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Association of a preoperative dental screening approach with 90-day mortality after cardiac valve surgery
ABSTRACTS
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Study Design: Forty patients attending the Department of Oral Medicine were randomly included in the study and were categorized into 2 groups, group A and group B. Group A (control group) and group B (case group) each comprised 20 patients with clinically and histopathologically confirmed OLP and symptoms of burning sensation. Group A received the 0.1% triamcinolone acetonide Orabase 2 times daily. Group B received 50 mg zinc acetate tablets plus Ora-base 2 times daily for 8 weeks. Orabase was discontinued after 1 week of application in the case group, whereas zinc acetate tablets were continued throughout the treatment period. The follow-up period was 2 months. Lesion size and burning sensation were measured by using the Thongprasom scale and the visual analogue scale (VAS) at initial and weekly visits till cessation of treatment. Results: A decrease in pain intensity from the first visit to the follow-up visit was statistically significant in both groups (P = .000). Group B showed higher mean pain intensity from the initial visit to the follow-up visit compared with group A. Mean difference between the first and follow-up visits in the study group showed that there was a gradual decrease in pain intensity, whereas the control group showed minimal difference compared with the study group; the difference was not statistically significant (P = .498). There was statistically significant gradual decrease in lesion size till the follow-up period in both groups (P = .000). Conclusions: Oral zinc therapy was found to be an adjunct in reducing burning sensation and lesion size in symptomatic OLP.
ASSOCIATION OF A PREOPERATIVE DENTAL SCREENING APPROACH WITH 90-DAY MORTALITY AFTER CARDIAC VALVE SURGERY. NAMAN RAOA,C, NATHANIEL TREISTERB,C, ANDREA AXTELLD, JILLIAN MUHLBAUERB, PUHAN HEB, AGNES LAUB,E, LCYDA ROSSB,E, ELBERT HENGD, DANIEL RINEWALTE, SIOBNHAN MCGURKF, A,F TSUYOSHI KANEKO , DUKE CAMEROND, HERVE SROUSSIB,C. A HARVARD MEDICAL SCHOOL, USA, B HARVARD SCHOOL OF DENTAL MEDICINE, USA, C DIVISION OF ORAL MEDICINE, BRIGHAM AND WOMEN’S HOSPITAL, USA, D CORRIGAN MINEHAN HEART CENTER AND DIVISION OF CARDIAC SURGERY, MASSACHUSETTS GENERAL HOSPITAL, USA, E DIVISION OF CARDIOTHORACIC SURGERY, STANFORD MEDICINE, USA, AND F DIVISION OF CARDIOVASCULAR SURGERY, BRIGHAM AND WOMEN’S HOSPITAL, USA Objectives: Preoperative dental screening (PDS) before valvular surgery has been adopted widely by cardiac surgeons to prevent poor outcomes associated with infections of oral origin. However, there is limited evidence to guide PDS protocols. This study was designed to compare a focused approach versus a comprehensive approach to PDS to determine its association with 90day mortality. Study Design: A retrospective cohort analysis was performed on 1835 adult patients who underwent elective valvular surgery and PDS at the Massachusetts General Hospital (MGH) and the Brigham and Women’s Hospital (BWH) from January 2009 to December 2016. Patients with a history of intravenous drug abuse were excluded. At the MGH (n = 692), PDS involved a detailed dental examination, including diagnostic radiography and definitive therapy for teeth with active and/or chronic disease
OOOO January 2020 (comprehensive protocol). At the BWH (n = 1143), PDS consisted of minimal number of diagnostic radiographs limited to symptomatic teeth and intervention only when active signs of disease were observed (focused protocol). Univariate and multivariate analyses were performed to compare 90-day mortality rates after surgery with the 2 different approaches. Results: There were no differences in demographic characteristics and baseline comorbidities between the 2 study sites. At the MGH, 340 (49.2%) of 692 patients received dental clearance at the initial visit, with 94.2% (n = 652) undergoing radiography. Dental findings included carious teeth (n = 250; 36.2%), root tips (n = 118; 17%), periodontically hopeless teeth (n = 48; 6.9%), and periapical infections (n = 149; 21.6%); 40 patients (5.8%) were symptomatic. Extractions were performed in 151 patients (21.8%), and 15 (2.2%) had postoperative complications. At the BWH, 1097 of 1143 patients (96%) received dental clearance at the initial visit, with 3.3% (n = 38) undergoing radiography. Dental findings included carious teeth (n = 197; 17.2%), root tips (n = 135; 11.8%), periodontically hopeless teeth (n = 27; 2.4%), and periapical infections (n = 20; 1.7%); 16 patients (1.4%) were symptomatic. Extractions were performed in 38 patients (3.3%), and 4 (0.4%) had postoperative complications. There was no significant differences in 90-day mortality rates between the 2 study sites (10% vs 8.4%; P = .317). This remained unchanged in a multivariate model after adjusting for demographic characteristics and baseline comorbidities (odds ratio [OR] focused vs comprehensive: 1.32; 95% confidence interval [CI] 0.91 1.93); P = .14). Conclusions: Despite the differences in PDS protocols at both study sites, there was no significant difference in 90-day mortality rates after valvular surgery. Further randomized comparative prospective studies are needed to validate and expand on these findings.
PD-L1 CONJUGATED ALL-TRANS RETINOIC ACID NANOPARTICLES FOR TARGETED TREATMENT OF ORAL DYSPLASIA AND ORAL SQUAMOUS CELL CARCINOMA. XIAO-JIE CHENA, XUE-QIONG ZHANGB, MING-XIU TANGB, GANG ZHOUA,C. A THE STATE KEY LABORATORY BREEDING BASE OF BASIC SCIENCE OF STOMATOLOGY (HUBEI-MOST) AND KEY LABORATORY OF ORAL BIOMEDICINE MINISTRY OF EDUCATION, SCHOOL AND HOSPITAL OF STOMATOLOGY, WUHAN UNIVERSITY, CHINA, B SCHOOL OF CHEMISTRY, CHEMICAL ENGINEERING AND LIFE SCIENCES, WUHAN UNIVERSITY OF TECHNOLOGY, CHINA, AND C DEPARTMENT OF ORAL MEDICINE, SCHOOL AND HOSPITAL OF STOMATOLOGY, WUHAN UNIVERSITY, CHINA Objectives: The present study conjugated all-trans retinoic acid (ATRA) with poly(lactic acid-co-glycolic acid)-blockpoly(ethylene glycol) (PLGA-PEG) nanocarriers, and combined with anti programmed death-ligand 1 (PD-L1) antibody to achieve targeted therapy for oral squamous cell carcinoma (OSCC) and oral dysplasia. Study Design: The molecular mechanism of ATRA and PD-L1 was studied by using Cell Counting Kit-8 (CCK8), flow cytometry, Western blot, and immunohistochemistry. The effect of ATRA on OSCC and oral dysplasia cell proliferation inhibition, apoptosis induction, and PD-L1 downregulation was
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Study Design: Forty patients attending the Department of Oral Medicine were randomly included in the study and were categorized into 2 groups, group A and group B. Group A (control group) and group B (case group) each comprised 20 patients with clinically and histopathologically confirmed OLP and symptoms of burning sensation. Group A received the 0.1% triamcinolone acetonide Orabase 2 times daily. Group B received 50 mg zinc acetate tablets plus Ora-base 2 times daily for 8 weeks. Orabase was discontinued after 1 week of application in the case group, whereas zinc acetate tablets were continued throughout the treatment period. The follow-up period was 2 months. Lesion size and burning sensation were measured by using the Thongprasom scale and the visual analogue scale (VAS) at initial and weekly visits till cessation of treatment. Results: A decrease in pain intensity from the first visit to the follow-up visit was statistically significant in both groups (P = .000). Group B showed higher mean pain intensity from the initial visit to the follow-up visit compared with group A. Mean difference between the first and follow-up visits in the study group showed that there was a gradual decrease in pain intensity, whereas the control group showed minimal difference compared with the study group; the difference was not statistically significant (P = .498). There was statistically significant gradual decrease in lesion size till the follow-up period in both groups (P = .000). Conclusions: Oral zinc therapy was found to be an adjunct in reducing burning sensation and lesion size in symptomatic OLP.
ASSOCIATION OF A PREOPERATIVE DENTAL SCREENING APPROACH WITH 90-DAY MORTALITY AFTER CARDIAC VALVE SURGERY. NAMAN RAOA,C, NATHANIEL TREISTERB,C, ANDREA AXTELLD, JILLIAN MUHLBAUERB, PUHAN HEB, AGNES LAUB,E, LCYDA ROSSB,E, ELBERT HENGD, DANIEL RINEWALTE, SIOBNHAN MCGURKF, A,F TSUYOSHI KANEKO , DUKE CAMEROND, HERVE SROUSSIB,C. A HARVARD MEDICAL SCHOOL, USA, B HARVARD SCHOOL OF DENTAL MEDICINE, USA, C DIVISION OF ORAL MEDICINE, BRIGHAM AND WOMEN’S HOSPITAL, USA, D CORRIGAN MINEHAN HEART CENTER AND DIVISION OF CARDIAC SURGERY, MASSACHUSETTS GENERAL HOSPITAL, USA, E DIVISION OF CARDIOTHORACIC SURGERY, STANFORD MEDICINE, USA, AND F DIVISION OF CARDIOVASCULAR SURGERY, BRIGHAM AND WOMEN’S HOSPITAL, USA Objectives: Preoperative dental screening (PDS) before valvular surgery has been adopted widely by cardiac surgeons to prevent poor outcomes associated with infections of oral origin. However, there is limited evidence to guide PDS protocols. This study was designed to compare a focused approach versus a comprehensive approach to PDS to determine its association with 90day mortality. Study Design: A retrospective cohort analysis was performed on 1835 adult patients who underwent elective valvular surgery and PDS at the Massachusetts General Hospital (MGH) and the Brigham and Women’s Hospital (BWH) from January 2009 to December 2016. Patients with a history of intravenous drug abuse were excluded. At the MGH (n = 692), PDS involved a detailed dental examination, including diagnostic radiography and definitive therapy for teeth with active and/or chronic disease
OOOO January 2020 (comprehensive protocol). At the BWH (n = 1143), PDS consisted of minimal number of diagnostic radiographs limited to symptomatic teeth and intervention only when active signs of disease were observed (focused protocol). Univariate and multivariate analyses were performed to compare 90-day mortality rates after surgery with the 2 different approaches. Results: There were no differences in demographic characteristics and baseline comorbidities between the 2 study sites. At the MGH, 340 (49.2%) of 692 patients received dental clearance at the initial visit, with 94.2% (n = 652) undergoing radiography. Dental findings included carious teeth (n = 250; 36.2%), root tips (n = 118; 17%), periodontically hopeless teeth (n = 48; 6.9%), and periapical infections (n = 149; 21.6%); 40 patients (5.8%) were symptomatic. Extractions were performed in 151 patients (21.8%), and 15 (2.2%) had postoperative complications. At the BWH, 1097 of 1143 patients (96%) received dental clearance at the initial visit, with 3.3% (n = 38) undergoing radiography. Dental findings included carious teeth (n = 197; 17.2%), root tips (n = 135; 11.8%), periodontically hopeless teeth (n = 27; 2.4%), and periapical infections (n = 20; 1.7%); 16 patients (1.4%) were symptomatic. Extractions were performed in 38 patients (3.3%), and 4 (0.4%) had postoperative complications. There was no significant differences in 90-day mortality rates between the 2 study sites (10% vs 8.4%; P = .317). This remained unchanged in a multivariate model after adjusting for demographic characteristics and baseline comorbidities (odds ratio [OR] focused vs comprehensive: 1.32; 95% confidence interval [CI] 0.91 1.93); P = .14). Conclusions: Despite the differences in PDS protocols at both study sites, there was no significant difference in 90-day mortality rates after valvular surgery. Further randomized comparative prospective studies are needed to validate and expand on these findings.
PD-L1 CONJUGATED ALL-TRANS RETINOIC ACID NANOPARTICLES FOR TARGETED TREATMENT OF ORAL DYSPLASIA AND ORAL SQUAMOUS CELL CARCINOMA. XIAO-JIE CHENA, XUE-QIONG ZHANGB, MING-XIU TANGB, GANG ZHOUA,C. A THE STATE KEY LABORATORY BREEDING BASE OF BASIC SCIENCE OF STOMATOLOGY (HUBEI-MOST) AND KEY LABORATORY OF ORAL BIOMEDICINE MINISTRY OF EDUCATION, SCHOOL AND HOSPITAL OF STOMATOLOGY, WUHAN UNIVERSITY, CHINA, B SCHOOL OF CHEMISTRY, CHEMICAL ENGINEERING AND LIFE SCIENCES, WUHAN UNIVERSITY OF TECHNOLOGY, CHINA, AND C DEPARTMENT OF ORAL MEDICINE, SCHOOL AND HOSPITAL OF STOMATOLOGY, WUHAN UNIVERSITY, CHINA Objectives: The present study conjugated all-trans retinoic acid (ATRA) with poly(lactic acid-co-glycolic acid)-blockpoly(ethylene glycol) (PLGA-PEG) nanocarriers, and combined with anti programmed death-ligand 1 (PD-L1) antibody to achieve targeted therapy for oral squamous cell carcinoma (OSCC) and oral dysplasia. Study Design: The molecular mechanism of ATRA and PD-L1 was studied by using Cell Counting Kit-8 (CCK8), flow cytometry, Western blot, and immunohistochemistry. The effect of ATRA on OSCC and oral dysplasia cell proliferation inhibition, apoptosis induction, and PD-L1 downregulation was