Κυριακή 10 Ιουλίου 2022

Real‐life impact of tenofovir disoproxil fumarate and entecavir therapy on lipid profile, glucose and uric acid in chronic hepatitis B patients

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Abstract

Background & Aims

The impact of long-term nucleos(t)ide analogs treatment on host metabolism is a concern. Hence, we conducted this study to compare the effect of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) on metabolic parameters among CHB patients.

Methods

In this real-life retrospective study, 2,030 CHB outpatients treated with ETV or TDF at Nanfang Hospital, China, were included. For treatment-naïve patients, pretreatment and semiannual metabolic parameters were collected. For treatment-experienced patients, metabolic parameters were collected at the first visit. Propensity score matching (PSM) was used to balance the effects of potential confounding factors.

Results

Among 122 treatment-naïve patients and 1908 treatment-experienced patients, ETV-treated patients were older with a higher percentage of metabolic syndrome. After PSM, the characteristics were comparable between the two groups. For treatment-naïve patients, fou r lipid parameters, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein and triglyceride levels showed a decreasing trend during the 42-month TDF treatment, while they remained relatively stable or increased during ETV treatment. At month 30, the levels of TC and LDL among TDF-treated patients were significantly lower than those among ETV-treated patients (TC: 4.7 vs. 3.9 mmol/L, p=0.004; LDL: 3.0 vs. 2.4 mmol/L, p=0.009). For treatment-experienced patients, we also observed lower levels of lipid parameters in patients with different durations of TDF treatment. The levels of glucose and uric acid were similar among ETV- and TDF-treated patients.

Conclusion

TDF has a lipid-lowering effect in CHB patients, which provides a basis for the selection of antiviral drugs for aging CHB patients.

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Longitudinal follow‐up of HPV16 sequence after cervical infection: low intra‐host variation and no correlation with clinical evolution

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ABSTRACT

Human papillomavirus (HPV) 16 exhibits different variants that may differ in their carcinogenic risk. In order to identify some high-risk variants, we sequenced and compared HPV16 whole genomes obtained from a longitudinal cohort of 34 HPV16-infected women who had either spontaneously cleared their infection (clearance group or "C"), or developed cervical high-grade lesions following a viral persistence (group persistence or "P"). Phylogenetic analysis of paired samples obtained at the beginning (C0 or P0) and at the end (C2 or P2) of the follow-up (median intervals between C0-C2 and between P0-P2 were 16 and 36.5 months, respectively) revealed a low genetic variability within the host compared to the genetic inter-host diversity. By comparing our HPV16 sequences to a reference sequence, we observed 301 different substitutions, more often transitions (60.9%) than transversions (39.1%), that occurred throughout the viral genome, but with a low frequen cy in E6 and E7 oncogenes (10 and 9 substitutions), suggesting a high conservation of these genes. Deletions and insertions were mostly observed in intergenic regions of the virus. The only significant substitution found between the subgroups C2 and P2 was observed in the L2 gene (L330F), with an unclear biological relevance. Our results suggest a low longitudinal intra-host evolution of HPV16 sequences and no correlation between genetic variations and clinical evolution.

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Influence of supplement administration of omega‐3 on the subcutaneous tissue response of endodontic sealers in Wistar Rats

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Abstract

Aim

Natural substances such as omega-3 have been used in the medical field due to their numerous properties and, in particular, modulating effect on the systemic and local inflammatory processes. Thus, this study evaluated the influence of omega-3 supplementation on the subcutaneous tissue response of endodontic sealers in Wistar Rats.

Methodology

Polyethylene tubes were implanted in the subcutaneous tissue of 48 animals (one empty for control and three filled with Sealapex, AH Plus or Endofill). The animals were treated with omega-3 (TO) or water (TW). Treatments started 15 days before implantation until euthanasia. After 5, 15 and 30 days (n=8), animals were euthanized and polyethylene tubes and surrounding tissue were removed and processed for histological analysis. The inflammatory reaction was analysed by Haematoxylin and Eosin stain and immunolabeling for IL-6 and TNF-α. The collagen maturity was analysed by picrosirius red stain and calcium deposition by von Kossa stain and polarized light. Results were statistically analysed (p<0.05).

Results

Among TW sealers groups, Endofill evoked a more intense inflammatory infiltrate compared with AH Plus and control in the 30-day period (p=0.009). However, in TO sealers groups, there was no difference among the sealers and control in all periods (p>0.05). Comparing each sealer as a function of the supplementation with water or omega-3, there are differences for Endofill (p=0.001) and Sealapex (p=0.005) in the 30-day period, presenting lower inflammatory infiltrate in the animals treated with omega 3. A higher percentage of immature fibres was observed at 15 and 30 days in the TO group, compared with TW group (p<0.05). The deposition of calcium particles was observed only by Sealapex in all periods, despite the supplementation procedure.

Conclusions

Omega-3 supplementation influence the tissue reactions of endodontic sealers, modulating inflammation, the immunolabeling of IL-6 and TNF-α, the repair process and it does not interfere with calcium deposition.

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Πέμπτη 7 Ιουλίου 2022

New-Generation Low-Field Magnetic Resonance Imaging of Hip Arthroplasty Implants

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imageObjectives Despite significant progress, artifact-free visualization of the bone and soft tissues around hip arthroplasty implants remains an unmet clinical need. New-generation low-field magnetic resonance imaging (MRI) systems now include slice encoding for metal artifact correction (SEMAC), which may result in smaller metallic artifacts and better image quality than standard-of-care 1.5 T MRI. This study aims to assess the feasibility of SEMAC on a new-generation 0.55 T system, optimize the pulse protocol parameters, and compare the results with those of a standard-of-care 1.5 T MRI. Materials and Methods Titanium (Ti) and cobalt-chromium total hip arthroplasty implants embedded in a tissue-mimicking American Society for Testing and Materials gel phantom were evaluated using turbo spin echo, view angle tilting (VAT), and combined VAT and SEMAC (VAT + SEMAC) pulse sequences. To refine an MRI protocol at 0.55 T, the type of metal artifact reduction techniques and the effect of various pulse sequence parameters on metal artifacts were assessed through qualitative ranking of the images by 3 expert readers while taking measured spatial resolution, signal-to-noise ratios, and acquisition times into consideration. Signal-to-noise ratio efficiency and artifact size of the optimized 0.55 T protocols were compared with the 1.5 T standard and compressed-sensing SEMAC sequences. Results Overall, the VAT + SEMAC sequence with at least 6 SEMAC encoding steps for Ti and 9 for cobalt-chromium implants was ranked higher than other sequences for metal reduction (P
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Safety of High-Dose Nasal Theophylline Irrigation in the Treatment of Postviral Olfactory Dysfunction

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This case series aims to determine the maximum tolerable dose of theophylline delivered via high-volume, low-pressure nasal saline irrigation for treatment of postviral olfactory dysfunction.
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Surgeon Thyroidectomy Case Volume Impacts Disease‐free Survival in the Management of Thyroid Cancer

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Surgeon Thyroidectomy Case Volume Impacts Disease-free Survival in the Management of Thyroid Cancer

In this population-based cohort study involving 37,233 thyroidectomies performed in Ontario, Canada between 1993 and 2017, we found both high-volume surgeons and hospitals to be predictors of better disease-free survival (DFS) in patients with well-differentiated thyroid cancer. DFS is higher among surgeons performing more than 40 thyroidectomies a year.


Objectives

To assess the association between surgeons thyroidectomy case volume and disease-free survival (DFS) for patients with well-differentiated thyroid cancer (WDTC). A secondary objective was to assess a surgeon volume cutoff to optimize outcomes in those with WDTC. We hypothesized that surgeon volume will be an important predictor of DFS in patients with WDTC after adjusting for hospital volume and sociodemographic and clinical factors.

Methods

In this retrospective population-based cohort study, we identified WDTC patients in Ontario, Canada, who underwent thyroidectomy confirmed by both hospital-level and surgeon-level administrative data between 1993 and 2017 (N = 37,233). Surgeon and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively and divided into quartiles. A multilevel hierarchical Cox regression model was used to estimate the effect of volume on DFS.

Results

A crude model without patient or treatment characteristics demonstrated that both higher surgeon volume quartiles (p < 0.001) and higher hospital volume quartiles (p < 0.001) were associated with DFS. After controlling for clustering and patient/treatment covariates and hospital volume, moderately low (18–39/year) and low (0–17/year) volume surgeons (hazard ratios [HR]: 1.23, 95% confidence interval [CI]: 1.09–1.39 and HR: 1.34, 95% CI: 1.17–1.53 respectively) remained an independent statistically significant negative predictor of DFS.

Conclusion

Both high-volume surgeons and hospitals are predictors of better DFS in patients with WDTC. DFS is higher among surgeons performing more than 40 thyroidectomies a year.

Level of Evidence

3 Laryngoscope, 2022

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Τρίτη 5 Ιουλίου 2022

Associated factors of primary snoring and obstructive sleep apnea in patients with sleep bruxism: a questionnaire study

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Abstract

Background

By being aware of the associated factors of primary snoring (PS) and obstructive sleep apnea (OSA) in sleep bruxism (SB) patients, dentists may contribute to the screening and early recognition of SB patients with PS or OSA.

Objective

To identify the associated factors of PS and OSA from questionnaire-based data in SB patients.

Methods

A total of 968 self-reported SB patients (31.6% men; median age 44.5 years) were retrospectively enrolled. Self-reported sleep-related breathing status (viz., no sleep-related breathing condition, PS, and OSA) was the dependent variable. Independent variables were questionnaire-based data on demographics, lifestyle, psychological status, pain, and sleep.

Results

For PS, no statistically significant associated factor was identified in analyses. For OSA, increased age (OR = 1.04 [1.03-1.06]), male gender (OR = 3.33 [2.17-5.00]), daily alcohol consumption (OR = 1.96 [1.18-3.33]), depression (OR = 1.10 [1.06-1.14]), daytime sleepiness (OR = 2.94 [1.85-4.76]), and high risk of gastroesophageal reflux disease (GERD; OR = 2.63 [1.52-4.76]) were found to be significant risk factors, while high risk of temporomandibular disorder (TMD) pain (OR = 0.51 [0.30-0.86]) and chronic pain (OR = 0.73 [0.59-0.90]) were significant protective factors. These results were confirmed in the subsequent network analysis.

Conclusion

Within the limitations of this study, no associated factor is identified for PS. For OSA, dentists should keep in mind that increased age, male gender, daily alcohol consumption, depression, daytime sleepiness, and high GERD risk are associated with increased OSA risk in SB patients, while high TMD pain risk and chronic pain are associated with decreased OSA risk in this population.

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