Nevin Manimala

Clin Implant Dent Relat Res. 2023 Sep 20. doi: 10.1111/cid.13278. Online ahead of print.

ABSTRACT

AIMS: To compare the accuracy of the Yakebot dental implant robotic system with that of fully guided static computer-assisted implant surgery (CAIS) template in edentulous implantation.

MATERIALS AND METHODS: Thirteen patients with edentulous were recruited and divided into two groups: the Yake robotic system group (experimental) (n = 5) and the CAIS group (control) (n = 8). Postoperative cone-beam computed tomography (CBCT) was performed immediately, and the 3-dimensional positions of implants were obtained and compared with that in the preoperative design. The comparison showed platform, apical, depth, and angular deviations. A value of p < 0.05 was considered statistically significant.

RESULTS: A total of 84 implants (36 in the robotic group and 48 in the CAIS group) were placed. The mean deviation at the implant platform, apex, depth, and angle in the CAIS group was 1.37 ± 0.72 mm, 1.28 ± 0.68 mm, 0.88 ± 0.47 mm, and 3.47 ± 2.02°, respectively. However, the mean deviation at the implant platform, apex, depth, and angle in the robotic group was 0.65 ± 0.25 mm, 0.65 ± 0.22 mm, 0.49 ± 0.24 mm, and 1.43 ± 1.18°, respectively. Significant differences in the four types of deviation (p < 0.05) between the two groups were observed.

CONCLUSION: The accuracy of robotic system in edentulous implant placement was superior to that of the CAIS template, suggesting that robotic system is more accurate, safe, and flexible, can be considered a promising treatment in clinical practice.

PMID:37728030 | DOI:10.1111/cid.13278

J Cachexia Sarcopenia Muscle. 2023 Sep 20. doi: 10.1002/jcsm.13330. Online ahead of print.

ABSTRACT

Metabolic acidosis unfavourably influences the nutritional status of patients with non-dialysis dependent chronic kidney disease (CKD) including the loss of muscle mass and functionality, but the benefits of correction are uncertain. We investigated the effects of correcting metabolic acidosis on nutritional status in patients with CKD in a systematic review and meta-analysis. A search was conducted in MEDLINE and the Cochrane Library from inception to June 2023. Study selection, bias assessment, and data extraction were independently performed by two reviewers. The Cochrane risk of bias tool was used to assess the quality of individual studies. We applied random effects meta-analysis to obtain pooled standardized mean difference (SMD) and 95% confidence intervals (CIs). We retrieved data from 12 intervention studies including 1995 patients, with a mean age of 63.7 ± 11.7 years, a mean estimated glomerular filtration rate of 29.8 ± 8.8 mL/min per 1.73 m² , and 58% were male. Eleven studies performed an intervention with oral sodium bicarbonate compared with either placebo or with standard care and one study compared veverimer, an oral HCl-binding polymer, with placebo. The mean change in serum bicarbonate was +3.6 mEq/L in the intervention group and +0.4 mEq/L in the control group. Correcting metabolic acidosis significantly improved muscle mass assessed by mid-arm muscle circumference (SMD 0.35 [95% CI 0.16 to 0.54], P < 0.001) and functionality assessed with the sit-to-stand test (SMD -0.31 [95% CI -0.52 to 0.11], P = 0.003). We found no statistically significant effects on dietary protein intake, handgrip strength, serum albumin and prealbumin concentrations, and blood urea nitrogen. Correcting metabolic acidosis in patients with CKD improves muscle mass and physical function. Correction of metabolic acidosis should be considered as part of the nutritional care for patients with CKD.

PMID:37728018 | DOI:10.1002/jcsm.13330

Chem Biodivers. 2023 Sep 20:e202301129. doi: 10.1002/cbdv.202301129. Online ahead of print.

ABSTRACT

This work described a comprehensive study to estimate chemical constituents of essential oils (EOs) extracted from different parts of the Callistemon citrinus viz: fruits, leaves and aerial part. The EOs were characterized using physicochemical parameters, and GC-FID/MS. It was observed that among different parts, aerial part has the highest oil yield (0.90%) followed by leaves and fruits. Further, seventeen compounds were characterized, and represented total amount (97.2-99.5%) with domination of monoterpenes (12.5-34.6%) and oxygenated monoterpenes hydrocarbon (61.8-86.8%). α-pinene (11.8-24.7%), α-phellandrene (1.2-3.0%), p-cymene (3.3-3.9%) and 1,8-cineole (58.3-85.1%) were found as major compounds in C. citrinus samples. These major compounds are the quality chemical markers of C. citrinus oil. The findings revealed significant quantitative variations in EO composition of samples and were also clearly supported by multivariate statistical analysis. Moreover, EOs were evaluated for glucosidase and colon cancer cell lines inhibitory activities, which were found promising.

PMID:37728015 | DOI:10.1002/cbdv.202301129

J Endovasc Ther. 2023 Sep 20:15266028231199036. doi: 10.1177/15266028231199036. Online ahead of print.

ABSTRACT

AIM: Blunt traumatic thoracic aortic injury (BTAI) is a highly fatal surgical emergency and is treated with endovascular procedures. We aimed to analyze and report the early and midterm outcomes of surgeon-modified fenestrated stent-grafts (SMFSG) compared with other conventional endovascular methods in patients with BTAI repaired with zone 2 endovascular surgery.

MATERIALS AND METHODS: Before and after the study was performed, from January 2015 to January 2020 for a period in which conventional endovascular treatments were used and from January 2020 to January 2023 for the second period in which the SMFSG technique was used. A total of 25 patients who underwent zone 2 endovascular repair for BTAI were included. The patients treated with conventional endovascular methods in the first period, chimney thoracic endovascular aortic repair (TEVAR) (n=3 patients); Left subclavian artery (LSA)-covered (intentionally total) (n=12 patients) LSA-covered (LSAC) TEVAR; carotid-subclavian bypass TEVAR (n=2 patients) was defined as group 1, and the group of patients treated with SMFSG in the second period was defined as group 2. The primary endpoints of the study were technical success, defined as complete closure of BTAI, and in-hospital mortality. Secondary outcomes were aortic pathology-related morbidity, mortality, and re-interventions during the follow-up period.

RESULTS: The mean age was 42.6±14.3 years, and 21 (84%) of the patients were male. The patients were compared with respect to the proximal landing zone, fluoroscopy time, duration of the procedure, length of intensive care unit stay, and hospital stay, no statistically significant difference was found between the 2 groups (p>0.05). The mean follow-up time of patients in group I was 46±9 months, while in group II, it was 14±6 months (p<0.001). While no TEVAR-related complications were detected in group II throughout follow-up, they occurred in 4 patients (28.6%) in group I.

CONCLUSION: TEVAR is the most appropriate treatment for BTAI in the modern era, especially for polytrauma patients with successful outcomes. Intentional coverage of the LSA can be performed, but SMFSG is an effective, economical, rapid, and available technique for endovascular revascularization of the LSA.

CLINICAL IMPACT: Altough intentional left subclavian artery coverage is preferred routinely in patients with blunt traumatic aortic injury (in Zone 2) which is a highly fatal surgical emergency, surgeon-modified fenestrated stent-grafts is also effective, economical, rapid and available technique.

PMID:37728012 | DOI:10.1177/15266028231199036

J Endovasc Ther. 2023 Sep 20:15266028231199923. doi: 10.1177/15266028231199923. Online ahead of print.

ABSTRACT

PURPOSE: This study examines the use and impact of directional atherectomy with antirestenotic therapy (DAART) versus angioplasty plus Supera stent implantation on the outcomes during endovascular treatment of popliteal lesions in clinical practice.

METHODS: Overall 143 consecutive patients (mean age 75.0±12.2 years, 72% male), with isolated atherosclerotic disease of the popliteal artery who underwent endovascular treatment using DAART therapy or percutaneous transluminal angioplasty (PTA)/Supera stenting of the popliteal artery between January 2016 and December 2021 were identified from a retrospectively database. Patient and plaque characteristics were collected. A propensity-score matched, case-control analysis was conducted to balance covariates between the group of patients who underwent DAART and the one treated by PTA/Supera stenting.

RESULTS: A total of 51 patients (35.7%) showed severe claudication and 92 (64.3%) critical limb ischemia. There was a trend toward longer treated lesions (90.4±81 vs 72.5±5.3 mm, p=0.089) and more chronic total occlusions (60.5% vs 46.8%, p=0.058) in the PTA/Supera stenting group, although not reaching statistically significance. Moderate-to-severe calcification was present in most lesions treated (75.8% of DAART group, 80.2% of PTA/Supera stenting group, and 78.3% of total cohort). Among the 53 case-matched pairs of patients treated with DAART or PTA/Supera stenting, there were no significant differences in short-term outcomes, including rate of technical success (96.2% vs 98.1%, p=0.232), procedural success (88.7% vs 90.1%, p=0.251), distal embolization (1.9% vs 1.9%, p=0.178), dissection (5.7% vs 1.9%, p=0.268), perforation (3.8% vs 5.6%, p=0.163), hospital discharge (1.2±0.1 vs 1.0±0.1, p=0.325), 30 day minor (28.3% vs 32.1%, p=0.264) or major amputation rates (7.5% vs 3.8%, p=0.107), and 30 day mortality (1.9% vs 1.9%, p=0.173). At 1 year, there was no difference in primary patency (73.6% vs 77.4%, p=0.233), primary assisted patency (81.3% vs 84.9%, p=0.167), secondary patency (86.8% vs 92.5%, p=0.094), ipsilateral minor (35.8% vs 39.6%, p=0.472) or major amputation (9.4% vs 7.5%, p=0.186), ankle brachial index improvement (0.32±0.12 vs 0.37±0.37, p=0.401), or mortality (5.7% vs 5.7%, p=0.121) rate between patients who underwent DAART or PTA/Supera stenting for popliteal lesions.

CONCLUSION: Twelve-month results following DAART technique or PTA/Supera stenting of atherosclerotic lesions of the popliteal artery are not different, regardless of patient and plaque characteristics.

CLINICAL IMPACT: The DAART technique for the treatment of popliteal artery atherosclerotic disease is presented as a “leave nothing behind” strategy with on-year clinical outcomes similar to ATP/Supera stenting.

PMID:37728000 | DOI:10.1177/15266028231199923

Stat Med. 2023 Sep 20. doi: 10.1002/sim.9909. Online ahead of print.

ABSTRACT

Graphical approach provides a useful framework for multiplicity adjustment in clinical trials with multiple endpoints. When designing a graphical approach, initial weight and transition probability for the endpoints are often assigned based on clinical importance. For example, practitioners may prefer putting more weights on some primary endpoints. The clinical preference can be formulated as a constrain in the sample size optimization problem. However, there has been a lack of theoretical guidance on how to specify initial weight and transition probability in a graphical approach to meet the clinical preference but at the same time to minimize the sample size needed for a power requirement. To fill this gap, we propose statistical methods to optimize sample size over initial weight and transition probability in a graphical approach under a common setting, which is to use marginal power for each endpoint in a trial design. Importantly, we prove that some of the commonly used graphical approaches such as putting all initial weights on one endpoint are suboptimal. Our methods are flexible, which can be used for both single-arm trials and randomized controlled trials with either continuous or binary or mixed types of endpoints. Additionally, we prove the existence of optimal solution where all marginal powers are placed exactly at the prespecified values, assuming continuity. Two hypothetical clinical trial designs are presented to illustrate the application of our methods under different scenarios. Results are first presented for a design with two endpoints and are further generalized to three or more endpoints. Our findings are helpful to guide the design of a graphical approach and the sample size calculation in clinical trials.

PMID:37727983 | DOI:10.1002/sim.9909

Acta Obstet Gynecol Scand. 2023 Sep 20. doi: 10.1111/aogs.14681. Online ahead of print.

ABSTRACT

INTRODUCTION: Few studies have described obstetric and critical care outcomes in pregnant women with COVID-19 needing intensive care unit (ICU) admission.

MATERIAL AND METHODS: Obstetric and critical care outcomes of COVID-19 women admitted to eight ICUs from April 1, 2020 to September 15, 2021, in the North West of England were retrospectively analyzed. Women admitted to ICU were assigned to three groups: antepartum women discharged from ICU prior to delivery (antepartum ICU-discharged group), antepartum women who had expedited delivery (antepartum ICU-delivered group) and a postpartum group. Our aims were to describe maternal characteristics and assess how delivery influenced the obstetric and critical care outcomes in these women.

RESULTS: During the study period, 615 women tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of whom 62 (10.1%) needed ICU admission due to symptomatic COVID-19. Pregnancy loss (3.2%) was recorded in two women. Detailed obstetric and critical outcomes from 60 women are reported. Nine antepartum women (15%) admitted to ICU were discharged and continued their pregnancy, 13 antepartum women (21.7%) had expedited delivery by cesarean birth after ICU admission and 38 (63.3%) women were admitted to ICU during the postpartum period. Antepartum ICU-discharged women contracted the SARS-CoV-2 at an earlier median gestational age (23 weeks; p = 0.0003) and needed ICU admission at an earlier median gestational age (28 weeks, p = 0.03) compared with antepartum ICU-delivered (28 and 32 weeks) and postpartum women (35.5 and 36 weeks). Antepartum ICU-discharged women had the lowest rate of mechanical ventilation receipt (11.1%) compared with antepartum ICU-delivered women (52.3%) and postpartum women (44.3%) but the difference was not statistically significant (p = 0.13). No significant differences were observed in the frequency and severity of critical care complications in the antepartum ICU-discharged, antepartum-ICU delivered and postpartum women.

CONCLUSIONS: Of the women admitted to ICU antepartum, 40% were discharged while remaining pregnant and 60% had expedited delivery. Antepartum women who were discharged from ICU without giving birth may receive lower rates of mechanical ventilation than those who delivered in ICU or admitted postpartum; however, further studies are needed to confirm or refute this association.

PMID:37727968 | DOI:10.1111/aogs.14681

Asia Pac J Public Health. 2023 Sep 20:10105395231199570. doi: 10.1177/10105395231199570. Online ahead of print.

ABSTRACT

Tuberculosis (TB) infection causes mortality among PLHIV, so the treatment of TB-HIV coinfection is crucial. The study aims to identify the determinants contributing to TB coinfection among PLHIV in Papua. It is a descriptive-analytic study with a cross-sectional design involving 188 PLHIV at the four hospitals in Papua. CD4⁺ was carried out using CD4⁺ counter and viral load using the qPCR technique. A logistic regression test and R statistic with a significance level of 0.05 were used to analyze the determinants of TB coinfection among PLHIV. PLHIV having CD4⁺ count of fewer than 350 cells/mm³ had a 17.8 higher risk for TB-HIV coinfection, P-value = 0.0. In addition, a viral load of more than 10 000 copies/ml will be 12.1 times more likely to be co-infected with TB-HIV compared to those who have a viral load of fewer than 10 000 copies/ml, P-value = 0.0. CD4⁺ markers and viral load are factors that play a role in TB coinfection among PLHIV in Papua Province.

PMID:37727963 | DOI:10.1177/10105395231199570

Otolaryngol Head Neck Surg. 2023 Sep 20. doi: 10.1002/ohn.529. Online ahead of print.

ABSTRACT

OBJECTIVE: There is a link between laryngopharyngeal reflux (LPR) and the formation of benign vocal fold lesions (BVFLs). However, previous studies have mainly focused on LPR suggested by symptoms and signs, rather than objectively diagnosed LPR via pharyngeal pH monitoring. We, therefore, conducted a Meta-analysis to evaluate the association between pharyngeal pH monitoring diagnosed LPR and the odds of BVFLs.

DATA SOURCES: Relevant observational studies were identified by searching PubMed, Embase, Cochrane Library, and Web of Science.

REVIEW METHODS: We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I² statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used.

RESULTS: Thirteen datasets from 9 studies were included. Among them, 493 were diagnosed with LPR and 344 had BVFLs. LPR was related to a higher odds of BVFLs (odds ratio: 3.26, 95% confidence interval: 1.84-5.76, P < .001) with moderate heterogeneity (P for Cochrane Q test = .006, I² = 57%). Subgroup analyses showed that the association was similar in studies with only pharyngeal pH monitoring (Restech), with double-probe or 3-site pH monitoring, and with 24-hour multichannel intraluminal impedance-pH monitoring (P for subgroup difference = .15). In addition, subgroup analysis showed consistent results in studies from Asia and Europe (P for subgroup analysis = .12), and the association seemed to be consistent for vocal Reinke’s edema, nodules, and polyps (P for subgroup difference = .09).

CONCLUSION: Pharyngeal pH monitoring diagnosed LPR is associated with the formation of BVFLs.

PMID:37727944 | DOI:10.1002/ohn.529

Oral Dis. 2023 Sep 20. doi: 10.1111/odi.14743. Online ahead of print.

ABSTRACT

OBJECTIVE: Proper identification of oral potentially malignant disorders (OPMDs) provides an opportunity for oral cancer prevention. This study aims to assess the competency of dental health professionals in identifying OPMDs and, in turn, reducing the incidence of oral malignancy by early detection.

METHODS: A 26-case online questionnaire of oral mucosal lesions was distributed to cohorts of 363 dental health professionals and dental students in Australia. The participants were asked to provide their provisional diagnosis for each case based on the available information.

RESULTS: The overall accuracy in identifying oral mucosal lesions was 65.9%. There were no significant differences in the overall diagnostic accuracies between dental specialists, general dental practitioners and final-year dental students (p > 0.05). The lowest diagnostic accuracies were associated with normal mucosal variations and OPMDs. The predoctoral dental curriculum showed statistically significant values in terms of improving skills in diagnosing oral mucosal lesions.

CONCLUSIONS: Lack of adequate knowledge in identifying OPMDs was evident among the participants, highlighting a non-promising figure in reducing the incidence of oral cancers in Australia. Comprehensive modifications of the current continuing professional development system are required to ensure adequate knowledge among dental health providers in Australia.

PMID:37727932 | DOI:10.1111/odi.14743