EPA Consensus Project Paper: Do Implant- Supported/Retained Prostheses Improve the Quality of Life of Patients with Intraoral Maxillofacial Defects? - A Systematic Review.

BACKGROUND: There is limited evidence available regarding patient satisfaction and quality of life assessment in patients with intraoral maxillofacial defects managed with maxillofacial prostheses. OBJECTIVES: This systematic review aims to understand the impact of intraoral implant prostheses in improving the quality of life in patients with intraoral maxillofacial defects/abnormalities. METHODS: A comprehensive search was performed of nine electronic databases from January 1970 to August 2022. Hand searching of the reference lists of the included papers and of relevant journal publications between 2012 and 2022 was also undertaken. Key information was extracted from included studies alongside quality and risk of bias assessments. RESULTS: The systematic review encompassed a total of seven studies, comprising five retrospective and two prospective investigations, with one of the prospective studies being a randomised clinical trial. The evaluation of the risk of bias and quality assessment revealed heterogeneity in the results, preventing meaningful comparisons among the included studies. CONCLUSION: Within the limitation of the systematic review, there is limited evidence to suggest that implant prostheses improve the quality of life in patients with intraoral maxillofacial defects or abnormalities.

A systematic review of methods used to sample and analyse periradicular tissue fluid during root canal treatment.

AIM: The primary aim was to identify techniques used to sample and analyse periradicular tissue fluid (PTF) in permanent teeth diagnosed with apical disease during root canal treatment. Secondly, to identify the types of inflammatory mediators studied using this approach. METHODOLOGY: Data Sources: PubMed, EMBASE, Cochrane Library, Science Direct, Web of Science and OpenGrey. Eligibility Criteria: Clinical studies published until 1 June 2018 which utilized orthograde techniques to sample and analyse PTF were included. Cell culture, laboratory or animal studies and those concerned with investigating inflammatory mediator activity from within healthy or diseased pulp tissue, and not periradicular tissues, were excluded. Study appraisal and methods: In accordance with PRISMA guidelines, data were extracted on study characteristics, target mediators, sampling and assay techniques and the parameters associated with the PTF sampling and eluting protocol. A qualitative synthesis was conducted, and studies were critically appraised using a modified version of the Cochrane risk of bias tool. RESULTS: Study Characteristics: From 251 studies, 33 were eligible for inclusion. Sampling techniques included the use of paper points (n = 27), fine needle aspiration (n = 4) and filter strips (n = 2). Assay techniques included enzyme-linked immunosorbent assay (n = 18), quantitative polymerase chain reaction (n = 9), radioimmunoassay (n = 4), colorimetric assay (n = 2), immunofluorometric assay (n = 1) and cytometric bead array (n = 1). Forty-five different inflammatory mediators were targeted at the proteomic/metabolomic (n = 25) or transcriptomic level (n = 9). LIMITATIONS: Significant heterogeneity exists within the methodology, and only 5 studies disclosed unambiguous information about their PTF sampling and eluting protocols. CONCLUSIONS: Paper points and proteomic/metabolomic analysis are currently the preferred methods for studying and analysing PTF during root canal treatment. The most studied analytes were IL-1ß and TNF-α. IMPLICATIONS: Further research is required to develop an optimized PTF sampling and eluting protocol to overcome methodological heterogeneity, and future studies are advised to follow a standardized approach to reporting their methodology.

Why might patients in the UK consult a general medical practitioner when experiencing dental problems? A literature review of patients' perspectives.

OBJECTIVE: to systematically appraise and synthesise the existing evidence regarding the reasons why patients in the UK may consult a general medical practitioner (GMP) when experiencing a dental problem. BASIC RESEARCH DESIGN: a systematic review of the scientific and grey literature published between 1996 and 2017. PARTICIPANTS: dental service users (adults or children) from the UK and/or their carers who were seeking, or had sought, care for a dental problem from a GMP. MAIN OUTCOMES: patients' perspectives on reasons for consulting a GMP were qualitatively synthesised according to Levesque et al.'s conceptual framework of access to health care. RESULTS: Out of 1,232 references screened, 2 studies met the inclusion criteria for the review. They identified the following factors that can influence care-seeking for dental problems: patients' interpretation of their symptoms; their understanding of practitioners' scope of practice; the availability of timely dental care; and the affordability of care. Both studies had weaknesses with regard to either their conduct and/or reporting. CONCLUSIONS: Choice of practitioner for dental problems is likely to be influenced by both the beliefs and attitudes of the individual patient and the organisation and attributes of the providers of dental and medical care. However, in light of the quality of the existing evidence base, there is a need for high-quality studies exploring the reasons why patients in the UK may seek care from a GMP when experiencing dental problems.

Effects of silver nanoparticles on survival, biomass change and avoidance behaviour of the endogeic earthworm Allolobophora chlorotica.

Increasing commercial application of silver nanoparticles (Ag NP) and subsequent presence in wastewater and sewage sludge has raised concerns regarding their effects in the aquatic and terrestrial environment. Several studies have employed standardised acute and chronic earthworm-based tests to establish the toxicological effects of Ag NP within soil. These studies have relied heavily on the use of epigiec earthworm species which may have limited ecological relevance in mineral soil. This study assessed the influence of Ag NP (uncoated 80nm powder) and AgNO3 on survival, change in biomass and avoidance behaviour in a soil dwelling (endogiec) species, Allolobophora chlorotica. Earthworms were exposed for 14 days to soils spiked with Ag NP or AgNO3 at 0, 12.5, 25, 50 and 100mgkg-1 either separately for survival and biomass measurement, or combined within a linear gradient to assess avoidance. Avoidance behaviour was shown to provide the most sensitive endpoint with an observable effect at an Ag NP/AgNO3 concentration of 12.5mgkg-1 compared with 50mgkg-1 for biomass change and 100mgkg-1 for survival. Greater mortality was observed in AgNO3 (66.7%) compared with Ag NP-spiked soils (12.5%) at 100mgkg-1, attributed to increased presence of silver ions. Although comparison of results with studies employing Eisenia fetida and Eisenia andrei suggest that the A. chlorotica response to Ag NP is more sensitive, further research employing both epigeic and endogeic earthworms under similar experimental conditions is required to confirm this observation.

Avoidance, biomass and survival response of soil dwelling (endogeic) earthworms to OECD artificial soil: potential implications for earthworm ecotoxicology.

Soil dwelling earthworms are now adopted more widely in ecotoxicology, so it is vital to establish if standardised test parameters remain applicable. The main aim of this study was to determine the influence of OECD artificial soil on selected soil-dwelling, endogeic earthworm species. In an initial experiment, biomass change in mature Allolobophora chlorotica was recorded in Standard OECD Artificial Soil (AS) and also in Kettering Loam (KL). In a second experiment, avoidance behaviour was recorded in a linear gradient with varying proportions of AS and KL (100% AS, 75% AS + 25% KL, 50% KS + 50% KL, 25% AS + 75% KL, 100% KL) with either A. chlorotica or Octolasion cyaneum. Results showed a significant decrease in A. chlorotica biomass in AS relative to KL, and in the linear gradient, both earthworm species preferentially occupied sections containing higher proportions of KL over AS. Soil texture and specifically % composition and particle size of sand are proposed as key factors that influenced observed results. This research suggests that more suitable substrates are required for ecotoxicology tests with soil dwelling earthworms.

Urologic complications in renal transplant recipients by donor type.

BACKGROUND AND PURPOSE: Reduced donor morbidity has been established after laparoscopic donor nephrectomy compared with open harvest, but differences in recipient outcomes remain less obvious. We compared the urologic complications in patients receiving kidneys procured by cadaveric, open, and laparoscopic harvest. PATIENTS AND METHODS: A retrospective study of all the kidney transplantations performed between January 1998 and December 2003 was undertaken to extract 100 consecutive patients in each group. All urologic complications were obtained and grouped by the type of donor procurement. RESULTS: Overall, 48 of the 276 transplant patients (17%) had urologic complications: 14% of the cadaveric-donor recipients, 20% of the open-donor recipients, and 18% of the laparoscopic-donor recipients. There were no ureteral complications in the laparoscopic group. CONCLUSIONS: Laparoscopically procured donor kidneys were associated with significantly fewer recipient ureteral complications than open cadaver or live-donor procurement.

Complications of laparoscopic gastric banding in renal transplant recipients: a case study.

As bariatric surgery becomes more popular, the number of renal transplant recipients who undergo weight loss surgery will continue to grow. This population presents unique challenges because of increased infection risks, tendency to posttransplant weight gain, and inferior tissue-healing properties. We present two cases of renal transplant recipients who experienced the complications of band erosion and band migration after laparoscopic gastric banding, and we discuss the special considerations that apply to this patient population.

Relationship of renal transplantation to hypertension in end-stage renal failure.

The relationship of renal transplantation to new onset or persistence of previously established hypertension was analyzed in 164 transplant recipients in whom the renal allograft functioned for six months or longer. Of the 164, thirty-seven (23%) had normal blood pressure and 127 (77%) were hypertensive prior to transplantation. Following transplantation 83 patients (51%) were normotensive; high blood pressure was found in 81 (49%). Posttransplant hypertension could not be correlated with the recipient's original renal disease, age, sex, renal donor source, donor age, or maintenance dose of prednisone. More normotensive paients had undergone prior binephrectomy when compared with the hypertensive group (P less than .05). Mean serum creatinine levels was higher (2.0 mg/dl) in hypertensives than in normotensives (1.54 mg/dl) (P greater than .05). Selective renal veins' renin measurements in patients with severe hypertension were not helpful in predicting the beneficial effects of either bilateral nephrectomy or surgical correction of transplant renal artery stenosis.

Adverse impact of hypertension on diabetic recipients of transplanted kidneys.

The effect of hypertension on patient and allograft survival in 60 diabetic recipients of transplanted kidneys was assessed by retrospective chart analysis. Hypertension was present in 81% of recipients. Of eight of these patients who became normotensive after transplantation, all had functioning allografts and one died. By contrast, persistent hypertension after transplantation was associated with a higher mortality rate (25 of 54, 48%) and loss of kidney graft function (19 of 54, 35%). At a mean of 21 months after transplantation, living hypertensive diabetic recipients had worse renal function (mean serum creatinine of 3.1 mg/dl) than did nonhypertensive recipients (mean serum creatinine of 1.6 mg/dl). It is concluded that hypertension is a significant risk factor for diabetic patients and kidneys after transplantation.

Listeria monocytogenes: brain abscess or meningoencephalitis?

A brain abscess caused by Listeria monocytogenes developed in an immunosuppressed renal transplant patient. Meningitis and meningoencephalitis from this organism were encountered in three other renal transplant recipients at this medical center during the past 4 years. Focal neurologic deficits occurred in patients with either Listeria abscess or meningoencephalitis. Computerized tomography was a rapid aid to the diagnosis of abscess. Immunosuppression has increased the incidence of central nervous system Listeria infections, but ampicillin still provides effective treatment, even when immunosuppressive therapy is continued. Limited experience with Listeria brain abscess suggests that surgical intervention improves the prognosis.

Strategies for optimizing growth in children with kidney transplants.

Children with a well-functioning graft continue to show growth retardation even with low-dose prednisone. We have attempted to utilize the steroid-sparing effect of cyclosporine by discontinuing prednisone after graft stabilization. Since 1983, 53 children have received cyclosporine as primary immunosuppressant for renal graft maintenance. The children, aged 6 months to 18 years, received 60 transplants. One-year and four-year patient survival for cadaveric transplants was 91% and 91%, compared with 96% and 96% for living related transplants. One-year and four-year graft survivals were 82% and 65% for cadaveric transplants (n = 25), compared with 91% and 63% for living related transplants (n = 35). Of 53 patients, 23 were able to discontinue prednisone and be maintained on monodrug cyclosporine therapy, and 21 of the 53 patients had growth hormone measured using L-dopa stimulation. In patients receiving more than 5 mg of prednisone daily, growth hormone levels were lower than normal (less than 10 ng/ml). Of 15 patients who had discontinued prednisone for more than 6 months, 13 showed accelerated growth by improvement in their standard deviation scores. In 4 pubescent children with growth retardation and need for maintenance prednisone, accelerated growth occurred following growth hormone administration for 3-6 months. Based on these data we suggest that (1) discontinuation of even very small doses of prednisone may be essential for normalizing growth hormone response to L-dopa and (2) further studies are needed to exploit the growth stimulation effect of recombinant growth hormone in transplanted children.

Renal transplantation in multiple myeloma. Case report and review of the literature.

A patient with end-stage renal disease and known benign monoclonal gammopathy underwent kidney transplantation at Westchester County Medical Center, Valhalla, NY. After surgery, during routine follow-up, the patient had laboratory evidence of frank multiple myeloma. However, she did not show any clinical signs or symptoms of the disease. Four years later, the patient is asymptomatic and continues to have stable renal function. As a result of our experience, and that of others, we support transplantation as a viable option for patients with multiple myeloma.

Renal transplantation from elderly living donors.

A worldwide shortage of cadaveric donors has led to the increased utilization of elderly living donors, with controversial results. In an attempt to assess the effect of donor age on graft survival and subsequent renal function, we analyzed our clinical results in 276 consecutive recipients of living related renal transplants spanning both the cyclosporine and the azathioprine eras, of whom a total of 44 recipients received kidneys from donors over 55 years old. All recipients were otherwise similar in age, race, haplotype mismatch, number of retransplants, and number of pretransplant transfusions, apart from an increased number of diabetics among the CsA-treated recipients of elderly kidneys (38% vs. 14%). The cumulative patient and graft survival rates at 1 and 5 years were independent of donor age whether CsA or AZA was utilized. Nor was the incidence of rejection or infection significantly different in the older donor group when compared with the younger cohort. Short-term and intermediate-term renal function, as assessed by serum creatinine, was however poorer but stable in the older donor group when compared with the younger one. The mean serum creatinine levels at 1 year in the CsA- and AZA-treated recipients of kidneys from older donors were 2.4 and 2.0 mg/dl, respectively, compared with 1.6 and 1.4 mg/dl, respectively, when the donor age was less than 55 years (P less than 0.001). Since renal function at the end of the first posttransplant year is considered a determinant of long-term graft survival, this is a cause for concern, but in view of the universal shortage of organs and the negligible morbidity to donors, renal transplantation from elderly living donors remains an acceptable practice.

Diabetes mellitus after renal transplantation in the cyclosporine era--an analysis of risk factors.

Despite mounting experimental evidence that cyclosporine inhibits pancreatic islet cell function, clinical data on posttransplant diabetes mellitus (PTDM) in renal allograft recipients in the cyclosporine era are scarce. Between June 1983 and December 1988, 39 of 337 (11.6%) cyclosporine-treated adult renal transplant recipient whose grafts survived longer than 1 year developed PTDM. Of these, 43.6% and 74.4% were diagnosed by 3 and 12 months posttransplant, respectively, and 51.3% were insulin-dependent. Incidence of PTDM was highest in blacks (19.8%) and Hispanics (21.3%) and in those with HLA-A 30 and Bw 42 antigens. Older recipients and those that received cadaveric kidneys were more likely to develop diabetes than those who received living related allografts (14% vs. 5.3%, P less than 0.05). The rate of PTDM appeared to be independent of the type of induction, immunosuppressant therapy, incidence of rejection, total steroid and cyclosporine dose, percentage of body weight gain in the first posttransplant year, and serum creatinine concentration. Actuarial 5-year, decaying from 100% at 1 year, patient and graft survival rates were 87% and 70%, respectively, in the PTDM group compared with 93% and 90%, respectively, in controls. Causes of graft failure among the diabetics included chronic rejection (6), patient death (3), noncompliance with immunosuppressants (2), and sepsis (1). The incidence of infectious complications was significantly higher in the PTDM group compared with the control group (53% vs. 16%, P less than 0.05), with all 5 deaths among the diabetics being sepsis-related.

Influence of cadaver donor age on the success of kidney transplants.

To investigate the impact of donor age on the outcome of renal transplants, a retrospective analysis of 440 consecutive cadaver donor kidney transplants were performed by dividing the transplants into six groups, according to the decade of donor age. These groups were comparable with regard to recipient age, sex, race, and HLA matching grade, while the pediatric group received kidneys preferentially from the first and second decade donors. Although cadaver donor age, between 11 and 50 years, did not appear to influence the result of kidney transplants, the kidneys retrieved from the first and sixth or higher decades of donors fared significantly worse. Improved criteria for the evaluation, selection, and management of cadaver donors of extreme ages is needed to achieve a satisfactory result.

Prolonged epicardial mapping in myocardial infarction: the effects of propranolol and intra-aortic balloon pumping following coronary artery occlusion.

A methods of prolonged epicardial surface mapping of myocardial infarction by serial epicardial ECG's is described. The progression of infarction following coronary artery ligation in dogs was monitored over a 4 day period and the early and late changes in the configuration of the epicardial ECG's associated with the underlying myocardial injury were defined. The determination of the infarct size by surface mapping in vivo correlated accurately with the final infarct size determined by dehydrogenase staining in vitro. Treatment with propranolol resulted in a significant reduction in the infarct size. Treatment with intra-aortic balloon pumping did not alter the size of the myocardial infarction induced in this experimental model.

Ultrastructure of size-regulated hetero-spheroids composed of human keratinocytes and fibroblasts.

In order to develop a new in vitro skin model multicellular floating hetero-spheroids were prepared by culturing keratinocytes and fibroblasts on hydrophilic culture dishes coated with type I collagen and a thermo-responsive polymer. Upon decreasing the substratum's temperature to an ambient temperature, the spheroids detached from the substratum and were thereafter maintained in either: Medium I, a medium mixture of keratinocyte growth medium (KGM) and supplemented Dulbecco's modified Eagle's medium (DMEM) at a ratio of 1 to 2; or medium II, KGM for the initial 24 h followed by supplemented DMEM for the remainder of the culture periods. The spheroids displayed a typical pattern of an external rim of keratinocytes with an internal core of fibroblasts. A minute space separated the keratinocytes and fibroblasts. The stratification of cells cultured in medium II was more prominent than that of the cells cultured in medium I. Markers of the advanced stages of keratinization such as keratohyalin granules, membrane coating granules and the cornified envelope were not observed. Interestingly, keratinocytes underwent the same differentiation pathway as non-keratinized stratified epithelia such as esophagus. With consideration to keratinocyte-fibroblast interactions, it may be of interest to incorporate the study of such morphological impairments when investigating the effects of growth factors and their ligands.

Immunolocalization of epimorphin in skin.

Epimorphin was originally identified as a mesenchymal cell surface-associated protein that modulates epithelial morphogenesis in embryonic skin and lung epithelia. A previous report which utilized embryonic mouse skin, showed that epimorphin was localized non-homogeneously in a region adjacent to the epidermis and in a mesenchymal cell condensation located in front of growing hair follicles. We report herein a further detailed localization of this protein in adult mouse skin using immunoelectron microscopy. Epimorphin was found to be localized on the undersurface of basal cells, in the cytoplasm of cell processes of fibroblasts, as well as on the plasma membrane of fibroblasts, endothelial cells, pericytes, perineurium and endomysium. Our present finding indicated that epimorphin is one of the factors involved in multiple biological functions in a variety of structures derived from various origins and that it is not a specific epithelial morphogenetic factor.

A new vascular access for hemodialysis: the arterial jump graft.

In seven patients in whom conventional vascular access for maintenance hemodialysis was not possible, a new access in the form of a femoropopliteal jump graft was employed. A follow-up of 3 months to 3 years (92 patient months) and an experience of more than 1,000 dialysis treatments have shown it to be a stable and satisfactory access.

Vascular complications in human renal transplantation.

There were 13 arterial complications in 202 transplants done in 162 patients, an incidence of 6.5 percent. Renal arterial stenosis was demonstrated by angiogram in six kidneys; four were reconstructed successfully. Four renal arterial occlusions were found in delayed rejected kidneys. Of three arterial dehiscences secondary to infection, all led to graftectomy. One of these patients died 56 days later due to infectious hepatitis, and one underwent a successful retransplant. One patient had an occluded iliac artery which was repaired successfully. A single venous complication occurred in one patient.