Category: Nevin Manimala

J Pediatr Surg. 2024 Oct 20:162024. doi: 10.1016/j.jpedsurg.2024.162024. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: This study aimed to evaluate contemporary management strategies of pediatric renal trauma, focusing on the failure of conservative management and identifying its predictors.

METHODS: The National Trauma Database (2018-2021) was queried for pediatric patients (≤18 years) with renal injury, identified via AIS codes aligned with the AAST kidney injury grading system. Urological surgical procedures were identified via ICD-10 Procedure Codes. Patients were categorized into immediate surgical management (within 4 h), conservative management (no surgery), and failed conservative management (surgery after 4 h). Demographics, injury characteristics, and clinical data were analyzed using descriptive and univariate statistical analyses (Wilcoxon Rank Sum, Chi-square, Odds Ratios).

RESULTS: Of 7266 pediatric renal trauma patients, most were white (63.4 %) males (69.1 %), aged 12-18 (76.6 %), suffering from unintentional blunt trauma (86.9 %). Most (n = 6610, 95 %) received conservative management; however, 4.5 % (n = 298) failed. Common surgical interventions included ureteral stent placement (n = 200, 59 %), renal IR procedures (n = 44, 13 %), and nephrectomy (n = 33, 9.7 %). Nephrectomy rates at low AAST kidney injury grades (I-II) were higher with upfront surgical management (n = 7, 3.5 %) than with failed conservative management (n = 0). Predictors of failed conservative management included higher Injury Severity Score (ISS) and higher AAST kidney injury grades (III-V) (p < 0.05).

CONCLUSION: Conservative management failed in 4.5 % of paediatric renal trauma cases, associated with higher AAST kidney injury grade and ISS. Upfront surgical management correlated with a higher nephrectomy rate at lower injury grades compared to failed conservative management. Refinement of pediatric trauma protocols is needed for optimal care.

LEVEL OF EVIDENCE: III.

PMID:39472232 | DOI:10.1016/j.jpedsurg.2024.162024

J Cyst Fibros. 2024 Oct 28:S1569-1993(24)01801-0. doi: 10.1016/j.jcf.2024.10.006. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to characterize the uptake of elexacaftor/tezacaftor/ivacaftor (ETI) following Food and Drug Administration (FDA) approval in October 2019.

METHODS: People with cystic fibrosis (PwCF) ≥12 years enrolled in the CF Foundation Patient Registry (CFFPR) from 2019-2022 with at least one copy of F508del were included. We calculated summary statistics according to ETI prescription status. We used a Kaplan-Meier estimator to determine median days to ETI prescription to identify differences in prescription uptake by lung function, race, and ethnicity and a Cox proportional hazards model to identify risk factors associated with timing of first ETI prescription.

RESULTS: A total of 17,183 people (91 %) were prescribed ETI. The median time to prescription was 121 days (95 % CI: 119, 122), with 75 % prescribed within 311 days (95 % CI: 301, 325). PwCF prescribed ETI were younger, had lower lung function, more pulmonary exacerbations in the prior year, earlier age of diagnosis, and were more likely to have been prescribed another CFTR modulator (if eligible). Public health insurance, ppFEV₁ >90, Black race and Hispanic ethnicity were associated with lower hazards (e.g., later) of ETI prescription whereas prior modulator prescription, pancreatic insufficiency, increased exacerbation frequency and prior infections were associated with a higher hazard (earlier) of prescription.

CONCLUSIONS: While over 90 % of eligible individuals were prescribed ETI within three years, time of first prescription was associated with demographic factors and disease severity. Further research should investigate the reasons for this delay and approaches to reduce time to initiation for ETI and future therapies.

PMID:39472230 | DOI:10.1016/j.jcf.2024.10.006

Diagn Interv Imaging. 2024 Oct 28:S2211-5684(24)00237-7. doi: 10.1016/j.diii.2024.10.005. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to assess the capabilities of MRI-based Node Reporting and Data System (Node-RADS) in diagnosing regional lymph node metastasis (RLNM) and to estimate its prognostic significance in patients with renal cell carcinomas (RCCs).

MATERIALS AND METHODS: Patients with RCC who underwent nephrectomy and regional lymph node dissection between January 2010 and August 2023 were retrospectively included. Two senior radiologists scored lymph nodes in consensus using MRI-based Node-RADS. The performance of MRI-based Node-RADS for the diagnosis of RLNM was estimated using area under receiver operating characteristic (AUC) curves and compared against size criteria. Three additional readers scored all lesions to assess interobserver agreement. Progression-free survival and overall survival were estimated and compared between patients with low (1-3) and high (4-5) scores.

RESULTS: Overall, 216 patients with RCC were enrolled, including 58 with RLNM. There were 157 men and 59 women with a median age of 54 years (range: 8-83 years). Node-RADS showed larger AUC (0.93 [95 % confidence interval (CI): 0.87-0.97]) and higher specificity (96.8 % [95 % CI: 92.8-99.0]) compared to size criteria (0.88 [95 % CI: 0.83-0.94] and 87.3 % [95 % CI: 81.1-92.1], respectively) for the diagnosis of RLNM (P = 0.039 and P < 0.001, respectively). Substantial interobserver agreement in Node-RADS scoring was obtained between the three readers (weighted κ, 0.75 [95 % CI: 0.69-0.80]). During a median follow-up of 56 months, patients with high Node-RADS score experienced poorer progression-free survival (P < 0.001) and overall survival (P < 0.001) than those with low Node-RADS score. At multivariable Cox regression analysis, Node-RADS was an independent variable associated with RCC prognosis after adjustment for confounders.

CONCLUSIONS: The MRI-based Node-RADS demonstrates notable performance in detecting RLNM and showed potential prognostic significance for RCCs.

PMID:39472219 | DOI:10.1016/j.diii.2024.10.005

J World Fed Orthod. 2024 Oct 28:S2212-4438(24)00069-9. doi: 10.1016/j.ejwf.2024.09.005. Online ahead of print.

ABSTRACT

BACKGROUND: While orthodontic miniscrews have been widely documented for their successful application, limited research exists on the stability and effectiveness of reused miniscrews. This systematic review aims to evaluate the stability and effectiveness of reused miniscrews in orthodontic treatments.

METHODS: An electronic search was conducted for studies published up to February 2024 across MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane CENTRAL. Additionally, gray literature sources and manual searches of prominent orthodontic journals from 2010 to 2023, were also examined. Studies that investigated the use of miniscrews after retrieval and sterilization involving both in vitro studies and clinical trials were included.

RESULTS: From 946 searched studies, 18 were finally included in our review. Thirteen studies investigated retrieved and sterilized miniscrews, while five examined unused and sterilized miniscrews to isolate the effects of sterilization. After performing a meta-analysis on in vitro studies, no significant difference in insertion, removal, or fracture torque between retrieved and unretrieved miniscrews was found, though sterilized miniscrews had a statistically significant increase in insertion torque without affecting fracture resistance. Meta-analysis of clinical studies revealed that retrieved miniscrews exhibited a significantly higher failure rate with a risk ratio of 0.46 (95% confidence interval = 0.24, 0.69), indicating a higher likelihood of failure on reuse.

CONCLUSION: There were no significant differences in insertion and fracture torque between new and reused miniscrews. However, reused miniscrews were associated with a higher failure rate. This outcome may be influenced by factors such as sterilization methods, insertion technique, and patient-specific anatomical considerations.

PMID:39472213 | DOI:10.1016/j.ejwf.2024.09.005

Acad Radiol. 2024 Oct 28:S1076-6332(24)00780-3. doi: 10.1016/j.acra.2024.10.019. Online ahead of print.

ABSTRACT

OBJECTIVE: We investigated the value of PET/CT-based multimodal parameters in predicting the degree of differentiation and epidermal growth factor receptor (EGFR) mutations in invasive lung adenocarcinoma (ILA) and assessed the correlation between PET/CT-based multimodal parameters and Ki67.

METHODS: We retrospectively collected 113 patients with ILA who underwent PET/CT examination, and differences in PET/CT multimodal parameters between different differentiation groups were analyzed. Binary logistic regression was used to establish a multiparameter model for predicting EGFR mutation, and ROC curve was used to compare the diagnostic efficiency. Independent predictors of the Ki67 index were screened using multiple linear regression analysis.

RESULTS: The poorly differentiated group was more likely to have large-diameter, solid foci, pleural pulling signs, and vacuolar signs compared with other groups (all P < 0.05). The differences in metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in all three different differentiated groups were statistically significant compared to the other parameters (all P < 0.05). The PET/CT regression model predicted EGFR mutations with an AUC of 0.820 and was higher than other models; the sensitivity, specificity, positive predictive value, and negative predictive value for discriminating EGFR mutations were 84.74%, 70.37%, 75.76%, and 80.85%, respectively. PET/CT multiple linear regression analysis showed that vascular convergence, SUVpeak, MTV, and TLG explaining 62.0% changes in Ki67 (R² = 0.620). SUVpeak, MTV, and TLG (r = 0.580, r = 0.662, and r = 0.680, all P < 0.001) were all strongly correlated with increased Ki67 index.

CONCLUSION: MTV and TLG can better identify the degree of ILA differentiation compared to CT and other PET parameters. The nomogram constructed by multimodal PET/CT parameters can better dynamically monitor the changes of EGFR status and Ki67 index.

PMID:39472205 | DOI:10.1016/j.acra.2024.10.019

Eur Urol. 2024 Oct 28:S0302-2838(24)02647-2. doi: 10.1016/j.eururo.2024.10.006. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Lymph node dissection (LND) has been standard in cancer surgery for more than a century, yet evidence from randomized trials showing a benefit is scarce. We conducted a clinically integrated randomized trial comparing limited versus extended pelvic LND (PLND) during radical prostatectomy and previously reported comparable biochemical recurrence (BCR) rates. We report updated BCR rates and compare rates of metastasis between the study arms.

METHODS: Between October 2011 and March 2017, 1432 patients undergoing radical prostatectomy were enrolled at a single center. Surgeons were cluster randomized to perform limited (external iliac nodes) or extended PLND (external iliac, obturator, and hypogastric nodes) with crossover for 3-mo periods. Cox proportional-hazards regression with robust standard errors clustered by surgeon was used to assess whether the PLND template affected BCR or distant or locoregional metastasis.

KEY FINDINGS AND LIMITATIONS: There were 452 BCR events at median follow-up of 4.2 yr for participants who did not develop BCR. The results confirm our previous finding of comparable BCR rates between the arms (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.97-1.13; p = 0.3). However, with 123 metastasis events and median follow-up of 5.4 yr for patients without metastasis, we found a clinically and statistically significant protective effect of extended PLND against metastasis (any metastasis: HR 0.82, 95% CI 0.71-0.93; p = 0.003; distant metastasis: HR 0.75, 95% CI 0.64-0.88; p < 0.001).

CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients undergoing radical prostatectomy should receive extended PLND that includes the external iliac, obturator, and hypogastric nodes. Further research should examine biological mechanisms regarding the anatomic location of affected nodes. Trials of LND for other cancers are warranted and should consider our clinically integrated design. This trial is registered on ClinicalTrials.gov as NCT01407263.

PMID:39472200 | DOI:10.1016/j.eururo.2024.10.006

J Voice. 2024 Oct 28:S0892-1997(24)00356-4. doi: 10.1016/j.jvoice.2024.10.011. Online ahead of print.

ABSTRACT

OBJECTIVE: In professional singers, allergic rhinitis can lead to dysphonia and alterations in resonance. Each episode of laryngeal inflammation increases the risk of vocal strain or forces singers to cancel performances. This study aimed to analyze differences between allergic and nonallergic professional singers in self-evaluation of voice quality, objective examination of voice, and limitations of professional activities due to voice troubles.

METHODS: Two groups, one with 30 subjects diagnosed with allergic rhinitis (the study group) and the other with 30 subjects without allergic rhinitis (the control group), were recruited from a pool of 167 professional pop singers. All subjects underwent comprehensive rhinological and phoniatric evaluations. The rhinological evaluation included nasal endoscopy, rhinomanometry, and 22-item Sinonasal Outcome Test (SNOT-22) questionnaire. The phoniatric evaluation included laryngostroboscopy, the Voice Handicap Index (VHI) and Singing Voice Handicap Index (SVHI) questionnaires, and the Dysphonia Severity Index (DSI). Statistical analysis was conducted using the Statistical Package for Social Sciences 25.0 (SPSS).

RESULTS: Dust mite allergy was the main cause of symptoms in our series of allergic singers, particularly when associated with seasonal allergens. Comparing singers with allergic rhinitis to those without, the study group had significantly higher scores on the SNOT-22, VHI, and SVHI assessments. Although the median DSI value indicated a good quality of voice in all subjects, it was significantly lower in the allergic group compared with the control group. The odds ratio (OR) indicated an increased risk for allergic singers of needing to postpone performances (OR 3.7), singing with laryngeal inflammation (OR 4.4), or changing the song pitch (OR 22.2).

CONCLUSIONS: Allergic singers experienced severe limitations in their professional activities. Our results suggest that careful management of allergic rhinitis is essential for singers to avoid conditions that could lead to vocal strain.

PMID:39472170 | DOI:10.1016/j.jvoice.2024.10.011

J Voice. 2024 Oct 28:S0892-1997(24)00315-1. doi: 10.1016/j.jvoice.2024.09.024. Online ahead of print.

ABSTRACT

OBJECTIVES: The current study aimed to classify voice signals using narrowband spectrograms and investigate acoustic measures in samples classified as type 1 and rated normal based on auditory-perceptual evaluation.

METHODS: Voice samples of sustained phonation of /a/ of 234 males and 223 females aged between 4 and 16; 11 years were recorded and classified into 5 age groups. Narrowband spectrograms were generated and signal typing was done by two raters. Acoustic parameters for type-I signals were derived using PRAAT software (version 6.3.01). Inter-rater reliability was measured for both signal typing and auditory-perceptual evaluation.

RESULTS: Based on agreement by two raters, around 79% of samples were classified as type 1, 8.5% as type II, and 7.8% as type-III signals. Inter-rater reliability for signal typing and GRBAS (Grade,Roughness, Breathiness, Asthenia, Strained) rating were found to be good (Intraclass Correlation Coefficient-0.90 and 0.81). Overall comparison using analysis of variance revealed statistically significant difference F0-related measures and NHR values (P < 0.05). Within males and females, F0 measures were statistically significant (P < 0.05). Noise-related measures were significant in males (P < 0.05). Independent t test revealed sex differences for F0 measures, jitter %, and NHR values in children above 13 years of age (P < 0.05).

CONCLUSIONS: Normative data obtained in this study can be used as a reference to compare with children with pediatric dysphonia.

PMID:39472169 | DOI:10.1016/j.jvoice.2024.09.024

J Prosthet Dent. 2024 Oct 28:S0022-3913(24)00643-7. doi: 10.1016/j.prosdent.2024.09.015. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: The effects of nonaxial forces on peri-implant bone loss have been investigated, mostly in reference to buccal mesiodistal implant angulations as potential risk indicators. However, when implant angulations are multidirectional, including the buccolingual aspect, evaluations of peri-implant bone loss based solely on mesiodistal measurements may skew the correlation.

PURPOSE: The purpose of this retrospective study was to evaluate the correlation between the magnitudes of multidirectional implant angulations and peri-implant crestal bone loss.

MATERIAL AND METHODS: Data were retrospectively collected and analyzed from clinical records, periapical radiographic images, and computer-aided design (CAD) files of custom abutments. The study included 288 patients with 506 dental implants, and the mean follow-up duration after the placement of definitive prostheses was 5.1 years. Patients with uncontrolled systemic disease were excluded. Variables such as age, sex, type of unit (single-unit or multi-unit), location (maxillary or mandibular and anterior, premolar, or molar), and antagonist (natural tooth, implant-supported prosthesis, or removable prosthesis) were evaluated. The angulation of the implant (mesiodistal and buccolingual) and status of attrition (normal, localized, or generalized) were assessed using the CAD file. The angulation of the implant was then derived from the mesiodistal and buccolingual angle measurements by using a mathematical formula. Peri-implant bone loss was measured from periapical radiographs. A comparison of peri-implant bone loss between axial and nonaxial implants was performed using the Student t test (α=.05). Additional comparative evaluations were performed according to the type of unit, location, antagonist, and status of attrition in reference to the angulation categories.

RESULTS: The mean ±standard deviation peri-implant bone loss over 5 years was 0.10 ±0.39 mm in the axial implants and 0.22 ±0.48 mm in the nonaxial implants. Statistical analysis showed that nonaxial implants had a significantly greater bone loss (P<.05), which was more pronounced when the antagonists were implant-supported prostheses (P<.05) and when the implants were located in the mandible (P<.05).

CONCLUSIONS: A significant correlation was observed between implant angulation and peri-implant bone loss. Nonaxially positioned implants exhibited greater bone loss compared with axially positioned implants. Additionally, the location of the implant and the type of antagonist were found to influence the extent of bone loss. These findings suggest that careful consideration of implant angulation, as well as the position and type of antagonist, is crucial in minimizing peri-implant bone loss.

PMID:39472164 | DOI:10.1016/j.prosdent.2024.09.015

J Prosthet Dent. 2024 Oct 28:S0022-3913(24)00691-7. doi: 10.1016/j.prosdent.2024.09.030. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Speed sintering techniques have been introduced to shorten the sintering time of zirconia ceramics, yet their impact on multilayered zirconia properties remains understudied.

PURPOSE: The purpose of this in vitro study was to assess the effect of speed sintering on the optical properties and the mechanical flexural strength of multilayered zirconia materials.

MATERIAL AND METHODS: A total of 360 disks (Ø14 ±2 mm ×1.2 ±0.02 mm) were fabricated by following the International Organization for Standardization (ISO) 6872:2015 standard using 2 types of Vita A2 shade multilayered zirconia materials: IPS e.max ZirCAD Prime (ZP) and IPS e.max ZirCAD Prime Esthetic (ZPE). Each material comprised translucent (Tr), gradient l (Gr), and dentin (De) layers, with 60 disks per layer. Half were sintered using a standard sintering protocol and half using a speed sintering protocol. Biaxial flexural strength was accessed using a universal testing machine equipped with the Blue Hill Universal software program by following the ISO 6872:2015 standard, with 20 disks per subgroup. The spectrophotometric analysis of optical properties (contrast ratio [CR], translucency parameter [TP], and total transmittance [Tt%]) was performed using a dual-beam spectrophotometer (Ultrascan VIS) in accordance with the ISO 7491:2000 standard, with 10 disks per subgroup. The comparison of the optical properties and the mechanical flexural strength between the speed and standard protocol was analyzed using an unpaired t test (α=.05).

RESULTS: Speed sintering reduced biaxial flexural strength in all ZP layers (P<.05) and in ZPE-Gr (P<.05). A statistically significant difference in the CR was observed in the ZP-Tr, ZP-Gr, and ZPE-Gr layers (P<.05). The TP of the ZP-Gr, ZP-De, and ZPE-Gr layers was significantly lower when using the speed sintering protocol. Tt% was significantly lower with speed sintering for both materials (P<.05).

CONCLUSIONS: Speed sintering statistically changed both the optical (CR, TP, Tt%) and mechanical (flexural strength) properties of multilayered zirconia materials, but the differences may not be clinically relevant.

PMID:39472162 | DOI:10.1016/j.prosdent.2024.09.030