Effect of Non-surgical Periodontal Therapy on Levels of Inflammatory Markers in Gingival Crevicular Fluid and Serum of Patients With Breast Cancer and Periodontitis.

Purpose: studies have demonstrated the positive impact of non-surgical periodontal therapy (NSPT) on the control of local and systemic infection/inflammation in normosystemic and systemically compromised patients, represented by the improvement of periodontal clinical parameters and reduction in the levels of inflammatory markers in the gingival crevicular fluid (GCF), saliva and serum. This study aimed to evaluate periodontal clinical parameters and inflammatory mediators in GCF and serum, before and after NSPT, in patients with periodontitis and breast cancer, before chemotherapy. Methods: seventeen women with histopathological diagnosis of invasive ductal carcinoma and periodontitis were submitted to the evaluation of clinical periodontal parameters (plaque index – PI, bleeding on probing – BOP, probing depth – PD, clinical attachment level – CAL) and submitted to scaling and root planing (SRP), at an interval of 24 hours. At the beginning of the study (baseline), before NSPT, samples of tumor microenvironment fluid (TM), GCF and peripheral blood (serum) were collected for the determination of inflammatory markers IL-1β, TNF-α, TGF-β and IL-17, using the LUMINEX methodology. Seven days after SRP, new GCF and serum samples were obtained and analyzed.Results: TGF-β levels were significantly decreased in GCF and serum (p<0.05), while IL-17 concentrations were statistically reduced in GCF (p<0.05). Conclusion: NSPT decreased local and systemic inflammatory markers and may be an important tool in the multidisciplinary approach of women with breast cancer and periodontitis before chemotherapy.

A Novel Metastasis-related Genes Based Signature for Predicting the Progression-free Interval of Patients With Papillary Thyroid Carcinoma

Background: We aimed to build a novel model with metastasis-related genes (MTGs) signature and relevant clinical parameters for predicting progression-free interval (PFI) after surgery for papillary thyroid carcinoma (PTC).Methods: We performed a bioinformatic analysis of integrated PTC datasets with the MTGs to identify differentially expressed MTGs (DE-MTGs). Then we generated PFI-related DE-MTGs and established a novel MTGs based signature. After that, we validated the signature on multiple datasets and PTC cell lines. Further, we carried out uni- and multivariate analysis to identify independent prognostic characters. Finally, we established a signature and clinical parameters-based nomogram for predicting the PFI of PTC. Results: We identified 155 DE-MTGs related to PFI in PTC. The functional enrichment analysis showed that the DE-MTGs were associated with an essential oncogenic process. Consequently, we found a novel 10-gene signature and could distinguish patients with poorer prognoses and predicted PFI accurately. The novel signature had a C-index of 0.76 and the relevant nomogram had a C-index of 0.80. Also, it was closely related to pivotal clinical characters of datasets and invasiveness of cell lines. And the signature was confirmed a significant independent prognostic factor in PTC. Finally, we built a nomogram by including the signature and relevant clinical factors. Validation analysis showed that the nomogram's efficacy was satisfying in predicting PTC’s PFI. Conclusions: The MTG signature and nomogram were closely associated with PTC prognosis and may help clinicians improve the individualized prediction of PFI, especially for high-risk patients after surgery.

Implantoplasty Improves Clinical Parameters over a 2-Year Follow-Up: A Case Series

Background and Objectives: Peri-implantitis treatment is still undefined. Regenerative treatment is expensive and technically demanding due to the need to handle biomaterials, membranes and different methodologies of decontamination. Resective treatment and implantoplasty might be a viable solution. This case series presents a 24 month retrospective observational study of 10 peri-implantitis patients treated with implantoplasty. Materials and Methods: In the present case series, 10 peri-implantitis patients (20 implants) were treated with a resective approach and implantoplasty. Previous to implantoplasty, all patients underwent non-surgical treatment. This surgery consisted in a full-thickness flap and implant surface exposure. The exposed non-osseointegrated implant body was submitted to implantoplasty. The flap was apically repositioned and sutured. Patients were accompanied for 24 months. Results: The mean initial probing depth (PD) (PD = 5.37 ± 0.86 mm), bleeding on probing (BoP = 0.12 ± 0.06%) and suppuration (Sup = 0.01 ± 0.01%) decreased significantly at the 12 month evaluation (PD = 2.90 ± 0.39 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Between the 12 and 24 month evaluations, there were no significant clinical changes (PD = 2.85 ± 0.45 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Mucosal recession (MR) had a significant increase between the baseline and the first 12 months (0.69 ± 0.99 mm vs. 1.96 ± 1.33 mm), but there were no significant changes between the 12th and 24th month (1.94 ± 1.48 mm). The success rate was 100% without implant fracture or loss. Conclusions: Resective surgery and implantoplasty might be a valid option in some specific peri-implantitis cases. Properly designed clinical trials are needed to confirm this possibility.

Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease

Objective:Owing to the lack of long-term observations and/or comprehensive adjustment for confounding factors, reliable conclusions regarding long-term effects of exercise and regular physical activity in Parkinson’s disease (PD) have yet to be drawn. Here, using data from the Parkinson’s Progression Markers Initiative study that includes longitudinal and comprehensive evaluations of many clinical parameters, we examined the long-term effects of regular physical activity and exercise habits on the course of PD.Methods:In this observational cohort study, we primarily used the multivariate linear mixed-effects models to analyze the interaction effects of their regular physical activity and moderate-to-vigorous exercise levels, measured through the Physical Activity Scale for the Elderly questionnaire, on the progression of clinical parameters, after adjusting for age, sex, levodopa-equivalent dose, and disease duration. We also calculated bootstrapping 95% confidence intervals (CIs), and conducted sensitivity analyses using the multiple imputation method and subgroup analyses using the propensity score matching to match for all baseline background factors.Results:237 early PD patients [median (interquartile range); age, 63.0 (56.0–70.0) years; Male, 69.2%; follow-up duration, 5.0 (4.0–6.0) years] were included. Regular physical activity and moderate-to-vigorous exercise levels at the baseline did not significantly affect the subsequent clinical progression of PD. However, average regular overall physical activity levels over time were significantly associated with slower deterioration of postural and gait stability [standardized fixed-effects coefficients of the interaction term (βinteraction) = -0.10 (95% CI, -0.14 to -0.06)], activities of daily living [βinteraction = 0.08 (95% CI, 0.04 to 0.12)], and processing speed [βinteraction = 0.05 (95% CI, 0.03 to 0.08)] in PD patients. Moderate-to-vigorous exercise levels were preferentially associated with slower decline of postural and gait stability [βinteraction = -0.09 (95% CI, -0.13 to -0.05)] and work-related activity levels were primarily associated with slower deterioration of processing speed [βinteraction = 0.07 (95% CI, 0.04 to 0.09)]. Multiple imputation and propensity score matching confirmed the robustness of our results.Conclusions:In the long-term, the maintenance of high regular physical activity levels and exercise habits was robustly associated with better clinical course of PD, with each type of physical activity having different effects.Trial Registration Information:Clinicaltrials.gov (NCT01176565). A link to trial registry page is https://clinicaltrials.gov/ct2/show/NCT01141023.Classification of Evidence:This study provides Class II evidence that sustained increase in overall regular physical activity levels in patients with early Parkinson disease was associated with slower decline of several clinical parameters.

Incidence and Predictors of Cerebral Salt Wasting Syndrome in Stroke Patients – Results of a Prospective Observational Study

BackgroundCerebral salt wasting syndrome (CSWS) and Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH) are the most common aetiological factors for developing hyponatremia following stroke. The differentiation of these two entities is crucial as the treatment options are completely different. Hence the knowledge on predictors of CSWS is important to make a more accurate diagnosis of CSWS. MethodsTwo hundred and fourty six patients with confirmed stroke were prospectively observed throughout the hospital stay in a tertiary referral center in Sri Lanka to identify the possible predictors of CSWS. Hyponatremia was defined as serum Na+ level less than 131mmo/l. Serum osmolality, urine osmolality, urinary Na+, serum cortisol and thyroid function tests were performed on all the hyponatremic patients. Differentiation of the CSWS and SIADH was based on physical examination findings and laboratory parameters. ResultsThe incidence of hyponatremia in our study population was 19.1% (95% Confidence Interval 14.39-24.58). The majority of patients (24, 51%) were attributed to CSWS. SIADH group comprised of 17 (36.2%) patients and 6 (12.7%) patients had other undetermined causes. There was a significant statistical difference between the aetiologies of hyponatremia and laboratory investigations like urinary Na+, urinary osmolality and serum osmolality. Demographic characteristics, comorbidities, imaging findings and clinical parameters like systolic blood pressure, diastolic blood pressure, on admission GCS were considered in the multivariable logistic regression model and the overall model was not significant. Conclusion The incidence of CSWS is higher than the incidence of SIADH. The demographic characteristics, comorbidities, imaging and clinical parameters like blood pressure, on admission GCS could not predict the occurrence of CSWS

The Clinical Significance of Forkhead Box M1 in Esophageal Squamous Cell Carcinoma Tissues: A Study Based on In-house Immunohistochemistry, RNA-sequencing, and Data Mining

BackgroundEsophageal squamous cell carcinoma (ESCC) ranks the sixth in mortality rates in cancers due to a lack of a specific target of diagnosis and treatment in the early stages. Although Forkhead box M1 (FOXM1) has been reported to be differentially expressed in ESCC, its clinical role and function in ESCC remained unclarified.MethodsData from our hospital and public databases (n = 1906) were combined to estimate how FOXM1 overexpression showed its discriminatory ability between ESCC and non-ESCC esophageal tissues. Downstream targets of FOXM1 were predicted by using Cistrome database. Functional enrichment analyses were performed to explore the potential signaling pathways related to FOXM1 in ESCC. Based on the available clinical parameters, we investigated the prognosis potential of FOXM1 and its targets.ResultsThe pooled standard mean difference (SMD) for FOXM1 is 2.62 (95% CI: 2.08–3.16), indicating that FOXM1 is upregulated in ESCC. FOXM1 has an extremely high discrimination potential in ESCC because the area under the curve (AUC) of the summary receiver operating characteristic curve (sROC) is 0.99 (95% CI: 0.97–0.99). A total of 168 downstream targets were identified, and nine hub genes were screened from them. We found that FOXM1 and its targets were significantly enriched in the cell cycle. Additionally, the correlation between FOXM1 and clinical parameters had not been observed, except for age.ConclusionsFOXM1 is upregulated in ESCC and has an extremely high discrimination potential in ESCC.

Circulating Lymphocyte Subsets are Prognostic Factors in Patients with Nasopharyngeal Carcinoma

Background: Nasopharyngeal carcinoma (NPC) is a geographically and racially variable disease which has a high incidence in Southeast China. According to previous studies on tumor immunity, we compared multiple clinical parameters and blood indexes to find its relationship with prognosis in NPC patients.Methods: According to the load of EBV at diagnosis, 220 NPC patients receiving concurrent chemoradiotherapy (CRT) were divided into two groups. We compared clinical parameters, peripheral blood mononuclear cells, lymphocyte subsets and biochemical indexes between them. We analyzed distant metastases and overall survival rate between them.Results: In most cases, the two groups showed the same trend. Most blood indexes were decreased during CRT, the decrease in absolute count was more significant than in percentage. The younger age showed the higher CD3+ and CD3+CD8+ percentage. Patients whose EBV DNA≥1500 copies/mL at first diagnosis showed higher pN grade. Among them, higher CD3+CD8+ percentage or lower CD3-CD56+ percentage had batter OS rates. Patients whose EBV DNA<1500 copies/mL at first diagnosis had higher survival rate and longer survival time.Conclusions: CRT cause overall decrease of blood cells in NPC patients. The initial EBV load was related to prognosis. Among all the blood indexes, CD3+CD8+ percentage showed correlation with age and OS rates in patients whose EBV DNA≥1500 copies/mL at first diagnosis, which is worthy of further study.

Gene expression of inflammatory immune factors and clinical parameters in diabetes and nondiabetes patients with periodontal disease

Objective: This study evaluated clinical, glucose, and immunological parameters in patients with type 2 diabetes mellitus (DM) compared to those without systemic alterations (NDM), both with generalized chronic periodontitis. Methodology: Twenty-one patients were selected with indications of tooth loss. Surgeries were performed using the Widman flap modified to obtain a gingival collar at 1 mm from the gingival margin. Before the surgical procedure, the following clinical parameters were evaluated: pocket probing depth (PPD), gingival recession (GR), clinical attachment level (CAL), and bleeding on probing (BOP). Fasting glucose levels (FGL) and glycosylated hemoglobin Hba1c (HbA1c) were also assessed. During the surgery, gingival tissue samples were collected and frozen for later laboratorial analysis. The samples were processed to obtain mRNA, cDNA and determine the gene expression of the immune parameters IL-1-β, IL-6, TNF-α, IL-10 and NF-kB by real-time polymerase chain reaction (RT-PCR). Data were analyzed statistically considering p<0.05. Results: The clinical and glucose parameters BOP, FGL, and HbA1c were statistically higher in the DM group. RNAm levels of IL-1β, TNF-α, and NF-kB were higher in the DM group (p<0.05). Conclusion: The presence of diabetes and hyperglycemic status increase the levels of pro-inflammatory immune factors and severity of the periodontal disease.