Nevin Manimala

Eur J Pain. 2021 Nov 8. doi: 10.1002/ejp.1882. Online ahead of print.

ABSTRACT

BACKGROUND: Visual and acoustic virtual reality (VR) has been increasingly explored as a non-pharmacological tool for pain relief in clinical settings.

OBJECTIVE: We aimed to evaluate the effectiveness of VR as a distraction technique in the management of acute pain during operative hysteroscopy in the outpatient setting.

METHODS: A prospective, open-label, randomized control trial in a tertiary university-affiliated medical center between April to August 2020. Overall, 82 women were randomly allocated to undergo operative hysteroscopy either with the use of VR (n = 44, study group) or with standard treatment (control group, n = 38). VR was applied throughout the procedure and no anesthesia was given. The primary outcome measures included self-reported intraoperative pain. Other objectives included vital parameters as pulse rate (PR) and respiratory rate (RR) before and during the first 3 minutes of the procedure. Pain and anxiety outcomes were measured as numeric rating scores.

RESULTS: The baseline parameters were similar between groups. The mean duration for the procedure was 8.1 ±3.2 vs. 7.3± 6.0 minutes for the study and the control groups (p = 0.23). There were no statistically significant differences between the reported pain scores during the procedure [median (interquartile range) 5.0 (3.0-7.2) vs 5.0 (3.0-8.0), respectively; P = .67]. While neither intraoperative heart rate nor respiratory rate differed between groups [14.0 (13.0-16.0) vs 14.0 (11.0-16.5); P = .77)], the increase of heart rate was found greater in the VR group [+7.0 (8.5) vs. +1.0 (12.2); P = .01].

CONCLUSION: VR was not effective in reducing pain during an outpatient operative hysteroscopy.

PMID:34748679 | DOI:10.1002/ejp.1882

J Oral Pathol Med. 2021 Nov 8. doi: 10.1111/jop.13257. Online ahead of print.

ABSTRACT

BACKGROUND: Oral lichen planus (OLP) is considered an oral potentially malignant disorder. While OLP has been associated with the development of oral squamous cell carcinoma (OSCC), little is known about the role of topical corticosteroids therapy (TCT) in the promotion of carcinogenesis. The study aims to determine if TCT influences the time of malignant transformation of OLP to OSCC. The study also investigates this correlation in the presence or absence of Candida overgrowth, and in the context of conventional OSCC risk factors such as smoking, alcohol use, and male gender.

METHODS: A retrospective analysis of electronic health records at a tertiary care academic medical center was performed. Patients with OLP and OSCC were considered for inclusion. The diagnosis of OLP required both clinical and histological documentation.

RESULTS: Eighty-two patients met inclusion criteria, consisting of 48 women (58.25%) and 34 men (41.5%) and the mean patient age was 65.9 years (SD=13.25). Forty-five patients (54.9%) received TCT for OLP before they developed OSCC. The time between the OLP and OSCC diagnoses increased by four years in patients who received topical steroid therapy for OLP (P<.001) and decreased by three years (P= .010) in those with Candida overgrowth. Gender, smoking, and alcohol use did not have a statistically significant influence on the time between OLP and OSCC.

CONCLUSION: The management of OLP using TCT potentially delayed cancer development in our study. Conversely, it appears that Candida may play a role in the field cancerization of OLP patients.

PMID:34748663 | DOI:10.1111/jop.13257

Med Phys. 2021 Nov 8. doi: 10.1002/mp.15327. Online ahead of print.

ABSTRACT

PURPOSE: Cardiovascular magnetic resonance (CMR) is a vital diagnostic tool in the management of cardiovascular diseases. The advent of advanced CMR technologies combined with artificial intelligence (AI) has the potential to simplify imaging, reduce image acquisition time without compromising image quality, and improve magnetic field uniformity. Here we aim to implement two AI-based deep learning techniques for automatic slice alignment and cardiac shimming and evaluate their performance in clinical cardiac MRI.

METHODS: Two deep neural networks were developed, trained and validated on pre-acquired cardiac MRI datasets (>500 subjects) to achieve automatic slice planning and shimming (implemented in the scanner) for CMR. To examine the performance of our automated cardiac planning (EasyScan) and AI-based shim (AI shim), two prospective studies were performed subsequently. For the EasyScan validation, 10 healthy subjects underwent two identical CMR protocols: with manual cardiac planning and with AI-based EasyScan to assess protocol scan time difference and accuracy of cardiac plane prescriptions on a 1.5T clinical MRI scanner. For the AI shim validation, a total of 20 subjects were recruited: 10 healthy and 10 cardio-oncology patients with referrals for a CMR examination. Cine images were obtained with standard cardiac volume shim and with AI shim to assess signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), overall image quality (sharpness and MR image degradation), ejection fraction (EF) and absolute wall thickening. A hybrid statistical method using of non-parametric (Wilcoxon) and parametric (t-test) assessments was employed for statistical analyses.

RESULTS: CMR protocol with AI-based plane prescriptions, EasyScan, minimized operator dependence and reduced overall scanning time by over 2 minutes (∼ 13 % faster, P < 0.001) compared to the protocol with manual cardiac planning. EasyScan plane prescriptions also demonstrated more accurate (less plane angulation errors from planes manually prescribed by a certified cardiac MRI technologist) cardiac planes than previously reported strategies. Additionally, AI shim resulted in improved B0 field homogeneity. Cine images obtained with AI shim revealed a significantly higher SNR (12.49 %; P = 0.002) than those obtained with volume shim (volume shim: 32.90 ± 7.42 vs. AI shim: 37.01 ± 8.87) for the left ventricle (LV) myocardium. LV myocardium CNR was 12.48 % higher for cine imaging with AI shim (149.02 ± 39.15) than volume shim (132.49 ± 33.94). Images obtained with AI shim resulted in sharper images than those obtained with volume shim (P = 0.012). The LVEF and absolute wall thickening also showed that differences exist between the two shimming methods. The LVEF by AI shim was shown to be slightly larger than LVEF by volume shim in two groups: 2.87 % higher with AI shim for the healthy group, and 1.70 % higher with AI shim for the patient group. The LV absolute wall thickening (in mm) also showed that differences exist between shimming methods for each group with larger changes observed in the patient group (healthy: 3.31 %, P = 0.234, and patient group: 7.29 %, P = 0.059).

CONCLUSIONS: CMR exams using EasyScan for cardiac planning demonstrated accelerated cardiac exam compared to the CMR protocol with manual cardiac planning. Improved and more uniform B0 magnetic field homogeneity also achieved using AI shim technique compared to volume shimming. This article is protected by copyright. All rights reserved.

PMID:34748660 | DOI:10.1002/mp.15327

Photodermatol Photoimmunol Photomed. 2021 Nov 8. doi: 10.1111/phpp.12751. Online ahead of print.

ABSTRACT

BACKGROUND/PURPOSE: The aim was to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical instrumentation (MI) in reducing Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) counts from C-shaped root-canals.

METHODS: Teeth with C-shaped canals as identified on cone beam computed tomographic images were included. Following incubation with E. faecalis and C. albicans, samples were divided into 4 groups as follows: Group-1: MI with adjunct aPDT; Group-2: aPDT alone; Group-3: MI alone; and Group-4: no treatment. The pulp chambers of these teeth were exposed and coronal pulp was mechanically derided using sterile endodontic excavators. Using flexible files, all canals were debrided up to size #30 K-files with intermittent irrigation with 2.5% sodium hypochlorite irrigation. In groups 1 and 3, methylene-blue was injected in all canals and aPDT was performed using a 600 nm diode laser. Sample-size estimation was done on data from a pilot investigation and group-comparisons were done using one way analysis of variance and Bonferroni post-hoc adjustment tests. P<0.05 was considered statistically significant.

RESULTS: Sixty periodontally hopeless mandibular second molars with C-shaped canals were included. There was a statistically significant reduction CFU/ml of E. faecalis (P<0.001) and C. albicans (P<0.001). at post-operative microbial assessments in Group-1. There was no difference CFU/ml of E. faecalis and C. albicans at post-operative microbial assessments in groups 2, 3 and 4.

CONCLUSION: MI with adjunct aPDT is more effective in reducing count of E. faecalis and C. albicans from C-shaped root canals.

PMID:34748657 | DOI:10.1111/phpp.12751

J Prosthodont. 2021 Nov 8. doi: 10.1111/jopr.13447. Online ahead of print.

ABSTRACT

PURPOSE: This is a clinical study to compare complete digital workflows generated using intraoral scanning and the split-file technique with a conventional workflow for cement-retained implant-supported restorations.

MATERIALS AND METHODS: Forty patients requiring posterior single-unit implant restorations were included. Twenty patients were randomly assigned to the complete digital workflow group, involving intraoral scanning and manufacture of cement-retained crowns using the split-file technique (test group). The remaining 20 patients were assigned to the hybrid workflow group (control group), involving conventional impressions and CAD/CAM-fabricated crowns based on stone casts. Scanning of the crowns was performed before and after clinical adjustment using an intraoral scanner (TRIOS Color; 3Shape). Two 3D digital models were trimmed and superimposed to evaluate changes in dimensions using Geomagic Control 2014 software. Chair-side and laboratory times for the entire workflow were recorded. Independent-sample t tests were used for the statistical analysis.

RESULTS: All crowns were inserted without re-fabrication. The average maximum occlusal adjustment of the crowns, measured as maximum deviation of occlusal area in superimposed pre and post scans, was -212.7 ±150.5 and -330.7 ±192.5 μm in the test and control groups, respectively (p = 0.037).The average area of occlusal adjustment, measured as area of deviation larger than 100 μm, was 8.4 ±8.1 and 17.1 ±12.3 mm² in the test and control groups, respectively (p = 0.012). The mesial and distal contact adjustment amounts, maximum deviations of proximal area, were -33.0 ±96.2 and -48.6 ±70.5 μm in the test group, and -3.7 ±66.7 μm and -11.4 ±106.7 μm in the control group, respectively. The mean chair-side time was 20.20 ± 3.00 and 26.65 ± 4.53 min in the test and control groups, respectively (p < 0.001). The mean laboratory time was 43.70 ± 5.56 and 84.55 ± 5.81 min in the test and control groups, respectively (p < 0.001).

CONCLUSIONS: Single-unit cement-retained crowns with complete digital workflows required fewer crown adjustments and had shorter clinical and laboratory times compared to conventional impressions and hybrid workflows. Digital impressions and the split-file technique provided customized abutments and cement-retained crowns, thus broadening the indications for digital workflows for implants. This article is protected by copyright. All rights reserved.

PMID:34748653 | DOI:10.1111/jopr.13447

J Periodontal Res. 2021 Nov 8. doi: 10.1111/jre.12943. Online ahead of print.

ABSTRACT

OBJECTIVE: The current study aimed to evaluate the effect of electronic cigarette (EC) aerosol, Cannabis, and conventional cigarettes smoke on gingival fibroblast/gingival mesenchymal stem cells’ (GF/G-MSCs) of never smokers.

MATERIAL AND METHODS: Human GF/G-MSCs (n = 32) were isolated and characterized using light microscopy, flow cytometry, and multilineage differentiation ability. Following the application of aerosol/smoke extracts, GF/G-MSCs were evaluated for cellular proliferation; colony-forming units (CFU-F) ability; cellular viability (using the MTT assay); mitochondrial depolarization using JC-1 dye; and genes’ expression of ATM, p21, Oct4, and Nanog.

RESULTS: Colony-forming units and viability (OD 450 nm) were significantly reduced upon exposure to Cannabis (mean ± SD; 5.5 ± 1.5; p < .00001, 0.47 ± 0.21; p < .05) and cigarettes smoke (2.3 ± 1.2 p < .00001, 0.59 ± 0.13, p < .05), while EC aerosol showed no significant reduction (10.8 ± 2.5; p = .05, 1.27 ± 0.47; p > .05) compared to the control group (14.3 ± 3, 1.33 ± 0.12). Significantly upregulated expression of ATM, Oct4, and Nanog (gene copies/GADPH) was noticed with Cannabis (1.5 ± 0.42, 0.82 ± 0.44, and 1.54 ± 0.52, respectively) and cigarettes smoke (1.52 ± 0.75, 0.7 ± 0.14, and 1.48 ± 0.79, respectively; p < .05), whereas EC aerosol caused no statistically significant upregulation of these genes compared to the control group (0.63 ± 0.1, 0.31 ± 0.12, and 0.64 ± 0.46, respectively; p > .05). The p21 gene was not significantly downregulated in EC aerosol (1.22 ± 0.46), Cannabis (0.71 ± 0.24), and cigarettes smokes (0.83 ± 0.54) compared to the control group (p = .053, analysis of variance).

CONCLUSION: Cannabis and cigarettes smoke induce DNA damage and cellular dedifferentiation and negatively affect the cellular proliferation and viability of GF/G-MSCs of never smokers, whereas EC aerosol showed a significantly lower impact on these properties.

PMID:34748642 | DOI:10.1111/jre.12943

J Gerontol A Biol Sci Med Sci. 2021 Nov 8:glab335. doi: 10.1093/gerona/glab335. Online ahead of print.

ABSTRACT

In this study we investigated how the concentrations, pairwise correlations, and ratios of 202 free circulating blood metabolites and lipids vary with age in a panel of n=1882 subjects ranging from 48 to 94 years. We report a statistically significant sex-dependent association with age of a panel of metabolites and lipids involving, in women cohort, linoleic acid, α-linoleic acid, and carnitine, and, in men sub-group, monoacylglycerols and lysophosphatidylcholines. Evaluating the association of correlations among metabolites and/or lipids with age, we found that phosphatidylcholines correlations tend to have a positive trend associated with age in women, and monoacylglycerols and lysophosphatidylcholines correlations tend to have a negative trend associated with age in men. The association of ratio between molecular features with age reveals that the ratio between decanoyl L-carnitine and lysophosphatidylcholine in women have a negative association with age, while the ratios between L-carnitine, L-acetylcarnitine, and phosphatidylcholines in men have a positive association with age. These results suggest an age-dependent remodeling of lipid metabolism that induces changes in cell membrane bilayer composition and cell cycle mechanisms. Furthermore, we conclude that lipidome is directly involved in this age-dependent differentiation. Our results demonstrate that, using a comprehensive approach to aging focused on the changes of concentrations and relationships thereof, as expressed by their correlations and ratios, it is possible to obtain relevant information about metabolic dynamics associated with age.

PMID:34748631 | DOI:10.1093/gerona/glab335

Clin Infect Dis. 2021 Nov 8:ciab945. doi: 10.1093/cid/ciab945. Online ahead of print.

ABSTRACT

BACKGROUND: ‘Classic’ symptoms (cough, fever, loss of taste/smell) prompt SARS-CoV-2 PCR-testing in the UK. Studies have assessed the ability of different symptoms to identify infection, but few have compared symptoms over time (reflecting variants) and by vaccination status.

METHODS: Using the COVID-19 Infection Survey, sampling households across the UK, we compared symptoms in PCR-positives vs. PCR-negatives, evaluating sensitivity of combinations of 12 symptoms (percentage symptomatic PCR-positives reporting specific symptoms) and tests per case (TPC) (PCR-positives or PCR-negatives reporting specific symptoms/ PCR-positives reporting specific symptoms).

RESULTS: Between April 2020 and August 2021, 27,869 SARS-CoV-2 PCR-positive episodes occurred in 27,692 participants (median 42 years), of whom 13,427 (48%) self-reported symptoms (“symptomatic PCR-positives”). The comparator comprised 3,806,692 test-negative visits (457,215 participants); 130,612 (3%) self-reported symptoms (“symptomatic PCR-negatives”). Symptom reporting in PCR-positives varied by age, sex, and ethnicity, and over time, reflecting changes in prevalence of viral variants, incidental changes (e.g. seasonal pathogens (with sore throat increasing in PCR-positives and PCR-negatives from April 2021), schools re-opening) and vaccination roll-out. After May-2021 when Delta emerged, headache and fever substantially increased in PCR-positives, but not PCR-negatives. Sensitivity of symptom-based detection increased from 74% using ‘classic’ symptoms, to 81% adding fatigue/weakness, and 90% including all eight additional symptoms. However, this increased TPC from 4.6 to 5.3 to 8.7.

CONCLUSIONS: Expanded symptom combinations may provide modest benefits for sensitivity of PCR-based case detection, but this will vary between settings and over time, and increases tests/case. Large-scale changes to targeted PCR-testing approaches require careful evaluation given substantial resource and infrastructure implications.

PMID:34748629 | DOI:10.1093/cid/ciab945

Clin Infect Dis. 2021 Nov 8:ciab947. doi: 10.1093/cid/ciab947. Online ahead of print.

NO ABSTRACT

PMID:34748626 | DOI:10.1093/cid/ciab947

J Clin Endocrinol Metab. 2021 Nov 8:dgab809. doi: 10.1210/clinem/dgab809. Online ahead of print.

ABSTRACT

BACKGROUND: The association between impaired fasting glucose (IFG) and cardiovascular disease (CVD) in participants without atherosclerotic cardiovascular disease (ASCVD) risk factors based on current definitions is unclear. The study aimed to examine the association of fasting glucose levels with CVD and its subtypes in persons without ASCVD risk factors.

METHODS: This study included 38,297 participants (men, 62.1%; mean age, 47.9 [12.9] years) who were free of a history of CVD, absent of ASCVD risk factors, and had a fasting plasma glucose (FPG) level between 70 to 125 mg/dl at baseline from Kailuan Study during 2006 to 2007, participants were followed up until new-onset CVD event, death or December 31, 2017. Cox proportional hazards models were performed to evaluate the associations.

RESULTS: During a median follow-up of 11.0 years (interquartile range, 10.7-11.2 years), we observed 1,217 incident CVD events. Compared with participants with FPG 70 to 99 mg/dl, the multivariable adjusted hazard ratios for CVD among participants with FPG 100 to 109 mg/dl and 110 to 125 mg/dl were 1.18 (95% confidence interval [CI], 1.02-1.38) and 1.27 (95%CI, 1.03-1.55), respectively. Multivariable-adjusted spline regression model showed a J-shaped association between FPG and the risk of CVD.

CONCLUSIONS: We found that among individuals without diabetes or other traditional ASCVD risk factors, there is an increased risk of incident CVD with increasing abnormal FPG levels. These results highlight the importance of primordial prevention for FPG level increases along with other traditional ASCVD risk factors.

PMID:34748624 | DOI:10.1210/clinem/dgab809