To investigate whether oral microbiome diversity is associated with all-cause mortality in the general US population and in individuals with chronic diseases.
Materials and Methods
We included 8224 individuals with oral microbiome diversity data from the National Health and Nutrition Examination Survey (2009–2012), representing 164,000,205 US adults, using a survey-weighted analysis method. Cox regression analyses were performed to identify the association between oral microbiome diversity and all-cause mortality.
Results
During a survey-weighted mean follow-up period of 8.86 years, 429 all-cause deaths (survey-weighted number: 7,124,920) occurred in 8224 participants. Cox regression analysis revealed that higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk. Significant differences in all-cause mortality risk were observed among the different clusters based on oral microbiome β-diversity (log-rank p < 0.001). Subgroup analyses revealed that the oral microbiome diversity was independently associated with all-cause mortality in individuals with diabetes mellitus and hypertension. A multivariate logistic regression model showed that current smoking and antibiotic use were significantly associated with lower oral microbiome α diversity.
Conclusions
Higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk in the general US population and in individuals with diabetes mellitus and hypertension.
{"title":"Association of Oral Microbiome Diversity and All-Cause Mortality in the General US Population and in Individuals With Chronic Diseases: A Prospective Cohort Study","authors":"Zhiwen Yang, Fengling He, Haoxiang Huang, Junyang Xu, Yifei Ruan, Kai Cui, HuiLei Zhou, Yijin Chen, Dan Liu, Zhiwen Xiao, Feng Chen, Yulin Liao, Jianping Bin, Yanmei Chen","doi":"10.1111/jcpe.14056","DOIUrl":"10.1111/jcpe.14056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate whether oral microbiome diversity is associated with all-cause mortality in the general US population and in individuals with chronic diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We included 8224 individuals with oral microbiome diversity data from the National Health and Nutrition Examination Survey (2009–2012), representing 164,000,205 US adults, using a survey-weighted analysis method. Cox regression analyses were performed to identify the association between oral microbiome diversity and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a survey-weighted mean follow-up period of 8.86 years, 429 all-cause deaths (survey-weighted number: 7,124,920) occurred in 8224 participants. Cox regression analysis revealed that higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk. Significant differences in all-cause mortality risk were observed among the different clusters based on oral microbiome β-diversity (log-rank <i>p</i> < 0.001). Subgroup analyses revealed that the oral microbiome diversity was independently associated with all-cause mortality in individuals with diabetes mellitus and hypertension. A multivariate logistic regression model showed that current smoking and antibiotic use were significantly associated with lower oral microbiome α diversity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk in the general US population and in individuals with diabetes mellitus and hypertension.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caspar Victor Bumm, Falk Schwendicke, Katrin Heck, Iris Frasheri, Burkhard Summer, Christina Ern, Richard Heym, Nils Werner, Matthias Folwaczny
Objective
To investigate the association between interleukin-8 (IL-8) levels in gingival crevicular fluid (GCF) and total oral fluid (TOF) and the responsiveness to steps 1 and 2 of periodontal therapy.
Materials and Methods
One-hundred and fifty-nine patients affected by periodontitis received steps 1 and 2 of periodontal therapy. At baseline, TOF and GCF samples were collected and analysed for IL-8 (Il-8TOF/IL-8GCF) using flow cytometry. Therapy outcomes were relative proportions of residual periodontal pockets (PPD%), pocket closure (PC) rates and pocket probing depth (PPD) reductions; these were associated with IL-8TOF/IL-8GCF.
Results
High IL-8TOF was significantly associated with higher residual PPD% (p = 0.044) and lower PPD reduction compared to low IL-8TOF (high 0.79 ± 1.20 mm vs. low 1.20 ± 1.20 mm, p < 0.001) in non-smokers, while in smokers high IL-8GCF was related to lower PPD reduction (high 0.62 ± 1.22 mm vs. low 0.84 ± 1.12 mm, p = 0.009). Furthermore, high baseline IL-8TOF was significantly associated with poorer PC rates compared to medium and low concentrations in both non-smokers (high 41% vs. medium 55% vs. low 58%, p < 0.001) and smokers (high 34% vs. medium 44% vs. low 46%, p < 0.001).
Conclusion
High IL-8 concentrations at baseline had a significant impact on residual PPD%, PC rates and PPD reduction. The findings suggest that, especially in non-smokers, baseline IL-8 levels collected from the TOF could serve as a component in the estimation of responsiveness to steps 1 and 2 of periodontal therapy.
目的研究龈沟液（GCF）和总口腔液（TOF）中的白细胞介素-8（IL-8）水平与牙周治疗步骤 1 和 2 的反应性之间的关系：159名牙周炎患者接受了牙周治疗的第一步和第二步。基线时，收集 TOF 和 GCF 样本，并使用流式细胞术分析 IL-8 (Il-8TOF/IL-8GCF) 的含量。治疗结果为残留牙周袋的相对比例（PPD%）、牙周袋闭合率（PC）和牙周袋探诊深度（PPD）的减少；这些结果与IL-8TOF/IL-8GCF有关：结果：与低IL-8TOF相比，高IL-8TOF与较高的残余PPD%（p = 0.044）和较低的PPD减少率明显相关（高0.79 ± 1.20 mm vs. 低1.20 ± 1.20 mm，p GCF与较低的PPD减少率相关（高0.62 ± 1.22 mm vs. 低0.84 ± 1.12 mm，p = 0.009）。此外，与中浓度和低浓度相比，基线 IL-8TOF 高与非吸烟者较低的 PC 率显著相关（高 41% vs. 中 55% vs. 低 58%，p 结论：基线 IL-8TOF 高与非吸烟者较低的 PC 率显著相关：基线IL-8浓度高对残留PPD%、PC率和PPD减少率有显著影响。研究结果表明，特别是在非吸烟者中，从TOF中收集的基线IL-8水平可作为估计牙周治疗步骤1和步骤2反应性的一个组成部分。
{"title":"The Role of Interleukin-8 in the Estimation of Responsiveness to Steps 1 and 2 of Periodontal Therapy","authors":"Caspar Victor Bumm, Falk Schwendicke, Katrin Heck, Iris Frasheri, Burkhard Summer, Christina Ern, Richard Heym, Nils Werner, Matthias Folwaczny","doi":"10.1111/jcpe.14055","DOIUrl":"10.1111/jcpe.14055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the association between interleukin-8 (IL-8) levels in gingival crevicular fluid (GCF) and total oral fluid (TOF) and the responsiveness to steps 1 and 2 of periodontal therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>One-hundred and fifty-nine patients affected by periodontitis received steps 1 and 2 of periodontal therapy. At baseline, TOF and GCF samples were collected and analysed for IL-8 (Il-8<sub>TOF</sub>/IL-8<sub>GCF</sub>) using flow cytometry. Therapy outcomes were relative proportions of residual periodontal pockets (PPD%), pocket closure (PC) rates and pocket probing depth (PPD) reductions; these were associated with IL-8<sub>TOF</sub>/IL-8<sub>GCF</sub>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High IL-8<sub>TOF</sub> was significantly associated with higher residual PPD% (<i>p</i> = 0.044) and lower PPD reduction compared to low IL-8<sub>TOF</sub> (high 0.79 ± 1.20 mm vs. low 1.20 ± 1.20 mm, <i>p</i> < 0.001) in non-smokers, while in smokers high IL-8<sub>GCF</sub> was related to lower PPD reduction (high 0.62 ± 1.22 mm vs. low 0.84 ± 1.12 mm, <i>p</i> = 0.009). Furthermore, high baseline IL-8<sub>TOF</sub> was significantly associated with poorer PC rates compared to medium and low concentrations in both non-smokers (high 41% vs. medium 55% vs. low 58%, <i>p</i> < 0.001) and smokers (high 34% vs. medium 44% vs. low 46%, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High IL-8 concentrations at baseline had a significant impact on residual PPD%, PC rates and PPD reduction. The findings suggest that, especially in non-smokers, baseline IL-8 levels collected from the TOF could serve as a component in the estimation of responsiveness to steps 1 and 2 of periodontal therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.14055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikola Saulacic, Niklaus P. Lang, Slavko Corluka, Maria Permuy Mendaña, Fernando M. Muñoz Guzón
Aim
To assess the possibility of vertical alveolar ridge augmentation by means of activation of the periosteum.
Materials and Methods
Six adult male Beagle dogs were used for the study. All premolars and first molars were extracted, and one vertical saucer-shaped bony defect was created on each side of the mandible. After 3 months of healing, full-thickness muco-periosteal flaps were elevated, and one distraction device was placed on each side of the mandible. The distraction plate was left submerged, and the activation mechanism connected to the distraction rod was exposed intra-orally. The protocol of periosteal activation (PP: periosteal ‘pumping’) was initiated after a latency of 7 days. The alternation of activation and relaxation at the rate of 0.35 mm/12 h during 5 days was followed by the sole activation of 0.35 mm/12 h for 5 days (PP group). Devices were left inactivated on the contralateral control side of the mandible (C group). All animals were euthanized after 8 weeks of consolidation. Samples were analysed histologically and by means of micro-CT.
Results
New mature lamellar bone was formed over the pristine bone in all groups. More intensive signs of bone modelling and remodelling were observed in the PP group compared to the C group. Mean new bone, bone marrow, connective tissue and total volumetric densities were greater in the PP group (p < 0.001, p = 0.001, p = 0.003 and p < 0.001, respectively). No differences were observed in the relative area parameters. Total tissue volume and bone volume were higher in the PP group (p = 0.031 and p = 0.076, respectively), while the bone mineral densities were higher in the C group (p = 0.041 and p = 0.003, respectively). Trabecular number, trabecular thickness and trabecular separation values were similar between the two groups.
Conclusions
Regeneration of vertical alveolar bone ridge defects may be enhanced by activation of the periosteum, without the application of bone grafting materials.
{"title":"Vertical Alveolar Ridge Regeneration by Means of Periosteal Activation—A Proof-of-Principle Study","authors":"Nikola Saulacic, Niklaus P. Lang, Slavko Corluka, Maria Permuy Mendaña, Fernando M. Muñoz Guzón","doi":"10.1111/jcpe.14057","DOIUrl":"10.1111/jcpe.14057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the possibility of vertical alveolar ridge augmentation by means of activation of the periosteum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Six adult male Beagle dogs were used for the study. All premolars and first molars were extracted, and one vertical saucer-shaped bony defect was created on each side of the mandible. After 3 months of healing, full-thickness muco-periosteal flaps were elevated, and one distraction device was placed on each side of the mandible. The distraction plate was left submerged, and the activation mechanism connected to the distraction rod was exposed intra-orally. The protocol of periosteal activation (PP: periosteal ‘pumping’) was initiated after a latency of 7 days. The alternation of activation and relaxation at the rate of 0.35 mm/12 h during 5 days was followed by the sole activation of 0.35 mm/12 h for 5 days (PP group). Devices were left inactivated on the contralateral control side of the mandible (C group). All animals were euthanized after 8 weeks of consolidation. Samples were analysed histologically and by means of micro-CT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>New mature lamellar bone was formed over the pristine bone in all groups. More intensive signs of bone modelling and remodelling were observed in the PP group compared to the C group. Mean new bone, bone marrow, connective tissue and total volumetric densities were greater in the PP group (<i>p</i> < 0.001, <i>p</i> = 0.001, <i>p</i> = 0.003 and <i>p</i> < 0.001, respectively). No differences were observed in the relative area parameters. Total tissue volume and bone volume were higher in the PP group (<i>p</i> = 0.031 and <i>p</i> = 0.076, respectively), while the bone mineral densities were higher in the C group (<i>p</i> = 0.041 and <i>p</i> = 0.003, respectively). Trabecular number, trabecular thickness and trabecular separation values were similar between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Regeneration of vertical alveolar bone ridge defects may be enhanced by activation of the periosteum, without the application of bone grafting materials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.14057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Davi N. A. Silva, Sepehr Monajemzadeh, Maísa Casarin, Jaclyn Chalmers, Jacob Lubben, Clara E. Magyar, Sotirios Tetradis, Flavia Q. Pirih
Aim
To investigate the influence of diabetes mellitus (DM) in a murine model of peri-implantitis (PI).
Materials and Methods
Twenty-seven 4-week-old C57BL/6J male mice had their first and second maxillary left molars extracted. Eight weeks later, one machined implant was placed in each mouse. Four weeks after osseointegration, the mice were divided into three groups: (a) control (C), (b) PI and (c) DM + PI. DM was induced by streptozotocin (STZ) administration. After DM induction, PI was induced using ligatures for 2 weeks. The hemimaxillae were collected for micro-CT and histological analyses. The primary outcomes consisted of linear (mm) and volumetric (mm3) bone loss. Secondary outcomes were based on histological analysis and included inflammatory infiltrate, osteoclastic activity, matrix organization, composition and remodelling. Data are presented as means ± SEM. Statistical analyses were performed using one-way ANOVA, followed by Tukey's test.
Results
Gingival tissue oedema was detected in the PI and DM + PI groups. Micro-CT showed significantly increased linear and volumetric bone loss in the DM + PI group compared to the C and PI groups. H&E staining showed greater inflammatory response and bone resorption in the PI and DM + PI groups than in the C group. The DM + PI group had significantly higher osteoclast numbers than the C and PI groups. Picrosirius red stained less for types I and III collagen in the PI and DM + PI groups than in the C group. There was a significant increase in monocyte/macrophage (CD-11b) counts and matrix metalloproteinases (MMP-2 and MMP-8) marker levels and a significant decrease in the matrix metalloproteinases inhibition marker (TIMP-2) levels in the DM + PI group compared to the C and PI groups.
Conclusions
DM exacerbates PI-induced soft-tissue inflammation, matrix degradation and bone loss.
目的：研究糖尿病（DM）对小鼠种植体周围炎（PI）模型的影响：27只4周大的C57BL/6J雄性小鼠拔除了上颌左侧第一和第二臼齿。八周后，为每只小鼠植入一颗加工好的种植体。骨结合四周后，小鼠被分为三组：(a) 对照组（C）、(b) PI 组和 (c) DM + PI 组。通过注射链脲佐菌素（STZ）诱导 DM。DM 诱导后，使用结扎法诱导 PI 2 周。收集半月板进行显微 CT 和组织学分析。主要结果包括线性骨质流失（毫米）和体积骨质流失（立方毫米）。次要结果基于组织学分析，包括炎症浸润、破骨细胞活性、基质组织、成分和重塑。数据以均数 ± SEM 表示。统计分析采用单因素方差分析，然后进行 Tukey 检验：结果：PI 组和 DM + PI 组检测到牙龈组织水肿。显微 CT 显示，与 C 组和 PI 组相比，DM + PI 组的线性骨质流失和体积骨质流失明显增加。H&E 染色显示，与 C 组相比，PI 组和 DM + PI 组的炎症反应和骨吸收更为严重。DM + PI 组的破骨细胞数量明显高于 C 组和 PI 组。与 C 组相比，PI 组和 DM + PI 组的 I 型和 III 型胶原的毕赤染色较少。与C组和PI组相比，DM + PI组的单核细胞/巨噬细胞（CD-11b）计数和基质金属蛋白酶（MMP-2和MMP-8）标记物水平明显增加，基质金属蛋白酶抑制标记物（TIMP-2）水平明显下降：结论：DM会加剧PI诱导的软组织炎症、基质降解和骨质流失。
{"title":"Diabetes mellitus exacerbates inflammation in a murine model of ligature-induced peri-implantitis: A histological and microtomographic study","authors":"Davi N. A. Silva, Sepehr Monajemzadeh, Maísa Casarin, Jaclyn Chalmers, Jacob Lubben, Clara E. Magyar, Sotirios Tetradis, Flavia Q. Pirih","doi":"10.1111/jcpe.14051","DOIUrl":"10.1111/jcpe.14051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the influence of diabetes mellitus (DM) in a murine model of peri-implantitis (PI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Twenty-seven 4-week-old C57BL/6J male mice had their first and second maxillary left molars extracted. Eight weeks later, one machined implant was placed in each mouse. Four weeks after osseointegration, the mice were divided into three groups: (a) control (C), (b) PI and (c) DM + PI. DM was induced by streptozotocin (STZ) administration. After DM induction, PI was induced using ligatures for 2 weeks. The hemimaxillae were collected for micro-CT and histological analyses. The primary outcomes consisted of linear (mm) and volumetric (mm<sup>3</sup>) bone loss. Secondary outcomes were based on histological analysis and included inflammatory infiltrate, osteoclastic activity, matrix organization, composition and remodelling. Data are presented as means ± SEM. Statistical analyses were performed using one-way ANOVA, followed by Tukey's test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Gingival tissue oedema was detected in the PI and DM + PI groups. Micro-CT showed significantly increased linear and volumetric bone loss in the DM + PI group compared to the C and PI groups. H&E staining showed greater inflammatory response and bone resorption in the PI and DM + PI groups than in the C group. The DM + PI group had significantly higher osteoclast numbers than the C and PI groups. Picrosirius red stained less for types I and III collagen in the PI and DM + PI groups than in the C group. There was a significant increase in monocyte/macrophage (CD-11b) counts and matrix metalloproteinases (MMP-2 and MMP-8) marker levels and a significant decrease in the matrix metalloproteinases inhibition marker (TIMP-2) levels in the DM + PI group compared to the C and PI groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DM exacerbates PI-induced soft-tissue inflammation, matrix degradation and bone loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pasquale Santamaria, Giuseppe Troiano, Matteo Serroni, Tiago G. Araùjo, Andrea Ravidà, Luigi Nibali
Aim
The aim of this analysis was to compare a clinical periodontal prognostic system and a developed and externally validated artificial intelligence (AI)-based model for the prediction of tooth loss in periodontitis patients under supportive periodontal care (SPC) for 10 years.
Materials and Methods
Clinical and radiographic parameters were analysed to assign tooth prognosis with a tooth prognostic system (TPS) by two calibrated examiners from different clinical centres (London and Pittsburgh). The prediction model was developed on the London dataset. A logistic regression model (LR) and a neural network model (NN) were developed to analyse the data. These models were externally validated on the Pittsburgh dataset. The primary outcome was 10-year tooth loss in teeth assigned with ‘unfavourable’ prognosis.
Results
A total of 1626 teeth in 69 patients were included in the London cohort (development cohort), while 2792 teeth in 116 patients were included in the Pittsburgh cohort (external validated dataset). While the TPS in the validation cohort exhibited high specificity (99.96%), moderate positive predictive value (PPV = 50.0%) and very low sensitivity (0.85%), the AI-based model showed moderate specificity (NN = 52.26%, LR = 67.59%), high sensitivity (NN = 98.29%, LR = 91.45%), and high PPV (NN = 89.1%, LR = 88.6%).
Conclusions
AI-based models showed comparable results with the clinical prediction model, with a better performance in specific prognostic risk categories, confirming AI prediction model as a promising tool for the prediction of tooth loss.
{"title":"Exploring the accuracy of tooth loss prediction between a clinical periodontal prognostic system and a machine learning prognostic model","authors":"Pasquale Santamaria, Giuseppe Troiano, Matteo Serroni, Tiago G. Araùjo, Andrea Ravidà, Luigi Nibali","doi":"10.1111/jcpe.14023","DOIUrl":"10.1111/jcpe.14023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this analysis was to compare a clinical periodontal prognostic system and a developed and externally validated artificial intelligence (AI)-based model for the prediction of tooth loss in periodontitis patients under supportive periodontal care (SPC) for 10 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Clinical and radiographic parameters were analysed to assign tooth prognosis with a tooth prognostic system (TPS) by two calibrated examiners from different clinical centres (London and Pittsburgh). The prediction model was developed on the London dataset. A logistic regression model (LR) and a neural network model (NN) were developed to analyse the data. These models were externally validated on the Pittsburgh dataset. The primary outcome was 10-year tooth loss in teeth assigned with ‘unfavourable’ prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1626 teeth in 69 patients were included in the London cohort (development cohort), while 2792 teeth in 116 patients were included in the Pittsburgh cohort (external validated dataset). While the TPS in the validation cohort exhibited high specificity (99.96%), moderate positive predictive value (PPV = 50.0%) and very low sensitivity (0.85%), the AI-based model showed moderate specificity (NN = 52.26%, LR = 67.59%), high sensitivity (NN = 98.29%, LR = 91.45%), and high PPV (NN = 89.1%, LR = 88.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI-based models showed comparable results with the clinical prediction model, with a better performance in specific prognostic risk categories, confirming AI prediction model as a promising tool for the prediction of tooth loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.14023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pasquale Santamaria, Yi Jin, Mandeep Ghuman, Saeed Shoaie, David Spratt, Giuseppe Troiano, Luigi Nibali
Aim
To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation-involved defects.
Materials and Methods
Fifty-seven participants with periodontitis contributed with a degree II–III furcation involvement (FI), a non-furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3–V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI-clustering method was also applied.
Results
In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (p = .01) was detected in FI compared with NF; IL-6, MMP-3, MMP-8, BMP-2, SOST, EGF and TIMP-1 levels were increased in the GCF of FI compared with NF.
Conclusions
This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI-based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects.
{"title":"Microbiological and molecular profile of furcation defects in a population with untreated periodontitis","authors":"Pasquale Santamaria, Yi Jin, Mandeep Ghuman, Saeed Shoaie, David Spratt, Giuseppe Troiano, Luigi Nibali","doi":"10.1111/jcpe.14034","DOIUrl":"10.1111/jcpe.14034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation-involved defects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Fifty-seven participants with periodontitis contributed with a degree II–III furcation involvement (FI), a non-furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3–V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI-clustering method was also applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (<i>p</i> = .01) was detected in FI compared with NF; IL-6, MMP-3, MMP-8, BMP-2, SOST, EGF and TIMP-1 levels were increased in the GCF of FI compared with NF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI-based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.14034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Flavia R F Teles, Ganesh Chandrasekaran, Lynn Martin, Michele Patel, Michael J Kallan, Camila Furquim, Tahir Hamza, Andrew J Cucchiara, Alpdogan Kantarci, Olivia Urquhart, James Sugai, William V Giannobile
Aim: To identify serum- and salivary-derived inflammatory biomarkers of periodontitis progression and determine their response to non-surgical treatment.
Materials and methods: Periodontally healthy (H; n = 113) and periodontitis patients (P; n = 302) were monitored bi-monthly for 1 year without therapy. Periodontitis patients were re-examined 6 months after non-surgical periodontal therapy (NSPT). Participants were classified according to disease progression: P0 (no sites progressed; P1: 1-2 sites progressed; P2: 3 or more sites progressed). Ten salivary and five serum biomarkers were measured using Luminex. Log-transformed levels were compared over time according to baseline diagnosis, progression trajectory and after NSPT. Significant differences were sought using linear mixed models.
Results: P2 presented higher levels (p < .05) of salivary IFNγ, IL-6, VEGF, IL-1β, MMP-8, IL-10 and OPG over time. Serum analytes were not associated with progression. NSPT led to clinical improvement and significant reduction of IFNγ, IL-6, IL-8, IL-1β, MMP-8, IL-10, OPG and MMP-9 in saliva and of CRP, MMP-8, MMP-9 and MPO in serum.
Conclusions: Periodontitis progression results from a sustained pro-inflammatory milieu that is reflected in salivary biomarkers, but less so in serum, likely because of the limited amount of progression per patient. NSPT can significantly decrease the levels of several salivary analytes.
{"title":"Salivary and serum inflammatory biomarkers during periodontitis progression and after treatment.","authors":"Flavia R F Teles, Ganesh Chandrasekaran, Lynn Martin, Michele Patel, Michael J Kallan, Camila Furquim, Tahir Hamza, Andrew J Cucchiara, Alpdogan Kantarci, Olivia Urquhart, James Sugai, William V Giannobile","doi":"10.1111/jcpe.14048","DOIUrl":"10.1111/jcpe.14048","url":null,"abstract":"<p><strong>Aim: </strong>To identify serum- and salivary-derived inflammatory biomarkers of periodontitis progression and determine their response to non-surgical treatment.</p><p><strong>Materials and methods: </strong>Periodontally healthy (H; n = 113) and periodontitis patients (P; n = 302) were monitored bi-monthly for 1 year without therapy. Periodontitis patients were re-examined 6 months after non-surgical periodontal therapy (NSPT). Participants were classified according to disease progression: P0 (no sites progressed; P1: 1-2 sites progressed; P2: 3 or more sites progressed). Ten salivary and five serum biomarkers were measured using Luminex. Log-transformed levels were compared over time according to baseline diagnosis, progression trajectory and after NSPT. Significant differences were sought using linear mixed models.</p><p><strong>Results: </strong>P2 presented higher levels (p < .05) of salivary IFNγ, IL-6, VEGF, IL-1β, MMP-8, IL-10 and OPG over time. Serum analytes were not associated with progression. NSPT led to clinical improvement and significant reduction of IFNγ, IL-6, IL-8, IL-1β, MMP-8, IL-10, OPG and MMP-9 in saliva and of CRP, MMP-8, MMP-9 and MPO in serum.</p><p><strong>Conclusions: </strong>Periodontitis progression results from a sustained pro-inflammatory milieu that is reflected in salivary biomarkers, but less so in serum, likely because of the limited amount of progression per patient. NSPT can significantly decrease the levels of several salivary analytes.</p>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Moshe Goldstein, Nikolaos Donos, Wim Teughels, Nikolaos Gkranias, Andy Temmerman, Jan Derks, Bahar Eren Kuru, Maria Clotilde Carra, Ana Belen Castro, Xanthippi Dereka, Christel Dekeyser, David Herrera, Katleen Vandamme, Elena Calciolari
Aim: To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs).
Methods: Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates.
Results: Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment.
Conclusion: An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.
{"title":"Structure, governance and delivery of specialist training programs in periodontology and implant dentistry.","authors":"Moshe Goldstein, Nikolaos Donos, Wim Teughels, Nikolaos Gkranias, Andy Temmerman, Jan Derks, Bahar Eren Kuru, Maria Clotilde Carra, Ana Belen Castro, Xanthippi Dereka, Christel Dekeyser, David Herrera, Katleen Vandamme, Elena Calciolari","doi":"10.1111/jcpe.14033","DOIUrl":"https://doi.org/10.1111/jcpe.14033","url":null,"abstract":"<p><strong>Aim: </strong>To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs).</p><p><strong>Methods: </strong>Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates.</p><p><strong>Results: </strong>Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment.</p><p><strong>Conclusion: </strong>An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.</p>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Thiemann, M. Katzschner, G. Hanna, A. B. Kruse, K. Vach, P. Ratka-Krüger, J. P. Woelber
Aim
Oral hygiene-related self-efficacy (OHSE) describes one's confidence to successfully execute oral hygiene behaviour. The aim of this study was to investigate the long-term course of OHSE in patients during initial periodontal therapy (IPT) and supportive periodontal therapy (SPT) and its association with clinical parameters.
Materials and Methods
Patients diagnosed with periodontitis, undergoing either IPT or SPT, were evaluated at two timepoints. Clinical examination included pocket probing depths (PPDs), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI) and gingival index (GI). Patients' OHSE was assessed with a questionnaire. Statistical analyses included t-tests and linear regression models.
Results
Ninety-eight patients from an initial group of 201 patients were evaluated after 4 years. The overall OHSE score increased significantly in the IPT group (mean 11.65 ± 15.6, p = .001). The increase in the OHSE category ‘interdental cleaning’ was significantly correlated with a decrease in the number of pockets requiring treatment (Spearman correlation rs = −.2349, p = .022) and periodontal inflamed surface area (PISA) (rs = −.2099, p = .042).
Conclusions
Patients under IPT showed a significant increase of OHSE compared to those under SPT. Improved OHSE, particularly in interdental cleaning, appears to be associated with sustained success of periodontal therapy.
{"title":"Oral-hygiene-related self-efficacy in periodontal therapy: A 4-year longitudinal study","authors":"L. Thiemann, M. Katzschner, G. Hanna, A. B. Kruse, K. Vach, P. Ratka-Krüger, J. P. Woelber","doi":"10.1111/jcpe.14043","DOIUrl":"10.1111/jcpe.14043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Oral hygiene-related self-efficacy (OHSE) describes one's confidence to successfully execute oral hygiene behaviour. The aim of this study was to investigate the long-term course of OHSE in patients during initial periodontal therapy (IPT) and supportive periodontal therapy (SPT) and its association with clinical parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Patients diagnosed with periodontitis, undergoing either IPT or SPT, were evaluated at two timepoints. Clinical examination included pocket probing depths (PPDs), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI) and gingival index (GI). Patients' OHSE was assessed with a questionnaire. Statistical analyses included <i>t</i>-tests and linear regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-eight patients from an initial group of 201 patients were evaluated after 4 years. The overall OHSE score increased significantly in the IPT group (mean 11.65 ± 15.6, <i>p</i> = .001). The increase in the OHSE category ‘interdental cleaning’ was significantly correlated with a decrease in the number of pockets requiring treatment (Spearman correlation <i>r</i><sub><i>s</i></sub> = −.2349, <i>p</i> = .022) and periodontal inflamed surface area (PISA) (<i>r</i><sub><i>s</i></sub> = −.2099, <i>p</i> = .042).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients under IPT showed a significant increase of OHSE compared to those under SPT. Improved OHSE, particularly in interdental cleaning, appears to be associated with sustained success of periodontal therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpe.14043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haoyun Zhang, Tao Xu, Yiping Wei, Ning Wei, Ziyao Han, Wenjie Hu
Aim
This study aimed to assess hard and soft tissue contour changes following micro crestal flap-alveolar ridge preservation (MCF-ARP) and natural healing (NH) in periodontally compromised molar extraction sites and to analyse the feasibility and need for bone augmentation during implant therapy.
Materials and Methods
Fifty-six patients with 70 sites were randomized into two groups at the site level (35 sites from 31 patients in the test group and 35 sites from 29 patients in the control group). Among whom, four patients contributed one tooth to the control group and one tooth to the test group. Hard tissue indicators were measured using cone beam computed tomography performed before tooth extraction and 6 months after surgery. Soft tissue contour changes were assessed using intraoral scanning performed before and immediately after surgery and also 2 weeks and 1, 3 and 6 months after surgery.
Results
Six months after surgery, the MCF-ARP group showed less resorption in buccal bone height (p = .032) and greater augmentation in central bone height (p = .001) and ridge width (p = .009). The mean, vertical and horizontal collapse of buccal soft tissue contour in the MCF-ARP group were 0.95 mm (p = .010), 0.61 mm (p = .019) and 0.56 mm (p = .013) less than that in the NH group, respectively. There were significantly (p = .007) fewer sites in the MCF-ARP group than in the NH group (0% vs. 26.7%) for staged bone augmentation and more sites that could be treated with simple implant procedure in the MCF-ARP group than in the NH group (71.9% vs. 56.6%).
Conclusions
Compared with NH, MCF-ARP reduced bone resorption in periodontally compromised molar extraction sites and maintained the buccal soft tissue contour. MCF-ARP reduces the need for complex bone augmentation procedures in implant therapy. Trial registration: Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on 4 February 2022, Version 1.0.
{"title":"Assessment of soft and hard tissue changes following micro crestal flap—Alveolar ridge preservation and augmentation at molar extraction sites in patients with stage III/IV periodontitis: A randomized controlled trial","authors":"Haoyun Zhang, Tao Xu, Yiping Wei, Ning Wei, Ziyao Han, Wenjie Hu","doi":"10.1111/jcpe.14045","DOIUrl":"10.1111/jcpe.14045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to assess hard and soft tissue contour changes following micro crestal flap-alveolar ridge preservation (MCF-ARP) and natural healing (NH) in periodontally compromised molar extraction sites and to analyse the feasibility and need for bone augmentation during implant therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Fifty-six patients with 70 sites were randomized into two groups at the site level (35 sites from 31 patients in the test group and 35 sites from 29 patients in the control group). Among whom, four patients contributed one tooth to the control group and one tooth to the test group. Hard tissue indicators were measured using cone beam computed tomography performed before tooth extraction and 6 months after surgery. Soft tissue contour changes were assessed using intraoral scanning performed before and immediately after surgery and also 2 weeks and 1, 3 and 6 months after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six months after surgery, the MCF-ARP group showed less resorption in buccal bone height (<i>p</i> = .032) and greater augmentation in central bone height (<i>p</i> = .001) and ridge width (<i>p</i> = .009). The mean, vertical and horizontal collapse of buccal soft tissue contour in the MCF-ARP group were 0.95 mm (<i>p</i> = .010), 0.61 mm (<i>p</i> = .019) and 0.56 mm (<i>p</i> = .013) less than that in the NH group, respectively. There were significantly (<i>p</i> = .007) fewer sites in the MCF-ARP group than in the NH group (0% vs. 26.7%) for staged bone augmentation and more sites that could be treated with simple implant procedure in the MCF-ARP group than in the NH group (71.9% vs. 56.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared with NH, MCF-ARP reduced bone resorption in periodontally compromised molar extraction sites and maintained the buccal soft tissue contour. MCF-ARP reduces the need for complex bone augmentation procedures in implant therapy. <i>Trial registration</i>: Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on 4 February 2022, Version 1.0.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15380,"journal":{"name":"Journal of Clinical Periodontology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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