Occlusal Interferences in Localised and Generalized Periodontitis

Značaj okuzijskih zapreka u razvoju i u terapiji parodontnih bolesti i poremećaja iznimno je kontroverzan. Još uvijek su u najstručnijim krugovima znanstvenika aktualne rasprave o povezanosti zapreka i okluzijske traume i o njihovoj ulozi u parodontnoj bolesti. Svrha rada bila je istražiti postoji li statistički znatna razlika u pojavnosti okluzijskih zapreka ( na radnoj i balansnoj strani) između skupine pacijenata s lokaliziranim parodontitisom i skupine pacijenata s generaliziranim parodontitisom. Ispitanici su bili pacijenti s parodontnom bolesti, koji su klasificirani prema Extent and Severity Indexu (ESI) na ispitivanu skupinu lokaliziranih parodontitisa i ispitivanu skupinu generaliziranih parodontitisa. Kretnje na laterotruzijskoj strani/kontakti u interkaninom području tijekom protruzijske kretnje bilježene su plavim artikulacijskim papirom debljine 12µ, a kontakti na mediotruzijskoj strani/kontakti u lateralnim područjima tijekom protruzijske kretnje bilježeni su crvenim artikulacijskim papirom debljine 12µ. U obje ispitivane skupine 45,12% ispitanika imalo je zapreke na radnoj strani, a 48,78% ispitanika imalo je zapreke na balansnoj strani. U skupini lokaliziranoga parodontitisa 33,33% ispitanika imalo je zapreke na radnoj strani, a 50,81% ispitanika imalo ih je u skupini generaliziranoga parodontitisa. Zapreke na balansnoj strani postojale su u 52,38% ipitanika u skupini lokaliziranoga parodontitisa, a 47,54% ispitanika imalo ih je u skupini generaliziranoga parodontitisa. Hi-kvadrat testom utvrđeno je da ne postoji statistički znatna razlika između pojavnosti okluzijskih zapreka u skupini ispitanika s lokaliziranim parodontitisom u usporedbi sa skupinom ispitanika s generaliziranim parodontitisom. Iako nema statistički znatne razlike, postoji tendencija razlike u frekvencijama (p = 0,054) te je vidljivo da u skupini ispitanika s generaliziranim parodontitisom postoji više slučajeva bez zapreka na balansnoj strani (52,45%) u odnosu prema skupini ispitanika s lokaliziranim parodontitisom (47,61%). Rezultati ovog istraživanja pokazuju da ne postoji statistički znatna razlika u pojavnosti okluzijskih zapreka u skupini ispitanika s lokaliziranim parodontitisom i u skupini ispitanika s generaliziranim parodontitisom.The significance of occlusal interference in the development and therapy of periodontal disease is very controversial. There are still very vivid discussions going on between experts whether or not interferences cause occlusal trauma, and wath is its role in periodontal disease. The aim of the study was to investigate whether there i statistically significant difference in the manifestation of occlusal interferences (working side and balancing side) among a group of patients sufferig from localised periodontitis and a group of patients with generalized periodontitis. Examinees were patients with periodontal disease, classified according to Extent and Severity Index (ESI) into a group with localised periodontitis and a group with generalized peiodontitis. Movements on the laterotrusion side/contacts in the intercanine segment in protrusion were marked with blue articulation paper 12µ thick, while contacts on the mediotrusion side/contacts in lateral segments during protrusion were marked with red articulation paper (12µ thick). Of al patients, there were 45.12% with working side interferences, and 48.78% with balancing side interferences in both examined groups. 33.33% of the examinees in the group with localised periodontitis had working side interferences, and 50.81% of the examinees in the group with generalized periodontitis. Balancing side interferences were found in 52.38% of patients in the group with localised periodontitis, and 47.54% of patients in the group with generalized periodontitis. Chi-square test showed that there was statistically significant difference between manifestation of occlusal interferences in the group of patients with localised periodontitis compared to manifestation of articulation interferences in the group of patients with generalized periodontitis (chi-square = 3.561; p = 0.313). Although there was no statistically significant difference, there was a tendency to difference in frequencies (p = 0.054), and it is shown that in the group of patients with generalized periodontitis there were more cases with no balancing side interferences on any side (52.45%), compared to the group of patients with localised periodontitis (47.61%). Results showed that there was no difference in manfestation of occlusal interferences in localised peiodontitis compared to generalized periodontitis

Apical Leakage after Four Endodontic Instrumentation and Filling Procedures

Svrha je bila ispitati apeksnu propusnost punjenih korijenskih kanala uporabom konstrukcije za prijenos tekućine, nakon dvije različite tehnike instrumentacije (“double flare” i step-back”) kombinirane s uporabom dvaju različitih materijala za punjenje (eukaperka i Roeko seal®). U pokusu je rabljen uzorak od 40 trajnih jednokorijenskih zuba. Zubi su dekoronirani na razini caklinskocementnog spojišta, a zatim podijeljeni u četiri skupine od po 10 zuba. Korijenski kanali prve i druge skupine mehanički su obrađeni “double flare” tehnikom, a “stepback” tehnika primijenjena je u trećoj i četvrtoj skupini. kanali su tijekom instrumentacije ispirani 2,5% otopinom NaOCl. Obrađeni korijenski kanali prve i treće skupine punjeni su gutaperka kolčićima i eukaperka pastom tehnikom hladne alteralne kondenzacije, dok je u drugoj i četvrtoj skupini rabljen Roeko seal® umjesto eukaperke tijekom punjenja. Učinjenim endodontskim postupcima stvorene su četiri skupine: skupina DF/EF (double-flare / eukaperka) skupina DF/RS (double-flare / Roeko seal®) skupina, skupina SB/EP (step back/eukaperka) i skupina SB/RS (step back / Roeko seal®). Punjeni korijeni pohranjeni su u sterilnu fiziološku otopinu na 37°C u razdoblju od 7 dana nakon čega su postavljeni u konstrukciju za prijenos tekućine. Propusnost je mjerena pomakom zračnoga mjehurića u kapilarnoj cijevi spojenoj s apeksnim krajem napunjenoga zubnog korijena. Razlika između skupine DF/EF (0,152 μL ± 0,12), skupine DF/RS (0,186 μL ± 0,098), skupine SB/EP (0,195 μL ± 0,12), i skupine SB/RS (0,360 μL ± 0,230) statistički je analizirana Sheffe (ANOVA) testom. statistički znatna razlika utvrđena je između skupine DF/EP i skupine SB/RS. Daljnjom statističkom raščlambom s pomoću Mann-Whitney U testa utvrđeno je da različita tehnika instrumentacije utječe na rezultate raščlambe. U uvjetima pokusa, rezultati dobiveni primjenom konstrukcije za prijenos tekućine pokazuju da različiti materijali za punjenje korijenskih kanala ne utječu na apeksnu propusnost.The aim of this research was to examine apical obturation leakage of filled root canals by a fluid transport model after two different instrumentation techniques (“double flare” and “step-back”) combined with use of two different sealers (eucapercha and Roeko seal®). A sample of 40 permanent single-rooted teeth was used. The coronal part of each tooth was removed at the amelo-cement junction. Teeth were divided into four groups of 10 teeth each. Root-canals of the first and second group were cleaned and shaped by “double flare” technique while “step-back” technique was performed in the third and fourth group. All root-canals were irrigated with 2.5% NaOCl during instrumentation. Prepared root-canals of the first and third group were filled with gutta-percha points and eucapercha sealer by the cold lateral condensation technique while in the second and fourth group Roeko seal® was used as a sealer instead of eucapercha during filling procedure. Filled roots were stored in NaCl 3% at 37°C for 7 days. These procedures formed four groups: group DF/EO (double flare/eucapercha), group DF/RS (double flare/Roeko seal®, group SB/EP (step back/eucapercha) and group SB/RS (step back/Roeko seal®). Each root was mounted in a fluid transport model and leakage was measured by the movement of an air bubble in a capillary glass tube connected to the experimental root section. The difference between group DF/EP (0,152 μL ± 0,12), group DF/RS (0,186 μL ± 0,098), group SB/EP (0,195 μL ± 0,12), and group SB/RS (0,360 μL ± 0,230) was statistically analyzed by Sheffe test. Statiatically significant difference was determined between group DF/EO and group SB/RS. Further statistical anlysis peformed by Mann-Whitney U test showed that different instrumentation technique were responsable for the results of analysis. Under the conditions of this research, results obtained with fluid transport model indicate that there is no statistically significant difference between groups where rootcanals were filled with different materials. Apical leakage was signifuicantly lower where root-canals were instrumented by “double flare” technique

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Decreasing NF-κB Expression Enhances Odontoblastic Differentiation and Collagen Expression in Dental Pulp Stem Cells Exposed to Inflammatory Cytokines

Inflammatory response in the dental pulp can alter the collagen matrix formation by dental pulp stem cells and lead to a delay or poor healing of the pulp. This inflammatory response is mediated by cytokines, including interleukin-1β and tumor necrosis factor-α. In this study, it is hypothesized that suppressing the actions of these inflammatory cytokines by knocking down the activity of transcription factor Nuclear Factor–κB will lead to dental pulp stem cell differentiation into odontoblasts and the production of collagen. Here, the role of Nuclear Factor–κB signaling and its reduction was examined during odontogenic behavior in the presence of these cytokines. The results showed a significant increase in Nuclear Factor–κB gene expression and p65 protein expression by interleukin-1β and tumor necrosis factor-α. Nuclear Factor–κB activation in the presence of these cytokines decreased significantly in a dose-dependent manner by a Nuclear Factor–κB inhibitor (MG132) and p65 siRNA. Down-regulation of Nuclear Factor–κB activity also enhanced the gene expression of the odontoblastic markers (dentin sialophosphoprotein, Nestin, and alkaline phosphatase) and displayed an odontoblastic cell morphology indicating the promotion of odontogenic differentiation of dental pulp stem cells. Finally, dental pulp stem cells exposed to reduced Nuclear Factor–κB activity resulted in a significant increase in collagen (I)-α1 expression in the presence of these cytokines. In conclusion, a decrease in Nuclear Factor-κB in dental pulp stem cells in the presence of inflammatory cytokines enhanced odontoblastic differentiation and collagen matrix formation.The open access fee for this work was funded through the Texas A&M University Open Access to Knowledge (OAK) Fund

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone