The prognostic value of elevated neutrophil–lymphocyte ratio for cardiac surgery-associated acute kidney injury: A systematic review and meta-analysis

Background

Patients undergoing cardiac surgery are at significant risk of developing postoperative acute kidney injury (AKI). Neutrophil–lymphocyte ratio (NLR) is a widely available inflammatory biomarker which may be of prognostic value in this setting.

Methods

We conducted a systematic review and meta-analysis of studies reporting associations between perioperative NLR with postoperative AKI. We searched Medline, Embase and the Cochrane Library, without language restriction, from inception to May 2022 for relevant studies. We meta-analysed the reported odds ratios (ORs) with 95% confidence intervals (CIs) for both elevated preoperative and postoperative NLR with risk of postoperative AKI and need for renal replacement therapy (RRT). We conducted a meta-regression to explore inter-study statistical heterogeneity.

Results

Twelve studies involving 10,724 participants undergoing cardiac surgery were included, with eight studies being deemed at high risk of bias using PROBAST modelling. We found statistically significant associations between elevated preoperative NLR and postoperative AKI (OR 1.45, 95% CI 1.18–1.77), as well as postoperative need for RRT (OR 2.37, 95% CI 1.50–3.72). Postoperative NLR measurements were not of prognostic significance.

Conclusions

Elevated preoperative NLR is a reliable inflammatory biomarker for predicting AKI following cardiac surgery.     

COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms

In December 2019 a novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic. Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease. Typical symptoms of the initial phase include fever and cough, with possible progression to acute respiratory distress syndrome. Gastrointestinal manifestations such as diarrhoea, vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2. The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses. Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations, such as fatigue and psychological impairment. To date, there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection. Since COVID-19 can directly or indirectly affect the gut physiology in different ways, it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations (dysbiosis, disruption of the intestinal barrier, mucosal microinflammation, post-infectious states, immune dysregulation and psychological stress). In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.     

Benefits of an implant platform modification technique to reduce crestal bone resorption

PURPOSE: The alveolar bone resorption that occurs around a 2-piece implant following abutment attachment is a well-documented observation. Several investigators propose that crestal bone loss is a response to the invasion of the biologic width by secondary bacterial colonization and micromovements at the implant-abutment interface. This study proposes the creation of a difference between the diameter of the implant platform and diameter of the abutment (implant platform modification), shifting the implant-abutment interface medially to minimize invasion of the biologic width. MATERIAL AND METHODS: We present a series of 30 control cases and 30 study cases using the platform-modification technique. Interproximal bone resorption on the medial and distal of each implant was assessed using digital radiography at 1, 4, and 6 months after abutment attachment. RESULTS: The mean value of bone resorption observed in the mesial measurement for the control group was 2.53 mm, whereas for those patients included in the study group, it was 0.76 mm. The mean value of bone resorption observed in the distal measurement for patients in the control group was 2.56 mm, whereas for those included in the study group, it was 0.77 mm. CONCLUSIONS: All patients in the study group had a significant reduction of bone loss in comparison to the control group (P < 0.0005).     

Viadent, ethanol, and pH effects upon gingival epithelial-like cells, in vitro

Interest has recently been directed towards the use of antiplaque mouthrinses. Most published material concerns the antimicrobial effects of these agents rather than their effects upon oral tissue. This study was conducted to evaluate the effect of a sanguinarine-containing mouthrinse called Viadent upon epithelial-like gingival cells. The cells were grown for 24 hours in supplemented Earle's medium, with and without different Viadent dilutions. Cell counts were made with a hematocytometer. It was found that 50% of the cells were inhibited at 1.2% Viadent. In similar studies, it was found that 70% ethanol and two pH buffers were less toxic than Viadent. Exposure of preformed cell monolayers to Viadent also showed significant inhibition. The relative toxicity of different antiplaque agents may be compared using such cells as a model system. In conclusion, it was observed that Viadent significantly affected gingival cell growth in vitro, that viable cell numbers were greatly reduced by short time exposure, and that the toxic effect of Viadent could only partially be accounted for by ethanol content and/or pH.     

Bone regeneration around an osseointegrated implant. A simultaneous approach in a fenestrated defect: a case report.

The use of a barrier membrane, with or without osseous allograft, has been shown to establish regeneration of osseous tissue around dental implants. Following three episodes of persistent symptomatic failed apicoectomy and subsequent tooth extraction, an osseointegrated implant was placed in a wide fenestrated defect. Demineralized freeze-dried bone allograft was covered by an occlusive expanded polytetrafluorethylene membrane. The reentry procedure revealed complete bone fill that followed the texture of the augmentation material beyond the previous buccal bony envelope.