Publications by authors named "Philippe Bouchard"

156 Publications

Esophageal cancer after sleeve gastrectomy: a population-based comparative cohort study.

Surg Obes Relat Dis 2021 May 29;17(5):879-887. Epub 2020 Dec 29.

Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada.

Background: Sleeve gastrectomy (SG) is the most common bariatric surgery; however, this approach may induce gastroesophageal reflux disease (GERD). Both obesity and GERD are independent risk factors for esophageal cancer, however the impact of SG on risk of esophageal cancer remains unknown.

Objective: To evaluate the risk of esophageal cancer after reflux-prone bariatric surgery.

Setting: Population-level, provincial administrative healthcare database, Quebec, Canada.

Methods: We identified a population-based cohort of all patients with obesity who underwent reflux-prone surgery (SG and duodenal switch [DS]) or reflux-protective Roux-en-Y gastric bypass (RYGB) during 01/2006-12/2012 in Quebec, Canada. For every surgical patient, 2-3 nonsurgical controls with obesity matched for age, sex, and geography were also identified. Crude incidence rate ratios (IRRs) for esophageal cancer were calculated using person-time analysis. Hazard ratios (HRs) were obtained using multivariate cox regression.

Results: A total of 4121 patients had reflux-prone procedures and 852 underwent RYGB. At a mean follow-up of 7.6 years, 8 cases of esophageal cancer were identified after bariatric surgery. Compared with RYGB, IRR for esophageal cancer in reflux-prone group was 1.45 (95%CI: .19-65.5) and HR = .83 (95%CI: .10-7.27). The crude incidence rate of esophageal cancer in the reflux-prone group was higher than that of nonsurgical controls (n = 12,159; IRR = 3.46, 95%CI: 1.00-12.5), but after adjustment the difference disappeared (HR = 2.47, 95%CI: .82-7.45).

Conclusions: Long-term incidence of esophageal cancer after reflux-prone bariatric surgery is not greater than RYGB. While crude incidence of esophageal cancer after reflux-prone surgery is higher than in nonsurgical patients with obesity, such difference disappears after accounting for confounders. Given the low incidence of esophageal cancer and slow progression of dysplastic Barrett esophagus, studies with longer follow-up are needed.
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http://dx.doi.org/10.1016/j.soard.2020.12.011DOI Listing
May 2021

Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center.

Acta Chir Belg 2021 Jan 28:1-10. Epub 2021 Jan 28.

Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada.

Background: End-stage renal disease (ESRD) and renal replacement therapy (RRT) are important risk factors for post-operative morbidity and mortality but remains poorly reported in colorectal surgery. This study aims to evaluate postoperative outcomes of ESRD patients under RRT undergoing colorectal resection.

Methods: All ESRD patients under RRT who underwent colorectal resection between 2006 and 2019 were retrospectively reviewed. Perioperative outcomes were analysed, such as risk factors of postoperative complications.

Results: Forty-two patients were analysed, including 27 emergency and 15 elective surgeries. The most frequent indication was acute colonic ischemia for emergency and malignancy for elective procedures. Laparoscopic approach was used in 12 patients (29%), without difference between elective and emergency groups. Postoperative severe complications rate (including deaths) was 50% (21/42), including 56% (15/27) and 40% (6/15) in emergency and elective groups, respectively ( = .334). Anastomotic leak was observed in 3 of the 23 patients (13%) undergoing digestive anastomosis, (1 in emergency and 2 in elective groups,  = .246). The postoperative mortality rate was 29%, not significantly different between groups. The median hospital stay was 14.5 days (8-42). At univariate analysis, history of cardiac event ( = .028) and open approach ( = .040) were associated with severe complications, and ASA score >3 ( = .043), history of cardiac event ( = .001) and diabetes ( = .030) associated with mortality.

Conclusions: Colorectal surgery in ESRD patient exposes to high risk of morbidity and mortality, even in the elective setting, especially in patients with comorbidities like cardiac event and diabetes. Careful patient selection and closed management is required in such fragile patients.
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http://dx.doi.org/10.1080/00015458.2020.1871290DOI Listing
January 2021

Association between periodontitis and pulse wave velocity: a systematic review and meta-analysis.

Clin Oral Investig 2021 Feb 7;25(2):393-405. Epub 2021 Jan 7.

Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - UFR Odontologie-Garancière, University of Paris, 5, rue Garancière, 75006, Paris, France.

Objectives: Severe periodontitis has been associated with endothelial dysfunction and arterial stiffness. The present study aimed to provide a critical appraisal and a meta-analysis of the literature investigating pulse wave velocity (PWV) in patients with and without severe periodontitis and to assess whether treatments influence PWV.

Materials And Methods: English literature was searched on multiple databases up to April 2020 by two independent reviewers. Studies comparing PWV between patients with and without severe periodontitis or assessing the impact of periodontal treatments on PWV were searched and retrieved. Pool data analyses with random effect models were performed. The risk of bias was assessed using Newcastle-Ottawa Scale and RoB2 tools.

Results: Seventeen studies were selected. Of these, 10 were used for the meta-analysis. Twelve were cross-sectional studies and 5 interventional studies, including 3176 patients, of whom 1894 had severe periodontitis and 1282 were considered as the controls (without severe periodontitis). Based on carotid-femoral PWV measurement, patients with severe periodontitis (n = 309) have a significantly higher PVW than patients with non-severe periodontitis (n = 213), with a mean difference of 0.84 m/s (95% CI 0.50-1.18; p < 0.0001; I = 5%). Similarly, carotid-radial or brachial-ankle PWV values were significantly higher in patients with severe periodontitis. Results concerning the effect of non-surgical periodontal therapy were not conclusive. Overall, 9 studies (53%) were classified at a low risk of bias.

Conclusions: The present study demonstrates that patients with severe periodontitis have higher PWV compared to patients with non-severe periodontitis.

Clinical Significance: Severe periodontitis is associated with arterial stiffness, supporting the mutual involvement of dentists and physicians.
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http://dx.doi.org/10.1007/s00784-020-03718-2DOI Listing
February 2021

Oral microbiota and atherothrombotic carotid plaque vulnerability in periodontitis patients. A cross-sectional study.

J Periodontal Res 2021 Apr 25;56(2):339-350. Epub 2020 Dec 25.

Department of Periodontology, Faculty of Odontology Garancière, Université de Paris, Paris, France.

Background: An increased risk of atherothrombotic vascular events has been reported in periodontitis patients. Periodontitis is associated with dysbiotic subgingival biofilms and bacteremia.

Objective: We hypothesized (a) that the oral microbiome is associated with the carotid microbiome and (b) that periodontitis could contribute to plaque vulnerability. The aim of this study was to determine the associations between periodontitis, the carotid microbiome, and the local innate immune response in carotid atherothrombotic plaques vulnerable to rupture.

Methods: In this cross-sectional study, 45 patients admitted for carotid endarterectomy underwent a preoperative periodontal examination. The volume of intraplaque hemorrhage reflected by the hemoglobin level released in carotid-conditioned media was considered as a criterion of carotid plaque vulnerability. Levels of antibodies against periodontal bacteria were determined in sera. The signature of the oral microbiota was assessed by microbial whole-genome sequencing, nested PCR, and immunostaining in carotid plaque samples. Markers of neutrophil recruitment (leukotriene B4), neutrophil activation (myeloperoxidase, defensins), and cytokines were measured in carotid-conditioned media and/or plasma.

Results: All patients exhibited periodontitis. One hundred and forty-four bacterial genera were detected in the carotid microbiome. While Streptococcus was found in 84% of the carotid samples, periodontitis-associated genera were detected in 21%. P. gingivalis DNA and gingipains were also identified in carotid samples. There were significant inverse correlations between periodontal attachment loss/serum anti-P. gingivalis Immunoglobulin A and cytokine inhibiting neutrophils (all P < .01). There were also significant positive correlations between lipopolysaccharides, myeloperoxidase/human neutrophil peptides1-3, and hemoglobin levels (all P < .01).

Conclusions: In patients at risk of stroke, the carotid plaque microbiome was highly diverse and compatible with an oral origin. Periodontitis was significantly associated with neutrophil activation markers and plaque vulnerability to rupture.
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http://dx.doi.org/10.1111/jre.12826DOI Listing
April 2021

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): short-term outcomes from a prospective cohort study.

Surg Obes Relat Dis 2021 Feb 14;17(2):414-424. Epub 2020 Sep 14.

Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada.

Background: Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of the classic duodenal switch (DS). These modifications are intended to address concerns about DS, including malnutrition, longer operative times, and technical challenges, while preserving the benefits.

Objectives: To evaluate safety and outcomes of SADI-S as it compares to classic DS procedure.

Setting: Bariatric Surgery Center of Excellence, University Hospital, Montreal, Canada.

Methods: In a single-institution prospective cohort study, we compared safety and outcomes of the SADI-S versus DS procedures (ClinicalTrials.gov: NCT02792166; registered: 06/2016). Data is depicted as count (percentage) or median (interquartile range).

Results: There were 42 patients who underwent SADI-S, of whom 11 had it as a second-stage procedure (26%). There were 20 patients who underwent DS, of whom 12 had it as second-stage procedures (60%). Both groups were similar at baseline. The median age was 45 (14) years, 39 (63%) were female, the median body mass index (BMI) was 48.2 (7.7) kg/m, and 29 (47%) patients had diabetes. The operative time was shorter for 1-stage SADI-S versus DS surgery (211 [70] versus 250 [60] min, respectively; P = .05) but was similar for second-stage procedures (P = .06). The 90-day complication rates were 11.9% (N = 5/42) after SADI-S and 5.0% (N = 1/20) after DS surgery (P = .64). There were no mortalities. Median follow-ups for 1-stage SADI-S and DS were 17 (11) and 12 (24) months, respectively (P = .65). Similar BMI changes were observed after 1-stage SADI-S (17.9 kg/m [8.7]) and DS (17.5 kg/m [16]; P = .65). At median follow-ups of 10 (20) and 14 (16) months after second-stage SADI-S and DS, respectively (P = .53), surgical procedures yielded added 5.0 kg/m (5.8) and 6.5 kg/m (7.1) changes in BMI, respectively (P = .26). Complete remission rates for diabetes were 91% after SADI-S (n = 21/23) and 50% after DS (n = 3/6). Compared with the SADI-S procedure, DS surgery was associated with higher frequencies of deficiencies in some fat-soluble vitamins, especially vitamin D.

Conclusions: The SADI-S procedure is safe, and its short-term outcomes, including weight loss and the resolution of co-morbidities, are similar to those of DS. SADI-S surgery also has promising potential as a second-stage procedure after sleeve gastrectomy.
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http://dx.doi.org/10.1016/j.soard.2020.09.015DOI Listing
February 2021

Alcoholic beverage consumption, smoking habits, and periodontitis: A cross-sectional investigation of the NutriNet-Santé study.

J Periodontol 2020 Sep 8. Epub 2020 Sep 8.

Department of Periodontology, U.F.R. of Odontology, Garanciere, Université de Paris, Paris, France.

Background: Recent evidence suggests that dietary habits influence the development and severity of periodontitis. The present cross-sectional study evaluated the association between different types and quantity of alcoholic beverage consumption (alone and interacting with smoking) and the probability to suffer from severe periodontitis in the French e-cohort NutriNet-Santé.

Methods: The study population consisted of 35,390 adults (mean age: 49.04 ± 13.94 years), who filled oral health questionnaires and completed at least three non-consecutive 24-hour dietary records. Data on type and frequency of alcoholic beverage consumption were obtained from a semi-quantitative self-reported alcohol frequency questionnaire; the daily quantity (g/day) was estimated from the 24-hour dietary records. The probability of severe periodontitis (main dependent variable) was assessed by calculating the modified periodontal screening score (mPESS) from selected questions.

Results: A total of 7263 individuals (20.5%) presented a high probability of suffering from severe periodontitis (high-mPESS). After adjusting for confounding factors, the frequency of alcoholic beverage consumption was significantly higher among high-mPESS group than their low-mPESS counterparts, especially for hard liquor/spirits (1.9 ± 1.4 days/week for high-PESS versus 1.6 ± 1.1 days/week the low-PESS [P < 0.0001]). The mean daily quantity of ethanol was also higher in high-mPESS versus low-mPESS individuals (11.2 ± 15.6 versus 7.9 ± 12.3 g/day; P = 0.011). A stronger association with self-report severe periodontitis was noted when alcohol consumption exceeding > 20 g/day for women and > 30 g/day for men was combined with smoking habit (OR = 7.30 [95% CI: 6.1-8.73]).

Conclusion: The present results support an association between alcoholic beverage consumption and self-report severe periodontitis, particularly when it is associated with current smoking.
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http://dx.doi.org/10.1002/JPER.20-0192DOI Listing
September 2020

Short-term outcomes of revisional surgery after sleeve gastrectomy: a comparative analysis of re-sleeve, Roux en-Y gastric bypass, duodenal switch (Roux en-Y and single-anastomosis).

Surg Endosc 2020 Aug 11. Epub 2020 Aug 11.

Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.

Background: Sleeve gastrectomy (SG) is the most common primary bariatric surgery. Long-term, up to 20% of patients may need revisional surgery. We aimed to evaluate the short-term outcomes of various revisional bariatric surgeries after a failed primary SG.

Methods: This is a single-center retrospective study of a prospectively collected database of obese patients who underwent revisional bariatric surgery during 2010-2018 for a failed previous SG. Failure was defined as inadequate weight loss (< 50% excess weight loss), ≥ 20% weight regain of the weight lost, and presence of refractory non-reflux obesity-related comorbidities ≥ 1 year after SG. Revisions included were re-sleeve, Roux en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD/DS), and single-anastomosis duodenal switch (SADS). The primary outcome was weight loss after revision. Secondary outcomes included postoperative complications. Due to varying follow-up rates, short-term outcomes (≥ 6 and ≤ 18 months) were assessed. Descriptive statistics are expressed as count(percentage) or median(interquartile range).

Results: Ninety-four patients met inclusion criteria. Forty-one underwent conversion to RYGB, 33 had BPD/DS, 7 had SADS, and 13 underwent re-sleeve surgery. Median interval between SG and revision was 31(27) months. At a median of 14(18) months, follow-up rate was 76% for the study cohort. Prior to revision, median BMI was 41.9(11.7) kg/m and 1 year after decreased by 6.3(5.1) kg/m. BPD/DS resulted in the largest total weight loss of 21.8(10.9) kg followed by RYGB 13.2(11.3), SADS 12.2(6.1), and re-sleeve 12.0(11.9) kg; p = 0.023. Major 90-day and long-term complications occurred only after RYGB and BPD/DS and were similar (7.3% vs. 3.0%; p = 0.769 and 9.8% vs. 24.2%; p = 0.173, respectively).

Conclusions: At 1 year, revisional procedures offer further weight loss after a failed primary SG. Bypass-type revisions are preferred over re-sleeve surgery. In the absence of refractory reflux symptoms, duodenal switch-type procedures are safe and effective options especially in patients with severe obesity before SG.
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http://dx.doi.org/10.1007/s00464-020-07891-zDOI Listing
August 2020

Vascular consequences of inflammation: a position statement from the ESH Working Group on Vascular Structure and Function and the ARTERY Society.

J Hypertens 2020 09;38(9):1682-1698

Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité.

: Inflammation is a physiological response to aggression of pathogenic agents aimed at eliminating the aggressor agent and promoting healing. Excessive inflammation, however, may contribute to tissue damage and an alteration of arterial structure and function. Increased arterial stiffness is a well recognized cardiovascular risk factor independent of blood pressure levels and an intermediate endpoint for cardiovascular events. In the present review, we discuss immune-mediated mechanisms by which inflammation can influence arterial physiology and lead to vascular dysfunction such as atherosclerosis and arterial stiffening. We also show that acute inflammation predisposes the vasculature to arterial dysfunction and stiffening, and alteration of endothelial function and that chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease and psoriasis are accompanied by profound arterial dysfunction which is proportional to the severity of inflammation. Current findings suggest that treatment of inflammation by targeted drugs leads to regression of arterial dysfunction. There is hope that these treatments will improve outcomes for patients.
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http://dx.doi.org/10.1097/HJH.0000000000002508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610698PMC
September 2020

Oral Care and Quality Evaluation: A Multicentric Study on Periodontal Treatment.

Oral Health Prev Dent 2020 Apr 1;18(1):363-371. Epub 2020 Apr 1.

Purpose: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it.

Materials And Methods: 306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model.

Results: Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04).

Conclusions: Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment.
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http://dx.doi.org/10.3290/j.ohpd.a44444DOI Listing
April 2020

Image distortion of intra-oral photographs: The root coverage model.

J Clin Periodontol 2020 07 5;47(7):875-882. Epub 2020 May 5.

Department of Periodontology, U.F.R. of Odontology, Université de Paris, Paris, France.

Aim: Clinical photographs have been advocated in studies dealing with the quantity of root coverage. Changes in different angles of the camera when taking a photograph may lead to parallax errors resulting in inaccurate measurements. The aim of this study was to explore the distortion of the photographs according to the shooting angle.

Methods: A dental simulation model with a recession defect on tooth 21 was used. Photographs were taken with a digital camera at 5° intervals between 0° to 35°, by shifting the position of the model. Recession depth and root surface area were calculated with ImageJ and implemented in a mathematical model. The relationship between the experimental measurements and the outcomes of the mathematical model was statistically evaluated. The model was confirmed by clinical data.

Results: When the central axis of the lens of the camera focused on the experimental tooth is within a cone angle ≤36°, the maximum distortion of the recession area ranges from 0% to 14%, the maximum percentage occurring when the angle is coronal to the central axis.

Conclusions: Photographs without an external device connected to the camera provide a valuable support for root coverage assessment when using ImageJ as a measuring tool.
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http://dx.doi.org/10.1111/jcpe.13294DOI Listing
July 2020

[Levothyrox crisis].

Rev Prat 2019 Sep;69(7):721-728

Médecin, député honoraire, ancien membre du conseil d'administration de l'ANSM.

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September 2019

In Memoriam: C. Wayne Bardin, MD (1934 - 2019).

Andrology 2020 Mar;8(2):264-265

University Pierre et Marie Curie, Paris, France.

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http://dx.doi.org/10.1111/andr.12738DOI Listing
March 2020

Surgeon and hospital volume outcomes in bariatric surgery: a population-level study.

Surg Obes Relat Dis 2020 May 23;16(5):674-681. Epub 2020 Jan 23.

Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada. Electronic address:

Background: Outcomes after bariatric surgery are tied to surgical volume; however, this relationship is not clearly established for each procedure.

Objectives: To evaluate the impact of surgeon/hospital volumes on morbidity after bariatric surgery and identify volume cutoffs.

Setting: Multi-centric population-level study, province of Quebec, Canada.

Methods: We studied a population-based cohort of all morbidly obese patients who underwent bariatric surgery in Quebec, Canada during 2006 to 2012. We evaluated only the most common procedures in North America, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Multilevel, cross-classified logistic regressions were used to test the effects of annual surgeon volume (SV) and hospital volume (HV) on a composite 90-day postoperative outcome. Receiver operator curve was used to identify volume thresholds.

Results: Overall, 821 patients had RYGB and 1802 underwent SG by 34 surgeons in 15 centers. For RYGB, 10-case increase in SV was associated with adjusted odds ratio of .82 (95% confidence interval: .71-.94). Similar increase in HV resulted in odds ratio of .86 (95% confidence interval: .77-.96). Annual SV threshold of 21 RYGBs and HV of 25 cases were identified (area under the curve = .60 and .61, respectively). For SV, being in the higher volume category translated into an absolute risk reduction of 12.5% for 90-day major morbidity. For SG, annual 10-case increase in SV and HV was not significantly associated with a decrease in 90-day postoperative morbidity.

Conclusion: SV and HV are significant independent predictors of 90-day major morbidity after RYGB. This study further supports establishing minimum surgical volume requirements for more complex anastomotic procedures like RYGB. However, the role of volume targets in SG remains unclear.
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http://dx.doi.org/10.1016/j.soard.2020.01.012DOI Listing
May 2020

Periodontitis and cardiovascular diseases: Consensus report.

J Clin Periodontol 2020 03 3;47(3):268-288. Epub 2020 Feb 3.

Department of Prosthetic Dentistry, School of Dental Medicine, Karl-Franzens University Graz, Graz, Austria.

Background: In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause of these CVD related deaths. Periodontitis is also a chronic non-communicable disease (NCD) with a high prevalence, being severe periodontitis, affecting 11.2% of the world's population, the sixth most common human disease.

Material And Methods: There is now a significant body of evidence to support independent associations between severe periodontitis and several NCDs, in particular CVD. In 2012 a joint workshop was held between the European Federation of Periodontology (EFP) and the American Academy of Periodontology to review the literature relating periodontitis and systemic diseases, including CVD. In the last five years important new scientific information has emerged providing important emerging evidence to support these associations RESULTS AND CONCLUSIONS: The present review reports the proceedings of the workshop jointly organised by the EFP and the World Heart Federation (WHF), which has updated the existing epidemiological evidence for significant associations between periodontitis and CVD, the mechanistic links and the impact of periodontal therapy on cardiovascular and surrogate outcomes. This review has also focused on the potential risk and complications of periodontal therapy in patients on anti thrombotic therapy and has made recommendations for dentists, physicians and for patients visiting both the dental and medical practices.
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http://dx.doi.org/10.1111/jcpe.13189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027895PMC
March 2020

Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: A systematic review.

J Clin Periodontol 2020 07;47 Suppl 22:72-89

Department of Periodontology, U.F.R. of Odontology, Université de Paris, Paris, France.

Aim: This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases.

Methods: A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups.

Results: Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes.

Conclusions: Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time.
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http://dx.doi.org/10.1111/jcpe.13234DOI Listing
July 2020

Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: A systematic review.

J Clin Periodontol 2020 07;47 Suppl 22:90-106

Service of Odontology, Department of Periodontology, Rothschild Hospital, AP-HP, Université de Paris, U.F.R. of Odontology, Paris, France.

Aim: The aim of this systematic review was to identify the most recent widely accepted guidelines for risk factor control interventions and to assess their impact in patients with periodontitis.

Materials And Methods: The electronic search strategy included a first systematic search to identify guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar) reduction and weight loss in the general population and a second systematic search to identify the studies evaluating these interventions in periodontitis patients.

Results: A total of 13 guidelines and 25 studies were selected. Most guidelines included recommendations for all healthcare providers to provide interventions and follow-up counselling with the risk factors considered in the present review. In patients with periodontitis, interventions for smoking cessation and diabetes control were shown to improve periodontal health while the impact of dietary interventions and the promotion of other healthy lifestyles were moderate or limited.

Conclusions: While aiming to improve treatment outcomes and the maintenance of periodontal health, current evidence suggests that interventions for smoking cessation and diabetes control are effective, thus emphasizing the need of behavioural support in periodontal care.
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http://dx.doi.org/10.1111/jcpe.13240DOI Listing
July 2020

Shared detection of in cohabiting family members: a systematic review and meta-analysis.

J Oral Microbiol 2020 7;12(1):1687398. Epub 2019 Nov 7.

Department of Periodontology, Service of Odontology, Rothschild Hospital, Paris, France.

: Periodontitis is an inflammatory dysbiotic disease. Among putative dysbiosis causes, transmission of between individuals of the same family remains unclear. The aim of this systematic review and meta-analysis is to assess the likelihood of shared detection of among cohabiting family members. : A literature search was conducted on different databases up to September 2018. Articles assessing the presence of between members of the same family were screened. Only English literature was retrieved, whereas no limits were applied for bacterial sampling and detection methods. : Overall, 26 articles published between 1993 and 2017 met the inclusion criteria. Of these, 18 articles were used for meta-analyses. Based on bacterial culture, the likelihood of an intra-familial transmission of once a member of the family harbors the bacterium is estimated at 63.5% (n = 132 pairs of family members); this drops to 45% when pooling together culture and Polymerase-Chain-Reaction (n = 481 pairs), whereas it is estimated at 35.7% when genotyping is applied (n = 137 pairs). : Pooled results suggest that the likelihood of detecting within within family members is moderately frequent. Personalized periodontal screening and prevention may consider intra-familial co-occurrence of as feasible.
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http://dx.doi.org/10.1080/20002297.2019.1687398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844440PMC
November 2019

High serum ferritin levels are associated with a reduced periodontium in women with anorexia nervosa.

Eat Weight Disord 2020 Dec 16;25(6):1763-1770. Epub 2019 Dec 16.

Department of Periodontology, U.F.R. of Odontology, Faculty of Odontology, Université de Paris, 75006, Paris, France.

Purpose: Impaired oral health is a well-known complication in individuals with eating disorders, although this is difficult to identify by mental health professionals. The aim of this study was to evaluate the relationship between routine blood parameters and two oral health outcomes (dental erosion, reduced periodontium) in women with eating disorders.

Methods: A face-to-face interview and a clinical oral examination were carried out in a cohort of 70 women from an addiction and psychiatry hospital unit. Biochemical and hematological parameters were collected in medical records at admission. Biological factors associated with a generalized reduced periodontium (≥ 30% of sites with clinical attachment loss ≥ 3 mm) and dental erosion [a basic erosive wear examination (BEWE) score ≥ 3] were determined by logistic regression models.

Results: Forty-five women with either anorexia nervosa (n = 27) or bulimia nervosa (n = 18) were included in the study. None of the women had active periodontitis or other inflammatory comorbidity. Women with ≥ 30% of sites with clinical attachment loss ≥ 3 mm and those with a BEWE score ≥ 3 were older than women that did not exhibit a generalized reduced periodontium or dental erosion (37.1 ± 10.4 versus 28.8 ± 7.4, p < 0.01 and 35.2 ± 9.7 versus 28.1 ± 7.8, p = 0.01), respectively. After adjustments for age and duration of eating disorder, high serum ferritin levels were associated with a generalized reduced periodontium [OR (95%CI) = 1.04 (1.01; 1.07)]. No association was found between biological factors and dental erosion.

Conclusion: Serum ferritin levels together with age may be helpful to mental health professionals in screening patients with eating disorders for adequate referral to a dentist.

Level Iii: Evidence obtained from a case-control analytic study.
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http://dx.doi.org/10.1007/s40519-019-00832-3DOI Listing
December 2020

Transanal endoscopic microsurgery for rectal villous tumours: Can we rely solely on preoperative biopsies and the surgeon’s experience?

Can J Surg 2019 12;62(6):454-459

From the Department of Surgery, Faculty of Medicine, Université Laval, Québec, Que. (Letarte, Drolet, Laliberté, Lebrun, P. Bouchard, A. Bouchard); and the Department of Colorectal Surgery, Centre hospitalier universitaire de Québec – Hôpital Saint-François d’Assise, Québec, Que. (Drolet, P. Bouchard, A. Bouchard).

Background: Transanal endoscopic microsurgery has become the standard of treatment for rectal villous adenomas. However, the role of preoperative imaging for these lesions is not clear. The aim of this study was to compare the value of preoperative imaging and surgeon clinical staging in the preoperative evaluation of patients with rectal villous adenomas having transanal endoscopic microsurgery resection.

Methods: We conducted a single-centre comparative retrospective cohort study of patients who underwent transanal endoscopic microsurgery surgery for rectal villous adenomas from 2011 to 2013. The intervention was preoperative imaging versus surgeon clinical staging. The primary outcome was the accuracy of clinical staging by preoperative imaging and surgeon clinical staging according to the histopathologic staging.

Results: A total of 146 patients underwent transanal endoscopic microsurgery surgery for rectal villous adenomas. One hundred and twelve (76.7%) of those patients had no preoperative imaging while 34 patients (23.3%) had either endorectal ultrasound (22 patients) or magnetic resonance imaging (12 patients). Surgeon staging was accurate in 89.3% of cases whereas staging by endorectal ultrasound was accurate in 40.9% cases and magnetic resonance imaging was accurate in 0% of cases. In the imaging group, inaccurate staging would have led to unnecessary radical surgery in 44.0% of patients.

Conclusion: This study was subject to selection bias because of its retrospective nature and the limited number of patients with imaging. Patients with rectal villous tumours without invasive carcinoma on biopsies and without malignant characteristics on appearance in the judgment of an experienced colorectal surgeon might not benefit from preoperative imaging before undergoing transanal endoscopic microsurgery procedures.
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http://dx.doi.org/10.1503/cjs.012416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877397PMC
December 2019

Hematopoietic stem cell transplantation using single UM171-expanded cord blood: a single-arm, phase 1-2 safety and feasibility study.

Lancet Haematol 2020 Feb 6;7(2):e134-e145. Epub 2019 Nov 6.

Division of Hematology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada; Department of Medicine, Montreal, QC, Canada; Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada; ExCellThera, Montreal, QC, Canada.

Background: Benefits of cord blood transplantation include low rates of relapse and chronic graft-versus-host disease (GVHD). However, the use of cord blood is rapidly declining because of the high incidence of infections, severe acute GVHD, and transplant-related mortality. UM171, a haematopoietic stem cell self-renewal agonist, has been shown to expand cord blood stem cells and enhance multilineage blood cell reconstitution in mice. We aimed to investigate the safety and feasibility of single UM171-expanded cord blood transplantation in patients with haematological malignancies who do not have a suitable HLA-matched donor.

Methods: This single-arm, open-label, phase 1-2 safety and feasibility study was done at two hospitals in Canada. The study had two parts. In part 1, patients received two cord blood units (one expanded with UM171 and one unmanipulated cord blood) until UM171-expanded cord blood demonstrated engraftment. Once engraftment was documented we initiated part 2, reported here, in which patients received a single UM171-expanded cord blood unit with a dose de-escalation design to determine the minimal cord blood unit cell dose that achieved prompt engraftment. Eligible patients were aged 3-64 years, weighed 12 kg or more, had a haematological malignancy with an indication for allogeneic hematopoietic stem cell transplant and did not have a suitable HLA-matched donor, and a had a Karnofsky performance status score of 70% or more. Five clinical sites were planned to participate in the study; however, only two study sites opened, both of which only treated adult patients, thus no paediatric patients (aged <18 years) were recruited. Patients aged younger than 50 years without comorbidities received a myeloablative conditioning regimen (cyclophosphamide 120 mg/kg, fludarabine 75 mg/m, and 12 Gy total body irradiation) and patients aged older than 50 years and those with comorbidities received a less myeloablative conditioning regimen (cyclophosphamide 50 mg/kg, thiotepa 10 mg/kg, fludarabine 150 mg/m, and 4 Gy total body irradiation). Patients were infused with the 7-day UM171-expanded CD34-positive cells and the lymphocyte-containing CD34-negative fraction. The primary endpoints were feasibility of UM171 expansion, safety of the transplant, kinetics of hematopoietic reconstitution (time to neutrophil and platelet engraftment) of UM171-expanded cord blood, and minimal pre-expansion cord blood unit cell dose that achieved prompt engraftment. We analysed feasibility in all enrolled patients and all other primary outcomes were analysed per protocol, in all patients who received single UM171-expanded cord blood transplantation. This trial has been completed and was registered with ClinicalTrials.gov, NCT02668315.

Findings: Between Feb 17, 2016, and Nov 11, 2018, we enrolled 27 patients, four of whom received two cord blood units for safety purposes in part 1 of the study. 23 patients were subsequently enrolled in part 2 to receive a single UM171-expanded cord blood transplant and 22 patients received a single UM171-expanded cord blood transplantation. At data cutoff (Dec 31, 2018), median follow-up was 18 months (IQR 12-22). The minimal cord blood unit cell dose at thaw that achieved prompt engraftment as a single cord transplant after UM171 expansion was 0·52 × 10 CD34-positive cells. We successfully expanded 26 (96%) of 27 cord blood units with UM171. Among the 22 patients who received single UM171-expanded cord blood transplantation, median time to engraftment of 100 neutrophils per μL was 9·5 days (IQR 8-12), median time to engraftment of 500 neutrophils per μL was 18 days (12·5-20·0), and no graft failure occurred. Median time to platelet recovery was 42 days (IQR 35-47). The most common non-haematological adverse events were grade 3 febrile neutropenia (16 [73%] of 22 patients) and bacteraemia (nine [41%]). No unexpected adverse events were observed. One (5%) of 22 patients died due to treatment-related diffuse alveolar haemorrhage.

Interpretation: Our preliminary findings suggest that UM171 cord blood stem cell expansion is feasible, safe, and allows for the use of small single cords without compromising engraftment. UM171-expanded cord blood might have the potential to overcome the disadvantages of other cord blood transplants while maintaining the benefits of low risk of chronic GVHD and relapse, and warrants further investigation in randomised trials.

Funding: Canadian Institutes of Health Research, Canadian Cancer Society and Stem Cell Network.
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http://dx.doi.org/10.1016/S2352-3026(19)30202-9DOI Listing
February 2020

The relationship between dental implant papilla and dental implant mucosa around single-tooth implant in the esthetic area: A retrospective study.

Clin Oral Implants Res 2019 Dec 27;30(12):1229-1237. Epub 2019 Sep 27.

Department of Periodontology, U.F.R. of Odontology, Université de Paris, Paris, France.

Objective: The aim of the present study was (a) to evaluate the relationship between dental implant mucosa and dental implant papilla levels; and (b) to identify the clinical parameters associated with peri-implant soft tissue stability over time.

Materials And Methods: This is a retrospective study on a cohort of patients seeking a single-tooth implant therapy in a private practice in the Paris area. Two independent examiners analyzed photographs and radiographs taken the day of definitive crown load (baseline) and the last follow-up visit (at least 12 months later) in order to measure four peri-implant soft and hard tissue parameters.

Results: Seventy-four patients corresponding to 90 implants were analyzed. During a mean follow-up of 53.88 months, five implants (5.6%) presented with an apical displacement of the mid-facial marginal mucosal level of at least 1 mm. Changes in the mid-facial mucosa level were explained by changes in (a) the keratinized tissue height over time (p < .0001); (b) changes in the papilla height (p < .0001); and (c) by the periodontal phenotype (p = .007). A significant difference between papillae that gain in height (n = 85) and papilla that lost height (n = 78) was observed concerning (a) the timing of the implant placement (p = .019); and (b) the presence of an incomplete papilla fill (distance from the top of the papilla to the contact point) at baseline (p = .004).

Conclusions: The present findings indicate a dependent association between dental implant mucosa and dental implant papilla levels. Stability of peri-implant soft tissues depends on periodontal phenotype, keratinized tissue height and papilla height.
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http://dx.doi.org/10.1111/clr.13536DOI Listing
December 2019

Role of good oral hygiene on clinical evolution of rheumatoid arthritis: a randomized study nested in the ESPOIR cohort.

Rheumatology (Oxford) 2020 05;59(5):988-996

Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Denis Diderot University.

Objective: There is a relationship between RA and periodontal disease. We aimed to investigate if a good oral hygiene could improve activity of RA.

Methods: The patients with RA according to ACR/EULAR 2010 criteria and included in the French early arthritis ESPOIR cohort were included in a randomized nested study into: (i) intervention group: general recommendations of good oral hygiene including teeth brushing, daily antiseptic mouthwash and twice a year scaling; and (ii) control group: no intervention. The primary end point was the delta DAS28-ESR.

Results: Four hundred and seventy-two patients were randomized (238 in intervention and 234 in control). 92/238 from the intervention group accepted the procedure and 81 had a first visit to the dentist. 56% of patients had periodontal disease at baseline. Duration of RA was 9.0±0.7 years. Baseline DAS28-ESR was 2.7±1.3. After a median duration of 24 months, delta DAS28-ESR was -0.17±1.29 and -0.09±1.28 in intervention and control groups, respectively (mean difference (complier average causal effect): -0.37 (95% CI -1.12, 0.37), P = 0.33). In the intervention group, there was a significant decrease of the bacteria involved in the red complex: Porphyromonas gingivalis (P = 0.002), Tannerella forsythia (P = 0.002) and Treponema denticola (P = 0.019). The patients with baseline periodontal disease and those who became negative for one red complex bacterium had a slightly more important decrease of DAS28-ESR.

Conclusion: Oral hygiene instruction together with regular scaling and polishing of the teeth significantly decreased the load of periodontal pathogens but did not decrease RA activity. This intervention should be tested in patients with earlier RA and more active disease.

Trial Registration: ClinicalTrials.gov, http://clinicaltrials.gov, NCT01831648.
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http://dx.doi.org/10.1093/rheumatology/kez368DOI Listing
May 2020

Impact of Polymorphisms on Busulfan Oral Clearance in Adult Patients Undergoing Hematopoietic Stem Cell Transplantation.

Pharmaceutics 2019 Sep 1;11(9). Epub 2019 Sep 1.

Faculty of Pharmacy, Université de Montréal, Montreal, QC H3C 3J7, Canada.

Background: Busulfan pharmacokinetics exhibit large inter-subject variability. Our objective was to evaluate the influence of glutathione S-transferase A1 () gene variants on busulfan oral clearance (CLo) in a population of patients undergoing hematopoietic stem cell transplantation.

Methods: This is a quasi-experimental retrospective study in adult patients ( = 87 included in the final analyses) receiving oral busulfan. Pharmacokinetics data (area under the plasma concentration-time curve (AUC) determined from 10 blood samples) were retrieved from patients' files and and allele polymorphisms determined from banked DNA samples. Three different limited sampling methods (LSM) using four blood samples were also compared.

Results: Carriers of exhibited lower busulfan CLo than patients with an genotype ( < 0.002): Busulfan CLo was 166 ± 31, 187 ± 37 vs. 207 ± 47 mL/min for and genotypes, respectively. Similar results were obtained with the tested LSMs. Using the standard AUC method, distribution of patients above the therapeutic range after the first dose was 29% for , 50% for and 65% for . The LSMs correctly identified ≥91% of patients with an AUC above the therapeutic range. The misclassified patients had a mean difference less than 5% in their AUCs.

Conclusion: Patients carrying loss of function allele were at increased risk of overdosing on their initial busulfan oral dose. Genetic polymorphisms associated with explain a significant part of busulfan CLo variability which could be captured by LSM strategies.
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http://dx.doi.org/10.3390/pharmaceutics11090440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6781287PMC
September 2019

European survey on criteria of aesthetics for periodontal evaluation: The ESCAPE study.

J Clin Periodontol 2019 11 18;46(11):1116-1123. Epub 2019 Sep 18.

Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R of Odontology, Paris, France.

Objective: The ESCAPE multicentre survey was designed to (a) compare the agreement of three relevant aesthetic scoring systems among different centres, and (b) evaluate the reproducibility of each question of the questionnaires.

Materials And Methods: EFP centres (n = 14) were involved in an e-survey. Forty-two participants (28 teachers, 14 postgraduate students) were asked to score the one-year aesthetic outcomes of photographs using the Before-After Scoring System (BASS), the Pink Esthetic Score (PES) and the Root coverage Esthetic Score (RES). Mean values of kappa statistics performed on each question were provided to resume global agreement of each method.

Results: Between teachers, a difference of kappa ≥ 0.41 (p = .01) was found for BASS (75%) and PES (57%). Similarly, RES (84%) and PES (57%) were different (p < .001). No difference was found between BASS (75%) and RES (84%). No difference was found between students, whatever the scoring system. Questions of each scoring system showed differences in their reproducibility.

Conclusions: The outcomes of this study indicate that BASS and RES scoring systems are reproducible tools to evaluate aesthetic after root coverage therapies between different centres. Among the various variables, lack of scar, degree of root coverage, colour match and gingival margin that follows the CEJ show the best reliability.
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http://dx.doi.org/10.1111/jcpe.13182DOI Listing
November 2019

Safety and efficacy of the sleeve gastrectomy as a strategy towards kidney transplantation.

Surg Endosc 2020 06 31;34(6):2657-2664. Epub 2019 Jul 31.

Department of Surgery, Center for Bariatric Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room: E16-165A, H3G 1A4, Montreal, QC, Canada.

Background: Obese individuals suffering from advanced chronic kidney disease (CKD) may be precluded from accessing kidney transplantation. Bariatric surgery is an effective treatment for obesity and related conditions but its use in those with severe CKD remains limited due to morbidity concerns. We aimed to evaluate the safety and efficacy of sleeve gastrectomy (SG) in patients with severe CKD as a bridging strategy towards kidney transplant candidacy.

Methods: This is a single-center retrospective study of a prospectively collected database of obese patients referred by the multi-organ transplant team for surgical weight loss, who underwent SG during 2013-2018. The primary outcome was 90-day major morbidity. Secondary outcomes included weight loss, and successful kidney transplantation. Descriptive statistics are expressed as count (percent) or median (interquartile range).

Results: 32 patients met inclusion criteria. 18 (56%) were male with a median age and BMI of 51 (11) years and 42.3 (5.2) kg/m, respectively. 29 (91%) patients were on dialysis for a median duration of 28 months before SG. Diabetes, hypertension, and dyslipidemia were present in 15 (47%), 25 (78%), and 21 (66%) patients, respectively. At 90 days after SG, there were no leaks, reoperations, or mortality. The median length of stay was 2 (1.3) days. At 1 year, change in BMI and percent excess weight loss (EWL) were -9.8 (3.7) kg/m and 56% (27), respectively. In the year after SG, 20 (63%) patients were listed for transplant. 14 (44%) underwent successful kidney transplantation. One patient died while waiting for transplant. At time of transplant, median change in BMI and EWL were -9.0 (5.5) kg/m and 59% (30), respectively. After transplant, no patient required dialysis at a median follow-up of 17 (32) months.

Conclusion: SG is safe and effective for weight loss and bridging to candidacy for kidney transplantation in patients with severe CKD. The acceptable safety and efficiency of SG in this high-risk population makes it an optimal choice as a bridging procedure.
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http://dx.doi.org/10.1007/s00464-019-07042-zDOI Listing
June 2020

The Role of transanal (Ta) dissection in the management of difficult primary and recurrent rectal cancer.

BMJ Open Gastroenterol 2019 21;6(1):e000305. Epub 2019 Jun 21.

Department of surgery, Local B1-520, 10 rue de L'Espinay, Pavillon St François d'Assise, CHU de Quebec, Quebec City, G1L 3L5, Quebec, Canada.

Background: The objective of this study was to review the postoperative and short-term oncological outcomes of our first cohort of patients having had a transanal (Ta) approach for primary or recurrent rectal cancer.

Methods: A retrospective chart review was performed on all cases of Ta dissection occurring between 2013 and 2016. We reviewed data concerning case selection, tumour characteristics, perioperative and postoperative data and final pathology.

Results: A total of 24 males were operated for primary (92% (22/24)) or recurrent rectal cancer (8.3% (2/24)). Four patients (16.7% (4/24)) had a history of previous rectal surgery and two had a history of previous Ta total mesorectal excision (TME). A majority of patients were obese, with 58.3% (14/24) having a body mass index >30. The laparoscopic approach was used in the majority of cases (95.8% (23/24)). Most patients had a low anterior resection (95.8% (23/24)). Sixteen patients received a temporary ileostomy (66.7% (16/24)). Three patients suffered perioperative complications (including colonic ischaemia, rectal perforation and arterial bleeding). Five patients (21.7% (5/23)) had an anastomotic leak treated with Ta drainage in two patients. Final pathology revealed negative margins in 95.8% (23/24). TME was considered complete in 87.5% (21/24) overall and in 95% (21/22) when considering only primary cancer cases.

Conclusion: According to our cohort of selected difficult cases, Ta dissection approach helped achieve complete mesorectal excision in complex primary rectal cancer but also allowed for rectal resection in patients with previous rectal surgery. This technique also helped perform a primary anastomosis in these difficult cases.
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http://dx.doi.org/10.1136/bmjgast-2019-000305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590964PMC
June 2019

Chewing capacity and ideal cardiovascular health in adulthood: A cross-sectional analysis of a population-based cohort study.

Clin Nutr 2020 05 13;39(5):1440-1446. Epub 2019 Jun 13.

INSERM U970, Paris Cardiovascular Research Centre (PARCC), University of Paris, 56 rue Leblanc, 75015 Paris, France; INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease (Team 4), 56 rue Leblanc, 75015 Paris, France.

Background And Aims: To study the association between chewing capacity-a prerequisite for eating- and the level of cardiovascular health (CVH).

Methods: This is a cross-sectional analysis conducted on 5430 study participants from the Paris Prospective Study 3 that were subjected to an oral examination by trained dentists at study recruitment between 2008 and 2012. Chewing capacity was determined by the number of functional tooth units (FTUs), and ≥ 5FTUs defined adequate chewing capacity. Subjects were categorized into poor, intermediate, or ideal CVH for the 4 behavioural (smoking status, body mass index, physical activity, diet) and the 3 biological (total cholesterol, fasting glycemia, and blood pressure) factors according to the American Heart Association Life's Simple 7. Multinomial logistic regression was used to explore the association between the number of FTUs (exposure) and ideal or intermediate vs. poor CVH (main outcome).

Results: 10.31% of the study participants had an ideal CVH and 7% presented an impaired chewing capacity (<5 FTUs). Subjects with at least 5 FTUs (OR = 2.37; 95% CI: 1.37-4.12) were more likely to have an ideal global CVH, after adjustment for age, sex, marital status, education, deprivation, depressive status, and dental plaque. This association existed for the behavioural but not the biological CVH, with the strongest association being observed with the diet metric.

Conclusion: This is the first study suggesting that adults with a preserved chewing capacity have an increased likelihood to be at an ideal behavioural CVH.
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http://dx.doi.org/10.1016/j.clnu.2019.05.029DOI Listing
May 2020

Biological factors involved in alveolar bone regeneration: Consensus report of Working Group 1 of the 15 European Workshop on Periodontology on Bone Regeneration.

J Clin Periodontol 2019 06;46 Suppl 21:6-11

Faculty of Dentistry, University of Oslo, Oslo, Norway.

Background And Aims: To describe the biology of alveolar bone regeneration.

Material And Methods: Four comprehensive reviews were performed on (a) mesenchymal cells and differentiation factors leading to bone formation; (b) the critical interplay between bone resorbing and formative cells; (c) the role of osteoimmunology in the formation and maintenance of alveolar bone; and (d) the self-regenerative capacity following bone injury or tooth extraction were prepared prior to the workshop.

Results And Conclusions: This summary information adds to the fuller understanding of the alveolar bone regenerative response with implications to reconstructive procedures for patient oral rehabilitation. The group collectively formulated and addressed critical questions based on each of the reviews in this consensus report to advance the field. The report concludes with identified areas of future research.
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http://dx.doi.org/10.1111/jcpe.13130DOI Listing
June 2019

Dental and periodontal health in adults with eating disorders: A case-control study.

J Dent 2019 05 12;84:55-59. Epub 2019 Mar 12.

Department of Periodontology, Odontology Unit, AP-HP, GH Paris-Est, Rothschild Hospital, Paris, France; UFR of Odontology, University of Paris Diderot, 5 rue Garancière, Paris, France; Laboratory Orofacial Pathologies, Imaging and Biotherapies, EA 2496, Dental School, University of Paris Descartes, 1 rue Maurice Arnoux, 92120 Paris, France. Electronic address:

Objectives: This study evaluates dental and periodontal health in anorexia nervosa and bulimia nervosa patients.

Methods: Seventy females with eating disorders (36 anorexia nervosa) attending a public hospital Psychiatry and Addiction unit were compared with age-matched controls (n = 70). Full-mouth examination and oral hygiene behaviours were recorded for all participants.

Results: More frequent dental attendance and toothbrushing were observed in patients with eating disorders than in controls (p < 0.01), while lower plaque index and bleeding on probing were observed in controls than in patients (p ≤ 0.03). Percentages of sites with gingival recession >2 mm were higher in patients with eating disorders than in controls (2.3 ± 4.1 versus 0.0 ± 0.1, p < 0.01). The BEWE score >2 was significantly more frequent in bulimia nervosa patients than in anorexia nervosa patients (76.5% versus 41.7%, p < 0.01). Regarding periodontal parameters, mean plaque index, bleeding on probing and clinical attachment loss were increased in anorexia nervosa patients compared to bulimia nervosa patients.

Conclusions: The present data suggest different oral health approaches in eating disorder patients according to diagnosis type.

Clinical Significance: Periodontal and dental health should be considered rigorously in patients with eating disorders. Personalized oral hygiene recommendations and treatments can be delivered according to the type of eating disorder.
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http://dx.doi.org/10.1016/j.jdent.2019.03.005DOI Listing
May 2019

Endoscopic Submucosal Dissection for Esophageal Adenocarcinoma: A North American Perspective.

J Gastrointest Surg 2019 06 31;23(6):1087-1094. Epub 2019 Jan 31.

McGill University, Montreal, QC, Canada.

Background: Data are limited regarding the application of endoscopic submucosal dissection (ESD) in Western countries or for esophageal adenocarcinoma in any part of the world. We sought to review our experience employing ESD in patients with early esophageal cancer at a high volume North American esophageal cancer treatment center.

Methods: A prospectively maintained database of all patients with esophageal cancer treated at the McGill University Health Center was used to identify ESDs performed for adenocarcinoma between 2012 and 2016. Patient demographics, pre-resection tumor characteristics, endoscopic resection technical variables, pathologic results, and short- and long-term outcomes were recorded.

Results: Of 650 patients in the database, 26 underwent 27 procedures. The majority (67%) had pre-treatment EUS. There were no post-ESD bleeding events requiring re-intervention. Perforation occurred in 2/27 (7%), one of which required operative repair. Complete RO resection was achieved in 18/27(67%). Salvage laparoscopic esophagectomy was performed in six patients. At a median follow-up of 18.5 (7-35) months, cancer recurrence occurred in only one patient who subsequently underwent successful repeat ESD.

Conclusions: Although technically challenging, ESD represents a safe and effective treatment of early esophageal adenocarcinoma and has the potential to become a more important tool in management of these early lesions in Western countries.
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http://dx.doi.org/10.1007/s11605-018-04093-wDOI Listing
June 2019