Aim
To evaluate the long‐term outcomes of Acellular Dermal Matrix (ADM) with Coronally Advanced Flap (CAF) or Tunnel technique (TUN) in the treatment of multiple adjacent gingival recessions (MAGRs).
...Material and methods
Nineteen of the original 24 patients contributing to a total number of 33 sites for CAF and 34 for TUN were available for the 12 years follow‐up examination. Recession depth, mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) were evaluated and compared with baseline values and 6‐months results. Regression analysis was performed to identify factors related to the stability of the gingival margin.
Results
A highly significant drop in mRC was observed for both groups from the 6 months timepoint to the 12 years recall (p < .001). While there were no statistically significant differences between the two groups in terms of Clinical Attachment Level (CAL), KTW, GT changes and Root Coverage Esthetic Score at each timepoint (p > .05). KTW ≥ 2 mm and GT ≥ 1.2 mm at 6‐months were two predictors for stability of the gingival margin (p = .03 and p = .01, respectively).
Conclusions
A significant relapse of the gingival margin of MAGRs treated with CAF or TUN + ADM was observed after 12 years.
Longitudinal cohort studies can provide important evidence about preventable causes of disease, but the success relies heavily on the commitment of their participants, both at recruitment and during ...follow up. Initial participation rates have decreased in recent decades as have willingness to participate in subsequent follow ups. It is important to examine how such selection affects the validity of the results. In this article, we describe the conceptual framework for selection bias due to nonparticipation and loss to follow up in cohort studies, using both a traditional epidemiological approach and directed acyclic graphs. Methods to quantify selection bias are introduced together with analytical strategies to adjust for the bias including controlling for covariates associated with selection, inverse probability weighting and bias analysis. We use several studies conducted in the Danish National Birth Cohort as examples of how to quantify selection bias and also understand the underlying selection mechanisms. Although women who chose to participate in this cohort were typically of higher social status, healthier and with less disease than all those eligible for study, differential selection was modest and the influence of selection bias on several selected exposure–outcome associations was limited. These findings are reassuring and support enrolling a subset of motivated participants who would engage in long‐term follow up rather than prioritize representativeness. Some of the presented methods are applicable even with limited data on nonparticipants and those lost to follow up, and can also be applied to other study designs such as case–control studies and surveys.
Background Left atrial (LA) volume is a marker of cardiac remodeling and prognosis in heart failure (HF) with reduced ejection fraction (EF), but LA function is rarely measured or characterized. We ...investigated determinants and prognostic impact of LA reservoir function in patients with HF with reduced EF. Methods and Results In 405 patients with stable HF with reduced EF (EF, ≤40%) in sinus rhythm, we assessed LA reservoir function by both LA total EF (by phasic volume changes) and peak atrial longitudinal strain (PALS; by speckle tracking echocardiography); LA functional index was also calculated. During follow-up (median, 30 months; Q1-Q3, 13-52), 139 patients (34%) reached the composite end point (all-cause death/HF hospitalization). Median PALS was 15.5% (interquartile range, 11.2-20.6). By univariable analysis, all LA function parameters significantly predicted outcome ( P <0.01 for all), with PALS showing the highest predictive accuracy (area under the curve, 0.75; sensitivity, 73%; specificity, 70%). Impaired PALS was associated with greater left ventricular and LA volumes, worse left ventricular EF, left ventricular global longitudinal strain, right ventricular systolic function, and more severe diastolic dysfunction. After multivariable adjustment (including LA volume and left ventricular global longitudinal strain), PALS, but not LA total EF or LA functional index, remained significantly associated with outcome (hazard ratio per 1-SD decrease, 1.38; 95% CI, 1.05-1.84; P=0.030). Adding PALS to a base model, including age, sex, LA volume, EF, E/E' ratio, and global longitudinal strain, provided incremental predictive value (continuous net reclassification improvement, 0.449; P=0.0009). Conclusions In HF with reduced EF, assessment of LA reservoir function by PALS allows powerful prognostication, independently of LA volume and left ventricular longitudinal contraction.
•This ESMO Clinical Practice Guideline provides key recommendations for managing immunotherapy-related toxicity.•The guideline covers assessment, diagnosis and treatment of the most common and severe ...immunotherapy-related toxicities.•Recommended assessment and treatment algorithms according to the grade of toxicity are provided.•The authors comprise a multidisciplinary group of experts from different institutions in Europe, Australia and the USA.•Recommendations are based on available scientific data and the authors’ collective expert opinion.
Background
Long‐term studies of ≥10 years are important milestones to get a better understanding of potential factors causing implant failures or complications.
Purpose
The present study investigated ...the long‐term outcomes of titanium dental implants with a rough, microporous surface (titanium plasma sprayed TPS) and the associated biologic and technical complications in partially edentulous patients with fixed dental prostheses over a 20‐year follow‐up period.
Materials and Methods
Sixty‐seven patients, who received 95 implants in the 1980s, were examined with well‐established clinical and radiographic parameters. Based on these findings, each implant was classified as either successful, surviving, or failed.
Results
Ten implants in nine patients were lost during the observation period, resulting in an implant survival rate of 89.5%. Radiographically, 92% of the implants exhibited crestal bone loss below 1 mm between the 1‐ and 20‐year follow‐up examinations. Only 8% yielded peri‐implant bone loss of >1 mm and none exhibited severe bone loss of more than 1.8 mm. During the observation period, 19 implants (20%) experienced a biologic complication with suppuration. Of these 19 implants, 13 implants (13.7%) had been treated and were successfully maintained over the 20‐year follow‐up period. Therefore, the 20‐year implant success rate was 75.8 or 89.5% depending on the different success criteria. Technical complications were observed in 32%.
Conclusion
The present study is the first to report satisfactory success rates after 20 years of function of dental implants with a TPS surface in partially edentulous patients.
Background and Aim
In high or moderate risk populations, periodic surveillance of patients at risk of progression from gastric precursor lesions (PL) to gastric cancer (GC) is the most effective ...strategy for reducing the burden of GC. Incomplete type of intestinal metaplasia (IIM) may be considered as the best candidate, but it is still controversial and more research is needed. To further assess the progression of subtypes of IM as predictors of GC occurrence.
Methods
A follow‐up study was carried‐out including 649 patients, diagnosed with PL between 1995–2004 in 9 participating hospitals from Spain, and who repeated the biopsy during 2011–2013. Medical information and habits were collected through a questionnaire. Based on morphology, IM was sub‐classified as complete (small intestinal type, CIM) and incomplete (colonic type, IIM). Analyses were done using Cox (HR) models.
Results
At baseline, 24% of patients had atrophic gastritis, 38% CIM, 34% IIM, and 4% dysplasia. Mean follow‐up was 12 years. 24 patients (3.7%) developed a gastric adenocarcinoma during follow‐up. The incidence rate of GC was 2.76 and 5.76 per 1,000 person‐years for those with CIM and IIM, respectively. The HR of progression to CG was 2.75 (95% CI 1.06‐6.26) for those with IIM compared with those with CIM at baseline, after adjusting for sex, age, smoking, family history of GC and use of NSAIDs.
Conclusions
IIM is the PL with highest risk to progress to GC. Sub‐typing of IM is a valid procedure for the identification of high risk patients that require more intensive surveillance.
PDF
