Objectives
To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri‐implantitis.
Material and Methods
During a resective surgical ...intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline‐soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow‐up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full‐mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann–Whitney U test.
Results
No differences between the test and control group were found for BoP over 12 months of follow‐up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1‐year follow‐up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%).
Conclusions
Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri‐implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success.
Trial registry: https://www.trialregister.nl/ Identifier: NL8621.
The potential of perioperative goal-directed therapy (PGDT) to improve outcome after high-risk abdominal surgery remains subject of debate. In particular, there is a need for large, multicenter ...trials focusing on relevant patient outcomes to confirm the evidence found in small, single center studies including minor complications in their composite endpoints. The present study therefore aims to investigate the effect of an arterial waveform analysis based PGDT algorithm on the incidence of major complications including mortality after high-risk abdominal surgery.
Prospective randomized controlled multicenter trial.
Operating theatres and Post-Anesthesia/Intensive Care units (PACU/ICU) of four tertiary hospitals in The Netherlands.
A total number of 482 patients undergoing elective, abdominal surgery that is considered high-risk due to the extent of the procedure and/or patient comorbidities.
Hemodynamic therapy using an age-specific PGDT algorithm including cardiac index (CI) and stroke volume variation (SVV) measurements during a 24-h perioperative period starting at induction of anesthesia.
The average number of major complications (including mortality) within 30 days after surgery, the number of minor complications, hospital and PACU/ICU length of stay (LOS), amounts of fluids and vasoactive medications used. Complications were graded using the Accordion severity grading system.
The average number of major complications per patient was 0.79 (PGDT group) versus 0.69 (control group) (p = 0.195). There were no statistically significant differences in the number of minor complications, hospital LOS, PACU/ICU LOS, or grading of complications. Patients in the PGDT group received more fluids intraoperatively, more dobutamine intra- and postoperatively, while patients in the control group received more phenylephrine during the operation.
PGDT based on a CI and SVV driven algorithm did not result in improved outcomes after high-risk abdominal surgery.
Netherlands Trial Registry: NTR3380.
•Generalized perioperative goal-directed therapy results in variable patient outcomes after high-risk abdominal surgery.•The effect of perioperative goal-directed therapy on outcomes in larger multi-center trials is still unclear.•In this large trial, an age-specific cardiac index algorithm did not improve outcomes after high-risk abdominal surgery.
Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume variation (SVV) are increasingly being used for optimizing cardiac preload since they have been demonstrated to ...predict fluid responsiveness in a variety of perioperative settings. However, in open-chest conditions, the value of these indices has not been systematically examined yet. We, therefore, evaluated the ability of PPV and SVV to predict fluid responsiveness under open- and closed-chest conditions.
Prospective, controlled, clinical study.
University hospital.
Twenty-two patients scheduled for elective coronary artery bypass graft surgery.
Defined volume loads (VL) (10 mL kg-1 hydroxyethyl starch 6%) intra- and postoperatively.
Stroke volume index was measured 1) before and after a VL intraoperatively in open-chest conditions, and 2) under closed-chest conditions within 1 hour after arrival in the intensive care unit. Central venous pressure and global end diastolic volume were assessed as static preload indicators. In addition, PPV and SVV (both obtained with PiCCO system) were recorded. Fluid-responders were defined by an increase in stroke volume index >or=12% subsequent to the VL. Receiver operating characteristic analysis showed that all preload indicators failed to predict fluid responsiveness in open-chest conditions. Under closed-chest conditions, the areas under the receiver operating characteristic curve for PPV and SVV were 0.884 (p = 0.004) and 0.911 (p = 0.003), respectively, whereas the static and volumetric preload parameters failed to predict fluid responsiveness. A PPV of >or=10% identified fluid-responders with a sensitivity of 64% and a specificity of 100%, while a SVV of >8% identified fluid-responders with a sensitivity of 100% and a specificity of 78%.
Our results suggest that the dynamic preload indicators PPV and SVV are able to predict fluid responsiveness under closed-chest conditions, whereas all static and dynamic preload indicators fail to predict fluid responsiveness under open-chest conditions.
To evaluate the accuracy and precision of an arterial pulse contour-based continuous cardiac output device (Vigileo). Vigileo cardiac output (VigileoCO) was compared with intermittent transpulmonary ...thermodilution cardiac output (TPCO) and an established arterial pulse contour-based cardiac output (PCCO).
Prospective clinical study.
University hospital.
Twenty-two patients undergoing coronary artery bypass graft surgery.
Defined volume load during surgery and in the postoperative period.
We obtained 184 pairs of VigileoCO and TPCO, 140 pairs of VigileoCO and PCCO, and 140 pairs of PCCO and TPCO. Measurements were performed after induction of anesthesia (T1), after sternotomy (T2), immediately after (T3) and 20 mins after volume challenge with 10 mL.kg hydroxyethyl starch 6% (T4), 15 mins after coronary pulmonary bypass (T5), after retransfusion of autologous blood (T6), after arrival at the intensive care unit (T7), and immediately after (T8) and 20 mins after (T9) a second volume load with 10 mL.kg hydroxyethyl starch 6%. TPCO was used to calibrate PCCO. For pooled data, including uncalibrated PCCO data immediately after weaning from coronary pulmonary bypass (T5), the correlation coefficient of TPCO vs. VigileoCO, PCCO vs. VigileoCO, and TPCO vs. PCCO was 0.75, 0.60, and 0.75 respectively. Bland-Altman analysis showed a bias of 0.00, -0.01, and 0.02 L.min, the precision (=sd) was 0.87, 1.08, and 0.93 L.min, and the mean error was 33%, 40%, and 35%. When we compared calibrated PCCO values (T2-T4, T6, T7-9), the correlation coefficients of PCCO-VigileoCO and TPCO-PCCO were 0.72 and 0.85, bias was -0.16 and 0.19 L.min, and mean error was 33% and 27%, respectively. Best correlations and the least differences between TPCO and VigileoCO were observed in postbypass closed-chest conditions and in the intensive care unit.
Our results showed that VigileoCO enables clinically acceptable assessment of cardiac output in postbypass closed-chest conditions and during stable conditions in the intensive care unit.
IntroductionPeri-implantitis, a common biological complication of dental implant, has attracted considerable attention due to its increasing prevalence and limited treatment efficacy. Previous ...studies have reported several risk factors associated with the onset of peri-implantitis (eg, history of periodontitis, poor plaque control and smoking). However, inadequate data are available on the association between these risk factors and successful outcome after peri-implantitis therapy. This prospective cohort study aims to identify the local and systemic predictive factors for the treatment success of peri-implantitis.Methods and analysisA single-centre cohort study will be conducted by recruiting 275 patients diagnosed with peri-implantitis. Sociodemographic variables, healthy lifestyles and systemic disorders will be obtained using questionnaires. In addition, clinical and radiographic examinations will be conducted at baseline and follow-up visits. Treatment success is defined as no bleeding on probing on more than one point, no suppuration, no further marginal bone loss (≥0.5 mm) and probing pocket depth ≤5 mm at the 12-month follow-up interval. After adjustment for age, sex and socioeconomic status, potential prognostic factors related to treatment success will be identified using multivariable logistic regression models.Ethics and disseminationThis cohort study in its current version (2.0, 15 July 2022) is in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Stomatological Hospital, Southern Medical University (EC-CT-(2022)34). The publication will be on behalf of the study site.Trial registration numberChiCTR2200066262.
Response to comments de Waal, Eric E.C.; Frank, Michael; Scheeren, Thomas W.L. ...
Journal of clinical anesthesia,
11/2022, Letnik:
82
Journal Article
Recenzirano
Odprti dostop
Mean arterial pressures were not significant between groups (p = 0.49) (Fig. 1). ...average mean arterial pressures were above 70 mmHg, with lower levels (average - standard deviation) most often ...above 65 mmHg, with, as published previously, low Odds ratios for adverse outcomes 6. ...we reported in the manuscript that a total of 939 interventions based on the protocol in the PGDT group were analyzed. Besides these per protocol interventions, other interventions were possible at the discretion of the attending anesthesiologist when blood pressures were lower, or urine production was lower with adequate cardiac index above the threshold cardiac index. On the contrary, not measuring cardiac output with lower blood pressure may trigger anesthesiologists to use phenylephrine to counteract anesthetics induced vasodilation to obtain adequate blood pressures (neglecting flow). ...phenylephrine was intraoperatively used in 102 patients and postoperatively in 6 patients in the control group.
Methotrexate is an off-label therapy for atopic dermatitis. A lack of consensus on dosing regimens poses a risk of underdosing and ineffective treatment or overdosing and increased risk of side ...effects. This systematic review summarizes the available evidence on dosing regimens.
A literature search was conducted, screening all randomized controlled trials (RCTs) and guidelines published up to 6 July 2023, in the MEDLINE, Embase, and Cochrane Library databases.
Five RCTs and 21 guidelines were included. RCTs compared methotrexate with other treatments rather than different methotrexate dosing regimens. The start and maintenance doses in RCTs varied between 7.5-15 mg/week and 14.5-25 mg/week, respectively. Despite varied dosing, all RCTs demonstrated efficacy in improving atopic dermatitis signs and symptoms. Guidelines exhibited substantial heterogeneity but predominantly proposed starting doses of 5-15 mg/week for adults and 10-15 mg/m
/week for children. Maintenance doses suggested were 7.5-25 mg/week for adults and 0.2-0.7 mg/kg/week for children. One guideline suggested a test dose and nearly half advised folic acid supplementation.
This systematic review highlights the lack of methotrexate dosing guidelines for atopic dermatitis. It identifies commonly recommended and utilized dosing regimens, serving as a valuable resource for clinicians prescribing methotrexate off-label and providing input for an upcoming consensus study.
Discussion remains on how to advise women with a past medical history of surgically corrected anorectal malformations (ARMs) regarding vaginal delivery. The aim of this review is to evaluate and ...review the reported obstetrical complications and outcomes after vaginal delivery for these women.
A systematic search was performed from inception up to 25 July 2022 in PubMed, Embase.com and Clarivate Analytics/Web of Science Core Collection, with backward citation tracking.
All articles reported on the outcomes of interest in women with a past medical history of surgically corrected anorectal malformation and had a vaginal delivery were included with the exception of editorial comments or invitational commentaries. Screening, data extraction and risk of bias assessment was done by two authors independently with a third and fourth reviewer in case of disagreement. Tool for Quality assessment depended on the type of article. As low quality evidence was expected no meta-analysis was performed.
Only five of the 2377 articles screened were eligible for inclusion with a total of 13 attempted vaginal deliveries in eight women. In three patients complications were reported: failed vaginal delivery requiring urgent cesarean section in two patients, and vaginal tearing in one patient.
High quality evidence regarding outcomes and complications after vaginal delivery in women with a history of surgically corrected anorectal malformation is lacking. Therefore, based upon this systematic review no formal recommendation can be formulated regarding its safety. Future studies are essential to address this problem.
CRD42020201390. Date: 28-07-2020s.
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