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Abstract

Background: Systemic sclerosis (Ssc) is an autoimmune disease characterized by graduate cutaneous and tissue fibrosis development and irreversible fibroproliferative vascular changes. The aim of the current systematic review was to update the list of proteomic candidate biomarkers identified from Ssc samples with mass spectrometry techniques.

Methods: Medline and Scopus databases were searched on 1st September 2020. Relevant articles were searched from March 2014 until September 2020. Two independent reviewers evaluated the retrieved articles.

Results: From a total of 97 articles, 9 articles were included in the final analysis summarizing 539 candidate proteomic biomarkers from various samples from Ssc patients (a larger number compared to the previous systematic review). Most biomarkers were identified from cutaneous biopsies. Only 5 articles included a validation step of the findings with only 13 biomarkers being validated.

Conclusions: Although many candidate biomarkers were additionally identified, independent validation studies are needed in order to evaluate the importance of these biomarkers for Ssc patients.

Abstract

Background: Renal transplant recipients are at increased risk for developing complications of vaccine-preventable diseases. They benefit from a comprehensive pre-transplant evaluation when they might safely receive live vaccines. The primary aim of our study was to investigate the number of renal transplant recipients who were evaluated for serologic status against measles, mumps, rubella (MMR), and varicella. Secondarily, we investigated if pre-transplant Infectious Diseases consultation (IDC) improved vaccination rates.

Methods: We retrospectively analyzed 282 kidney-alone and kidney-plus adult transplant recipients who were born in or after 1957. Patients were evaluated at Mayo Clinic, Florida Transplant Center between January 2015 and December 2017. Serologic status evaluation and vaccination rates were compared in two groups created based on IDC and no ID consultation (NIDC).

Results: 235 (83%) of a total 282 patients received an IDC pre-transplantation. Varicella IgG levels were screened in all 235 IDC candidates. Among the IDC patients, mumps, measles and rubella IgG serologies were performed in 7 (3%), 143 (61%) and 144 (61%), respectively. Among 44 patients seronegative for any of MMR, 24 (55%) were vaccinated. Ten (66%) of 15 varicella seronegative patients were vaccinated. Zostavax was not given to 18% of IDC patients. Zostavax and MMR were administered more frequently in the IDC group compared to NIDC (p<.001 and p=0.0016, respectively).

Conclusion: Although the majority of patients had IDC, the screening rate for MMR serologies was lower than varicella. A protocol-driven serologic screening similar to the one for VZV is required for MMR. Pre-transplant IDC increases vaccination rates.

Abstract

West Nile virus (WNV) outbreaks raise the concern of WNV infection in donated blood and blood products destined for transfusion. We describe methods we developed to estimate time-dependent risk of WNV infection in donated blood, including improvements not previously detailed. The methods are then extended for use in estimation of the risk of WNV infection in donated cadaveric tissues by introducing stratification and stratum-specific weighting to address novel aspects of this application. Data from the WNV outbreak in Colorado in 2003 are used to estimate risk for donated cardiac tissue.

Abstract

Background

Human immunodeficiency virus (HIV) viral failure occurs when antiretroviral therapy fails to suppress and sustain a person’s viral load count below 1,000 copies of viral ribonucleic acid per milliliter. For those newly diagnosed with HIV and living in a setting where healthcare resources are limited, such as a low- and middle-income country, the World Health Organization recommends viral load monitoring six months after initiation of antiretroviral treatment and yearly thereafter. Deviations from this schedule are made in cases where viral failure occurs or at the discretion of the clinician. Failure to detect viral failure in a timely fashion can lead to delayed administration of essential interventions. Clinical prediction models based on information available in the patient medical record are increasingly being developed and deployed for decision support in clinical medicine and public health. This raises the possibility that prediction models can be used to detect potential for viral failure in advance of viral measurements, particularly when those measurements occur infrequently.

Objective

Our goal is to use electronic health record data from a large HIV care program in Kenya to characterize and compare the predictive accuracy of several statistical machine learning methods for predicting viral failure at the first and second measurements following initiation of antiretroviral therapy. Predictive accuracy is measured in terms of sensitivity, specificity and area under the receiver-operator characteristic curve.

Methods

We trained and cross-validated 10 statistical machine learning models and algorithms on data from over 10,000 patients in the Academic Model Providing Access to Healthcare care program in western Kenya. These included parametric, non-parametric, ensemble, and Bayesian methods. The input variables included 50 items from the clinical record, hand picked in consultation with clinician experts. Predictive accuracy measures were calculated using 10-fold cross validation.

Results

Viral load failure rate is about 20% in this patient cohort at both the first and second measurements. Ensemble techniques generally outperformed other methods. For predicting viral failure at the first follow up measure, specificity was over 90% for these methods, but sensitivity was typically in the 50–60% range. Predictive accuracy was greater for the second follow up measure, with sensitivities over 80%. Super Learner, gradient boosting and Bayesian additive regression trees consistently outperformed other methods. For a viral failure rate of 20%, the positive predictive value for the top-performing methods is between 75 and 85%, while the negative predictive value is over 95%.

Conclusion

Evidence from this study suggests that machine learning techniques have potential to identify patients at risk for viral failure prior to their scheduled measurements. Ultimately, prognostic virologic assessment can help guide the administration of earlier targeted intervention such as enhanced drug resistance monitoring, rigorous adherence counseling, or appropriate next-line therapy switching. External validation studies should be used to confirm the results found here.

Abstract

Great efforts are devoted to end the HIV epidemic as it continues to have profound public health consequences in the United States and throughout the world, and new interventions and strategies are continuously needed. The use of HIV sequence data to infer transmission networks holds much promise to direct public heath interventions where they are most needed. As these new methods are being implemented, evaluating their benefits is essential. In this paper, we recognize challenges associated with such evaluation, and make the case that overcoming these challenges is key to the use of HIV sequence data in routine public health actions to disrupt HIV transmission networks.

Abstract

Objectives

Estimation of the cascade of HIV care is essential for evaluating care and treatment programs, informing policy makers and assessing targets such as 90-90-90. A challenge to estimating the cascade based on electronic health record concerns patients “churning” in and out of care. Correctly estimating this dynamic phenomenon in resource-limited settings, such as those found in sub-Saharan Africa, is challenging because of the significant death under-reporting. An approach to partially recover information on the unobserved deaths is a double-sampling design, where a small subset of individuals with a missed clinic visit is intensively outreached in the community to actively ascertain their vital status. This approach has been adopted in several programs within the East Africa regional IeDEA consortium, the context of our motivating study. The objective of this paper is to propose a semiparametric method for the analysis of competing risks data with incomplete outcome ascertainment.

Methods

Based on data from double-sampling designs, we propose a semiparametric inverse probability weighted estimator of key outcomes during a gap in care, which are crucial pieces of the care cascade puzzle.

Results

Simulation studies suggest that the proposed estimators provide valid estimates in settings with incomplete outcome ascertainment under a set of realistic assumptions. These studies also illustrate that a naïve complete-case analysis can provide seriously biased estimates. The methodology is applied to electronic health record data from the East Africa IeDEA Consortium to estimate death and return to care during a gap in care.

Conclusions

The proposed methodology provides a robust approach for valid inferences about return to care and death during a gap in care, in settings with death under-reporting. Ultimately, the resulting estimates will have significant consequences on program construction, resource allocation, policy and decision making at the highest levels.

Summary

Background/Aim: The aim of this study was to evaluate the bond strength of glass ceramic inlay system using 2 antibacterial adhesive luting protocols with 2 cementation techniques to bur-cut dentin.

Material and Methods: Class I inlay cavities with 6-degree occlusal divergence and size of 6-, 3- and 2-mm in length, width and depth, were prepared on extracted human molars, randomly assigned to 2 main groups; each to 1 cementation technique, with or without immediate-dentin-bonding (IDB or NIDB) further divided into 3 subgroups; 2 to 2 antibacterial luting protocols, traditional (T) and experimental (E); and 1 to a control (C) group. In group IDBT, IDB-E and IDB-C dentin bonding was applied immediately after cavity preparation. In group NIDB-T, NIDB-E and NIDB-C dentin bonding was applied just before cementation of the restorations. The cavities in IDB-T and NIDB-T were treated with 2% chlorhexidine-digluconate (CHX) prior to dentin bonding application. The cavities in IDB-E and NIDB-E were treated only with dentin bonding system containing MDPB (12-methacryloyloxydodecylpyridinium bromide) active monomer featuring antibacterial effect. IDB-C and NIDB-C served as control. Dual-cure adhesive resin cement was used for the cementation of lithium disilicate-based ceramic inlay restorations. Fourteen test specimens per group were prepared for microtensile testing and consecutively subjected to tensile load at a crosshead speed of 1 mm/min. The mode of failure was observed under SEM and evaluated for each group. The Kruskal-Wallis test was used to investigate the statistical difference between groups (α=0.05).

Results: The microtensile load was 5.96 MPa (median: 5.99 MPa) for IDB-T, 7.23 MPa (median: 7.55 MPa) for IDB-E, 6.68 MPa (median: 6.56 MPa) for IDB-C, 7.24 MPa (median: 7.20 MPa) for NIDB-T, 6.98 MPa (median: 6.30 MPa) for NIDB-E, and 7.02 MPa (median: 6.99 MPa) for NIDB-C, with no statistical difference between the groups (p>0.05). SEM monitoring for mode of failure revealed either cohesive (within resin cement) or adhesive-cohesive (mostly within resin cement along with partially involved areas between resin cement and ceramic restoration) character.

Conclusions: Within the limitations of the current study, none of the tested antibacterial luting protocols with either cementation technique was found to be superior in terms of bond strength.

Summary

Background/Aim: Panoramic radiographs have been used widely for pre-implant evaluation and the preparation of treatment protocols. Panoramic radiography is often the first choice method for the implant placements because it gives information on the overall shape of the jaws, the position of the maxillary sinus floor and the nasal cavity floor, and vertical position of the mandibular canal and the mental foramen in relation to dental implants. The specific aim of the present study was to evaluate 10-year survival rate of dental implants by analysis of dental panoramic radiographs.

Material and Methods: This retrospective study was conducted on 507 panoramic radiographs of 156 implant patients. Initial oral health status, proceedings of Restorative/Endodontic treatments before implant placement, missing number of teeth and edentulism types, finalization of implant related prosthetic treatments during controls, implant quality scorings at baseline/ controls and implant fails were analyzed.

Results: The study results reveal statistically significant difference between the performed R/E treatment rates, according to the need for R/E treatments (p= 0.008). During the initial radiograph 96.1% of the implants were successful and 3.9% had satisfactory survival. At last control 86% of the implants were successful, 10.3% had satisfactory survival, 1% had impairment in survival and 2.8% were unsuccessful. The change in the last control compared to the initial radiograph is statistically significant (p= 0.000) regarding satisfactory survival.

Conclusion: Long-term implant survival is not significantly affected by gender, age, type of edentulism, the presence of periodontal disease, R/E treatment needs, implant location, prosthesis type, and the presence of multiple implants.

Summary

Background/Aim: The aim of this study is to evaluate the prevalence of a canalis sinuosus (CS) in the anterior maxilla.

Material and Methods: CBCT images of 673 patients (322 females and 351 males) were examined retrospectively with regard to age, gender, location of CS and relation to impacted canines. The age of the patients ranged from 14 to 82 years; the mean age of the female patients was 43.54 years and that of the males was 45.75 years. IBM SPSS 22 for Windows was used for statistical analysis of the results. Statistical comparisons between two categorical variables were conducted using chi-square tests. Significance was set at (p< 0.05).

Results: It was observed that 8.17% of the patients in this study exhibited accessory canals (AC) of CS (n= 55). There was no significant difference in CS prevalence between ages, age groups, and location in our study (p> 0.5). There was significant difference in CS prevalence between the genders (p< 0.5). Conclusions: It is important to take into consideration the presence of AC of the CS during surgical procedures in the anterior maxilla. It was also found that CBCT is more helpful than other techniques in detecting accessory canals in the region of interest.