The global prevalence of apical periodontitis: a systematic review and meta-analysis.

BACKGROUND: Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. OBJECTIVES: To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. METHODS: A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. RESULTS: The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2  = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2  = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2  = 98.5%) and 3% (95% CI 2%-3%; I2  = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2  = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2  = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2  = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2  = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2  = 98.3%). DISCUSSION: The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. CONCLUSIONS: Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.

[Retinal detachment in children and adolescents. Specific clinical features]. / Ablatio retinae bei Kindern und Jugendlichen. Spezifische Befundmerkmale.

BACKGROUND: Due to the long life expectancy, retinal detachment is a special threat to visual acuity in children and adolescents. This study presents the clinical features of retinal detachment in childhood and adolescence up to the age of 20 years. PATIENTS AND METHODS: A cohort was selected comprising 259 patients who suffered from unilateral or bilateral retinal detachment, were not older than 20 years of age at the first diagnosis of the first or only affected eye and had undergone surgery at least once at the Department of Ophthalmology of the University Medical Center of Munich during a period of 18 years (1980-1998). This patient collective was retrospectively analyzed with respect to the clinical features of the first retinal detachment. The group consisting of only one affected eye or the first affected eye (259 eyes) was included. The fellow eyes affected later were excluded (19 eyes). RESULTS: The time period between the first visual symptoms and the diagnosis of retinal detachment was on average 9.6 weeks and the most commonly manifested symptom was loss of vision (36.3% of patients). In 40.2% of the patients the detachment was discovered fortuitously. The most frequent presentation (34.0%) was a 2-quadrant retinal detachment and was (sub)total in 27.0% of eyes. Macular detachment was found in 154 eyes (59.5%). The commonest type of retinal break was a tear near the ora serrata (36.1% of all breaks). Giant tears (12.8% of all breaks) occurred preferentially in the area of the ora serrata, round atrophic holes were identified especially in the area of the equator, often in the form of a chain of holes. Breaks most frequently occurred in the inferior temporal quadrant. In 22.4% of retinal detachments no break was found even intraoperatively. A primary proliferative vitreoretinopathy (PVR) of at least stage C was involved in 25.5% of detachments. CONCLUSION: In childhood and adolescence a characteristic delay of diagnosis enables a large sized expansion of the retinal detachment with frequent macular involvement and a high proportion with (sub)total detachment and severe primary PVR. Tears in the ora serrata area, giant tears, multiple round atrophic holes in the area of the equator and a high rate of undetectable breaks are the intrinsic characteristics of juvenile retinal detachment.

An otoprotective role for the apoptosis inhibitor protein survivin.

Hearing impairment caused by ototoxic insults, such as noise or gentamicin is a worldwide health problem. As the molecular circuitries involved are not yet resolved, current otoprotective therapies are rather empirical than rational. Here, immunohistochemistry and western blotting showed that the cytoprotective protein survivin is expressed in the human and guinea pig cochlea. In the guinea pig model, moderate noise exposure causing only a temporary hearing impairment transiently evoked survivin expression in the spiral ligament, nerve fibers and the organ of Corti. Mechanistically, survivin upregulation may involve nitric oxide (NO)-induced Akt signaling, as enhanced expression of the endothelial NO synthase and phosphorylated Akt were detectable in some surviving-positive cell types. In contrast, intratympanic gentamicin injection inducing cell damage and permanent hearing loss correlated with attenuated survivin levels in the cochlea. Subsequently, the protective activity of the human and the guinea pig survivin orthologs against the ototoxin gentamicin was demonstrated by ectopic overexpression and RNAi-mediated depletion studies in auditory cells in vitro. These data suggest that survivin represents an innate cytoprotective resistor against stress conditions in the auditory system. The pharmacogenetic modulation of survivin may thus provide the conceptual basis for the rational design of novel therapeutic otoprotective strategies.

[Retinal detachment in pediatrics : Etiology and risk factors]. / Ablatio retinae bei Kindern und Jugendlichen : Atiologie und Risikofaktoren.

BACKGROUND: Juvenile retinal detachment is uncommon but is a severe threat to visual acuity. This study demonstrates the etiology and risk factors of retinal detachment in patients age 0-20 years. PATIENTS AND METHODS: A cohort was selected comprising 259 patients (278 eyes) who were not older than 20 years at the age at onset of retinal detachment in the only or the first affected eye and had undergone surgery at least once at the Department of Ophthalmology of the University Medical Center of Munich between January 1980 and October 1998. This cohort was analyzed retrospectively with regard to medical antecedents. We separated the group consisting of only one affected eye or the first affected eye (259 eyes) from the group with bilateral retinal detachment (56 eyes). RESULTS: Of the 259 patients, 72% were male. The average age of onset was 13.5 years, and 27.8% suffered from a systemic disease in which malformations were frequent. The most frequent ocular antecedents were ocular trauma in 52.9% and ocular malformations, especially myopia in 37.5%. In 58.7% of the fellow eyes, there was a disorder predisposing to retinal detachment, and10.8% of the patients suffered from bilateral retinal detachment. The group with bilateral retinal detachment had a remarkably high percentage of systemic diseases as well as malformations that were most frequent in systemic and ocular antecedents. CONCLUSIONS: The study confirms ocular trauma and myopia as important risk factors for juvenile retinal detachment. Because of the high association with malformations as an endogenous background and their conspicuous frequency in patients with bilateral retinal detachment, a genetic background for retinal detachment may be concluded.

[Visual rehabilitation in patients with hereditary retinal dystrophy: current data from a Low Vision Department]. / Visuelle Rehabilitation bei Patienten mit hereditärer Netzhautdystrophie: aktuelle Daten einer Sehbehindertenambulanz.

BACKGROUND: Especially during adolescence, hereditary retinal dystrophies can cause visual impairment. Because of their high mobility and working activities, these patients represent a great challenge for a Low-Vision Department. This study illustrates the spectrum of appropriate magnifying devices for them, as prescribed in our Low-Vision Department. PATIENTS AND METHODS: Between January 2003 and October 2004, we took care of 2,500 patients in our Low-Vision Department. 141 (5.6 %) of them suffered from a hereditary retinal dystrophy. After ascertaining the best corrected distance and near visual acuity as well as the magnification demand we prescribed the appropriate optic or electronic magnifying aids. RESULTS: The preferential age for the first visit was between 15 and 40 years. Within the retinal dystrophies we saw cone-rod dystrophy in 46 (33 %) patients, Stargardt's disease in 38 (27 %), retinitis pigmentosa in 37 (26 %), albinism in 15 (11 %) and achromatopsia in 5 (3 %) patients. The average of the best corrected distance visual acuities of the better eye was 0.142 (SD +/- 3.3 lines), the best corrected visual acuity for reading was 0.124 (SD +/- 6.1 lines). The average magnification demand was 5 x (SD +/- 6.7). The most prescribed optic magnifying aids were distance spectacles and magnifying glasses (each 20 %), monocular telescopes, contrast enhancing filters (each 13 %) and reading glasses (8 %). Electronic magnifying aids were prescribed in only 8 %. CONCLUSIONS: Fluent reading ability in hereditary retinal dystrophies could be achieved mostly by optic magnifying aids. The high proportion of prescribed distance glasses and magnifying glasses shows that often simple magnifying aids are suitable for these patients. Because of the high photophobia, contrast-enhancing filters should always be considered.

The effects of canal preparation and filling on the incidence of dentinal defects.

AIM: To evaluate ex vivo the incidence of defects in root dentine before and after root canal preparation and filling. METHODOLOGY: Eighty extracted mandibular premolars were divided equally in four groups. Group 1 was left unprepared. All other root canals were prepared using Gates Glidden drills and System GT files up to size-40, 0.06 taper at the working length. Group 2 was not filled while the canals of the other groups were filled with gutta-percha and AH26, either with a master cone and passive insertion of secondary gutta percha points (group 3) or lateral compaction (group 4). Roots were then sectioned horizontally 3, 6, and 9 mm from the apex and observed under a microscope. The presence of dentinal defects (fractures, craze lines or incomplete cracks) was noted and the differences between the groups were analysed with the Fisher's exact test. RESULTS: No defects were observed in the roots with unprepared canals. The overall difference between the groups was significant (P < 0.05). Canal preparation alone created significantly more defects than unprepared canals (P < 0.05). The total number of defects after lateral compaction was significantly larger than after noncompaction canal filling. CONCLUSION: Root canal preparation and filling of extracted teeth created dentine defects such as fractures, craze lines and incomplete cracks.

Dynamic intracellular survivin in oral squamous cell carcinoma: underlying molecular mechanism and potential as an early prognostic marker.

Survivin functions as an apoptosis inhibitor and a regulator of cell division in many tumours. The intracellular localization of survivin in tumours has been suggested as a prognostic marker. However, current reports are inconsistent and the underlying molecular mechanisms are not understood. The present study has examined the localization and prognostic value of nuclear and cytoplasmic survivin in the pre-therapeutic biopsies from 71 oral and oropharyngeal squamous carcinoma (OSCC) patients. Statistical analysis indicated that preferential nuclear versus cytoplasmic survivin correlated with favourable versus unfavourable disease outcome. Uni- and multi-variate analysis showed that in contrast to total survivin expression, the difference between nuclear and cytoplasmic survivin was a strong predictor for relapse-free survival (p=0.0003). As a potential underlying molecular mechanism, it is shown in OSCC cell lines that predominantly cytoplasmic survivin mediates protection against chemo- and radio-therapy-induced apoptosis. Importantly, the cytoplasmic localization of survivin is regulated by its nuclear export signal (NES), and export-deficient nuclear survivin is not cytoprotective. This study suggests that the difference between cytoplasmic and nuclear survivin is an indicator for survivin activity in tumour cells. Thus, this difference may serve as a predictive marker of outcome in OSCC patients undergoing multi-modality therapy. The pharmacogenetic interference with survivin's cytoplasmic localization is also to be pursued as a potential therapeutic strategy.

Comparative in vivo analysis of the sealing ability of three endodontic sealers in post-prepared root canals.

AIM: To compare the sealing ability of the endodontic sealers AH Plus, Sealer 26 and Endofill in premolar teeth of dogs exposed to the oral cavity after post-preparation. METHODOLOGY: Forty teeth with two canals each underwent root canal cleaning and shaping. Before filling, the canals were randomly distributed into three groups according to the sealer to be used: Group 1 - AH Plus; Group 2 - Sealer 26; and Group 3 - Endofill (Dentsply, Indústria e Comércio Ltda.). Immediately after filling, the gutta percha and sealer were partially removed from the canals, leaving material only in the apical third of the root. The teeth were temporarily sealed with glass ionomer sealer for 72 h to ensure setting. The coronal seal was then removed and the canals were exposed to the oral cavity for 45 days. The animals were euthanased and their mandibles and maxillae were removed. After abundant irrigation with distilled water, the canals were dried and filled with India ink. The teeth were sealed again for 96 h before extraction. The roots of the extracted premolars were separated and stored in labelled test tubes. The roots were cleared and the extent of dye penetration was measured with a 20x stereoscopic magnifying lens. RESULTS: Statistical analysis revealed that there were significant differences between the sealers studied (P < 0.001). Means for the extent of dye penetration for AH Plus, Endofill and Sealer 26 were, respectively, 0.13, 2.27 and 3.08 mm. CONCLUSIONS: After 45 days exposure to the oral cavity, none of the sealers was capable of preventing leakage and coronal dye penetration. There were significant differences between the sealers studied, in terms of mean dye penetration.

The potential of carboxypeptidase G2-antibody conjugates as anti-tumour agents. I. Preparation of antihuman chorionic gonadotrophin-carboxypeptidase G2 and cytotoxicity of the conjugate against JAR choriocarcinoma cells in vitro.

Carboxypeptidase G2, a zinc metalloenzyme isolated from Pseudomonas sp. strain RS-16, which catalyses the hydrolytic cleavage of reduced and non-reduced folates to pteroates and L-glutamate, has been linked to a monoclonal antibody (W14A) raised to human chorionic gonadotrophin. The coupling efficiency and retention of antibody and enzymatic activities are compared for three separate methods of preparing 1:1 conjugates. Preliminary in vitro studies on the cytotoxicity of the free enzyme and the conjugated enzyme towards JAR choriocarcinoma cells are reported. Despite the limitations of the in vitro model, it could be demonstrated that a significant proportion of 10(6) choriocarcinoma cells lost viability when exposed to either free or conjugated enzyme for 72 hours at concentrations of carboxypeptidase G2 of 1-3 units ml-1 of medium.

A subchronic inhalation toxicity study of a Matacil formulation in the albino rat.

The subchronic toxicity of a new formulation of Matacil (aminocarb) was assessed by exposing male and female Sprague-Dawley rats via a nose-only technique to a respirable (2.0- to 4.1-microns diameter) aerosol at chamber concentrations of 22.5, 45, and 90 micrograms of insecticide/liter of air for 2 hr/day for 30 consecutive days. Control groups were exposed to a vehicle aerosol or to room air. Randomly selected rats of each group were bled after 8, 15, and 30 days of treatment, and after a 30-day recovery period. Routine clinical laboratory investigations (hematology, blood chemistry, and urinalysis) were conducted during treatment. Other parameters measured included body weight, feed intake, plasma, red blood cell count, brain cholinesterase activity, and hepatic and renal carboxylesterase activities. Organ weights were recorded at necropsy and routine histopathological evaluation was performed. Mild muscle tremors were observed occasionally in the intermediate- and high-dose groups. Treated females, but not males, demonstrated a dose-dependent inhibition of cholinesterase activity, though within treatment groups, there were no differences associated with the number of days of treatment. Enzyme values had returned to baseline levels by 30 days post-treatment. Hepatic carboxylesterase activity was significantly reduced only in male rats at the highest dose. Lung weights were increased in vehicle and Matacil-treated groups. Histological studies indicated that these changes were a nonspecific tissue response to a heavy burden of an oil-based irritant, which was partially resolved by 30 days post-treatment. The results showed that, at the concentrations tested, the formulation produced little or no acute symptoms and minimal long-term sequellae.

A biometrical approach for determining the effects of treatment with a chemotherapeutic agent upon heart weight in the mature rabbit.

Changes in heart weight as attributable to treatments involving a chemotherapeutic agent (CTA) were studied using adult rabbits. CTA was administered to each subject three times a week until sacrifice. Dose level per administration was held constant with respect to mg of CTA per kgm of body weight. The level of treatment for a given animals was then determined by the length of time the animal was in the treatment program prior to sacrifice. At sacrifice, variations in heart weight were evaluated relative to sex, initial body weight, relative change in body weight and level of treatment. Regression techniques were used in the analysis of data. This procedures allowed for differentiation between the direct effects and indirect effects of treatment. The direct effect was shown to cause a significant increment in heart weight. The indirect effect as related to loss body weight was shown to lead to a significant decrement in heart weight.

Function of myocardial mitochondria in the adriamycin-induced cardiomyopathy of rabbits.

Ultrastructural examination of the myocardia of New Zealand White rabbits showed a progressive cardiomyopathy with prominent mitochondrial lesions after 56 days of increased doses of adriamycin. During all phases of study, similar respiratory control rates and ADP:O ratios were found in myocardial mitochondria isolated from adriamycin-treated and control rabbits.