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Objectives: Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is a progressive and fatal condition. Although prognosis can be determined at the time of diagnosis according to National Amyloidosis Centre (NAC) transthyretin amyloidosis (ATTR) stage, the clinical course varies substantially between individuals. There are currently no established measures of rate of disease progression. Through systematic analysis of functional, biochemical and echocardiographic disease-related variables we aimed to identify prognostic markers of disease progression in wtATTR-CM.Methods: This is a retrospective observational study of 432 patients with wtATTR-CM diagnosed at the UK NAC, none of whom received disease-modifying therapy. The association between mortality from the 12-month timepoint and change from diagnosis to 12 months in a variety of disease-related variables was explored using Cox regression.Results: Change in N-terminal pro-B-type natriuretic peptide concentration (∆ NT-proBNP) at 12 months from diagnosis was the strongest predictor of ongoing mortality and was independent of both change in other disease-related variables (HR 1.04 per 500 ng/L increase (95% CI 1.01 to 1.07); p=0.003) and a range of known prognostic variables at the time of diagnosis (HR 1.07 per 500 ng/L increase (95% CI 1.02 to 1.13); p=0.007). An increase in NT-proBNP of >500 ng/L, >1000 ng/L and >2000 ng/L during the first year of follow-up occurred in 45%, 35% and 16% of patients, respectively.Conclusion: Change in NT-proBNP concentration during the first year of follow-up is a powerful independent predictor of mortality in wtATTR-CM. [ABSTRACT FROM AUTHOR]

Aims Cardiac involvement, a major determinant of prognosis in AL (light-chain immunoglobulin) amyloidosis, is characterized by an impairment of longitudinal strain (LS%). We sought to evaluate the utility of LS% in a prospectively observed series of patients. Methods and results A total of 915 serial newly diagnosed AL patients with comprehensive baseline assessments, inclusive of echocardiography, were included. A total of 628/915 (68.6%) patients had cardiac involvement. The LS% worsened with advancing cardiac stage with mean −21.1%, −17.1%, −12.9%, and −12.1% for stages I, II, IIIa, and IIIb, respectively (P < 0.0001). There was a highly significant worsening of overall survival (OS) with worsening LS% quartile: LS% ≤−16.2%: 80 months, −16.1% to −12.2%: 36 [95% confidence interval (CI) 20.9–51.1] months, −12.1% to −9.1%: 22 (95% CI 9.1–34.9) months, and ≥−9.0%: 5 (95% CI 3.2–6.8) months (P < 0.0001). Improvement in LS% was seen at 12 months in patients achieving a haematological complete response (CR) (median improvement from −13.8% to −14.9% in those with CR and difference between involved and uninvolved light chain <10 mg/L). Strain improvement was associated with improved OS (median not reached at 53 months vs. 72 months in patients without strain improvement, P = 0.007). Patients achieving an LS% improvement and a standard N-terminal pro-brain natriuretic peptide-based cardiac response survived longer than those achieving a biomarker-based cardiac response alone (P < 0.0001). Conclusion Baseline LS% is a functional marker that correlates with worsening cardiac involvement and is predictive of survival. Baseline LS% and an absolute improvement in LS% are useful additional measures of prognosis and response to therapy in cardiac AL amyloidosis, respectively. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present systematic review was to address the following question: in patients treated with dental implants placed in pristine bone, what are the clinical and radiographic outcomes of bone-level (BL) implants in comparison to tissue-level (TL) implants after restoration with dental prostheses? Materials and Methods: Scanning of online literature databases from 1966 to January 2012, supplemented by hand searching, was conducted to identify relevant prospective randomized controlled trials, controlled clinical trials, and cohort studies. Sequential screenings at the title, abstract, and full-text levels were performed independently and in duplicate. A meta-analysis was conducted to compile data from the primary studies included in this systematic review. Results: The search strategy revealed a total of 5,998. Screening at the title level resulted in 752 papers, while screening at the abstract level yielded 92 publications. Full-text reading identified nine articles that fulfilled the inclusion criteria of this review. The pooled estimated difference between BL and TL implants in mean marginal bone loss was 0.05 mm (95% confidence interval [CI], -0.03 to 0.13 mm), with no statistically significant difference between the groups at 1 year after placement of the definitive prostheses. The relative risk of implant loss was estimated at 1.00 (95% CI, 0.99 to 1.02) at 1 year and at 1.01 (95% CI, 0.99 to 1.03) at 3 years after restoration, indicating no evidence of an increased risk of implant loss in BL compared to TL implants. Conclusions: No statistically significant differences in bone loss and survival rates were detected between BL and TL dental implants over a short-term observation period (1 to 3 years). Thus, both implant systems fulfill the requirements for the replacement of missing teeth in implant dentistry. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to (1) compare 2 scales in the assessment of first-stage implant surgery, (2) assess the interrater reliability of these scales, and (3) compare self-assessment with observer assessment. Materials and Methods: Twenty-three patients underwent first-stage implant surgery. One assessor, an experienced dental surgeon, assisted and supervised the operator, while the second, a postgraduate trained in assessment, observed the procedure closely. The assessment scales consisted of a checklist and a global rating scale. Results: A significant correlation was found between the checklist and the global rating scale scores (r = 0.47, P = .002). The British Standards Reproducibility Coefficients were 2.5 (checklist) and 7.4 (global rating scale) for interrater reproducibility and 7.0 (checklist) and 12.6 (global rating scale) for self-assessment versus assessor reproducibility. Finally, analysis of the intraclass correlation coefficients between the assessors (0.74 and 0.64 for the checklist and the global rating scale, respectively) and between the surgeons' and trainers' scores (0.09 for the checklist and 0.18 for the global rating scale) showed a much weaker agreement for the latter. Discussion: There was good correlation between scores using the 2 different methods of assessment. The interrater reliability was substantial for both scales. However, training of assessors to ensure higher levels of interrater reliability may be necessary. These results also demonstrated the inability of some surgeons to assess their performance accurately. Conclusion: Both the checklist and the global rating scales provided useful assessment data, and both were considered of value by the assessors and surgeons in providing feedback. The development of assessment and self-assessment skills in implant surgery is necessary if we are to establish a culture of commitment to lifelong learning. [ABSTRACT FROM AUTHOR]

The article focuses on a study about the detection of extracellular volume overload and sarcopenia in systemic AL amyloidosis with the application of bioimpedance vector analysis. An overview of Systemic AL amyloidosis, which causes heart failure (HF) and proteinuric chronic kidney disease (CKD) such that both extracellular volume (ECV) overload and sarcopenia, is presented.

Background: Rate of progression of periodontitis has been used to inform the design of classifications of periodontal diseases. However, the evidence underpinning this topic is unclear and no systematic review has yet been conducted. Objectives: The focused question for this systematic review was: in adults, what is the progression of periodontitis in terms of clinical attachment loss, radiographic bone loss, and tooth loss? Data sources: Highly sensitive electronic search was conducted for published data in MEDLINE, EMBASE, LILACS, and unpublished grey literature in OpenGrey up to February 2016. Reference lists of retrieved studies for full‐text screening and reviews were hand‐searched for potentially eligible studies. Study eligibility criteria and participants: Prospective, longitudinal observational studies with follow‐up of at least 12 months and presenting data on the primary outcome, change in clinical attachment level, in adults (age ≥18 years). Secondary outcomes, tooth loss and bone level change, were only assessed in studies reporting the primary outcome. Studies investigating specific disease populations or only on treated periodontitis patients were excluded. Study appraisal and synthesis methods: Risk of bias and methodology were assessed using the Newcastle‐Ottawa Scale with two additional questions on security of outcome assessment. Studies were pooled by abstracting or estimating mean annual attachment or bone level change and annual tooth loss. Random effects meta‐analysis was conducted with investigation of effect of potential modifiers where possible. Results: A total 11,482 records were screened for eligibility; 33 publications of 16 original studies reporting on more than 8,600 participants were finally included as eligible for the review. The studies represented populations from both developing and developed economies. Mean annual attachment loss was 0.1 mm per year (95% CI 0.068, 0.132; I2 = 99%) and mean annual tooth loss was 0.2 teeth per year (95% CI 0.10, 0.33; I2 = 94%). Observational analysis of highest and lowest mean attachment change quintiles suggested substantial differences between groups with minimal annual change in the lowest quintile and an average deterioration of 0.45 mm mean attachment loss per year in the highest group. This value increased to 0.6 mm per year with periodontitis alone. There was surprisingly little effect of age or gender on attachment level change. Geographic location, however, was associated with more than three times higher mean annual attachment loss in Sri Lanka and China (0.20 mm, 95% CI 0.15, 0.27; I2 = 83%) vs North America and Europe (0.056 mm, 95% CI 0.025, 0.087; I2 = 99%) P < 0.001. Limitations: There were a limited number of studies (N = 16), high variability of design in key study components (sampling frames, included ages, data analyses), and high statistical heterogeneity that could not be explained. Conclusions: Within the limitations of the research, the data show that mean annual attachment level change varies considerably both within and between populations. Overall, the evidence does not support or refute the differentiation between forms of periodontal diseases based upon progression of attachment level change. [ABSTRACT FROM AUTHOR]