Comparison of chemotherapy and hematopoietic stem cell transplantation pre and postterm DMFT scores: a preliminary study.

AIMS: Chemotherapy is frequently used as a conditioning regimen to destroy malignant marrow cells before transplantation. Xerostomia, dysphagia, altered taste perception, mucositis, soft-tissue ulceration, and infection are common adverse oral effects of chemotherapy. The study was aimed to compare decayed, missing, filled teeth (DMFT) scores before and after hematopoietic stem cell transplantation (HSCT) and chemotherapy. MATERIALS AND METHODS: Thirty-six patients undergoing HSCT were included in the study. A pre-HSCT dental treatment protocol was implemented that consisted of restoration of all active carious lesions, treatment of periodontal infections, and extraction of all teeth with advanced periodontal disease. Upon completion of dental treatment, the importance of rigorous and effective oral hygiene was reemphasized, and patients were recalled 6 months later. DMFT scores were calculated prior to the initiation of HSCT treatment and 6 months after transplantation. STATISTICAL ANALYSIS USED: Regression analysis was used to evaluate the effects of HSCT and chemotherapy on DMFT scores. RESULTS: Wilcoxon T test showed a statistically significant difference in DMFT scores before and after HSCT ( P < 0.001). CONCLUSIONS: DMFT scores were found to increase after chemotherapy and HSCT, suggesting that the risk of infection is higher among HSCT patients when compared to other individuals. The results emphasize the need for dental examinations as an integral part of examination and treatment planning for patients undergoing HSCT and chemotherapy.

Effect of hyaluronic acid on the osseointegration of dental implants.

The mechanism of osseointegration is related to many factors, including the quality of the bone, the biocompatibility and surface characteristics of the implant material, the surgical technique, and functional loading. The purpose of this study was to investigate the effects of hyaluronic acid gel on the osseointegration of implants placed in defined areas of the mandible in rabbits. Hyaluronic acid is known to have an osteoinductive effect during regeneration of bony defects, and we thought that it might also have a favourable effect on osseointegration, a specialised mechanism to heal bone. Ten New Zealand rabbits aged 10 weeks and weighing 2.5-3.0kg were used, and sites for implants that were far enough from the apices of the teeth in the mandibular molar area were chosen. Two cavities were prepared in each rabbit, one (anterior) for the control implant, and one (posterior) for the implant with hyaluronic acid gel (Medical Instinct GmbH, Bovenden). New bone and the osteoid matrix content around the dental implants were evaluated histologically and histomorphometrically two months after the operation, and no significant difference was found between the two groups.

Does Renal Tubular Injury-Induced Local Tissue Hypoxia Involve Post-Transplantation Erythrocytosis?

BACKGROUND: The pathogenesis of post-transplantation erythrocytosis (PTE) is not well understood and appears to be multifactorial. Our hypothesis in this study was that several factors, including toxicity of calcineurin inhibitor, immunologic factors, and chronic allograft nephropathy, can trigger local tissue hypoxia in peritubular interstitium, which is where production of erythropoietin (EPO) takes place. This local interstitial tissue hypoxia can cause an increase in renal EPO production, which induces the development of PTE. METHODS: This cross-sectional study included 15 renal transplant recipients, in whom polycythemia developed after kidney transplantation, with elevated hematocrit level to >51%. Forty-eight age- and gender-matched renal transplant recipients with normal hematocrit level were included as the renal transplant control group. In addition, 13 age- and gender-matched healthy subjects were also included as the healthy control group. We used urine hypoxia-inducible factor-2 alpha (HIF-2α) levels to evaluate whether there is local tissue hypoxia in renal allograft. HIF-2α levels were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). Serum EPO and insulin-like growth factor-1 (IGF-1) levels were also measured. RESULTS: HIF-2α levels were significantly lower in the polycythemia group than the other two groups, but there was no significant difference between the healthy control group and the renal transplant control group with regard to HIF-2α levels. There was no significant difference among the 3 study groups in terms of levels of serum EPO and IGF-1. CONCLUSION: Local tissue hypoxia in renal allograft does not seem to play an important role in the development of PTE.

Association Between Cardiac Valvular Calcification and Serum Fetuin-A Levels in Renal Transplant Recipients.

BACKGROUND: The presence of cardiac valvular calcification in patients with chronic kidney disease has become important. We aimed to evaluate the prevalence of cardiac valvular calcification and its association with serum Fetuin-A levels in kidney transplant recipients. METHODS: The cardiac valvular calcification was assessed by echocardiography in 89 kidney transplant recipients. Serum Fetuin-A levels were measured by use of the enzyme-linked immunosorbent assay method. RESULTS: Patients were divided into 3 groups: patients without cardiac valvular calcification (n = 14), patients with aortic valve calcification (n = 51), and patients with both aortic and mitral valve calcification (n = 24). Aortic calcification area and number of aortic calcifications were significantly increased in the group with aortic and mitral calcification group compared with the other two groups. These two parameters were also significantly increased in patients with cardiac valvular calcification compared with patients without cardiac valvular calcification. Serum Fetuin-A levels were significantly increased in patients with aortic valve calcification compared with the other two groups, whereas there were no significant differences between these two groups. Serum Fetuin-A levels were positively correlated with blood urea nitrogen level (r = .241, P = .025) and serum creatinine level (r = .262, P = .014), whereas it was negatively correlated with serum phosphorus level (r = -.409, P < .001). CONCLUSIONS: Serum Fetuin-A levels can be taken into consideration for the assessment of patients in terms of cardiac valvular calcification, depending on the relationship between serum Fetuin-A levels and cardiac valvular calcification during follow-up after kidney transplantation.

Relationships Between Metabolic Syndrome, Microalbuminuria, and C-Reactive Protein in Turkish Kidney Transplant Recipients.

AIM: The aims of this study were to report the prevalence of metabolic syndrome (MS) in a cohort of Turkish kidney transplant recipients and to define the relationships between MS, microalbuminuria and C-reactive protein (CRP), which are cardiovascular risk factors, in kidney transplant setting. METHODS: This cross sectional study included 170 adult renal transplantation recipients with a mean follow-up of 53.1 ± 49.9 months. The diagnosis of MS was made according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 30-300 mg/g. CRP levels ≥6.0 were classified as high CRP. RESULTS: Mean age was 39.3 ± 11 years. The prevalence of MS was 45.8% (n = 78). The prevalence of microalbuminuria was not different in patients with MS compared to those without MS (39.7% vs 37%, P = .428). In multivariate logistic regression analyses, systolic blood pressure (SBP) (odds ratio 1.68; 95% confidence interval [CI] 1.12-2.52; P = .011) and high fasting glucose (odds ratio 2.82; 95% confidence interval [CI] 1.16-6.86; P = .022) were significantly associated with microalbuminuria. When patients with MS and high CRP were compared with patients with normal CRP and without MS, microalbuminuria did not differ between the groups (P = .213). CONCLUSION: The prevalence of MS in our kidney recipient cohort was found to be increased compared to general population. MS was not related to increased prevalence of microalbuminuria, even when combined with high CRP. Microalbuminuria was associated with elevated SBP and hyperglycemic status.

Biomechanical evaluation of a new design titanium miniplate for the treatment of mandibular angle fractures.

The optimal management of mandibular angle fractures remains controversial. The aim of this experimental study was to test the stability and resistance to mechanical force of a new titanium miniplate design. Thirty fresh sheep hemimandibles, sectioned at the angle region, were used to evaluate two plating techniques. One group received fixation via a new design single non-compression titanium miniplate and the second group via a six-hole straight non-compression titanium miniplate. A custom-made biomechanical test model was used for the samples. Each hemimandible was subjected to compressive and tensile forces using an Instron machine. The biomechanical forces (N) that caused 4-mm displacement or fixation loosening were compared. Comparison between the groups showed that fixation with the new design miniplate had more resistance to lateral compression forces than with a six-hole straight miniplate (P<0.009). Moreover, the new design miniplate fixation displayed more resistance to vertical compression and tensile forces (P>0.46 and P>0.61, respectively). The study demonstrated that mandibular fracture fixation with the new design non-compression titanium miniplate offered greater resistance to lateral displacement forces and may also provide increased resistance to vertical compressive and tensile forces than a conventional six-hole straight miniplate.

Microalbuminuria is associated with high prevalence of anemia in renal transplant recipients.

BACKGROUND AND AIM: Prevalence of anemia is higher in diabetic patients with microalbuminuria than those with normoalbuminuria despite the absence of significant renal impairment. The aim of this study was to investigate whether there was a relationship between microalbuminuria and anemia in renal transplant recipients (RTRs). PATIENTS AND METHOD: Twenty-eight RTRs with microalbuminuria and 21 control RTRs with normoalbuminuria were classified based on urinary albumin creatinine ratios (UACR) of 0.03-0.3 versus <0.03, respectively. Anemia was defined as a hemoglobin level <13 g/dL for men and <12 g/dL for women. RESULTS: Anemia was observed in 13 (46.4%) microalbuminuric and 4 (19%) normoalbuminuric patients (P = 0.044). Hemoglobin level was significantly lower in the microalbuminuric than the normoalbuminuric group (13.3 ± 1.3 g/dL vs 14.4 ± 1.9 g/dL, respectively; P = .018). Although creatinine clearance was significantly higher among the normoalbuminuric group (84 ± 30 mL/min vs 65 ± 22 mL/min, respectively; P = .017), mean creatinine clearance in microalbuminuric group was >60 mL/min, the threshold value for anemia due to erythropoietin (EPO) deficiency. In contrast, there was no significant difference between the 2 groups for age, gender, donor source, and transplant duration. CONCLUSION: Anemia was frequent among RTRs displaying microalbuminuria, which may reflect EPO deficiency due to the tubulointerstitial injury of chronic allograft nephropathy. The EPO deficiency may begin before significant deterioration in excretory function of the kidney.

Loss of bone mineral density in renal transplantation recipients.

AIM: This study investigated the prevalence and contributing factors of loss of bone mineral density after renal transplantation among Turkish patients. PATIENTS AND METHODS: The study included 70 subjects, namely 50 males and 20 females of overall mean age of 36.94 ± 10.09 years. We measured femoral neck mineral density by dual-energy X-ray absorptiometry (DEXA). A T score above -1 was defined as a normal bone mineral density compared with T scores of -1.0 to -2.5 or below -2.5 which were defined as either osteopenia or osteoporosis, respectively. RESULTS: At a median duration of 23 months after renal transplantation, osteopenia or osteoporosis was observed among 30 (42.9%) or 30 (42.9%) of the 70 patients, respectively. The mean body mass index (BMI) value was significantly higher among the normal than the osteoporotic group: 27.59 ± 4.66 kg/m(2) vs 24.18 ± 3.57 kg/m(2), respectively. However, no significant differences occurred in terms of BMI among the other groups. The amount of proteinuria was significantly lower in the normal than the osteopenic or osteoporotic group: (12.5 (range, 10.0-20.0); 105.0 (10.0-2800.0) or 215.5 (10.0-1880.0) mg/d (P = .001 and .004, respectively). In contrast, there was no significant difference between the amounts of proteinuria displayed by the osteopenic group and the osteoporotic group (P < .05)]. These patient groups showed no difference in age, gender, donor source, cause of end-stage renal disease (ESRD), pretransplant dialysis modality, duration of dialysis, use of a vitamin D preparation, immunosuppressive regimen, posttransplantation period, levels of iPTH or 25 hydroxy vitamin D3 (25OH vit D), exposure to tacrolimus or cyclosporine (CyA), calcium × phosphate product, serum albumin and hemoglobin content, creatinine clearance, or serum bicarbonate concentrations (P > .05). The T scores of the femoral neck correlated with BMI (r: 0.415; P = .001), 25OH vit D level (r: 0.268, P = .026), creatinine clearance (r: 0.273, P = .022), and serum glucose level (r: 0.349, P = .003). It inversely correlated with the amount of proteinuria (r: -0.263, P = .028), serum alkaline phosphatase level (r: -0.329, P = .005), and serum magnesium concentration (r: -0.252, P = .035). Upon multivariate analysis, BMI and 25OH vit D level were observed to be independent risk factors for loss of femoral mineral density. CONCLUSION: Loss of bone mineral density is a common complication that correlates with low BMI values and decreased 25OH vit D levels as major risk factors for this problem.