Post-transplantation outcome in non-alcoholic steatohepatitis cirrhosis: Comparison with alcoholic cirrhosis

Introduction and objectivesNon-alcoholic steatohepatitis (NASH) indication of liver transplant (LT) has increased recently, whereas alcoholic cirrhosis remains a major indication for LT. To characterize NASH-related cases and to compare the post-transplant outcome of these two conditions represents our major objective.Material and methodsPatients undergoing LT for NASH between 1997 and 2016 were retrieved. Those transplanted between 1997 and 2006 were compared to an “age and LT date” matched group of patients transplanted for alcoholic cirrhosis (ratio 1:2). Baseline features and medium-term outcome measures were compared.ResultsOf 1986 LT performed between 1997 and 2016, 40 (2%) were labeled as NASH-related indications. NASH-related cases increased initially (from 0.8% in 1997–2001 to 2.7% in 2002–2006) but remained stable in subsequent years (2.3%). Hepatocellular carcinoma (HCC) prevalence was greater in NASH-vs alcohol-related cirrhosis (40% vs 3%, p = 0.001). The incidence of overweight, obesity, arterial hypertension, dyslipidemia, diabetes, hyperuricemia, renal insufficiency and cardiovascular (CV) disease was similar in both groups at 5 years post-LT. Five-year survival was higher in NASH but without reaching statistical significance (83% vs 72%, p = 0.21). The main cause of mortality in NASH-LT patients was HCC recurrence.ConclusionMost previously considered cryptogenic cases are actually NASH-cirrhosis. While the incidence of this indication is increasing in many countries, it has remained relatively stable in our Unit, the largest LT center in Spain. HCC is common in these patients and represents a main cause of post-transplant mortality. Metabolic complications, CV-related disease and 5-yr survival do not differ in patients transplanted for NASH vs alcohol.     

Rehabilitation of irradiated patients with chemically modified and conventional SLA implants: five‐year follow‐up

The aim of this study is to evaluate the clinical and radiological parameters of standard SLA surface implants compared to chemically modified hydrophilic SLActive implants in irradiated patients after the initial 12‐month loading period up to 5 years. Twenty patients with a mean age of 61·1 years were treated with dental implants after ablative surgery and radio‐chemotherapy of oral cancer. All patients were non‐smokers. The placement of 102 implants (50 SLA, 52 SLActive) was performed bilaterally according to a split‐mouth design. Mean crestal bone changes were evaluated using standardised orthopantomographies and clinical parameters. Data were analysed using a Kaplan–Meier curve, Mann–Whitney U‐test and two‐factorial non‐parametric analysis. The average observation period was 60 months. The amount of bone loss at the implant shoulder of SLA implants was mesial and distal 0·7 mm. The SLActive implants displayed a bone loss of mesial 0·6 mm as well as distal 0·7 mm after 5 years. Two SLA implants were lost before loading. One patient lost five implants due to recurrence of a tumour. The overall cumulative 12‐month, 3‐year and 5‐year survival rate of SLA implants was 92%, 80% and 75·8% and of SLActive implants 94·2%, 78·8% and 74·4%, respectively. Eighteen implants were considered lost because the patients had died. Sandblasted acid‐etched implants with or without a chemically modified surface can be used in irradiated patients with a high predictability of success. Lower implant survival rates in patients with irradiated oral cancer may be associated with systemic effects rather than peri‐implantitis.     

Efficacy of low‐level laser therapy in the treatment of TMDs: a meta‐analysis of 14 randomised controlled trials

This study was designed to evaluate the efficacy of low‐level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta‐analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = ?19·39; 95% confidence interval = ?40·80–2·03; P < 0·00001; I² = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum active vertical opening (MAVO) (weighted mean difference = 4·18; 95% confidence interval = 0·73–7·63; P = 0·006; I² = 73%), maximum passive vertical opening (MPVO) (weighted mean difference = 6·73; 95% confidence interval = 01·34–12·13; P = 0·06; I² = 73%), protrusion excursion (PE) (weighted mean difference = 1·81; 95% confidence interval = 0·79–2·83; P = 0·59; I² = 0%) and right lateral excursion (RLE) (weighted mean difference = 2·86; 95% confidence interval = 1·27–4·45; P = 0·01; I² = 73%). The results of our meta‐analysis have provided the best evidence on the efficacy of LLLT in the treatment of TMDs. This study indicates that using LLLT has limited efficacy in reducing pain in patients with TMDs. However, LLLT can significantly improve the functional outcomes of patients with TMDs.     

Quand la détresse émotionnelle se traduit par des idées ou comportements suicidaires : une revue exploratoire (Scoping Review) sur le risque suicidaire chez les moins de 12 ans

To understand the different dimensions of suicidal risk for children 12 and under, a scoping review inspired by the Arskey and O’Malley (2005) model was conducted. Research engines used were PubMed, Web of Science, CINAHL, EMBASE and Google Scholar. A total of 13 articles and one report, published between 2005 and 2017 in French or English, were included in this study. Findings show that overall, for both girls and boys under 12 years old suicidal ideation and verbalizations are more prevalent than attempts. The means frequently used to attempt suicide are medication intoxication, hanging and strangulation. It is very difficult to assess the suicidal intent (wish to die) behind the attempt. It often appears to be an impulsive act. Methodological bias are often present in the studies found. Furthermore, even if children do not fully understand the concept of death, they still can attempt suicide. They need to be considered seriously by people working in the health care system. It is important that their emotional pain be heard to prevent further attempts in the future.     

Structural risk and limits on agency among exotic dancers: HIV risk practices in the exotic dance club

This paper provides longitudinal examination of women’s health and sexual risk trajectories in US exotic dance clubs, which represent an important commercial setting for the economic mainstreaming of sexual services and an important target for public health programmes. Between July 2014 and May 2015, two semi-structured interviews (at baseline and at three months) were conducted with 24 female exotic dancers who had recently started working in in Baltimore City, USA. Results from a constant comparative analysis point to the interrelationship between the structures of the club setting, including the social context, and women’s agentic practices concerning their sexual health. Study findings highlight the centrality of the interrelationship between individual- and structural-level experiences in influencing dancers’ risk behavior. Findings point to the need for interventions to empower women both individually and collectively so as to provide the foundation for longer-term structural change.