High cytomegalovirus viral load is associated with 182-day all-cause mortality in hospitalized people with human immunodeficiency virus (PWH)

alexandrossfakianakis shared this article with you from Inoreader High cytomegalovirus viral load is associated with 182-day all-cause mortality in hospitalized people with human immunodeficiency virus (PWH) via Clinical Infectious Diseases Advance Access Abstract Background Cytomegalovirus (CMV) infection is associated with increased mortality in PWH. It is less clear whether CMV infection is still associated with mortality when routinely screened and adequately treated. Methods This retrospective cohort study recruited 1003 hospitalized HIV-infected adults with CD4 cell counts of less than 200 cells/μL from 2017-2021. Blood CMV DNA was routinely measured and CMV DNAemia was treated if end-organ disease occurre d. CMV viral load was categorized into below the limit of quantification (BLQ;  < 500 IU/mL), low viral load (LVL; 500-10000 IU/mL), and high viral load (HVL;  ≥ 10000 IU/mL) groups. We compared the 182-day all-cause mortalities among different groups. Results The median CD4 cell count of the patients was 33 cells/μL (IQR, 13-84). The prevalence of CMV DNAemia was 39.8% (95%CI, 36.7%-42.9%) and was significantly associated with CD4 cell count. The 182-day all-cause mortality was 9.9% (95%CI, 8.0%-11.7%). Univariable analysis showed that, compared to BLQ, LVL and HVL were associated with 1.73-fold and 3.81-fold increased risks of mortality, respectively (P = 0.032 and P < 0.001). After adjustment for pre-defined confounding factors, HVL but not LVL was still associated increased risk of mortality (adjusted hazard ratio 2.63; 95%CI, 1.61-4.29; P < 0.001). However, for patients on effective anti-retroviral therapy, the impact of HVL on 182-day mortality was not statistically significant (P = 0.713). Conclusions High CMV viral load in hospitalized PWH was associated with higher mortality, even when early identified by screening. Optimalization of the management for those patients needs to be explored in future studies. View on Web

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Clinical, radiographic, and esthetic evaluation of immediate implant placement with buccal bone dehiscence in the anterior maxilla: A 1‐year prospective case series

alexandrossfakianakis shared this article with you from Inoreader Clinical, radiographic, and esthetic evaluation of immediate implant placement with buccal bone dehiscence in the anterior maxilla: A 1‐year prospective case series via Clinical Implant Dentistry and Related Research Abstract Objectives To evaluate the clinical, radiographic, and esthetic outcomes of immediate implant placement with buccal bone dehiscence in the anterior maxilla. Methods In this case series, implants were inserted immediately after tooth extraction in sockets with buccal bone dehiscence. Guided bone regeneration (GBR) with a papilla preservation flap and simultaneous connective tissue grafting (CTG) was used. The following outcome variables were measured: mid-facial mucosal recession, probing depth, bleeding on probing, Pink Esthetic Score (PES), marginal bone loss, and thickness of buccal bone plate (TBP). Results 12 patients were recruited. Stable mid-facial mucosal level (−0.03 ± 0.17 mm) and excellent soft-tissue esthetic outcomes (PES, 9.17 ± 0.72) were achieved at 1 year. The TBP at platform level was 2.01 ± 0.31 mm at 1-year follow up with a resorption rate of 28.90% ± 15.14%. Conclusions Immediate implant placement using GBR performed with a papilla preservation approach and simultaneous CTG is a feasible treatment procedure in compromised extraction sockets in the anterior region. Favorable esthetic outcomes and buccal bone thickness were obtained. Further studies were needed to evaluate the long-term tissue alteration. View on Web

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A Prospective Study of BurstDRTM Spinal Cord Stimulation for non‐Operated Discogenic Low Back Pain

alexandrossfakianakis shared this article with you from Inoreader A Prospective Study of BurstDRTM Spinal Cord Stimulation for non‐Operated Discogenic Low Back Pain via Pain Practice Abstract Introduction Chronic discogenic low back pain (CD-LBP) is caused by degeneration of the disc due to trauma to the annulus or by unprovoked degeneration, resulting in chronic pain. Spinal cord stimulation (SCS) employing the BurstDRTM waveform has been shown to be an effective treatment in a variety of chronic pain conditions. The aim of this prospective case study was to determine the effect of BurstDRTM SCS on pain relief, disability, and patient satisfaction in a population with CD-LBP. Methods 17 subjects with CD-LBP received a SCS trial with BurstDRTM stimulation. Patients with >50% pain relief after a trial period of 2 weeks were permanently implanted (n=15). Patients then rated LBP and leg pain using the numeric rating scale (NRS), Oswestery disability index (ODI), patient global impression of change (PGIC), EQ-5D quality of life and paindetect for neuropathic pain at baseline following trial, 3, 6 and 12 months after permanent implantation. Results Treatment with BurstDRTM SCS resulted in significant reduction of LBP as the NRS was reduced from 71.7± 7.3 at baseline to 42.5 ± 18.1 at 12 months. Average pain relief at 12 months was 42.5%. In patients with leg pain (n=8), pain was significantly reduced from 66.9 ± 8.2, to 11.7 ± 10.4 at 12 months. PainDETECT scores for neuropathic pain significantly reduced from 18.9 ± 4.8 at baseline, and 14.8 ± 3.2 at 12 months. Baseline ODI score significantly reduced from 41.2 ± 12.8, to 25.8 ± 8.6 at 12 months. PGIC scores remained low from 2.6 ± 1.6 at 3 months, 2.5 ± 1.0 at 6 months and 2.5 ± 1.3 at 12 months. EQ-5D-5L rates remained constant from baseline 56.10 ± 23.9 to 68.6 ± 12.9 at 12 months. Conclusion BurstDRTM SCS resulted in significant reduction of back pain, leg pain and quality of life in patients with CD-LBP and decreased the level of disability and generated positive patient satisfaction scores.. View on Web

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Efficacy of chemical approaches for implant surface decontamination in conjunction with sub‐marginal instrumentation, in the non‐surgical treatment of peri‐implantitis. A systematic review

alexandrossfakianakis shared this article with you from Inoreader Efficacy of chemical approaches for implant surface decontamination in conjunction with sub‐marginal instrumentation, in the non‐surgical treatment of peri‐implantitis. A systematic review via Journal of Clinical Periodontology Abstract Aim To answer the PICOS question: in adult patients with peri-implantitis, what is the efficacy of sub-marginal instrumentation combined with chemical surface decontamination in comparison with sub-marginal instrumentation with or without placebo, in terms of changes in probing depth (PD) and/or bleeding on probing (BOP), as reported in prospective randomized controlled trials, nonrandomized controlled trials or prospective cohort studies, with a minimum of 6-month "follow-up". Materials and methods A systematic literature search was performed in: PubMed, Web of Science (WOS), Embase, Scopus, Ovid Medline and The Cochrane Library of the Cochrane Collaboration (CENTRAL) for articles published until March 2022. Data addressing the primary and secondary outcomes were extracted. Results The search gave 2033 results of which three studies fulfilled the inclusion criteria. Two studies investigated the use of antimicrobial photodynamic therapy as adjunct to submarginal instrumentation and the third study assessed the adjunctive use of a desiccant material. A meta-analysis was not deemed meaningful due to the large heterogeneity among studies. All three studies showed favourable results in terms of PD reduction for chemical surface decontamination over control approaches, but were inconsistent or showed no differences for the other outcome variables. Conclusions Adjunctive chemical approaches for implant surface decontamination may offer an advantage over sub-marginal instrumentation alone, in terms of improved PD. View on Web

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Diagnostic Criteria for Temporomandibular Disorders − INfORM recommendations: Comprehensive and short‐form adaptations for children

alexandrossfakianakis shared this article with you from Inoreader Diagnostic Criteria for Temporomandibular Disorders − INfORM recommendations: Comprehensive and short‐form adaptations for children via Journal of Oral Rehabilitation Abstract Background The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. Objective To present comprehensive and short-form adaptations of Axis I and II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings. Methods Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children. Results The proposed adaptation is suitable for children aged 6−9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire, and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, and (ii) adding anxiety and depression assessments that have been validated in children, and (iii) adding three constructs (stress, catastrophizing, and sleep disorders) to assess psychosocial functioning in children. Conclusion The recommended DC/TMD, including Axis I and Axis II, for children aged 6−9 years, is appropriate for use in clinical and research settings. This adapted first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation. View on Web

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Full arch immediate occlusal loading using site specific implants: a clinical series of 10 patients (13 arches)

alexandrossfakianakis shared this article with you from Inoreader Full arch immediate occlusal loading using site specific implants: a clinical series of 10 patients (13 arches) via Journal of Prosthodontics Abstract Purpose Osseointegration of dental endosseous implants has proven to be effective, predictable, and clinically successful. Unloaded healing protocols were originally used in treating edentulous patients. Full arch immediate occlusal loading protocols have been shown to be as effective as unloaded healing protocols. This paper reports on the results, benefits, and limitations of one specific immediate loading protocol using site specific implants for fresh extraction and healed extraction sites. Materials and Methods Ten consecutive patients [{13 arches} (age range: 64–81 years; average: 70.1) (4 males/6 females) were treated by the first 2 authors in private practice settings. Hopeless teeth were scheduled for extraction with immediate implant placement and immediate loading with insertion of full arch, screw-retained, acrylic resin interim prostheses within 24 hours. Implants were also placed into healed edentulous ridges. Insertion torque values for each implant were recorded. Interim prostheses were removed after at least 3 months of healing. Implants were reverse torque tested (35Ncm) and evaluated for macroscopic mobility. Definitive full arch prostheses were made. Patients were followed for 21- 48 months post implant surgery. Panoramic radiographs were taken immediately post implant placement and one year post operative. Results Thirteen arches were treated; 11 ultrawide diameter implants were placed into molar sockets, 26 inverted body-shift implants were placed into anterior sockets; 25 standard diameter, tapered implants were placed into edentulous sites; 2 zygomatic implants were placed in one patient. The total number of implants placed was 64 (4 pre-existing implants were also used and not included in this study). The minimum implant insertion torque value was 20Ncm. After 12–18 months of function (average 14 months), the implant and prosthetic survival rates were 100%. Eight patients were restored with definitive zirconia or acrylic resin hybrid fixed prostheses. Two patients were restored with bar titanium frameworks and removable overdenture prostheses. No prosthetic complications were reported for the definitive prostheses. Conclusions The results of this clinical series with site specific implants and immediate full arch occlusal loading in treating edentulous patients resulted in 100% clinical implant and prosthetic survival rates. According to this study, this protocol can be used with high levels of anticipated success. This article is protected by copyright. All rights reserved View on Web

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Gastrectomy Versus Esophagectomy for Gastroesophageal Junction Tumors: Short- and Long-Term Outcomes From the Dutch Upper Gastrointestinal Cancer Audit

alexandrossfakianakis shared this article with you from Inoreader Gastrectomy Versus Esophagectomy for Gastroesophageal Junction Tumors: Short- and Long-Term Outcomes From the Dutch Upper Gastrointestinal Cancer Audit via Annals of Surgery - Most Popular Articles Objective: Investigate long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for gastroesophageal junction (GEJ) cancer. Background: Both a total gastrectomy and an esophagectomy may be valid treatment options in patients with GEJ cancer. Which procedure results in the most optimal patient outcome is not well studied. The aim of this study was to investigate the long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for GEJ cancer. Methods: A retrospective comparative cohort study of prospectively collected data from the Dutch Upper GI Cancer Audit combined with survival data of the Dutch medical insurance database was performed. Patients with GEJ cancer in whom a total gastrectomy or an esophagectomy was performed between 2011 and 2016 were compared. The primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, radicality of resection, and lymph node yield were secondary endpoints. Results: A total of 871 patients were included: 790 following esophagectomy and 81 following gastrectomy. The 3-year overall survival was 35.8% after esophagectomy and 28.4% after gastrectomy (hazard ratio 1.2, 95% confidence interval 0.721–1.836, P = 0.557). Postoperative morbidity, mortality, radicality of resection, lymph node yield, and 3-year conditional survival did not differ significantly between groups. Conclusion: A total gastrectomy and an esophagectomy for GEJ cancer show largely comparable results with regard to long-term survival, postoperative morbidity, mortality, and pathology results. If both procedures are feasible, other parameters such as surgeon's experience and quality of life should be considered when planning for surgery. View on Web

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DDEL-02. LUMBAR OMMAYA RESERVOIR- A COST EFFECTIVE ALTERNATIVE TO INTRAVENTRICULAR OMMAYA RESERVOIR FOR TREATMENT OF LEPTOMENINGEAL DISEASE

alexandrossfakianakis shared this article with you from Inoreader DDEL-02. LUMBAR OMMAYA RESERVOIR- A COST EFFECTIVE ALTERNATIVE TO INTRAVENTRICULAR OMMAYA RESERVOIR FOR TREATMENT OF LEPTOMENINGEAL DISEASE via # Neuro-Oncology Current Issue Abstract Introduction Lumbar puncture (LP) is a well-established approach for intrathecal (IT) delivery of chemotherapeutics for leptomeningeal disease (LMD). Intraventricular Ommaya reservoir (OR) has supplanted LPs as an easier and safer route for IT administration. Radiotherapy for treatment of LMD must be delayed in order for surgical wound healing following OR placement. Furthermore, prior cranial radiation can thin the scalp, predisposing to wound breakdown. Placement of lumbar Ommaya reservoir (LOR) provides an alternative to IT delivery, but this has not reached a wide-spread acceptance. Objective Provide cost-analysis and report patient outcomes after placement of LOR. METHODS Following IRB approval, all patients undergoing LOR placement between 2018 and 2020 were retrospectively reviewed. Patients age, primary tumor, survival lengths and complications were reviewed. Average procedure-related treatment cost was obtained from an uncomplicated representative case excluding the surgeon's fee. RESULTS Fourteen patients (mean age 46.35 years) were identified. The mean follow-up was 440.7 (25-1003) days post-surgery. Acute lymphoblastic leukemia (n = 4), acute myeloblastic leukemia (n = 3), breast carcinoma (n = 3), ependymoma (n = 3), lymphoma (n = 2) and lung adenocarcinoma (n = 1) were identified as underlying malignancy. LMD was diagnosed on average after 581.1 days after the diagnosis of the underlying malignancy. 8 patients succumbed to their malignancy on average after 463.9 and 314.6 days after the diagnosis of LMD and LOR surgery, respectively. There were 2 complications – pain at the site of the LOR and a fractured catheter caused by inadvertent puncture of the catheter. No infections or wound healing complications were noted. Typical cost for placement of LOR and OR was – 17,350 USD and 29,052 USD, respectively. Placement of the LOR proved to be more cost-effective in this cohort by ap proximately 40% cost reduction. CONCLUSION Placement of LOR is a cost effective alternative to cranial OR with low complication profile, and well tolerated by patients. View on Web

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TMIC-19. NEURODEVELOPMENTAL SUBTYPES SHAPE LIPID METABOLIC REPROGRAMMING IN GLIOMAS

alexandrossfakianakis shared this article with you from Inoreader TMIC-19. NEURODEVELOPMENTAL SUBTYPES SHAPE LIPID METABOLIC REPROGRAMMING IN GLIOMAS via # Neuro-Oncology Current Issue Abstract Gliomas have been classified into molecular (proneural, classical, mesenchymal) and neurodevelopmental (astrocyte, mesenchymal, neural progenitor cell (NPC), oligodendrocyte progenitor cell (OPC)) subtypes describing inter- and intra-tumoral heterogeneity; however, the functional outcomes and therapeutic implications of these subtypes has yet to be fully described. Metabolic reprogramming is a hallmark of cancer, and malignant cells, including gliomas, acquire metabolic adaptations in response to a multitude of intrinsic (oncogenotype, mutations) and extrinsic (tumor microenvironment) factors to fuel neoplastic progression. Altered metabolism in glioma is of particular interest given the extensive molecular heterogeneity of tumors, while also developing in the brain microenvironment, a tissue known for its unique metabolic milieu. It is unknown whether neurodevelopmental subtypes influence metabolism in gliomas. Preliminary comprehensive lipidomi c and transcriptomic analysis of over 200 patient-derived glioma samples revealed that distinct lipid signatures were linked to neurodevelopmental subtypes. Specifically, proneural-like gliomas (OPC, NPC, Neuron) had a lipid metabolic profile enriched in ether lipids. Conversely, mesenchymal-like gliomas (radial glia, MES.progenitor, vascular) have a lipid metabolic profile enriched in triacylglycerides (TAGs). Intriguingly, these differences in lipid metabolic programs between subtypes were associated with environmental dependencies; in contrast to more mesenchymal like gliomas, which could grow irrespective of tumor microenvironment (brain or in vitro cell culture), the proneural-like gliomas required features of the brain microenvironment to accumulate complex fatty acids and grow. Collectively, these data emphasize the metabolic heterogeneity within gliomas, and reveal a subset of gliomas that lack metabolic plasticity in fatty acid biosynthetic programs, indicating a potential brain-microenvironment specific metabolic dependency linked to transcriptional identity that may be targeted for therapy. View on Web

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NCMP-10. NEURO-OPHTHALMOLOGICAL FINDINGS IN CHILDREN AND ADOLESCENTS WITH MEDULLOBLASTOMA - A RETROSPECTIVE ANALYSIS

alexandrossfakianakis shared this article with you from Inoreader NCMP-10. NEURO-OPHTHALMOLOGICAL FINDINGS IN CHILDREN AND ADOLESCENTS WITH MEDULLOBLASTOMA - A RETROSPECTIVE ANALYSIS via # Neuro-Oncology Current Issue Abstract BACKGROUND Medulloblastoma represents the most common malignant pediatric brain tumor. Ophthalmic complications are possible sequelae. METHODS Pediatric medulloblastoma (MB) patients treated at the Medical University of Vienna from January 2012 to August 2021 were analyzed and their last ophthalmic assessment was reviewed. RESULTS Fifty-six MB patients could be included (71.4% non-WNT/non-SHH, 16.1% SHH-activated, 8.9% WNT-activated, 3.6% non-specified). Mean age at diagnosis was 7.2 years (range 0-19). Median follow-up to last ophthalmological assessment was 19.7 months (range 0.1-93.2). Thirty-four children underwent tumor resection at our hospital, their tumor localizations were: vermis (55.9%), floor of the 4th ventricle (26.5%), cerebellar hemispheres (11.8%), lateral recess (5.9%). Symptoms at presentation were evaluable for 51 children: 92.2% had symptoms of elevated intracranial pressure, 76.5% ataxi a and 21.6% visual disturbances. Postoperative posterior fossa syndrome was observed in 11.1% of 54 children. 98.2% had chemotherapy as part of their initial treatment and all children older than four years (85.7%) received postoperative irradiation of the posterior fossa. In 13 (23.2%) intraventricular chemotherapy was applied. At the last follow-up 21 patients experienced relapse after primary treatment. At the final assessment, frequent neuro-ophthalmological abnormalities included: oculomotor disturbance (75%), esotropia (35.7%) including abducens palsy (12.5%), other cranial nerve palsies (21.4%), horizontal gaze-evoked nystagmus (51.8%), spontaneous nystagmus (16.1%), ocular tilt reaction (21.4%), and optic disc abnormalities (14.3%). Good visual acuity (≥20/25) was maintained in 62.5% patients. Visual field and optical coherence tomography was successfully performed in 75% and 66.1% of patients, respectively. Optic pathway lesions were detected in 4 patients (7.1%), includi ng two cases with occipital metastases, one with optic nerve metastasis and one with leptomeningeal carcinomatosis. Orthoptic treatment with prisms and strabismus surgery was required in 14.3% and 7.7% of children, respectively. CONCLUSION Children with MB frequently suffer from neuro-ophthalmological late-effects. Regular monitoring is warranted to initiate appropriate management. View on Web

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