CI (0.367 to 0.764). The multivariate analysis revealed that albumin (OR = 2.78, [1.11;3.98], INR (OR = 0.198, [0.066;0.596], creatinine (OR = 0.292, [0.1; 0.81], CRP (OR = 3.18, [1.239;4.52] total leukocytic count (TLC) (OR = 1.97, [1.878; 2.07], platelets (OR = 2.09, [0.99; 2.31] and neutrophil (OR = 3.43, [1.04;3.89] were significantly associated with higher prediction rates for culture positive SBP. CONCLUSIONS: NPAR could be a new, affordable, noninvasive test for diagnosing SBP.
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BACKGROUND: Diagnosis of cutaneous hypopigmentation can sometimes be challenging. Dermoscopy may play a role in identifying hypo or-depigmented dermatoses. The aim was to investigate which dermoscopic criteria represent potent indicators for the diagnosis of vitiligo, nevus depigmentosus, pityriasis alba, hypopigmented pityriasis versicolor, idiopathic guttate hypomelanosis, hypopigmented mycosis fungoides (MF), lichen sclerosus et atrophicus and ash leaf hypopigmented macules of tuberous sclerosis, and evaluate their diagnostic accuracy. 168 individuals diagnosed with one of these hypopigmented disorders were evaluated for the presence or absence of predetermined dermoscopic criteria. Evaluation of dermatoscopic characteristics in each condition and analysis for sensitivity and specificity of dermatoscopic diagnosis in these hypopigmented lesions was performed. The starburst pattern, micro-koebnerization, and trichrome pattern were unique to vitiligo diagnosis. Vitiligo had higher comet-tail appearance, perifollicular pigmentation, and perilesional hyperpigmentation than other hypopigmented illnesses. Other hypopigmented lesions had greater incidence of amoeboid pattern, faint or diminished pigment network, islands of pigmentation, ill-defined boundaries, pseudopods, and widespread scaling than vitiligo. Finally, perifollicular scaling, comedo-like openings, blue-gray specks, and fibrotic regions excluded vitiligo. Dermoscopy can help identify common hypopigmented skin lesions and reduce the need for skin biopsy. Nevus depigmentosus, pityriasis alba and idiopathic guttate hypomelanosis were the top three hypopigmented dermatoses that could be diagnosed by dermoscopy with 100% sensitivity. Vitiligo was in the second rank (94.7%), followed by lichen sclerosis et atrophicus (93.3%) then hypopigmented MF at 81.2% sensitivity. Dermoscopy sensitivity was lowest in pityriasis versicolor and ash leaf macules of tuberous sclerosis (52.6% and 46.7%, respectively).
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Dermoscopia , Hipopigmentação , Sensibilidade e Especificidade , Vitiligo , Humanos , Hipopigmentação/diagnóstico , Hipopigmentação/diagnóstico por imagem , Hipopigmentação/patologia , Feminino , Masculino , Adolescente , Adulto , Criança , Vitiligo/diagnóstico , Vitiligo/diagnóstico por imagem , Vitiligo/patologia , Adulto Jovem , Pessoa de Meia-Idade , Pré-Escolar , Pele/patologia , Pele/diagnóstico por imagem , Diagnóstico Diferencial , IdosoRESUMO
Cephalosporin-resistant Escherichia coli has been increasingly reported worldwide. In this study, 32 cephalosporin resistant E. coli isolates identified from cancer patients in Cairo, Egypt in 2009-2010 were analyzed. Twenty-three were of phylogenetic group D, seven A and one each B1 and B2. By rep-PCR 15 phylogroup D isolates were grouped in four clusters, one with sequence type (ST) 405 and three ST68. Seventeen isolates showed single patterns. blaCTX-M-15 and aac(6')-Ib-cr were the most common resistance determinants. blaOXA-48 and blaVIM were also detected. Multidrug resistant E. coli seriously affects healthcare, especially in immunocompromised hosts, such as cancer patients.
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Antibacterianos/farmacologia , Cefalosporinas/farmacologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/efeitos dos fármacos , Neoplasias/complicações , Resistência beta-Lactâmica , Adulto , Criança , Pré-Escolar , Análise por Conglomerados , DNA Bacteriano/genética , Egito , Escherichia coli/classificação , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Genes Bacterianos , Genótipo , Humanos , Tipagem Molecular , Reação em Cadeia da Polimerase , Estudos Retrospectivos , beta-Lactamases/genéticaRESUMO
Cancer is considered one of the most burdensome diseases affecting lives and, hence, the economy. Breast cancer is one of the most common types of cancer. Patients with breast cancer are divided into two groups: one group responds to the chemotherapy, and the other group resists the chemotherapy. Unfortunately, the group which resists the chemotherapy is still suffering the pain associated with the severe side effects of the chemotherapy. Therefore, there is a critical need for a method to differentiate between both groups before the administration of the chemotherapy. Exosomes, the recently discovered nano-vesicles, are often used as cancer diagnostic biomarkers as their unique composition allows them to represent their parental cells, which makes them promising indicators for tumor prognosis. Exosomes contain proteins, lipids, and RNA that exist in most body fluids and are expelled by multiple cell types, including cancer cells. Furthermore, exosomal RNA has been significantly used as a promising biomarker for tumor prognosis. Herein, we have developed an electrochemical system that could successfully differentiate between MCF7 and MCF7/ADR depending on the exosomal RNA. The high sensitivity of the proposed electrochemical assay opens the door for further investigation that will address the other type of cancer cells.
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Objectives Circadian dysregulation (jetlag), sleep loss (extended wakefulness), sleep deprivation (acute or chronic), fatigue (exhaustion), preexisting medical and mental conditions, and medication use can all affect the cognitive and behavioral performance of commercial aircraft pilots. This study evaluated the sleep habits of pilots and copilots flying short-haul flights in the Gulf region. Methods This cross-sectional study examined Airbus A320 pilots and copilots for one of Saudi Arabia's commercial airlines. Data such as age, sex, body mass index (BMI), employment position, work experience, flight hours, and rest time were collected. Each participant completed the Epworth Sleepiness Scale (ESS) for daytime sleepiness, the Pittsburgh Sleep Quality Index (PSQI), and the Fatigue Severity Index (FSI). Actigraphy equipment was used to perform objective sleep evaluations. Results Twenty-four participants were included. Actigraphy showed that 66.7% had an irregular sleep pattern and that 41.7% had poor sleep efficiency. We found that 12.5% had daytime sleepiness, 33% had poor sleep quality, and 29.2% had fatigue. We found a significant negative correlation between years of experience and time in bed; however, there was no significant difference in sleep time or sleep efficiency between pilots with different levels of experience. Conclusions We found that pilots and copilots are at risk of irregular sleep patterns, poor sleep efficiency, poor sleep quality, daytime sleepiness, and fatigue. This study emphasizes the need to instigate measures to minimize these risks.
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An ideal denture base must have good physical and mechanical properties, biocompatibility, and esthetic properties. Various polymeric materials have been used to construct denture bases. Polymethyl methacrylate (PMMA) is the most used biomaterial for dentures fabrication due to its favorable properties, which include ease of processing and pigmenting, sufficient mechanical properties, economy, and low toxicity. This article aimed to comprehensively review the current knowledge about denture base materials (DBMs) types, properties, modifications, applications, and construction methods. We searched for articles about denture base materials in PubMed, Scopus, and Embase. Journals covering topics including dental materials, prosthodontics, and restorative dentistry were also combed through. Denture base material variations, types, qualities, applications, and fabrication research published in English were considered. Although PMMA has several benefits and gained popularity as a denture base material, it has certain limitations and cannot be classified as an ideal biomaterial for fabricating dental prostheses. Accordingly, several studies have been performed to enhance the physical and mechanical properties of PMMA by chemical modifications and mechanical reinforcement using fibers, nanofillers, and hybrid materials. This review aimed to update the current knowledge about DBMs' types, properties, applications, and recent developments. There is a need for specific research to improve their biological properties due to patient and dental staff adverse reactions to possibly harmful substances produced during their manufacturing and use.
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BACKGROUND AND AIM: There is lack of 30-day hospital readmission prediction score in patients with liver cirrhosis and SBP. The aim of this study is to recognize factors capable of predicting 30-day readmission and to develop a readmission risk score in patients with SBP. METHODS: This study prospectively examined the 30-day hospital readmission for patients previously discharged with a diagnosis of SBP. Based on index hospitalization variables, a multivariable logistic regression model was implemented to recognize predictors of patient hospital readmission within 30 days. Consequently, Mousa readmission risk score was established to predict 30-day hospital readmission. RESULTS: Of 475 patients hospitalized with SBP, 400 patients were included in this study. The 30-day readmission rate was 26.5%, with 16.03% of patients readmitted with SBP. Age ≥ 60, MELD > 15, serum bilirubin > 1.5 mg/dL, creatinine > 1.2 mg/dL, INR > 1.4, albumin < 2.5 g/dL, platelets count ≤ 74 (103/dL) were found to be independent predictors of 30-day readmission. Incorporating these predictors, Mousa readmission score was established to predict 30-day patient readmissions. ROC curve analysis demonstrated that at a cutoff value ≥ 4, Mousa score had optimum discriminative power for predicting the readmission in SBP with sensitivity 90.6% and specificity 92.9%. However, at cutoff value ≥ 6 the sensitivity and specificity were 77.4% and 99.7%, respectively, while a cutoff value ≥ 2 had sensitivity of 99.1% and specificity of 31.6%. CONCLUSIONS: The 30-day readmission rate of SBP was 25.6%. With the suggested simple risk assessment Mousa score, patients at high risk for early readmission can be easily identified so as to possibly prevent poorer outcomes.
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Infecções Bacterianas , Peritonite , Humanos , Readmissão do Paciente , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Cirrose Hepática/complicações , Peritonite/diagnóstico , Peritonite/microbiologiaRESUMO
Introduction: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted the danger posed by human coronaviruses. Rapid emergence of immunoevasive variants and waning antiviral immunity decrease the effect of the currently available vaccines, which aim at induction of neutralizing antibodies. In contrast, T cells are marginally affected by antigen evolution although they represent the major mediators of virus control and vaccine protection against virus-induced disease. Materials and methods: We generated a multi-epitope vaccine (PanCoVac) that encodes the conserved T cell epitopes from all structural proteins of coronaviruses. PanCoVac contains elements that facilitate efficient processing and presentation of PanCoVac-encoded T cell epitopes and can be uploaded to any available vaccine platform. For proof of principle, we cloned PanCoVac into a non-integrating lentivirus vector (NILV-PanCoVac). We chose Roborovski dwarf hamsters for a first step in evaluating PanCoVac in vivo. Unlike mice, they are naturally susceptible to SARS-CoV-2 infection. Moreover, Roborovski dwarf hamsters develop COVID-19-like disease after infection with SARS-CoV-2 enabling us to look at pathology and clinical symptoms. Results: Using HLA-A*0201-restricted reporter T cells and U251 cells expressing a tagged version of PanCoVac, we confirmed in vitro that PanCoVac is processed and presented by HLA-A*0201. As mucosal immunity in the respiratory tract is crucial for protection against respiratory viruses such as SARS-CoV-2, we tested the protective effect of single-low dose of NILV-PanCoVac administered via the intranasal (i.n.) route in the Roborovski dwarf hamster model of COVID-19. After infection with ancestral SARS-CoV-2, animals immunized with a single-low dose of NILV-PanCoVac i.n. did not show symptoms and had significantly decreased viral loads in the lung tissue. This protective effect was observed in the early phase (2 days post infection) after challenge and was not dependent on neutralizing antibodies. Conclusion: PanCoVac, a multi-epitope vaccine covering conserved T cell epitopes from all structural proteins of coronaviruses, might protect from severe disease caused by SARS-CoV-2 variants and future pathogenic coronaviruses. The use of (HLA-) humanized animal models will allow for further efficacy studies of PanCoVac-based vaccines in vivo.
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COVID-19 , Vacinas Virais , Cricetinae , Humanos , Animais , Camundongos , COVID-19/prevenção & controle , SARS-CoV-2 , Vacinas contra COVID-19 , Epitopos de Linfócito T , Administração Intranasal , Anticorpos Neutralizantes , Antígenos HLA-ARESUMO
Two genetically unrelated OXA-163-carrying Klebsiella pneumoniae strains were identified from two infection cases in June 2009 and May 2010 in Cairo, Egypt. OXA-163-producing Enterobacteriaceae had been previously reported in Argentina only. Both patients had no history of travel abroad. The emergence of this newly recognized OXA-48-related ß-lactamase able to hydrolyze cephalosporins and carbapenems is especially worrying in a geographic area where OXA-48 is endemic and effective surveillance for antibiotic resistance is largely unaffordable.