Nevin Manimala

J Prosthodont. 2021 Nov 18. doi: 10.1111/jopr.13454. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the accuracy of additive manufacturing (AM) by means of internal fit of fixed dental prostheses (FDPs) fabricated with two AM technologies using different resins and printing modes (validated vs non-validated) compared to milling and direct manual methods.

MATERIAL AND METHODS: Sixty 3-unit interim FDPs replacing the first mandibular molar were divided into 6 groups (n = 10): manual (Protemp 4), milled (Telio-CAD), and AM groups were subdivided based on AM technology (direct light processing (Rapidshape P30 [RS]) and stereolithography (FormLabs 2 [FL])) and the polymer type (P-Pro-C&B [St] and SHERAprint-cb [Sh]) (RS-St, RS-Sh, FL-St, FL-Sh). Validated (RS-Sh and RS-St) or non-validated (FL-St and FL-Sh) modes were adopted for AM. The specimens were scanned to 3D align (GOM inspect) according to the triple scan method. The internal space between the FDPs and preparation surfaces in four sites (marginal, axial, occlusal, and total) was measured using equidistant surface points (GOM Inspect). Statistical analysis was done using Kruskal Wallis and Dunn post-hoc tests. (α = .05).

RESULTS: One AM group (FL-Sh) and milling exhibited better adaptation compared to manual and RS-St at molar site (P<.05). FDPs with St resin (FL-St and RS-St) displayed bigger marginal space than milled, FL-Sh, and RS-Sh. The non-validated printing mode showed better mean space results (P<.05) with higher predictability and repeatability (P<.001).

CONCLUSIONS: The AM interim FDPs tested provided valid alternatives to the milled ones in regard to their accuracy results. The printing mode, resin, and the AM technology used significantly influenced the manufacturing accuracy of interim FDPs, particularly at the marginal area. The non-validated printing mode with lower-cost 3D printers is a promising solution for clinical applications. This article is protected by copyright. All rights reserved.

PMID:34792821 | DOI:10.1111/jopr.13454

J Rural Health. 2021 Nov 18. doi: 10.1111/jrh.12635. Online ahead of print.

ABSTRACT

INTRODUCTION: Broadband access is a “super determinant of health.” Understanding the spatial distribution and predictors of access may help target government programs and telehealth applications. Our aim was to examine broadband access across geography and sociodemographic characteristics using American Community Survey (ACS) data.

METHODS: We used 5-year ACS estimates from 2014 to 2018 to evaluate broadband access across contiguous US census tracts. Rural-Urban Commuting Area (RUCA) codes were categorized as metropolitan, micropolitan, small town, and isolated rural. We performed bivariate analyses to determine differences by RUCA categories and meeting the Healthy People 2020 (HP2020) objective (83.2% broadband access) or not. We conducted spatial statistics and spatial regression analyses to identify clusters of broadband access and sociodemographic factors associated with broadband access.

RESULTS: No RUCA grouping met the HP2020 objective; 80.6% of households had broadband access, including 82.0% of metropolitan, 73.9% of micropolitan, 70.7% of small town, and 70.0% of isolated rural households. Areas with high percentages of Black residents had lower broadband access, particularly in isolated rural tracts (54.9%). Low access was spatially clustered in the Southeast, Southwest, and northern plains. In spatial regression models, poverty and education were most strongly associated with broadband access, while the proportion of American Indian/Alaska Native population was the strongest racial/ethnic factor.

CONCLUSIONS: Rural areas had less broadband access with the greatest disparities experienced among geographically isolated areas with larger Black and American Indian/Alaska Native populations, more poverty, and lower educational attainment, following well-known social gradients in health. Resources and initiatives should target these areas of greatest need.

PMID:34792815 | DOI:10.1111/jrh.12635

Histopathology. 2021 Nov 18. doi: 10.1111/his.14600. Online ahead of print.

ABSTRACT

BACKGROUND: A number of randomized controlled trials (RCT) have compared different techniques to improve lymph node yield (LNY) in colorectal cancer specimens but data on comparative effectiveness are sparse. Our aim was to compare the relative effectiveness and rank all available techniques.

METHODS: A systematic search of Embase, Cochrane, PubMed and Scopus was performed for randomized trials. Pairwise meta-analysis performed if more than two homogeneous studies were available for each comparison. Network meta-analysis was used to rank and compare all available techniques.

RESULTS: Fifteen studies fulfilled the inclusion criteria. Techniques that were compared included methylene blue (MB), GEWF, Carnoy solution (CS), patent blue (PB), formalin, fat clearing (FC) and their combinations. The overall quality of studies was found to be fair. In pairwise meta-analysis MB had a higher lymph node yield weighted mean difference [WMD] 13.67 [4.83-22.51], P<0.01, lower number of specimens with less than 12 lymph nodes log Odds Ratio= -1.88(-2.8, -0.91), P<0.01 and higher LNY in patients with prior chemoradiotherapy (WMD 9.11 [3.15,15.08], p=0.02) as compared to formalin. Evaluation of the network plot revealed a well-connected network. In network meta-analysis MBFC had a higher LNY with [Mean Difference (MD) 13 and 95% credible interval (CI) (2.09- 23.91)] as compared to formalin. MBFC probability of being the best technique for LNY was 91.4%. In network meta-analysis MB did not have a statistically significant difference when compared to formalin.

CONCLUSIONS: MBFCS seems to be the most effective technique for LNY. Further studies are required to make safe conclusions for outcomes such positive lymph nodes and upstaging.

PMID:34792803 | DOI:10.1111/his.14600

Med Phys. 2021 Nov 18. doi: 10.1002/mp.15362. Online ahead of print.

ABSTRACT

PURPOSE: Conventional model observers (MO) in CT are often limited to a uniform background or varying background that is random and can be modelled in an analytical form. It is unclear if these conventional MOs can be readily generalized to predict human observer performance in clinical CT tasks that involve realistic anatomical background. Deep-learning-based model observers (DL-MO) have recently been developed, but have not been validated for challenging low contrast diagnostic tasks in abdominal CT. We consequently sought to validate a DL-MO for a low-contrast hepatic metastases localization task.

METHODS: We adapted our recently-developed DL-MO framework for the liver metastases localization task. Our previously-validated projection-domain lesion- / noise-insertion techniques were used to synthesize realistic positive and low-dose abdominal CT exams, using the archived patient projection data. Ten experimental conditions were generated, which involved different lesion sizes / contrasts, radiation dose levels, and image reconstruction types. Each condition included 100 trials generated from a patient cohort of 7 cases. Each trial was presented as liver image patches (160×160×5 voxels). The DL-MO performance was calculated for each condition and was compared with human observer performance, which was obtained by 3 sub-specialized radiologists in an observer study. The performance of DL-MO and radiologists was gauged by the area under localization receiver-operating-characteristic curves. The generalization performance of the DL-MO was estimated with the repeated 2-fold cross-validation method over the same set of trials used in human observer study. A multi-slice Channelized Hoteling Observers (CHO) was compared with the DL-MO across the same experimental conditions.

RESULTS: The performance of DL-MO was highly correlated to that of radiologists (Pearson’s correlation coefficient: 0.987; 95% C.I.: 0.942, 0.997). The performance level of DL-MO was comparable to that of the grouped radiologists, i.e. the mean performance difference was -3.3%. The CHO performance was poorer than the grouped radiologist performance, before internal noise could be added. The correlation between CHO and radiologists was weaker (Pearson’s correlation coefficient: 0.812, and 95% C.I.: [0.378, 0.955]), and the corresponding performance bias (-29.5%) was statistically significant.

CONCLUSION: The presented study demonstrated the potential of using the DL-MO for image quality assessment in patient abdominal CT tasks. This article is protected by copyright. All rights reserved.

PMID:34792800 | DOI:10.1002/mp.15362

Med Biol Eng Comput. 2021 Nov 18. doi: 10.1007/s11517-021-02469-w. Online ahead of print.

ABSTRACT

Nowadays, retinal optical coherence tomography (OCT) plays an important role in ophthalmology and automatic analysis of the OCT is of real importance: image denoising facilitates a better diagnosis and image segmentation and classification are undeniably critical in treatment evaluation. Synthetic OCT was recently considered to provide a benchmark for quantitative comparison of automatic algorithms and to be utilized in the training stage of novel solutions based on deep learning. Due to complicated data structure in retinal OCTs, a limited number of delineated OCT datasets are already available in presence of abnormalities; furthermore, the intrinsic three-dimensional (3D) structure of OCT is ignored in many public 2D datasets. We propose a new synthetic method, applicable to 3D data and feasible in presence of abnormalities like diabetic macular edema (DME). In this method, a limited number of OCT data is used during the training step and the Active Shape Model is used to produce synthetic OCTs plus delineation of retinal boundaries and location of abnormalities. Statistical comparison of thickness maps showed that synthetic dataset can be used as a statistically acceptable representative of the original dataset (p > 0.05). Visual inspection of the synthesized vessels was also promising. Regarding the texture features of the synthesized datasets, Q-Q plots were used, and even in cases that the points have slightly digressed from the straight line, the p-values of the Kolmogorov-Smirnov test rejected the null hypothesis and showed the same distribution in texture features of the real and the synthetic data. The proposed algorithm provides a unique benchmark for comparison of OCT enhancement methods and a tailored augmentation method to overcome the limited number of OCTs in deep learning algorithms.

PMID:34792759 | DOI:10.1007/s11517-021-02469-w

Appl Biochem Biotechnol. 2021 Nov 18. doi: 10.1007/s12010-021-03732-4. Online ahead of print.

ABSTRACT

The aim of this study is to compare and analyze the structure and diversity of intestinal flora between gastric cancer patients and healthy people in the Qinghai-Tibet Plateau and to explore the characteristics of the intestinal flora composition in gastric cancer patients in the plateau area, and to determine the possible correlation between the intestinal flora and gastric cancer. Fresh feces from 22 cases of gastric cancer patients diagnosed in a tertiary hospital in Qinghai Province and 30 cases of healthy people during the same period were collected. The 52 subjects were undergone for 16S rDNA gene sequencing of intestinal bacteria to analyze and compare the diversity and compositional characteristics of intestinal flora. Analysis of the diversity of intestinal flora between the gastric cancer group and the healthy group was based on the Chao1 index of species richness, Shannon diversity index, and Simpson index. It showed that the gastric cancer group had no statistically difference from the healthy group (P > 0.05). In the Venn diagram, the number of OTU units shared by the gastric cancer group and the healthy group is 6997, and the number of unique OTU units in the healthy group is 2282, while the number of OTU units in the gastric cancer group is 896 and the difference is statistically significant (χ² = 495.829), P < 0.000). Analysis of the composition and abundance distribution of intestinal flora showed that at the phylum level, there is no significant deference in abundance between the healthy group of Bacteroides and Firmicutes compared with the gastric cancer group (P > 0.05). However, there is a statistically significant difference in abundance between the healthy groups of Proteobacteria compared with the gastric cancer group (P < 0.05). At the genus level, the gastric cancer group of Prevotella_9 is significantly different from the healthy group (P < 0.05). Meanwhile, the gastric cancer group of Streptococcus and Lactobacillus are significantly different from the healthy group (P < 0.001). There are differences in the composition and abundance of intestinal flora between patients with gastric cancer and healthy people in plateau areas, suggesting that Proteobacteria, Prevotella_9, Streptococcus, and Lactobacillus have increased in the Qinghai-Tibet Plateau and becoming one of the factors related to the incidence of gastric cancer in the region.

PMID:34792749 | DOI:10.1007/s12010-021-03732-4

Mol Biol Rep. 2021 Nov 18. doi: 10.1007/s11033-021-06956-z. Online ahead of print.

ABSTRACT

BACKGROUND: Folate has a pivotal role in maintaining different cellular processes including DNA integrity and neurotransmitter levels. Further, folate deficiency was reported in subjects with neuropsychiatric disorders including autism spectrum disorder (ASD).

METHODS AND RESULTS: We recruited ASD probands following the Diagnostic and Statistical Manual of Mental Disorder-IV/-5. Severity was assessed by the Childhood Autism Rating Scale2-Standard Test (CARS2-ST). Functional SNPs in reduced folate carrier1 (rs1051266), methylenetetrahydrofolate dehydrogenase (rs2236225), methylenetetrahydrofolate methyltransferase (rs1805087), methylenetetrahydrofolate reductase (rs1801133 and rs1801131), cystathionine-beta- synthase (rs5742905), and serine hydroxymethyltransferase (rs1979277) genes were analyzed in the ASD probands (N = 203), their parents and controls (N = 250) by PCR/TaqMan based methods. Plasma homocysteine and vitamin B12 levels were examined by Enzyme-Linked ImmunoSorbent Assay. Statistical analysis revealed higher frequencies of rs1051266 and rs1805087 “A” alleles (P = 8.233e-005 and P = 0.010 respectively) and rs1051266 “AA” genotype (P = 0.02) in the ASD probands. Gender based stratified analysis revealed higher frequency of rs1051266 “AA” in the male probands (P = 0.001) while frequencies of rs1805087 “A” (P = 0.001) and “AA” (P < 0.05), and rs2236225 “CC” (P = 0.03) were higher in the females. The case-control analysis also exhibited a significant difference in the occurrence of biallelic and triallelic haplotypes. rs1051266 “A”, rs1979277 “T” and rs5742905 “C” alleles showed biased parental transmission (P = 0.02). CARS2-ST scores were higher in the presence of rs5742905 “T” while scores were lower in the presence of rs1979277 “T” and rs1051266 “A”. ASD probands showed vitamin B12 deficiency.

CONCLUSION: Based on these observations, we infer that components needed for proper folate metabolism may influence ASD severity in this population.

PMID:34792727 | DOI:10.1007/s11033-021-06956-z

Clin Transl Oncol. 2021 Nov 18. doi: 10.1007/s12094-021-02729-z. Online ahead of print.

ABSTRACT

PURPOSE: Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer.

METHODS: Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration.

RESULTS: In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively).

CONCLUSIONS: The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.

PMID:34792726 | DOI:10.1007/s12094-021-02729-z

Eur J Epidemiol. 2021 Nov 18. doi: 10.1007/s10654-021-00820-x. Online ahead of print.

NO ABSTRACT

PMID:34792692 | DOI:10.1007/s10654-021-00820-x

Neurol Sci. 2021 Nov 18. doi: 10.1007/s10072-021-05729-7. Online ahead of print.

ABSTRACT

BACKGROUND: Telephone-based cognitive screening (TBCS) is crucial to telehealth care of neurological patients, prevention campaigns, and epidemiological studies on cognitive impairment. The Telephone Interview for Cognitive Status (TICS) is one of the most widespread and psychometrically/diagnostically sound TBCS test, with several versions developed worldwide (e.g., with and without a delayed recall item). In Italy, only attempts of adaptation and preliminary evidence of its statistical features have been provided so far. This study thus aimed at (1) developing an Italian version of the TICS and assessing its (2) psychometric and (3) diagnostic properties.

METHODS: A back-translated and culturally adapted version of the TICS was developed. Three-hundred and sixty-five healthy individuals from different regions of Italy (147 males, 216 females; age: 53.2 ± 16 years; education: 13 ± 4.5 years) were administered the TICS and the Italian telephone-based Mini-Mental State Examination (Itel-MMSE). Validity was tested by convergence and at the structure level, whereas reliability as internal consistency, test-retest, and inter-rater. Diagnostic accuracy, item difficulty, and discrimination were also examined.

RESULTS: The TICS featured a single component and its score converged with that of the Itel-MMSE (r_s = .37). Reliability was excellent as inter-rater (ICC = .94), good as test-retest (ICC = .78), and acceptable as internal consistency (Cronbach’s α = .63). Accuracy was high as tested against the Itel-MMSE (AUC = .83) and did not improve when adding the delayed recall. Backward subtraction was the most difficult and discriminative task.

DISCUSSION: The Italian TICS is a valid, reliable, and diagnostically accurate TBCS test. The original format of the TICS can be thus adopted in both clinical and research settings.

PMID:34792669 | DOI:10.1007/s10072-021-05729-7