Nevin Manimala

J Craniofac Surg. 2022 Jun 1;33(4):e398-e401. doi: 10.1097/SCS.0000000000008256. Epub 2021 Oct 12.

ABSTRACT

OBJECTIVE: To evaluate whether the maxillary complex would be sagittally, vertically, or mutually displaced after the transverse maxillary correction by surgically assisted rapid maxillary expansion and how the facial profile would be affected.

MATERIALS AND METHODS: The sample comprised 28 adult patients (mean age 25.8 [age range 19-39 years]; 50% women) with transverse maxillary deficiency greater than 7 mm who underwent the surgical rapid maxillary expansion. Cephalometric analysis (n = 112), intra- and extra-oral registries, and radiographic records were taken before treatment (T1), right after the end of the expansion (T2), 4 months after the expansion (T3), and 10 months after the end of the expansion (T4). Dental and skeletal cephalometric measurements were evaluated at each time-point, whereas soft tissue cephalometric analyses were determined at 2 time points (T1 and T4).

RESULTS: The results indicated that no sagittal, vertical, skeletal, or soft tissue variation was found after the surgical expansion. However, statistically significant dental changes (P < 0.05) were observed in dental angles (1.NA/1.SN/1.PoOR/1.PP) throughout the different time-points. The authors found statistically relevant posterior inclination of the incisors from T2 to T3 based on multiple comparisons.

CONCLUSIONS: Surgically assisted rapid maxillary expansion does not promote anterior and vertical displacement of the maxilla. Notwithstanding, the surgical intervention causes upper incisor palatal inclination.

PMID:36041096 | DOI:10.1097/SCS.0000000000008256

J Craniofac Surg. 2022 Jun 1;33(4):e382-e384. doi: 10.1097/SCS.0000000000008210. Epub 2021 Sep 21.

ABSTRACT

Facial trauma is now considered an epidemic due to its high incidence. This type of injury represents an impact on the social, psychological and professional life of the victim. It may be associated with poor protection and exposure of this region of the body, as well as with the attempt to disfigure the face of victims of aggression, to affect their identity and self-image. This study aims to carry out an epidemiological survey on the profile of facial trauma related to violence at the First Aid Hospital of Porto Alegre from November 2015 to July 2016. In this retrospective descriptive cross-sectional study, data such as age and sex of the patient, type of trauma, anatomical region, etiology, and reasons for the aggression of patients’ records were analyzed using the Chi-Square test in Paws Statistics 18 software, evaluating P < 0.05. During the period evaluated, 1224 cases were recorded. The most prevalent sex was male. The age group with the most injuries varied from 21 to 40. The most affected type of lesion was soft tissue injury. Scalp regions (parietal, occipital, temporal) and multiple regions were the most affected in males, differing from females, where the frontal and nasal regions were the most predominant. Violence is a major risk factor for facial trauma in adult patients and it is from epidemiological studies like this that we have the possibility to know the magnitude and severity of the results of violence, allowing the definition of public policies for coping.

PMID:36041094 | DOI:10.1097/SCS.0000000000008210

J Craniofac Surg. 2022 Jun 1;33(4):e376-e382. doi: 10.1097/SCS.0000000000008174. Epub 2021 Oct 26.

ABSTRACT

OBJECTIVE: To evaluate the accuracy of intentional change of the frontal ramal inclination (FRI) from virtual to actual orthognathic surgery.

MATERIALS AND METHODS: A total of 16 patients who underwent orthognathic surgery for correction of facial asymmetry and took cone-beam computed tomography 2 to 3 weeks before surgery (T0) and 3 days after surgery (T1A) were selected. After reorientation of cone-beam computed tomography, the digital imaging and communications in medicine data was converted to StereoLithography format for the merging with dental cast scan using R2GATE software (MegaGen Implant, Daegu, Republic of Korea). During virtual surgery using Geomagic Freeform Plus software (3D Systems, Rock Hill, SC), bilateral FRI discrepancy was corrected (T1V) and 3D-printed surgical wafers and customized metal plates were manufactured using 3D printer (Meg-printer II, MegaGen Implant, Daegu, Republic of Korea) and computer numerical control milling machine (ARDEN, TPS Korea Ltd., Gwangju, Republic of Korea) accordingly. During surgery, FRI correction was done using surgical guide and customized plates. The difference between preoperative and virtually corrected FRI (Δ T1V – T0) and the difference between preoperative and actually surgically corrected FRI (Δ T1A – T0) were measured, and the achieved FRI correction in percentage ([Δ T1A – T0]/[Δ T1V – T0] × 100) was calculated.

RESULTS: The mean absolute value of virtual FRI correction (Δ T1V – T0) and actual FRI correction (Δ T1A – T0) were 3.0° and 2.9°, respectively (n = 32). In the increased (medial rotation) FRI group, mean virtual and actual correction amount were 3.2° and 2.8° (n = 17), whereas in the decreased (lateral rotation) group, mean virtual and actual correction amount were -2.7° and -3.1°, respectively (n = 15). No statistically significant difference between virtual and actual measurements were present in either group. The mean achievement rate was 102.8%. Tendency of undercorrection (91.2%) in the increased FRI group and overcorrection (116.0%) in the decreased FRI group were noted.

DISCUSSION: With virtual planning and computer-aided design and computer-aided manufacturing-made customized plates, it is possible to correct FRI during orthognathic surgery of patients with facial asymmetry.

PMID:36041093 | DOI:10.1097/SCS.0000000000008174

J Craniofac Surg. 2022 Jun 1;33(4):e350-e355. doi: 10.1097/SCS.0000000000008059. Epub 2021 Aug 3.

ABSTRACT

Dacryocystitis diagnosis is important for preventing rapid blurring and vision loss. Existing state-of-the-art methods focus on routine clinical examinations and objective scattering index-based statistical analysis. Such approaches are invasive operations or lack quantitative indicators, and their application is limited. in addition, little attention has been paid to the explainability and clinical utility of models. This paper proposes an explainable dacryocystitis prediction model from noninvasive ocular indicators. The proposed model is based on an deep stacked network with 4 improvements: a multivariable feature extraction module, obtaining comprehensive predictive factors including the quantitative ocular indictors, conventional texture features, and deep learning features from shallow to deep convolutional layers; a multifeature fusion and attribute selection module based on the ReliefF method, guiding the network to focus on useful information at variables; Decision curve analysis the model is introduced into the model to evaluates the risks and benefits; and appending a SHapley Additive exPlanations (SHAP) module to the framework to automatically and efficiently interpret the prediction of the models. By integrating the above improvements in series, the models’ performances are gradually enhanced. Real labeled data samples are used to train and test the model, and our model achieves high accuracy and reliability.

PMID:36041091 | DOI:10.1097/SCS.0000000000008059

J Craniofac Surg. 2022 Jun 1;33(4):1255-1259. doi: 10.1097/SCS.0000000000008110. Epub 2021 Sep 13.

ABSTRACT

OBJECTIVE: This study aimed to evaluate 4 methods of osteosynthesis in the maxilla after a linear advance of 11 mm.

METHODOLOGY: Le Fort I osteotomies were performed on 24 resin models and different osteosynthesis were applied in the anterior region. Group I received Lindorf plates; group II, modified Lindorf plates; group III, inverted “T” plates; and group IV, “L” plates. All groups received “L” plates in the posterior region. Analysis were performed through universal mechanical testing machine with an axial linear load until 5-mm displacement. The data obtained about the force and the amount of deformation were computed, thus the energy required for displacement and stiffness was calculated. Statistical analysis was performed using 2-way analysis (Shapiro-Wilk, followed by Holm-Sidak) (P < 0.05).

RESULTS: Groups I and II showed greater resistance to displacement (P < 0.05) than the other groups. The largest amount of maximum force exerted for the 5-mm displacement was in group II (91.73 N), followed by group I (87.46 N), presenting the best values in comparison with the other groups (P < 0.001). Group III had less stiffness (P < 0.001) than the other groups.

CONCLUSIONS: The use of preclinical methodologies to verify the mechanical stability of fixation models allows a prediction in the choice of greater resistance systems. The fixation type with greater resistance to deformation was achieved with modified Linford plates followed by Linford plates in the anterior region and plate “L” bilaterally in the posterior region.

PMID:36041090 | DOI:10.1097/SCS.0000000000008110

J Homosex. 2022 Aug 30:1-25. doi: 10.1080/00918369.2022.2111536. Online ahead of print.

ABSTRACT

This study focuses on the relations between minority stressors, protective factors and psychological wellbeing among lesbian, gay and bisexual (LGB) people. Experimental data based on a sample of 156 showed that participants asked to recall a negative coming out experience to somebody significant reported more identity threat and distress and less positive affect compared to those recalling a neutral coming out experience. In the negative recall condition, the effects of the stressors of discrimination and rejection on the variance of distress through the mediation of identity threat were statistically significant but not in the neutral recall condition and the two conditions statistically significantly differed in regards to the relationship between discrimination and distress. Identity resilience-continuity was associated with less identity threat and distress in the negative recall condition only, while social support was negatively associated and LGB stigma sensitivity was positively associated with distress in both conditions. Degree of outness (operating as a coping strategy) was associated with increased positive affect in both the neutral and negative recall conditions. When recalling a negative coming out experience, LGB people may be more susceptible to distress associated with minority stressors but also capitalize on available coping strategies.

PMID:36041082 | DOI:10.1080/00918369.2022.2111536

Surg Technol Int. 2022 Aug 30;41:sti41/1602. Online ahead of print.

ABSTRACT

INTRODUCTION: Posture, temperature, and moisture have been identified as critical modifiable risk factors in pressure injury (PI) development. Microclimate is defined as temperature and humidity at the interface of the support surface and body. To our knowledge, no studies have used sensor technology to measure these parameters simultaneously in real time. Continuous monitoring of repositioning and microclimate provide real-time actionable insights to help deliver personalized care and measure the effectiveness of interventions.

OBJECTIVE: To evaluate the ability of a smart surface platform to collect and document clinical data on monitoring patients’ movement and microclimate simultaneously and to compare data generated to nursing observations in order to construct an algorithm that is expected to evolve over time: (1) comparing the blinded data from nurses interacting with the patients and the system; and (2) data being collected is validating an algorithm that is expected to become more accurate over time.

MATERIALS AND METHODS: This prospective, descriptive single-site trial was conducted at a tertiary care facility in a large urban centre in Canada. Patients identified at risk of PIs received standard of care while placed on the smart surface for timed intervals. Nurses’ assessment data were collected at three hourly timepoints using a comprehensive tool developed for the study. Sensors monitored patients’ interface pressure moisture and temperature every four seconds. A comparative statistical analysis was conducted between the two datasets retrospectively.

RESULTS: The study included a total of 104 participants; mean age of 59 years (range 21-92, ± 19.15). Sensor monitoring hours (1,407) generated 1,101,780 frames of surface data. A total of 511 nursing assessments were recorded during the study period. Sensor-generated data correlated strongly with nurse-collected data at cross-sectional intervals. There was a high level of agreement between information collected from sensors and nursing assessments: 94.7% for moisture (p<0.05), and 87.1% for temperature (p<0.05). Nurse-recorded posture assessments were compared to the smart surface platform interface pressure visualizations to determine the device’s posture detection, resulting in a 92% accordance (matching 552 out of 600 nurse postures), with a binomial test determining the posture results to be statistically significant (p<0.05) (CI 95%). In addition, moisture events were matched to nurse assessments with 94.7% in accordance, identifying 39 bladder incontinence and 93 non-urinary moisture events (125 total events captured out of 132).

CONCLUSION: The technology’s ability to capture PI risk factors supports nursing practice. Supplementary data generated has the potential to improve efficiency of professional caregiver workflow and patient outcomes by informing targeted microclimate management strategies and decreasing unnecessary interventions. The large volume of data collected will be used as a basis for artificial intelligence applications with the potential to inform other clinical decision-making areas.

PMID:36041077

Diabetes Care. 2022 Aug 30:dc220105. doi: 10.2337/dc22-0105. Online ahead of print.

ABSTRACT

OBJECTIVE: Diabetes and dementia are diseases of high health care burden worldwide, and studies have shown that diabetes is associated with an increased relative risk of dementia. We set out to examine whether type 2 diabetes-associated genetic variants were associated with dementia and whether they differed by race/ethnicity or clinical dementia diagnosis.

RESEARCH DESIGN AND METHODS: We evaluated associations of two type 2 diabetes genetic risk scores (GRS and GRS-nonAPOE: a score without rs429358, a variant associated with Alzheimer disease [AD]) with three classifications of clinical dementia diagnoses in the Million Veteran Program (MVP): all-cause dementia, vascular dementia (VaD), and AD. We conducted our analysis stratified by European (EUR), African (AFR), and Hispanic (HIS) races/ethnicities.

RESULTS: In EUR, we found associations of the GRS with all-cause dementia (odds ratio [OR] 1.06, P = 1.60e-07) and clinically diagnosed VaD (OR 1.12, P = 5.2e-05) but not with clinically diagnosed AD (OR 1.02, P = 0.43). The GRS was not associated with any dementia outcome in AFR or HIS. When testing with GRS-nonAPOE, we found that effect size estimates in EUR increased and P values decreased for all-cause dementia (OR 1.08, P = 2.6e-12), for VaD (OR 1.14, P = 7.2e-07), and for AD (OR 1.06, P = 0.018). For AFR, the association of GRS-nonAPOE and clinically diagnosed VaD (OR 1.15, P = 0.016) was statistically significant. There were no significant findings for HIS.

CONCLUSIONS: We found evidence suggesting shared genetic pathogenesis of diabetes with all-cause dementia and clinically diagnosed VaD.

PMID:36041056 | DOI:10.2337/dc22-0105

Nicotine Tob Res. 2022 Aug 30:ntac202. doi: 10.1093/ntr/ntac202. Online ahead of print.

ABSTRACT

INTRODUCTION: In July 2018, the U.S. Department of Housing and Urban Development passed a rule requiring public housing authorities to implement smoke-free housing (SFH) policies. We measured secondhand smoke (SHS) exposure immediately before, and repeatedly up to 36 months post-SFH policy implementation in a purposeful sample of 21 New York City (NYC) high-rise buildings (>15 floors): 10 NYC Housing Authority (NYCHA) buildings subject to the policy and 11 privately managed buildings in which most residents received housing vouchers (herein ‘Section 8’).

METHODS: We invited participants from non-smoking households (NYCHA n=157, Section 8 n=118) to enroll into a longitudinal air monitoring study, measuring (1) nicotine concentration with passive, bi-sulfate-coated filters, and (2) particulate matter (PM2.5) with low-cost particle sensors. We also measured nicotine concentrations and counted cigarette butts in common areas (n=91 stairwells and hallways). We repeated air monitoring sessions in households and common areas every 6 months, totaling six post-policy sessions.

RESULTS: After three years, we observed larger declines in nicotine concentration in NYCHA hallways than in Section 8, [difference-in-difference (DID) = -1.92 µg/m 3 (95% CI -2.98, -0.87), p=0.001]. In stairwells, nicotine concentration declines were larger in NYCHA buildings, but the differences were not statistically significant [DID= -1.10 µg/m 3 (95% CI -2.40, 0.18), p=0.089]. In households, there was no differential change in nicotine concentration (p=0.093) or in PM2.5 levels (p=0.385).

CONCLUSIONS: Nicotine concentration reductions in NYCHA common areas over three years may be attributable to the SFH policy, reflecting its gradual implementation over this time.

IMPLICATIONS: Continued air monitoring over multiple years has demonstrated that SHS exposure may be declining more rapidly in NYCHA common areas as a result of SFH policy adherence. This may have positive implications for improved health outcomes among those living in public housing, but additional tracking of air quality and studies of health outcomes are needed. Ongoing efforts by NYCHA to integrate the SFH policy into wider healthier-homes initiatives may increase policy compliance.

PMID:36041039 | DOI:10.1093/ntr/ntac202

Epileptic Disord. 2022 Dec 1;24(6):1-13. doi: 10.1684/epd.2022.1484.

ABSTRACT

OBJECTIVE: Presurgical long-term video-EEG monitoring (LT-VEEG) is an important part of the presurgical evaluation in patients with focal epilepsy. Multiple seizures need to be recorded, often in limited time and with the need to taper anti-seizure medication (ASM). The aim of this study was to systematically study the yield – in terms of success – and risks associated with presurgical LT-VEEG, and to identify all previously reported contributing variables.

METHODS: A systematic review of the databases of PubMed Medline, Embase, Cochrane Central, and the Cochrane Database of Systematic Reviews were searched following the Preferred Reporting Items for Systematic Reviews (PRISMA) guideline. Publications about presurgical LT-VEEG reporting on variables contributing to yield and risk were included. Study characteristics of all included studies were extracted following a standardized template. Within these articles, studies presenting multivariable analyses of factors contributing to the risk of adverse events or the success of LT-VEEG were identified.

RESULTS: We found 36 articles reporting on LT-VEEG, including 4,703 presurgical patients, both children and adults. Presurgical LT-VEEG monitoring led to an average yield of 85%. Adverse events occurred with an averaged total event rate of 17%, but the type of included events was variable among studies. Factors reported to independently contribute to successful LT-VEEG were: baseline seizure frequency, a shorter interval from the most recent seizure, extratemporal lobe epilepsy, and no requirement for ASM reduction. Factors independently contributing to the occurrence of adverse events were: ASM tapering, a history of status epilepticus, a history of focal to bilateral tonic-clonic seizures, psychiatric comorbidity, and ASM taper rate.

SIGNIFICANCE: This study reveals that the data on factors contributing to yield and risk of adverse events is significant and variable, and often reported with inadequate statistics. Future research is warranted to develop guidelines for ASM withdrawal during presurgical video-EEG monitoring, taking predefined factors for success and risks of adverse events into account.

PMID:36039766 | DOI:10.1684/epd.2022.1484