Tag: nevin manimala

Int Heart J. 2024;65(2):237-245. doi: 10.1536/ihj.23-331.

ABSTRACT

Serum chloride level has clinical significance in the prognosis of heart failure. Little is known regarding the association between serum chloride levels and in-hospital mortality in patients with heart failure.This retrospective study used clinical data obtained from the Medical Information Mart for Intensive Care Database. The study cohort comprised patients who were categorized on the basis of their serum chloride levels, and the primary endpoint was in-hospital mortality. To assess the impact of serum chloride levels at the time of intensive care unit admission on in-hospital mortality, we used various statistical approaches, including multivariable logistic regression models, a generalized additive model, and a two-piecewise linear regression model. In addition, subgroup analysis was conducted to examine the robustness of the main findings.This study comprised 15,983 participants. When compared with the reference group (Q5), the groups with the highest (Q7) and lowest (Q1) blood chloride levels exhibited increased in-hospital mortality, with fully adjusted odds ratios (ORs) of 1.36 [95% confidence interval (CI): 1.08-1.71] and 1.25 (95% CI: 1-1.56), respectively. A U-shaped relationship was observed between blood chloride levels and in-hospital mortality, with the lowest risk observed at a threshold of 105.017 mmol/L. The effect sizes and corresponding CIs below and above the threshold were 0.969 (95% CI: 0.957-0.982) and 1.039 (95% CI: 1.002-1.076), respectively. Stratified analyses demonstrated the robustness of this correlation.The relationship between serum chloride levels and in-hospital mortality in patients with heart failure was U-shaped, with an inflection point of 105.017 mmol/L.

PMID:38556334 | DOI:10.1536/ihj.23-331

J Oleo Sci. 2024;73(4):619-623. doi: 10.5650/jos.ess23140.

ABSTRACT

The distribution of electrolytes near the air/water surface plays an essential role in many processes. While the general distribution is governed by classic Poisson-Boltzmann statistics, the analytical solution is only available for symmetric electrolytes. From the recent studies in the literature, it is evident that surface adsorption is dependent on specific ions as well as the H-bond structure at the surface. Experimental data can capture the macro properties of the surface, such as surface tension and surface potential. Yet, the underpinning mechanisms behind this experimental macro-observation remain unclear. To address the challenge, we developed a framework combining experimental studies and numerical calculations. The model was developed for electrolytes with unequal cationic and anionic charges. The asymmetric model was successfully applied to describe the surface charge of MgCl ₂ aqueous solution. The results can be explained by the role of cationic size and charge on the surface layer.

PMID:38556295 | DOI:10.5650/jos.ess23140

J Am Pharm Assoc (2003). 2024 Mar 29:102078. doi: 10.1016/j.japh.2024.102078. Online ahead of print.

ABSTRACT

BACKGROUND: Pharmacist-driven continuous glucose monitoring (CGM) is associated with reduced hemoglobin A1c (HbA1c) and achievement of daily glycemic goals. Community-based pharmacists are well positioned to improve CGM uptake among patients with diabetes due to their accessibility and expertise. However, little data exists evaluating outcomes of CGM services led by a community-based pharmacist.

OBJECTIVE: To evaluate the impact of a community-based pharmacy resident-driven CGM service on HbA1c, revenue, and patient satisfaction.

PRACTICE DESCRIPTION: Independent community pharmacy sharing a clinical services agreement with a primary care clinic for Postgraduate Year One (PGY1) Community-based Pharmacy Residents to provide patient care under general supervision of the physician.

PRACTICE INNOVATION: Patients were offered CGM services if they were 18+ years with a HbA1c >7.0% and insurance coverage for CGM. Enrolled patients engaged in three months of pharmacist-led appointments for CGM application, data interpretation, diabetes education, and lifestyle management. Current Procedural Terminology (CPT) codes 99211, 95250, or 95251 were billed based on each encounter. HbA1c values were collected at program enrollment and conclusion. Patients completed a satisfaction survey at program conclusion.

EVALUATION METHODS: Demographics and billed CPT codes were collected from the electronic health record. Descriptive statistics were used to analyze survey data.

RESULTS: Eighteen patients were included. A mean reduction of 1.2% occurred in HbA1c (n=12; 9.7% to 8.5%). Forty CPT codes were billed, generating $3,671.40 of revenue. Satisfaction surveys were collected for 50% of participants (n=9). Most were satisfied with the CGM service and its individual components (n=8, 89%). Most were willing to continue using CGM devices and receive diabetes education from a pharmacist (n=8, 89%).

CONCLUSION: A community-based pharmacist led CGM service demonstrated a reduction in HbA1c and generated revenue for the clinic. Patients reported satisfaction and willingness to continue the service.

PMID:38556247 | DOI:10.1016/j.japh.2024.102078

J Dent. 2024 Mar 29:104970. doi: 10.1016/j.jdent.2024.104970. Online ahead of print.

ABSTRACT

OBJECTIVES: Deep networks have been preliminarily studied in caries diagnosis based on clinical X-ray images nowadays. However, the performance of different deep networks on caries detection is still unclear. This study aims to comprehensively compare the caries detection performances of recent multifarious deep networks with clinical dentist level as a bridge.

METHODS: Based on the self-collected periapical radiograph dataset in clinic, four most popular deep networks in two types, namely YOLOv5 and DETR object detection networks, and UNet and Trans-UNet segmentation networks, were included in the comparison study. Five dentists carried out the caries detection on the same testing dataset for reference. Key tooth-level metrics, including precision, sensitivity, specificity, F1-score and Youden index, were obtained, based on which statistical analysis was conducted.

RESULTS: The F1-score order of deep networks is YOLOv5 (0.87), Trans-UNet (0.86), DETR (0.82) and UNet (0.80) in caries detection. A same ranking order is found using the Youden index combining sensitivity and specificity, which are 0.76, 0.73, 0.69 and 0.64 respectively. A moderate level of concordance was observed between all networks and the gold standard. No significant difference (p>0.05) was found between deep networks and between the well-trained network and dentists in caries detection.

CONCLUSIONS: Among investigated deep networks, YOLOv5 is recommended to be priority for caries detection in terms of its high metrics. The well-trained deep network could be used as a good assistance for dentists to detect and diagnose caries.

CLINICAL SIGNIFICANCE: The well-trained deep network shows a promising potential clinical application prospect. It can provide valuable support to healthcare professionals in facilitating detection and diagnosis of dental caries.

PMID:38556194 | DOI:10.1016/j.jdent.2024.104970

J Dent. 2024 Mar 29:104979. doi: 10.1016/j.jdent.2024.104979. Online ahead of print.

ABSTRACT

OBJECTIVES: the aim of the present in vitro study was to evaluate the effect of a novel auxiliary geometric device (AGD) on the accuracy of full-arch scans made with 3 different intra-oral scanners (IOS).

METHODS: An edentulous maxillary model with four internal connection implant replicas was scanned using three different IOS: iTero Element 5D (ITERO) (Align Technology, Tempe, AZ, USA), Trios 4 (TRIOS) (3Shape A/S Holmens Kanal 7 1060 Copenhagen Denmark), and Carestream 3700 (CS) (Carestream Dental, Atlanta, USA). Thirty-six scans were taken with each IOS, 18 with the AGD in place, and 18 without the AGD. A digital master model was created using an industrial optical structured light scanner (ATOS compact Scan 5M, GOM GmbH, Braunschweig, Germany). The master and IOS models were aligned using the scan bodies as a reference area. A surface comparison was performed, and deviation labels were exported for each scan body to evaluate the linear and angular deviation. Total body and platform deviations, and angular deviations were measured.

RESULTS: The use of AGD resulted in a statistically significant increase of angular deviation: 0.87° (SD=0.21) in the AGD group versus 0.64° (SD=0.46) in the no AGD group (p-value=0.005). The difference between the AGD and no AGD groups was not statistically significant for total body and platform deviation values (p-value=0.051 and 0.302 respectively). Using AGD, ITERO showed a statistically significant increase in angular deviation (mean difference=-0.46 µm, p-value=0.002) and a decrease in mean platform deviation (mean difference=63.19 µm, p-value<0.001). No statistically significant differences were found for the other IOSs.

CONCLUSIONS: The use of auxiliary geometric devices (AGD) did not add benefit on CS and TRIOS. On ITERO there is an improvement in platform deviation that is outweighed by the worsening of the angular deviation.

CLINICAL SIGNIFICANCE: In vitro data suggest that intraoral scans can be successfully used in full-arch cases. The use of AGD has no additional benefit on CS and TRIOS. On ITERO there is an improvement in platform deviation that is outweighed by the worsening of the angular deviation. Translational application to clinical practice deserves further investigation, taking into account patients’ related and anatomical variables.

PMID:38556193 | DOI:10.1016/j.jdent.2024.104979

Radiother Oncol. 2024 Mar 29:110262. doi: 10.1016/j.radonc.2024.110262. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: To evaluate modern clinical outcomes for patients with brain-only metastatic non-small cell lung cancer (NSCLC) treated with intracranial stereotactic radiosurgery (SRS) with or without definitive treatment of the primary site.

MATERIALS AND METHODS: Patients with synchronously diagnosed NSCLC and brain-only metastatic disease treated with intracranial SRS at a single institution were retrospectively identified. Patients were stratified based on whether they did (A) or did not (B) receive definitive primary site treatment. Patient characteristics and clinical outcomes were compared.

RESULTS: From 2008 to 2022, 103 patients were identified, 53 of whom received definitive primary site treatment. Median follow-up was 2.1 y (A) and 0.8 y (B) (p < 0.001). 28 (53 %) patients in Group A received immune checkpoint inhibitor (ICI) therapy versus 19 (38 %) in Group B (p = 0.13) and there were no other statistically significant baseline or treatment characteristic differences between the groups. 5-year local-PFS was 34.5 % (A) versus 0 % (B) (p < 0.001). 5-year regional-PFS was 33.0 % (A) versus 0 % (B) (p < 0.001). 5-year distant body-PFS was 34.0 % (A) versus 0 % (B) (p < 0.001). 5-year CNS-PFS was 14.7 % (A) versus 0 % (B) (p = 0.12). 5-year OS was 40.2 % (A) versus 0 % (B) (p = 0.001). 5-year CSS was 67.6 % (A) versus 0 % (B) (p = 0.002). On multivariable analysis, lack of definitive treatment to the primary site (HR = 2.40), AJCC T3-4 disease (HR = 2.73), and lack of ICI therapy (HR = 2.86) were significant predictors of death.

CONCLUSION: Definitive treatment to the thoracic primary site in patients with brain-only metastatic NSCLC after intracranial radiosurgery was associated with slower progression of disease and improved survival.

PMID:38556172 | DOI:10.1016/j.radonc.2024.110262

J ISAKOS. 2024 Mar 29:S2059-7754(24)00056-7. doi: 10.1016/j.jisako.2024.03.011. Online ahead of print.

ABSTRACT

OBJECTIVES: The goal of this project was to develop and validate a patient-specific, anatomically correct graft for cartilage restoration using magnetic resonance imaging (MRI) data and 3-dimensional (3D) printing technology. The specific aim was to test the accuracy of a novel method for 3D printing and implanting individualized, anatomically shaped bio-scaffolds to treat cartilage defects in a human cadaveric model. We hypothesized that an individualized, anatomic 3D printed scaffold designed from MRI data would provide a more optimal fill for a large cartilage defect compared to a generic flat scaffold.

METHODS: Four focal cartilage defects (FCDs) were created in paired human cadaver knees, age <40 years, in the weight-bearing surfaces of the medial femoral condyle (MFC), lateral femoral condyle (LFC), patella, and trochlea of each knee. MRIs were obtained, anatomic grafts were designed and 3D printed for the left knee as an experimental group, and generic flat grafts for the right knee as a control group. Grafts were implanted into corresponding defects and fixed using tissue adhesive. Repeat post-implant MRIs were obtained. Graft step-off was measured as the distance in mm between the surface of the graft and the native cartilage surface in a direction perpendicular to the subchondral bone. Graft contour was measured as the gap between the undersurface of the graft and the subchondral bone in a direction perpendicular to the joint surface.

RESULTS: Graft step-off was statistically significantly better for the anatomic grafts compared to the generic grafts in the MFC (0.0±0.2 mm vs. 0.7±0.5 mm, p<0.001), LFC (0.1±0.3 mm vs. 1.0±0.2 mm, p<0.001), patella (-0.2±0.3 mm vs. -1.2±0.4 mm, p<0.001), and trochlea (-0.4±0.3 vs. 0.4±0.7, p=0.003). Graft contour was statistically significantly better for the anatomic grafts in the LFC (0.0±0.0 mm vs. 0.2±0.4 mm, p=0.022) and trochlea (0.0±0.0 mm vs. 1.4±0.7 mm, p<0.001). The anatomic grafts had an observed maximum step-off of -0.9 mm and a maximum contour mismatch of 0.8 mm.

CONCLUSION: This study validates a process designed to fabricate anatomically accurate cartilage grafts using MRI and 3D printing technology. Anatomic grafts demonstrated superior fit compared to generic flat grafts.

LEVEL OF EVIDENCE: Level IV.

PMID:38556170 | DOI:10.1016/j.jisako.2024.03.011

J Stomatol Oral Maxillofac Surg. 2024 Mar 29:101854. doi: 10.1016/j.jormas.2024.101854. Online ahead of print.

ABSTRACT

INTRODUCTION: The present study aimed to identify the morphological differences in cranial and dentofacial structures between individuals with mouth-breathing and nasal-breathing.

MATERIALS AND METHODS: The study included 120 individuals, 60 each in the nasal breathing (NB) and mouth breathing (MB) groups. 3D stereophotogrammetry, lateral cephalometric radiographs, and intraoral examination results were recorded by the researchers to determine the morphological differences between the MB group and the NB group. The study utilized cephalometric radiographs for 2D hard tissue measurements and 3D stereophotogrammetric records for linear and angular measurements.

RESULTS: Statistically significant differences were found between the NB and MB groups’ SNB angles (respectively, 79.3±3.04, 76.6±4.24, and p=0.002). Also, the NB group’s SN-GoGn angle was lower than the MB group’s (respectively, 31.5±5.12, 36.0±5.55, and p=0.002). Considering the Jarabak ratio, the NB group’s Jarabak ratio was higher than the MB group (respectively,65.7±4.16, 62.6±4.10, and p=0.014). In 3D stereophotogrammetry measurements, increased Li-Me’ was detected in the MB group than in NB group.

CONCLUSION: Mouth breathing results in significant morphological differences that affect the development of both soft tissues and skeletal structures. Orthodontists utilize these characteristic features observed in mouth-breathing anomalies for early diagnosis and consider referring their patients for medical treatment of mouth breathing.

PMID:38556168 | DOI:10.1016/j.jormas.2024.101854

J Stomatol Oral Maxillofac Surg. 2024 Mar 29:101857. doi: 10.1016/j.jormas.2024.101857. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes.

MATERIAL AND METHODS: Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed.

RESULTS: The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥ 0.99).

CONCLUSIONS: This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.

PMID:38556166 | DOI:10.1016/j.jormas.2024.101857

J Stomatol Oral Maxillofac Surg. 2024 Mar 29:101858. doi: 10.1016/j.jormas.2024.101858. Online ahead of print.

ABSTRACT

INTRODUCTION: Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600000 new diagnosis each year. Nowadays, in locally advanced disease, radiotherapy (RT) play an important role, this with or without chemotherapy in organ preservation strategies. More specific for early stage localized disease, RT (or surgery) seems to give similar results on locoregional control (LRC) and choice is made according to the organ preservation issue. Despite the fact that technical improvements have been made to optimize the radiation dose delivery and minimize the normal tissue toxicity, RT is associated with potential early and late toxicities. Osteoradionecrosis of the jaw (ORNJ), especially seen after teeth extraction, is one of the associated toxicities and can significantly impair the patient’s quality of life. Because of the fear of developing ORNJ, one is very reluctant to extract or place a dental implant post-radiotherapy, especially in high irradiation dose zones (>40Gy). Hence, it is important to define teeth at risk of future extraction before initiating RT and to handle those in high-risk irradiation zones. In order to optimise extractions, we created a predictive model of the expected irradiation dose, and thus the need for extraction, to the teeth bearing bones. The aim of this study is to validate our model and to define the potential relationship between the radiation dose received by each tooth and the dental complications observed.

MATERIAL AND METHODS: Between March 2012 and March 2018, patients with HNSCC treated by intensity modulated RT were retrospectively analyzed. The mean irradiation dose for each tooth was generated on the administered treatment plan by contouring each tooth separately on each dosimetric scan section using dedicated software (Eclipse, Varian). In order to validate our predictive model, we compared the actual generated/administered teeth irradiation doses with the irradiation doses predicted by our model.

RESULTS: Our predictive model was accurate in 69.6% of the cases. In 12.5% of cases the predicted dose was higher than the calculated dose and lower in 17,8 % of the cases. A correct- or over-estimation (is the latter being clinically less worrying than an underestimated dose) was achieved in 82% of cases. For the 18% of cases underfitting, the mean margin of error was 5.7Gy. No statistically significant association was found between the development of caries and doses to the teeth, doses to the parotid glands or dental hygiene. However, a significant association between dental irradiation at more than 40Gy and the occurrence of dental fractures (p=0.0002) were demonstrated.

CONCLUSIONS: Our predictive model seems to be 82 % accurate for dose prediction, hence might be helpful for optimizing/minimizing prophylactic extractions. Indeed, following our model, professionals could decide not to extract damaged teeth in areas not at risk of ORNJ, lowering morbidity during and after RT. Contrary to the literature, no relationship was found between the occurrence of dental caries and parotid irradiation and the patient’s oral hygiene. However, for the first time, a highly significant correlation between the occurrence of dental fracture and dental irradiation at more than 40Gy was observed.

PMID:38556165 | DOI:10.1016/j.jormas.2024.101858