Nevin Manimala

Int J Oral Maxillofac Implants. 2023 Nov 8;0(0):1-25. doi: 10.11607/jomi.10560. Online ahead of print.

ABSTRACT

AIM: This report stems from a homogeneous patient cohort from two similarly designed prospective controlled studies in the same center on surgical reconstructive treatment of peri-implantitis. The aim of this re-analysis study was exploring prognostic factors associated with surgical outcomes.

MATERIALS AND METHODS: Individual patient data of both studies were gathered. The initial study employed a submerged healing approach via primary wound closure with implant supra-structure removal and complete coverage of grafted sites. The second study employed a non-submerged healing protocol in which healing abutments were kept in place and the implant was not fully submerged. Both studies measured all outcomes at similar timepoints throughout 1 year, to include clinical and radiographic defect fill (DF and RDF), reduction of pocket depth (PDR) and bleeding on probing (BOP). Multi-level regression was used for statistical assessment of outcomes, relative to the impact of site-/local-, surgical- and patient-related variables.

RESULTS: Overall, 59 implants (30 in submerged and 29 in the non-submerged group) were treated. A statistically significant higher DF (on average 0.9 mm higher), RDF (1.7 mm) and PDR (1.3 mm) were observed when a submerged reconstructive approach was performed, whereas BOP reduction was similar. After controlling for treatment (submerged/non-submerged), there were no other significant associations with patient- (age, gender, smoking, prior periodontitis etc.), or implant-related (previous prosthesis type, arch, KTW, etc.) factors.

CONCLUSION: Within its limitations, we conclude that a submerged reconstructive approach for surgical management of peri-implantitis leads to significantly enhanced clinical and radiographic outcomes when compared to a non-submerged approach.

PMID:37939242 | DOI:10.11607/jomi.10560

Int J Oral Maxillofac Implants. 2023 Nov 8;0(0):1-23. doi: 10.11607/jomi.10468. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this clinical study was to determine the accuracy of dental implant placement by using haptic robotic guidance in a large clinical series.

MATERIAL AND METHODS: In a prospective single-arm clinical study, 108 patients received 273 individual endosteal implants. A virtual preoperative restorative and surgical plan was created from a cone beam computed tomography (CBCT) scan and matched to the surgical workspace on the day of surgery via either a tooth-based or a bone-based fiducial splint. Intraoperatively, the surgeon manipulated a handpiece attached to haptic robotic guidance arm. A variety of drills and implants were used in this series. Both the osteotomy and the implant placement were guided by 3D haptic constraints according to the virtual plan. A postoperative CBCT scans permitted the calculation of the deviations of the actual implant placement compared to the plan for accuracy. Precision was calculated by comparing standard deviations from published literature.

RESULTS: The implants were evenly distributed by jaw with 47% placed in the maxilla and 53% in the mandible. The mean ± standard deviation signed depth deviation was 0.14 ± 0.87 mm proud. The global angular deviation averaged 1.42 ± 1.53 degrees with 95% confidence limits of 1.24 degrees and 1.60 degrees. The crown of the actual placed implant showed an average deviation from the plan of 1.10 ± 0.69 mm and the apex a deviation of 1.12 ± 0.69 mm. Haptic robotic-guidance showed greater precision than freehand, static computer-guided and dynamic computer-guided implant placement.

CONCLUSION: This large clinical series of 273 implants shows a high accuracy of implant placement in comparison to published accuracy for angular deviations for any technology as well as demonstrating statistically greater precision. Long-term clinical studies are necessary to establish the true effect of increased accuracy on clinical outcomes. Using haptic robotic guidance provides accurate implant placement while allowing additional benefits compared to computer-guided surgery, namely full visualization of the surgical field and the ability to change the plan intra-operatively.

PMID:37939239 | DOI:10.11607/jomi.10468

Int J Oral Maxillofac Implants. 2023 Nov 8;0(0):1-22. doi: 10.11607/jomi.10449. Online ahead of print.

ABSTRACT

PURPOSE: Clopidogrel is a P2Y12 purinergic receptor inhibitor and a widely prescribed antiplatelet drug for the prevention of atherosclerotic events. Accumulated evidence suggests that purinergic receptors regulate important functions in bone healing and homeostasis. The purpose of the present study was to evaluate the effect of continuous perioperative clopidogrel treatment on osseointegration of titanium implants.

MATERIALS AND METHODS: Thirty two white New Zealand rabbits were randomly assigned in two groups: a clopidogrel group and a control group. Rabbits of the clopidogrel group received daily 3mg/kg of clopidogrel and the control group received vehicle for one week prior to the surgical placement of a titanium implant in their medial femoral condyle; treatment was continued for another six weeks postoperative. At this time, postmortem histologic and histomorphometric evaluation of the implants was performed.

RESULTS: Surgical procedures and postoperative period were uneventful and well tolerated by all animals without any surgical wound dehiscence, signs of infection or other complication. No implant failure was observed in any of the groups. Histomorphometric analysis showed that BIC (%) was 48.77% for the clopidogrel group and 34.65% for the control group with statistically significant difference between them (P < 0.001). Moreover, clopidogrel group had significantly greater bone tissue density (40.52 % vs 28.74 %, p<0.001) and mean trabecular thickness (284.7 μm vs 180.7 μm, p<0.001) in proximity to the implant surface, while mean trabecular number had no difference between groups (1.56 vs 1.60, p=0.961).

CONCLUSIONS: The present study showed that continuous clopidogrel treatment does not negatively affect osseointegration, but rather promotes it in terms of BIC and bone density around the titanium implants. Further studies on the effect of the P2Y12 receptor and its antagonists on peri-implant bone homeostasis may provide useful information or applications for long-term success of dental implant therapy.

PMID:37939235 | DOI:10.11607/jomi.10449

J Nurs Adm. 2023 Nov 8. doi: 10.1097/NNA.0000000000001360. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to investigate the relationship between nurses’ job crafting, organizational identification, and work attachment.

BACKGROUND: Job crafting is a proactive activity in which nurses adapt the physical, cognitive, or social aspects of their jobs to make them more meaningful. Nurses are considered fundamental healthcare stakeholders who are able to transform initiatives implemented by the healthcare organization into valuable work outcomes. Nurses’ perceptions of their jobs shape the community’s opinion toward an organization.

METHODS: This is a descriptive correlational study. Two hundred seventy nurses were recruited from 1 governmental hospital in Egypt. Respondents completed the self-administered, printed questionnaires. Measures included job crafting, organizational identification, and work attachment questionnaires. Findings were investigated via descriptive and inferential statistics.

RESULTS: Over half of the nurses reported a moderate level of job crafting, whereas none of the nurses reported a high level of organizational identification. More than half of the nurses reported low levels of work attachment.

CONCLUSION: Job crafting is significantly related to nurses’ organizational identification and work attachment.

PMID:37939170 | DOI:10.1097/NNA.0000000000001360

Clin Cancer Res. 2023 Nov 8. doi: 10.1158/1078-0432.CCR-23-0561. Online ahead of print.

ABSTRACT

BACKGROUND: The MONALEESA-2, -3, -7 trials demonstrated statistically significant and clinically meaningful progression-free survival (PFS) and overall survival (OS) benefits with ribociclib + endocrine therapy (ET) vs ET alone in hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer (ABC). Understanding the association of intrinsic subtypes with survival outcomes could potentially guide treatment decisions. Here, we evaluated the association of intrinsic subtypes with OS in MONALEESA-2, -3, -7.

PATIENTS AND METHODS: Tumor samples from MONALEESA-2, -3, -7 underwent PAM50-based subtyping. The relationship between subtypes and OS was assessed using univariable and multivariable Cox proportional hazards models. Multivariable models were adjusted for clinical prognostic factors.

RESULTS: Overall, 990 tumors (among 2066 patients) from ribociclib (n=580) and placebo (n=410) arms were profiled. Subtype distribution was luminal A, 54.5%; luminal B, 28.0%; HER2E, 14.6%; basal-like, 2.8%; and was consistent across treatment arms. The luminal A subtype had the best OS outcomes in both arms, while basal-like had the worst. Patients with HER2E (HR, 0.60; P=.018), luminal B (HR, 0.69; P=.023), and luminal A (HR, 0.75; P=.021) subtypes derived OS benefit with ribociclib. Patients with basal-like subtype did not derive benefit from ribociclib (HR, 1.92; P=.137); however, patient numbers were small (n=28).

CONCLUSION: The prognostic value of intrinsic subtypes for OS was confirmed in this pooled analysis of the MONALEESA trials (largest data set in HR+/HER2- ABC). While basal-like subtype did not benefit, a consistent OS benefit was observed with ribociclib added to ET across luminal and HER2E subtypes.

PMID:37939142 | DOI:10.1158/1078-0432.CCR-23-0561

PLoS Comput Biol. 2023 Nov 8;19(11):e1011607. doi: 10.1371/journal.pcbi.1011607. Online ahead of print.

ABSTRACT

Ecological interactions are fundamental at the cellular scale, addressing the possibility of a description of cellular systems that uses language and principles of ecology. In this work, we use a minimal ecological approach that encompasses growth, adaptation and survival of cell populations to model cell metabolisms and competition under energetic constraints. As a proof-of-concept, we apply this general formulation to study the dynamics of the onset of a specific blood cancer-called Multiple Myeloma. We show that a minimal model describing antagonist cell populations competing for limited resources, as regulated by microenvironmental factors and internal cellular structures, reproduces patterns of Multiple Myeloma evolution, due to the uncontrolled proliferation of cancerous plasma cells within the bone marrow. The model is characterized by a class of regime shifts to more dissipative states for selectively advantaged malignant plasma cells, reflecting a breakdown of self-regulation in the bone marrow. The transition times obtained from the simulations range from years to decades consistently with clinical observations of survival times of patients. This irreversible dynamical behavior represents a possible description of the incurable nature of myelomas based on the ecological interactions between plasma cells and the microenvironment, embedded in a larger complex system. The use of ATP equivalent energy units in defining stocks and flows is a key to constructing an ecological model which reproduces the onset of myelomas as transitions between states of a system which reflects the energetics of plasma cells. This work provides a basis to construct more complex models representing myelomas, which can be compared with model ecosystems.

PMID:37939139 | DOI:10.1371/journal.pcbi.1011607

Clin Cancer Res. 2023 Nov 8. doi: 10.1158/1078-0432.CCR-23-1889. Online ahead of print.

ABSTRACT

PURPOSE: Evidence suggests that MAPK pathway activation, as measured by ERK1/2 phosphorylation (p-ERK), predicts overall survival (OS) in recurrent glioblastoma patients receiving anti-PD-1 therapy. We aimed to validate these findings in independent cohorts.

EXPERIMENTAL DESIGN: In a 24-patient clinical trial on recurrent glioblastoma and high-grade gliomas, we examined the link between p-ERK levels and overall survival (OS). Patients received intravenous nivolumab, followed by maximal safe resection and an intracerebral injection of either ipilimumab alone or combined with nivolumab. Bi-weekly adjuvant nivolumab was then administered up to five times (NCT03233152). Using REMARK criteria, we conducted independent analyses for p-ERK quantification and statistical evaluations. Additional comparative analysis included prior cohorts, totaling 65 patients. Cox proportional hazards models and meta-analysis were employed to assess p-ERK as a predictive biomarker post-immunotherapy.

RESULTS: Lower median p-ERK+ cell density was observed compared to prior studies, likely due to tissue handling variances. Nonetheless, high p-ERK was associated with prolonged OS, particularly in IDH wild-type glioblastomas (P=0.036). Median OS for high and low p-ERK patients were 55.6 and 30 weeks, respectively. Multivariable analysis reinforced p-ERK’s significance in survival prediction (P=0.011). Meta-analysis across three cohorts (n=65) supported the survival benefit of elevated tumor p-ERK levels (P=0.0424).

CONCLUSIONS: This study strengthens the role of p-ERK as a predictive biomarker for OS in glioblastoma patients on immune checkpoint blockade. Future research should focus on further validation in prospective trials and the standardization of preanalytical variables influencing p-ERK quantification.

PMID:37939133 | DOI:10.1158/1078-0432.CCR-23-1889

PLoS Biol. 2023 Nov 8;21(11):e3002373. doi: 10.1371/journal.pbio.3002373. Online ahead of print.

ABSTRACT

Corrective feedback received on perceptual decisions is crucial for adjusting decision-making strategies to improve future choices. However, its complex interaction with other decision components, such as previous stimuli and choices, challenges a principled account of how it shapes subsequent decisions. One popular approach, based on animal behavior and extended to human perceptual decision-making, employs “reinforcement learning,” a principle proven successful in reward-based decision-making. The core idea behind this approach is that decision-makers, although engaged in a perceptual task, treat corrective feedback as rewards from which they learn choice values. Here, we explore an alternative idea, which is that humans consider corrective feedback on perceptual decisions as evidence of the actual state of the world rather than as rewards for their choices. By implementing these “feedback-as-reward” and “feedback-as-evidence” hypotheses on a shared learning platform, we show that the latter outperforms the former in explaining how corrective feedback adjusts the decision-making strategy along with past stimuli and choices. Our work suggests that humans learn about what has happened in their environment rather than the values of their own choices through corrective feedback during perceptual decision-making.

PMID:37939126 | DOI:10.1371/journal.pbio.3002373

PLoS One. 2023 Nov 8;18(11):e0293948. doi: 10.1371/journal.pone.0293948. eCollection 2023.

ABSTRACT

INTRODUCTION: Telemonitoring involves the transmission of clinical information through digital means, including internet-connected devices such as smartphones, health tracking apps and video conferencing platforms. This strategy could provide a viable alternative to facilitate follow-up in several conditions, including cancer.

OBJECTIVES: To synthesise the available evidence on the effectiveness of internet-based telemonitoring platforms amongst oncological patients. Relevant endpoints include overall quality of life, the ability to detect postoperative complications, severe toxicity reactions attributable to chemotherapy, reducing the frequency of hospitalisations, emergency department visits and mortality.

METHODS: A systematic review of published and unpublished randomised and controlled studies will be carried out. Iterative searches in PubMED/MEDLINE, EMBASE, Epistemonikos, LILACS, and Cochrane CENTRAL repositories from January 2000 to January 2023 will be conducted. Grey literature repositories, such as Clinicaltrials, BioRxiv and MedRxiv will be searched as well. The Cochrane risk of bias tool will be used to assess the quality of the eligible studies. If possible, a meta-analysis based on the random-effects model will be conducted to evaluate changes in any of the aforementioned outcomes. Heterogeneity will be assessed with Cochrane’s Q and I2 statistics. Its exploration will be carried out using subgroup and sensitivity analyses. Relevant subgroups include the proportion of elderly patients in each study, characteristics of each platform, study type, type of funding and moment of conduction (i.e. before or after the COVID-19 pandemic). Publication bias will be assessed using funnel plots and Egger’s test.

REGISTRATION: This systematic review protocol is registered in PROSPERO. Its registration number is CRD42023412705.

PMID:37939125 | DOI:10.1371/journal.pone.0293948

PLoS One. 2023 Nov 8;18(11):e0292496. doi: 10.1371/journal.pone.0292496. eCollection 2023.

ABSTRACT

BACKGROUND: Obstetric ultrasound is one of the most important advances in antenatal tests. Despite the importance of knowing the knowledge status of ultrasound and the category of attitude, there is no similar study done in Ethiopia. Thus, this study aimed to assess knowledge and attitude and associated factors toward ultrasound examination at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

METHODS: Institutional-based cross-sectional study was conducted at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia from May 15, 2022, to Jun 30, 2022. Data was collected and transferred from the Open data Kit server and analyzed using STATA version 14. The strength of the association, presented using an adjusted odds ratio with a 95% confidence interval and p-value ≤0.05, is considered to declare statistically significant variables.

RESULTS: A total of 422 pregnant women participated, with a response rate of 100%. Of the total pregnant women, only 39% of them are knowledgeable about obstetric ultrasound whereas 52% of them have a favorable attitude. Being a housewife, government employee, and private employee (AOR = 17, 95% CI = 2.12, 151), (AOR = 10, 95% CI = 1.2, 85) and (AOR = (13, 95% CI = 1.5, 115), respectively were associated positively with knowledge about ultrasound. However, residing in a rural (AOR = 0.07; 95%CI = 0.02, 0.21), never been pregnant before (AOR = 0.59 95% CI = 0.38, 0.94), and having information (AOR = 1.7, 95% CI = 1, 2.9) were negatively associated with knowledge about ultrasound. Whereas, attaining primary education (AOR = 2.61; 95%CI = 1.1, 6.4) was positively associated with favorable attitudes while living in rural areas was negatively associated with a favorable attitude (AOR = 0.42; 95%CI = 0.18, 0.97).

CONCLUSION: In this study, knowledge and attitude about ultrasound among pregnant women in Gondar City are low. Residence, occupation, being pregnant before, and having information were significantly associated factors of knowledge. While residence and educational status of the respondents were significant factors of attitude. Therefore, health information about obstetric ultrasound shall be given to women who live in rural areas, women who are students, merchants and farmers, illiterate, and primigravida.

PMID:37939118 | DOI:10.1371/journal.pone.0292496