Scalloped Implant-Abutment Connection Compared to Conventional Flat Implant-Abutment Connection: a Systematic Review and Meta-Analysis.

OBJECTIVES: The objective was to test the hypothesis of no difference in implant treatment outcome after installation of implants with a scalloped implant-abutment connection compared to a flat implant-abutment connection. MATERIAL AND METHODS: A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. No language or year of publication restriction was applied. RESULTS: The search provided 298 titles. Three studies fulfilled the inclusion criteria. The included studies were characterized by low or moderate risk of bias. Survival of suprastructures has never been compared within the same study. High implant survival rate was reported in all the included studies. Significantly more peri-implant marginal bone loss, higher probing depth score, bleeding score and gingival score was observed around implants with a scalloped implant-abutment connection. There were no significant differences between the two treatment modalities regarding professional or patient-reported outcome measures. Meta-analysis disclosed a mean difference of peri-implant marginal bone loss of 1.56 mm (confidence interval: 0.87 to 2.25), indicating significant more bone loss around implants with a scalloped implant-abutment connection. CONCLUSIONS: A scalloped implant-abutment connection seems to be associated with higher peri-implant marginal bone loss compared to a flat implant-abutment connection. Therefore, the hypothesis of the present systematic review must be rejected. However, further long-term randomized controlled trials assessing implant treatment outcome with the two treatment modalities are needed before definite conclusions can be provided about the beneficial use of implants with a scalloped implant-abutment connection on preservation of the peri-implant marginal bone level.

Development of obstetrical and gynecological journals, 2007 to 2013: a trend analysis.

PURPOSE: To analyze the trends and developments among journals in the specialty of obstetrics and gynecology. METHODS: Using the Journal Citation Reports from 2007 to 2013, we analyzed the impact factor (IF), Eigenfactor® Score (ES), and Article Influence® Score (AIS) of 43 journals in the field of obstetrics and gynecology published in this time period. RESULTS: From 78 journals of the Journal Citation Report 2013, 43 were selected for this study. The mean IF grew from 1.68 ± 0.97 in 2007 to 2.12 ± 1.05 in 2013, the ES from 0.0113 ± 0.0169 to 0.0114 ± 0.0140, and the AIS from 0.513 ± 0.302 to 0.663 ± 0.359. Differences in the IF, ES, and AIS between journals from the United States versus Europe could be observed. In most cases, the IF, ES, and AIS increased between 2007 and 2013. Strong correlations could be found between IF, AIS, and ES. CONCLUSIONS: The overall mean IF for obstetrical and gynecological journals increased over the analyzed time period. The IF remains the standard measure to compare scientific journals. It correlates well with two major alternative measures of scientific impact, the ES and especially the AIS. Other measures are evolving and might show superior usage in the future.

Prevention of Rebleeding From Esophageal Varices in Patients With Cirrhosis Receiving Small-Diameter Stents Versus Hemodynamically Controlled Medical Therapy.

BACKGROUND & AIMS: Patients with cirrhosis and variceal hemorrhage have a high risk of rebleeding. We performed a prospective randomized trial to compare the prevention of rebleeding in patients given a small-diameter covered stent vs those given hepatic venous pressure gradient (HVPG)-based medical therapy prophylaxis. METHODS: We performed an open-label study of patients with cirrhosis (92% Child class A or B, 70% alcoholic) treated at 10 medical centers in Germany. Patients were assigned randomly more than 5 days after variceal hemorrhage to groups given a small covered transjugular intrahepatic portosystemic stent-shunt (TIPS) (8 mm; n = 90), or medical reduction of portal pressure (propranolol and isosorbide-5-mononitrate; n = 95). HVPG was determined at the time patients were assigned to groups (baseline) and 2 weeks later. In the medical group, patients with an adequate reduction in HVPG (responders) remained on the drugs whereas nonresponders underwent only variceal band ligation. The study was closed 10 months after the last patient was assigned to a group. The primary end point was variceal rebleeding. Survival, safety (adverse events), and quality of life (based on the Short Form-36 health survey) were secondary outcome measures. RESULTS: A significantly smaller proportion of patients in the TIPS group had rebleeding within 2 years (7%) than in the medical group (26%) (P = .002). A slightly higher proportion of patients in the TIPS group experienced adverse events, including encephalopathy (18% vs 8% for medical treatment; P = .05). Rebleeding occurred in 6 of 23 patients (26%) receiving medical treatment before hemodynamic control was possible. Per-protocol analysis showed that rebleeding occurred in a smaller proportion of the 32 responders (18%) than in nonresponders who received variceal band ligation (31%) (P = .06). Fifteen patients from the medical group (16%) underwent TIPS placement during follow-up evaluation, mainly for refractory ascites. Survival time and quality of life did not differ between both randomized groups. CONCLUSIONS: Placement of a small-diameter, covered TIPS was straightforward and prevented variceal rebleeding in patients with Child A or B cirrhosis more effectively than drugs, which often required step-by-step therapy. However, TIPS did not increase survival time or quality of life and produced slightly more adverse events. Clinical Trial no: ISRCTN 16334693.

Retrograde Autologous Priming as a Safe and Easy Method to Reduce Hemodilution and Transfusion Requirements during Cardiac Surgery.

BACKGROUND: During the last decades many efforts have been made to reduce transfusion requirements and adverse clinical effects during cardiopulmonary bypass (CPB). The minimal extracorporeal circulation (MECC) system and the technique of retrograde autologous priming (RAP) of a conventional CPB circuit have been associated with decreased hemodilution. Our study aimed to compare conventional CPB (cCPB), RAP, and the ROCsafe MECC (Terumo Europe N.V., Leuven, Belgium) system in elective coronary artery bypass patients. PATIENTS AND METHODS: Data were retrospectively collected on three cohorts of 30 adult CPB patients. Patients were operated using cCPB, RAP, and the ROCsafe MECC system. RESULTS: The three groups were comparable in demographic data. The priming volume in the ROCsafe and RAP group was significantly less compared with the conventional priming group (p <0.05). The mean time of extracorporeal circulation and aortic cross-clamp time (p <0.05) were significantly shorter in the ROCsafe group. The levels of hemoglobin (Hb) and hematocrit (Hct) during CPB and postoperatively showed significant differences between the three groups (p < 0.05) and resulted in significantly higher blood transfusion requirements (p < 0.05). Lactate, serum creatinine, troponin, and creatine kinase-myocardial band (CK-MB) levels did not differ significantly among the three groups (p >0.05). There was also no statistically significant difference in ventilation time, intensive care unit (ICU) stay, overall hospital stay, and postoperative complications (p >0.05). CONCLUSION: In conclusion, RAP is compared with cCPB and MECC a safe and low-cost technique in reducing the priming volume of the CPB system, causes less hemodilution, and reduces the need for intra- and postoperative blood transfusion.

Influence of smoking dosage and chronic obstructive lung disease on the incidence of appropriate therapies and mortality in patients with structural heart disease and an implantable cardioverter defibrillator.

BACKGROUND: Smoking is known as a relevant risk factor for severe cardiac morbidities and mortality. This study was initiated to explore the influence of smoking dosage and presence of chronic obstructive lung disease (COPD) on the incidence of appropriate implantable cardioverter defibrillator (ICD) interventions and on mortality. METHODS: Prior studies on patients equipped with an ICD suggested that nicotine consumption increases the risk of experiencing an appropriate ICD therapy. There is no substantial data regarding the influence of cigarette smoking dosage on overall mortality in such endangered patients. A total of 349 patients with structural heart disease, either coronary artery disease or nonischemic cardiomyopathy equipped with an ICD, were included. Every patient answered a questionnaire regarding his smoking status and performed a spirometry and body plethysmography. RESULTS: A total of 104 patients (30%) suffered from COPD. Fifty-eight patients (17%) were "current smokers," 196 patients (56%) were revealed as "former smokers," while 93 (27%) patients were registered as "never smokers." A total of 163 patients (47%) received at least one appropriate ICD intervention during follow-up (median 48 ± 8 months). Twenty-three patients died during this study (6.6%). There was no association of COPD with the incidence of appropriate ICD therapies or mortality. Smoking dosage revealed as a significant risk factor for both appropriate ICD interventions (hazard ratio [HR] 1.5 for 60 pack years [PY] P = 0.04) and mortality (HR 2.3 for 60 PY P = 0.02). CONCLUSION: This study demonstrates a dose-related increased risk of smokers for appropriate ICD interventions and mortality. The results of this trail urge a strict nicotine abstinence, especially in patients with a structural heart disease undergoing ICD therapy.

Usefulness of sleep-disordered breathing to predict occurrence of appropriate and inappropriate implantable-cardioverter defibrillator therapy in patients with implantable cardioverter-defibrillator for primary prevention of sudden cardiac death.

Advanced heart failure (HF) is associated with severe sleep-disordered breathing (SDB). In addition, most patients with HF are treated with an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The incidence of ICD therapy in such a patient cohort with SDB has never been investigated. The present study sought to determine the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with a categorical primary prevention ICD indication. A total of 133 consecutive ICD patients with New York Heart Association class II-III HF and depressed left ventricular function (≤35%) with no history of ventricular arrhythmia underwent a sleep study before ICD implantation and were followed for 24 ± 8 months, prospectively. A relevant SDB was defined as an apnea-hypopnea index of ≥10 events/hour. Of these 133 patients, 82 (62%) had SDB. Overweight (body mass index >29.1 vs 24.7 kg/m(2); p <0.001) was identified as the only independent risk factor for SDB. Appropriate ICD therapy intervention was significantly greater among patients with SDB than among patients without SDB (54% vs 34%, p = 0.03). Inappropriate ICD therapy intervention was documented more often in patients with SDB (n = 24 [29%] vs 7 [14%]; p = 0.04). An apnea-hypopnea index >10 events/hour was an independent predictor of appropriate ICD therapy on multivariate analysis (odds ratio 2.5, 95% confidence interval 1.8 to 4.04; p = 0.01). In conclusion, the present study is the first trial exploring the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with HF with a primary prevention indication. These results indicate that a preimplantation sleep study will identify patients with HF prone to receive appropriate and inappropriate ICD therapy.

Elevated expression of LSD1 (Lysine-specific demethylase 1) during tumour progression from pre-invasive to invasive ductal carcinoma of the breast.

BACKGROUND: Lysine-specific demethylase1 (LSD1) is a nuclear protein which belongs to the aminooxidase-enzymes playing an important role in controlling gene expression. It has also been found highly expressed in several human malignancies including breast carcinoma. Our aim was to detect LSD1 expression also in pre-invasive neoplasias of the breast. In the current study we therefore analysed LSD1 protein expression in ductal carcinoma in situ (DCIS) in comparison to invasive ductal breast cancer (IDC). METHODS: Using immunohistochemistry we systematically analysed LSD1 expression in low grade DCIS (n = 27), intermediate grade DCIS (n = 30), high grade DCIS (n = 31) and in invasive ductal breast cancer (n = 32). SPSS version 18.0 was used for statistical analysis. RESULTS: LSD1 was differentially expressed in DCIS and invasive ductal breast cancer. Interestingly, LSD1 was significantly overexpressed in high grade DCIS versus low grade DCIS. Differences in LSD1 expression levels were also statistically significant between low/intermediate DCIS and invasive ductal breast carcinoma. CONCLUSIONS: LSD1 is also expressed in pre-invasive neoplasias of the breast. Additionally, there is a gradual increase of LSD1 expression within tumour progression from pre-invasive DCIS to invasive ductal breast carcinoma. Therefore upregulation of LSD1 may be an early tumour promoting event.

Second- and third-trimester termination of pregnancy in women with uterine scar - a retrospective analysis of 111 gemeprost-induced terminations of pregnancy after previous cesarean delivery.

BACKGROUND: This study was conducted to evaluate and analyze the efficacy and safety of using gemeprost for second- and third-trimester termination of pregnancy (TOP) in women with uterine scar due to previous cesarean section. STUDY DESIGN: Retrospective analysis of 111 medical TOPs for fetal anomaly or death at 14 to 34 weeks of gestation in women with a history of cesarean section was performed at a German tertiary care center from 2005 to 2009. Abortion was induced via intravaginal application of the prostaglandin analogue gemeprost (1 mg) every 6 h. RESULTS: One hundred eleven women with one (89.2%) or two (10.8%) previous cesarean sections underwent medical TOP with gemeprost. The median induction-to-expulsion interval was 18 h 24 min (range, 2 h 20 min-168 h 28 min), and in 34 (30.6%) cases, the induction interval was longer than 24 h. The overall incidence of severe complications was 9/111 (8.1%), including one case of silent uterine rupture (with the need for blood transfusion), four cases of atonic and three secondary hemorrhages and one case of peritonitis due to uterine perforation during curettage. Failure of induction (induction-to-expulsion >48 h) occurred in 11 cases (9.9%). CONCLUSION: Gemeprost-induced TOP in the second and third trimester in women with uterine scar due to previous cesarean section is effective and has a low complication rate.