Nevin Manimala

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Dec 24:S2212-4403(21)00887-7. doi: 10.1016/j.oooo.2021.12.121. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate subjective and objective outcomes in patients with temporomandibular joint (TMJ) ankylosis treated with TMJ alloplastic reconstruction (TMJR).

STUDY DESIGN: All patients diagnosed with TMJ ankylosis that underwent TMJR at our institution between 2010 and 2019 were retrospectively reviewed. Patients were divided into 2 cohorts: bony and fibrous ankylosis. Subjective variables assessed were facial pain and headaches, TMJ pain, jaw function, diet, and disability. Objective variables assessed were maximum interincisal opening and lateral excursions. The Mann-Whitney test was employed to analyze subjective variables and an unpaired t-test was used to analyze the objective variables. P < .05 was considered statistically significant.

RESULTS: Twenty-eight patients met the inclusion criteria (21 female, 7 male). The mean age at the time of surgery was 42 years, and the mean number of prior TMJ surgeries was 3. A total of 52 TMJRs were performed in the 28 patients, and the mean follow-up time was 46 months. All subjective variables were significantly improved, and the mean maximum interincisal opening increased from 16.9 mm to 37.25 mm.

CONCLUSIONS: The results of the study demonstrate that TMJR is an effective and reliable method for the management of both fibrous and bony TMJ ankylosis.

PMID:35431176 | DOI:10.1016/j.oooo.2021.12.121

Pract Radiat Oncol. 2022 Apr 14:S1879-8500(22)00080-7. doi: 10.1016/j.prro.2022.03.003. Online ahead of print.

ABSTRACT

PURPOSE: This study reports the impact of using a centralized database system for major equipment quality assurance (QA) at a large institution.

METHODS AND MATERIALS: A centralized database system has been implemented for radiation therapy machine QA in our institution at 6 campuses with 11 computed tomographies and 22 linear accelerators (LINACs). The database system was customized to manage monthly and annual computed tomography and LINAC QA. This includes providing the same set of QA procedures across the enterprise, digitally storing all measurement records, and generating trend analyses. Compared with conventional methods (ie, paper forms), the effectiveness of the database system was quantified by changes in the compliance of QA tests and perceptions of staff to the efficiency of data retrieval and analyses. An anonymized questionnaire was provided to physicists enterprise-wide to assess workflow changes.

RESULTS: With the implementation of the database system, the compliance of QA test completion improved from 80% to >99% for the entire institution. This resonates with the 56% of physicists who found the database system helpful in guiding them through QA, and 25% of physicists found the contrary, and 19% reported no difference (n = 16). Meanwhile, 40% of physicists reported longer times needed to record data using the database system compared with conventional methods, and another 40% suggested otherwise. In addition, 87% and 80% found the database more efficient to analyze and retrieve previous data, respectively. This was also reflected by the shorter time taken to generate year-end QA statistics using the software (5 vs 30 min per LINAC). Overall, 94% of physicists preferred the centralized database system over conventional methods and endorsed continued use of the system.

CONCLUSIONS: A centralized database system is useful and can improve the effectiveness and efficiency of QA management in a large institution. With consistent data collection and proper data storage using a database, high-quality data can be obtained for failure modes and effects analyses as per TG 100.

PMID:35431152 | DOI:10.1016/j.prro.2022.03.003

Urol Oncol. 2022 Apr 14:S1078-1439(22)00105-3. doi: 10.1016/j.urolonc.2022.03.014. Online ahead of print.

ABSTRACT

PURPOSE: To test for survival differences in metastatic urothelial carcinoma of the urinary bladder (mUCUB) patients, according to years of diagnosis, age, sex, and race/ethnicity over time and for the effect of chemotherapy on overall mortality (OM).

MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results (2000-2016), we identified 6860 mUCUB patients. Of those, 3,249 were exposed to chemotherapy. Kaplan-Meier plots and Cox regression models focused on OM. First, we tested the effect of years of diagnosis (historical [2000-2005] vs. intermediate [2006-2011] vs. contemporary [2012-2016]) in chemotherapy exposed mUCUB patients. Second, we tested the effect of chemotherapy in all mUCUB patients.

RESULTS: In chemotherapy exposed mUCUB patients according to historical vs. intermediate vs. contemporary years, median overall survival was 11 vs. 13 vs. 14 months respectively, which translated into hazard ratios (HR) of 0.86 (P = 0.005) and 0.75 (P < 0.001) in intermediate and contemporary vs. historical, respectively. Subgroup analyses in <70 years old, males and Caucasians were in agreement regarding statistically significant differences between historical vs. intermediate vs. contemporary, respectively. In multivariable Cox regression models fitted in the entire mUCUB cohort, chemotherapy exposure reduced OM (HR: 0.46; P < 0.001). Virtually the same results were recorded in age, sex, and race/ethnicity subgroups analyses.

CONCLUSIONS: Contemporary chemotherapy exposed mUCUB patients exhibited better survival than their historical and intermediate counterparts. Chemotherapy reduced mortality by half, across all patient types.

PMID:35431135 | DOI:10.1016/j.urolonc.2022.03.014

Urol Oncol. 2022 Apr 14:S1078-1439(22)00104-1. doi: 10.1016/j.urolonc.2022.03.013. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the representation of women, minorities, and the elderly groups in clinical trials and whether participation has changed over time.

METHODS: Retrospective study in the National Cancer Institute (NCI) Clinical Data Update System and Center for Disease Control and Prevention United States Cancer Statistics 2000 to 2019. We compared cancer incidence proportion to proportion of patients enrolled in an NCI trial when stratified by race/ethnicity, sex, and age. We performed multivariable analysis to determine the odds of participating in a clinical trial in 2015 to 2019 when compared to 2000 to 2004.

RESULTS: This study included 14,094 patients, 12,169 (86.3%) non-Hispanic White patients, 662 (4.7%) Black patients, and 660 (4.7%) Hispanic patients. There were 3,701 (26.3%) female patients and 10,393 (73.7%) male patients. For bladder cancer clinical trials, Black patients and Hispanic patients were underrepresented in clinical trials compared to Non-Hispanic White patients (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.88, P = 0.002) and (OR 0.69, 95%CI 0.54-0.88, P = 0.003), respectively. For kidney cancer trials, Black and Hispanic patients were underrepresented in clinical trials compared to Non-Hispanic White patients (OR 0.42, OR 0.33-0.54, P < 0.001) and (OR 0.68, 95% CI 0.55-0.83, P < 0.001), respectively. Women were underrepresented in kidney cancer trials compared to men (OR 0.80, 95% CI 0.72-0.89) and similarly for bladder cancer trials (OR 0.72, 95% CI 0.64-0.81, P < 0.001). For bladder cancer trials, the participation of Black patients over time (OR 1.04, P = 0.814) and female patients over time (OR 1.03, P = 0.741) were unchanged. For kidney cancer trials, the participation of Black patients over time (OR 1.17, P = 0.293) and female patients over time (OR 1.03, P = 0.663) participation was also unchanged.

CONCLUSION: In this study of clinical trials in bladder and kidney cancer, we identified that Blacks, Hispanics, and females were underrepresented. Additionally, Black and female participation was unchanged over the span of 20 years.

PMID:35431133 | DOI:10.1016/j.urolonc.2022.03.013

J Plast Reconstr Aesthet Surg. 2022 Mar 1:S1748-6815(22)00123-1. doi: 10.1016/j.bjps.2022.02.044. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to assess the improvement of sleep apnea after secondary Le Fort III facial advancement with distraction (LF3) in faciocraniosynostosis (FCS) patients with sleep apnea who have previously undergone fronto-facial monobloc advancement (FFMBA) with distraction.

METHODS: Patients having undergone secondary LF3 were selected from a cohort of FCS patients with documented sleep apnea who had previously undergone fronto-facial monobloc advancement. Patient charts and polysomnographic records were reviewed. Apnea-hypopnea index (AHI) was recorded before and at least 6 months after secondary LF3. The primary outcome was normalization of AHI (less than 5/h was considered normal). Hierarchical multilevel analysis was performed to predict postoperative AHI evolution.

RESULTS: Seventeen patients underwent a secondary LF3, 7.0 ± 3.9 years after the primary FFMBA. The mean age was 9.6 ± 3.9 years. A total of 15 patients (88%) normalized their AHI. Two of four patients were decannulated (50%). There was a statistically significant decrease in AHI (preoperative AHI 21.5/h vs. 3.9/h postoperatively, p=0.003). Hierarchic multilevel modeling showed progressive AHI decrease postoperatively.

CONCLUSION: Secondary LF3 improves residual or relapsing sleep apnea in FCS patients who have previously had FFMBA.

PMID:35431130 | DOI:10.1016/j.bjps.2022.02.044

Pancreatology. 2022 Mar 31:S1424-3903(22)00109-0. doi: 10.1016/j.pan.2022.03.020. Online ahead of print.

ABSTRACT

BACKGROUND: Chemoprevention’s ability to slow down or prevent the progression of BD-IPMNs is extremely appealing. Aspirin (ASA), Ace Inhibitors/Angiotensin Receptor Blockers (ACEIs/ARBs) and Statins (STATs) are frequently prescribed drugs with a possible beneficial effect on different cancer types. Their effect on IPMNs is largely unknown.

AIM: To evaluate the association between the use of ASA, ACEIs/ARBs and STATs and the risk of progression of BD-IPMNs in follow-up.

MATERIALS AND METHODS: multicenter, retrospective cohort study on patients with presumed BD-IPMNs without relative or absolute indication for surgery. Pharmacological exposures and risk factors were collected. We identified clinically relevant progression (occurrence of radiological absolute or relative indication for surgery) and any progression (occurrence of clinically relevant progression OR any dimension increase OR the occurrence of new cysts).

RESULTS: Overall 594 patients were included. ACEIs were associated with a lower occurrence of any progression (HR = 0.70; 95% CI 0.49-0.98, p = 0.04) and clinically relevant progression, HR = 0.42 (95% CI 0.20-0.88; p = 0.02). No significant effect was shown for factors associated with the occurrence of pancreas cancer such as smoking, alcohol consumption and 1st degree family history of pancreas cancer. Among pharmacological exposures, no convincing effect was shown for the chronic use of ASA, ARB and STAT.

CONCLUSIONS: ACEIs might have an effect in slowing the progression of BD-IPMNs. ASA, STAT and ARBs show no convincing effect on the progression of BD-IPMNs. Further, prospective, and long-term multicenter studies are needed to verify such association and to define the potential underlying mechanisms.

PMID:35431111 | DOI:10.1016/j.pan.2022.03.020

Surgery. 2022 Apr 14:S0039-6060(22)00153-2. doi: 10.1016/j.surg.2022.03.008. Online ahead of print.

ABSTRACT

BACKGROUND: Donor safety is essential in living donor liver transplantation. In this study we assessed the association among perioperative factors, liver dysfunction, and complications in 251 consecutives right hepatectomies for living donation.

METHODS: Retrospectively collected data from a prospectively assembled cohort of 251 consecutive living donors who underwent right hepatectomy between 1999 and 2020 were evaluated.

RESULTS: Median age was 36 years; 54% were men. There was a statistically significant relationship between standardized liver volume by body surface area and the volumes calculated by imaging, weighting, and volume displacement. (r² = 0.40, r² = 0.34, and r² = 0.34, respectively), with the relationship between standardized liver volume and liver volume by imaging being the strongest. The median remnant liver volume was 35%. Fifty-eight donors (23%) developed postoperative hepatic dysfunction, which was associated with increased length of stay (P = .04), and complications (P < .01). Men had a 2.5 times higher chance of developing postoperative hepatic dysfunction. Age >50 years was an independent predictor of increased bilirubin at postoperative day 4 (P < .01), and remnant liver volume was inversely associated with higher peak international normalized ratio (P < .01). Eighty-one donors (32%) experienced complications. Postoperative hepatic dysfunction was associated with 2.4 times higher chances of complications (odds ratio = 2.4, P < .01).

CONCLUSION: Early postoperative hepatic dysfunction is associated with the development of post-live liver donor complications. A thoughtful balancing of preoperative risk factors for postoperative hepatic dysfunction may indeed and by association reduce postoperative complications.

PMID:35431090 | DOI:10.1016/j.surg.2022.03.008

Dent Mater. 2022 Apr 14:S0109-5641(22)00093-8. doi: 10.1016/j.dental.2022.04.001. Online ahead of print.

ABSTRACT

OBJECTIVE: Implant-supported frameworks constructed from high-performance polymer CAD/CAM composites are exposed to liquids from the oral environment and routine care maintenance. Therefore, this study investigated the effect of food-simulating liquids (FSLs) on surface properties of three CAD/CAM polymer composite blocks.

METHODS: The composites investigated were (i) a carbon fibre-reinforced composite (CarboCAD 3D dream frame; CC), (ii) a glass fibre-reinforced composite (TRINIA; TR), and (iii) a reinforced PEEK (DentoKeep; PK). The filler contents were determined by thermo-gravimetry. The surface properties were roughness, Vickers hardness (HV), properties measured by Martens force/depth indentation, namely: hardness (HM), modulus (E_IT) and creep (C_IT). Property measurements were made at baseline on polished specimens and then, where possible, after 1- and 7-days storage at 37 ℃ in three different media: water, 70% ethanol/water and MEK (methyl ethyl ketone). Specimens were selected for light and scanning electron microscopy. Statistical analysis was performed by two-way repeated measures ANOVA, one-way ANOVA, and multiple comparison tests (α = 0.05).

RESULTS: The baseline roughness and hardness (HV, HM) and modulus (E_IT) correlated approximately with filler content (wt%), with the fibre-reinforced composites being rougher, harder and stiffer than PK. At baseline, roughness (Sa) ranged from 0.202 to 0.268 µm; HV from 23.1 to 36.9; HM from 224.5 to 330.6 N/mm²; E_IT: from 6 to 9.8 GPa. After ageing in 70% ethanol and MEK, more pronounced roughness and hardness changes were observed than in water. MEK caused greater deterioration for the FRC than 70% ethanol, while PK specimens showed slight changes in 70% ethanol.

SIGNIFICANCE: Storage media adversely affected the surface and mechanical properties of each CAD/CAM composite. However, during ageing, the reinforced PEEK showed greater relative stability in these properties. Nevertheless, the deterioration may indicate the need for full protection by a veneer material on each surface of an implant-supported framework.

PMID:35431089 | DOI:10.1016/j.dental.2022.04.001

Dent Mater. 2022 Apr 14:S0109-5641(22)00097-5. doi: 10.1016/j.dental.2022.04.007. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study is to develop novel CaF₂/SiO₂ nanoclusters (NCs) fillers, which can endow the dental resin composites (DRCs) with excellent mechanical properties, stable and sustained fluoride ion release, and good antibacterial activity.

METHODS: The CaF₂/SiO₂ NCs were efficiently fabricated by assembling CaF₂/SiO₂ nanoparticles (NPs) as building blocks with a spray-drying technology. CaF₂/SiO₂ NCs with different SiO₂ coating amounts (20 wt%, 50 wt% and 80 wt%) were incorporated into the DRCs at the filler content of 55 wt% for the measurement of mechanical properties including flexural strength, flexural modulus, compressive strength, and hardness. The effect of the filling amount of CaF₂/50SiO₂ NCs (50 represents 50 wt% SiO₂ coating amount) in the DRCs was investigated, while CaF₂/50SiO₂ NPs were adopted as comparison group. The fluoride ion release and antibacterial activity of the DRCs with the optimal mechanical performances were evaluated. Furthermore, the statistical analyses were performed for mechanical properties.

RESULTS: Spherical CaF₂/50SiO₂ NCs with an average size of 2.4 µm were obtained at the feed rate of 7.4 mL/min and the CaF₂/50SiO₂ NPs solid content of 2 wt% in the suspension. The optimum comprehensive performances of the DRCs can be achieved by filling 55 wt% CaF₂/50SiO₂ NCs. Compared with CaF₂/50SiO₂ NPs, the filling amount of CaF₂/50SiO₂ NCs was increased by 5 wt% (50-55 wt%), and under the same filling amount of 50 wt%, the flexural strength, flexural modulus, compressive strength, and hardness of the DRCs containing CaF₂/50SiO₂ NCs were improved by 9.8%, 17.7%, 7.5% and 69.8%, respectively. Furthermore, the DRCs filled with 50 wt% CaF₂/50SiO₂ NCs exhibited more cumulative F-release by 126% and more stable F-release rate than the counterpart filled with 50 wt% CaF₂/50SiO₂ NPs after immersed for 1800 h. And 55 wt% CaF₂/50SiO₂ NCs filled DRCs could inhibit the growth of S. mutans, reaching an antibacterial ratio of 93%.

SIGNIFICANCE: The spray-dried CaF₂/50SiO₂ NCs are promising fillers for the development of high-performance multifunctional DRCs.

PMID:35431087 | DOI:10.1016/j.dental.2022.04.007

Vet Parasitol Reg Stud Reports. 2022 May;30:100708. doi: 10.1016/j.vprsr.2022.100708. Epub 2022 Feb 15.

ABSTRACT

Co-infection by two paramphistome species, Orthocoelium sp. and Paramphistomum epiclitum, is found in cattle in Thailand. The morphological features of these and other paramphistomes under a light microscope are similar, resulting in misidentification and misdiagnosis. We classified these paramphistomes into three morphological variation types, namely Orthocoelium sp., P. epiclitum MV1 (immature), and P. epiclitum MV2 (matured). Ten morphological characteristics were investigated, and the values were transformed into 25 ratio criteria for statistical investigation. Morphometric analysis can classify the variation of these specimens using differences in the bifurcal level, the vitellaria starting level, the starting level of the anterior testis, and the center level of the posterior testis positions by body length ratios. These ratios can separate the samples into three morphologically different groups, whereas molecular analysis based on the nuclear internal transcribed spacer 2 (ITS2) region and the mitochondrial cytochrome c oxidase subunit I (COI) gene could only distinguish two specific groups. In addition, the Orthocoelium specimen, related to O. dicranocoelium and O. parvipapillatum according to morphological and histological analysis, was monophyletic grouped via ITS2 analysis. Our study provides a scientific basis for the taxonomic classification and clustering of morphologically varying species, improving the identification, detection, and diagnosis of co-infecting paramphistomes.

PMID:35431066 | DOI:10.1016/j.vprsr.2022.100708