Evaluation of a clinical preventive treatment using Er,Cr:YSGG (2780 nm) laser on the susceptibility of enamel to erosive challenge

Abstract

The purpose of this in vitro study was to evaluate the effect of a clinical preventive treatment using Er,Cr:YSGG laser irradiation on bovine enamel susceptibility after erosive challenge. Twelve sound bovine incisors were used and twenty-four enamel specimens were prepared in total. Two experimental groups (n = 12) were assigned as follows: Group 1 was the control group and in Group 2, the enamel specimens were irradiated with an Er,Cr:YSGG (2780 nm) laser system for 20 s, with average output power of 0.25 W, pulse repetition rate at 20 Hz without water or air flow and the pulse duration was fixed at 140 μsec. The tip diameter was 600 μm, the tip to tissue distance was 1 mm, the speed of handpiece movement was 2 mm/s, the power density was 88.34 W/cm², and the fluence was 31.25 J/cm². The specimens were submitted to erosive challenge using a common soft drink. Surface microhardness changes, surface roughness changes, and surface loss were evaluated after erosive challenge. The data were statistically analyzed using one-way ANOVA and Tukey's post-hoc test at a level of significance a = 0.05. Er,Cr:YSGG laser-treated enamel exhibited significantly less decrease in surface microhardness and significant less surface loss compared to control enamel after the erosive challenge (p < 0.05). The experimental groups did not show significant differences in surface roughness increase after the erosive challenge (p > 0.05). Er,Cr:YSGG laser treatment may be promising for the limitation of enamel erosive tooth wear induced by excessive consumption of soft drinks. Clinical studies are needed to clarify whether this protective effect is clinically significant.

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Ethnic and Age Disparities in Outcomes among Liver Transplant Waitlist Candidates

Background Despite the increasing prevalence of end-stage liver disease in older adults, there is no consensus to determine suitability for liver transplantation (LT) in the elderly. Disparities in LT access exist, with a disproportionately lower percentage of African Americans (AAs) receiving LT. Understanding waitlist outcomes in older adults, specifically AAs, will identify opportunities to improve LT access for this vulnerable population. Methods All adult, liver-only white and AA LT waitlist candidates (1/1/2003-10/1/2015) were identified in the Scientific Registry of Transplant Recipients. Age and race categories were defined: younger (age

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First Report of siRNA Uptake During Ex Vivo Hypothermic and Normothermic Liver Machine Perfusion

No abstract available

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Patient selection and ethical considerations - justifying combined lung AND liver transplantation

No abstract available

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Pretransplant cancer in kidney recipients in relation to recurrent and de novo cancer incidence posttransplantation and implications for graft and patient survival

Background Whether kidney transplant recipients who were treated for a malignant tumor prior to transplantation are at an increased risk of developing a tumor post transplantation has not been adequately quantified and characterized. Methods We studied more than 270 000 patients on whom pre and posttransplant malignancy data were reported to the Collaborative Transplant Study. More than 4000 of these patients were treated for pretransplant malignancy. The posttransplant tumor incidence in these patients was compared to that in recipients without a pretransplant tumor. Cox regression considering multiple confounders was applied. Results Significant increases in posttransplant tumor incidence with HR ranging from 2.10 to 5.47 (all P

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Steatosis in Liver Transplantation: Current Limitations and Future Strategies

In parallel with the pandemic of obesity and diabetes, the prevalence of nonalcoholic fatty liver disease (NAFLD) has progressively increased. Non-alcoholic steatohepatitis (NASH), a subtype of NAFLD has also augmented considerably being currently cirrhosis due to NASH the second indication for liver transplantation in USA. Innovative treatments for NASH have shown promising results in phase-2 studies and are being presently evaluated in phase-3 trials. On the other hand, the high mortality on the liver transplant wait list and the organ shortage has obligated the transplant centres to consider suboptimal grafts, such as steatotic livers for transplantation. Fatty livers are vulnerable to preservation injury resulting in a higher rate of primary non-function, early allograft dysfunction and post-transplant vascular and biliary complications. Macrosteatosis of more than 30% in fact is an independent risk factor for graft loss. Therefore, it needs to be considered into the risk assessment scores. Growing evidence supports that moderate and severe macrosteatotic grafts can be successfully used for liver transplantation with careful recipient selection. Protective strategies, such as machine-based perfusion have been developed in experimental setting to minimize preservation related injury and are now on the verge to move into the clinical implementation. This review focuses on the current and potential future treatment of NASH and the clinical practice in fatty liver transplantation, highlights its limitations and optimal allocation, and summarizes the advances of experimental protective strategies, and their potential for clinical application to increase the acceptance and improve the outcomes after liver transplantation with high-grade steatotic livers. Authors contributed equally to this paper, Ivan Linares MD, Matyas Hamar MD. Correspondence author: Markus Selzner, MD, Associate Professor of Surgery, University of Toronto, General Surgery & Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11 PMB 178, Toronto, ON M5G 2N2, Phone: 416-340-4800 ext. 5884 Fax: 416-340-5321, e-mail: markus.selzner@uhn.ca Authorship: -Ivan Linares participated in performance of research, research design and writing the paper (lin85ij@outlook.com) -Matyas Hamar participated in performance of research, research design and writing the paper (mahamar@gmail.com) -Nazia Selzner participated in research design and writing the paper (Nazia.Selzner@uhn.ca) -Markus Selzner participated in research design and writing the paper (Markus.Selzner@uhn.ca) Disclosure: The authors of this manuscript have no conflicts of interest to disclose as described by the Transplantation Journal. Funding: None Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Impact of Donor Hepatectomy Time during Organ Procurement in Donation after Circulatory Death Liver Transplantation: The United Kingdom Experience

Background No data exists to evaluate how hepatectomy time (HT), in the context of donation after cardiac death (DCD) procurement, impacts on short and long-term outcomes following liver transplantation (LT). In this study we analyse the impact of the time from aortic perfusion to end of hepatectomy on outcomes following DCD LT in the UK. Methods An analysis of 1112 DCD donor LT across all UK transplant centres between 2001 and 2015 was performed, using data from the UK Transplant Registry. Donors were all Maastricht Category III. Graft survival after transplantation was estimated using Kaplan-Meier method and logistic regression to identify risk factors for PNF and short and long-term graft survival after LT. Results Incidence of PNF was 4% (40) and in multivariate analysis only CIT >8 hrs. (HR 2.186 (1.113-4.294, p=0.023) and HT > 60 mins (HR 3.669 (1.363-9.873, p=0.01) were correlated with PNF. Overall 90-day, 1 year, 3 year and 5 year graft survival in DCD LT was 91.2%, 86.5%, 80.9% and 77.7% (compared to a DBD cohort in the same period (n=7221) 94%, 91%, 86.6%, and 82.6% respectively (p 60mins, donor age >45 yrs., CIT> 8 hours and recipient previous abdominal surgery. Conclusions There is a negative impact of prolonged HT on outcomes on DCD LT and although HT > 60 mins is not a contraindication for utilisation it should be part of a multifactorial assessment with established prognostic donor factors such as age (>45yrs) and CIT (>8hrs) for an appropriately selected recipient. No conflicts of interest Correspondence: Mr. Shahid Farid, Consultant Transplant Surgeon, Department of Transplantation, St James University Hospital, Beckett Street, Leeds, United Kingdom, LS9 7TF. s.farid@nhs.net Authorship Page: SG Farid: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. MS Attia: Participated in research design and final review of the paper. D Vijayanand: Participated in research design, writing and final review of the paper. V Upasani: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. S Willis: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. A Barlow: Participated in the writing and final review of the paper. E Hidalgo: Participated in research design, performance of the research, writing and final review of the paper. N Ahmad: Participated in research design, performance of the research, statistical analysis, writing and final review of the paper. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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