Nevin Manimala

MMW Fortschr Med. 2021 Jun;163(Suppl 2):28-35. doi: 10.1007/s15006-021-9713-1.

ABSTRACT

The steady development of the antiretroviral therapy (ART) has led to a significant change in the demands on the quality of care. There are different regional challenges.It is a non-interventional, bicentric correlation study in the form of a retrospective data analysis including data of 43 HIV-positive patients in Greifswald and 1669 in Berlin. All variables were evaluated with R. Statistical significance was assumed at a p-value of ≤ 0.05.The immunological parameters showed a significantly lower CD4+ T-lymphocyte cell count in patients from Greifswald compared to those from Berlin (B: 516/μl blood; G: 266/μl blood; p < 0.001). The supply of ART was > 80% (B: 153/184 [83.15%]; G: 36/41 [87.8%]; p = 0.64) in both cohorts and led to a permanent (> than 4 quarters) drop of the viral load below the detection limit in 115/184 [62.25%] patients in Berlin and 23/41 [56.09%] patients in Greifswald (p = 0.008).This study has shown that the quality of care for HIV-infected patients in both urban and rural areas is of a high standard and carried out in accordance with the guidelines.

PMID:34146315 | DOI:10.1007/s15006-021-9713-1

Eur Arch Paediatr Dent. 2021 Jun 19. doi: 10.1007/s40368-021-00641-2. Online ahead of print.

ABSTRACT

PURPOSE: Pulpectomy may be indicated in restorable primary teeth exhibiting irreversible pulpitis or pulpal necrosis. The purpose of this study was to compare the cleaning and shaping efficacy of NiTi systems (Reciproc^® Blue and MTwo^®) with manual stainless-steel instrumentation in primary molars using micro-CT analysis.

METHODS: Fifty-seven maxillary second primary molars were scanned using micro-CT. Teeth with three divergent roots were divided randomly (n = 15) according to instrument type (K file, MTwo®, and Reciproc® Blue). Teeth with root fusion were instrumented manually as a separate group (n = 12). Pre- and post-instrumentation micro-CT images were superimposed, and the instrumentation area (IA) and procedural complications were recorded.

RESULTS: No statistically significant differences in IA between file systems was observed in the non-fused teeth. The mean IA of fused roots was significantly lower than in the non-fused distobuccal (p = 0.003) and palatal (p < 0.001) roots. The root segment had a significant effect on IA (p < 0.001) and the highest mean IA was observed in the apical third. Manual instrumentation had fewer procedural complications compared with rotary systems.

CONCLUSION: No differences were determined in the cleaning and shaping effectiveness of all systems in non-fused teeth. Uninstrumented areas (> 60%) occurred in both non-fused and fused primary teeth with fewer procedural complications observed after manual instrumentation.

PMID:34146251 | DOI:10.1007/s40368-021-00641-2

Endocrine. 2021 Jun 19. doi: 10.1007/s12020-021-02797-9. Online ahead of print.

ABSTRACT

PURPOSE: Thyroid Bethesda classification system provides 6 diagnostic categories, the first being a sample deemed non-diagnostic or insufficient and requiring a subsequent second biopsy. Our objective was to evaluate differences in non-diagnostic fine needle aspiration (FNA) of thyroid nodules conducted with a 23-gauge(G) needle vs. those conducted with a 25 G needle.

METHODS: Data from 298 aspiration procedures using either 23 G or 25 G needles were collected, including cytological findings, ultrasound characteristics and patient demographics. The samples were classified as diagnostic or non-diagnostic according to final cytology.

RESULTS: There was no statistically significant difference between the 25 G and 23 G needles in terms of non-diagnostic rates (35.7%, 31.9%; p = 0.494). Nodules defined as cystic had higher non-diagnostic rates (p < 0.05). Older patients as well as cystic nodules were associated with a higher non-diagnostic rate (OR = 1.018, p = 0.047, OR = 13.533, p = 0.0001, respectively), while nodule size was associated with lower non-diagnostic rates (OR = 0.747, p = 0.017).

CONCLUSIONS: The use of 25 G needle did not produce a lower non-diagnostic rate when compared to 23 G needle. Larger nodules might increase diagnostic rates, while older patients and cystic nodules are prone to inadequate samples. Patients and caregivers should be aware that FNA of small or cystic nodules as well as nodules in older patients may result in a higher non-diagnostic rate. Further research comparing other needles gauges should be conducted.

PMID:34146249 | DOI:10.1007/s12020-021-02797-9

J Robot Surg. 2021 Jun 19. doi: 10.1007/s11701-021-01254-z. Online ahead of print.

ABSTRACT

Robotic-assisted total knee arthroplasty (RA-TKA) has potential benefits of improved restoration of mechanical alignment, accuracy of bony resection, and balancing. The purpose of this study was to determine the number of cases necessary for a single surgeon to achieve a constant, steady-state surgical time. The secondary purpose was to identify which steps demonstrated the most time reduced. This was a prospective study assessing intraoperative time for 60 RA-TKA with the Navio surgical system. Overall arthroplasty time and duration for each step were recorded. Statistical analysis included a nonlinear regression and survival regression. Successful implementation required 29 cases to achieve a steady-state. The average time decreased from 41.8 min for the first cohort to 31.1 min for the last cohort, a 26% decrease. The step with the greatest reduction was the “Review of Intraoperative Plan” with a reduction of 2.1 min. This study demonstrates surgical times averaging below 60 min and a learning curve that is complete in 29 cases with the surgeon reporting a high level of confidence with the system at 10 cases. Though Navio assisted TKA showed a significantly slower operative time, we are hopeful that future generations of robotic technology will be more efficiently implemented by surgeons.

PMID:34146231 | DOI:10.1007/s11701-021-01254-z

Int J Comput Assist Radiol Surg. 2021 Jun 19. doi: 10.1007/s11548-021-02423-z. Online ahead of print.

ABSTRACT

PURPOSE: Rhinoplasty is one of the most common and challenging plastic surgery procedures. Facial analysis is a crucial step in planning. Utilizing three-dimensional (3D) model of a patient’s face is an emerging way of performing facial analysis. This paper evaluates the agreement and reliability of facial measurements taken using a web app, located at digitized-rhinoplasty.com, that utilizes 3D models of the patient’s face.

METHODS: Eleven measurements were calculated on 16 human subjects. Three methods of measurements were performed: direct measurements on human subjects’ faces, measurements on 2D photographs, and measurements on 3D models of face scans. The Bland-Altman plot is used for testing the agreement between the web app and the well-known Blender 3D modeling software. Intra-rater and inter-rater reliability was calculated and compared for 2D and 3D methods using the intraclass correlation coefficient (ICC) method. The statistical analysis methods were checked for the normality and homoscedasticity assumptions.

RESULTS: The results indicate that the web app and Blender software show agreement within 95% confidence limits. The web app performs well in intra-rater and inter-rater reliability statistical analysis. The web app’s reliability scores are consistently better than facial analysis software which was found highly reliable in a previous study. We also compare the methods of measurements in terms of time, ease of use, and cost.

CONCLUSION: The utilization of 3D computer modeling for facial analysis has its advantages and started to become more common due to recent advances in technology. The web app utilizes 3D face scans for pre-operative planning and post-operative evaluation of facial surgeries. The web app performs well in agreement and inter-/intra-reliability analysis and performs consistently better than software that works utilizing 2D photographs. The web app provides accurate, repeatable, affordable, and fast facial measurements for facial analysis when compared to direct and 2D methods.

PMID:34146225 | DOI:10.1007/s11548-021-02423-z

Environ Geochem Health. 2021 Jun 19. doi: 10.1007/s10653-021-00995-y. Online ahead of print.

ABSTRACT

This study discusses an estimate of the risk associated with the intake of soil contaminated by lead, based on the nature of the source, through a detailed study of the parameters that can influence the bioaccessibility of the element from soil intake. Statistical variables that are related to the solubility and bioavailability of lead are used for this purpose. This includes considering the values of pH, electrical conductivity, particle size, mineralogical composition and the bioaccessibility/bioasimilability of lead. Obtaining an algorithm, represented by different probability distributions of the parameters considered, needs a thorough knowledge of the source materials, which may allow estimating/evaluating the intake health risk provided by the concentration of the metal present. The selected materials are from sites affected by mining activities in the Region of Murcia (SE of Spain) and soils in nearby areas, using a total of 186 samples. Soil samples, once screened and homogenized, were parameterized by determining pH, electrical conductivity, granulometry, both total and water-extractable Pb content. Oral bioaccessibility tests were also performed, and a detailed mineralogical analysis by X-ray diffraction was carried out.

PMID:34146209 | DOI:10.1007/s10653-021-00995-y

Lasers Med Sci. 2021 Jun 19. doi: 10.1007/s10103-021-03362-6. Online ahead of print.

ABSTRACT

The periocular region is challenging for cosmetic laser surgeons. Surgery and laser resurfacing have traditionally been used to correct periorbital lines and wrinkles. Although effective, the associated downtime with these methods has made many people reluctant to decide for such treatments. More recently, the non-ablative long-pulse 2940 nm Er:YAG laser is being used to improve the structure and function and hence the appearance of skin in the periorbital region. The objective of this study is to evaluate the safety and efficacy of long-pulse 2940 nm Er:YAG laser for non-ablative treatment of periorbital static wrinkles and skin laxity. This is a prospective analysis of 30 patients treated for periorbital rejuvenation using three sessions of non-ablative long-pulse Er:YAG laser over a 3-month period. All patients were assessed according to Fitzpatrick’s classification of periorbital wrinkles to class I, II, or III and were treated with 2940 nm Er:YAG laser using a fluence of 3.75 J/cm², a repetition rate of 1.7-2 Hz, and with the SMOOTH™ pulse mode (250 ms). The treatment sessions were performed on each patient, 4 weeks apart. Patient improvement was assessed before each laser session as well as at 12 months after the final treatment. Blind photographic evaluations were performed by three independent physicians using unlabeled before and after photos arranged in non-chronological order. Reviewers were asked to determine the before and after photos. Patients were asked to answer a questionnaire measuring satisfaction 4 weeks after each session, and to report any adverse reactions. There was statistically and clinically significant improvement in the Fitzpatrick classification of the periorbital wrinkles. Blinded evaluators correctly identified the before and after photos in all cases. All patients reported mild edema and erythema, which persisted for 1 to 2 days, and superficial peeling of the skin for 4 to 6 days after each laser treatment. No long-term adverse effects were reported. The non-ablative long-pulse 2940 nm Er:YAG laser seems to be a safe and effective treatment for periocular rejuvenation with minimal and tolerable adverse reaction. The improvement attained from the laser sessions was persisting after 1 year denoting the long-term efficacy of the procedure.

PMID:34146192 | DOI:10.1007/s10103-021-03362-6

Ann Surg Oncol. 2021 Jun 19. doi: 10.1245/s10434-021-10294-6. Online ahead of print.

NO ABSTRACT

PMID:34146188 | DOI:10.1245/s10434-021-10294-6

Skeletal Radiol. 2021 Jun 19. doi: 10.1007/s00256-021-03813-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The popliteofibular ligament (PFL) is an important stabilizer of the knee found within the posterolateral corner (PLC) of the joint. Injuries to the PLC can cause substantial patient morbidity. Accurate PFL visualization has been historically challenging, impeding injury diagnosis and treatment. The gold standard for in vivo PFL visualization is magnetic resonance imaging (MRI), but this procedure has slice thickness limitations, is costly, and is subject to longer wait times. Ultrasonographic (US) PFL assessment is a potentially viable alternative to MRI. This study aimed to determine the viability of US PFL assessment.

MATERIALS AND METHODS: Ten fresh-frozen lower limb specimens were evaluated for the presence and morphometric characteristics of the PFL via US using an 18.0-MHz linear transducer. The cadavers were then dissected and reassessed for the presence and morphometric characteristics of the PFLs for comparison with US findings. Moreover, the fracture of the fibular styloid process near the site of the insertion of the PFL (the arcuate sign) was simulated and assessed via US.

RESULTS: The PFL was visualized and measured in all ten knees via both US and cadaveric assessments. There were no statistically significant differences in PFL morphometric characteristics determined via US examination and dissection. The fibular styloid fracture was easily identified in US examination.

CONCLUSION: US imaging is a viable alternative for accurate and effective assessment of the normal PFL. Moreover, the arcuate sign can be evaluated via US.

PMID:34146118 | DOI:10.1007/s00256-021-03813-9

Arch Orthop Trauma Surg. 2021 Jun 19. doi: 10.1007/s00402-021-03999-6. Online ahead of print.

ABSTRACT

OBJECTIVES: Intertrochanteric femur fractures (ITFF) are frequently fixed with proximal femoral nailing (PFN), and a common cause of fixation failure is cut-out of the lag screws. In the literature, many factors have been defined to determine the failure risk, including the tip-apex distance (TAD), calcar-referenced tip-apex distance (CalTAD), the Cleveland zone and Parker’s ratio. In this study, a novel technique is described which favors infero-posterior placement of the lag screw and predicts failure risk for PFN. The purpose of this study was to evaluate the tip-neck distance ratio as a factor for the prediction of cut-out after PFN of ITFF.

MATERIALS AND METHODS: A retrospective evaluation was made of the data of 125 patients applied with PFN for ITFF between October 2016 and September 2019. The occurrence of mechanical complications was analyzed in relation to age, gender, fracture side, American Society of Anaesthesiologists classification, fracture classification, reduction quality, bone quality, Cleveland zone, Parker’s ratio, TAD, CalTAD and the TNDR.

RESULTS: A total of 125 patients, including 16 with mechanical complications, were suitable for full analysis. In the univariate analysis, reduction quality (p = 0.003), the TAD (p = 0.048) and the TNDR (p = 0.030) were statistically associated with mechanical complications (p < 0.05). In the multivariate analysis, good quality of reduction reduced risk of mechanical failure (p = 0.011) and the TNDR (p < 0.001) indicated that these were two independent factors affecting mechanical complications.

CONCLUSION: The results of this study provide clinical evidence that the TNDR is a predictor for cut-out risk. Placement of the lag screw posterior and inferior reduces the risk of mechanical complications.

LEVEL OF EVIDENCE: Level 3.

PMID:34146115 | DOI:10.1007/s00402-021-03999-6