Prevalence of canalis sinuosus and accessory canals of canalis sinuosus on cone beam computed tomography: a systematic review and meta-analysis.

The aim of this systematic review was to determine the prevalence of the canalis sinuosus (CS) and accessory canals of the canalis sinuosus (ACCS) as identified on cone beam computed tomography (CBCT). Online searches were conducted in the MEDLINE (via PubMed), Scopus, LILACS, Cochrane CENTRAL, Web of Science, and SIGLE (via OpenGrey) databases. Primary studies that determined the prevalence of canalis sinuosus and/or its anatomical variations using CBCT were included. The risk of bias assessment was performed using the AQUA tool. The quality effects model using double arcsine transformation was used for the meta-analysis of prevalence. Heterogeneity, publication bias, and sensitivity analyses were performed. Of 3237 initial results, 17 papers were included for systematic review. The meta-analysis comprising 1994 patients showed a pooled prevalence of CS of 0.80 (95% confidence interval (CI) 0.51-0.99; P = 0.001; I2 = 99%). Publication bias analysis revealed minor asymmetry (LFK index 1.84). The meta-analysis of 4605 patients showed a pooled prevalence of ACCS of 0.54 (95% CI 0.38-0.69; P = 0.001; I2 = 99%). The sensitivity analysis showed a pooled prevalence of ACCS of 0.53 (95% CI 0.32-0.74; P = 0.001; I2 = 99%) for studies with ≥ 1000 patients and 0.55 (95% CI 0.33-0.76; P = 0.001; I2 = 98%) for studies with< 1000 patients. Canalis sinuosus showed a pooled prevalence of 0.80 and ACCS showed a pooled prevalence of 0.54; hence both should be considered as anatomical structures, which means that they are present in most people. Surgeons must be aware of the CS and ACCS on CBCT analysis during pre-surgical planning. PROSPERO REGISTRATION NUMBER: CRD42020154195.

Fibras musculares cardíacas en las cúspides de la valva atrioventricular izquierda humana / Cardiac muscle fibers at the cusps of the human left atrioventricular valve

Las valvas cardíacas y especialmente la valva atrioventricular izquierda (VAVI) ha sido considerada por largo tiempo, como una estructura pasiva. Sin embargo, han surgido nuevas teorías que reconocen a esta estructura como una "valva viva", con un funcionamiento de mayor autonomía y dinámico. En esta línea, existen estudios en donde se ha concluido que la ausencia de tejidos contráctiles en una valva, generan ondulaciones no fisiológicas. Por el contrario, se ha señalado la presencia de tejido contráctil en la valva, lo que refleja una activación ondulante. Basado en lo anterior, el objetivo del presente estudio fue determinar la presencia de fibras musculares cardíacas en las cúspides de la VAVI. Se utilizaron 12 cúspides, 6 anteriores y 6 posteriores, de 7 cadáveres adultos (4) y lactantes (3) de distintas edades, sin patologías cardíacas. Las muestras pertenecían a la Facultad de Medicina de la Universidad Estadual de Ciencias da Saúde de Alagoas, Maceió, Brasil. Estas muestras fueron tratadas con procesamiento histológico de rutina. Los hallazgos morfológicos a un aumento de 4x mostraron células musculares que fueron visibles principalmente por el lado atrial en la totalidad de las cúspides, tanto inmersas en el tejido conectivo denso del anillo fibroso como en el tejido conectivo laxo. Al verificar la naturaleza de las fibras con un aumento mayor (100x), se detectaron estrías transversales en todas las muestras estudiadas, lo cual afirma la presencia de fibras musculares estríadas cardíacas en la VAVI. Los resultados obtenidos aportan al conocimiento de la microestructura y tejido contráctil de las cúspides de la VAVI. Por lo tanto, resulta de gran relevancia seguir profundizando en los conocimientos morfológicos de la VAVI, para sentar una base sólida sobre la microestructura contráctil en los diferentes estadíos del ser humano.

Cardiac valves and particularly, the left atrioventricular valve (LAVV) have long been considered passive structures. Nonetheless, there are more recent hypothesis that recognize this structure as a "living valve", with greater autonomy and dynamic function. Along these lines, some studies have concluded that the absence of contractile tissues in a valve, generates non-physiological undulations. In contrast, the presence of contractile tissue in the valve has been reported, reflecting a waving activation. Based on the above, the objective of the present study was to determine the presence of cardiac muscle fibers in the cusps of the LAVV. 12 cusps, 6 anterior and 6 posterior. Therefore, 7 adult (4) and lactating (3) bodies of different ages without cardiac pathologies were used. The samples belonged to the Faculty of Medicine of the Universidade de Ciencias da Saude de Alagos, Maceió, Brazil. The samples were treated with routine histological processing. Morphological findings at an increase of 4x showed muscle cells that were visible mainly from the atrial side in all the cusps, both immersed in the dense connective tissue of the fibrous ring and in loose connective tissue. Transverse striations were detected in all samples studied, when verifying the nature of the fibers with greater increase (100x), confirming the presence of cardiac striated muscle fibers in the LAVV. The results obtained contribute to the knowledge of the microstructure and contractile tissue of the LAVV cusps. Therefore it is relevant to further morphological knowledge of this valve, in order to build a solid foundation on the contractile microstructure in the different stages of the human development.

Immediate dental implants placed into infected sites present a higher risk of failure than immediate dental implants placed into non-infected sites: Systematic review and meta-analysis.

BACKGROUND: Alveolar infection is known as a risk factor for implant failure. Current meta-analysis on the theme could not prove statistically that immediate dental implants placed into infected sites have a higher risk of failure than immediate dental implants placed into non-infected sites. The purpose of this meta-analysis was to determine the effectiveness of immediate dental implants placed into infected versus non-infected sites. MATERIAL AND METHODS: Seven databases were sought by two reviewers. Randomized or non-randomized clinical trials that compared the placement of dental implants into infected versus non-infected sites were eligible for the study. Exclusion criteria were: papers in which the survival rate was not the primary outcome; papers without a control group; studies with less than one year of follow-up; studies whose patients did not receive antibiotic therapy; studies with medically compromised patients; duplicated papers. Risk of bias assessment was performed with the Cochrane Collaboration tool. RESULTS: Of the 3.253 initial hits, 8 studies were included in both qualitative and quantitative synthesis (kappa=0.90; very good agreement). Forest plot for implant failure showed that immediate implants placed into infected sites presented a statistically significant risk of failure that is almost 3 times higher than when placed into non-infected sites (risk ratio= 2.99; 95% confidence interval: 1.04, 8.56; p= 0.04; 935 implants; i2= 0%). Peri-implant outcomes showed no statistical difference. CONCLUSIONS: Immediate dental implants placed into infected sites presented a statistically significant higher risk of failure than immediate dental implants placed into non-infected sites. Peri-implant outcomes were not statistically affected in this intervention.

Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews.

BACKGROUND: Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. MATERIAL AND METHODS: An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed. RESULTS: We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome. CONCLUSIONS: Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies.