Association of chairside salivary aMMP-8 findings with periodontal risk assessment parameters in patients receiving supportive periodontal therapy

Schmalz, Gerhard,Kummer, Max Kristian,Kottmann, Tanja,Rinke, Sven,Haak, Rainer,Krause, Felix,Schmidt, Jana,Ziebolz, Dirk Korean Academy of Periodontology 2018 Journal of Periodontal & Implant Science Vol.48 No.4

Purpose: The aim of this retrospective cross-sectional study was to evaluate whether salivary findings of active matrix-metalloproteinase 8 (aMMP-8) chairside (point of care; POC) tests were associated with periodontal risk assessment parameters in patients receiving supportive periodontal therapy (SPT). Methods: A total of 125 patients receiving regular SPT were included, and their records were examined. The following inclusion criteria were used: a diagnosis of chronic periodontitis, at least 1 non-surgical periodontal treatment (scaling and root planning) with following regular SPT (minimum once a year), at least 6 remaining teeth, and clinical and aMMP-8 findings that were obtained at the same appointment. In addition to anamnestic factors (e.g., smoking and diabetes), oral hygiene indices (modified sulcus bleeding index [mSBI] and approximal plaque index), periodontal probing depth simultaneously with bleeding on probing, and dental findings (number of decayed, missing, and filled teeth) were recorded. Salivary aMMP-8 levels were tested using a commercial POC test system (Periomarker, Hager & Werken, Duisburg, Germany). Statistical analysis was performed using the t-test, Mann-Whitney U test, Fisher's exact test, and ${\chi}^2$ test, as appropriate (P<0.05). Results: Only the mSBI was significantly associated with positive salivary aMMP-8 findings (aMMP-8 positive: $27.8%{\pm}20.9%$ vs. aMMP-8 negative: $18.0%{\pm}14.5%$; P=0.017). No significant associations were found between aMMP-8 and smoking, diabetes, periodontal parameters, or parameters related to the maintenance interval (P>0.05). Conclusions: Salivary aMMP-8 chairside findings were not associated with common parameters used for periodontal risk assessment in patients receiving SPT. The diagnostic benefit of POC salivary aMMP-8 testing in risk assessment and maintenance interval adjustment during SPT remains unclear.

Clinical Predictors of Excessive Daytime Sleepiness in Patients with Parkinson’s Disease

Bruno Terra Junho,Arthur Kummer,Francisco Cardoso,Antonio Lucio Teixeira,Natalia Pessoa Rocha 대한신경과학회 2018 Journal of Clinical Neurology Vol.14 No.4

Background and Purpose Excessive daytime sleepiness (EDS) is a common complaint among patients with Parkinson’s disease (PD). Several factors have been associated with EDS in PD, especially neuropsychiatric symptoms. This study aimed to determine the relationships between neuropsychiatric symptoms, sociodemographic and clinical parameters, and EDS in PD. Methods This cross-sectional study analyzed 85 patients with PD. All patients underwent socioeconomic and clinical data evaluations followed by a psychiatric interview and a neurological examination, including the assessment of sleep features. Patients were divided into two groups according to the presence or absence of EDS, which was defined as a score higher than 10 on the Epworth Sleepiness Scale. Binary logistic regression was performed in order to describe the predictors of EDS. Results We found that EDS affects 40% of PD patients and is associated with older age, restless legs syndrome, depressive and anxious symptoms, and worse sleep quality. In the multivariate analysis, older age, levodopa use, and worse sleep quality remained as significant predictors of EDS in PD. Conclusions Nighttime sleep problems, older age, and levodopa use are significantly associated with EDS in PD. A careful assessment and the management of sleep problems in PD patients might help to improve their quality of life.

Association of chairside salivary aMMP-8 findings with periodontal risk assessment parameters in patients receiving supportive periodontal therapy

Gerhard Schmalz,Max Kristian Kummer,Tanja Kottmann,Sven Rinke,Rainer Haak,Felix Krause,Jana Schmidt,Dirk Ziebolz 대한치주과학회 2018 Journal of Periodontal & Implant Science Vol.48 No.4

Purpose: The aim of this retrospective cross-sectional study was to evaluate whether salivary findings of active matrix-metalloproteinase 8 (aMMP-8) chairside (point of care; POC) tests were associated with periodontal risk assessment parameters in patients receiving supportive periodontal therapy (SPT). Methods: A total of 125 patients receiving regular SPT were included, and their records were examined. The following inclusion criteria were used: a diagnosis of chronic periodontitis, at least 1 non-surgical periodontal treatment (scaling and root planning) with following regular SPT (minimum once a year), at least 6 remaining teeth, and clinical and aMMP-8 findings that were obtained at the same appointment. In addition to anamnestic factors (e.g., smoking and diabetes), oral hygiene indices (modified sulcus bleeding index [mSBI] and approximal plaque index), periodontal probing depth simultaneously with bleeding on probing, and dental findings (number of decayed, missing, and filled teeth) were recorded. Salivary aMMP-8 levels were tested using a commercial POC test system (Periomarker, Hager & Werken, Duisburg, Germany). Statistical analysis was performed using the t-test, Mann-Whitney U test, Fisher's exact test, and χ2 test, as appropriate (P<0.05). Results: Only the mSBI was significantly associated with positive salivary aMMP-8 findings (aMMP-8 positive: 27.8%±20.9% vs. aMMP-8 negative: 18.0%±14.5%; P=0.017). No significant associations were found between aMMP-8 and smoking, diabetes, periodontal parameters, or parameters related to the maintenance interval (P>0.05). Conclusions: Salivary aMMP-8 chairside findings were not associated with common parameters used for periodontal risk assessment in patients receiving SPT. The diagnostic benefit of POC salivary aMMP-8 testing in risk assessment and maintenance interval adjustment during SPT remains unclear. Keywords: Maintenance; Metalloproteinase

How Does Country Risk Influence Bilateral M&A and Greenfield FDI Flows Differently?

( Badassa Wolteji Chala ),( Hyun Hoon Lee ),( Christopher Kummer ) 한국국제경제학회 2013 한국국제경제학회 학술대회발표 논문집 Vol.2013 No.4

Despite the fact that country risk is a very important factor as seen by multinationals when they make a decision on their investment activities abroad, there is no consensus in the literature on how different types of country risk affect Foreign Direct Investment (FDI) flows. This paper aims to assess comprehensively how different types of host country risk (political and financial) influence differently two distinct types of FDI flows: Merger and Acquisition (M&A) and greenfield FDI. For this purpose, we run a gravity model using bilateral FDI flow data from 20 major Organization for Economic Cooperation and Development (OECD) countries to 179 OECD and non-OECD individual countries for the period 2001 - 2011. We find that financial risk is quite different from political risk in affecting M&A, deal margins, and greenfield FDI. While financial stability is associated negatively with lower inflows of M&A aggregate values and deal extensive margin, greater political stability is associated with higher greenfield FDI inflows. Also, we find that multinationals have recently become less sensitive to host country risk in their overseas investment decisions and the ‘‘fire sale argument’’ based on the occurrence of a financial crisis is more likely to be applied in the rest of the world than in high income countries.

Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients

Peter G. Passias,Katherine E. Pierce,Nicholas Kummer,Oscar Krol,Lara Passfall,M. Burhan Janjua,Daniel Sciubba,Waleed Ahmad,Sara Naessig,Bassel Diebo 대한척추신경외과학회 2021 Neurospine Vol.18 No.3

Objective: Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied. Methods: Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-year data were included. Modified Japanese Orthopaedic Association (mJOA) score categorized BL myelopathy (mJOA=18 excluded), with moderate myelopathy mJOA being 12 to 17 and severe myelopathy being less than 12. BL deformity severity was categorized using the mismatch between T1 slope and cervical lordosis (TS-CL), with CL being the angle between the lower endplates of C2 and C7. Moderate deformity was TS-CL less than or equal to 25° and severe deformity was greater than 25°. Categorizations were combined into 4 groups: group 1 (G1), severe myelopathy and severe deformity; group 2 (G2), severe myelopathy and moderate deformity; group 3 (G3), moderate myelopathy and moderate deformity; group 4 (G4), moderate myelopathy and severe deformity. Univariate analyses determined whether myelopathy or deformity had greater impact on outcomes. Results: One hundred twenty-eight CD patients were included (mean age, 56.5 years; 46% female; body mass index, 30.4 kg/m2) with a BL mJOA score of 12.8±2.7 and mean TS-CL of 25.9°±16.1°. G1 consisted of 11.1% of our CD population, with 21% in G2, 34.6% in G3, and 33.3% in G4. At BL, Neck Disability Index (NDI) was greatest in G2 (p=0.011). G4 had the lowest EuroQol-5D (EQ-5D) (p<0.001). Neurologic exam factors were greater in severe myelopathy (p<0.050). At 1-year, severe deformity met minimum clinically important differences (MCIDs) for NDI more than moderate deformity (p=0.002). G2 had significantly worse outcomes compared to G4 by 1-year NDI (p=0.004), EQ-5D (p=0.028), Numerical Rating Scale neck (p=0.046), and MCID for NDI (p=0.001). Conclusion: Addressing severe deformity had increased clinical weight in improving patient-reported outcomes compared to addressing severe myelopathy.

Concurrent Presence of Thoracolumbar Scoliosis and Chiari Malformation: Is Operative Risk Magnified?

Naessig Sara,Tretiakov Peter,Patel Karan,Ahmad Waleed,Pierce Katherine,Kummer Nicholas,Joujon-Roche Rachel,Imbo Bailey,Williamson Tyler,Krol Oscar,Janjua Muhammad Burhan,Vira Shaleen,Diebo Bassel,Sciu 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4

Study Design: Retrospective review of Kids’ Inpatient Database (KID).Purpose: Identify the risks and complications associated with surgery in adolescents diagnosed with Chiari and scoliosis.Overview of Literature: Scoliosis is frequently associated with Chiari malformation (CM). More specifically, reports have been made about this association with CM type I in the absence of syrinx status.Methods: The KID was used to identify all pediatric inpatients with CM and scoliosis. The patients were stratified into three groups: those with concomitant CM and scoliosis (CMS group), those with only CM (CM group), and those with only scoliosis (Sc group). Multivariate logistic regressions were used to assess association between surgical characteristics and diagnosis with complication rate.Results: A total of 90,707 spine patients were identified (61.8% Sc, 37% CM, 1.2% CMS). Sc patients were older, had a higher invasiveness score, and higher Charlson comorbidity index (all <i>p</i><0.001). CMS patients had significantly higher rates of surgical decompression (36.7%). Sc patients had significantly higher rates of fusions (35.3%) and osteotomies (1.2%, all <i>p</i><0.001). Controlling for age and invasiveness, postoperative complications were significantly associated with spine fusion surgery for Sc patients (odds ratio [OR], 1.8; <i>p</i><0.05). Specifically, posterior spinal fusion in the thoracolumbar region had a greater risk of complications (OR, 4.9) than an anterior approach (OR, 3.6; all <i>p</i><0.001). CM patients had a significant risk of complications when an osteotomy was performed as part of their surgery (OR, 2.9) and if a spinal fusion was concurrently performed (OR, 1.8; all <i>p</i><0.05). Patients in the CMS cohort were significantly likely to develop postoperative complications if they underwent a spinal fusion from both anterior (OR, 2.5) and posterior approach (OR, 2.7; all <i>p</i><0.001).Conclusions: Having concurrent scoliosis and CM increases operative risk for fusion surgeries despite approach. Being independently inflicted with scoliosis or Chiari leads to increased complication rate when paired with thoracolumbar fusion and osteotomies; respectively.

Prioritization of Realignment Associated With Superior Clinical Outcomes for Cervical Deformity Patients

Katherine E. Pierce,Peter G. Passias,Avery E. Brown,Cole A. Bortz,Haddy Alas,Lara Passfall,Oscar Krol,Nicholas Kummer,Renaud Lafage,Dean Chou,Douglas C. Burton,Breton Line,Eric Klineberg,Robert Hart,J 대한척추신경외과학회 2021 Neurospine Vol.18 No.3

Objective: To prioritize the cervical parameter targets for alignment. Methods: Included: cervical deformity (CD) patients (C2–7 Cobb angle>10°, cervical lordosis>10°, cervical sagittal vertical axis [cSVA]>4 cm, or chin-brow vertical angle>25°) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical [C] or cervicothoracic [CT] Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA (<4 cm) and T1 slope minus cervical lordosis (TS–CL) (<15°) were excluded. Patients assessed: meeting minimum clinically important differences (MCID) for NDI (<-15 ΔNDI). Ratios of correction were found for regional parameters categorized by primary Ames driver (C or CT). Decision tree analysis assessed cutoffs for differences associated with meeting NDI MCID at 1Y. Results: Seventy-seven CD patients (mean age, 62.1 years; 64% female; body mass index, 28.8 kg/m2). Forty-one point six percent of patients met MCID for NDI. A backwards linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R2 of 0.820 (p=0.032) included TS–CL, cSVA, McGregor’s slope (MGS), C2 sacral slope, C2–T3 angle, C2–T3 SVA, cervical lordosis. By primary Ames driver, 67.5% of patients were C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and CT were not significant between the 2 groups (p> 0.050). Decision tree analysis determined cutoffs for radiographic change, prioritizing in the following order: ≥42.5° C2–T3 angle, >35.4° cervical lordosis, <-31.76° C2 slope, <-11.57-mm cSVA, <-2.16° MGS, >-30.8-mm C2–T3 SVA, and ≤-33.6° TS–CL. Conclusion: Certain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient-reported outcomes for patients undergoing CD surgery.