Hypertension

High blood pressure induced by vitamin D deficiency is associated with renal overexpression and hyperphosphorylation of Na+-K+-2Cl- cotransporter type 2 Objectives: Clinical and epidemiological studies have suggested a correlation between vitamin D deficiency (VDD) and high blood pressure (BP). This study aimed to test the hypothesis that high BP induced by VDD is associated with altered expression and covalent modification of apical sodium transporters along the nephron. The contributions of the intrarenal renin–angiotensin system (RAS) and oxidative stress were also investigated. Methods: Male Wistar rats were fed a vitamin D-free (n = 26) or standard diet (n = 25) for 30 days. BP was recorded using noninvasive and invasive procedures. The expression levels of total and phosphorylated apical sodium transporters in rat renal cortex and medulla were evaluated by immunoblotting. Intrarenal RAS components were assessed by immunoblotting and ELISA. Renal oxidative stress was analyzed by measuring the concentrations of thiobarbituric acid reactive substances and reduced glutathione. Results: Higher BP levels in VDD rats than controls were accompanied by overexpression and hyperphosphorylation of renal cortical and medullary Na+-K+-2Cl- cotransporter type 2, enhanced levels of phosphorylated Na+/H+ exchanger type 3, and reduced expression levels of total and phosphorylated Na+/Cl- cotransporter. Changes in intrarenal RAS induced by VDD vs. controls included the marked elevation of medullary renin expression, higher expression of cortical angiotensinogen, higher urinary angiotensinogen excretion, and higher cortical and medullary angiotensin II content. VDD rats displayed higher thiobarbituric acid reactive substances/glutathione ratios in the renal cortex and medulla than controls. Conclusion: These results suggest that the molecular mechanisms underlying the effects of VDD on BP may include the upregulation of Na+-K+-2Cl- cotransporter type 2 and activation of intrarenal RAS and oxidative stress. Correspondence to Adriana C.C. Girardi, Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Avenida Dr Enéas de Carvalho Aguiar, 44, 10° andar, Bloco II, 05403-900 São Paulo, SP, Brazil. Tel: +55 11 2661 5929; fax: +55 11 2661 5022; e-mail: adriana.girardi@incor.usp.br Received 2 April, 2020 Revised 27 October, 2020 Accepted 15 November, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Validity of five formulas in estimating 24-h urinary sodium via spot urine sampling in hypertensive patients living in Northeast China Objective: The objective was to evaluate the accuracy of five formulas -- the Kawasaki, Tanaka, INTERSALT, Mage, and Uechi methods -- using spot urinary sampling for 24-h urinary sodium (UNa) prediction in hypertensive patients living in northeast China. Methods: There were 1154 hypertensive patients enrolled from multiple centers. Five different formulas were used to predict 24-h UNa excretion via spot morning urinary samples. Actual UNa excretion was measured from 24-h urine samples. The estimated value was compared with the actual value by examining biases, the intraclass correlation coefficients (ICC), and Bland–Altman plots. Results: The average excretion of sodium was 2.97 ± 1.26 g/day. The formula-produced mean biases for actual UNa were 0.31 g/day for INTERSALT, 0.80 g/day for Mage, 0.88 g/day for Tanaka, 1.14 g/day for Uechi, and 1.95 g/day for Kawasaki. The ICC was 0.511 for Kawasaki, 0.499 for INTERSALT, 0.468 for Tanaka, 0.402 for Mage, and 0.378 for Uechi. The least mean bias in the lower and moderate salt intake subgroups was 1.22 and 0.07 g/day, respectively, which was calculated using the Mage and INTERSALT methods. The least mean bias in the higher salt intake subgroup was 0.10 g/day for the Uechi method. The INTERSALT method was more efficiency at the individual level, with 17.4% of participants having relative differences within 10%, and 22.3% participants having absolute differences within 393 mg. Conclusion: The INTERSALT method may exhibit a good performance in estimating 24-h urinary sodium level for the hypertensive population living in northeast China. Correspondence to Wei Song, Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China. Tel: +86 18098875773; e-mail: songwei8124@163.com Received 1 September, 2020 Revised 10 November, 2020 Accepted 1 December, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque Background: Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD. Materials and methods: We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured. Results: Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ2 = 3.74) improved by adding GCCS (χ2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19. Conclusion: Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS. Video abstract: Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors. Correspondence to Chunyan Ma, First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, Liaoning 110001, China. Tel/fax: +86 24 83282114; e-mail: cmu1h_mcy@126.com Received 20 August, 2020 Revised 14 November, 2020 Accepted 6 December, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Targeting persistent normal left ventricular geometry in the general population: a 25-year follow-up study Aim: Findings regarding the extent of persistence over time of normal left ventricular (LV) geometry, a reference healthy echocardiographic phenotype, in the community are scanty. We sought to assess this issue in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. Methods: The study included 433 participants who attended the second and third survey of the Pressioni Arteriose Monitorate e Loro Associazioni study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, office, home, ambulatory blood pressure, routine blood examinations and echocardiography. Results: During 25-year follow-up 167 participants showed persistently normal LV mass (LVM) and LV geometry pattern, whereas 266 participants exhibited LV hypertrophy or LV concentric remodelling at any point during study. Compared with participants developing, maintaining or regressing from LV hypertrophy and LV concentric remodelling those with a persistently normal LVM index and geometry were younger (−8 years) and more frequently female (63 vs. 45%), exhibited baseline (and follow-up) lower office and out-of-office blood pressure, BMI, serum creatinine, fasting blood glucose total serum cholesterol and rate of antihypertensive treatment. In multivariate regression analysis age [odds ratio (OR): 0.93, confidence interval (CI): 0.91–0.96, P < 0.0001] BMI (OR: 0.90, CI: 0.83–0.97, P = 0.008), office SBP (OR: 0.97, CI: 0.95–0.99, P = 0.005) and fasting blood glucose (OR: 0.96, CI: 0.93–0.99, P = 0.007) were independently associated with persistent normal LVM index and geometry. Conclusion: The current long-term longitudinal study suggests that persistence of normal LV geometry is associated with normal/optimal SBP, BMI and blood glucose. Thus, a closer control of these risk factors in midlife may increase the likelihood of maintaining normal ventricular geometry and, in turn, reduce the burden of subclinical cardiac organ damage and related complications in advanced age. Correspondence to Cesare Cuspidi, Clinical Research Unit, Istituto Auxologico Italiano, Viale della Resistenza 23, 20036 Meda, Italy. Tel: +39 0362 772433; fax: +39 0362 772416; e-mail: cesare.cuspidi@unimib.it Received 26 September, 2020 Revised 3 November, 2020 Accepted 15 November, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Neck-to-height ratio and arterial stiffness in Chinese adults: cross-sectional associations in a community-based cohort Objectives: The aim of this study was to investigate the association between neck-to-height ratio (NHR) and arterial stiffness in adults from a community-based Chinese cohort in a cross-sectional study. Methods: We conducted cross-sectional analysis using data from the Kailuan study, a population-based cohort research. Altogether, 18 972 individuals were included in the analysis. Brachial ankle pulse wave velocity (baPWV), anthropometric indexes and cardiovascular risk factors were recorded. Data were analyzed by multiple lineal regression model. Results: NHR was positively associated with baPWV after adjusted for age, sex, blood pressure, heart rate, BMI, waist–hip ratio, current smoking, fasting blood glucose, serum cholesterol, uric acid, high-sensitivity C reactive protein and creatinine clearance (β = 5.76, P < 0.001), while the association of neck circumference and baPWV was NS after adjusting the variables mentioned above. In subgroups analysis, the association between NHR and baPWV did not reach statistical significance in female, while in males, the association was significant. Interaction effects were observed among BMI stratifications and the individuals with metabolic syndrome and history of cardiovascular events (P for intereaction = 0.002, 0.038 and 0.003, respectively). Conclusion: The current study demonstrated for the first time that NHR was positively associated with baPWV in community-based population, NHR might be a promising independent predictor for cardiovascular disease. Correspondence to Jun Tao, Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China. E-mail: taojungz123@163.com Received 4 August, 2020 Revised 27 October, 2020 Accepted 22 November, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Association between arterial stiffness and the clustering of metabolic syndrome risk factors: a systematic review and meta-analysis Objectives: Metabolic syndrome (MetS) is a cluster of different cardiometabolic risk factors (CMRFs), and its different combinations with other CMRFs, such as arterial stiffness have been hypothesized to explain, at least partially, increased risk of cardiovascular disease. Thus, in this systematic review and meta-analysis, we aimed to synthesize the evidence regarding the association between the clustering of MetS-related CMRFs and arterial stiffness measured using pulse wave velocity (PWV). Methods: Original studies analysing the association between arterial stiffness, measured using PWV, and MetS were systematically searched. Pooled effect size estimates and their respective 95% confidence intervals (CI) were calculated using the DerSimonian and Laird method for two separate analyses: the diagnosis of MetS and PWV values and the number of CMRFs and PWV values. Results: Moderate effect size estimates were observed between MetS and PWV (0.68, 95% CI: 0.54–0.82) with a slightly higher effect size for the low-risk compared with the high-risk population group (0.75, 95% CI: 0.58–0.92; and 0.51, 95% CI: 0.32–0.82, respectively). A trend between the number of MetS-related CMRFs and PWV was found with the pooled effect size nearly doubling as the number of MetS-related CMRFs increased, 0.11 (95% CI: 0.04–0.17) for one MetS-related CMRF, 0.26 (95% CI: 0.13–0.4) for two, and 0.4 (95% CI: 0.2–0.6) for three or more. Conclusion: These results demonstrated a clinically relevant association between MetS and PWV and an increasing trend in PWV values, such as a MetS-related CMRF increase. Although these results should be considered cautiously because of the considerable heterogeneity, our findings reinforce the rationale of MetS as an aggregation of risk factors with common causes, which could provide additional useful information to guide clinical management. Correspondence to Iván Cavero-Redondo, PhD, Universidad de Castilla-La Mancha, Edificio Melchor Cano, Centro de Estudios Socio-Sanitarios, Santa Teresa Jornet s/n, 16071 Cuenca, Spain. E-mail: Ivan.Cavero@uclm.es Received 8 September, 2020 Revised 31 October, 2020 Accepted 22 November, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Effect of frequency and pattern of night shift on hypertension risk in female nurses: a cross-sectional study Objectives: Understanding the effect of night shift on hypertension risk in nurses is important to improve the health of nurses and ensure patient safety. This study aimed to evaluate the effect of the frequency and pattern of night shift on hypertension risk and the interaction of them in female nurses. Methods: This cross-sectional study constituted 84 697 female nurses in 13 cities in China. The main contents of the survey included SBP, DBP, the frequency and pattern of night shift, and some other factors that might be associated with hypertension. Logistic regression analyses were used to calculate ORs and 95% CIs to estimate the effect of the frequency and pattern of night shift on hypertension risk and the interaction of them in relation to hypertension risk. Results: Having more than 5 to 10 or more than 10 night shifts per month were significantly more likely to be hypertensive (OR 1.19, 95% CI 1.10–1.28; OR 1.32, 95% CI 1.13–1.54), whereas having less than or equal to 5 night shifts per month was not (OR 1.05, 95% CI 0.95–1.16). The patterns of night shift were all associated with a higher probability of hypertension and participants engaging in rapidly rotating night shift had a lower OR (1.14) than those having slowly rotating night shift (1.23) and permanent night shift (1.46). No significant interaction was observed between the frequency and the pattern of night shift (Pinteraction = 0.281). Conclusion: The frequency and pattern of night shift were associated with hypertension risk in female nurses and no significant interaction was observed between them. Correspondence to Wei Cui, Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang city, Hebei Province, China. E-mail: cuiwei21c@163.com Received 25 February, 2020 Revised 15 November, 2020 Accepted 22 November, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Hemodynamic profiles in treatment-naive arterial hypertension and their clinical implication for treatment choice: an exploratory post hoc analysis Objective: Noninvasive thoracic bioimpedance by the HOTMAN System estimates hemodynamic modulators and expresses them as hemodynamic profiles. Aims of this analysis were to describe hemodynamic profiles among treatment-naive hypertensive patients compared with normotensive controls and to investigate whether a hemodynamic-guided choice of therapy improves blood pressure (BP) control within 4 weeks. Method: This exploratory post hoc analysis used data of a randomized parallel-group trial including 80 outpatients with newly diagnosed arterial hypertension (AHT), randomized to four antihypertensive first-line monotherapies, and 20 age-matched and sex-matched normotensive controls. Hemodynamic profiles were measured at baseline and after four weeks of treatment. On the basis of the hemodynamic profiles, the most appropriate pharmacological treatment was determined retrospectively and patients were categorised to have received concordant (ConTG) or discordant treatment (DisTG). Results: In the hypertensive group, hypervolemia with vasoconstriction was the predominant hemodynamic profile in 48% of patients and hypervolemia without vasoconstriction in 45%, compared with 15 and 50%, respectively, in the control group. After 4 weeks of treatment, the mean (±SD) 24-h BP was 129.9 (±11.0)/81.5 (±8.0) mmHg in the DisTG vs. 133.9 (±12.3)/84.0 (±9.1) mmHg in the ConTG (P = 0.158/0.222). The mean 24-h BP reductions were −9.7 (±10.1)/−5.0 (±6.2) mmHg in the DisTG and −12.4 (±14.8)/−6.9(±6.9) mmHg in the ConTG (P = 0.353/0.223). After 4 weeks of treatment, the BP control rate was 53.7% (43/80) among all, 55.7% (29/52) in the DisTG and 48% (12/25) in the ConTG (P = 0.628). Conclusion: Our findings do not support the hypothesis that personalized treatment initiation based on hemodynamic profiles improves BP control in newly diagnosed hypertensive outpatients. Correspondence to Thilo Burkard, Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. E-mail: thilo.burkard@usb.ch Received 6 October, 2020 Revised 29 November, 2020 Accepted 29 November, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

The adrenal medulla in cardiovascular medicine: an untold story Unlike noradrenaline, the sympathetic neurotransmitter which overflows to the circulation, adrenaline (ADR) is a secreted hormone, with a low plasma concentration, and plasma concentration for biological action a log order lower than that of noradrenaline. The venous drainage of the left adrenal medulla into the left renal vein does expose this vein to uniquely high plasma ADR concentrations and possible risk of thrombosis at high rates of ADR secretion. There is typically a different timeframe for adrenal medullary and sympathetic nervous system responses: ADR release is short term in contrast with sympathetic activation persisting for years in heart failure and hypertension. The historic view of Walter Cannon, subject to recent review, that the sympathoadrenal system is a unified biological system, was deconstructed further with demonstration of frequent mismatching of adrenal medullary and sympathetic nervous responses. Under gravity stimulation with standing, there is prompt sympathetic activation without ADR release. In many diseases, notably obesity, hypertension, heart failure and depressive illness, an activated sympathetic nervous system and silent adrenal medulla coexist. The therapeutic corollary of this is that ADR blockade is much less commonly needed clinically than pharmacological antagonism of the sympathetic nervous system. Correspondence to Murray D. Esler, Baker Heart and Diabetes Institute, PO Box 6492, Melbourne 3004, VIC, Australia. Tel: +61 409 178 058; fax: +61 3 8532 1100; e-mail: murray.esler@baker.edu.au Received 19 October, 2020 Revised 15 November, 2020 Accepted 16 November, 2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Uterine fibroids increase the risk of hypertensive disorders of pregnancy: a prospective cohort study Objective: It is unclear whether uterine fibroids are associated with the occurrence of hypertensive disorders of pregnancy (HDP). Thus, this study aimed to evaluate the association between uterine fibroids and HDP in a prospective cohort. Methods: Overall, 2404 pregnant women who received antenatal care were enrolled in a prospective cohort in China between 2014 and 2016; 2277 women met the inclusion criteria of this study. The clinical characteristics of participants were assessed via questionnaires and physical examinations at baseline (before the 20th week of gestation), 21st–27th, 28th–34th, and 35th–39th gestational weeks. Ultrasound examination was performed before the 20th week of pregnancy to determine the presence of uterine fibroids. Linear mixed-effect and Cox proportional hazard regression models were used to analyze the association of uterine fibroids with blood pressure and HDP. Results: Of 2277 pregnant women, 242 (10.6%) had uterine fibroids, and 45 (2.0%) subsequently developed HDP. The incidence of HDP in women with and without uterine fibroids was 5% (n = 12) and 1.6% (n = 33), respectively. The longitudinal SBPs and DBPs were significantly higher in women with uterine fibroids than in those without. The multivariable Cox model showed that the presence of uterine fibroids was associated with increased HDP risk (adjusted hazard radio: 2.95, 95% confidence interval: 1.35–6.44). Conclusion: Uterine fibroids in early pregnancy were associated with an increased HDP risk. Blood pressure of women with uterine fibroids should be closely monitored, and HDP preventive measures are crucial. Correspondence to Xuerui Tan, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong 515041, China. Tel: +86 754 88611690; fax: +86 754 88259850; e-mail: doctortxr@126.com. Received 26 July, 2020 Revised 8 October, 2020 Accepted 2 November, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,

Maxillofacial Surgery

Organizing craniofacial surgery teams Arun K Singh National Journal of Maxillofacial Surgery 2020 11(2):157-158

Oral mucositis Vibha Singh, Akhilesh Kumar Singh National Journal of Maxillofacial Surgery 2020 11(2):159-168 Oral mucositis is one of the most common complications of cancer therapy. It is a nonhematologic complication of cytotoxic chemotherapy and radiotherapy and reduces the quality of life. It is estimated that 40% the cases on standard chemotherapy may develop oral mucositis. Patients receiving radiation, especially in the cases of head and neck cancer, have 30%–60% chances of developing mucositis. Chemotherapy and radiotherapy interfere with the normal turnover of epithelial cells, leading to mucosal injuries. These injuries can also occur due to indirect invasion of Gram negative bacteria and fungi as most of the chemo-therapeutic agents will cause neutropenia and will give a favorable environment for the development of mucositis. The patient-related factors are also responsible for developing mucositis in chemo-induced and radiation-induced mucositis. Poor oral hygiene may also be responsible for bacterial super infection followed by chemotherapy. Mucositis is of two kinds: direct and indirect mucositis. Direct mucositis - The epithelial cells of the oral mucosa undergo rapid turnover in usually 7–14 days due to which these cells are more susceptible to the effect of the cytotoxic therapy which results in oral mucositis. Indirect mucositis – it can develop due to the infection caused by Gram-negative bacteria and fungal infection. There will be a greater risk for oral infection due to neutropenia. The onset of mucositis secondary to mylo-suppression varies depending upon the timing of the neutrophil count associated with chemotherapy agents but they typically develop around 10–21 days after chemotherapy administration.

Evaluating the role of local host factors in the candidal colonization of oral cavity: A review update Imran Khan, Tanveer Ahmad, Nikhat Manzoor, Moshahid Alam Rizvi, Uqba Raza, Shubhangi Premchandani National Journal of Maxillofacial Surgery 2020 11(2):169-175 Human oral cavity is home to a number of organisms, Candida albicans being one of them. This review article aims at understanding the correlation between the oral candidal colonization and the local host factors that may influence it with special emphasis on congenital craniofacial anomalies such as cleft lip and palate (CLP). Various scientific databases were searched online and relevant articles were selected based on the inclusion criteria. A comparative study was done to understand the interdependence of various factors (including CLP) and oral candidal colonization. The results revealed a strong association of certain local host factors which may influence the oral colonization of Candida species. Factors such as mucosal barrier, salivary constituents and quantity of saliva, congenital deformities like CLP, oral prostheses such as dentures/palatal obturators and fixed orthodontic appliances (FOAs) were identified. All these factors may directly affect the growth of Candida in the oral cavity. Although numerous studies have pointed a positive correlation between Oral Candidal colonization and local host factors such as oral prostheses, FOA, and oral mucosal barrier only one study has been done, in the Indian subcontinent with respect to the correlation of candidal colonization and CLP. After the evaluation of all the factors mentioned in various case studies, it can be concluded that the presence of local host factors such as orofacial clefts, dental prostheses, FOA, xerostomia, and atrophy of the oral mucous membrane lead to significant increase in candidal colonization, but since very few studies in regard to CLP have been done worldwide and in India, in particular, further studies are warranted.

Evaluation of osseintegration between traditional and modified hydrophilic titanium dental implants – Systematic analysis Geeta Arya, Varun Kumar National Journal of Maxillofacial Surgery 2020 11(2):176-181 The aim of the study was to conduct a systematic review to access the osseointegration between traditional and modified Hydrophilic Titanium Dental Implants for period of 10 years. PUBMed articles were searched from last ten years up to 15/12/2019 from which 24 studies included in this review. This systematic review compiles the data about osseintegration in hydrophilic titanium implants in human trials. It sheds light on the mechanism of integration of hydrophilic surfaces and numeric data to support the purpose of the review.

Does diagnostic accuracy of surgeon's perception outweigh frozen section analysis in determining intraoperative clear mucosal surgical margins in oral squamous cell carcinoma patients? Chetan Gupta, Nitin Bhola, Anendd Jadhav, Apoorva Mishra, Pawan Hingnikar, Chinmay Ghavat National Journal of Maxillofacial Surgery 2020 11(2):182-185 Introduction: The lucrativeness of the frozen section for intraoperative margin assessment in head and neck squamous cell carcinoma is debatable till date. The purpose of this study was to evaluate whether surgeon's perception by gross examination (GE) of margin is an alternative to frozen section. Aim: The aim was to compare the diagnostic accuracy (DA) of surgeon's perception of tumor-free mucosal and soft-tissue surgical margins intraoperatively assessed by GE and frozen section analysis (FSA). Methodology: A prospective, observational study was conducted on 59 histologically proven cases of oral squamous cell carcinoma. Two hundred and thirty-six mucosal margins were assessed by an experienced surgeon (ES) and thereafter subjected subsequently to FSA. These results were compared with the gold standard histopathology (HPE). The sensitivity (SS), specificity (SP), positive predictor value (PPV), negative predictor value (NPV), and DA of surgeon's perception by GE were calculated and subsequently compared with FSA and HPE using descriptive and inferential statistics. Results: The SS, SP, PPV, NPV, and DA of ES by GE were 80%, 99.12%, 80%, 99.12%, and 98.30%, respectively when compared to HPE, and the SS of 90%, SP of 98.32%, PPV, NPV, and DA were 69.23%, 99.57%, and 97.98%, respectively when compared with HPE. The results of the surgeon's perception by GE were comparable to the results of FSA. Conclusion: The study concludes that surgeon's perception by GE is upfront reliable alternative intraoperative method to FSA in places where FS is not available.

Rhinoplasty in secondary nasal deformities: Subjective and objective outcome evaluation Chandmani Tigga, Majumdar Swapan Kumar, Burman Subhasish, Mishra Siddartha, Hussain Mohsina National Journal of Maxillofacial Surgery 2020 11(2):186-192 Introduction: Secondary nasal deformities are associated with trauma and secondary cleft nose (after primary cleft nose surgery). Nasal deformities affect esthetic, function, and psychological status of the patient. The goal of the secondary rhinoplasty is to correct both form and function, so that this positively impacts on their facial appearance. Aims: The study aimed to evaluate the patient satisfaction (subjective outcome) by rhinoplasty outcome evaluation questionnaire (ROEQ) preoperatively and postoperatively and esthetic outcome (objective outcome) by surgical team in patients with secondary nasal deformities. Materials and Methods: Secondary rhinoplasty was done in 13 patients of traumatic and unilateral secondary cleft nose through the external approach. Objective outcome was assessed by surgical team with clinical measurement, radiograph (lateral cephalometric), and photographic documentation pre- and postoperatively. Clinical measurements include nasolabial and nasofrontal angle. The patients completed the ROEQ for the subjective outcome evaluation. Results: There was significant improvement of subjective outcome (83.30%) based on the ROEQ and objective outcome based on the clinical measurement. Conclusion: Our study suggests that secondary rhinoplasty in trauma and cleft patients leads to both subjective and objective improvement of the facial appearance.

Management of macrocystic lymphatic malformation at uncommon site with aqueous bleomycin sclerotherapy Ankur Bhatnagar, Vijai Datta Upadhyaya, Rajnikant Yadav, Basant Kumar National Journal of Maxillofacial Surgery 2020 11(2):193-198 Introduction: Lymphangioma are rare vascular malformation that results from maldevelopment of primitive lymphatic sacs. They are most frequently found in the neck and axilla, while intra-abdominal and mediastinal lymphangiomas are uncommon. Atypical site of cystic hygroma in pediatric age group are usually difficult to diagnose clinically but can be diagnosed easily by ultrasound. The aim of the study was to evaluate the result of the intralesional bleomycin for macrocystic lymphatic malformation (LM) presenting at atypical site Material and Method: All patients of LM of other than head& neck, axilla and abdomen presenting in pediatric age group were included in the study. Mainstay of diagnosis was ultrasound and was supplemented by CT scan wherever required. All patients were managed with intralesional bleomycin (ILB) and surgical excision was done only if primary therapy failed. Result: Total 15 cases of LM presenting at atypical sites were included in the study. Series include two case of cystic hygroma of breast, 4 cases of cystic hygroma of anterior chest wall, two case of substernal LM, three cases of LM of parotid gland, one case of inguinal region cystic hygroma and 4 cases involving submandicular area. Complete resolution was observed in 13 out of 15 cases, and two cases had less than 50% reduction in size and were managed with surgical excision after second session of ILB. Conclusion: Aqueous Intralesional bleomycin is a cost effective alternative to surgery even at rare sites of LM which provide better aesthetic outcome, and avoids complication associated with surgery.

Comparative evaluation of crestal bone level in patients having low level of Vitamin D treated with dental implant with or without Vitamin D3 supplements Pooja Garg, Pankaj Ghalaut, Kiran Dahiya, Reena Ravi, Anshu Sharma, Poonam Wakure National Journal of Maxillofacial Surgery 2020 11(2):199-206 Introduction: Vitamin D has been shown to play a vital role in bone mineral homeostasis by stimulating the intestinal absorption of calcium and phosphate. The critical role of Vitamin D in bone metabolism triggered the need to evaluate the effect of Vitamin D deficiency and hence replacement of the same on osseointegration of dental implants. This prospective study evaluated the crestal bone level in patients having low level of Vitamin D treated with dental implant with or without Vitamin D3 supplements. Materials and Methods: A prospective clinical study was conducted on 32 patients based on the inclusion and exclusion criteria. Patients were divided into two groups on the basis of Vitamin D level < 30 ng/ml (Group I: patients receiving Vitamin D3 supplements, i.e., cholecalciferol 1 g sachet 60,000 IU/month) or <30 ng/ml (Group II: not receiving Vitamin D3 supplements). The crestal bone level measurements were made with the help of Digimizer Image Analysis, MedCalc software. Results: All implants showed clinically acceptable crestal bone level at interval of 1 week (baseline), 3 months, and 6 months. There was a statistically nonsignificant difference seen for the values between the groups (P > 0.05) for all other values at various time intervals. However, there was a statistically significant/highly significant difference seen for the values between the groups (P < 0.01, 0.05) for 3 months distal with higher values for Group I as compared to Group II. Conclusion: From the study, it can be concluded that cholecalciferol has systemic effects on accelerating bone formation around titanium implant.

Evaluation of polycaprolactone scaffold for guided bone regeneration in maxillary and mandibular defects: A clinical study Charudatta Naik, N Srinath, Mahesh Kumar Ranganath, DN Umashankar, Himani Gupta National Journal of Maxillofacial Surgery 2020 11(2):207-212 Objective: This study was carried out to assess bone regeneration following the use of polycaprolactone (PCL) scaffold in maxillary and mandibular osseous defects. Materials and Methods: This prospective study included ten patients with maxillary or mandibular osseous defects present due to enucleation of periapical cysts or alveolar clefts requiring bone grafting and for lateral ridge augmentation that were treated with PCL scaffold. The patients were assessed clinically for pain, swelling, infection, and graft exposure at 1 week, 3rd, and 5th month postoperatively and were also evaluated radiographically for bone fill using intraoral periapical and/or panoramic radiographs at 4th, 6th, and 9th month postoperatively. Results: PCL scaffold was used in a total of six alveolar clefts and three cases of periapical cysts and one case of lateral ridge augmentation. Nine out of ten cases demonstrated wound dehiscence and scaffold exposure in the oral cavity. Radiographically, on comparison to the control regions, all these nine cases failed to demonstrate appreciable bone density gain. Only one case of radicular cyst in the mandible was recorded to have satisfactory healing. Conclusion: Although PCL scaffold has the potential for bone regeneration in osseous defects, the scaffold exhibited marked tendency for dehiscence in intraoral defects that significantly affected bone healing. A long-term study designed with a larger sample size and categorization of the defects is required to assess its efficacy in varied defects. Moreover, comparative evaluation of PCL and autogenous or alloplastic bone grafting material could provide assenting results.

Graftless crestal hydraulic sinus lift with simultaneous implant insertion Varsha Sunil Manekar National Journal of Maxillofacial Surgery 2020 11(2):213-218 Background: The posterior maxilla is always a challenge for dental implant restoration. The presence of maxillary sinus and reduced subantral bone height are the limitations for implant insertion. The need of the hour is to make the surgical procedures simple, minimally invasive, andpredictable. Can we perform the sinus lift and simultaneous implant insertion by minimally invasive,simple, cost-effective, and less time-consuming technique? With this in consideration, the author carriedout this study for graftless crestal hydraulic sinus lift (CHSL) and simultaneous implant insertion in partially edentulous posterior maxilla for 26 implants. The aim is to evaluate the clinical and radiological success of graftless CHSL with simultaneous implant insertion. Material and Method: The sample size was 17 patients and 26 implants were inserted. The clinical as well as radiological follow-up was done for 1 year. The outcome variables were the gain in bone height and implant survival. Result: Mean Bone height Gain is 5.6 mm; Mean torque used 32 nm, Mean age of the patient was 53 years. The literature shows a success of graftless lateral and osteotome-mediated sinus lift. The concept is the blood filling the gap around the implant in tented sinus lining can eventually result in the ossification to form bone. Until now, no study has demonstrated the bone formation in the peri-implant area of CHSL with simultaneous implant insertion. CHSL, a minimally invasive sinus lift surgery is very encouraging, easy to master, and predictive. The simultaneous implant insertion acts to retain the elevated sinus lining by tenting. It also reduces treatment time. After a sinus lifting procedure, the compartment around the implants under the sinus mucosal lining in the sinus floor is filled with a blood clot from surrounding bleeding. Blood clot can be considered autologous osteogenic graft material, to which osteoprogenitors can migrate, differentiate, and regenerate bone. Conclusion: The graftless CHSL is predictable and safe for the sinus lift. The gain of up to 5–6 mm of subantral bone is possible.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Dermatologica

C-reactive protein to albumin ratio: Is a new parameter for the disease severity in patients with psoriasis vulgaris? Funda Kemeriz, Burcu Tuğrul, Sibel Çiğdem Tuncer Dermatologica Sinica 2020 38(4):199-204 Background: C-reactive protein to albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in many inflammatory diseases. Objectives: In this study, we aimed to investigate whether there is a correlation between CAR value and disease severity in patients with psoriasis. Methods: The study included 70 plaque-type psoriasis patients and 67 healthy controls. CAR value was calculated after C-reactive protein (CRP) and albumin analysis was performed, Psoriasis Area and Severity Index (PASI) scores were documented. CAR value was compared with PASI scores in patient group. White blood cell count, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, erythrocyte sedimentation rate (ESR), and mean platelet volume and CAR values were compared among these groups. We investigated the most significant parameter for disease severity. In addition, to detect relationship between CAR, disease duration and patients' age and healthy controls, correlation analysis was performed. Results: The median CAR value was found statistically significant higher in the patient group than in the control group (P < 0.001). A significant difference of median CRP, albumin, CAR (all P values are <0.001) and ESR (P = 0.024) were found among the three groups which were arranged according to the severity of the disease. Among these parameters, CAR was found as the most associated parameter with the severity of psoriasis using receiving operator characteristic analysis. Conclusion: CAR value could be a useful parameter for evaluating disease severity, management of disease activity, and follow-up strategies.

Dermoscopic manifestations of nail diseases Sushmita Pradhan, Xin Ran, Siliang Xue, Yuping Ran Dermatologica Sinica 2020 38(4):205-216 Nail dermoscopy in recent years has become an auxiliary noninvasive tool for the diagnosis of nail diseases. It detects the differentiating characteristics of the nail units and assesses in the management of nail diseases. Dermoscopy may not be a diagnostic tool for all nail diseases; however, it is very useful for early observation with high magnification. This article discusses the important and common dermoscopic manifestations of nail disease cases in the daily practice. Currently, the indications of dermoscopy include viral, bacterial, fungal, inflammatory, pigmented, traumatic nail diseases, nail tumors, and connective tissue disease.

Clinical manifestations and neurofibromatosis type 1 gene mutations of 25 patients with neurofibromatosis type 1 from 10 Chinese pedigrees Hui Chen, Xuefei Lin, Shi Lian, Wei Zhu Dermatologica Sinica 2020 38(4):217-220 This study enrolled 25 patients with neurofibromatosis type 1 (NF1) from 10 Chinese pedigrees. Sanger sequencing analysis and multiplex ligation-dependent probe amplification analysis were used to detect mutations and large fragment losses of the NF1 gene. This study identified 10 NF1 mutations, which comprised six novel and four recurrent mutations. Majority of the mutations can lead to termination codon production, which results in the synthesis of the truncated gene product neurofibromin.

Disseminated superficial porokeratosis and disseminated superficial actinic porokeratosis: A case series of 39 patients Yu-Tung Hsueh, Tzu-Chien Hsu, Chao-Kai Hsu, Julia Yu-Yun Lee, Chao-Chun Yang Dermatologica Sinica 2020 38(4):221-224 Porokeratosis is characterized by keratotic papules or plaques with a ridge-like border. Both disseminated superficial porokeratosis (DSP) and disseminated superficial actinic porokeratosis (DSAP) manifest as numerous, small, round maculopapules with thin thread-like elevated border but differ in their distribution of lesions and the association with sunlight exposure. To analyze and compare the clinical features of DSP and DSAP, we conducted this hospital-based retrospective study. A total of 39 patients were recruited, including 19 DSP patients and 20 DSAP patients. The median age of diagnosis of DSP and DSAP patients was 63 years and 59 years, respectively. A male predominance was noted in DSP, while a female predominance was noted in DSAP. Itchiness was the most common symptom in both subtypes. Commonly used treatments included corticosteroids and retinoids, both topical and oral. Among the treatments, oral retinoid, diclofenac gel, and cryotherapy showed higher rates of improvement, but none of them yielded complete remission of the skin lesions. In conclusion, DSP and DSAP showed differences in the gender predilection, and both DSP and DSAP had prolonged clinical course and generally refractory to topical or systemic treatments.

A rare case of tumid lupus erythematosus with unilateral linear distribution in a young child Gwang Hoon Kim, Jong Heon Jeong, Jong Soo Hong, Seung Ho Lee, Ai-Young Lee Dermatologica Sinica 2020 38(4):225-227 Tumid lupus erythematosus (TLE) as a rare variant of cutaneous lupus erythematosus (CLE) is characterized by edematous, urticarial-like annular papules and plaques. TLE has similar histopathologic findings to CLE such as periadnexal lymphocytic infiltration and interstitial mucin deposition. Although TLE develops on sun-exposed areas at any age, it is rarely distributed along the Blaschko lines and develops in infancy and childhood. Unlike CLE, skin lesion of TLE heals without leaving scarring or dyspigmentation. Here, we report a rare case of unilateral linear TLE in a 4-year-old girl, which was improved by intralesional corticosteroid injection and oral antimalarial drug with leaving postinflammatory hyperpigmentation.

Vohwinkel syndrome associated with a p.Gly59Arg missense mutation in GJB2 Paul-Chen Hsieh, Chen-Chi Wu, Ni-Chung Lee, Jung-Hsien Hsieh, Yi-Hua Liao Dermatologica Sinica 2020 38(4):228-231 Vohwinkel syndrome is a rare autosomal dominant disease caused by GJB2 mutations. Patients present with sensorineural deafness, pseudoainhum, stellate keratosis on knuckles, and diffuse honeycombed palmoplantar keratoderma. We present a case of a Taiwanese patient with characteristics of Vohwinkel syndrome. A heterozygous missense mutation c.175G > C (p.Gly59Arg) was identified in the GJB2 gene, encoding the gap junction protein connexin 26. Pathogenic GJB2 mutations have been implicated in a spectrum of diseases from nonsyndromic hearing loss to syndromic hearing loss with palmoplantar keratoderma. This report expands the phenotypic spectrum of the p.Gly59Arg mutation to include Vohwinkel syndrome.

Terra firma-forme dermatosis involving the genitalia: Three pediatric case reports Hsiao-Yu Li, Hsiu-Chin Chen, Yu-Hung Wu Dermatologica Sinica 2020 38(4):232-235 Terra firma-forme dermatosis is a rare acquired keratinization disorder. Patients present with dirt-like brownish plaques on the neck, trunk, and limbs. It is often confused with dermatitis neglecta, confluent and reticulated papillomatosis, and acanthosis nigricans. Reportedly, it affects children, but genital involvement is rare. We describe three cases of uncircumcised boys with genital involvement, two of which had extragenital involvement. They all had good hygiene. Two underwent skin biopsy, and pathological examination showed papillomatosis and alternating keratinization in the stratum corneum. The disease can be diagnosed clinically by wiping off the lesions with 70% isopropyl alcohol pads, instead of water or soap.

Stevens–Johnson syndrome and toxic epidermal necrolysis related to immune checkpoint inhibitors: Two cases and literature review Ting-Jung Hsu, Kwei-Lan Liu Dermatologica Sinica 2020 38(4):236-239 Immune checkpoint inhibitor-related Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) were rarely reported. We summarized the courses and the characteristics of two cases. The first case was a 74-year-old woman receiving pembrolizumab for Stage 2 urothelial cell carcinoma of the bladder. SJS developed 27 days after the first dose of pembrolizumab. The other case was a 67-year-old woman receiving atezolizumab for Stage 4 renal urothelial cell carcinoma. TEN developed after the eighth cycle of atezolizumab. Both patients were treated with low-dose corticosteroid and supportive management. Their wounds healed without dermatologic sequelae.

Cutaneous cryptococcoma in association with CD4 lymphocytopenia: A patient with multiple sclerosis treated with fingolimod Tzu-Kun Lo, Julia Yu-Yun Lee Dermatologica Sinica 2020 38(4):240-241

Cutaneous clear cell sarcoma mimicking xanthogranuloma: A diagnostic pitfall Chung-Hao Hsu, Chi-Shun Yang, Chung-Yang Yen Dermatologica Sinica 2020 38(4):242-243

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,