The human microbiome consists of all microorganisms occupying the skin, mucous membranes and intestinal tract of the human body. The contact of the mucosal immune system with the human microbiome is ...a balanced interplay between defence mechanisms of the immune system and symbiotic or pathogenic microbial factors, such as microbial antigens and metabolites. In systemic autoimmune diseases (SADs) such as rheumatoid arthritis, systemic lupus erythematosus and Sjögren's syndrome, the immune system is deranged to a chronic inflammatory state and autoantibodies are an important hallmark. Specific bacteria and/or a dysbiosis in the human microbiome can lead to local mucosal inflammation and increased intestinal permeability. Proinflammatory lymphocytes and cytokines can spread to the systemic circulation and increase the risk of inflammation at distant anatomical sites, such as the joints or salivary glands. Increased intestinal permeability increases antigen exposure and the risk of autoantibody production. If the human microbiome indeed plays such a critical role in SADs, this finding holds a great promise for new therapeutic strategies, such as diet interventions and probiotics and prebiotics. This review provides a background on the human microbiome and mucosal immunity in the gut and oral cavity and gives a summary of the current knowledge on the microbiome–SADs connection.
To explore the relationship between oral mucositis and selected clinical and economic outcomes in blood and marrow transplant patients.
Subjects consisted of 92 transplant patients from eight centers ...who participated in a multinational pilot study of a new oral mucositis scoring system (Oral Mucositis Assessment Scale OMAS). In the pilot study, patients were evaluated for erythema and ulceration/pseudomembrane formation beginning on the first day of conditioning and continuing for 28 days. We examined the relationship between patients' peak OMAS scores and days with fever (body temperature > 38.0 degrees C), the occurrence of significant infection, days of total parenteral nutrition (TPN), and days of injectable narcotic therapy (all over 28 days), days in hospital (over 60 days), total hospital charges for the index admission, and vital status at 100 days.
Patients' peak OMAS scores spanned the full range of possible values (0 to 5) and were significantly (P <.05) correlated with all of the outcomes of interest except days with fever (P =.21). In analyses controlling for type of graft (autologous v allogeneic) and study center, a 1-point increase in peak OMAS score was associated with (1) 1.0 additional day with fever (P <.01), (2) a 2.1-fold increase in risk of significant infection (P <.01), (3) 2.7 additional days of TPN (P <.0001), (4) 2.6 additional days of injectable narcotic therapy (P <.0001), (5) 2.6 additional days in hospital (P <.01), (6) $25,405 in additional hospital charges (P <.0001), and (7) a 3.9-fold increase in 100-day mortality risk (P <.01). Mean hospital charges were $42,749 higher among patients with evidence of ulceration compared with those without (P =.06).
Oral mucositis is associated with significantly worse clinical and economic outcomes in blood and marrow transplantation.
Objectives
To quantitatively and qualitatively assess the characteristics of YouTube videos dealing with Sjögren's syndrome.
Materials & Methods
A comprehensive electronic search was performed for ...‘Sjögren's syndrome' in YouTube. After excluding duplicates, irrelevant videos, and non‐English‐language domains, 70 videos were included for analysis. Videos were classified as useful, misleading, or personal experience. The overall quality of videos was scored according to the Global Quality Scale (GQS). Useful videos were assessed for reliability and comprehensiveness based on two 5‐point scales. Key points of the misleading videos were explored and patients' personal experiences were further investigated.
Results
Thirty‐six videos (51.4%) were classified as useful, 6 (8.6%) as misleading, and 28 (40%) as patient's personal experience. Independent users tend to upload videos with personal experience, while university channels/professional organizations share useful videos with evidence‐based information. Significant difference was observed in GQS among useful, misleading videos, and patient's experiences. The mean reliability, comprehensiveness, and GQS scores of useful videos were 2.5 (s.d.:1.2), 2.6 (s.d.:1.4), and 3.4 (s.d.:1.0), respectively, whereas only six videos (16.7%) were rated as complete vis‐à‐vis content. The most frequently misleading topics were etiology and treatment.
Conclusions
Specialists should refer their patients to validated e‐information resources and actively participate in the development of video‐sharing platforms.
The location of the primary tumor or lymph node metastases dictates the inclusion of the oral cavity, salivary glands, and jaws in the radiation treatment portals for patients who have head and neck ...cancer. The clinical sequelae of the radiation treatment include mucositis, hyposalivation, loss of taste, osteoradionecrosis, radiation caries, and trismus. These sequelae may be dose-limiting and have a tremendous effect on the patient's quality of life. Most treatment protocols to prevent these sequelae are still based on clinical experience, but alternatives based on fundamental basic and clinical research are becoming more and more available. Many of these alternatives either need further study before they can be incorporated into the protocols commonly used to prevent and treat the radiation-related oral sequelae or await implementation of these protocols. In this review, the various possibilities for prevention and/or treatment of radiation-induced changes in healthy oral tissues and their consequences are discussed.
Objectives
To identify the most discussed dental articles on the Web and to assess the association between the intensity of online attention, publication characteristics, and citations.
Materials and ...methods
An Altmetric Explorer search was conducted for articles published in the 91 dental journals included in 2015 InCites™ Journal Citation Report® and mentioned online at all times. The 100 articles with the highest online attention, as measured by the “Altmetric Attention Score” (AAS), were screened for journal title, quartile of impact factor distribution (Q1–Q4), publication date, origin and affiliation of first author, article topic, type, and access. Citation counts were harvested from Scopus.
Results
The top 100 articles presented a median AAS of 119 and were mostly discussed on news outlets, Twitter, and Mendeley. Forty‐one articles were published in Q1 journals, 24 in Q2 journals, 32 in Q3 journals, and three in Q4 journals. AAS was significantly higher in articles of Q2 journals (median AAS = 398, range = 70–513) than in articles of Q1. A weak reverse correlation existed between AAS and time since publication (r = −.25, p < .05). No correlation was detected between AAS and other publication characteristics or number of citations.
Conclusions
Increased social impact of dental articles is not significantly associated with high citation rates.
In healthy subjects, dental implants have evolved to be a common therapy to solve problems related to stability and retention of dentures as well as to replace failing teeth. Although dental implants ...are applied in medically compromised patients, it is often not well known whether this therapy is also feasible in these patients, whether the risk of implant failure and developing peri‐implantitis is increased, and what specific preventive measures, if any, have to be taken when applying dental implants in these patients. Generally speaking, as was the conclusion by the leading review of Diz, Scully, and Sanz on placement of dental implants in medically compromised patients (J Dent, 41, 2013, 195), in a few disorders implant survival may be lower, and the risk of a compromised peri‐implant health and its related complications be greater, but the degree of systemic disease control outweighs the nature of the disorder rather than the risk accompanying dental implant treatment. So, as dental implant treatment is accompanied by significant functional benefits and improved oral health‐related quality of life, dental implant therapy is a feasible treatment in almost any medically compromised patient when the required preventive measures are taken and follow‐up care is at a high level.
Objective
To perform a systematic review and meta‐analysis on studies examining the properties of ultrasonography of major salivary glands for diagnosing Sjögren's syndrome.
Materials and Methods
We ...searched for the literature on eight databases. The quality of included articles was assessed with the QUADAS‐2 tool. Publication bias, pooled sensitivity, specificity, diagnostic odds ratio, and 95% confidence intervals (95%CI) were calculated. Meta‐regression analysis was performed.
Results
We identified 37 studies and 33 ultrasonographic scoring systems. High risk of bias was observed in ‘patient selection’, ‘conduct and interpretation of ultrasound’, and ‘flow of patients and timing of tests’ in 78%, 70%, and 51% of the studies. We included 29 studies in the meta‐analysis. Publication bias was highly probable. Pooled sensitivity was 0.69 (95%CI: 0.67–0.71), specificity 0.92 (95%CI: 0.91–0.93), and diagnostic odds ratio 33.89 (95%CI: 20.75–55.35). Significant heterogeneity was detected between studies. Meta‐regression analysis showed that studies with high risk of bias in ‘conduct and interpretation of ultrasound’ and studies evaluating only parenchymal homogeneity had higher log diagnostic odds ratio (1.09 and 2.49, respectively, p < 0.05).
Conclusions
The quality of current studies is low, thus not allowing to judge the likelihood of salivary gland ultrasonography as a reliable and practical tool in diagnosing Sjögren's syndrome.
Objectives
The aim of the present study was to compare the composition of the periodontal microflora at baseline (T0) with the submucosal microflora at least 1 year after implant placement (T1) in ...periodontally healthy patients.
Material and methods
For all 169 consecutive patients that visited our clinic during 1 year, we determined their periodontal parameters, implant mucosal index, and presence of implant calculus. At T0, self-reported smoking status was recorded and subgingival and submucosal biofilm samples were obtained and analyzed for the presence and numbers of selected periodontal pathogens. All measurements were repeated at T1.
Results
One hundred twenty patients completed the study. Periodontal parameters were stable or had improved at T1. The total bacterial load was lower at implant sites (
P
< 0.05). The prevalence of
Porphyromonas gingivalis
was low at baseline, but at T1, detection rate and numbers were higher at implant sites compared to dentate sites. At T1, the frequency of detection of
P. gingivalis
(
P
= 0.01),
Parvimonas micra
(
P
= 0.018), and
Fusobacterium nucleatum
(
P
= 0.035) was higher in smoking patients (
n
= 23) than in non-smokers (
n
= 97).
Conclusions
Colonization of the submucosal peri-implant area is similar to the composition of subgingival microbiota. Smoking has a measurable effect on the colonization of implant-associated biofilms and may select for
P. gingivalis
,
P. micra
, and
F. nucleatum
.
Clinical relevance
The colonization of implants by well-known periodontal pathogens is very similar to that in normal dentition, also in a healthy cohort. Smoking status was related with the prevalence of periodontal pathogens where smokers harbored more often periodontal pathogens such as
P. gingivalis
,
P. micra
, and
F. nucleatum
.
Swallowing dysfunction in cancer patients Raber-Durlacher, Judith E.; Brennan, Mike T.; Verdonck-de Leeuw, Irma M. ...
Supportive care in cancer,
03/2012, Letnik:
20, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Purpose
Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to ...review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools, prevalence, complications, and impact on quality of life in patients with a variety of different cancers, particularly in those treated with curative chemoradiation for head and neck cancer.
Methods
The literature search was limited to the English language and included both MEDLINE/PubMed and EMBASE. The search focused on papers reporting dysphagia as a side effect of cancer and cancer therapy. We identified relevant literature through the primary literature search and by articles identified in references.
Results
A wide range of assessment tools for dysphagia was identified. Dysphagia is related to a number of factors such as direct impact of the tumor, cancer resection, chemotherapy, and radiotherapy and to newer therapies such as epidermal growth factor receptor inhibitors. Concomitant oral complications such as xerostomia may exacerbate subjective dysphagia. Most literature focuses on head and neck cancer, but dysphagia is also common in other types of cancer.
Conclusions
Swallowing impairment is a clinically relevant acute and long-term complication in patients with a wide variety of cancers. More prospective studies on the course of dysphagia and impact on quality of life from baseline to long-term follow-up after various treatment modalities, including targeted therapies, are needed.
Purpose
This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine ...the quality of evidence-based management recommendations.
Methods
The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. For each article, two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results, and conclusions.
Results
Seventy-two interventional studies met the inclusion criteria. In addition, 49 intensity-modulated radiation therapy (IMRT) studies were included as a management strategy aiming for less salivary gland damage. Management guideline recommendations were drawn up for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer.
Conclusions
There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.
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