Nevin Manimala

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

J Prosthet Dent. 2024 Oct 28:S0022-3913(24)00687-5. doi: 10.1016/j.prosdent.2024.09.027. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: As part of the growing digitization of the dental field, clinicians are looking for ways to simplify digital workflow, reduce chairside time, and provide new work patterns for future applications. Whether scanning with a multifunctional apparatus (MFA) scan body results in improved scanning is unclear.

PURPOSE: The purpose of this in vitro study was to compare the horizontal, vertical, and angular deviations with the MFA scan body with a commercially available scan body (SBIO).

MATERIAL AND METHODS: Sixteen identically printed edentulous maxillary models were used to plan two Ø3.8×11.5-mm implants in the right maxillary first molar and left maxillary central incisor locations. Two implants in each model were installed using a surgical guide. The models were scanned using an intraoral scanner with MFA and then rescanned twice, with SBIO using the intraoral scanner and a laboratory 3D scanner. The implants were digitally positioned according to the scanned MFA and SBIO locations in standard tessellation language (STL) files. These STL files were superimposed on the reference laboratory 3D scanner STL files. Linear measurements included implant apex/cervical horizontal/vertical deviations, as well as implant axis angular deviations. Normality was evaluated with the Shapiro-Wilk test. Paired samples t tests (2 sided) were used for the mean SBIO-MFA deviation difference. To compare the molar/incisor sites, paired samples Wilcoxon tests were used (α=.05 for all tests).

RESULTS: No statistically significant differences were found between the MFA/ SBIO deviations, for each of the 10 sites × deviation combinations (P>.05). Overall, the lowest endpoint of the 95% confidence intervals among the 8 linear measurement comparisons was -0.107 mm (coronal vertical deviation, right maxillary first molar site) and -0.30 degrees between the 2 angular measurement comparisons.

CONCLUSIONS: The current in vitro study demonstrated high accuracy for the novel MFA device, similar to that of the standard SBIO scan body. Furthermore, the current study offers an alternative technique to evaluate the accuracy of implant placement by using scanning and back programming over the traditional postplacement cone beam computed tomography (CBCT) scanning.

PMID:39472161 | DOI:10.1016/j.prosdent.2024.09.027

Ultrasound Med Biol. 2024 Oct 28:S0301-5629(24)00369-7. doi: 10.1016/j.ultrasmedbio.2024.09.023. Online ahead of print.

ABSTRACT

OBJECTIVE: Arterial stiffening serves as an early indicator for a variety of cardiovascular diseases. Arterial Dispersion Ultrasound Vibrometry (ADUV) is a method that leverages acoustic radiation force to stimulate arterial wall motion, assess wave propagation characteristics, and subsequently calculate the arterial shear modulus. Previously, we introduced an inversion technique based on a guided cylindrical wave model, which proved effective in rubber tube phantom experiments. In this study, we broaden the scope of our investigation from phantom experiments to in vivo examination of common carotid arteries in human subjects, identify the challenges, and provide solutions, leading to a systematic protocol for ADUV application and robust estimation of the elastic modulus of common carotid arteries.

METHODS: We achieve this by analyzing ADUV data from 59 subjects categorized as (a) confirmed atherosclerotic cardiovascular disease (n = 27), (b) with cardiovascular risk factors (n = 20), and (c) healthy (n = 12). A crucial aspect of this work is the development of metrics to differentiate high-quality ADUV data from unusable data.

RESULTS AND CONCLUSIONS: With the proposed metrics, in our cohort, we observed 82% of diameter data and 78% of motion data as usable data. Future work will involve applying this protocol to a larger cohort with subsequent statistical analysis to assess and validate the resulting biomarkers.

PMID:39472160 | DOI:10.1016/j.ultrasmedbio.2024.09.023

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2024 Oct 20;42(10):757-762. doi: 10.3760/cma.j.cn121094-20231218-00159.

ABSTRACT

Objective: To investigate the health status and the influencing factors of abnormal lung function of welding fumes exposure workers in Tianjin from 2020 to 2022, and to provide theoretical basis for the protection and intervention of key occupational diseases. Methods: In October 2023, the relevant data of occupational health examination of welding fumes exposure workers in Tianjin from 2020 to 2022 (10831, 10758 and 21717 in 2020, 2021 and 2022, respectively) were collected from the China Disease Prevention and Control Information Platform. The electrocardiogram, chest radiograph and lung function abnormalities of workers in each year were analyzed, as well as the association between lung function abnormalities and gender, age, working age, region, etc. With gender, age and years of service as independent variables, logistic regression analysis was performed year by year on the influencing factors of abnormal lung function. Results: From 2020 to 2022, electrocardiogram, chest radiograph and lung function abnormality rates of workers exposed to welding fumes had statistical significances (χ(2)=301.79, 7.87, 1614.54, P<0.05), and the lung function abnormality rate showed a downward trend year by year (χ(2)(trend)=1516.19, P<0.001). The abnormal rates of lung function in male workers exposed to welding fumes were higher than those in female workers (χ(2)=61.65, 8.04, 15.22, P<0.05). With the increase of age, the abnormal rate of lung function showed an increasing trend (χ(2)(trend)=6.47, 10.81, 4.72, P<0.05). The abnormal rates of lung function in the four districts around the city in each year were 22.05% (318/1442), 8.91% (171/1919) and 6.48% (273/4212), respectively. Year by year logistic regression analysis showed that females were the protective factors for abnormal lung function (OR=0.369, 0.568, 0.546; 95%CI: 0.298-0.458, 0.367-0.879, 0.388-0.767; P<0.05) . Conclusion: Attention should be paid to the health status of welding fumes workers in Tianjin, focusing on the protection of middle-aged male workers, and effective prevention measures should be taken for key areas and industries such as the four districts around the city.

PMID:39472139 | DOI:10.3760/cma.j.cn121094-20231218-00159

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2024 Oct 20;42(10):743-745. doi: 10.3760/cma.j.cn121094-20230609-00200.

ABSTRACT

Objective: To analyse the characteristics of micronuclus and chromosomal aberrations and the lens opacity in different working years, ages and work type of radiation workers with lens opacity. Methods: In January 2022, we selected 400 radiation workers with lens opacity who had undergone occupational health examination in Hangzhou Hospital for the Prevention and Treatment of Occupational Disease from March 2014 to December 2021 as research objects. To analyze the differences of micronucleus, chromosome aberration and the lens opacification rates of different length of service, type of work, age radiologic workers. Results: The results showed that radiation the micronucleus abnormality (0.59‰) and chromosome aberration (2.67%) in peripheral blood in workers who served more than 20 years were significantly higher than that of micronucleus abnormality (0.18‰) and chromosome aberration (0.31%) in workers served less than 20 years, the differences were statistically significant (P<0.05). The micronucleus abnormality (0.32‰) and chromosome aberration (0.57%) in the interventionist were higher than oral radiation workers (0.12‰ and 0.19%) and diagnostic radiologist (0.05‰ and 0.12%), the differences were statistically signcficant (χ(2)=23.98, 6.72, P<0.05) . Conclusion: The rates of micronucleus and chromosome aberration of the interventionaist are higher than oral radiation workers and the traditional radiologist. Workers engaged in radiation should improve personal protection and undertake regular occupational health examinations.

PMID:39472136 | DOI:10.3760/cma.j.cn121094-20230609-00200

Blood Adv. 2024 Oct 29:bloodadvances.2024013926. doi: 10.1182/bloodadvances.2024013926. Online ahead of print.

ABSTRACT

Disease-modifying therapies are standard of care (SOC) for sickle cell disease (SCD), but hematopoietic cell transplantation (HCT) has curative potential. We compared outcomes prospectively through 2-years after biologic assignment to a Donor or No Donor (SOC) Arm based on the availability of an HLA-matched sibling or unrelated donor (BMTCTN 1503; NCT02766465). A donor search was commenced after eligibility confirmation. The primary endpoint was the comparison of survival 2 years after biologic assignment between treatment arms. Power calculations required 60 participants on the Donor Arm and 140 on the No Donor Arm to determine if early transplant-related mortality might be balanced by disease-related mortality over a longer period of follow-up. Secondary objectives compared changes in SCD-related events, functional outcomes, and organ function. Data were analyzed by the intent-to-treat principle. A total of 113 participants were enrolled, 28 on the Donor and 85 on the No Donor Arm The 2-year probabilities of survival were 89% and 93%, on the Donor and No Donor Arms, respectively. Vaso-occlusive pain (VOC) was less frequent on the Donor Arm in the second year after biologic assignment (p < 0.001). On PROMIS-57 surveys there was decreased fatigue (p=0.003) and an increased ability to participate in social roles and activities (p=0.003) on the Donor Arm 2-years after biologic assignment. Differences in other secondary outcomes did not reach statistical significance. Barriers to accrual prevented an objective comparison of survival. Assignment to the Donor Arm led to improvements in VOC, fatigue, and social function.

PMID:39471440 | DOI:10.1182/bloodadvances.2024013926