Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis

Introduction The purposes of this review were to appraise the level of evidence of the existing regenerative endodontic therapy (RET) publications, perform a meta-analysis on the survival and healing rates of necrotic immature permanent teeth treated with RET, and run a meta-analysis on the quantitative assessment of the root development of those teeth. Methods Electronic searches were performed in Web of Science, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Library databases. Two authors independently screened the titles and abstracts for eligibility. The analyses were performed on the clinical outcomes (ie, survival, healing, and root development) of the procedure. Results Eleven articles were included in the qualitative and quantitative syntheses. Three studies were randomized controlled trials, 6 were prospective cohort studies, and 2 were retrospective cohort studies. The pooled survival and healing rates were 97.3% and 93.0%, respectively. The pooled rates of root lengthening, root thickening, and apical closure were 77.3%, 90.6%, and 79.1%, respectively. However, if 20% radiographic changes were used as a cutoff point, there were only 16.1% root lengthening and 39.8% root thickening. Conclusions Within the limitations of the present study, it can be concluded that RET yielded high survival and healing rates with a good root development rate. However, clinical meaningful root development after RET was unpredictable

The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore

Background In Singapore, the burden of hypertension disproportionately falls on the elderly population of low socio-economic status. Despite availability of effective treatment, studies have shown high prevalence of sub-optimal blood pressure control in this group. Poor hypertension management can be attributed to a number of personal factors including awareness, management skills and overall adherence to treatment. However, these factors are also closely linked to a broader range of community and policy factors. This paper explores the perceived social and physical environments of low socio-economic status and elderly patients with hypertension; and how the interplay of factors within these environments influences their ability to mobilise resources for hypertension management. Methods In-depth interviews were conducted in English, Chinese, Chinese dialects and Malay with 20 hypertensive patients of various ethnic backgrounds. Purposive sampling was adopted for recruitment of participants from a previous community health screening campaign. Interviews were translated into English and transcribed verbatim. We deductively analysed leveraging on the Social Model of Health to identify key themes, while inductive analysis was used simultaneously to allow sub-themes to emerge. Results and discussion Our finding shows that financing is an overarching topic embedded in most themes. Despite the availability of multiple safety nets, some patients were left out and lacked capital to navigate systems effectively, which resulted in delayed treatment or debt. The built environment played a significant role in enabling patients to access care easily and lead a more active lifestyle. A closer look is needed to enhance the capacity of patients with mobility challenges to enjoy equitable access. Furthermore, the establishment of community based elderly centres has enabled patients to engage in meaningful and healthy social activities. In contrast, participants' descriptions showed that their communication with healthcare professionals remained brief, and that personalised and meaningful interactions that are context and culturally specific are essential to advocate for patients' overall treatment adherence and lifestyle modification. Conclusion Elderly patients with hypertension from lower socio-economic background have various unmet needs in managing their hypertension and other comorbidities. These needs are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.This research was supported by MOE TIER - 1 FUND R-608-000-133-112 and the National University Health System (NUHS) Singapore Population Health Improvement Centre (SPHERiC)

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

An unusual endodontic complication following crown lengthening surgery: A Case Report.

A gummy smile is a form of excessive gingival display when smiling. The excessive gingival display due to altered eruption is likely to benefit from crown lengthening surgery in order to restore the esthetic smile. Case Report: The potential complications of the crown lengthening surgery include possible esthetic deformities, dentine hypersensitivity, transient mobility, and root resorption. The present case report reveals a rare complication happened after an esthetic crown lengthening surgery which was performed to correct the gummy smile of a 37-year-old female. The patient experienced dull throbbing pain and mild tender to percussion on tooth 11, 3 weeks after the surgery, and the symptoms did not improve after the composite restorations were placed at the cervical regions. Instead, the tooth was tender to percussion and palpation with a sign of coronal discoloration. Pulp necrosis was confirmed with the clinical tests. A cone-beam computed tomography was taken after the root canal treatment, and apical fenestration on tooth 11 was noted. Therefore, this case report shows the possible correlation between crown lengthening surgery on a tooth with apical fenestration and pulp necrosis, if the apical vasculature is severed accidentally during the procedure. Conclusion: A cone-beam computed tomography should be considered prior to the surgery and extra precaution during the surgery may reduce the risk of severing the apical vasculature if apical fenestration is evidenced.Una sonrisa gingival es una forma de exhibición gingival excesiva al sonreír. Es probable que el despliegue gingival excesivo debido a una erupción alterada se beneficie de la cirugía de alargamiento de la corona para restaurar la sonrisa estética. Reporte de Caso: Las posibles complicaciones de la cirugía de alargamiento coronal incluyen posibles deformidades estéticas, hipersensibilidad de la dentina, movilidad transitoria y reabsorción radicular. El presente reporte de caso revela una rara complicación ocurrida luego de una cirugía estética de alargamiento coronal que fue realizada para corregir la sonrisa gingival de una mujer de 37 años. El paciente experimentó un dolor sordo pulsátil y leve sensibilidad a la percusión en el diente 11, tres semanas después de la cirugía, y los síntomas no mejoran después de que se colocaron las restauraciones de composite en las regiones cervicales. En cambio, el diente presentaba sensibilidad a la percusión y la palpación con signos de decoloración coronal. La necrosis pulpar se confirmó con pruebas clínicas. Se tomó una tomografía computarizada de haz cónico después del tratamiento del conducto radicular y se observó una fenestración apical en el diente 11. Por lo tanto, este reporte de caso muestra la posible correlación entre la cirugía de alargamiento de corona en un diente con fenestración apical y necrosis pulpar, si la vasculatura apical se corta accidentalmente durante el procedimiento. Conclusión: Se debe considerar una tomografía computarizada de haz cónico antes de la cirugía y una precaución adicional durante la cirugía puede reducir el riesgo de seccionar la vasculatura apical si se evidencia una fenestración apical

Una complicación endodóntica inusual después de una cirugía de alargamiento coronal: Reporte de un Caso

A gummy smile is a form of excessive gingival display when smiling. The excessive gingival display due to altered eruption is likely to benefit from crown lengthening surgery in order to restore the esthetic smile. Case Report: The potential complications of the crown lengthening surgery include possible esthetic deformities, dentine hypersensitivity, transient mobility, and root resorption. The present case report reveals a rare complication happened after an esthetic crown lengthening surgery which was performed to correct the gummy smile of a 37-year-old female. The patient experienced dull throbbing pain and mild tender to percussion on tooth 11, 3 weeks after the surgery, and the symptoms did not improve after the composite restorations were placed at the cervical regions. Instead, the tooth was tender to percussion and palpation with a sign of coronal discoloration. Pulp necrosis was confirmed with the clinical tests. A cone-beam computed tomography was taken after the root canal treatment, and apical fenestration on tooth 11 was noted. Therefore, this case report shows the possible correlation between crown lengthening surgery on a tooth with apical fenestration and pulp necrosis, if the apical vasculature is severed accidentally during the procedure. Conclusion: A cone-beam computed tomography should be considered prior to the surgery and extra precaution during the surgery may reduce the risk of severing the apical vasculature if apical fenestration is evidenced. Una sonrisa gingival es una forma de exhibición gingival excesiva al sonreír. Es probable que el despliegue gingival excesivo debido a una erupción alterada se beneficie de la cirugía de alargamiento de la corona para restaurar la sonrisa estética. Reporte de Caso: Las posibles complicaciones de la cirugía de alargamiento coronal incluyen posibles deformidades estéticas, hipersensibilidad de la dentina, movilidad transitoria y reabsorción radicular. El presente reporte de caso revela una rara complicación ocurrida luego de una cirugía estética de alargamiento coronal que fue realizada para corregir la sonrisa gingival de una mujer de 37 años. El paciente experimentó un dolor sordo pulsátil y leve sensibilidad a la percusión en el diente 11, tres semanas después de la cirugía, y los síntomas no mejoran después de que se colocaron las restauraciones de composite en las regiones cervicales. En cambio, el diente presentaba sensibilidad a la percusión y la palpación con signos de decoloración coronal. La necrosis pulpar se confirmó con pruebas clínicas. Se tomó una tomografía computarizada de haz cónico después del tratamiento del conducto radicular y se observó una fenestración apical en el diente 11. Por lo tanto, este reporte de caso muestra la posible correlación entre la cirugía de alargamiento de corona en un diente con fenestración apical y necrosis pulpar, si la vasculatura apical se corta accidentalmente durante el procedimiento. Conclusión: Se debe considerar una tomografía computarizada de haz cónico antes de la cirugía y una precaución adicional durante la cirugía puede reducir el riesgo de seccionar la vasculatura apical si se evidencia una fenestración apical.&nbsp

Factors Influencing the Treatment Outcome of Intentional Replantation on Teeth with Periapical Periodontitis: A Systematic Review and Meta-Analysis

Objectives The purpose of this review was to appraise the quality of evidence of the existing publications on IR, and to perform a meta-analysis on the treatment outcomes of IR. Methods The specific PIO questions were as follows: Population: Patients with periapical periodontitis either before or after nonsurgical endodontic therapy. Intervention: IR performed with retrograde preparation and retrograde filling. Outcomes: the healing, treatment complications, and the factors influencing these outcomes after IR. Electronic and hand searches were performed in the Web of Science, PubMed, CINAHL, and Cochrane Library databases. Two authors independently screened the titles and abstracts for eligibility. The risk of bias was performed using the NIH Quality Assessment Tool, and each study was rated as ‘Good’, ‘Fair’ or ‘Poor’. The analyses were performed on the treatment outcome (healing and complications), and the factors influencing the outcome of the procedure. Results Fourteen articles were included in the qualitative and quantitative syntheses. One was a prospective cohort study, and the other 13 were retrospective cohort studies. Overall, the evidence of this review was of poor-to-fair quality. The pooled healing rate was 80.2%, and there was a 21.7% of complication rate. Longer follow-up period, the presence of perio-endo disease, the use of non-bioceramic material as retrograde filling, longer extraoral time, and maxillary molar were found to be associated with lower healing rates. However, the differences between the subgroups were not statistically significant. Conclusions The present review showed IR yielded a good overall healing rate with a low complication rate. Taking the quality of evidence into account, more high-quality studies are required to evaluate the validity of the factors that may influence the treatment outcome of IR

Optical Coherence Tomography Angiography in Retinal Vascular Disorders

Traditionally, abnormalities of the retinal vasculature and perfusion in retinal vascular disorders, such as diabetic retinopathy and retinal vascular occlusions, have been visualized with dye-based fluorescein angiography (FA). Optical coherence tomography angiography (OCTA) is a newer, alternative modality for imaging the retinal vasculature, which has some advantages over FA, such as its dye-free, non-invasive nature, and depth resolution. The depth resolution of OCTA allows for characterization of the retinal microvasculature in distinct anatomic layers, and commercial OCTA platforms also provide automated quantitative vascular and perfusion metrics. Quantitative and qualitative OCTA analysis in various retinal vascular disorders has facilitated the detection of pre-clinical vascular changes, greater understanding of known clinical signs, and the development of imaging biomarkers to prognosticate and guide treatment. With further technological improvements, such as a greater field of view and better image quality processing algorithms, it is likely that OCTA will play an integral role in the study and management of retinal vascular disorders. Artificial intelligence methods—in particular, deep learning—show promise in refining the insights to be gained from the use of OCTA in retinal vascular disorders. This review aims to summarize the current literature on this imaging modality in relation to common retinal vascular disorders

Protein Corona Formed from Different Blood Plasma Proteins Affects the Colloidal Stability of Nanoparticles Differently

© 2018 American Chemical Society. Significant progress in the characterization of protein corona has been made. However, insights on how the corona affects the aggregation of nanoparticles (NPs) and consequent biological identity are still lacking. Here, we examined how the corona formed from four major serum proteins, immunoglobulin G (IgG), fibrinogen (FBG), apolipoprotein A1 (ApoA1), and human serum albumin (HSA), over a range of concentrations affects the aggregation of gold NPs (AuNPs). We found that at physiological pH of 7.4, all four proteins aggregated the AuNPs at low concentrations but conferred colloidal stability at high concentrations due to the complete corona coat around individual AuNPs. Due to their immune-related functions, IgG and FBG aggregated the AuNPs to a greater extent compared to HSA and ApoA1 which were mostly involved in transport of small molecules. We then introduced the AuNP-corona formed from each protein into an acidic solution at pH 6.2 with high ionic concentration for up to 24 h as a model of the tumor microenvironment to examine for changes in their aggregation. We observed that protein corona formation sterically stabilized the AuNP-corona for all four proteins, resulting in a smaller increase in aggregation and size compared to citrate-capped AuNPs. This was especially true for corona formed at high protein:AuNP ratios. Our study therefore showed that the formation of a complete corona coat around NPs at sufficiently high protein:NP ratio was required for colloidal stability of designed NP systems in both physiological and cancer microenvironment to maintain efficiency and efficacy in cancer drug delivery