Nevin Manimala

Int J Comput Dent. 2023 Jul 21;0(0):0. doi: 10.3290/j.ijcd.b4224851. Online ahead of print.

ABSTRACT

AIM: New technologies such as tactile robots and artificial intelligence are about to find their way into clinical practice in dentistry and may contribute to the improvement of oral health care in the future. In this study we hypothesized that a collaborative, tactile robot programmed by a dental student removes interproximal artificial plaque as effectively as a human operator in an in vitro pilot trial.

MATERIAL AND METHODS: Model teeth were fully covered with artificial plaque and set into phantom jaws. First, a robot was programmed by a dental student to perform interproximal cleaning with an interproximal brush. Second, teeth were covered with artificial plaque again and the dental student performed the interproximal cleaning manually. Both experiments were repeated five times. Residual plaque was measured with binary pictures. Surface coverage was reported and comparison of methods was performed with significance defined at a= 0.05.

RESULTS: No statistically significant difference was found in the cleaning result between the robot and the human operator.

CONCLUSION: The results of this in vitro pilot study indicate that a tactile robot with integrated artificial intelligence programmed by a dental student can perform interproximal cleaning as effectively as the dental student. Practical lmplications: In the future, the use of robot assistants to support oral hygiene, e.g., in patients with reduced motor skills or impaired vision may be further investigated.

PMID:37477085 | DOI:10.3290/j.ijcd.b4224851

Int J Comput Dent. 2023 Jul 21;0(0):0. doi: 10.3290/j.ijcd.b4224643. Online ahead of print.

ABSTRACT

AIM: The purpose of this systematic review and meta-analysis is to evaluate the marginal adaptation of single unit full coverage lithium disilicate fixed dental restorations fabricated with the conventional heat pressed technique and the digital CAD/CAM workflow.

MATERIALS AND METHODS: This study is according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. study research was conducted in MEDLINE via PubMed and Cochrane Library databases together with a hand search of studies published until June 2022. The search terms were combining suitable Medical Subject Headings (MeSH terms) together with free text words in single or multiple conjunctions. A modified methodological index was used to assess the risk of bias of the included studies. A random effect model was applied to pool the effect estimates, and further assessment of the heterogeneity across studies using the Q test and the I2 metric was conducted. All statistical analyses were performed using Rstudio software, version 4.1.2, using the “meta” package.

RESULTS: The electronic search and hand search identified 51 articles. Eighteen met the inclusion criteria and were included in the systematic review, 17 of which were in vitro and only one was an in vivo study. However, 17 of the initial 18 could be included in the meta-analysis, due to lack of statistical data in one of the in vitro studies. Statistical analyses were conducted by using the Rstudio software program. Meta-analysis was performed with the random effects model (α=.05). No statistical difference was found between the two fabrication methods (p-value=0.49).

CONCLUSIONS: Although the mean marginal adaptation of lithium disilicate single crowns was found to be better with the heat-pressed technique, there was no statistical significance with the CAD/CAM fabricated restorations and both resulted in a clinically acceptable result. Nonetheless, more clinical studies are needed for safer conclusions.

PMID:37477084 | DOI:10.3290/j.ijcd.b4224643

Pharm Stat. 2023 Jul 21. doi: 10.1002/pst.2326. Online ahead of print.

ABSTRACT

In the statistical literature, treatment effects in clinical trials are frequently described as either ITT or per-protocol effects. The estimand given for the per-protocol effect is the effect in adherers, where adherers are typically defined as adhering to the intervention as specified in the trial protocol. This dichotomy of treatment effects is unhelpful when there are in reality multiple treatment effects that can be of clinical interest and relevance. The terms “per-protocol” and “adherence” are confusing to non-statisticians. Protocols always allow for discontinuation of randomized treatment so participants discontinuing have actually followed the protocol. When rescue or additional medication is available, the effect in adherers could mean the effect regardless of use of these medications or the effect in a counterfactual world where the participant did not take the medication. Adherence can mean continuing to be prescribed a treatment or some arbitrary level of compliance with a medication that has been prescribed. The ICH E9 (R1) estimands framework provides an improved alternative for the description of treatment effects in clinical trials. Identification of important intercurrent events and the strategy used to handle these events is key to determining the treatment effect. When designing a trial, estimands should be properly defined according to this framework. It is time the statistical literature abandoned describing treatment effects as the effect in adherers or the per-protocol effect.

PMID:37477077 | DOI:10.1002/pst.2326

Chemphyschem. 2023 Jul 21:e202300450. doi: 10.1002/cphc.202300450. Online ahead of print.

ABSTRACT

The reactive collision between 36Ar and the 36ArH+ species has been investigated by means of quantum mechanical (QM), quasiclassical trajectories (QCT) and statistical quantum mechanical (SQM) approaches. Reaction probabilities, cross sections as a function of the energy and rate constants in terms of the temperature have been obtained.Cumulative distributions as a function of the collision time and the inspection of selected QCT corresponding to specific dynamical mechanisms have been analysed. Predictions by means of the SQM method are in good agreement with the QM results, thus supporting the complex-forming nature of the process.

PMID:37477047 | DOI:10.1002/cphc.202300450

Circ Heart Fail. 2023 Jul 21:e010404. doi: 10.1161/CIRCHEARTFAILURE.122.010404. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic role of the congenital heart disease (CHD) anatomic/physiologic classification has not been systematically studied. The purpose of this study was to determine whether CHD physiologic stage provided improvement in prognostic power (to predict all-cause mortality) beyond conventional clinical risk models.

METHODS: Retrospective study of adults with CHD at the Mayo Clinic (2003-2019). The CHD physiologic stage was assessed at baseline and 36 (24-48) months, and patients were classified into stages A to D at these time points. Clinical stability (remaining in the same stage), clinical improvement (moving to less advanced stage), and clinical deterioration (moving to more advanced stage) were determined at 36 months. We defined conventional clinical risk indices as age/sex, functional class, comorbidities, cardiac procedures, hepatorenal dysfunction, and ventricular/valvular dysfunction.

RESULTS: Of 5321 patients, 1649 (31%), 1968 (37%), 1224 (23%), and 480 (9%) were in stages A, B, C, and D at baseline. Of 5321 patients, 4588 (86%) also had assessments at 36 months, and of these patients, 3347 (73%), 386 (8%), and 855 (19%) had clinical stability, deterioration, and improvement, respectively. Patients with clinical improvement were more likely to have undergone cardiac procedures between both assessments. Both baseline CHD physiologic stage (hazard ratio, 1.13 [95% CI, 1.09-1.17]; P<0.001, per unit increase in stage) and change in CHD physiologic stage (hazard ratio, 1.46 [95% CI, 1.32-1.61]; P=0.007, per unit increase in stage) were associated with mortality after adjustments for conventional risk indices and provided incremental improvement in prognostic power beyond conventional clinical risk models as evidence by an increase in C statistic from 0.702 (0.681-0.724) to 0.769 (0.754-0.787).

CONCLUSIONS: The CHD physiologic stage can potentially be used for risk stratification, as well as to monitor disease progression and response to therapy.

PMID:37476989 | DOI:10.1161/CIRCHEARTFAILURE.122.010404

Ophthalmic Physiol Opt. 2023 Jul 21. doi: 10.1111/opo.13207. Online ahead of print.

ABSTRACT

PURPOSE: ChatGPT is an artificial intelligence language model, which uses natural language processing to simulate human conversation. It has seen a wide range of applications including healthcare education, research and clinical practice. This study evaluated the accuracy of ChatGPT in providing accurate and quality information to answer questions on myopia.

METHODS: A series of 11 questions (nine categories of general summary, cause, symptom, onset, prevention, complication, natural history, treatment and prognosis) were generated for this cross-sectional study. Each question was entered five times into fresh ChatGPT sessions (free from influence of prior questions). The responses were evaluated by a five-member team of optometry teaching and research staff. The evaluators individually rated the accuracy and quality of responses on a Likert scale, where a higher score indicated greater quality of information (1: very poor; 2: poor; 3: acceptable; 4: good; 5: very good). Median scores for each question were estimated and compared between evaluators. Agreement between the five evaluators and the reliability statistics of the questions were estimated.

RESULTS: Of the 11 questions on myopia, ChatGPT provided good quality information (median scores: 4.0) for 10 questions and acceptable responses (median scores: 3.0) for one question. Out of 275 responses in total, 66 (24%) were rated very good, 134 (49%) were rated good, whereas 60 (22%) were rated acceptable, 10 (3.6%) were rated poor and 5 (1.8%) were rated very poor. Cronbach’s α of 0.807 indicated good level of agreement between test items. Evaluators’ ratings demonstrated ‘slight agreement’ (Fleiss’s κ, 0.005) with a significant difference in scoring among the evaluators (Kruskal-Wallis test, p < 0.001).

CONCLUSION: Overall, ChatGPT generated good quality information to answer questions on myopia. Although ChatGPT shows great potential in rapidly providing information on myopia, the presence of inaccurate responses demonstrates that further evaluation and awareness concerning its limitations are crucial to avoid potential misinterpretation.

PMID:37476960 | DOI:10.1111/opo.13207

Artif Organs. 2023 Jul 21. doi: 10.1111/aor.14617. Online ahead of print.

ABSTRACT

BACKGROUND: Short-term continuous flow (STCF) ventricular assist devices (VADs) are utilized in adults with cardiogenic shock, however, mortality remains high. Previous studies have found that high pre-operative MELD-XI scores in durable VAD patients is associated with mortality. The use of the MELD-XI score to predict outcomes in STCF-VAD patients has not been explored. We sought to determine the relationship between MELD-XI and outcomes in adults with STCF-VADs.

METHODS: This was a retrospective review of adults implanted with STCF-VADs between 2009-19. Receiver operating characteristic (ROC) analysis was performed to predict outcomes and Kaplan-Meier analysis was done to assess survival.

RESULTS: Seventy-nine patients were included with a median MELD-XI score of 21.2 (IQR 13.5, 27.0). Patients with an unsuccessful wean from support (p<0.001) or major post-operative bleeding (p=0.03) had significantly higher pre-implant MELD-XI scores. The optimal MELD-XI cut-point for mortality was 24.9 with 27.8 for major bleeding. Survival was worse among patients in the high-risk MELD-XI group, however, not statistically significant (p=0.09). Prior ECMO support, but not MELD-XI, was an independent predictor of unsuccessful wean (p=0.03).

CONCLUSIONS: Pre-operative MELD-XI score was a moderate predictor of unsuccessful wean with limited utility in predicting bleeding in patients on STCF-VAD support. This scoring system may be useful in the clinical setting for pre-implant risk stratification and counselling among patients and outcomes.

PMID:37476924 | DOI:10.1111/aor.14617

Stat Med. 2023 Aug 30;42(19):3547-3567. doi: 10.1002/sim.9819. Epub 2023 Jun 12.

ABSTRACT

Mendelian randomization is a technique used to examine the causal effect of a modifiable exposure on a trait using an observational study by utilizing genetic variants. The use of many instruments can help to improve the estimation precision but may suffer bias when the instruments are weakly associated with the exposure. To overcome the difficulty of high-dimensionality, we propose a model average estimator which involves using different subsets of instruments (single nucleotide polymorphisms, SNPs) to predict the exposure in the first stage, followed by weighting the submodels’ predictions using penalization by common penalty functions such as least absolute shrinkage and selection operator (LASSO), smoothly clipped absolute deviation (SCAD) and minimax concave penalty (MCP). The model averaged predictions are then used as a genetically predicted exposure to obtain the estimation of the causal effect on the response in the second stage. The novelty of our model average estimator also lies in that it allows the number of submodels and the submodels’ sizes to grow with the sample size. The practical performance of the estimator is examined in a series of numerical studies. We apply the proposed method on a real genetic dataset investigating the relationship between stature and blood pressure.

PMID:37476915 | DOI:10.1002/sim.9819

Turk J Med Sci. 2023 Jun;53(3):647-658. doi: 10.55730/1300-0144.5627. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Hepayocyte loss may develop secondary to liver surgery and at this point liver regeneration plays a significant act in terms of liver reserve. The purpose of this research was to investigate the efficacy of apocynin on liver regeneration and preservation after partial hepatectomy in rats.

METHODS: A total of 32 rats, have been divided into 4 groups (n: 8) for hepatectomy model. Inflammatory and antiinflammatory parameters were measured from blood and liver tissue samples. In addition, the effects of apocynin were examined immunohistochemically and histopathologically from liver tissue.

RESULTS: In liver tissue samples, a significant difference has been found in glutathione peroxidase, total nitrite, catalase, oxidative stress index, total antioxidant and total oxidant status between sham and hepatectomy groups. A significant difference has been achieved between hepatectomy and posthepatectomy-Apocynin in terms of glutathione peroxidase and oxidative stress index. Total antioxidant status, oxidative stress index, and total oxidant status were significantly different only between the sham and the hepatectomy groups. Statistical differences were found between sham and hepatectomy groups and between hepatectomy and pre+post-hepatectomy-Apocynin groups in terms of serum glutathione, malondialdehyde, total nitrite, and L-Arginine. There were significant differences between the sham and hepatectomy groups, between hepatectomy and posthepatectomy-apocynin groups, between posthepatctomy-apocynin and pre+posthepatectomy-apocynin groups in terms of sinusoidal dilatation, intracytoplasmic vacuolization and glycogen loss (p < 0.001), in all histopathologic parameters except sinusoidal dilatation (p < 0.05). However, significant Ki-67 increases have been elaborated in hepatectomy, posthepatectomy-apocynin, and pre+posthepatectomy-apocynin groups compared to sham group (p < 0.001), in pre+posthepatectomy apocynin group compared to hepatectomy and posthepatectomy-apocynin groups (p < 0.001).

DISCUSSION: Histopathology, immunohistochemistry, and biochemistry results of this study revealed that apocynin has a protective effect on enhancing liver regeneration in partial hepatectomy cases in rats.

PMID:37476910 | DOI:10.55730/1300-0144.5627

Turk J Med Sci. 2023 Jun;53(3):760-752. doi: 10.55730/1300-0144.5638. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Hydrochlorothiazide (HCTZ) possesses well-described photosensitizing properties, and a causal association with nonmelanoma skin cancer (NMSC) was recently shown. However, previous studies have not shown whether HCTZ use is associated with the risk of recurrence of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). This study aims to investigate the association between HCTZ use and recurrence in patients with NMSC.

METHODS: We identified cases with NMSC from our hospital archives during the period between 2013 and 2019. Patients were divided into groups according to the pathological diagnosis, HCTZ use, and recurrence. Multivariable analysis was performed to determine factors associated with recurrence in BCC and SCC.

RESULTS: Recurrences of BCC were significantly higher in HCTZ users with ORs of 4.839221 (95% confidence interval [CI], 1.22-19.12).In HCTZ users, NMSC cases were associated with increased age (p < 0.001 for both BCC and SCC). BCC recurrences were statistically significant with age, longer follow-up, and positive margins after excision in HCTZ users (p = 0.048, 0.020, and, 0.003, respectively). SCC recurrences were not significantly associated with HCTZ use.

DISCUSSION: HCTZ use is significantly associated with BCC recurrences. Especially in the elderly population, cases with a positive margin should be followed closely.

PMID:37476909 | DOI:10.55730/1300-0144.5638