Nevin Manimala

Clin Oral Implants Res. 2022 Mar 2. doi: 10.1111/clr.13914. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI).

MATERIALS AND METHODS: Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N=18) and a control group treated with NST alone (N=19). Clinical parameters were evaluated at 12 weeks post-treatment. The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP) and plaque. Data analysis was performed at patient level (one target site per patient).

RESULTS: All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction of PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs 1.47 ± 1.95 mm), however this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; thirty out of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD ≤5 mm, and absence of BoP and SoP.

CONCLUSIONS: NST was able to reduce PIPD at implants with PI. The adjunctive use of systemic AMX and MTZ did not show statistically significant better results compared to NST alone. NST with or without antibiotics was ineffective to completely resolve inflammation around dental implants.

PMID:35238084 | DOI:10.1111/clr.13914

Microsurgery. 2022 Mar 3. doi: 10.1002/micr.30873. Online ahead of print.

ABSTRACT

BACKGROUND: Retrospective studies evaluating tissue oximetry in a more recent cohort have shown superiority in flap outcomes. This study compares the use of tissue oximetry in a historical cohort to clinical observation and handheld doppler in a more recent cohort. We hypothesize that there is no benefit to using tissue oximetry.

METHODS: A retrospective review was performed on patients who underwent abdominal-based autologous breast reconstruction by five microsurgeons at an academic institution from 2009 to 2020. Method of postoperative flap monitoring was determined then operative details and complications were analyzed.

RESULTS: 1367 flaps were reviewed; 740 flaps in 460 patients were monitored with clinical observation and tissue oximetry, and 627 flaps in 391 patients were monitored with clinical observation and handheld doppler. There were no statistical differences in ischemic (p = .59) or congestive complications (p = .41), flap salvage rates when exploring for venous or arterial compromise (p = .52), or early flap loss (p = .56). Although not significant, acute flap-related return to the operating room was lower in the doppler group (4.6%) compared to the oximetry group (6.1%; p = .22). Flaps monitored with tissue oximetry had a statistical increase in length of stay (4.8 ± 1.4 days vs. 3.8 ± 1.6 days; p ≤ .001). The rates of late partial flap loss and fat necrosis were significantly higher in the oximetry group (2.6%, 19/740 vs. 0.3%, 2/740; p = .04) and (18.2%, 135/740 vs. 13.6%, 85/627; p = .02), respectively.

CONCLUSIONS: There is no statistical benefit to the use of tissue oximetry compared to handheld doppler in flap monitoring with regards to flap outcomes.

PMID:35238069 | DOI:10.1002/micr.30873

Evolution. 2022 Mar 2. doi: 10.1111/evo.14463. Online ahead of print.

ABSTRACT

Little is known about the intraspecific variation of parasite life-history traits and on how this variation may affect parasite fitness and evolution. We investigated how life-history traits predict success of individual tree-hole ticks Ixodes arboricola and estimated their evolutionary potential, as well as genetic correlations within stages and phenotypic correlations within and across stages. Ticks were followed individually over two generations while allowed to feed on great tits Parus major. After accounting for host and tick maternal effects, we found that short feeding times and high engorgement weights strongly increased moulting success. Moulting time was also positively correlated with feeding success in adults. In larvae and nymphs we found negative phenotypic correlations between engorgement weight and both feeding and moulting time, the latter supported by a negative genetic correlation. We found sex-related differences in feeding time (longer in male nymphs) and moulting time (longer in male larvae but shorter in male nymphs). Also, time since the last feeding event (set experimentally) reduced larval and nymphal fitness while it increased adult female fitness. Furthermore, we found significant heritability and evolvability, i.e. the potential to respond to selection, for engorgement weight and moulting time across all stages but no significant heritability for feeding time. Our findings suggest that variation in tick fitness is shaped by consistent individual differences in tick quality, for which engorgement weight is a good proxy, rather than by life-history trade-offs. This article is protected by copyright. All rights reserved.

PMID:35238032 | DOI:10.1111/evo.14463

Dev Med Child Neurol. 2022 Mar 2. doi: 10.1111/dmcn.15194. Online ahead of print.

ABSTRACT

AIM: To determine the rates of medical investigations, complications, interventions, and outcomes in children with achondroplasia.

METHOD: Children and adolescents with achondroplasia born between 2000 and 2019, aged between 0 and 18 years of age, and seen at The Children’s Hospital at Westmead skeletal dysplasia clinic were included. Data were collected retrospectively from clinical records. Standard descriptive statistics were used for analysis.

RESULTS: The study included 108 participants, 58 males and 50 females. Ninety-nine participants (91.7%) entered the study at birth. The other nine (8.3%) participants entered the study after birth (mean age = 2 years 4 months, SD = 1 year 8 months). The median age of exit from the study was 8 years 8 months (IQR = 8 years 9 months) with a median follow-up of 8 years 8 months (IQR = 8 years 9 months). Fifty-two (48%) participants presented with craniocervical stenosis, 15 (13.9%) with hydrocephalus, 66 (61.1%) with hearing impairment, 44 (40.7%) with sleep-disordered breathing, 46 (42.6%) with lower-limb malalignment, 24 (22.2%) with thoracolumbar kyphosis, 10 (9.3%) with symptomatic spinal stenosis, 12 (11.1%) with obesity, and 16 (14.8%) who had at least one admission for respiratory illness. Two children died during the study period.

INTERPRETATION: We report contemporary rates of medical complications in an Australian population of children with achondroplasia. Recommendations for surveillance in clinical practice are discussed. This information will help guide clinicians with their expectant management of achondroplasia and provide prognostic information to the families of children with achondroplasia.

PMID:35238031 | DOI:10.1111/dmcn.15194

Acta Obstet Gynecol Scand. 2022 Mar 2. doi: 10.1111/aogs.14321. Online ahead of print.

ABSTRACT

INTRODUCTION: Obstetric hemorrhage-related deaths are rare in high income countries. Yet, with increasing incidences of obstetric hemorrhage in these countries, it is of utmost importance to learn lessons from each obstetric hemorrhage-related death to improve maternity care. Our objective was to calculate the obstetric hemorrhage-related maternal mortality ratio (MMR), assess causes of obstetric hemorrhage-related deaths, and identify lessons learned.

MATERIAL AND METHODS: Nationwide mixed-methods prospective case-series with confidential enquiries into maternal deaths due to obstetric hemorrhage in the Netherlands from January 1, 2006 to December 31, 2019.

RESULTS: The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 was 0.7 per 100 000 livebirths and was not statistically significantly different compared with the previous MMR of 1.0 per 100 000 livebirths in 1993-2005 (odds ratio 0.70, 95% confidence interval 0.38-1.30). Leading underlying cause of hemorrhage was retained placenta. Early recognition of persistent bleeding, prompt involvement of a senior clinician and timely management tailored to the cause of hemorrhage with attention to coagulopathy were prominent lessons learned. Also, timely recourse to surgical interventions, including hysterectomy, in case other management options fail to stop bleeding came up as an important lesson in several obstetric hemorrhage-related deaths.

CONCLUSIONS: The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 has not substantially changed compared to the MMR of the previous enquiry in 1993-2005. Although obstetric hemorrhage is commonly encountered by maternity care professionals, it is important to remain vigilant for possible adverse maternal outcomes and act upon an ongoing bleeding following birth in a more timely and adequate manner. Our confidential enquiries still led to important lessons learned with clinical advice to professionals as how to improve maternity care and avoid maternal deaths. Drawing lessons from maternal deaths should remain a qualitative and moral imperative.

PMID:35238018 | DOI:10.1111/aogs.14321

J Opioid Manag. 2022 Jan-Feb;18(1):75-83. doi: 10.5055/jom.2022.0697.

ABSTRACT

OBJECTIVE: Primary care physicians (PCPs) are positioned to mitigate opioid morbidity and mortality, but their engagement in primary, secondary, and tertiary opioid-related prevention behaviors is unclear. The objective of this study was to evaluate Tennessee PCPs’ engagement in and intention to engage in multiple opioid-related prevention behaviors.

METHODS: A survey instrument was developed, pretested, and pilot tested with practicing PCPs. Thereafter, a census of eligible Tennessee PCPs was conducted using a modified, four-wave tailored design method approach. Three patient scenarios were employed to assess physician intention to engage in 10 primary, secondary, and tertiary prevention behaviors. Respondents were asked to report, given 10 similar scenarios, the number of times (0-10) they would engage in prevention behaviors. Descriptive statistics were calculated using SPSS version 25.

RESULTS: A total of 296 usable responses were received. Physician intention to engage in prevention behaviors varied across the 10 behaviors studied. Physicians reported frequently communicating risks associated with prescription opioids to patients (8.9 ± 2.8 out of 10 patients), infrequently utilizing brief questionnaires to assess for risk of opioid misuse (1.7 ± 3.3 out of 10 patients), and screening for current opioid misuse (3.1 ± 4.3 out of 10 patients). Physicians reported seldomly co-prescribing naloxone for overdose reversal and frequently discharging from practice patients presenting with an opioid use disorder.

CONCLUSIONS: This study noted strengths and opportunities to increase engagement in prevention behaviors. Understanding PCPs’ engagement in opioid-related prevention behaviors is important to effectively target and implement morbidity and mortality reducing interventions.

PMID:35238016 | DOI:10.5055/jom.2022.0697

Can J Anaesth. 2022 Mar 2. doi: 10.1007/s12630-022-02216-1. Online ahead of print.

ABSTRACT

PURPOSE: The high-thoracic erector spinae plane block (HT-ESPB) has been reported as an effective analgesic modality for the shoulder region without phrenic nerve palsy. The goal of this study was to compare the HT-ESPB as a phrenic nerve-sparing alternative to an interscalene block for total shoulder arthroplasty.

METHODS: Thirty patients undergoing total shoulder arthroplasty at Stanford Health Care (Palo Alto, CA, USA) were enrolled in a double-blind randomized controlled trial. We randomized 28 patients to receive either an interscalene or HT-ESPB perineural catheter preoperatively; 26 patients were included in the final analysis. The study was powered for the primary outcome of incidence of hemidiaphragmatic paralysis in the postanesthesia care unit (PACU). Other outcome measures included incentive spirometry volume, brachial plexus motor and sensory exams, adverse events, pain scores, and opioid consumption.

RESULTS: The incidence of hemidiaphragmatic paralysis in the HT-ESPB catheter group was significantly lower than in the interscalene catheter group (0/12, 0% vs 14/14, 100%; P < 0.001). No statistically significant differences were found in pain scores and opioid consumption (in oral morphine equivalents) between the interscalene and HT-ESPB groups through postoperative day (POD) 2. Nevertheless, the mean (standard deviation) point estimates for opioid consumption for the HT-ESPB group were higher than for the interscalene group in the PACU (HT-ESPB: 24.8 [26.7] mg; interscalene: 10.7 [21.7] mg) and for POD 0 (HT-ESPB: 20.5 [25.0] mg; interscalene: 6.7 [12.0] mg). In addition, cumulative postoperative opioid consumption was significantly higher at POD 0 (PACU through POD 0) in the HT-ESPB group (45.3 [39.9] mg) than in the interscalene group (16.6 [21.9] mg; P = 0.04).

CONCLUSIONS: This study suggests that continuous HT-ESPB can be a phrenic nerve-sparing alternative to continuous interscalene brachial plexus blockade, although the latter provided superior opioid-sparing in the immediate postoperative period. This was a small sample size study, and further investigations powered to detect differences in analgesic and quality of recovery score endpoints are needed.

STUDY REGISTRATION: www.ClinicalTrials.gov (NCT03807505); registered 17 January 2019.

PMID:35237953 | DOI:10.1007/s12630-022-02216-1

J Endocrinol Invest. 2022 Mar 2. doi: 10.1007/s40618-022-01760-3. Online ahead of print.

ABSTRACT

PURPOSE: Girls affected with Turner syndrome (TS) present with low bone mineral density (BMD) and osteopenia/osteoporosis. Thus, they have an increased risk to develop fractures compared to normal population. The aim of this study was to deepen the pathophysiology of skeletal fragility in TS subjects by evaluating the serum levels of Dickkopf-1 (DKK-1) and sclerostin, main regulators of bone mass, as well as the percentage of circulating osteoblast precursors (OCPs).

METHODS: Thirty-four TS girls and 24 controls were recruited. All subjects underwent anthropometric measures (height, weight, body mass index-BMI). A peripheral venous blood sample was collected to determine serum levels of active intact parathyroid hormone (PTH), 25-OH vitamin D, calcium, phosphorus, bone alkaline phosphatase (bALP), osteocalcin, sclerostin, DKK-1, RANKL and OPG. OCPs were detected by flow cytometry. In TS subjects bone mineralization was measured at lumbar spine by dual energy X-ray absorptiometry (DXA).

RESULTS: bALP, 25-OH Vitamin D, and osteocalcin levels were significant lower in TS subjects than in the controls. Statistically significant higher levels of sclerostin, DKK-1 and RANKL were measured in patients compared with the controls. The percentage of OCPs did not show significant differences between patients and controls. Sclerostin and DKK-1 levels were related with anthropometric parameters, bone metabolism markers, HRT, rhGH therapy, RANKL and lumbar BMAD-Z-score.

CONCLUSION: TS patients showed higher levels of sclerostin and DKK-1 than controls which can be related to HRT, and to reduced bone formation markers as well as the increased bone resorption activity.

PMID:35237949 | DOI:10.1007/s40618-022-01760-3

Emerg Radiol. 2022 Mar 3. doi: 10.1007/s10140-022-02031-7. Online ahead of print.

ABSTRACT

PURPOSE: To test the hypothesis that an automated post-processing workflow reduces trauma panscan exam completion times and variability.

METHODS: One-hundred-fifty consecutive trauma panscans performed between June 2018 and December 2019 were included, half before and half after implementation of an automated software-driven post-processing workflow. Acquisition and reconstruction timestamps were used to calculate total examination time (first acquisition to last reformation), setup time (between the non-contrast and contrast-enhanced acquisitions), and reconstruction time (for the contrast-enhanced reconstructions and reformations). The performing technologist was recorded and accounted for in analyses using linear mixed models to assess differences between the pre- and post-intervention groups.

RESULTS: Exam, setup, and recon times were (mean ± standard deviation) 33.5 ± 4.6, 9.2 ± 2.4, and 23.6 ± 4.7 min before and 27.8 ± 1.5, 8.9 ± 1.4, and 18.9 ± 1.7 min after intervention. These reductions of 5.7 and 4.7 min in the mean exam and recon times were statistically significant (p < 0.001) while the setup time was not (p = 0.49). The reductions in standard deviation were statistically significant for exam and recon times (p < 0.0001) but not for setup time (p = 0.13). All automated panscans were completed within 36 min, versus 65% with the traditional workflow.

CONCLUSION: Automation of image reconstruction workflow significantly decreased mean exam and reconstruction times as well as variability between exams, thus facilitating a consistently rapid imaging assessment, and potentially reducing delays in critical management decisions.

PMID:35237937 | DOI:10.1007/s10140-022-02031-7

Atten Percept Psychophys. 2022 Mar 2. doi: 10.3758/s13414-022-02456-9. Online ahead of print.

ABSTRACT

Visual perception is capable of pooling multiple local orientation signals into a single more accurate summary orientation. However, there is still a lack of systematic inquiry into which summary statistics are implemented in that process. Here, the task was to recognize in which direction, clockwise or counter-clockwise, the mean orientation of a set of randomly distributed Gabor patches (N = 1, 2, 4, and 8) was rotated from the implicit vertical. The mean orientation discrimination accuracy did not improve with the increase of the number N of elements in proportion to the square-root-N, as could be expected if noisy internal representations were arithmetically averaged. The Proportion of Informative Elements (PIE), defined as the percentage of elements having an orientation different from the vertical, also affected the discrimination precision, violating the arithmetic averaging rules. The decrease in the orientation discrimination precision with the increase of the PIE would suggest that the orientation pooling could be more adequately described by a quadratic or higher power mean. Thus, we parameterized the averaging process for the power parameter of the generalized mean formula. The results indicate that different pooling rules in different trials may apply, for example, the arithmetic mean in some and the maximal deviation rule in others. It is concluded that pooling of orientation information is a relatively inaccurate process for which different perceptual cues and their combination rules can be used.

PMID:35237931 | DOI:10.3758/s13414-022-02456-9