Microbial Differences Between Progressive and Stable Peri-Implantitis

Peri-implantitis has a polymicrobial etiology and is a major cause of dental implant loss. Various clinical protocols for its prevention and treatment have been proposed; however, some cases show a rapid progression with non-resolving clinical symptoms. To clear a means of differentiating between such cases, the implants with peri-implantitis in this study were categorized as the progressive group and the stable group and that two kinds of samples were obtained from the same subjects (n= 20). The microbiome was analyzed through pyrosequencing of the 16S rRNA gene. The stable group was found to have a diverse bacterial flora when compared to the progressive group. Porphyomonas, Fusobacterium, Treponema, Tannerella, and other periodontal pathogens were abundant in the progressive group, while Lactobacillales and Bifidobacterium were abundant in the stable group. These findings suggest that the bacterial flora dominated by these periodontal pathogens caused disease progression, while the bacterial flora dominated by Lactobacillales and Bifidobacterium stabilized the disease. Thus, the disease progression and stability of peri-implantitis may be influenced by the bacterial flora of the peri-implant pocket.

Investigation on Risk Stratification and the Prognostic Value of hs-TnT Combined with MMP-2 in Patients with Acute Coronary Syndrome

Objective. The aim of this study was at investigating the risk stratification and prognostic value of hypersensitive troponin T (hs-TnT) combined with matrix metalloproteinase 2 (MMP-2) in patients with acute coronary syndrome (ACS). Methods. 80 patients with coronary syndrome admitted to our hospital from January 2019 to January 2020 and 40 healthy people (control group) in the same period were selected. According to different types of diseases, the patients were divided into an acute group ( n = 40 ) and stable group ( n = 40 ). Besides, they all were monitored by the hs-TnT value, serum MMP-2, and coronary angiography at admission and the comparative analysis was carried out. The patients in both groups were followed up for 30 days, and the incidence of adverse cardiovascular events in the patients during this period was recorded. Results. Compared with those in the control group, the MMP-2 and hs-TnT levels in the acute group and the stable group were significantly higher and the MMP-2 and hs-TnT levels in the acute group were significantly higher than those in the stable group, with statistically significant differences ( P < 0.05 ). The 30-day follow-up results showed that the incidence of adverse cardiovascular events in the acute group was significantly higher than that in the stable group, with statistically significant differences ( P < 0.05 ). The hs-TnT and MMP-2 levels in the acute myocardial infarction (AMI) group were significantly higher than those in the unstable angina pectoris (UAP) group, with statistically significant differences ( P < 0.01 ). The hs-TnT and MMP-2 levels in the non-single-vessel group were significantly higher than those in the single-vessel group, with statistically significant differences ( P < 0.01 ). Conclusion. The hs-TnT and MMP-2 high expression levels are closely associated with myocardial injury, and they can effectively predict the severity of patients’ disease. In addition, the hs-TnT and MMP-2 elevated levels can be considered as an important index to judge the short-term treatment efficacy and the risk stratification of early ACS, playing an important role in clinical treatment and rehabilitation in the later stage.

Prognostic Value of Dynamic Monoclonal Protein Pattern on Probability of Myeloma Progression from the Precursor State

Multiple Myeloma (MM) is a cancer of terminally differentiated plasma cell resides in bone marrow, which is always preceded by clinically asymptomatic precursor states. The process of malignant transformation however is not fully understood. Analyses of cells from precursor state have provided evidence that it is a genetically advanced lesion, wherein tumor cells carry many of the genetic changes found in MM cells. Furthermore, mice xenografts from patient (pt) with precursor disease showed progressive growth on its own suggesting progression potential is counteracted by active extrinsic restraints that prevent its progression to MM (Das R et al. Nature Medicine, 2016). Hence, precursor progression to MM can be viewed as a dynamic process in which the clonal mass is the net result of pro-growth, pro-survival replicative capacity of the myeloma clones vs. anti-tumor immunity. The change in the net clonal mass sometimes is large enough to be detected by measurable fluctuations in serum monoclonal protein spike (M-spike) levels and reflects a highly dynamic battle between plasma cell clone and cell-mediated anti-myeloma immunity among those pts. The prognostic value of this highly dynamic state on risk of progression to MM is largely unknown. In this study we sought to assess the association between the dynamic M-spike pattern and the risk of progression from a precursor clone to MM. Methods: All pts with positive serum electrophoresis (SPEP) values measured from January 2011 to January 2021 for our institution were included for this study. All pts that had &lt;3 M-spike readings before requiring anti-myeloma regimen, received active treatment for MM within 90 days of the first positive SPEP, had M-spike values &gt;3g/l or had clear evidence of progression by serial increasing M-spike values were excluded.. We assigned the pattern of M-spike values over time into two groups according to stability. To eliminate the test-to-test variability, we defined stable disease as lack of more than 20% difference from lowest M-spike, and fluctuating disease if the difference exceeds 20%. The time-to-treatment (TTT) was then measured from the first positive SPEP to the time of treatment and was censored at the date of last follow-up for pts who did not have anti-myeloma treatment with death as competing risk. The effect of M-spike pattern on TTT, treating as binary outcome, was also evaluated using logistic regression analysis. Univariate analysis of TTT was performed using Gray's method. All tests were two-sided and p-value ≤ 0.05 were considered statistically significant. Results: A total of 565 pts were studied, 193 with a fluctuating pattern and 372 with a stable pattern. Median age at first positive SPEP was 76 years old (range: 38-101), 271 (48%) of them were male; 427 (75%) were Caucasian and 123 (22%) African American. Baseline creatinine was 1.17 mg/dl (range 0.5-11.2 SD 0.94). Baseline albumin was 3.97 g/dl (range 1.6-5.2 SD 0.47), 336 pts (59%) were IgG, 75 (13%) IgA, and 142 (25%) had IgM M-spike; 326 (58%) pts had Kappa light chain and 239 (42%) had Lambda. Autoimmune diseases were more common in the stable disease pattern (17% vs. 10% p=0.028), the most frequent one was Rheumatoid arthritis in 33 pts (6%). Furthermore, baseline albumin was statistically higher in pts in the stable cohort (4.04 vs. 3.85g/dl, p=&lt;0.0001). Median follow up was 46.9 months (range: 3.2-120.9). Logistic regression: the odds ratio (OR) of having progression to treatment for fluctuation group was 4.5 (95% CI: 1.37-14.18, p= 0.013) in comparison to stable group. Time-to-event analysis: pts with fluctuating M-spike had higher chance of needing therapy (Hazard Ratio: 3.73, 95% CI: 1.19-11.66, p=0.024) than stable group. Cumulative incidence of needing treatment is shown in Figure-1. Conclusion: The dynamic pattern of M-spike seen here with fluctuating values over time (over time is two words) was significantly predictive of progression to MM in pts with a precursor disease state. These findings may reflect a different nature of tumor vs. immune system balance and possible impaired immunity in these pts which may have implications for future clinical trials that evaluate the efficacy of anti-myeloma immunotherapeutics. Furthermore, our finding suggest that fluctuations in M-spike levels may be factored into risk models that predict the progression to MM among pts with precursor clones. Larger studies are warranted to further study this concept. Figure 1 Figure 1. Disclosures Malek: Medpacto Inc.: Research Funding; Janssen: Other: Advisory board ; Takeda: Honoraria; Cumberland Inc.: Research Funding; Amgen: Honoraria; BMS: Honoraria, Research Funding; Bluespark Inc.: Research Funding; Sanofi: Other: Advisory Board.

Tree Diversity, Conservation Status and Utilization Potentials of Shasha Rainforest Reserve, Southwestern, Nigeria

An inventory of the entire tree species ≥10cm diameter at breast height (dbh) was carried out within Forestry Research Institute of Nigeria (FRIN) investigation 133 Shasha in Osun State, Nigeria. This study was carried out to ascertain the tree species diversity, conservation status and utilization potentials in the study area. The results were obtained from 16 sample plots of 50×50m in four tracts located through cluster sampling technique. In all, an average total of 295 stands distributed among 66 tree species and 28 families were encountered. High value of Shannon-Weinner index H'=3.73 and Evenness of E=0.89 were obtained for the reserve. At present, only few trees have attained the merchantable size of 48cm dbh. The 63 tree species in the study site were categorized into four groups namely, stable, vulnerable, endangered and threatened status. The result revealed that stable group had 1.59%, vulnerable 4.76%, endangered 44.44% and threatened 49.21%. Result of the Utilization potentials revealed that utility classes 7 - 8 accounted for 55.6% (comprises of tree species with no potential use for sawn timber), while 45.4%. of trees in classes 1 – 6 comprises of trees with timber potentials. This study highlighted species population diversity, conservation status and utilization potentials of the study site and called for ecological application in the management of forest reserves in Nigeria.

Monitoring for glaucoma progression with SAP, electroretinography (PERG and PhNR) and OCT

Purpose To investigate the value of pattern electroretinography (PERG) and photopic negative response (PhNR) in monitoring glaucoma compared to standard clinical tests (standard automated perimetry (SAP) and clinical optic disc assessment) and structural measurements using spectral-domain OCT. Methods A prospective study included 32 subjects (32 eyes) with ocular hypertension, suspect or early glaucoma monitored for progression with clinical examination, SAP, PERG, PhNR and OCT for at least 4 years. Progression was defined clinically by the documented change of the optic disc and/or significant visual field progression (EyeSuite™ trend analysis). One eye per patient was included in the analysis. Results During the follow-up, 13 eyes (40.6%) showed progression, whereas 19 remained stable. In the progressing group, all parameters showed significant worsening over time, except for the PhNR, whereas in the stable group only the OCT parameters showed a significant decrease at the last visit. The trend of change over time using linear regression was steepest for the OCT parameters. At baseline, only the ganglion cell complex (GCC) and peripapillary retinal nerve fibre (pRNFL) thicknesses significantly discriminated between the stable and progressing eyes with the area under the ROC curve of 0.72 and 0.71, respectively. The inter-session variability for the first two visits in the stable group was lower for OCT (% limits of agreement within ± 17.4% of the mean for pRNFL and ± 3.6% for the GCC thicknesses) than for ERG measures (within ± 35.9% of the mean for PERG N95 and ± 59.9% for PhNR). The coefficient of variation for repeated measurements in the stable group was 11.9% for PERG N95 and 23.6% for the PhNR, while it was considerably lower for all OCT measures (5.6% for pRNFL and 1.7% for GCC thicknesses). Conclusions Although PERG and PhNR are sensitive for early detection of glaucomatous damage, they have limited usefulness in monitoring glaucoma progression in clinical practice, mainly due to high inter-session variability. On the contrary, OCT measures show low inter-session variability and might have a predicting value for early discrimination of progressing cases.

Stronger Association of Albuminuria with the Risk of Vascular Complications than Estimated Glomerular Filtration Rate in Type 2 Diabetes

<b><i>Introduction:</i></b> Albuminuria is a risk factor for macro- and microvascular complications of type 2 diabetes (T2D).With an increasing trend of normoalbuminuria, however, of the 2 predictors – estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) – which one is a better predictor of vascular complications of T2D is not clear. <b><i>Objective:</i></b> This study aimed to compare the impacts of albuminuria and eGFR on patients with T2D associated with micro- and macrovascular complications. <b><i>Methods:</i></b> This retrospective study recruited 4,715 patients with T2D and grouped them based on the values of UACR (high UACR: ≥30 mg/g, low UACR: &#x3c;30 mg/g) and eGFR (mL/[min × 1.73 m²]) (G1: eGFR ≥ 90; G2: eGFR = 60–89; G3–5: eGFR &#x3c; 60) from April 2008 to November 2018. Logistic regression analysis was carried out for risk factors in patients with diabetic retinopathy (DR), diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), left ventricular remodeling, diastolic disorders, and carotid atherosclerotic plaque in 6 different groups: low UACR + G1 (control group), low UACR + G2, low UACR + G3–5, high UACR + G1, high UACR + G2, and high UACR + G3–5. Patients were grouped according to the change in the UACR value (UACR-decreased group: ≤−30%, UACR-stable group: −30 to 30%, and UACR-increased group ≥30%), eGFR value (eGFR-decreased group: &#x3e;3%, and eGFR-stable group: ≤3%) and followed up. <b><i>Results:</i></b> Compared with the control group, patients with higher albuminuria and lower eGFR had higher adjusted odds ratio (OR) trends of complications, especially in the high UACR + G3–5 group. The OR of 2.010, 3.444, 1.633, 2.742, and 3.014 were obtained for DR, DPN, PAD, left ventricular remodeling, and diastolic disorders, respectively. No statistically significant difference was found in the risk of complications within each one of 2 phenotypes, regardless of the change in the eGFR. After grouping by eGFR, the regression analysis of the urinary protein level in each stage revealed that a majority of complications had a statistically significant difference, except for DR and PAD in the high UACR + G3–5 group. DR in the follow-up study had a higher risk in the UACR-stable/increased group than the UACR-decreased group (UACR stable: OR = 2.568; 95% confidence interval (CI): 1.128–5.849; <i>p</i> = 0.025; UACR increased: OR = 2.489; 95% CI: 1.140–5.433; <i>p</i> = 0.022). <b><i>Conclusion:</i></b> UACR is a more predictive risk factor for diabetic complications compared with a reduced eGFR.

Characteristics of Patients with Accommodative Esotropia Who Need Glasses for Stable Alignment after Myopic Shift

Purpose: We analyzed the characteristics of patients with refractive accommodative esotropia (RAET) who required glasses for stable alignment after a myopic shift.Methods: We retrospectively analyzed the medical records of patients diagnosed with RAET at the initial visit, and who had developed a myopic shift in both eyes over the 5-year follow-up period. To evaluate clinical factors associated with the persistence of esotropia after myopia, the enrolled patients were divided into two groups; patients with RAET who needed glasses for stable alignment after a myopic shift (unstable group) and patients with RAET whose esotropia resolved after a myopic shift (stable group).Results: A total of 55 patients met the inclusion criteria. The mean follow-up period was 13.8 ± 5.7 years (5-27 years). Spherical equivalent (SE) refractive errors at the initial visit were +3.1 ± 1.6 diopters (D) (+1.00 to +7.25 D) and -1.5 ± 0.9 D (-4.38 to -0.5 D) at the last visit. Of the 55 RAET patients, 24 were included in the unstable group and 31 were included in the stable group. No significant differences in gender, age at diagnosis, SE refractive error, or angle of esotropia with glasses were observed between the two groups. However, significantly more patients failed the Lang I test or had anisometropia over 1.5 D at the last visit, and the duration between the onset of esotropia and prescribing glasses was significantly longer in the unstable group than in the stable group.Conclusions: Glasses may be needed for stable alignment even after a myopic shift in RAET patients with long durations of misalignment, poor stereopsis, and anisometropia.

Two-year longitudinal trajectory patterns of albuminuria and subsequent rates of end-stage kidney disease and all-cause death: a nationwide cohort study of biopsy-proven diabetic kidney disease

IntroductionData on the association between longitudinal trajectory patterns of albuminuria and subsequent end-stage kidney disease (ESKD) and all-cause mortality in diabetic kidney disease (DKD) are sparse.Research design and methodsDrawing on nationally representative data of 329 patients with biopsy-proven DKD and an estimated glomerular filtration rate above 30 mL/min/1.73 m2 at the time of biopsy, we used joint latent class mixed models to identify different 2-year trajectory patterns of urine albumin to creatinine ratio (UACR) and assessed subsequent rates of competing events: ESKD and all-cause death.ResultsA total of three trajectory groups of UACR were identified: ‘high-increasing’ group (n=254; 77.2%), ‘high-decreasing’ group (n=24; 7.3%), and ‘low-stable’ group (n=51; 15.5%). The ‘low-stable’ group had the most favorable risk profile, including the baseline UACR (median (IQR) UACR (mg/g creatinine): ‘low-stable’, 109 (50–138); ‘high-decreasing’, 906 (468–1740); ‘high-increasing’, 1380 (654–2502)), and had the least subsequent risk of ESKD and all-cause death among the groups. Although there were no differences in baseline characteristics between the ‘high-decreasing’ group and the ‘high-increasing’ group, the ‘high-decreasing’ group had better control over blood pressure, blood glucose, and total cholesterol levels during the first 2 years of follow-up, and the incidence rates of subsequent ESKD and all-cause death were lower in the ‘high-decreasing’ group compared with the ‘high-increasing’ group (incidence rate of ESKD (per 1000 person-years): 32.7 vs 77.4, p=0.014; incidence rate of all-cause death (per 1000 person-years): 0.0 vs 25.4, p=0.007).ConclusionsDynamic changes in albuminuria are associated with subsequent ESKD and all-cause mortality in DKD. Reduction in albuminuria by improving risk profile may decrease the risk of ESKD and all-cause death.

High Serum Uric Acid Trajectories are Associated with Risk of Myocardial Infarction and All-Cause Mortality in General Chinese Population

Background: Long-term patterns of serum uric acid (SUA) and their association with the risk of myocardial infarction (MI) and mortality are poorly characterized as prior studies measured SUA at a single time point. This study aimed to identify SUA trajectories and determine their associations with incident MI and all–cause mortality.Methods: We included 85,503 participants who were free of MI in or prior 2012 from the Kailuan study. SUA trajectories during 2006-2012 were identified by group-based trajectory modeling. Cox proportional hazard models were used to assess the association of SUA trajectories with MI and all–cause mortality.Results: We identified three SUA trajectories during 2006-2012: low-stable (n=44,124, mean SUA: 236.55-249.53 μmmol/L), moderate-stable (n=34,431, mean SUA: 324.38 -354.24 μmmol/L) and high-stable (n=6,984, mean SUA: 425.16-463.25 μmmol/L). During a median follow-up of 6.76 years, we documented 817 (0.96%) incident MI and 6,498 (7.60%) mortality. Compared with the low-stable group, high-stable group experienced a higher risk of MI (hazard ratio [HR], 1.35; 95% confidence [CI], 1.07-1.71) and all–cause mortality (HR, 1.22; 95% CI, 1.12-1.33). Multiple sensitivity analyses yielded similar results. Additionally, the association of SUA trajectory with MI and all–cause mortality was more pronounced in individuals without a history of hypertension (P-interaction=0.0359) and those aged <60 years (P-interaction<0.0001), respectively.Conclusions: Higher SUA trajectories were associated with altered risk of MI and all–cause mortality, suggesting that monitoring SUA trajectory may assist in identifying subpopulations at higher risk of MI and all-cause mortality.

Can We Extrapolate SINS Score to Evaluate Instability in Spinal Tuberculosis?

Study Design: Prospective Observational Study. Objectives: To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis. Methods: Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with “indeterminate stability” were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc. Results: Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in “indeterminate group” were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [ P < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [ P < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [ P < .0001 for both groups]. Conclusions: SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.