Category: Statistics

Open Forum Infect Dis. 2024 Jun 18;11(7):ofae328. doi: 10.1093/ofid/ofae328. eCollection 2024 Jul.

ABSTRACT

BACKGROUND: Recent advances in shotgun metagenomic sequencing (sMGS) for detecting microbial cell-free DNA (mcfDNA) in peripheral blood have shown promise across various patient populations. This study evaluates the application of sMGS for diagnosing osteoarticular infections (OAIs), a condition with significant diagnostic challenges.

METHODS: We conducted a retrospective analysis on 73 patients suspected of OAIs at the Mayo Clinic from 2019 to 2023, incorporating mcfDNA sMGS (Karius test [KT]) into their diagnostic evaluation. We categorized the clinical impact of KT on OAI diagnoses and management into 4 distinct outcomes. (1) KT was able to confirm an established diagnosis, (2) KT supported noninfectious diseases diagnosis, (3) KT established an unsuspected diagnosis, (4) KT did not add relevant information.

RESULTS: In our cohort, KT was performed in 73 patients. Among the infected individuals, KT yielded positive results in 22 of 43 (51.2%) cases. Of these 22 cases, 11 (50%) showed agreement with conventional diagnostic workup, whereas in 5 (22.7%) cases, the KT established an unsuspected diagnosis. Native vertebral osteomyelitis diagnosis (P < .001) or OAIs with concomitant presence of endocarditis or endovascular infection (P = .005) were statistically associated with a definite, probable, or possible diagnostic certainty of KT result.

CONCLUSIONS: In complex OAIs, KT enhanced diagnostic accuracy by 11.6%, proving especially beneficial in diagnosing native vertebral osteomyelitis and infections with concurrent endocarditis or endovascular complications. Our findings underscore the utility of KT in the diagnostic workflow for challenging OAI cases, potentially altering clinical management for a significant subset of patients.

PMID:38989532 | PMC:PMC11234144 | DOI:10.1093/ofid/ofae328

J Conserv Dent Endod. 2024 Jun;27(6):584-590. doi: 10.4103/JCDE.JCDE_138_24. Epub 2024 Jun 6.

ABSTRACT

AIM OF THE STUDY: This study aims to assess the effect of apical foraminal enlargement on inflammatory markers and pain in patients with asymptomatic single-rooted mandibular teeth with apical periodontitis.

MATERIALS AND METHODS: The study included 60 patients based on inclusion and exclusion criteria. Before beginning root canal treatment (RCT), a blood sample was obtained from the antecubital fossa to evaluate the inflammatory markers, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Access opening was done and initial irrigation was done. Working length (WL) was determined with an electronic apex locator and verified with a radiograph. In the control group, the determined WL was maintained, while in the experimental group, the WL was set till the apical foramen. Biomechanical preparation was done in both groups till F2 or F3 based on the initial apical file, followed by final irrigation and obturation based on the master apical file size. Patients were given a Visual Analog Scale to record pain sensations at 24, 48, and 72 h postoperative. After 72 h, patients were recalled for follow-up appointments, and blood was taken from the antecubital fossa again to evaluate inflammatory markers.

STATISTICAL ANALYSIS: The resultant findings for the reduction in inflammatory markers before and after RCT with or without foraminal enlargement were statistically analyzed using the Student’s t-test. The pain was statistically examined with one-way “analysis of variance” and Tukey’s post hoc test for inter-group comparison of pain. The level of significance was set at P < 0.05. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 23 for Windows (SPSS Inc., Chicago, IL, USA). As pain in the control groups is zero before and after RCT, statistical analysis is not required as the overall pain score is zero.

RESULTS: The P values of the CRP and ESR of the control group were 0.02 and 0.03, respectively, which indicates it is significant whereas the P values of the ESR and CRP of the experimental group were 0.0002 and 0.0008 which indicates it is highly significant. Results indicate that the experimental group is more effective compared to the control group in reducing inflammatory markers. Pain in the control group after RCT was zero at the end of 24, 48, and 72 h. In the experimental group, where RCT was done with apical foraminal enlargement, mild pain was present at the end of 24 h which gradually decreased at the end of 48 h and no pain was reported at the end of 72 h.

CONCLUSION: Reduction in inflammatory markers was more effective in RCT with apical enlargement than without apical enlargement. RCT with apical enlargement caused mild pain in the patients immediately after treatment which gradually decreased over time.

PMID:38989502 | PMC:PMC11232762 | DOI:10.4103/JCDE.JCDE_138_24

J Conserv Dent Endod. 2024 Jun;27(6):603-607. doi: 10.4103/JCDE.JCDE_158_24. Epub 2024 Jun 6.

ABSTRACT

CONTEXT: To improve efficiency, biomechanical preparation in root canal treatment is shifting from manual SS to nickel-titanium (NiTi) rotary devices. While multi-file NiTi systems entail crack and fracture issues, modern single-file systems address these concerns.

AIMS: The aim of this study was to evaluate and compare the effects of different torque settings on dentinal crack formation using single-file systems (SFS) (One Curve [OC]) and multi-file systems (ProTaper Next [PTN]) at different levels of the tooth.

SUBJECTS AND METHODS: The study was conducted on 45 freshly extracted human mandibular premolars divided into groups: OC at minimal and maximal torque, PTN at minimal and maximal torque, and a control group. After canal preparation, teeth were horizontally sectioned at 3, 6, and 9 mm from the apex, and then examined for cracks using a stereomicroscope.

STATISTICAL ANALYSIS USED: This was analyzed using Chi-square test.

RESULTS: PTN group: Highest crack rates at the middle (55.6%) and apical (77.8%) thirds with maximum torque; OC group: Highest rates at the middle (22.2%) with minimal torque and apical (11.1%) with maximum torque.

CONCLUSIONS: Maximal torque settings had more incidence of cracks compared to minimal torque settings. It can be stated that SFS (OC) produced less cracks compared to multi-file system (PTN) at both minimal and maximal torque settings.

PMID:38989499 | PMC:PMC11232774 | DOI:10.4103/JCDE.JCDE_158_24

J Conserv Dent Endod. 2024 Jun;27(6):577-583. doi: 10.4103/JCDE.JCDE_167_24. Epub 2024 Jun 6.

ABSTRACT

CONTEXT AND AIMS: This study evaluated the effect of calcium silicate and sodium phosphate (CSSP) dentifrice and serum on the surface of enamel bleached with hydrogen peroxide (H₂O₂).

MATERIALS AND METHODS: A total of 160 bovine enamel slabs were bleached with 35% H₂O₂ and treated with sodium fluoride (NaF) dentifrice-GI, CSSP dentifrice-GII; CSSP dentifrice + CSSP serum-GIII, or NaF dentifrice + NaF gel-GIV. The dentifrices were applied using a brushing machine three times daily for 7 days. After brushing, sodium phosphate gel and CSSP serum were applied. The microhardness (KNH, n = 14), surface roughness (Ra, n = 14), energy dispersive spectroscopy (n = 6), and scanning electron microscopy (n = 6) were assessed at t₀ (before bleaching), t₁ (after bleaching), and t₂ (after postbleaching treatments).

STATISTICAL ANALYSIS USED: The data were subjected to a two-way analysis of variance and Bonferroni’s test.

RESULTS: The KNH decreased at t₁ (P < 0.001) but recovered at t₂ for all treatments, although only GII showed restored baseline values (P = 0.0109). The surface roughness increased at t₁ (P < 0.001) and reduced at t₂ (P < 0.001) for all groups, with no significant differences among groups. Enamel composition and morphology did not differ after the treatments, except for silicon accumulation in GIII.

CONCLUSIONS: Postbleaching treatment with CSSP dentifrice and serum yielded superior remineralizing effects on bleached enamel.

PMID:38989498 | PMC:PMC11232766 | DOI:10.4103/JCDE.JCDE_167_24

J Conserv Dent Endod. 2024 Jun;27(6):613-620. doi: 10.4103/JCDE.JCDE_126_24. Epub 2024 Jun 6.

ABSTRACT

AIM: The aim of the study was to investigate the disinfecting efficacy of a standardized irrigating solution activated by ultrasonics or laser irradiation on mature dual-species biofilms at different root levels in vitro.

MATERIALS AND METHODS: Conventional access cavity preparations were done on 160 single-rooted mandibular premolar teeth with single canals. Freshly extracted oral microbial strains of Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, and Candida albicans after biochemical confirmation were used to generate two discrete dual-species microbial inoculums. The sterilized tooth samples were randomly segregated into two groups (n = 80) and inoculated with a mixed inoculum of S. aureus + E. faecalis strains (Group 1) and S. mutans + C. albicans strains (Group 2), respectively. Following the 21-day incubation period under aerobic conditions, the infected specimens in each group were divided into four subgroups (n = 20) and subjected to experimental treatment protocols. This included a positive control (no treatment of biofilms), syringe irrigation alone with TruNatomy needle, passive ultrasonically activated irrigation with 20# Irrisafe tip, and laser agitation of irrigant with Er,Cr:YSGG laser using RFT 2 laser tip. Root canals of experimental specimens (except the control samples) are instrumented with TruNatomy rotary file system using 1:1 mixture of 3% NaOCl and 18% etidronic acid as irrigants. The quantitative assessment of reduction in viable biofilm microbes after treatment was done using colony-forming unit counts and confocal laser scanning microscopy image analysis. The obtained data were analyzed statistically with a significant level set at 0.05.

RESULTS: Laser-assisted irrigation has shown a considerably higher mean percentage reduction of microbes compared to ultrasonic agitation and the syringe irrigation showed the least microbial reduction (P = 0.001). No significant difference was noted between the three root regions of ultrasonic and laser groups (P > 0.05), whereas in the syringe groups, apical portions showed higher microbial counts compared to cervical and mid-root regions (P = 0.001).

CONCLUSION: Erbium laser-assisted irrigation has performed superior to ultrasonic agitation against both the experimental dual-species biofilms, while the syringe irrigation showed the least microbial reduction specifically at apical root portions.

PMID:38989494 | PMC:PMC11232759 | DOI:10.4103/JCDE.JCDE_126_24

J Conserv Dent Endod. 2024 Jun;27(6):654-661. doi: 10.4103/JCDE.JCDE_146_24. Epub 2024 Jun 6.

ABSTRACT

INTRODUCTION: This study aimed to evaluate and compare postoperative pain (PP) in single-visit nonsurgical endodontic retreatment (SV NSER) with 2% chlorhexidine (CHX), 0.1% octenidine (OCT) with or without ozone, and 5.25% sodium hypochlorite (NaOCl).

MATERIALS AND METHODS: In this randomized, parallel, prospective, double-blind, clinical trial, 132 single-rooted, root-filled teeth with symptomatic apical periodontitis (AP) requiring NSER were allocated into six groups randomly (n = 22/group): 2% CHX with NaOCl (CHXH), 2% Ozonated CHX without NaOCl (OCHX), 2% Ozonated CHX with NaOCl (OCHXH), 0.1% OCT with NaOCl (OCTH), 0.1% Ozonated OCT without NaOCl (OOCT), and 0.1% Ozonated OCT with NaOCl (OOCTH). Standard NSER protocol was followed groups were irrigated with 15 ml of ozonated or nonozonated irrigant (CHX/OCT) for 3-5 min with ultrasonic agitation. PP at baseline, after 6, 12, 24, 48 h, and 7 days was recorded using the Visual Analog Scale (VAS). Logistic regression of predictor variables was compared using the Chi-square test. For group-wise and time-wise comparisons, a two-way analysis of variance followed by the post hoc Bonferroni test was carried out.

RESULTS: None of the patient-related variables in logistic regression obtained a statistically significant (P > 0.05) role in PP. The VAS score after 6 h was OCHX (4.72) > OOCT (4.42) > CHXH (4.23) > OCTH (3.95) > OCHXH (3.42) > OOCTH (3.21). OOCTH and OCHXH groups demonstrated statistically significant reductions in VAS scores at various time intervals (P < 0.05).

CONCLUSION: SV NSER with ozonated OCT, CHX irrigation, and NaOCl resulted in lesser PP at all time intervals, i.e., 6, 12, 24, 48 h, and 7 days in patients with symptomatic AP.

PMID:38989488 | PMC:PMC11232761 | DOI:10.4103/JCDE.JCDE_146_24

J Conserv Dent Endod. 2024 Jun;27(6):634-638. doi: 10.4103/JCDE.JCDE_130_24. Epub 2024 Jun 6.

ABSTRACT

CONTEXT: An unfavorable event that can hinder endodontic treatment and affect the outcome of root canal treatment is the separation of endodontic instruments. Endodontic instrument separation can occur due to clinical or metallurgical factors. Friction between the ultrasonic tip and the remaining dentin generates heat, which is subsequently transferred to the external root surface. Elevated temperatures exceeding 10°C above body temperature for more than a minute may result in injury to periodontal or bone tissue.

AIM: The aim of this study was to evaluate and compare temperature rise on the external root surface of teeth during retrieval of broken NiTi instrument using two different ultrasonic tips and two power settings.

MATERIALS AND METHODS: In each group, a sample size of 8 was sufficient to attain a statistical power exceeding 90%, enabling the detection of a minimum mean difference of 0.9204 (delta) through a one-way ANOVA test at a 95% confidence level (alpha 0.05). After access opening and working length determination, samples were randomly distributed into two groups – Group 1 (A and B) – ProUltra tip at high and low power settings and Group 2 (A and B) – Cric Dental IR3 at high and low power settings. The temperature rise was measured using K-type thermocouple thermometer. The comparisons were analyzed using the Kruskal-Wallis test with pairwise comparisons using the Dunn’s test.

RESULTS: Group 1A and Group 1B resulted in lower heat generation compared to Group 2A and 2B and its difference was statistically significant (P < 0.05). Minimum temperature rise is seen in the ProUltra group at lower power settings (Group 1A) at the apical level and maximum temperature rise is seen in the Cric Dental IR3 group at higher power settings (Group 2B) at the middle third level.

CONCLUSION: It was found that there is a significant temperature rise seen when ultrasonic tips are used for the retrieval of separated files, especially at higher power settings. The ProUltra tip demonstrated the lowest temperature rise at lower power settings, particularly at the apical level, whereas the IR3 Cric Dental tip exhibited the highest temperature rise, notably at higher power settings and the middle third level.

PMID:38989487 | PMC:PMC11232763 | DOI:10.4103/JCDE.JCDE_130_24

J Conserv Dent Endod. 2024 Jun;27(6):591-597. doi: 10.4103/JCDE.JCDE_115_24. Epub 2024 Jun 6.

ABSTRACT

AIM: The aim of this study was to compare the effect of two calcium silicate-based and an epoxy resin-based root canal sealers on postoperative pain and analgesic intake following single-visit root canal treatment.

MATERIALS AND METHOD: Ninety patients with at least one first or second molar tooth diagnosed as symptomatic irreversible pulpitis and symptomatic apical periodontitis were selected and allocated into three groups (n=30) according to the sealer used. Root canals were prepared using Protaper Gold instruments (Dentsply Sirona) in a crown down technique and irrigated with 2.5% NaOCl (Calyx, India) and saline solution. Root canal filling was then accomplished with a single cone obturation technique and treated in a single visit by the same endodontist. Patients were told to use a Visual Analog Scale (VAS) to rate their postoperative pain severity as none, minimal, moderate, or severe after 6 h, 24 h, 48 h, 5 days and 7 days following obturation using the appropriate sealers. The need for analgesic intake was also recorded. The data were statistically analyzed.

RESULTS: Results showed a significant difference among the studied groups. Bio-C Sealer Ion+ reported the least pain score followed by Nishika Canal Sealer BG and AH plus sealer at all the time intervals recorded. The intergroup analysis, revealed was a significant difference in postoperative pain at 6 h (p=0.000) and 24 h (p = 0.028), but not at 48 h, 5 day or 7 days (P > 0.05). VAS ratings for all the three groups decreased over time. Also, there were significant differences between the means of analgesic intake among 3 groups (p=0.022). Analgesic intake in group BIO-C Sealer Ion+ is significantly lesser than AH Plus and Nishika Canal Sealer BG group.

CONCLUSION: Calcium silicate-based sealer (Nishika Canal Sealer BG and Bio-C Sealer Ion+) resulted in significantly lower levels of pain as compared to epoxy resin-based sealer (AH Plus) at 6h and 24-h interval, there was no significant difference in postoperative pain occurrence at 48-h, 5 day and 7-day period. The analgesic intake in Bio-C Sealer Ion+ group is significantly lesser than Nishika Canal Sealer BG and AH Plus group.

PMID:38989484 | PMC:PMC11232765 | DOI:10.4103/JCDE.JCDE_115_24

J Conserv Dent Endod. 2024 Jun;27(6):621-625. doi: 10.4103/JCDE.JCDE_136_24. Epub 2024 Jun 6.

ABSTRACT

AIM: The study aimed to comparatively evaluate the effect of eugenol exposure time on the micro-shear bond strength (μ-SBS) of etch-and-rinse and a self-etch adhesive to dentin.

MATERIALS AND METHODS: One hundred and twelve teeth samples were prepared from bisectioning 56 freshly extracted human mandibular molars and were randomly divided into 14 subgroups of 8 samples each (n = 8). Three subgroups containing eugenol and a noneugenol-based restorative material were placed on the dentin surface and left for 24 h, 7 days, and 14 days, respectively, and were compared to a control. Two bonding systems were evaluated: one being etch-and-rinse and the other self-etch adhesive. The μ-SBS were calculated and expressed in MPa.

STATISTICAL ANALYSIS: The data were analyzed using mixed model analysis of variance. The level of statistical significance was set at 5%.

RESULTS: There was a statistically significant reduction in the μ-SBS values when the self-etch adhesive was used, after the removal of eugenol-containing cement placed for 24 h. However, the reduction in the μ-SBS values after 7 days or 14 days was not significant.

CONCLUSION: Exposure to eugenol containing temporary cement for 24 h significantly reduces the μ-SBS of self-etching adhesives to dentin. However, exposure for 1 week or more has minimal effects.

PMID:38989483 | PMC:PMC11232768 | DOI:10.4103/JCDE.JCDE_136_24

J Gastrointest Oncol. 2024 Jun 30;15(3):1112-1121. doi: 10.21037/jgo-24-282. Epub 2024 Jun 17.

ABSTRACT

BACKGROUND: Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) can achieve longer overall survival (OS) and disease-free survival (DFS) in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI). We investigated whether this treatment strategy could benefit these patients by mediating the dysfunctional immunological status. Therefore, a retrospective cohort study was conducted to investigate the effect of early PA-TACE in HCC patients with MVI by measuring the levels of T helper cell 17 (Th17) and regulatory T cell (Treg).

METHODS: This study retrospectively included 472 patients with HCC undergoing hepatectomy between December 2015 and December 2018, and 115 patients with MVI confirmed by postoperative pathology were enrolled and divided into two groups of TACE group and non-TACE group according to whether TACE was performed. HCC patients with MVI. The proportion of Treg and Th17 cells in peripheral blood was measured one day before and four weeks after TACE. All patients in the two groups were followed up until death or until the study ended in December 2023. The rates of OS and progression-free survival (PFS) in patients with MVI were compared between those who received hepatectomy alone and those who underwent early PA-TACE.

RESULTS: Among 115 HCC patients with MVI from 472 patients, the study enrolled 51 patients with PA-TACE into the TACE group and 42 patients without TACE into the non-TACE group. There were no statistical differences in baseline data between the two groups (all P>0.05). The frequency of Treg among CD4+ T cells in HCC patients with PA-TACE was significantly lower than baseline (7.34%±3.61% vs. 5.82%±2.76%, P<0.001), and the frequency of Th17 among CD4⁺ T cells in these patients was significantly higher than baseline (0.49%±0.28% vs. 0.50%±0.25%, P<0.001). Among all the patients, the median OS was 61.8 months. The OS rate and PFS rate at 12, 36, and 60 months in the TACE group were significantly higher than those in the non-TACE group (all P<0.05).

CONCLUSIONS: PA-TACE may have roles in improving survival outcomes, and restoring immune homeostasis in HCC patients with MVI after hepatectomy.

PMID:38989441 | PMC:PMC11231867 | DOI:10.21037/jgo-24-282