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European Journal of Nuclear Medicine... Jan 2019F-FDG PET/CT is an emerging technique for diagnosis of cardiac implantable electronic devices infection (CIEDI). Despite the improvements in transvenous lead extraction... (Observational Study)
Observational Study
PURPOSE
F-FDG PET/CT is an emerging technique for diagnosis of cardiac implantable electronic devices infection (CIEDI). Despite the improvements in transvenous lead extraction (TLE), long-term survival in patients with CIEDI is poor. The aim of the present study was to evaluate whether the extension of CIEDI at F-FDG PET/CT can improve prediction of survival after TLE.
METHODS
Prospective, monocentric observational study enrolling consecutive candidates to TLE for a diagnosis of CIEDI. F-FDG PET/CT was performed in all patients prior TLE.
RESULTS
There were 105 consecutive patients with confirmed CIEDI enrolled. An increased F-FDG uptake was limited to cardiac implantable electrical device (CIED) pocket in 56 patients, 40 patients had a systemic involvement. We had nine negative PET in patients undergoing prolonged antimicrobial therapy (22.5 ± 14.0 days vs. 8.6 ± 13.0 days; p = 0.005). Implementation of F-FDG PET/CT in modified Duke Criteria lead to reclassification of 23.8% of the patients. After a mean follow-up of 25.0 ± 9.0 months, 31 patients died (29.5%). Patients with CIED pocket involvement at F-FDG PET/CT presented a better survival independently of presence/absence of systemic involvement (HR 0.493, 95%CI 0.240-0.984; p = 0.048). After integration of F-FDG PET/CT data, absence of overt/hidden pocket involvement in CIEDI and a (glomerular filtration rate) GFR < 60 ml/min were the only independent predictors of mortality at long term.
CONCLUSIONS
Patient with CIEDI and a Cold Closed Pocket (i.e., a CIED pocket without skin erosion/perforation nor increased capitation at F-FDG PET/CT) present worse long-term survival. Patient management can benefit by systematic adoption of pre-TLE F-FDG PET/CT through improved identification of CIED related endocarditis (CIEDIE) and hidden involvement of CIED pocket.
Topics: Aged; Defibrillators, Implantable; Endocarditis, Bacterial; Female; Fluorodeoxyglucose F18; Humans; Male; Mortality; Pacemaker, Artificial; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections; Radiopharmaceuticals
PubMed: 30196365
DOI: 10.1007/s00259-018-4142-9 -
Community Dentistry and Oral... Dec 2018To measure dental caries, erosive tooth wear (ETW), periodontal health, self-reported oral health problems and performance impacts in a representative sample of UK elite...
OBJECTIVES
To measure dental caries, erosive tooth wear (ETW), periodontal health, self-reported oral health problems and performance impacts in a representative sample of UK elite athletes from different sports using standardized conditions clearly defined clinical indices and a measure of impact on performance with evidence of validity in sport.
METHODS
Cross-sectional study, with single, calibrated examiner, conducted in the local facilities of elite and professional UK athletes (UCL ethics number 6388/001). Main oral measures: dental caries (ICDAS), erosive tooth wear (BEWE), periodontal health (BPE) and athlete-reported performance impacts.
RESULTS
We recruited 352 athletes from eleven sports. The mean age was 25 years (range 18-39), and 67.0% were male. We found caries (ICDAS code ≥3) in 49.1% of athletes, ETW (BEWE score of ≥7) in 41.4%, gingival bleeding on probing/presence of calculus (BPE score 1 or 2) in 77.0% and pocket probing depths of at least 4 mm (BPE score 3 or 4) in a further 21.6%. One in five athletes reported previous wisdom teeth problems. The odds of having caries were 2.4 times greater in team sport than endurance sport (95% CI 1.3-3.2). The odds of having erosion were 2.0 times greater in team sport than endurance sport (95% CI 1.3-3.1). Overall, 32.0% athletes reported an oral health-related impact on sport performance: oral pain (29.9%), difficulty participating in normal training and competition (9.0%), performance affected (5.8%) and reduction in training volume (3.8%). Other impacts were difficulty with eating (34.6%), relaxing (15.1%) and smiling (17.2%). Several oral health problems were associated with performance impacts.
CONCLUSIONS
This is the first large representative sample study of oral health in athletes from different sports at elite level. Although experience of oral disease differs by sport, the prevalence, in UK elite and professional athletes, is substantial, with common self-reported performance impacts. Regular screening and use of effective oral health promotion strategies may minimize performance impacts from poor oral health.
Topics: Adolescent; Adult; Athletes; Athletic Performance; Cross-Sectional Studies; Dental Caries; Female; Gingival Pocket; Humans; Male; Oral Health; Periodontal Index; United Kingdom; Young Adult
PubMed: 29938820
DOI: 10.1111/cdoe.12392 -
Circulation May 1998Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in... (Review)
Review
BACKGROUND
Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in its occurrence.
METHODS AND RESULTS
Specimens were collected at the site of implantation for culture from the skin and the pocket before and after insertion in a consecutive series of patients who underwent elective permanent pacemaker implantation. Microorganisms isolated both at the time of insertion and of any potentially infective complication were compared by using conventional speciation and ribotyping. There were 103 patients (67 men and 36 women) whose age ranged from 16 to 93 years (mean+/-SD, 67+/-15). At the time of pacemaker implantation, a total of 267 isolates were identified. The majority (85%) were staphylococci. During a mean follow-up of 16.5 months (range, 1 to 24), infection occurred in four patients (3.9%). In two of them, an isolate of Staphylococcus schleiferi was recognized by molecular method as identical to the one previously found in the pacemaker pocket. In one patient, Staphylococcus aureus, an organism that was absent at the time of pacemaker insertion, was isolated. In another patient, a Staphylococcus epidermidis was identified both at the time of pacemaker insertion and when erosion occurred; however, their antibiotic resistance profiles were different.
CONCLUSIONS
This study strongly supports the hypothesis that pacemaker-related infections are mainly due to local contamination during implantation. S schleiferi appears to play an underestimated role in infectious colonization of implanted biomaterials and should be regarded as an important opportunistic pathogen.
Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Axilla; Bacteremia; Baths; Disinfection; Equipment Contamination; Female; France; Humans; Male; Middle Aged; Opportunistic Infections; Pacemaker, Artificial; Povidone-Iodine; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Thorax
PubMed: 9603533
DOI: 10.1161/01.cir.97.18.1791 -
Journal of Periodontology Jan 2005Herpes zoster (HZ) presents as a cutaneous vesicular eruption in the area innervated by the affected sensory nerve, usually associated with severe pain. Oral... (Review)
Review
BACKGROUND
Herpes zoster (HZ) presents as a cutaneous vesicular eruption in the area innervated by the affected sensory nerve, usually associated with severe pain. Oral manifestations of HZ appear when the mandibular or maxillary divisions of the trigeminal nerve are affected.
METHODS
This is a case report of a 63-year-old woman with HZ infection with trigeminal nerve involvement that led to a rapid loss of alveolar bone and exfoliation of two teeth.
RESULTS
The initial intraoral examination showed redness of the alveolar mucosa and gingiva of the lower right quadrant with multiple well-delimited and painful erosive lesions affecting the attached gingiva around the teeth. Two weeks later, teeth number 27 (lower right canine) and 28 (lower right first premolar) had class III mobility, flow of purulent exudate from the gingival sulcus, and deep pockets (>11 mm). The radiological examination showed advanced alveolar bone loss around both teeth. The prognosis for teeth number 27 and 28 was considered hopeless, and they were extracted. Due to extensive necrosis there was no interdental alveolar bone. The case is presented with a review of clinical data from patients with trigeminal HZ infection associated with osteonecrosis or exfoliation of teeth previously reported in the literature. The mechanisms by which the HZ infection leads to the alveolar bone necrosis are discussed.
CONCLUSIONS
Extensive osteonecrosis and exfoliation of teeth in the area innervated by the nerve affected by HZ has been reported after HZ infection. Clinicians should be aware of this possible outcome after a trigeminal HZ infection.
Topics: Acyclovir; Alveolar Bone Loss; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Mandibular Diseases; Middle Aged; Osteonecrosis; Tooth Exfoliation; Trigeminal Nerve
PubMed: 15830651
DOI: 10.1902/jop.2005.76.1.148 -
International Journal of Cardiology Feb 2022Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a high risk of ventricular arrhythmias. This study aimed to evaluate the safe replacement of TV-ICD with S-ICD based on updated recent evidence.
METHODS
We systematically searched EMBASE, JSTOR, PubMed/MEDLINE, and Cochrane Library on 30 July 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
We identified 26 studies that examined 7542 (58.27%) patients with S-ICD and 5400 (41.72%) with TV-ICD. The findings indicated that, compared to patients with TV-ICD, patients with S-ICD had a lower incidence of defibrillation lead failure (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.98; p = 0.05), lead displacement or fracture (OR, 0.25; 95% CI, 0.12-0.86; p = 0.0003), pneumothorax and/or hemothorax (OR: 0.22, 95% CI 0.05, 0.97, p = 0.05), device failure (OR: 0.70, 95% CI 0.51, 0.95, p = 0.02), all-cause mortality (OR: 0.44 [95% CI 0.32, 0.60], p < 0.001), and lead erosion (OR: 0.01, 95% CI 0.00, 0.05, p < 0.001). Patients with TV-ICD had a higher incidence of pocket complications than patients with S-ICD (OR, 2.13; 95% CI, 1.23-3.69; p = 0.007) and a higher but insignificant incidence of inappropriate sensing (OR, 3.53; 95% CI, 0.97-12.86; p = 0.06).
CONCLUSIONS
The S-ICD algorithm was safer and more effective than the TV-ICD system as it minimized the incidence of pocket complications, lead displacement or fracture, inappropriate sensing, defibrillation lead failure, pneumothorax/hemothorax, device failure, lead erosion, and all-cause mortality. Future studies should explore the scope of integrating novel algorithms with the current S-ICD systems to improve cardiovascular outcomes.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators, Implantable; Humans; Incidence; Treatment Outcome
PubMed: 34801615
DOI: 10.1016/j.ijcard.2021.11.029 -
Chemosphere Jul 2022A batch experiment was conducted to observe the liberation of micro- and nano-sized plastic particles and plastic additive-originated organic compounds from poly(vinyl...
A batch experiment was conducted to observe the liberation of micro- and nano-sized plastic particles and plastic additive-originated organic compounds from poly(vinyl chloride) under radiation-free ambient conditions. The weathering of PVC films in deionized water resulted in isolated pockets of surface erosion. Additional OH from Fenton reaction enhanced PVC degradation and caused cavity erosion. The detachment of plastic fragments from the PVC film surfaces was driven by autocatalyzed oxidative degradation. Over 90% of micro-sized plastic particles were <60 μm in length. The detached plastic fragments underwent intensified weathering, which involved strong dehydrochlorination and oxidative degradation. Further fragmentation of micro-sized particles into nano-sized particles was driven by oxidative degradation with complete dehydrochlorination being achieved following formation of nanoplastics. 20 organic compounds released from the PVC films into the solutions were identified. And some of them can be clearly linked to common plastic additives. In the presence of additional OH, the coarser nanoplastic particles (>500 nm) tended to be rapidly disintegrated into finer plastic particles (<500 nm), while the finest fraction of nanoplastics (<100 nm) could be completely decomposed and disappeared from the filtrates. The micro(nano)plastics generated from the PVC weathering were highly irregular in shape.
Topics: Microplastics; Plastics; Polyvinyl Chloride; Vinyl Chloride; Water; Water Pollutants, Chemical
PubMed: 35331748
DOI: 10.1016/j.chemosphere.2022.134399 -
Bone Mar 1995Numerous methods are currently being employed to estimate completed wall thickness and final erosion depth. Conflicting estimates of calculated bone balance have been...
Validation of wall thickness estimates obtained with polarized light microscopy using multiple fluorochrome labels: correlation with erosion depth estimates obtained by lamellar counting.
Numerous methods are currently being employed to estimate completed wall thickness and final erosion depth. Conflicting estimates of calculated bone balance have been obtained from the estimates of wall thickness and erosion depth using these various methods. To assess the utility of two specific methods to estimate wall thickness (polarized microscopy) and erosion depth (lamellar counts), we conducted a study in normal young adult beagle dogs, a model where bone balance should approximate 0. Dogs were administered multiple fluorochrome labels in vivo to label activity forming bone pockets. These labels were used to confirm the position of the cement line of the bone structural unit (BSU) in fluorescent light. Parallel measurements of wall thickness were then collected in polarized light. These estimates were compared to estimates of erosion depth obtained by lamellar counting and bone balance was calculated. Estimates of wall thickness correlated well with estimates of erosion depth with bone balance not differing significantly from 0. These data suggest that the combination of these two methods is a reasonable approach to obtaining estimates of bone balance at the level of the remodeling unit.
Topics: Animals; Bone Remodeling; Bone and Bones; Dogs; Fluorescent Dyes; Male; Microscopy, Polarization; Osteoblasts; Random Allocation
PubMed: 7786642
DOI: 10.1016/8756-3282(94)00053-0 -
Schweizer Monatsschrift Fur Zahnmedizin... 2012The primary goal of the prophylaxis and therapy of periodontitis is the establishment and the preservation of the secondary oral health. Thereby, the main expected... (Review)
Review
The primary goal of the prophylaxis and therapy of periodontitis is the establishment and the preservation of the secondary oral health. Thereby, the main expected outcomes are the reduction of inflammation and probing pocket depths. During the healing process, some tissue shrinkage during the reparative process and healing is inevitable in most cases and leads to more or less pronounced recession. The latter can cause subsequent secondary side effects due to dentin exposure, which appear - in most cases - unwanted and negative, i. e. hypersensitivity, increased caries risk, erosion and abrasion of the exposed dentin. These pathologic conditions may also encounter esthetic and functional impairments. The aim of this article is to elucidate and discuss these potential clinical pitfalls and their minimal-invasive management, especially when using adhesive strategies using composite resin materials.
Topics: Dentin Sensitivity; Esthetics, Dental; Gingival Recession; Humans; Oral Surgical Procedures; Periodontitis; Risk Factors; Root Caries; Tooth Cervix; Tooth Erosion; Wound Healing
PubMed: 22684997
DOI: No ID Found -
Annals of Plastic Surgery Jul 2007Erosion and exposure of pacemaker (PPM) and implantable cardiac defibrillator (ICD) devices are potentially dire complications, which have classically required the...
Erosion and exposure of pacemaker (PPM) and implantable cardiac defibrillator (ICD) devices are potentially dire complications, which have classically required the removal of the entire generator and lead systems. This study evaluates a series of cases wherein debridement, irrigation, pocket change, and local flap coverage were used for the successful salvage of indwelling leads after exposure and infection of implantable cardiac defibrillator devices. Patients with skin erosion, infection, and/or exposure of prepectoral infraclavicular cardiac defibrillator devices were treated over a 23-month period between June 2004 and April 2006. The surgical technique involved wide excision of the exposure site with a rhombic incision pattern, followed by removal of the generator unit and complete debridement of the peridevice capsule. Subclavian atrioventricular (AV) leads were preserved. The pocket was irrigated with antibiotic solution. A new pocket plane was selected and developed, and a new generator unit was implanted. A rhombic flap was developed and transposed to achieve tension-free closure over closed suction drains. Data were reviewed retrospectively. Six patients were treated, all male, mean age 66 years (range, 50 to 83 years). All patients presented with "new" exposure of the implantable generator within 48 hours. None demonstrated gross purulence, sepsis, or endocarditis. Initial gram stain was negative for bacteria in all cases, 1 (17%) grew sensitive Staphylococcus epidermidis species. Mean follow-up is 22 months (range, 8 to 31 months). One patient (17%) developed a hematoma, successfully treated by aspiration. Five patients (83%) were treated successfully, with no wound dehiscence, generator or lead exposure, or recurrence of infection. One patient (17%) developed drainage and exposure at a separate site (AV lead) at 10 months postoperative and required generator and lead explantation and site change to the contralateral anterior chest wall. In conclusion, in the absence of sepsis or gross infection, skin excision, pocket change, generator change with lead preservation, closed-suction drainage, and flap coverage for tension-free closure should be considered in the treatment of early ICD and PPM exposure.
Topics: Aged; Aged, 80 and over; Defibrillators, Implantable; Drainage; Female; Humans; Male; Middle Aged; Pacemaker, Artificial; Postoperative Complications; Reoperation; Retrospective Studies; Surgical Flaps; Surgical Procedures, Operative
PubMed: 17589255
DOI: 10.1097/01.sap.0000261846.73531.2e -
Bioorganic & Medicinal Chemistry Dec 2023Bromodomain and PHD finger-containing (BRPF) proteins function as epigenetic readers that specifically recognize acetylated lysine residues on histone tails. The...
Bromodomain and PHD finger-containing (BRPF) proteins function as epigenetic readers that specifically recognize acetylated lysine residues on histone tails. The acetyl-lysine binding pocket of BRPF has emerged as an attractive target for the development of protein interaction inhibitors owing to its potential druggability. In this study, we identified 3-acetylindoles as bone antiresorptive agents with a novel scaffold by performing structure-based virtual screening and hit optimization. Among those derivatives, compound 18 exhibited potent and selective inhibitory activities against BRPF1B (IC = 102 nM) as well as outstanding inhibitory activity against osteoclastogenesis (73.8% @ 1 μM) and differentiation (IC = 0.19 μM) without cytotoxicity. Besides, cellular mechanism assays demonstrated that compound 18 exhibited a strong bone antiresorptive effect by modulating the RANKL/RANK/NFATc1 pathway. Structural and functional studies on BRPF1 inhibitors aid in making advances to understand the epigenetic mechanisms of bone cell development and create innovative therapeutics for treating bone metastases from solid tumors and other bone erosive diseases.
Topics: Osteogenesis; Osteoclasts; NF-kappa B; Receptor Activator of Nuclear Factor-kappa B; Bone Density Conservation Agents; Ligands; Lysine; Cell Differentiation; RANK Ligand; NFATC Transcription Factors
PubMed: 37951134
DOI: 10.1016/j.bmc.2023.117440