Nevin Manimala

Amyotroph Lateral Scler Frontotemporal Degener. 2023 Oct 22:1-9. doi: 10.1080/21678421.2023.2271517. Online ahead of print.

ABSTRACT

OBJECTIVE: The Latin American Epidemiologic study of ALS (LAENALS) aims to gather data on ALS epidemiology, phenotype, and risk factors in Cuba, Chile, and Uruguay, to understand the impact of genetic and environmental factors on ALS.

METHODS: A harmonized data collection protocol was generated, and a Latin-American Spanish language Register was constructed. Patient data were collected in Uruguay in 2018, in Chile from 2017 to 2019, and in Cuba between 2017 and 2018. Statistical analysis was performed using SPSS 25.0.0 software. Crude cumulative incidence, standardized incidence, and prevalence were calculated in the population aged 15 years and older.

RESULTS: During 2017-2019, 90 people with ALS from Uruguay (55.6% men), 219 from Chile (54.6% men), and 49 from Cuba (55.1% men) were included. The cumulative crude incidence in 2018 was 1.73/100,000 persons in Uruguay, 1.08 in Chile and 0.195 in Cuba. Crude prevalence in 2018 was 2.19 per 100,000 persons in Uruguay, 1.39 in Chile and 0.55 in Cuba. Mean age at onset was 61.8 ± 11.96 SD years in Uruguay, 61.9 ± 10.4 SD years in Chile, and 60.21 ± 12.45 SD years in Cuba (p = 0.75). Median survival from onset was 32.43 months (21.93 – 42.36) in Uruguay, 24 months (13.5 – 33.5) in Chile, and 29 months (15 – 42.5) in Cuba (p = 0.006).

CONCLUSIONS: These preliminary data from LAENALS confirm the lower incidence and prevalence of ALS in counties with admixed populations. The LAENALS database is now open to other Latin American countries for harmonized prospective data collection.

PMID:37865869 | DOI:10.1080/21678421.2023.2271517

Am J Dent. 2023 Oct;36(5):246-250.

ABSTRACT

PURPOSE: To compare the accuracy and reliability of cone-beam computed tomography (CBCT) and laser scanner in measuring minor volume changes such as the root canal space.

METHODS: 35 maxillary incisors were endodontically prepared. A dimensionally stable silicone material was injected into the root canal space and scanned with CBCT. The root canal volume was measured using Romexis 3.0.1 R software. Replicas were carefully removed from the teeth and scanned using an extraoral laser scanner. These images were exported to the Rhinoceros software for volume measurement. The volume of each replica was also assessed using the gravimetric method. To determine the accuracy, the volume obtained from both devices was compared with the gravimetric method. Statistical analysis was done using a paired t-test. The reliability was assessed using the intraclass correlation coefficient.

RESULTS: There was no statistically significant difference between the mean volume of CBCT 27.04 ± 7.25 mm³ and the mean volume of the gravimetric method 27.87 ± 7.17 mm³ (P< 0.05). A statistically significant difference was seen with the laser scanner at 25.31 ± 6.89 mm³ and the gravimetric method at 27.87 ± 7.17 mm³ (P< 0.05). CBCT showed a good degree of agreement (ICC 0.899), while the laser scanner showed a moderate degree of agreement (ICC 0.644) with the gravimetric method. CBCT proved accurate and reliable in measuring minor volumes like the root canal space, ideally in the range of 20-25 mm³. The laser scanner presented acceptable reliability.

CLINICAL SIGNIFICANCE: The laboratory data showed satisfactory outcomes, providing an evidence-based approach and potentially motivating clinicians to integrate cone-beam computed tomography for volume analysis into clinical practice. The accuracy and reliability of laser scanners for small-volume analysis have not previously been evaluated. Consequently, the findings from this study warrant further clinical investigations.

PMID:37865812

Am J Dent. 2023 Oct;36(5):239-245.

ABSTRACT

PURPOSE: To evaluate the shear bond strengths (SBS) of permanent 3D-printed resin (PR) to primary dentin using different luting agents.

METHODS: 90 primary teeth were prepared. 45 cylinders (3 x 3 mm) were printed using PR, and 45 cylinders were milled using a Z block (to control). The cylinders were bonded to primary dentin by using three types of luting agent [glass-ionomer cement (GIC), resin-modified glass-ionomer cement (RMGIC), and self-adhesive resin cement (SRC)]. The SBS values of the specimens were calculated, and the fracture modes were examined.

RESULTS: There was a statistically significant difference between the three different luting agents that were used to lute the PR to primary dentin (P< 0.001). Changing the material (PR or Z) did not affect the SBS values of the luting agents (P> 0.05). The adhesive failure between cement and dentin in the PR-SRC group was significantly higher than the other groups (P< 0.001). The SBS values of the newly developed PR to primary dentin with RMGIC and SRC were similar, but GIC showed lower values than the others.

CLINICAL SIGNIFICANCE: This laboratory study suggests that bond strength of the permanent 3D-printed resin can be like that of zirconia. As the resin-modified glass-ionomer cement and self-adhesive resin cement showed higher bond strength to primary teeth making the 3D-printed resin a treatment option.

PMID:37865811

Am J Dent. 2023 Oct;36(5):233-238.

ABSTRACT

PURPOSE: To evaluate the effectiveness of a calcium phosphate-containing-desensitizer (Teethmate Desensitizer – TD), caries type, subject age, and preoperative hypersensitivity on postoperative sensitivity (POS) after composite restorations on deep or extremely deep lesions.

METHODS: 50 subjects, having two teeth with deep or extremely deep caries, participated in this study. TD was applied randomly to one tooth of each participant, and all teeth were restored with composite resin (Filtek Z250). After 1 week, POS was evaluated according to NRS (numerical rating scale) and VAS (visual analogue scale) by using participant diaries. At 6 weeks, POS was assessed considering subjects’ reports. The normality of data was analyzed with Shapiro-Wilk test. For analyses, Pearson’s chi-squared test, Mann-Whitney U and the Wilcoxon Signed-Rank test were used, and the effect sizes (ES) were calculated (α= 0.05).

RESULTS: 47 of the participants completed the 6-week study. There was a small effect size noted for TD for NRS and VAS (P> 0.05, ES < 0.30). Also, there was no statistically significant difference between POS and subject age (P= 0.294, ES= 0.161), type of caries (P= 0.680, ES= 0.042) and preoperative sensitivity (P= 1.000, ES= 0.138) after the first week.

CLINICAL SIGNIFICANCE: Teethmate Desensitizer had no significant effect on postoperative sensitivity occurrence with respect to caries type, subject age, and existence of preoperative sensitivity. The application of Teethmate Desensitizer demonstrated no significant relieving effect on postoperative sensitivity in deep or extremely deep cavities.

PMID:37865810

Am J Dent. 2023 Oct;36(5):227-232.

ABSTRACT

PURPOSE: To evaluate staining- and aging-dependent changes in the color and translucency of 3D-printed resin-modified ceramics (RMC).

METHODS: Specimens (n= 5 per condition and material) were fabricated from test materials: Permanent Crown Resin (PCR), Crowntec (CT), Vita Enamic (VE) and Tetric CAD (TC). Specimens were stained in wine, coffee, tea, and water (control) and exposed to artificial accelerated aging (AAA). Color measurements were obtained using a spectrophotometer at baseline (T0) and at 3.5 (T1) and 7 (T2) days after immersion. For AAA, measurements were obtained at baseline (T0) and after exposure to controlled irradiance of 150 kJ/m² (T1) and 300 kJ/m² (T2). Mean and standard deviations were calculated on CIEDE2000 color differences (ΔE₀₀), translucency parameter (TP₀₀) and treatment-dependent changes in the translucency parameter (ΔTP₀ ₀). Differences between materials and test conditions were tested by one-way ANOVA (α= 0.05). Results were additionally interpreted using visual color difference thresholds in dentistry ΔE₀₀= 0.8 for the 50:50 perceptibility threshold (PT) and ΔE₀₀= 1.8 for the 50:50 acceptability threshold (AT). ΔTP₀₀ values were interpreted using 5058;50 TPT₀₀= 0.6 and 50:0% TAT₀₀= 2.6.

RESULTS: Statistically significant differences were found among the materials when exposed to the different test conditions. At the T0-T1 time interval, the highest color difference was found with wine (0.1-2.2) on all materials except CT, which showed the highest ΔE₀₀ with AAA (2.5). The second highest color differences were obtained upon exposure to AAA (0.2-2.5) and tea (0.5-1.1). The TP₀₀ at baseline ranged from 5.1 to 9.8. Significant differences in ΔTP₀₀ were found among the tested materials and staining/aging conditions, but no significant differences were found among the staining/aging intervals (T0-T1, T0-T2 and T1-T2).

CLINICAL SIGNIFICANCE: Staining- and artificial aging-dependent changes of 3D-printed and milled resin modified ceramics used for definitive restorations could represent a challenge in terms of restoration acceptability or dissatisfaction. Staining and aging conditions produced significant color changes, while translucency changes were not significant.

PMID:37865809

Am J Dent. 2023 Oct;36(5):222-226.

ABSTRACT

PURPOSE: To evaluate the capacity of highly opaque cements on masking titanium abutment background.

METHODS: Dentin and titanium specimens were used to simulate respectively, a natural dental background and an implant abutment. To simulate the full-crowns, Y-TZP zirconia (ZC), lithium disilicate (LD), and resin composite (RC) blocks were used. The titanium specimens were divided into six cementation groups (n=10): two regular cements (BQM and RX); three opaque cements (MHA; VA and BHA); and a clear liquid (CL). The masking capacity of each cement was calculated as the color difference between the color of the crowns over dentin with clear liquid (reference) and the color of the crowns over the titanium with the different cements (ΔEab). Data were statistically analyzed using two-way ANOVA and Tukey test (α= 0.05).

RESULTS: Significant differences (P= 0.0001) were observed for both factors, cement and crown, and for the interactions between them. The results of Tukey test for cement were: BHA-2.25(0.98), MHA-2.94 (1.03), VA-3.45 (1.67), BQM-9.55 (2.77), RX-9.88 (3.12), CL-10.41 (3.47). The cements BHA, MHA and VA showed significantly smaller means than BQM, RX and CL. The results for crown were: ZC-3.66 (2.37), LD-7.50 (4.08), RC-8.08 (4.67). The means for all crown materials were significantly different. Highly opaque cements were more efficient on background masking than regular cements. Zirconia promoted the higher color masking while the resin composite the lowest.

CLINICAL SIGNIFICANCE: The use of a highly opaque cement can reduce the color interference of the titanium abutment background, favoring the esthetic outcome of metal-free cemented crowns.

PMID:37865808

World J Surg Oncol. 2023 Oct 21;21(1):332. doi: 10.1186/s12957-023-03229-w.

ABSTRACT

OBJECTIVE: To stratify patients with copy-number low (CNL) endometrial cancer (EC) by clinicopathological characteristics.

METHODS: EC patients who underwent surgery between June 2018 and June 2022 at Peking University People’s Hospital were included and further classified according to TCGA molecular subtyping: POLE ultramutated, microsatellite instability high (MSI-H), CNL, and copy-number high (CNH). Clinicopathological characteristics and prognosis of CNL patients were retrospectively reviewed. The Cox proportional hazards regression model was applied to perform univariate and multivariate analysis, and independent risk factors were identified. Differentially expressed genes (DEGs) according to overall survival (OS) were screened based on the transcriptome of CNL cases from the TCGA program. Finally, a nomogram was established, with an accuracy analysis performed.

RESULTS: (1) A total of 279 EC patients were included, of whom 168 (60.2%) were in the CNL group. A total of 21 patients had recurrence and 6 patients deceased, and no significant difference in recurrence-free survival (RFS) was exhibited among the four molecular subtypes (P = 0.104), but that in overall survival (OS) was statistically significant (P = 0.036). (2) CNL patients were divided into recurrence and non-recurrence groups, and significant differences (P < 0.05) were found between the two groups in terms of pathological subtype, FIGO stage, ER, PR, glycated hemoglobin (HbA1c), and high-density lipoprotein cholesterol (HDL-C). All the above factors were included in univariate and multivariate Cox regression models, among which pathological subtype, PR, and HDL-C were statistically different (P < 0.05), resulting in three independent risk factors for the prognosis of patients in the CNL group. (3) By comparing the transcriptome of tumor tissues between living and deceased CNL patients from the TCGA database, 903 (4.4%) DEGs were screened, with four lipid metabolism pathways significantly enriched. Finally, a nomogram was established, and internal cross-validation was performed, showing good discrimination accuracy with an AUC of 0.831 and a C-index of 0.748 (95% CI 0.444-1.052). (4) According to the established nomogram and the median total score (85.89), patients were divided into the high score group (n = 85) and low score group (n = 83), and the 8 patients with recurrence were all in the high score group. Survival analysis was performed between the two groups, and the difference in RFS was statistically significant (P = 0.010).

CONCLUSION: In the CNL group of EC patients, pathological subtype, PR, and HDL-C were independent prognostic risk factors, the nomogram established based upon which had a good predictive ability for the recurrence risk of patients with CNL EC.

PMID:37865800 | DOI:10.1186/s12957-023-03229-w

Eur J Med Res. 2023 Oct 21;28(1):452. doi: 10.1186/s40001-023-01440-9.

ABSTRACT

OBJECTIVE: This study compared remimazolam tosylate with propofol or midazolam to assess its safety and effectiveness for long-term sedation of intensive care unit (ICU) patients requiring mechanical ventilation.

METHODS: Adult patients in the ICU receiving sedation and mechanical ventilation for longer than 24 h were included in this single-center, prospective, observational study. Depending on the sedatives they were given, they were split into two groups (midazolam or propofol group; remimazolam group). ICU mortality was the main result. Laboratory tests, adverse events, and the length of ICU stay were considered secondary outcomes.

RESULTS: A total of 106 patients were involved (46 received propofol or midazolam versus 60 received remimazolam). Age (P = 0.182), gender (P = 0.325), and the amount of time between being admitted to the ICU and receiving medication infusion (P = 0.770) did not substantially differ between the two groups. Multivariate analysis revealed no statistically significant difference in ICU mortality between the two groups. The remimazolam group showed less variability in heart rate (P = 0.0021), pH (P = 0.048), bicarbonate (P = 0.0133), lactate (P = 0.0002), arterial blood gas analyses, liver, and kidney function. The Richmond Agitation and Sedation Scale scores, length of ICU stay, and occurrence of adverse events did not exhibit significant differences between the two groups.

CONCLUSION: Remimazolam tosylate did not increase the total inpatient cost, the incidence of adverse events, and ICU mortality in patients with mechanical ventilation. These findings suggest that remimazolam may represent a promising alternative for sedation in the ICU setting.

PMID:37865799 | DOI:10.1186/s40001-023-01440-9

Stem Cell Res Ther. 2023 Oct 21;14(1):303. doi: 10.1186/s13287-023-03534-x.

ABSTRACT

BACKGROUND: There is growing interest to application of regenerative medicine approaches in otorhinolaryngological practice, especially in the framework of the therapy of vocal fold (VF) scar lesions. The used conservative and surgical methods, despite the achieved positive outcomes, are frequently unpredictable and do not result in the restoration of the VF’s lamina propria’s structure, which provides the mechanical properties necessary for vibration. In this connection, the aim of this study was to ascertain the safety and efficacy of a bioequivalent in the treatment of VF scars using a rabbit model of chronic damage.

METHODS: The bioequivalent consisted of a hydrogel system based on a PEG-fibrin conjugate and human bone marrow-derived MSC. It was characterized and implanted heterotopically into rats and orthotopically into rabbits after VF scar excision.

RESULTS: We showed that the fabricated bioequivalent consisted of viable cells retaining their metabolic and proliferative activity. While being implanted heterotopically, it had induced the low inflammatory reaction in 7 days and was well tolerated. The orthotopic implantation showed that the gel application was characterized by a lower hemorrhage intensity (p = 0.03945). The intensity of stridor and respiratory rate between the groups in total and between separate groups had no statistically significant difference (p = 0.96 and p = 1; p = 0.9593 and p = 0.97…1, respectively). In 3 days post-implantation, MSC were detected only in the tissues closely surrounding the VF defect. The bioequivalent injection caused that the scar collagen fibers were packed looser and more frequently mutually parallel that is inherent in the native tissue (p = 0.018). In all experimental groups, the fibrous tissue’s ingrowth in the adjacent exterior muscle tissue was observed; however, in Group 4 (PEG-Fibrin + MSC), it was much less pronounced than it was in Group 1 (normal saline) (p = 0.008). The difference between the thicknesses of the lamina propria in the control group and in Group 4 was not revealed to be statistically significant (p = 0.995). The Young’s modulus of the VF after the bioequivalent implantation (1.15 ± 0.25 kPa) did not statistically significantly differ from the intact VF modulus (1.17 ± 0.45 kPa); therefore, the tissue properties in this group more closely resembled the intact VF.

CONCLUSIONS: The developed bioequivalent showed to be biocompatible and highly efficient in the restoration of VF’s tissue.

PMID:37865795 | DOI:10.1186/s13287-023-03534-x

Malar J. 2023 Oct 21;22(1):320. doi: 10.1186/s12936-023-04757-2.

ABSTRACT

BACKGROUND: Malaria infection during pregnancy is an important cause of maternal and infant mortality and morbidity with the greatest effect being concentrated in sub-Saharan Africa. In areas of moderate to high malaria transmission, the World Health Organization (WHO) recommends the administration of intermittent preventive treatment of malaria in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) to be given to all pregnant women at each scheduled antenatal care visit at monthly intervals. However, there is concern that increased resistance has compromised its effectiveness. This has led to a need for evaluation of alternatives to SP for IPTp with dihydroartemisinin-piperaquine (DP) emerging as a very promising candidate. Thus, this systematic review and aggregated data meta-analysis was conducted to establish the safety and tolerability of repeated doses with DP in IPTp.

METHODS: A systematic review and aggregated data meta-analysis of randomized controlled trials (RCTs) was performed by searching electronic databases of PubMed, Science Direct, ClinicalTrials.gov and Google Scholar. RCTs comparing IPTp DP versus recommended standard treatment for IPTp with these outcome measures were analyzed; change in QTc interval, serious adverse events (SAE), grade 3 or 4 adverse events possibly related to study drug and vomiting within 30 min after study drug administration. The search was performed up to 24th June 2023. Data was extracted from eligible studies and an aggregated data meta-analysis was carried out with data pooled as risk ratio (RR) with a 95% confidence interval (CI), using RevMan software (5.4). This study is registered with PROSPERO, CRD42022310041.

RESULTS: Six RCTs involving 7969 participants were included in this systematic review and aggregated data meta-analysis. The pooled analysis showed that DP was associated with a change from baseline of the QTc interval although this change was not associated with cardiotoxicity. There was no statistically significant difference in the risk of occurrence of SAEs among participants in both treatment groups (RR = 0.80, 95% CI [0.52-1.24], P = 0.32). However, significant difference was observed in grade 3 or 4 AEs possibly related to study drug where analysis showed that subjects on IPT DP were statistically significantly more likely to experience an AE possibly related to study drug than subjects on IPT SP (RR = 6.65, 95% CI [1.18-37.54], P = 0.03) and in vomiting within 30 min after study drug administration where analysis showed that the risk of vomiting is statistically significantly higher in subjects receiving IPT DP than in subjects receiving IPT SP (RR = 1.77, 95% CI [1.02-3.07], P = 0.04).

CONCLUSION: DP was associated with a higher risk of grade 3 or 4 AEs possibly related to study drug and a higher risk of vomiting within 30 min after study drug administration. However, these were experienced in a very small percentage of women and did not affect adherence to study drugs. DP was also better tolerated in these studies as compared to most alternatives that have been proposed to replace SP which have proved to be too poorly tolerated in IPTp use.

PMID:37865784 | DOI:10.1186/s12936-023-04757-2