Nevin Manimala

J Sleep Res. 2021 Feb 23:e13278. doi: 10.1111/jsr.13278. Online ahead of print.

ABSTRACT

Primary insomnia is often considered a disorder of 24-hr hyperarousal. Numerous attempts have been made to investigate nocturnal heart rate (HR) and its variability (HRV) as potential pathophysiological hallmarks of altered arousal levels in insomnia, with mixed results. We have aimed to overcome some of the pitfalls of previous studies by using a young, medication-free, age- and gender-matched population consisting of 43 students aged 18-30 years half with a subthreshold insomnia complaint. We employed at-home ambulatory polysomnography and compared this attenuated insomnia group to a good sleeping group. The poor sleepers had significantly higher wake after sleep onset, arousal count, mean HR in all sleep stages (with the exception of Stage 1) and lower sleep efficiency. Consistent with previous research, we also found a significant group-by-sleep stage interaction in the prediction of nocturnal HR, highlighting the insomnia group to have a lower wake-sleep HR reduction compared to good sleepers. When restricting our analyses to insomnia with objectively determined short sleep duration, we found significantly lower standard deviation of RR intervals (SDNN; a measure of HRV) compared to good sleepers. Taken together, this lends credence to the hyperarousal model of insomnia and may at least partially explain the increased prevalence of cardiovascular morbidity and mortality observed in patients with insomnia.

PMID:33622029 | DOI:10.1111/jsr.13278

Vet Clin Pathol. 2021 Feb 23. doi: 10.1111/vcp.12980. Online ahead of print.

ABSTRACT

BACKGROUND: The accessibility of thromboelastography (TEG) to general practitioners is limited by short sample storage times (30 minutes) and storage temperatures (20-23°C).

OBJECTIVES: We aimed to evaluate the stability of canine and equine citrated blood samples when stored for extended periods of time, both at room temperature (RT) (20-23°C) and refrigerator temperature (FT) (2-7.5°C).

METHODS: Citrated whole blood samples from healthy dogs and horses (n = 10 for each) were stored for 30 minutes (baseline) at RT before TEG analysis. Baseline values for TEG variables R, K, α, MA, LY30, and LY60 were compared with those from samples stored for 2, 8, and 22.5 h, at RT and FT. Results were compared using an ANOVA (P < .05). Total allowable analytical error (TE_a ) based on biological variation data was used to evaluate stability.

RESULTS: In dogs, statistically significant differences included shorter R, longer K, decreased MA, and increased LY60 at various time points and storage temperatures from 2 h onward. Only samples stored for 2 h at FT showed acceptable stability compared with TE_a . In horses, statistically significant differences included shorter R and K, and decreased α, LY30, and LY60 at various time points and storage temperatures from 2 h onward. Samples were not stable at any time compared with TE_a , regardless of the temperature.

CONCLUSIONS: In this study, canine samples could be stored for up to 2 h at FT without affecting TEG results; equine samples should be stored for 30 minutes at RT.

PMID:33622027 | DOI:10.1111/vcp.12980

Med J Aust. 2021 Feb 23. doi: 10.5694/mja2.50960. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the efficacy of a pro-active, absolute cardiovascular risk-guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic.

DESIGN: Prospective, randomised, open label, blinded endpoint study.

SETTING: The rapid access chest pain clinic of Royal Hobart Hospital, a tertiary hospital.

PARTICIPANTS: Patients who presented to the chest pain clinic between 1 July 2014 and 31 December 2017 who had intermediate to high absolute cardiovascular risk scores (5-year risk ≥ 8%). Patients with known cardiac disease or from groups with clinically determined high risk of cardiovascular disease were excluded.

MAIN OUTCOME MEASURES: The primary endpoint was change in 5-year absolute risk score (Australian absolute risk calculator) at follow-up (at least 12 months after baseline assessment). Secondary endpoints were changes in lipid profile, blood pressure, smoking status, and body mass index, and major adverse cardiovascular events.

RESULTS: The mean change in risk at follow-up was +0.4 percentage points (95% CI, -0.8 to 1.5 percentage points) for the 98 control group patients and -2.4 percentage points (95% CI, -1.5 to -3.4 percentage points) for the 91 intervention group patients; the between-group difference in change was 2.7 percentage points (95% CI, 1.2-4.1 percentage points). Mean changes in lipid profile, systolic blood pressure, and smoking status were larger for the intervention group, but not statistically different from those for the control group.

CONCLUSIONS: An absolute cardiovascular risk-guided, pro-active risk factor management strategy employed opportunistically in a chest pain clinic significantly improved 5-year absolute cardiovascular risk scores.

TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry, ACTRN12617000615381 (retrospective).

PMID:33622026 | DOI:10.5694/mja2.50960

J Magn Reson Imaging. 2021 Feb 23. doi: 10.1002/jmri.27575. Online ahead of print.

ABSTRACT

BACKGROUND: Computed tomography (CT) and magnetic resonance imaging (MRI) are both capable of predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC). However, which modality is better is unknown.

PURPOSE: To intraindividually compare CT and MRI for predicting MVI in solitary HCC and investigate the added value of radiomics analyses.

STUDY TYPE: Retrospective.

SUBJECTS: Included were 402 consecutive patients with HCC (training set:validation set = 300:102).

FIELD STRENGTH/SEQUENCE: T2-weighted, diffusion-weighted, and contrast-enhanced T1-weighted imaging MRI at 3.0T and contrast-enhanced CT.

ASSESSMENT: CT- and MR-based radiomics signatures (RS) were constructed using the least absolute shrinkage and selection operator regression. CT- and MR-based radiologic (R) and radiologic-radiomics (RR) models were developed by univariate and multivariate logistic regression. The performance of the RS/models was compared between two modalities. To investigate the added value of RS, the performance of the R models was compared with the RR models in HCC of all sizes and 2-5 cm in size.

STATISTICAL TESTS: Model performance was quantified by the area under the receiver operating characteristic curve (AUC) and compared using the Delong test.

RESULTS: Histopathologic MVI was identified in 161 patients (training set:validation set = 130:31). MRI-based RS/models tended to have a marginally higher AUC than CT-based RS/models (AUCs of CT vs. MRI, P: RS, 0.801 vs. 0.804, 0.96; R model, 0.809 vs. 0.832, 0.09; RR model, 0.835 vs. 0.872, 0.54). The improvement of RR models over R models in all sizes was not significant (P = 0.21 at CT and 0.09 at MRI), whereas the improvement in 2-5 cm was significant at MRI (P < 0.05) but not at CT (P = 0.16).

DATA CONCLUSION: CT and MRI had a comparable predictive performance for MVI in solitary HCC. The RS of MRI only had significant added value for predicting MVI in HCC of 2-5 cm.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

PMID:33622022 | DOI:10.1002/jmri.27575

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0041-1723065. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the effect of additional apical preparation using the ProDesign Logic (PDL) 50/.01 rotary heat-treated nickel-titanium (NiTi) file with a larger diameter and minimal taper for retreatment of curved root canals.

MATERIALS AND METHODS: Mesial curved root canals of 12 mandibular molars were prepared using PDL 25/.06 and filled using the continuous wave of condensation technique and AH Plus sealer. After retreatment using ProDesign S (PDS) 25/.08, PDL 25/.06 and PDL 35/05, a complementary procedure was performed with PDL 50/.01. Microcomputed tomography (micro-CT) scanning was performed before and after retreatment procedures. The cyclic fatigue resistance of unused PDS 25/.08, PDL 25/.06, PDL 35/.05 and PDL 50/.01 instruments (n = 12) was evaluated in a stainless-steel device.

STATISTICAL ANALYSIS: Data on the volumes of the root canals and the remaining filling materials were submitted to the paired t-test. Cyclic fatigue resistance data was submitted to one-way ANOVA and Tukey’s tests (α = 0.05).

RESULTS: Use of PDL 50/.01 decreased the remaining filling materials in the apical third (p < 0.05). The root canal volume was similar in the cervical and middle thirds before and after preparation using PDL 50/.01 (p > 0.05). PDL 50/.01 presented the highest cyclic fatigue resistance (p < 0.05).

CONCLUSIONS: Use of the PDL 50/.01 instrument as an additional apical preparation for retreatment of curved root canals improved filling material removal in the apical third, while maintaining the dentin in the cervical and middle thirds. In addition, PDL 50/.01 presented high-flexural resistance.

PMID:33622011 | DOI:10.1055/s-0041-1723065

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0041-1724158. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed to evaluate the existence of possible correlations among root canal configuration, quality of filling, and its sealability.

MATERIALS AND METHODS: Sixty human mandibular central incisors were selected for this study. The teeth were prepared with the Profile 04 system up to instrument 35/0.04 and irrigated with 2.5 mL of 2.5% sodium hypochlorite at each instrument change. Root canal filling was performed by the lateral compaction technique, using gutta-percha and an epoxy resin-based sealer (AH Plus) labeled with 0.1% Rhodamine B dye. Afterward, the specimens were submitted to fluid filtration tests to assess the sealability of the filling. Cross-sections were obtained at -3, -6, and -8 mm from the root apex and submitted to a metallographic treatment to determine the root canal configuration and the percentage of gutta-percha filled areas. The data were statistically analyzed by the Grubbs test. Pairs of correlations were analyzed by applying the Spearman test at a level of significance of 5%.

RESULTS: No correlation was observed among the analyzed variables as follows: root canal configuration versus filling quality (Spearman’s rho = 0.031); filling quality versus sealability (Spearman’s rho = 0.219); and root canal configuration versus sealability (Spearman’s rho = 0.184).

CONCLUSION: The root canal configuration did not affect the quality of the filling and its sealability.

PMID:33622010 | DOI:10.1055/s-0041-1724158

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0040-1722483. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the short-term effect of active skeletonized sutural distractor (ASSD) appliance on temporomandibular joint morphology of class III malocclusion subjects.

MATERIALS AND METHODS: This was a prospective interventional study. Cone-beam computerized tomography (CBCT) images of 22 patients were taken before and after treatment by using Planmeca Promax 3D CBCT machine version 2.9.2 (Planmeca OY Helsinki, Finland). The condylar width, height, length, roof of glenoid fossa thickness, and all joint spaces were measured. The condylar position was determined based on Pullinger and Hollander formula. The condylar shape was determined as per Kinzinger et al. The condylar volume was calculated by using Mimics software (Materialize, Belgium).

STATISTICAL ANALYSIS: Data analysis was performed by using SPSS software version 24. Wilcoxon paired signed-rank test was used to compare the difference in temporomandibular joint morphology and condylar volume between pre- and post-treatment measurements. Chi-square test was used to compare the condylar position and shape.

RESULTS: The superior (p = 0.000 on the right side, p = 0.005 on the left side) and posterior joint spaces (p = 0.000 on both sides) were decreased after the treatment, respectively. The condyles were rotated upward and backward, thereby increasing the anterior joint spaces (p = 0.000 on both sides) after the treatment. The condylar volume increases after treatment, but no significant differences were observed (p = 0.903 on the right side, p = 0.062 on the left side).

CONCLUSION: The significant changes were observed in joint spaces. The condyles were more anteriorly placed before treatment. Condylar position and shape alter in response to ASSD treatment. The condylar volume did not show any significant change.

PMID:33622009 | DOI:10.1055/s-0040-1722483

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0040-1722484. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effect of in-office bleaching on the enamel surface and the efficacy of calcium silicate-sodium phosphate-fluoride salt (CS) and NovaMin bioactive glass (NM) dentifrice in remineralizing bleached enamel.

MATERIALS AND METHODS: Forty extracted premolars were sectioned mesio-distally, and the facial and lingual enamel were flattened and polished. The samples were equally divided into nonbleached and bleached with 38% hydrogen peroxide (HP). Each group was further divided according to the remineralization protocol (n = 10); no remineralization treatment (nontreated), CS, or NM, applied for 3 minutes two times/day for 7 days, or CS combined with NR-5 boosting serum (CS+NR-5) applied for 3 minutes once/day for 3 days. The average Knoop hardness number (KHN) and surface roughness (utilizing atomic force microscopy) were measured. Surface topography/elemental analysis was analyzed by using scanning electron microscopy/energy dispersive X-ray analysis. All the tests were performed at baseline, after bleaching, and following each remineralization protocol. Data were statistically analyzed by two-way analysis of variance and Bonferroni post hoc multiple comparison tests (α = 0.05).

RESULTS: HP significantly reduced KHN and increased roughness (p < 0.05). All remineralization materials increased the hardness and reduced the surface roughness after bleaching except NM, which demonstrated significantly increased roughness (p < 0.05). Ca/P ratio decreased after bleaching (p < 0.05), and following treatment, CS and CS+NR-5 exhibited higher remineralization capacity in comparison to NM (p < 0.05).

CONCLUSION: Although none of the material tested was able to reverse the negative effect of high-concentration in-office HP on enamel completely, the remineralization efficacy of CS and CS+NR-5 was superior to that of NM.

PMID:33622008 | DOI:10.1055/s-0040-1722484

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0040-1721910. Online ahead of print.

ABSTRACT

OBJECTIVES: The present study aimed to investigate the dentists’ knowledge of the risks from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and how it will impact their practice.

MATERIALS AND METHODS: An ad hoc self-administered anonymous questionnaire was submitted to Italian dentists.

STATISTICAL ANALYSIS: Differences in rates were calculated using the chi-square test. The level of significance was set at p < 0.05.

RESULTS: A total of 849 dentists fully completed the survey. Eighty-eight per cent of Italian dentists are worried about the health of their families, with no difference in high-risk (red zone) and low-risk (orange zone) regions. About 86% of professionals report some income loss and 94% fear a drop in patients after the quarantine phase, with the dentists working the red zone claiming a greater economic loss and fearing a reduced practice after the end of the lockdown.

DISCUSSION: A large majority of the Italian dentists appears to be aware of the need for changes in their dental practices by planning specific sterilization processes between appointments, testing patients for SARS-CoV-2 serology, asking patients not to be accompanied, and reducing the number of visits per day.

CONCLUSION: The survey expresses the serious concern of the dentists for the pandemic’s effects on their profession.

PMID:33622007 | DOI:10.1055/s-0040-1721910

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0040-1722090. Online ahead of print.

ABSTRACT

OBJECTIVES: This study sought to present a view of head and neck neoplasms (HNN) prevalence with specific focus on sociodemographic determinants in Al-Madinah Province, Saudi Arabia.

MATERIALS AND METHODS: This was a hospital-based retrospective study based on retrieval of histopathological data for a period of 6 years between 2012 and 2018. Data was collected from the archives of the Oral and Maxillofacial Pathology Laboratory at King Fahad Hospital (the only referral center for biopsy services) in Al-Madinah City.

STATISTICAL ANALYSIS: An independent t-test and/or nonparametric (Mann-Whitney U test, chi-squared test) tests were used to determine the differences between groups. Statistical significance was set at the p-value < 0.05.

RESULTS: Out of 96 patients, a total of 58 patients had valid biopsy data with preoperative diagnosis. Over three quarters of the cases (n = 44) were benign with only 24% were malignant. Males were more likely to be diagnosed with a benign tumor than females (54.5 vs. 45.6%, respectively), and malignancy was also more common in males (64.3 vs. 24.1). A significant difference was found in relation to mean age of older patients who were more likely to be diagnosed with malignant tumors (p = 0.001).

CONCLUSIONS: The findings suggest that most of biopsied HNN cases are benign neoplasms. Age is a significant risk factor for head and neck malignancy in this region. Delays in diagnosis of HNN need to be explored.

PMID:33622006 | DOI:10.1055/s-0040-1722090