Xenograft materials in maxillary sinus floor elevation surgery: a systematic review with network meta-analyses.

A systematic review and network meta-analysis was conducted to compare different commercially available xenograft materials used in maxillary sinus floor elevation surgery (MSFES). Embase, PubMed, the Cochrane Library, Web of Science, Scopus, LILACS, and grey literature were searched up to 13 July 2020. Only randomised controlled trials (RCTs) were included. A frequentist network meta-analysis using a random effects model compared different commercially available xenograft materials. The primary outcomes were the percentage of newly-formed bone and residual bone-substitute rate. Both were measured by histomorphometric analysis from bone biopsies obtained during preparation of the implant site. Of the 659 studies initially identified, 11 involving 242 MSFES were included in the quantitative analyses. A total of six bone-substitute materials were analysed (Bio-Oss® (Geistlich Pharma), InduCera® Dual Coat, Lumina-Bone Porous® (Critéria), Osseous® (SIN - Sistema de Implantes Nacional), THE Graft® (Purgo Biologics), and Osteoplant Osteoxenon® (Bioteck)). The P-score estimation showed that Osteoplant Osteoxenon® produced the most newly-formed bone and reabsorbed faster than other xenograft materials after six months. The combination of Bio-Oss® plus bone marrow aspirate concentrate (BMAC) significantly increased the percentage of newly-formed bone compared with Bio-Oss® alone. In contrast, the addition of Emdogain® (Straumann) and leucocyte and platelet-rich fibrin (L-PRF) to Bio-Oss® did not significantly improve the amount of regenerated bone. Study-level data indicated that the percentage of newly-formed bone differs among commercially available xenograft materials. Osteoplant Osteoxenon® seems to result in the highest amount of new bone in MSFES.

Histomorphometric evaluation of different grafting materials used for alveolar ridge preservation: a systematic review and network meta-analysis.

In this systematic review and network meta-analysis including only randomized clinical trials (RCTs), different grafting materials used in alveolar ridge preservation after tooth extraction were analysed, focusing on histomorphometric new bone formation (NBF) in core biopsies obtained during implant placement. The PubMed, Embase, Cochrane Library, Web of Science, Scopus, and LILACS databases, as well as the grey literature, were searched for published and unpublished trials (from database inception to January 14, 2019). The primary outcome was the percentage of NBF. The secondary outcomes were the percentage of residual biomaterial and the percentage of soft tissue. An arm-based network meta-analysis was performed. The rank of intervention efficacy was obtained to measure the probability of each biomaterial being ranked first across all interventions. A total of 1526 studies were found, of which 38 were included for quantitative analysis. Three trials were rated as having a high risk of bias and 35 trials as having an unclear risk of bias. The network meta-analysis showed that nine grafting materials decreased NBF and 25 did not decrease NBF. The grafting material with the highest amount of NBF was plasma rich in growth factors. Due to the lack of studies with a low risk of bias, further RCTs are needed for definitive conclusions.

Platelet-rich fibrin in oral surgical procedures: a systematic review and meta-analysis.

The effect of platelet-rich fibrin (PRF) in enhancing the healing after oral surgical interventions is still a matter of debate. The purpose of this study was to identify instances where PRF has been shown to be effective in oral surgical procedures. A comprehensive literature search was performed up to 2017 on PubMed/MEDLINE, Cochrane Library, Web of Science, Scopus and LILACS databases and grey literature. The full-text of potentially relevant studies were reviewed and only randomized clinical trials (RCTs) were included. A total of 559 studies were found, of which 30 were included for qualitative analysis and 13 for quantitative analysis. Three review authors assessed the risk of bias independently. The available literature suggests that PRF has a positive effect in improving alveolar preservation on extraction sockets and around dental implants. The qualitative analysis showed a significantly better effect of PRF in promoting bone regeneration for alveolar cleft reconstruction. The meta-analysis for third molar surgery showed a decrease in prevalence of alveolar osteitis. PRF increased implant stability 1 week and 1 month after surgery (P=0.0005 and 0.0003). Due to the lack of studies with low risk of bias and a limited number of patients available, further RCTs are needed to confirm these results.

Influence of 3 calcium channel blockers on gingival overgrowth in a population of severe refractory hypertensive patients.

OBJECTIVE: The aim of the current study was to assess the association between 3 different calcium channel blockers (CCBs) (nifedipine, amlodipine and felodipine) and gingival overgrowth in patients with a diagnosis of severe refractory hypertension. METHODS: One hundred and sixty-two patients with severe refractory hypertension, taking CCBs, were selected. Gingival overgrowth was graded and periodontal measurements were recorded (probing pocket depth, clinical attachment level, plaque index and bleeding on probing). Unconditional multivariable binary logistic regression analyses were performed to assess the association between CCB intake and gingival overgrowth after adjusting for potential confounders. RESULTS: Of the 162 patients, 26 (16.0%) were current smokers and 101 (62.3%) were females. The mean age (SD) was 54.1 (8.5) years and the median age (range) 52.5 (39-78) years. Gingival overgrowth was observed in 55 patients (34.0%). Nifedipine was the most common medication (35.2%; 57 of 162). The results of multiple binary logistic regression showed statistically significant associations between CCB intake (exposure) and gingival overgrowth (outcome) after adjusting for the variables treatment time with antihypertensive and plaque index. Patients with gingival overgrowth were 2.5 (odds ratio = 2.46; 95% confidence interval: 1.04-5.82) and 4.0 (odds ratio = 3.90; 95% confidence interval: 1.47-10.35) times more likely to be taking nifedipine and amlodipine, respectively, than patients without gingival overgrowth. On the other hand, this significant association was not observed for felodipine. CONCLUSION: Nifedipine and amlodipine, but not felodipine, were associated with gingival overgrowth in patients with severe refractory hypertension.

Activity of inflammatory bowel disease influences the expression of cytokines in gingival tissue.

This study assessed the cytokine expression in gingival and intestinal tissues from periodontitis patients with inflammatory bowel disease (IBD) and evaluated if IBD activity is a covariate to the amount of gingival cytokines. Paired gingival and intestinal tissues were collected from 21 patients and homogenised using a cell disruptor. Cytokine expression (IL-1ß, IL-4, IL-6, IL-10, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IL-17A, IL-17F, IFN-γ, sCD40L, and TNF-α) was evaluated using bead-based multiplex technology. An inflammation score was developed using the intestinal cytokines that showed good accuracy to discriminate IBD active patients from those in remission and then a similar score was applied to gingival tissue. IL-4, IL-10 and IL-21 expressions were significantly increased in gingival tissue from patients with an active disease as compared to those with a disease in remission. The inflammation score (mean value of IL-1ß, IL-6, IL-21, and sCD40L) was significantly higher in gingival tissue from patients with IBD activity. There was a significant correlation between gingival and intestinal inflammation scores (rho=0.548; P=0.01). Significantly higher IL-23 and IFN-γ levels and lower IL-31 and TNF-α levels were observed in gingival tissues than in intestinal ones. Activity of inflammatory bowel disease influenced the cytokine expression in gingival tissue.

Periodontal treatment in patients with chronic kidney disease: a pilot study.

BACKGROUND AND OBJECTIVE: This pilot cohort study evaluated the effect of periodontal treatment on renal function, metabolic markers and asymmetric dimethylarginine (ADMA) in patients with pre-dialysis chronic kidney disease (CKD) presenting chronic periodontitis. MATERIAL AND METHODS: Twenty-six patients with CKD and severe chronic periodontitis were selected. Periodontal parameters included plaque index, bleeding on probing, probing pocket depth and clinical attachment level. Estimated glomerular filtration rate (eGFR), triglycerides, total cholesterol, albumin and ADMA levels were evaluated at baseline, 90 and 180 d after periodontal therapy. eGFR was evaluated by the Modification of Diet in Renal Disease equation. RESULTS: All periodontal clinical parameters significantly improved (p < 0.05) 180 d after periodontal therapy. There was a significant improvement on the median values (25%; 75% percentiles) of eGFR from 34.6 (27; 44.7) mL/min/1.73 m2 on baseline to 37.6 (29.7; 57) mL/min/1.73 m2 on day 90, and to 37.6 (28.6; 56) mL/min/1.73 m2 (p < 0.05) on day 180. ADMA levels significantly reduced 180 d after periodontal treatment. No significant differences were observed at the median values of metabolic markers comparing baseline and 180 d after periodontal treatment. CONCLUSIONS: The results point to a link of kidney disease with endothelium dysfunction and periodontitis, suggesting that periodontal treatment may be beneficial to the course of CKD.

Serum creatinine and alkaline phosphatase levels are associated with severe chronic periodontitis.

BACKGROUND AND OBJECTIVE: Periodontitis may alter systemic homeostasis and influence creatinine and alkaline phosphatase levels. Therefore, the aim of this study was to evaluate the relationship between severe chronic periodontitis and serum creatinine and alkaline phosphatase levels. MATERIAL AND METHODS: One hundred patients were evaluated, 66 with severe chronic periodontitis (test group) and 34 periodontally healthy controls (control group). Medical, demographic and periodontal parameters were registered. Blood sample was collected after an overnight fast and serum creatinine and alkaline phosphatase levels were determined. RESULTS: There were significant differences between test and control groups in ethnicity, gender and educational level (p < 0.05). Patients with periodontitis showed a lower mean creatinine level (p < 0.05) and higher mean alkaline phosphatase level (p < 0.001) than the control group. There were significant correlations between periodontal parameters and serum creatinine and alkaline phosphatase levels. CONCLUSION: Severe chronic periodontitis was associated to lower creatinine and higher alkaline phosphatase levels.

Additional effects of homeopathy on chronic periodontitis: a 1-year follow-up randomized clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this study was test the hypothesis that homeopathy (H) enhances the effects of scaling and root planing (SRP) in patients with chronic periodontitis (CP). MATERIALS AND METHODS: 50 patients with CP were randomly allocated to one of two treatment groups: SRP (C-G) or SRP + H (H-G). Assessments were made at baseline and after 3 and 12 months of treatments. The local and systemic responses to the treatments were evaluated by clinical and serologic parameters, respectively. RESULTS: Both groups displayed significant improvements, however, using clinical attachment gain and reductions in HDL, LDL and Total Cholesterol, Triglycerides, Glucose and Uric acid, from baseline to 1 year, as criteria for treatment success, H-G performed significantly better than C-G. CONCLUSION: The findings of this 1-year follow-up randomized clinical trial suggest that homeopathic medicines, as an adjunctive to SRP, can provide significant local and systemic improvements for CP patients.

The impact of non-surgical periodontal treatment on serum levels of long chain-polyunsaturated fatty acids: a pilot randomized clinical trial.

BACKGROUND AND OBJECTIVE: Our group recently found higher levels of serum long chain-polyunsaturated fatty acids (LC-PUFAs) in patients with chronic periodontitis compared to controls. However, the effect of periodontal treatment on LC-PUFA serum levels has not been investigated. The primary aim of the present study was to investigate the impact of periodontal treatment on LC-PUFA serum levels. A secondary aim was to assess the effect of dietary ω-3 supplementation on clinical outcome. MATERIAL AND METHODS: The test group was composed of 10 patients with generalized chronic periodontitis (mean age 44 ± 6.4 years) treated with scaling and root planing associated with 4 mo of ω-3 supplementation eicosapetaenoic acid (EPA) plus docosahexaenoic acid (DHA), 3 g/d. The placebo group was composed of 11 patients (47.9 ± 10.5 years) that received scaling and root planing plus placebo. The periodontal examination included probing depth, clinical attachment level, bleeding on probing and visible plaque index. Docosapentaenoic acid (DPA), EPA, DHA and arachidonic acid (AA) were detected using gas chromatograph. RESULTS: In the placebo group, all LC-PUFAs levels reduced significantly (DHA, DPA and AA, p = 0.004; EPA, p = 0.008). In the test group, only DPA and AA showed a significant reduction (p = 0.005). Moreover, a significant decrease in the ratios AA/EPA and AA/DHA (p = 0.005) was observed in the test group. CONCLUSION: Non-surgical periodontal treatment reduced significantly the serum levels of all analyzed LC-PUFAs except those presented in the supplementation. The ω-3 dietary supplementation had no effect on clinical outcome of treatment.

Extent and severity of chronic periodontitis in chronic kidney disease patients.

UNLABELLED: BACKGROUND AND OBJECTVE: Chronic inflammatory diseases have been investigated as a possible source of inflammation in chronic kidney disease patients; however, there is a shortage of information about the prevalence of periodontitis in such individuals. Therefore, the aim of this cross-sectional study was to determine the extent and severity of periodontitis in chronic kidney disease patients undergoing the following three different treatment modalities: predialysis; continuous ambulatory peritoneal dialysis (CAPD); and hemodialysis (HD); and to compare the findings with those from systemically healthy individuals. MATERIAL AND METHODS: Forty CAPD patients (mean age 52±12 years), 40 HD patients (mean age 50±10 years), 51 predialysis patients (mean age 54±11 years) and 67 healthy individuals (mean age 50±7 years) were examined. The periodontal examination included probing pocket depth, clinical attachment loss, bleeding on probing and presence of plaque. Patients with at least four sites with clinical attachment loss ≥6 mm were considered to have severe chronic periodontitis, and those with at least 30% of sites with clinical attachment loss ≥4 mm were considered to have generalized chronic periodontitis. RESULTS: Predialysis and HD patients had significantly more sites with clinical attachment loss ≥6 mm than healthy individuals. The CAPD patients had similar periodontal condition to healthy subjects. There were significantly more cases of severe chronic periodontitis in predialysis and HD patients. CONCLUSION: Predialysis and HD are associated with a higher prevalence of severe periodontitis compared with healthy individuals and CAPD patients.

Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study.

OBJECTIVE: The aim of this study was to assess the association of periodontitis with refractory arterial hypertension. STUDY DESIGN: A total of 137 patients were examined. Seventy patients (mean age of 55.2 ± 9.2 years) were included in the case group, while 67 non-hypertensive subjects (mean age of 50.0 ± 7.2) served as a control group. Periodontal clinical examination included plaque index, bleeding on probing, probing pocket depth and clinical attachment loss (CAL). Patients with at least five sites with CAL ≥6 mm were considered as severe periodontitis, and with at least 30% of the sites with CAL ≥4 mm generalized chronic periodontitis. RESULTS: The mean (±s.d.) number and percentage of sites with CAL ≥6 mm were 11 (±14) and 16.6 (±14) in the case group, and 5.7 (±9.5) and 5.8 (±9.7) in the control group (P < 0.05). The mean (±s.d.) percentage of sites with CAL ≥4 mm was 37 (±29.6) in the case group and 21.2 (±20) in the control group (P < 0.05). The significant associations with arterial hypertension were severe chronic periodontitis (OR = 4.04, 95% CI: 1.92; 8.49) and generalized chronic periodontitis (OR = 2.18, 95% CI: 1.04; 4.56). CONCLUSIONS: Severe and generalized chronic periodontitis seem to play a role as risk indicators for hypertensive patients.

Effect of non-surgical treatment on chronic and aggressive periodontitis: clinical, immunologic, and microbiologic findings.

BACKGROUND: Our goal was to examine differences in clinical, microbiologic, and immunologic responses to non-surgical mechanical therapy in patients with generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP). METHODS: Twenty patients with GCP and 14 patients with GAgP were evaluated. Clinical data, gingival crevicular fluid (GCF), and subgingival plaque samples were collected at baseline and 3 months after non-surgical periodontal treatment. Levels of 40 subgingival species were measured using checkerboard DNA-DNA hybridization. GCF interleukin (IL)-1ß, -4, and -8 and interferon-γ (IFN-γ) were analyzed using a multiplexed bead immunoassay, and elastase activity was measured using an enzymatic assay. The significance of changes with time was examined using the Wilcoxon rank sum test. Changes in clinical, microbiologic, and immunologic parameters after therapy were compared between groups using the Mann-Whitney U test. RESULTS: After periodontal therapy, we found significant improvements for all clinical parameters in both groups. We also observed significant reductions in elastase activity in shallow and deep sites from the GAgP group and in deep sites from the GCP group. Microbiologic data showed significant reductions in proportions of orange and red complexes and an increase in proportions of Actinomyces species in both clinical groups. When the clinical, microbiologic, and immunologic responses after therapy were compared between groups, only minor differences were found. CONCLUSION: This study fails to show any significant differences between severe forms of GCP and GAgP in response to non-surgical periodontal treatment.

Expression of cytokines in the gingival crevicular fluid and serum from patients with inflammatory bowel disease and untreated chronic periodontitis.

BACKGROUND AND OBJECTIVE: Previous studies have reported an increased prevalence/severity of chronic periodontitis in patients with inflammatory bowel disease. However, the pathogenesis of periodontal lesions in such patients has not been characterized. The aim of this pilot study was to characterize the pattern of expression of cytokines in the gingival crevicular fluid and serum from patients with untreated chronic periodontitis and Crohn's disease, ulcerative colitis and systemically healthy controls. MATERIAL AND METHODS: Fifteen patients with Crohn's disease, 15 patients with ulcerative colitis and 15 controls participated in the study. All subjects had been diagnosed with untreated chronic periodontitis. The clinical parameters evaluated were clinical attachment loss, bleeding on probing and percentage of plaque. The gingival crevicular fluid was sampled from four shallow and four deep periodontal sites of each patient. The concentrations of the cytokines interleukin (IL)-1ß, IL-4, IL-6, IL-10, IL-12p40, IL-12p70, interferon-γ and tumor necrosis factor-α were measured using a commercially available Lincoplex kit and the concentration of IL-18 was measured using an ELISA. RESULTS: Multiple comparisons analysis showed that clinical attachment loss, bleeding on probing, percentage of plaque and volume of gingival crevicular fluid were similar across the groups. The concentration of IL-4 in the gingival crevicular fluid differed significantly between groups in shallow sites (p = 0.046), with higher values found for the controls. In serum, the concentration of IL-18 was also significantly different between groups, with lower values found for controls (p = 0.018). CONCLUSION: This study showed a higher concentration of IL-18 in serum, but not in the gingival crevicular fluid, from periodontitis patients with Crohn's disease or ulcerative colitis compared with controls. The expression of cytokines was similar in the gingival crevicular fluid from patients with untreated chronic periodontitis who also had Crohn's disease or ulcerative colitis and in systemically healthy controls with untreated chronic periodontitis.

Increased interleukin-18 in gingival crevicular fluid from periodontitis patients.

INTRODUCTION: This study aimed to measure the levels of interleukin-18 (IL-18) in inflamed shallow sites and inflamed deep sites in patients with periodontitis and to compare the data with results from inflamed shallow sites in patients with gingivitis. A secondary aim was to examine the composition of the subgingival microbiota in the sampled sites. METHODS: Gingival crevicular fluid was collected from five gingivitis sites and five periodontitis sites from 18 patients with chronic periodontitis, and from five gingivitis sites from 15 patients with gingivitis. Samples from each site category were pooled and IL-18 levels were measured using an enzyme-linked immunosorbent assay. The subgingival microbiota was analyzed by checkerboard DNA-DNA hybridization. RESULTS: All clinical parameters and gingival crevicular fluid volumes were higher in periodontitis sites compared with gingivitis sites from patients with periodontitis and gingivitis. The total amount of IL-18 was higher in periodontitis sites than gingivitis sites in both periodontitis (P = 0.018) and gingivitis (P = 0.002) patients and was higher in gingivitis sites from periodontitis patients than in those from gingivitis patients (P = 0.015). There were higher levels of Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola (red complex species) in periodontitis sites compared with gingivitis sites in both the periodontitis and gingivitis patients (P < 0.001). CONCLUSION: Levels of IL-18 were higher in patients with chronic periodontitis compared with patients with gingivitis, even at sites with similar pocket depths. The presence of similar levels of red complex species in gingivitis sites from periodontitis patients and from gingivitis patients suggested that the higher levels of IL-18 were not associated with a different microbial challenge.

High concentration of residual aluminum oxide on titanium surface inhibits extracellular matrix mineralization.

In the present study we characterized titanium (Ti) surfaces submitted to different treatments and evaluated the response of osteoblasts derived from human alveolar bone to these surfaces. Five different surfaces were evaluated: ground (G), ground and chemical etched (G1-HF for 60 s), sand blasted (SB-Al(2)O(3) particles 65 mum), sand blasted and chemical etched (SLA1-HF for 60 s and SLA2-HF for 13 s). Surface morphology was evaluated under SEM and roughness parameters by contact scanning instrument. The presence of Al(2)O(3) was detected by EDS and the amount calculated by digital analyses. Osteoblasts were cultured on these surfaces and it was evaluated: cell adhesion, proliferation, and viability, alkaline phosphatase activity, total protein content, and matrix mineralization formation. Physical and chemical treatments produced very different surface morphologies. Al(2)O(3) residues were detected on SB and SLA2 surfaces. Only matrix mineralization formation was affected by different surface treatments, being increased on rough surface (SLA1) and reduced on surface with high amount of Al(2)O(3) residues (SB). On the basis of these findings, it is possible to conclude that high concentration of residual Al(2)O(3) negatively interfere with the process of matrix mineralization formation in contact with Ti implant surfaces.

Aberrant neutrophil reactions in periodontitis.

BACKGROUND: The aim of this study was to compare the activity of neutrophilic granulocytes in patients with severe periodontitis and patients with gingivitis alone. METHODS: The study population comprised 22 patients with gingivitis and 44 with periodontitis. Samples of gingival crevicular fluid (GCF) were collected from untreated patients with gingivitis and from shallow and deep pockets in untreated patients with periodontitis. GCF samples were analyzed for lactoferrin, elastase, matrix metalloproteinase-8 and -9, and collagenolytic activity. RESULTS: The free elastase activity and the neutrophil activity, estimated as the ratio between elastase and lactoferrin, were significantly higher in the samples from the periodontitis patients. These differences were also observed in shallow pockets in periodontitis patients compared to similar pockets in patients with gingivitis. CONCLUSION: This study shows higher levels of free elastase in untreated patients with periodontitis, relative to inflammation-matched controls, which may explain the tissue destruction seen in periodontitis.

The short-term effectiveness of non-surgical treatment in reducing protease activity in gingival crevicular fluid from chronic periodontitis patients.

OBJECTIVES: The aim of this study was to evaluate the short-term effect of non-surgical periodontal treatment on protease activity in gingival crevicular fluid (GCF) of patients with chronic periodontitis. MATERIAL AND METHODS: After clinical examination, in which pocket probing depth, probing attachment level, plaque and bleeding indices were recorded, gingival fluid samples from 21 chronic periodontitis patients were collected from gingivitis (GP) and periodontitis (PP) sites with an intracrevicular washing method. Samples were taken in the same way from a group of patients with gingivitis alone (GG). The periodontitis patients received non-surgical periodontal treatment and were re-evaluated 30 days later. We compared elastase and collagenase activities before and after treatment. The former activity was measured with a low-weight substrate (S-2484) and inhibited by alpha-1-antitrypsin. Matrix-metalloproteinase-8 (MMP-8) was measured with an ELISA and collagenolytic activity with fluorescein-conjugated collagen type I as substrate. RESULTS: All clinical parameters showed a significant improvement after treatment (p<0.05) which was accompanied by a significant reduction in the values of total elastase activity, free elastase, MPP-8 and collagenolytic activity in both GP and PP sites (p<0.05). However, the latter sites continued to have higher levels of MMP-8 and collagenolytic activity than the former ones after treatment. The free elastase activity and the proportion of free elastase in GP and PP samples after treatment remained higher than in untreated GG samples. CONCLUSION: This study shows that the clinical improvements after non-surgical treatment are accompanied by reductions in protease and neutrophil activities.

Oral nicardipine versus intravenous magnesium sulfate for the treatment of preterm labor.

OBJECTIVE: The aim of this study was to compare the efficacy and safety of oral nicardipine in acute therapy for preterm labor with those of parenteral magnesium sulfate. STUDY DESIGN: Patients between 24 and 34 weeks' gestation with documented preterm labor were randomly assigned to receive oral nicardipine (n = 57) or intravenous magnesium sulfate (n = 65) as initial tocolytic therapy. Patients in the nicardipine group received a 40-mg loading dose and then 20 mg every 2 hours as needed to stop contractions (total 80 mg). Patients in the magnesium sulfate group received a 6-g bolus followed by 2 to 4 g/h to provide uterine quiescence. Patients could be switched to another tocolytic regimen if they continued to have contractions after 6 hours of therapy. The main outcome variables examined were time to uterine quiescence, time gained in utero, recurrence of preterm labor, failure of tocolysis, and pertinent maternal and neonatal outcomes. RESULTS: There were no significant differences in maternal demographic characteristics between the groups. Among patients who responded with uterine quiescence within 6 hours, there was a significant decrease in the time to uterine quiescence in the nicardipine group (P <.01). Patients in the magnesium sulfate group were more likely to have recurrence of preterm labor necessitating further tocolytic attempts (P =.048). The patients in the magnesium sulfate group had more adverse side effects, mainly nausea and vomiting (P =.004). There were no differences in birth weight, estimated gestational age at delivery, or neonatal complications between the 2 groups. CONCLUSIONS: Oral nicardipine is an effective, safe, and well-tolerated tocolytic agent. In this prospective clinical trial patients randomly assigned to receive oral nicardipine had arrest of preterm labor more rapidly than did those randomly assigned to receive parenteral magnesium sulfate. Patients who received magnesium sulfate were more likely to have adverse medication effects and recurrent preterm labor.

Phytoestrogens and the management of menopause.

Phytoestrogens are plant compounds that are structurally or functionally similar to steroidal estrogens produced by the body, such as estradiol. Phytoestrogens are derived from dietary precursors. Methodologically rigorous studies demonstrate the benefit of phytoestrogens in addressing the climacteric syndrome--including vasomotor symptoms--and postmenopausal health risks. Studies suggest that phytoestrogen supplementation offers a potential alternative or complement to conventional HRT for osteoporosis prevention. Whether these effects will translate into reduced fracture rates or enhanced function and well-being remains for further study. The majority of evidence about the impact of plant estrogen consumption on the risk of cancer is epidemiologic. Rates of breast, endometrial and ovarian cancers are low in Asian cultures, where the diet is rich in soy isoflavones.

Increased interleukin-1beta concentration in gingival crevicular fluid as a characteristic of periodontitis.

BACKGROUND: The levels of interleukin-1beta (IL-1beta) have been reported to be higher in sites with periodontitis than in healthy controls. This may be the result of a more severe inflammation and/or constitutional differences in IL-1beta production. Our aim was to test the hypothesis that the level of IL-1beta in gingival crevicular fluid (GCF) is a characteristic trait of periodontitis, regardless of the degree of tissue destruction. As a secondary aim, we investigated the correlation between IL-1beta and neutrophil elastase. An untreated population was used. METHODS: GCF samples from inflamed sites in 13 patients with gingivitis (GG), and from inflamed sites with shallow (GP) and deep (PP) pockets in 18 patients with periodontitis were collected. Interleukin-1beta, elastase-alpha-1-antitrypsin complex (E-A1AT), alpha-1-antitrypsin (A1AT), and alpha-2-macroglobulin (A2MG) were measured with ELISA. Elastase activity was measured with a specific substrate. RESULTS: The concentration of IL-1beta was significantly higher in PP than in GG, but no significant differences were detected between PP and GP. A weak positive correlation between the elastase activity and IL-1beta was also observed. The elastase activity had a tendency to be higher in PP, although no significant difference was found among the 3 groups. The concentrations of E-A1AT, A1AT, and A2MG were similar in the 3 types of sites. CONCLUSIONS: The levels of IL-1beta in GCF were increased in samples from periodontitis patients, regardless of the severity of disease at the sampled site, suggesting that the levels of IL-1beta are typical of a given patient.