Nevin Manimala

Clin Oral Investig. 2022 Jun 25. doi: 10.1007/s00784-022-04587-7. Online ahead of print.

ABSTRACT

OBJECTIVES: In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite.

MATERIALS AND METHODS: Ninety non-carious cervical lesions (NCCLs) in 19 participants were involved in this trial. NCCLs were restored with a flowable composite (Clearfil Flow FX: FX, Kuraray Noritake, Japan) or a conventional resin composite (Clearfil AP-X: AP) in conjunction with a one-step self-etch adhesive (Clearfil S3 Bond). Each participant had both types of resin composite restorations that were randomly allocated. The restorations were evaluated at baseline and annually up to 8 years using modified USPHS criteria. The data were statistically analyzed using the Fisher’s exact test, Kaplan-Meier method, and a multivariate Cox-regression with frailty models (p < 0.05).

RESULTS: The 8-year participant recall rate was 95%. One hundred percent retention was recorded for AP, whereas four out of 46 restorations were lost for FX during the 8 years. The incidence of marginal staining increased over time regardless of the type of resin composite, showing 48% for AP and 57% for FX after 8 years. Wear of the resin composite occurred only for the flowable material and there was a significant difference between the types of resin composite (p = 0.024). Overall survival rates at 8 years for AP and FX were 98% and 82% respectively (p = 0.110).

CONCLUSIONS: The flowable resin composite presented lower wear resistance and showed a lower survival rate compared with the conventional composite after eight years of clinical service.

CLINICAL RELEVANCE: Flowable resin composites may show greater wear after long-term clinical service.

TRIAL REGISTRATION NUMBER: UMIN000028745, Date of registration: August 19, 2017.

PMID:35751704 | DOI:10.1007/s00784-022-04587-7

Eur Radiol. 2022 Jun 25. doi: 10.1007/s00330-022-08937-7. Online ahead of print.

ABSTRACT

OBJECTIVES: To test whether a 4-fold accelerated 3D T2-weighted (T2) CAIPIRINHA SPACE TSE sequence with isotropic voxel size is equivalent to conventional 2DT2 TSE for the evaluation of intrinsic and perilesional soft tissue tumors (STT) characteristics.

METHODS: For 108 patients with histologically-proven STTs, MRI, including 3DT2 (CAIPIRINHA SPACE TSE) and 2DT2 (TSE) sequences, was performed. Two radiologists evaluated each sequence for quality (diagnostic, non-diagnostic), tumor characteristics (heterogeneity, signal intensity, margin), and the presence or absence of cortical involvement, marrow edema, and perilesional edema (PLE); tumor size and PLE extent were measured. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios and acquisition times for 2DT2 in two planes and 3DT2 sequences were reported. Descriptive statistics and inter-method agreement were reported.

RESULTS: Image quality was diagnostic for all sequences (100% [108/108]). No difference was observed between 3DT2 and 2DT2 tumor characteristics (p < 0.05). There was no difference in mean tumor size (3DT2: 2.9 ± 2.5 cm, 2DT2: 2.8 ± 2.6 cm, p = 0.4) or PLE extent (3DT2:0.5 ± 1.2 cm, 2DT2:0.5 ± 1.0 cm, p = 0.9) between the sequences. There was no difference in the SNR of tumors, marrow, and fat between the sequences, whereas the SNR of muscle was higher (p < 0.05) on 3DT2 than 2DT2. CNR measures on 3DT2 were similar to 2DT2 (p > 0.1). The average acquisition time was shorter for 3DT2 compared with 2DT2 (343 ± 127 s vs 475 ± 162 s, respectively).

CONCLUSION: Isotropic 3DT2 MRI offers higher spatial resolution, faster acquisition times, and equivalent assessments of STT characteristics compared to conventional 2DT2 MRI in two planes. 3DT2 is interchangeable with a 2DT2 sequence in tumor protocols.

KEY POINTS: • Isotropic 3DT2 CAIPIRINHA SPACE TSE offers higher spatial resolution than 2DT2 TSE and is equivalent to 2DT2 TSE for assessments of soft tissue tumor intrinsic and perilesional characteristics. • Multiplanar reformats of 3DT2 CAIPIRINHA SPACE TSE can substitute for 2DT2 TSE acquired in multiple planes, thereby reducing the acquisition time of MRI tumor protocols. • 3DT2 CAIPIRINHA SPACE TSE and 2DT2 TSE had similar CNR of tissues.

PMID:35751699 | DOI:10.1007/s00330-022-08937-7

Eur Arch Otorhinolaryngol. 2022 Jun 25. doi: 10.1007/s00405-022-07478-5. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the prevalence and impact of various predictive factors including diabetes control in malignant external otitis (MEO) treatment response.

METHODS: In a cross-sectional study on MEO patients, we defined treatment response with three indices; ESR level decrease, hospitalization period, and systemic antifungal drug usage. The impact of diabetes control and other predictive factors on these indices have been evaluated.

RESULTS: Overall, 164 patients with a mean age of 67.8 ± 9.7 years were included. Cranial nerve involvement was present in 56 patients. Nine patients had immunodeficiency. 19.5% of cases had leukocytosis. Diabetes mellitus was present in 156 patients, suffering for an average of 13.9 ± 8.6 years. The overall mean hemoglobin A1C (HbA1c) level was 8.3% (4.4-12.8%), and the mean fasting blood sugar was 146.4 mg/dl (63-292 mg/dl). 29.3% of patients had good diabetes control before admission (HbA1c < 7%), 54.9% had poor control (7% < HbA1c < 10%) and 15.9% had very poor glycemic control (HbA1c > 10%). The predictive role for the following factors were not statistically significant: age, gender, comorbidities, diabetes, diabetes management method used before and during hospitalization, diabetes duration, leukocytosis, immunodeficiency, fasting blood sugar level, HbA1c level, glycemic control index, and insulin amount. However, CRP level with a mean value of 34.3 mg/L showed a significant correlation with ESR decrease, hospitalization period, and antifungal drug usage.

CONCLUSION: CRP level could be used as a predictor for the hospitalization period, the need for systemic antifungal and ESR level decrease. It would be helpful to check the CRP level at the time of diagnosis to predict the hospitalization period and the necessity of systemic antifungal management to adjust the treatment strategy.

PMID:35751693 | DOI:10.1007/s00405-022-07478-5

Brain Struct Funct. 2022 Jun 25. doi: 10.1007/s00429-022-02517-7. Online ahead of print.

ABSTRACT

The frontoparietal control network (FPCN) plays a central role in tuning connectivity between brain networks to achieve integrated cognitive processes. It has been proposed that two subnetworks within the FPCN separately regulate two antagonistic networks: the FPCNa is connected to the default network (DN) that deals with internally oriented introspective processes, whereas the FPCNb is connected to the dorsal attention network (DAN) that deals with externally oriented perceptual attention. However, cooperation between the DN and DAN induced by distinct task demands has not been well-studied. Here, we characterized the dynamic cooperation among the DN, DAN, and two FPCN subnetworks in a task in which internally oriented self-referential processing could facilitate externally oriented visual working memory. Functional connectivity analysis showed enhanced coupling of a circuit from the DN to the FPCNa, then to the FPCNb, and finally to the DAN when the self-referential processing improved memory recognition in high self-referential conditions. The direct connection between the DN and DAN was not enhanced. This circuit could be reflected by an increased chain-mediating effect of the FPCNa and the FPCNb between the DN and DAN in high self-referential conditions. Graph analysis revealed that high self-referential conditions were accompanied by increased global and local efficiencies, and the increases were mainly driven by the increased efficiency of FPCN nodes. Together, our findings extend prior observations and indicate that the coupling between the two FPCN subnetworks serves as a bridge between the DN and DAN, supporting the interaction between internally oriented and externally oriented processes.

PMID:35751677 | DOI:10.1007/s00429-022-02517-7

Arch Gynecol Obstet. 2022 Jun 25. doi: 10.1007/s00404-022-06522-3. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Ovarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making.

DESIGN: We conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010-2020).

PARTICIPANTS: Patients aged 0-18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions.

RESULTS: Ninety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary.

CONCLUSIONS: Our results showed that a post-menarchal age (p = .001), a pre-operative US ovarian size < 5 cm, (p = .001), the presence of severe abdominal pain (p = .002), a laparoscopic approach (p < .001), and the presence of a functional cyst (p = .002) were significantly associated with conservative surgery.

PMID:35751675 | DOI:10.1007/s00404-022-06522-3

Int Urogynecol J. 2022 Jun 25. doi: 10.1007/s00192-022-05274-7. Online ahead of print.

ABSTRACT

INTRODUCTION: The primary objective of this study is to determine the prevalence of overactive bladder (OAB) and detrusor overactivity (DO) in female patients who were referred for urodynamic study (UDS) because of lower urinary tract symptoms (LUTS). The secondary objective is to determine the subjective and objective differences between female OAB patients with and without DO.

MATERIALS AND METHODS: All female patients who underwent UDS for LUTS between June 2016 and September 2019 were retrospectively reviewed. Personal history, medical history, physical examination, and validated questionnaires were collected. One-hour pad test and multichannel urodynamic study was performed. All statistical analyses were conducted by SAS 9.4. P-value < 0.05 was considered statistically significant.

RESULTS: A total of 4184 female patients underwent UDS because of LUTS between June 2016 and September 2019; 1524 patients were analyzed for OAB or DO. The occurrence of OAB was 36.4%. The overall incidence of DO in OAB patients was 15.5%; 9.5% of all patients had DO findings on UDS, and 4.6% were incidental findings. There were significant differences among mean age, parity, ICIQ-UI SF, OABSS, POPDI-6, and all UDS parameters (except for maximal urethral pressure and pressure transmission ratio) between patients with and without DO. In patients with DO, there were no significant differences among age, parity, and BMI with or without OAB symptoms. However, there were significant differences among mean OABSS, ICIQ-UI SF, UDI-6, POPDI-6, IIQ-7, and pad test.

CONCLUSIONS: Patients with DO are associated with older age, increased parity, greater urine leakage, and worse storage and micturition functions on UDS. Combinations of subjective and objective measurements are better predictive models for OAB patients.

PMID:35751673 | DOI:10.1007/s00192-022-05274-7

World J Urol. 2022 Jun 25. doi: 10.1007/s00345-022-04069-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate whether reducing tract dilation diameter in PCNL (percutaneous nephrolithotomy) procedures results in minimizing of renal trauma of the percutaneous tract.

METHODS: A percutaneous renal access tract was established bilaterally to 11 pigs. Two pigs were euthanized immediately after the experiment, while nine pigs were sacrificed 1 month later. The percutaneous accesses were dilated up to 30Fr, 22Fr or 12Fr. The animals underwent a contrast-enhanced computer tomography immediately after the procedure and 30 days later. DMSA-scintigraphy with SPECT-CT was also performed. The kidneys of all animals were harvested for histological evaluation. The volume of scar tissue and the percentage of renal volume replaced by scar tissue were calculated.

RESULTS: Immediate post-procedural CT-scans revealed a significant difference in defect diameter among the three modalities. However, the scar volume calculated on CT-images and histopathology showed a significant difference only when 30Fr dilation was compared to 12Fr dilation. The percentage of scar volume was negligible in all cases, but there was still a statistical difference between 30 and 12Fr dilation. Dilation up to 22Fr revealed no statistical differences compared to the other two modalities. DMSA-scintigraphy showed no scar tissue in any case.

CONCLUSION: Dilation up to 30Fr may cause a significantly larger scar tissue on renal parenchyma compared to 12Fr dilation as it was shown on CT-images and microscopic evaluation, but based on the DMSA/SPECT-CT this difference seems to be insignificant to the renal function. The scar tissue caused by 22Fr dilation seemed to have no significant difference from the other modalities.

PMID:35751669 | DOI:10.1007/s00345-022-04069-1

Arch Dermatol Res. 2022 Jun 25. doi: 10.1007/s00403-022-02366-8. Online ahead of print.

ABSTRACT

Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of dermatology residency applicants over a 5-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC) for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of dermatology residency applicants during the 5-year study period. Prior to 2018 (midpoint of the study), 14.1% of applicants identified as URM compared to 16.2% after 2018, although this difference was not statistically significant (p = 0.25). Our findings suggest that in the study period analyzed, racial representation remained relatively similar, with a non-statistically significant increase in URM applicants. Outlining the current trends in dermatology residency applicants may be helpful in identifying factors affecting the disparity in racial representation within the field. There is hope that dermatology residency applicants are becoming more racially diverse with improved representation of URMs.

PMID:35751663 | DOI:10.1007/s00403-022-02366-8

Arch Dermatol Res. 2022 Jun 25. doi: 10.1007/s00403-022-02367-7. Online ahead of print.

ABSTRACT

Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of Mohs Micrographic Surgery (MMS) fellowship applicants over a five-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the San Francisco Match for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of MMS fellowship applicants during the five-year study period. Prior to 2018 (midpoint of study), 6.6% of matched applicants and 10.9% of unmatched applicants identified as URMs, compared to 8.1% of matched applicants and 10.1% of unmatched applicants after 2018, but this increase was not statistically significant (p = 0.62). There is hope that Mohs Micrographic Surgery fellowship applicants are becoming more racially diverse with improved representation of underrepresented minorities.

PMID:35751662 | DOI:10.1007/s00403-022-02367-7

Eur Heart J. 2022 Jun 25:ehac322. doi: 10.1093/eurheartj/ehac322. Online ahead of print.

ABSTRACT

AIMS: To search for sequence variants associated with ACEi discontinuation and to test their association with ACEi-associated adverse drug reactions (ADRs).

METHODS AND RESULTS: A genome-wide association study (GWAS) on ACEi discontinuation was conducted, including 33 959 ACEi-discontinuers and 44 041 controls. Cases were defined as persons who switched from an ACEi treatment to an angiotensin receptor blocker. Controls were defined as persons who continued ACEi treatment for at least 1 year. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were computed for ACEi discontinuation risk by mixed model regression analysis. Summary statistics from the individual cohorts were meta-analyzed with a fixed-effects model. To test for association with specific ACEi-associated ADRs, any genome-wide significant (P < 5 × 10-8) ACEi discontinuation variants was tested for association with ACEi-associated cough and angioedema. A polygenetic risk score (PRS) based on ACEi discontinuation GWAS data was constructed and tested for association with ACEi-associated cough and angioedema in two population-based samples. In total, seven genetic genome-wide loci were identified, of which six were previously unreported. The strongest association with ACEi discontinuation was at 20q13.3 (NTSR1; OR: 1.21; 95% CI: 1.17-1.24; P = 2.1 × 10-34). Five of seven lead variants were associated with ACEi-associated cough, whereas none were associated with ACEi-associated angioedema. The ACEi discontinuation PRS was associated with ACEi-associated cough in a dose-response manner but not with ACEi-associated angioedema. ACEi discontinuation was genetically correlated with important causes for cough, including gastro-esophageal reflux disease, allergic rhinitis, hay fever, and asthma, which indicates partly shared genetic underpinning between these traits.

CONCLUSION: This study showed the advantage of using prescription patterns to discover genetic links with ADRs. In total, seven genetic loci that associated with ACEi discontinuation were identified. There was evidence of a strong association between our ADR phenotype and ACEi-associated cough. Taken together, these findings increase insight into the pathophysiological processes that underlie ACEi-associated ADRs.

PMID:35751511 | DOI:10.1093/eurheartj/ehac322