Use of cone beam computed tomography in periodontology

Diagnosis of periodontal disease mainly depends on clinical signs and symptoms. However, in the case of bone destruction, radiographs are valuable diagnostic tools as an adjunct to the clinical examination. Two dimensional periapical and panoramic radiographs are routinely used for diagnosing periodontal bone levels. In two dimensional imaging, evaluation of bone craters, lamina dura and periodontal bone level is limited by projection geometry and superpositions of adjacent anatomical structures. Those limitations of 2D radiographs can be eliminated by three-dimensional imaging techniques such as computed tomography. Cone beam computed tomography(CBCT) generates 3D volumetric images and is also commonly used in dentistry. All CBCT units provide axial, coronal and sagittal multi-planar reconstructed images without magnification. Also, panoramic images without distortion and magnification can be generated with curved planar reformation. CBCT displays 3D images that are necessary for the diagnosis of intra bony defects, furcation involvements and buccal/lingual bone destructions. CBCT applications provide obvious benefits in periodontics, however; it should be used only in correctindications considering the necessity and the potential hazards of the examination.

Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment

Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multidisciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.

Modified approach of regenerative treatment for distal intrabony defect beneath non-keratinized mucosa at terminal molar:A case report

BACKGROUND Intrabony defects beneath non-keratinized mucosa are frequently observed at the distal site of terminal molars.Consequently,the application of regenerative treatment using the modified wedge-flap technique is considered impractical for these specific dental conditions.CASE SUMMARY This article proposes a modified surgical procedure aimed at exposing the distal intrabony defect by making a vertical incision in the keratinized buccal gingiva.The primary objective is to maintain gingival flap stability,thereby facilitating periodontal regeneration.The described technique was successfully employed in a case involving the left mandibular second molar,which presented with an intrabony defect without keratinized gingiva at the distal site.In this case,an incision was made on the disto-buccal gingival tissue,creating a tunnel-like separation of the distal non-keratinized soft tissue to expose the intrabony defect.Subsequently,bone grafting and guided tissue regeneration surgeries were performed,resulting in satisfactory bone fill at 9 mo postoperatively.CONCLUSION This technique offers a regenerative opportunity for the intrabony defects beneath non-keratinized mucosa and is recommended for further research.

A 3D In-vitro model of the human dentine interface shows long-range osteoinduction from the dentine surface

Emerging regenerative cell therapies for alveolar bone loss have begun to explore the use of cell laden hydrogels for minimally invasive surgery to treat small and spatially complex maxilla-oral defects.However,the oral cavity presents a unique and challenging environment for in vivo bone tissue engineering,exhibiting both hard and soft periodontal tissue as well as acting as key biocenosis for many distinct microbial communities that interact with both the external environment and internal body systems,which will impact on cell fate and subsequent treatment efficacy.Herein,we design and bioprint a facile 3D in vitro model of a human dentine interface to probe the effect of the dentine surface on human mesenchymal stem cells(hMSCs)encapsulated in a microporous hydrogel bioink.We demonstrate that the dentine substrate induces osteogenic differentiation of encapsulated hMSCs,and that both dentine andβ-tricalcium phosphate substrates stimulate extracellular matrix production and maturation at the gel-media interface,which is distal to the gel-substrate interface.Our findings demonstrate the potential for long-range effects on stem cells by mineralized surfaces during bone tissue engineering and provide a framework for the rapid development of 3D dentine-bone interface models.

Periodontitis exacerbates pulmonary hypertension by promoting IFNγ+T cell infiltration in mice

Uncovering the risk factors of pulmonary hypertension and its mechanisms is crucial for the prevention and treatment of the disease.In the current study,we showed that experimental periodontitis,which was established by ligation of molars followed by orally smearing subgingival plaques from patients with periodontitis,exacerbated hypoxia-induced pulmonary hypertension in mice.Mechanistically,periodontitis dysregulated the pulmonary microbiota by promoting ectopic colonization and enrichment of oral bacteria in the lungs,contributing to pulmonary infiltration of interferon gamma positive(IFNγ^(+))T cells and aggravating the progression of pulmonary hypertension.In addition,we identified Prevotella zoogleoformans as the critical periodontitis-associated bacterium driving the exacerbation of pulmonary hypertension by periodontitis,and the exacerbation was potently ameliorated by both cervical lymph node excision and IFNγneutralizing antibodies.Our study suggests a proof of concept that the combined prevention and treatment of periodontitis and pulmonary hypertension are necessary.

Relationship between Inter Canine Width and Inter Alar Width, Inter Commissural Width, and Inter Canthal Distance: A Pilot Study

The aim of this study was to determine the relationship between inter canine width (ICW) and inter alar width (IAW), inter commissural width (ICoW), and inter canthal distance (ICaD) in Bantu population. Materials and Methods: It was a pilot study included all participants who were aged at least 18 years, without a history of orthodontics treatment from Prosthodontics Department, Faculty of Dental Medicine, University of Kinshasa. The Ethics committee of the National Center of Research for Dental Sciences in DR Congo approved the study protocol (CNRSB 1504.218). The participants medical records were obtained from the interview and dental examination. Nature of the study was explained with participant information sheet, and an informed consent of all participants was obtained. The inclusion criteria were no missing maxillary and mandibular teeth, no diastema, and no anterior restorations, 18 years old before enrollment in the study. The exclusion criteria were inability to meet the above requirements, pregnancy, and refusal to participate in the study. The inter-canine width (ICW), inter alar width (IAW), inter canthal distance (ICaD) and inter-commissural width (ICoW) of each participant were measured with a digital Vernier caliper (Mitutoyo, UK Ltd.,) (0.01 mm) three times and the average value was recorded. The inter canthal distance (ICaD) was measured without applying pressure by bringing the recording parts of the caliper just in contact with the medial angle. The inter alar width (IAW) was marked with a fine marked pencil on the widest outer surface of the alae of the nose on either side or width. Those two points were measured without applying pressure by bringing the recording parts of the caliper just in contact with the outer surface. The participant was told to stop breathing shortly to avoid any change in shape of the nose. The inter-commissural width (ICoW) was determined by measuring the maxillary lip vermilion from commissure to commissure without the application of pressure on the tissue in the relaxed state. The inter-canine width (ICW) was measured indirectly using a dental floss. A dental floss was marked on one end prior to placement in the mouth. Using that point as reference, the dental floss was circumference along the curvature of the anterior dentition such that it passed along the contact point of all the teeth. The distal end of the canine teeth on both sides was then marked on the floss while it was stretched in the patients mouth. Floss was marked on both sides with the marker pencil. The distance between the two proximal contact points was measured and recorded. Data, analysis and validation were performed by the SPSS software (version 22.0, IBM SPSS Statistics, Chicago, IL, USA). Unpaired t-test was used, of Kolmogorov-Smirnov test. Analysis of variance (ANOVA) test was used to test for comparability between socio-demographic characteristics dental measurements. Pearsons correlation coefficients test was calculated to determine the relationship between facial and dental parameters. Significance was set at P 0.01. Results: Of 314 participants enrolled, 202 were included. The age ranged from 18 to 68 years, with a mean age of 40.62 12.99 years. Although the Pearsons correlation coefficients were negative. Ninety-three participants (46%) were men and one hundred and nine (54%) were women. The overall mean age was 40.62 12.99 years. Facial and dental measurements were greater in women than men with significant differences for ICW (p = 0.04). However, no significant difference was seen between men and women for IAW, ICaD and ICoW (p = 0.44, p = 0.23, p = 0.31 respectively). The correlation including Pearsons correlation coefficient and P-values for all participants is not demonstrated. Conclusion: Within the limitations of this study, the results suggest that IAW, ICaD and ICoW cannot be used as a preliminary method for determining the width of the maxillary for anterior teeth for edentulous patients.

High-fat diet and oral infection induced type 2 diabetes and obesity development under different genetic backgrounds

Background:Type 2 diabetes(T2D)is an adult-onset and obese form of diabetes caused by an interplay between genetic,epigenetic,and environmental components.Here,we have assessed a cohort of 11 genetically different collaborative cross(CC)mouse lines comprised of both sexes for T2D and obesity developments in response to oral infection and high-fat diet(HFD)challenges.Methods:Mice were fed with either the HFD or the standard chow diet(control group)for 12 weeks starting at the age of 8 weeks.At week 5 of the experiment,half of the mice of each diet group were infected with Porphyromonas gingivalis and Fusobacterium nucleatum bacteria strains.Throughout the 12-week experimental period,body weight(BW)was recorded biweekly,and intraperitoneal glucose tolerance tests were performed at weeks 6 and 12 of the experiment to evaluate the glucose tolerance status of mice.Results:Statistical analysis has shown the significance of phenotypic variations between the CC lines,which have different genetic backgrounds and sex effects in different experimental groups.The heritability of the studied phenotypes was estimated and ranged between 0.45 and 0.85.We applied machine learning methods to make an early call for T2D and its prognosis.The results showed that classification with random forest could reach the highest accuracy classification(ACC=0.91)when all the attributes were used.Conclusion:Using sex,diet,infection status,initial BW,and area under the curve(AUC)at week 6,we could classify the final phenotypes/outcomes at the end stage of the experiment(at 12 weeks).

Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis

A growing body of evidence from multiple areas proposes that periodontal disease,accompanied by oral inflammation and pathological changes in the microbiome,induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease(NAFLD).A subgroup of NAFLD patients have a severely progressive form,namely nonalcoholic steatohepatitis(NASH),which is characterized by histological findings that include inflammatory cell infiltration and fibrosis.NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma.The oral microbiota may serve as an endogenous reservoir for gut microbiota,and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis.Gut dysbiosis increases the production of potential hepatotoxins,including lipopolysaccharide,ethanol,and other volatile organic compounds such as acetone,phenol and cyclopentane.Moreover,gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall,leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation.In particular,many animal studies support that oral administration of Porphyromonas gingivalis,a typical periodontopathic bacterium,induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis.NAFLD,also known as the hepatic phenotype of metabolic syndrome,is strongly associated with metabolic complications,such as obesity and diabetes.Periodontal disease also has a bidirectional relationship with metabolic syndrome,and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively.In this review,we will describe the link between periodontal disease and NAFLD with a focus on basic,epidemiological,and clinical studies,and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome.In conclusion,it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease,gut microbiota,and metabolic syndrome.Thus,the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics,prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.

Saliva:a challenging human fluid to diagnose brain disorders with a focus on Alzheimer's disease

Biomarkers are molecules of biological processes that help in both the diagnosis of human diseases and in follow-up assessments of therapeutic responses. Biomarkers can be measured in many human fluids, such as blood, cerebrospinal fluid, urine, and saliva. The-omics methods(genomics, RNomics, proteomics, and metabolomics) are useful at measuring thousands of markers in a small volume. Saliva is a human fluid that is easily accessible, without any ethical concerns. Yet, saliva remains unexplored in regard to many human disease biomarkers. In this review, we will give an overview on saliva and how it can be influenced by exogenous factors. As we focus on the potential use of saliva as a diagnostic tool in brain disorders(especially Alzheimer's disease), we will cover how saliva is linked to the brain. We will discuss that saliva is a heterogeneous human fluid, yet useful for the discovery of biomarkers in human disorders. However, a procedure and consensus that is controlled, validated, and standardized for the collection and processing of saliva is required, followed by a highly sensitive diagnostic approach.

Platelet rich fibrin is not a barrier membrane!Or is it?

Platelet-rich fibrin(PRF)is widely used in dentistry and other fields of medicine,and its use has become popular in dental implantology.In several published studies,PRF has been used as a barrier membrane.A barrier membrane is a sheet of a certain material that acts as a biological and mechanical barrier against the invasion of cells that are not involved in bone formation,such as epithelial cells.Among the basic requirements of a'barrier membrane,occlusivity,stiffness,and space maintenance are the criteria that PRF primarily lacks;therefore,it does not fall under the category of barrier membranes.However,there is evidence that PRF membranes are useful in significantly improving wound healing.Does the PRF membrane act as a barrier?Should we think of adding or subtracting some points from the ideal requirements of a barrier membrane,or should we coin a new term or concept for PRF that will incorporate some features of a barrier membrane and be a combination of tissue engineering and biotechnology?This review is aimed at answering the basic question of whether the PRF membrane should be considered a barrier membrane or whether it is something more beyond the boundaries of a barrier membrane.

Could there be an interplay between periodontal changes and pancreatic malignancies?

The term"periodontal disease"refers to a group of chronic inflammatory illnesses caused by specific microorganisms from subgingival biofilm,that affect the toothsupporting tissues.Recent research has also shown that periodontal infection plays a role in aggravating systemic disease states at distal sites,reinforcing the significance of the oral cavity for general health.Additionally,it has been suggested that gastroenterological malignancies may be promoted by hematogenous,enteral or lymphatic translocation of periopathogens.In the past 25 years,the global burden of pancreatic cancer(PC)has more than doubled,making it one of the major causes of cancer-related mortality.Periodontitis has been linked to at least 50%increased risk of PC and it could be considered a risk factor for this malignancy.A recent study performed on 59000 African American women with a follow up of 21 years showed that participants who had poor dental health had higher chances of PC.The findings,according to researchers,might be related to the inflammation that some oral bacteria trigger.Regarding the mortality of PC,periodontitis considerably raises the chance of dying from PC.Microbiome alterations in the gut,oral cavity and pancreatic tissues of PC patients occur when compared to healthy flora,demonstrating a link between PC and microecology.Inflammation may also contribute to PC development,although the underlying pathway is not yet known.The function of the microbiome in PC risk has drawn more focus over the last decade.Future risk of PC has been linked to the oral microbiome,specifically increased levels of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and decreased relative abundance of Leptotrichia and Fusobacteria,suggesting that it may have an impact on the inflammatory condition by expanding,altering,and regulating the commensal microbiome.Patients who received periodontal treatment had significantly decreased incidence rate ratios for PC.By analyzing patterns in the microbiome composition throughout PC development and establishing strategies to enhance the cancerassociated microbial system,we can increase the efficacy of therapy and eventually find an application for the microbial system.The development of immunogenomics and gut microgenomics in the life sciences will result in a significant advancement in our understanding of how microbial systems and immunotherapy interact,and it may also have intriguing therapeutic implications for extending the lifetime of PC patients.

Differential molecular profiles and associated functionalities characterize connective tissue grafts obtained at different locations and depths in the human palate

The present study aimed to assess the molecular profiles of subepithelial connective tissue grafts(CTGs)obtained at different locations and depths in the human palate.Sixty-four CTGs belonging to anterior deep(AD),anterior superficial(AS),posterior deep(PD),and posterior superficial(PS)groups were subjected to RNA-Sequencing and their transcriptomes were analyzed computationally.Functional correlations characterizing the CTG groups were validated by cell biological experiments using primary human palatal fibroblasts(HPFs)extracted from the CTGs.A clearly more pronounced location-dependent than depth-dependent difference between the grafts,with a minimal number of genes(4)showing no dependence on the location,was revealed.Epithelial,endothelial,and monocytic cell migration was strongly(P<0.001)potentiated by AD-and PS-HPFs.Moreover,significantly increased expression of genes encoding C-C and C-X-C motif chemokine ligands as well as significantly(P<0.01)activated p38 signaling suggested immunomodulatory phenotype for AD-and PS-HPFs.Increased growth factor gene expression and significantly activated(P<0.001)Erk and Akt signaling in HPFs originating from A-CTGs implied their involvement in cell survival,proliferation,and motility.Prominent collagen-rich expression profile contributing to high mechanical stability,increased osteogenesis-related gene expression,and strongly activated(P<0.001)Smad1/5/8 signaling characterized HPFs originating from P-CTGs.The present data indicate that in humans,differences between palatal CTGs harvested from different locations and depths appear to be location-rather than depth-dependent.Our findings provide the basis for future personalization of the therapeutic strategy by selecting an optimal graft type depending on the clinical indications.

Oral pathogen aggravates atherosclerosis by inducing smooth muscle cell apoptosis and repressing macrophage efferocytosis

Periodontitis imparting the increased risk of atherosclerotic cardiovascular diseases is partially due to the immune subversion of the oral pathogen,particularly the Porphyromonas gingivalis(P.gingivalis),by inducing apoptosis.However,it remains obscure whether accumulated apoptotic cells in P.gingivalis-accelerated plaque formation are associated with impaired macrophage clearance.

Combination of Diclofenac Potassium and Propolis in the Therapy of Oral Aphthosis: A Randomized, Clinical, Double-Blind, Placebo-Controlled Study

Background: Oral aphthosis has a negative impact on oral health. This study aimed to assess the effectiveness of gel formulation including diclofenac and propolis in the treatment of oral ulcers. Methods: Participants included 100 normal individuals with aphthous, excluding those having allergies to any ingredient in the diclofenac formulation. Patients were randomly assigned into two groups: one group received treatment with a combination of diclofenac potassium 3% (10 mg/g, 60 g) and propolis 5% gel (Group II), and the other group received a placebo (Group 1). The patient was evaluated using standard digital photographs and chronic oral mucosal questionnaires on days 1, 3, 5, and 7 after healing. Utilizing the Mann-Whitney U test, the two groups were compared. Each group’s changes were examined using Friedman’s test. Results: There was a statistically dramatic change over time in Group II. After one day, the median total score dropped statistically significantly, and from one to three days with effect size (d) 2.485, Group II demonstrated 48% complete healing and 52% partial healing, while Group I demonstrated 4% partial healing and 96% no change. Effect size (V): 0.995. Conclusions: The combination of diclofenac and propolis provided instant relief and an affordable new regimen for treating oral aphthosis.

Correlations among core species corresponding to the clinical staging of periodontitis

The correlation between microbiota plays a vital role in the progression of periodontal disease.This study investigated the in situ interaction networks between periodontal pathogens in periodontal and peri-implant disease.We used quantitative real-time polymerase chain reaction and Pearson’s correlation coefficients to quantify the copy numbers and correlations of four oral core species—Fusobacterium nucleatum,Porphyromonas gingivalis,Prevotella intermedia,and Streptococcus gordonii—from 80 subgingival sites(healthy and with periodontitis or gingivitis)in patients with periodontitis,and 68 subgingival sites(healthy and with periodontitis,gingivitis,peri-implantitis,or peri-implant mucositis)in patients with implants.The highest bacterial counts were observed for Porphyromonas gingivalis and Prevotella intermedia at all the sites.Within the same cohorts,the bacterial loads were greater at diseased sites than at healthy sites.Bacterial counts did not differ among clinical sites in the same group(P>0.05)but differed between periodontitis and peri-implant mucositis sites in the two groups.Porphyromonas gingivalis,F.nucleatum,and Prevotella intermedia had strong correlations at gingivitis and healthy sites and moderate correlations at periodontitis sites in patients with periodontitis.In patients with implants,Prevotella intermedia,F.nucleatum,and S.gordonii had strong correlations only at peri-implantitis sites.Also,based on metagenomic analysis,F.nucleatum and Prevotella intermedia were significantly correlated at the subgingival plaque in peri-implantitis and periodontitis samples.Our results suggest that variations in microbe-microbe interactions in subgingival plaque reflect changes in the progression of periodontal disease,providing a new perspective for understanding the mechanisms of periodontitis and peri-implantitis.

An Automatic Threshold Selection Using ALO for Healthcare Duplicate Record Detection with Reciprocal Neuro-Fuzzy Inference System

ESystems based on EHRs(Electronic health records)have been in use for many years and their amplified realizations have been felt recently.They still have been pioneering collections of massive volumes of health data.Duplicate detections involve discovering records referring to the same practical components,indicating tasks,which are generally dependent on several input parameters that experts yield.Record linkage specifies the issue of finding identical records across various data sources.The similarity existing between two records is characterized based on domain-based similarity functions over different features.De-duplication of one dataset or the linkage of multiple data sets has become a highly significant operation in the data processing stages of different data mining programmes.The objective is to match all the records associated with the same entity.Various measures have been in use for representing the quality and complexity about data linkage algorithms,and many other novel metrics have been introduced.An outline of the problem existing in themeasurement of data linkage and de-duplication quality and complexity is presented.This article focuses on the reprocessing of health data that is horizontally divided among data custodians,with the purpose of custodians giving similar features to sets of patients.The first step in this technique is about an automatic selection of training examples with superior quality from the compared record pairs and the second step involves training the reciprocal neuro-fuzzy inference system(RANFIS)classifier.Using the Optimal Threshold classifier,it is presumed that there is information about the original match status for all compared record pairs(i.e.,Ant Lion Optimization),and therefore an optimal threshold can be computed based on the respective RANFIS.Febrl,Clinical Decision(CD),and Cork Open Research Archive(CORA)data repository help analyze the proposed method with evaluated benchmarks with current techniques.

Gingival Hyperplasia during Pregnancy: Frequency and Clinical Presentation in a Tertiary Level Hospital in Yaoundé-Cameroon

Gingival hyperplasia or gingival overgrowth, which is a common trait of gingival disease, is characterized by an increase in the size of the gingiva. Gingival hyperplasia according to past reports has numerous etiological factors one of which is pregnancy due to increased hormone levels. Although pregnancy does not directly cause gingival hyperplasia, it may catalyze local etiological factors. Objectives: To determine the frequency and clinical aspects of gingival hyperplasia during pregnancy. Methodology: We conducted a cross sectional descriptive study from November 2021 to June 2022 at the Yaoundé Gyneco-Obstetrics and Pediatrics Hospital. Data were collected using a pretested questionnaire and clinical assessments done using dental consultation kits. Data were analyzed with the International Business Machine Statistical Package for Social Sciences (IBM SPSS) version 21.0 software. Results: We recruited 231 eligible participants for our study. Of 231, 101 (43.7%) had gingival hyperplasia. Most of our study population were between 20 - 40 years old and gingival hyperplasia was most commonly found in the 3rd trimester (60.7%). We reported that 31.3% of our population had a plaque score 2 and only 7.8% had consulted a dentist during pregnancy. We also observed that 93.3% of our population manifested a mild/moderate form of the disease while 6.9% had a severe form. Our study showed that 72.3% and 27.3% had a localized and generalized form of the disease, respectively. Conclusion: We concluded that gingival hyperplasia is a common pathology in pregnant women. It is most found in the third trimester. It presents more commonly as a localized form, and degree of severity is mostly moderate.

Mortality Related to COVID-19 in Acute Renal Injury Patients: A Cohort Study

Introduction: The coronavirus, SARS-CoV-2, is the pathogen responsible for an acute respiratory distress syndrome that broke out in the Wuhan region and became a pandemic in early 2020. The clinical presentation of COVID-19 is polymorphic, dominated by respiratory symptoms and may be associated with cardiovascular, digestive and renal complications. The prognosis depends mainly on the patient’s condition. Acute kidney injury (AKI) during severe SARS CoV-2 infection is frequent, multifactorial and associated with excess mortality. Its pathophysiology has not been fully elucidated, and seems to involve both direct and indirect mechanisms. The aim of our work is to describe the epidemiological, clinical, paraclinical and therapeutic profile of patients presenting with AKI and confirmed COVID-19 disease, and determine the prognostic factors associated with death. Material and Methods: This was a retrospective study conducted at IBN SINA Hospital, Rabat, between March 2020 and November 2021. We included patients with confirmed SARS-CoV-2 infection who developed AKI either on admission or during hospitalization. Results: We enrolled 95 patients with a mean age of 68 ± 13 years and a M/F sex ratio of 1.9. Diabetes was present in 33.7% of cases and hypertension in 32.6%. Most patients had influenzalike illness, lymphopenia and hyperferritinemia. Median creatinine on admission was 32 mg/l [17 - 64]. Temporary catheter hemodialysis was used in 21% of cases, with hyperkalemia for purification and ultrafiltration. There were 63 deaths, it was statically significantly related (p Conclusion: AKI in COVID-19 is multifactorial, and may be secondary to sepsis, hemodynamic failure or direct viral toxicity to the kidney. In our study, mortality was secondary to viral toxicity, clinical presentation, intensive care unit management and recourse to hemodialysis.

High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study

BACKGROUND Epidemiological studies have revealed an association between obstructive sleep apnea(OSA)and hypertension in the general population,while the association in military personnel was rarely investigated.AIM To examine the association between high risk for OSA and hypertension by phenotypes in military young adults.METHODS A total of 746 military personnel,aged 27.9 years,were included in the cardiorespiratory fitness and health in armed forces(CHIEF)-sleep study in Taiwan in 2020.Antihypertensive medications were not used by the subjects.High risk for OSA was assessed using the Berlin Questionnaire.Hypertension was defined using the 7th Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure(JNC 7)and the 2017 American College of Cardiology(ACC)/American Heart Association(AHA)guidelines.The cutoff levels of systolic and diastolic blood pressure(SBP and DBP)for the 2017 ACC/AHA-and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg,respectively.Hypertension phenotypes included isolated systolic and diastolic hypertension(ISH,high SBP only and IDH,high DBP only)and combined hypertension(both high SBP and DBP).Multivariable logistic regression analysis with adjustment for demographics,lifestyle and metabolic biomarkers.RESULTS The prevalence of high risk for OSA,JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%,5.2%and 22.0%,respectively.Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension(odds ratios(ORs))and 95%confidence intervals:2.82(1.07-7.42)and 7.54(1.10-51.54),although the probabilities of ISH and IDH were unaffected by a high risk for OSA(ORs:1.96 and 2.35,respectively,both P>0.05).In contrast,no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria.CONCLUSION A high risk for OSA was associated with severe hypertension and combined hypertension among Asian military young adults.

MSCs-derived apoptotic extracellular vesicles promote muscle regeneration by inducing Pannexin 1 channel-dependent creatine release by myoblasts

Severe muscle injury is hard to heal and always results in a poor prognosis.Recent studies found that extracellular vesicle-based therapy has promising prospects for regeneration medicine,however,whether extracellular vesicles have therapeutic effects on severe muscle injury is still unknown.Herein,we extracted apoptotic extracellular vesicles derived from mesenchymal stem cells(MSCs-Apo EVs)to treat cardiotoxin induced tibialis anterior(TA)injury and found that MSCs-Apo EVs promoted muscles regeneration and increased the proportion of multinucleated cells.Besides that,we also found that apoptosis was synchronized during myoblasts fusion and MSCs-Apo EVs promoted the apoptosis ratio as well as the fusion index of myoblasts.Furthermore,we revealed that MSCs-Apo EVs increased the relative level of creatine during myoblasts fusion,which was released via activated Pannexin 1 channel.Moreover,we also found that activated Pannexin 1 channel was highly expressed on the membrane of myoblasts-derived Apo EVs(Myo-Apo EVs)instead of apoptotic myoblasts,and creatine was the pivotal metabolite involved in myoblasts fusion.Collectively,our findings firstly revealed that MSCs-Apo EVs can promote muscle regeneration and elucidated that the new function of Apo EVs as passing inter-cell messages through releasing metabolites from activated Pannexin 1 channel,which will provide new evidence for extracellular vesicles-based therapy as well as improving the understanding of new functions of extracellular vesicles.