Nevin Manimala

J Periodontal Implant Sci. 2021 Oct;51(5):342-351. doi: 10.5051/jpis.2100920046.

ABSTRACT

PURPOSE: The aim of this study was to compare the inflammatory and lipid profile of patients with and without peri-implantitis.

METHODS: A cross-sectional biochemical study was carried out in which blood samples were collected from 16 patients with peri-implantitis and from 31 subjects with healthy implants. Clinical peri-implant parameters were obtained from all subjects. Levels of tumor necrosis factor-alpha and interleukin-10 (IL-10) were measured in serum. Lipid fractions, glucose and creatinine levels, and complete blood count were also assessed.

RESULTS: After controlling for a history of periodontitis, statistically significant differences between peri-implantitis patients and controls were found for total cholesterol (estimated adjusted mean difference, 76.4 mg/dL; 95% confidence interval [CI], 39.6, 113.2 mg/dL; P<0.001), low-density lipoprotein (LDL) cholesterol (estimated adjusted mean difference, 57.7 mg/dL; 95% CI, 23.8, 91.6 mg/dL; P<0.001), white blood cells (WBC) (estimated adjusted mean difference, 2.8×10³/μL; 95% CI, 1.6, 4.0×10³/μL; P<0.001) and IL-10 (estimated adjusted mean difference, -10.4 pg/mL; 95% CI, -15.8, -5.0 pg/mL; P<0.001). The peri-implant probing pocket depth (PPD) was modestly positively correlated with total cholesterol (r=0.512; P<0.001), LDL cholesterol (r=0.463; P=0.001), and WBC (r=0.519; P<0.001). A moderate negative correlation was observed between IL-10 and PPD (r=0.609; P<0.001).

CONCLUSIONS: Otherwise healthy individuals with peri-implantitis showed increased low-grade systemic inflammation and dyslipidemia.

PMID:34713995 | DOI:10.5051/jpis.2100920046

Clin Exp Dent Res. 2021 Oct 29. doi: 10.1002/cre2.509. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim was to analyze clinical parameters of peri-implantitis in human subjects exposed and non-exposed to use of systemic statins.

MATERIAL AND METHODS: This retrospective cohort pilot study compared patient records of 60 exposed individuals to 196 non-exposed individuals as of 2011 throughout 2017. Source of records were specialist and general dentistry clinics in Public Dental Service, Stockholm County, Sweden. Extent/severity of peri-implantitis and peri-implant bone loss were registered as well as intake of systemic statins. Background variables considered were bleeding on probing, bone-loss, age, gender, earlier periodontitis, prosthetic quality, and smoking. Stepwise linear and logistic regression analysis at the individual level was adopted in order to study the influence of statin use on the severity of peri-implantitis and the incidence of peri-implant bone loss. Results were considered statistically significant at p < 0.05.

RESULTS: Peri-implant bone loss was significantly correlated to use of statin after compensation for age and sex.

CONCLUSIONS: The results render an actual effect of statins on peri-implant bone loss plausible. Further research is warranted.

PMID:34713988 | DOI:10.1002/cre2.509

J Ultrasound Med. 2021 Oct 29. doi: 10.1002/jum.15863. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate shear wave elastography (SWE) and quantitative ultrasound (QUS) parameters in patients hospitalized for lower limb deep vein thrombosis (DVT).

METHOD: Sixteen patients with DVT were recruited and underwent SWE and radiofrequency data acquisitions for QUS on day 0, day 7, and day 30 after the beginning of symptoms, in both proximal and distal zones of the clot identified on B-mode scan. SWE and QUS features were computed to differentiate between thrombi at day 0, day 7, and day 30 following treatment with heparin or oral anticoagulant. The Young’s modulus from SWE was computed, as well as QUS homodyned K-distribution (HKD) parameters reflecting blood clot structure. Median and interquartile range of SWE and QUS parameters within clot were taken as features.

RESULTS: In the proximal zone of the clot, the HKD ratio of coherent-to-diffuse backscatter median showed a significant decrease from day 7 to day 30 (P = .036), while the HKD ratio of diffuse-to-total backscatter median presented a significant increase from day 7 to day 30 (P = .0491). In the distal zone of the clot, the HKD normalized intensity of the echo envelope median showed a significant increase from day 0 to day 30 (P = .0062). No SWE features showed statistically significant differences over time. Nonetheless, a trend of lower median of Young’s modulus within clot for patients who developed a pulmonary embolism was observed.

CONCLUSION: QUS features may be relevant to characterize clot’s evolution over time. Further analysis of their clinical interpretation and validation on a larger dataset would deserve to be studied.

PMID:34713918 | DOI:10.1002/jum.15863

Med Phys. 2021 Oct 29. doi: 10.1002/mp.15309. Online ahead of print.

ABSTRACT

PURPOSE: The current state-of-the-art calculation of detectability index (d’) is largely phantom based, with the latest being based on a hybrid phantom NPS combined with patient specific noise magnitude and high-contrast air-skin interface. The purpose of this study was to develop and assess the use of fully-patient-specific measurements of noise and low-contrast resolution, derived entirely from patient images, on d’.

METHODS: This study developed a d’ calculation that is patient- and task-specific, employing newly developed algorithms for estimating patient-specific noise power spectrum (NPS) and low-contrast task transfer function (TTF). The TTF estimation methodology used a trained regression support vector machine (SVM) to estimate a fitted form of the TTF given a variance-normalized estimate of the noise power spectrum (referred to as the TTF_NPS ). The regression SVM was trained and tested using five-fold cross validation on 192 scans (4 dose levels x 6 reconstruction kernels x 4 repeats) of a phantom with low-contrast polyethylene insert, and reconstructed with filtered backprojection and iterative reconstructions across 12 clinically-relevant kernels (FBP: B20f, B31f, B45f; SAFIRE: I26f, I31f, J45f with Strengths: 2, 3, 5). To test the low contrast TTF estimation method, the estimated TTF_NPS measurements were compared to (1) TTF measurements from the air-phantom interface (referred to as the TTF_air , representing the most patient-specific clinical alternative) and (2) TTF measurements from the edge of the low-contrast polyethylene insert (referred to as the TTF_poly ) which represented the gold standard of low-contrast TTF measurement. Patient-specific NPS, patient-specific noise magnitude, and patient-specific low-contrast TTF were further combined with a reference task function to calculate a d’ (according to a non-pre-whitening matched filter model) across 1120 lesions previously evaluated in 2AFC human observer detection of liver lesions. The resulting values were compared to the observer results using a generalized linear mixed-effects statistical model. The correlations between the model and observer results were also compared with previously-reported values (using a hybrid method with phantom-derived NPS and TTF_air ).

RESULTS: The TTF_NPS more accurately represented resolution across the considered reconstruction settings compared with the TTF_air . The out-of-fold predictions of the TTF_NPS had statistically better RMSE concordance (p < 0.05, one-tailed Wilcoxon ranksum test) to gold standard than the TTF_air (the alternative, measured from the air-phantom interface). Detectability indices informed by purely patient-specific NPS and TTF were strongly correlated with 2AFC outcomes (p<0.05). R-squared between human detection accuracy and model-predicted detection accuracy were shown be greater for those measured with patient-specific d’ than for the hybrid d’ but failed to rise to the level of statistical significance (p >= 0.05, bootstrap resampled corrected paired Student’s t-test).

CONCLUSIONS: The results suggest that fully-patient-specific characterization of image quality based on in vivo NPS and low-contrast TTF offer advantages over hybrid methods. The results in terms of detectability index favorably relate to observer detection of liver lesions. The method can potentially be integrated into an automated image quality tracking system to assess image quality across a CT clinical operation without needing phantom scans. This article is protected by copyright. All rights reserved.

PMID:34713908 | DOI:10.1002/mp.15309

Nurs Forum. 2021 Oct 29. doi: 10.1111/nuf.12667. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to investigate if an extracurricular research skills development program builds the knowledge, attitudes, and skills (KAS) to support evidence-based practice (EBP).

METHODS: Twenty nursing students and six mentors in four teams completed small, student-led research projects over 1 year. Using a mixed-methods design, the knowledge, attitudes, and practice (KAP) survey was administered at three-time points, followed by qualitative interviews. A linear mixed-effects regression model was used to analyze survey data and thematic analysis for qualitative data.

RESULTS: The change from the KAP survey from the first to the third time point showed a statistically significant difference following engagement in the program. Qualitative data indicated benefits and challenges to participation for both students and mentors. Mentorship provided students with improved relationships, collaboration, and leadership skills. Students believed the program enhanced their understanding of research and reported increased confidence in using EBP.

CONCLUSION: Offering students innovative first-hand experiences with research develops research KAS to support EBP.

PMID:34713907 | DOI:10.1111/nuf.12667

Medicine (Baltimore). 2021 Oct 29;100(43):e27673. doi: 10.1097/MD.0000000000027673.

ABSTRACT

BACKGROUND: The present study aimed to systematically evaluate the diagnostic value of an isoform of alpha-fetoprotein (AFP), AFP-L3, for early hepatocellular carcinoma (HCC) by a meta-analysis.

METHODS: Diagnostic reports of AFP-L3% in early HCC were searched in the PubMed, Web of Science, Cochrane Library, and Embase databases up to December 2019. The retrieved literature was reviewed, and eligible articles were selected. Data were extracted from the eligible articles, and the risk of bias was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies scale. Statistical analyses were conducted by MetaDiSc1.4 and RevMan5.3 software. The sensitivities, specificities, and diagnostic odds ratios were pooled. The summary receiver operating characteristic curve was drawn, and the area under the curve was calculated.

RESULTS: Six studies with acceptable quality were included in the meta-analysis involving 2447 patients. No threshold effect was observed among the 6 studies, but there was obvious heterogeneity. The pooled sensitivity, specificity, and positive and negative likelihood ratios of AFP-L3% for the diagnosis of early HCC were 0.34 (95% CI 0.30-0.39, P < .0001), 0.92 (95% CI 0.91-0.93, P < .0001), 4.46 (95% CI 2.94-6.77, P = .0033), and 0.71 (95% CI 0.61-0.82, P = .0004), respectively. The diagnostic odds ratio was 6.78 (95% CI 4.02-11.44, P = .0074). The the area under the curve of the summary receiver operating characteristic was 0.755 (95% CI 0.57-0.94).

CONCLUSION: AFP-L3% has high specificity but low sensitivity for diagnose early HCC, suggesting that AFP-L3% is more valuable for excluding HCC in conditions with elevated AFP than for diagnosing early HCC. In addition, a hypersensitive detection method can improve the diagnostic accuracy of AFP-L3% for early HCC.

PMID:34713864 | DOI:10.1097/MD.0000000000027673

Medicine (Baltimore). 2021 Oct 29;100(43):e27628. doi: 10.1097/MD.0000000000027628.

ABSTRACT

Retinal vein occlusion (RVO) is an important cause of blindness. Hypertension is a well-known risk factor for RVO. Although the prevalence of hypertension increases in women after menopause, the relationship between blood pressure and RVO in women before and after menopause has not been studied in detail.We retrospectively analyzed 2,619,206 patients from the Korean National Health Insurance System database. A Cox proportional hazard regression model was used to evaluate the independent association between blood pressure and the risk of RVO development and identify differences between premenopausal and postmenopausal women.The incidence of RVO was higher among postmenopausal women than in premenopausal women. In the model adjusted for socioeconomic and clinical variables, there was an association between blood pressure and RVO development in premenopausal and postmenopausal women; however, this was stronger than premenopausal women.Both systolic and diastolic blood pressure are associated with an increased risk of RVO, and their effects are more potent in premenopausal women than postmenopausal women. Thus, comprehensive management of hypertension in premenopausal women is essential to reduce the risk of RVO.

PMID:34713852 | DOI:10.1097/MD.0000000000027628

Medicine (Baltimore). 2021 Oct 29;100(43):e27588. doi: 10.1097/MD.0000000000027588.

ABSTRACT

The purpose of this study was to analyze the outcomes of titanium elastic nail (TEN) for the children in 6 to 10 years old who sustained a Delbet IV femoral neck fracture.A total of 56 children aged 6 to 10 years old with Delbet IV femoral neck fracture treated with TEN or cannulated screw (SC) were identified at our hospital from January 2009 to December 2019. Of which 24 were treated with TEN, and 32 with SC. All of them were followed up for 1 year after operation, and the differences in operation time, intraoperative blood loss, hospitalization time, hip joint function, and complication between the 2 groups were compared. Harris and Ratliff hip score were used to evaluate the hip function.All 56 fractures united properly. No major complications were noted in both groups. The intraoperative blood loss and operation time in TEN group and SC group were (11.42 ± 3.41) mL, (19.66 ± 4.05) mL (P = .000) and (33.58 ± 7.89) min, (40.22 ± 7.48) min (P = .002), respectively. There was no significant statistical difference between hip regarding range of motion and femoral neck-shaft angle in both groups, as well as Harris and Ratliff hip score between the 2 groups.TEN represent safe and effective methods in the treatment of Delbet IV femoral neck fracture in 6 to 10 years old children. TEN internal fixation is a minimal invasive and simpler technique and suitable for young children of Delbet IV femoral neck fracture.

PMID:34713834 | DOI:10.1097/MD.0000000000027588

Medicine (Baltimore). 2021 Oct 29;100(43):e27586. doi: 10.1097/MD.0000000000027586.

ABSTRACT

BACKGROUND: Corona virus disease 2019 (COVID-19) is spreading fast and it brings great pressure to the social economy. Many reports revealed that ginseng can develop immunity for respiratory disease, but there is no evidence to prove its effects on COVID-19. This protocol of systematic review and meta-analysis will clarify the safety and effectiveness of ginseng adjuvant therapy on COVID-19 patients.

METHODS: Different databases (Web of Science, Cochrane Library, PubMed, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, Wan fang Database, ClinicalTrials, World Health Organization Trials, and Chinese Clinical Trial Registry) will be retrieved to search related articles according to pre-defined inclusion and exclusion criteria. Clinical recovery time and effective rates will be assessed as the primary outcomes and any changes of patient’s condition will be considered as the secondary outcomes. Subgroup analysis and sensitivity analysis will be conducted to explore sources of heterogeneity. Endnote X9.3 will be used to manage data screening. The statistical analysis will be completed by RevMan5.3 and Stata/SE 15.1 software.

RESULTS: This study will assess the effects and safety for ginseng adjuvant therapy on COVID-19 patients.

CONCLUSION: The discussion will be considered to determine whether sufficient evidence exists to prove the effects of ginseng adjuvant therapy for COVID-19 patients.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO (ID: CRD42021277843).

PMID:34713832 | DOI:10.1097/MD.0000000000027586

Medicine (Baltimore). 2021 Oct 29;100(43):e27567. doi: 10.1097/MD.0000000000027567.

ABSTRACT

To determine the economic burden of metastatic breast cancer (MBC) in Taiwan, we conducted a national retrospective claim database analysis to evaluate the incremental healthcare costs and utilization of MBC patients as compared to their breast cancer (BC) and breast cancer free (BCF) counterparts.Data were obtained from the National Health Insurance Claim Database and the Taiwan Cancer Registry database between 2012 and 2015. All healthcare utilization and costs were calculated on a per-patient-per-month (PPPM) basis and were compared among groups using the generalized linear model adjusting for age group, residential area, and Charlson comorbidity index group.A total of 1,606 MBC patients were matched to 6,424 BC patients and 6,424 BCF patients. The majority of overall MBC healthcare costs were attributed to outpatient costs (75.1%), followed by inpatient (23.2%) and emergency room costs (1.7%). The PPPM total healthcare costs of the MBC, BC, and BCF groups were TWD 7,422, 14,425, and 2,114, respectively. The adjusted PPPM total healthcare cost ratio of MBC to BCF was 4.1. Compared to BCF patients, the patients receiving both human epidermal growth factor receptor 2-targeted therapy and endocrine therapy incurred 28.1 times PPPM total costs. The adjusted PPPM total healthcare cost ratio of recurrent MBC to BCF was 2.3, while the ratio was 12.2 in the de novo MBC group.Patients with MBC are associated with substantial economic burden, particularly in outpatient costs. The study findings could be useful for MBC-related economic evaluations and health resource allocation.

PMID:34713830 | DOI:10.1097/MD.0000000000027567