Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women:a systematic review and network meta-analysis

To compare all available accuracy data on screening strategies for identifying cervical intraepithelial neoplasia grade ≥ 2 in healthy asymptomatic women, we performed a systematic review and network meta-analysis. MEDLINE and EMBASE were searched up to October 2020 for paired-design studies of cytology and testing for high-risk genotypes of human papillomavirus (hrHPV). The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, random-effects network meta-analysis of test accuracy, and GRADE rating. Twenty-seven prospective studies (185,269 subjects) were included. The combination of cytology (atypical squamous cells of undetermined significance or higher grades) and hrHPV testing (excepting genotyping for HPV 16 or 18 [HPV16/18]) with the either-positive criterion (OR rule) was the most sensitive/least specific, whereas the same combination with the both-positive criterion (AND rule) was the most specific/least sensitive. Compared with standalone cytology, non-HPV16/18 hrHPV assays were more sensitive/less specific. Two algorithms proposed for primary cytological testing or primary hrHPV testing were ranked in the middle as more sensitive/less specific than standalone cytology and the AND rule combinations but more specific/less sensitive than standalone hrHPV testing and the OR rule combination. Further research is needed to assess these results in population-relevant outcomes at the program level

Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

Background/Aims: Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care in hemodialysis patients. However, there is no clear evidence to support these recommendations. We investigated whether the proportion of attendance at a regular program for management of physical activity and physical function can predict all-cause mortality and cardiovascular events in hemodialysis patients. Methods: This retrospective cohort study consisted of 266 hemodialysis patients participating in the management program at least once. Participants were tracked for 3 years after their first attendance at the management program to determine their attendance proportion. The main study outcomes included all-cause mortality and a composite of fatal and nonfatal cardiovascular events. Results: Median patient age was 64.5 (interquartile range, 56.8 – 72.0) years, 45% were women, and the median time on hemodialysis was 35.5 (interquartile range, 12.0 – 114.3) months at baseline. Sixty-five patients died over a median follow-up of 79 months. The incidence of cardiovascular events was 60 over a median follow-up of 68 months. Even after adjusting for any of the prognostic models, participants who attended ≤ 75% of sessions (n = 140) had higher risks of mortality (hazard ratio (HR), 1.79; 95% confidence interval (CI): 1.00 – 3.36; P = 0.049) and cardiovascular events (HR, 1.84; 95% CI: 1.07 – 3.48; P = 0.03) than those attending > 75% of sessions (n = 126). Conclusion: Hemodialysis patients in whom physical activity and physical function could be assessed more regularly had better prognosis than those with only intermittent assessment

Periodontal disease and atherosclerosis from the viewpoint of the relationship between community periodontal index of treatment needs and brachial-ankle pulse wave velocity

BACKGROUND: It has been suggested that periodontal disease may be an independent risk factor for the development of atherosclerosis. However, the relationship between periodontal disease and atherosclerosis has not been fully elucidated. This study aimed to assess the effects of periodontal disease on atherosclerosis. METHODS: The study design was a cross-sectional study. Subjects were 291 healthy male workers in Japan. We used the Community Periodontal Index of Treatment Needs (CPITN) score, average probing depth and gingival bleeding index (rate of bleeding gums) to assess the severity of periodontal disease. We also used the Brachial-Ankle Pulse Wave Velocity (baPWV) as the index for the development of atherosclerosis. RESULTS: The unadjusted odds ratio (OR) of atherosclerosis in relation to the CPITN score was 1.41 [95% CI: 1.16–1.73]. However, after adjustment for age, systolic blood pressure and smoking, the CPITN score had no relationship with atherosclerosis (adjusted OR: 0.91 [0.68–1.20]). CONCLUSION: Our results show no relationship between mild periodontal disease and atherosclerosis after appropriate adjustments

口臭と胃内ヘリコバクタピロリ感染との関連

口臭の原因は,ほとんどが口腔内の舌苔や歯周病に起因し,その主な原因ガスは揮発性硫黄化合物(VSCs)だと言われている.胃内ヘリコバクタピロリ感染も口臭の一因であるとする報告がなされたが,VSCsを定性・定量的に測定した研究はない.この研究の目的は,胃内ヘリコバクタピロリ感染の陽性者群と陰性者群の口臭と舌苔臭を官能試験およびガスクロマトグラフィによるVSCsの測定を用いて比較することである.また,両群の背景因子として,年齢,性別,口臭に関連すると考えられる口腔内パラメーター(歯垢指数,歯肉炎指数,4mm以上の歯周ポケット数,出血歯周ポケット数,視診による舌苔スコア,舌苔重量)を検討した.80名の患者のうち,胃内ヘリコバクタピロリ感染の陽性者は31名(平均44.7歳)で,陰性者は49名(平均33.8歳)であった.年齢は陽性者の方が有意に高かったが,性別比や口腔内パラメーターなどの背景因子には差を認めなかった.口臭の官能試験では,息をとめた状態の口臭に有意差を認め(オッズ比:2.76,95%信頼区間:1.78～3.74),胃内ヘリコバクタピロリ感染の陽性者の方が陰性者に比較して口臭は臭いことが確認された.しかし,息を吐いた状態の口臭および舌苔臭には両群間に差を認めなかった.ガスクロマトグラフイによるVSCsの測定では,メチルメルカプタンに差を認めなかったが,硫化水素とジメチルサルファイドに有意差(p<0.05)を認めた.今後,胃内ヘリコバクタピロリ感染と口臭との関連について,さらに検討が必要である.The aim of the present study was to assess whether oral odour and tongue coating odour in the gastric Helicobacter pylori (H. pylori) positive patients are more severe organoleptically than those of the negative patients. Moreover, this is the first study of halitosis on H. pylori in which qualitative-quantitative measurements were made by gas chromatography (GC). In addition, the backgrounds (age, gender, oral periodontal parameters and tongue coating) were compared between the 31 H. pylori positive and 49 negative patients. The H. pylori positive group was significantly older than the H. pylori negative group. There were no significant differences in gender, periodontal parameters or visual tongue coating assessment between the two groups. The oral odour assessed with patient holding breath by organoleptic measurement, the gastric H. pylori positive patients was more severe than that of the negative patients (Odds ratio: 2.76, 95% CI: 1.78 to 3.74). There were no significant differences in oral odour assessed with patient exhaling breath and tongue coating odour. The levels of H_2S and (CH_3)_2S but not CH_3SH, in oral air measured by GC were significantly higher in the H. pylori positive patients than in the negative patients (p<0.05). Further research confirming the relation between gastric H. pylori infection and halitosis is needed