Tag: nevin manimala

Surg Today. 2022 Sep 21. doi: 10.1007/s00595-022-02590-9. Online ahead of print.

ABSTRACT

The Surgical Patient Safety System (SURPASS) has been proven to improve patient outcomes. However, few studies have evaluated the details of litigation and its prevention in terms of systemic and diagnostic errors as potentially preventable problems. The present study explored factors associated with accepted claims (surgeon-loss). We retrospectively searched the national Japanese malpractice claims database between 1961 and 2017. Using multivariable logistic regression models, we assessed the association between medical malpractice variables (systemic and diagnostic errors, facility size, time, place, and clinical outcomes) and litigation outcomes (acceptance). We evaluated whether or not the factors associated with litigation could have been prevented with the SURPASS checklist. We identified 339 malpractice claims made against general surgeons. There were 159 (56.3%) accepted claims, and the median compensation paid was 164,381 USD. In multivariable analyses, system (odds ratio, 27.2 95% confidence interval 13.8-53.5) and diagnostic errors (odds ratio 5.3, 95% confidence interval 2.7-10.5) had a significant statistical association with accepted claims. The SURPASS checklist may have prevented 7% and 10% of the accepted claims and systemic errors, respectively. It is unclear what proportion of accepted claims indicated that general surgeon loses should be prevented from performing surgery if the SURPASS checklist were used. In conclusion, systemic and diagnostic errors were associated with accepted claims. Surgical teams should adhere to the SURPASS checklist to enhance patient safety and reduce surgeon risk.

PMID:36127545 | DOI:10.1007/s00595-022-02590-9

Pediatr Surg Int. 2022 Sep 21. doi: 10.1007/s00383-022-05212-0. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to obtain information about the psychosocial functioning of adults with various congenital colorectal conditions (e.g., anorectal malformation, Hirschsprung disease).

METHODS: A research registry of adult patients with colorectal conditions was developed. Items included demographics, medical diagnosis/treatment, and measures of anxiety and depression. Descriptive and inferential statistical approaches were applied to summarize data and determine significant differences in the average scores for depression and anxiety between various groupings of diagnoses, gender, race, and the use of psychotropic medication.

RESULTS: Study measures were completed by 131 adults. Depression and anxiety scores were significantly higher for women than men and those self-identified as non-binary (p = 0.012, < 0.001, respectively). No significant differences in depression and anxiety scores were found due to colorectal diagnosis (p > 0.05). Participants who identified as Asian had significantly higher depression scores than participants of other races (p = 0.002); but no significant difference was noted for anxiety scores (p = 0.065).

CONCLUSIONS: Results suggest that depression and anxiety scores were significantly influenced by gender and race. However, colorectal diagnosis was not a predictor of depression or anxiety. It is important for colorectal providers to be aware of the psychosocial implications of congenital colorectal conditions and consider how to provide adequate support to address patients’ psychosocial needs.

PMID:36127514 | DOI:10.1007/s00383-022-05212-0

Commun Biol. 2022 Sep 20;5(1):991. doi: 10.1038/s42003-022-03953-1.

ABSTRACT

Long-read sequencing technology enable better characterization of structural variants (SVs). To adapt the technology to population-scale analyses, one critical issue is to obtain sufficient amount of high-molecular-weight genomic DNA. Here, we propose utilizing activated T lymphocytes, which can be established efficiently in a biobank to stably supply high-grade genomic DNA sufficiently. We conducted nanopore sequencing of 333 individuals constituting 111 trios with high-coverage long-read sequencing data (depth 22.2x, N50 of 25.8 kb) and identified 74,201 SVs. Our trio-based analysis revealed that more than 95% of the SVs were concordant with Mendelian inheritance. We also identified SVs associated with clinical phenotypes, all of which appear to be stably transmitted from parents to offspring. Our data provide a catalog of SVs in the general Japanese population, and the applied approach using the activated T-lymphocyte resource will contribute to biobank-based human genetic studies focusing on SVs at the population scale.

PMID:36127505 | DOI:10.1038/s42003-022-03953-1

Int Ophthalmol. 2022 Sep 21. doi: 10.1007/s10792-022-02486-0. Online ahead of print.

ABSTRACT

PURPOSE: Within a population-based follow-up study, to examine the 10-year incidence of pseudoexfoliation syndrome (PEX), possible risk factors for PEX and its association with ocular aging of the cornea, lens and retina.

METHODS: The baseline examination was conducted in 2006 on a random sample of 1,033 adult participants from Kaunas city (Lithuania) population of whom 631 had ophthalmic examination data at attendance of the 10-year follow-up in 2016. Detailed examination of the anterior and posterior segment of the eye was carried out. After diagnostic mydriasis PEX was diagnosed by the presence of typical grayish-white exfoliation material on the anterior capsule surface of the lens. The participants were divided to PEX and non-PEX groups.

RESULTS: PEX prevalence increased from 9.8 to 34.2% from baseline to 10-year follow-up. Nuclear cataract was common both in the PEX group (66.7%) and in those without PEX (72.2%), but this difference did not reach statistically significantly increased risk of developing cataract in those with PEX (OR 1.2; p = 0.61). Central corneal thickness (CCT) was thinner in the PEX group (529 ± 34 μm) and in the oldest group (525 ± 36 μm) (p < 0.001). Compared to baseline, corneal curvature (CC) became flatter in both groups (7.6 ± 0.27 vs 7.7 ± 0.26 mm; p < 0.001) during the follow-up, but the difference did not reach significance between groups. Corneal astigmatism was most commonly with-the-rule in both groups (37 (50.0%) vs 148 (68.5%); p > 0.05). Age, sex and PEX had no influence on age-related macular degeneration distribution.

CONCLUSION: The prevalence of PEX increased significantly with age in our population, with those with PEX having thinner and flatter corneae, but no difference in cataract and age-related macular degeneration characteristics.

PMID:36127504 | DOI:10.1007/s10792-022-02486-0

Int J Prosthodont. 2022 Sep 15. doi: 10.11607/ijp.8177. Online ahead of print.

ABSTRACT

PURPOSE: To assess stress and deformation in telescopic removable partial denture (RPD) frameworks manufactured with polyether ether ketone (PEEK) or graphene-modified polymethyl methacrylate (PMMA), as well as the stress of the underlying mucosa, via nonlinear 3D finite element analysis.

MATERIALS AND METHODS: The 3D model of a full mandible was merged with a 3D-scanned Kennedy Class I model with bilaterally missing molars. The tissues, the telescopic crowns, and the RPD framework were designed and created using dental CAD software. The model was duplicated, and two materials-PEEK and graphene-modified PMMA-were assigned to the telescopic crowns and their frameworks. A force of 200 N was applied perpendicularly to the molars, and constraints were placed in the mandibular ramus and the inferior border. The generated von Mises stress and deformation of the frameworks, as well as the stresses of the telescopic crowns and mucosa, were also assessed. Statistical analysis of the differences between the tested materials was conducted via an independent samples t test at (α = .05).

RESULTS: The von Mises stresses of the telescopic crowns and their frameworks in the graphene-modified PMMA model were significantly higher than in the PEEK model. In contrast, the deformation of the telescopic RPD framework of the PEEK model was significantly higher than the graphene-modified PMMA model. The stresses of the mucosa in both models showed an insignificant difference.

CONCLUSION: PEEK material showed better biomechanical performance than the graphene-modified PMMA in telescopic RPDs.

PMID:36125879 | DOI:10.11607/ijp.8177

Int J Prosthodont. 2022 Jul-Aug;35(4):545-552. doi: 10.11607/ijp.7563.

ABSTRACT

PURPOSE: To evaluate the shear bond strength (SBS) of different digital veneering techniques for zirconia and to critically discuss its suitability for application in single-implant prosthetics.

MATERIALS AND METHODS: A total of 112 square-shaped zirconia specimens were provided with four different veneering materials (n = 28 per group): a glass-ceramic (group GLA), a feldspathic ceramic (group FEL), a polymer-infiltrated ceramic network (group PIC), and a resin nanoceramic (group RNC). Discs in group GLA were sintered onto the core material, whereas all other specimens were adhesively connected. In each group, 14 specimens (GLA0, FEL0, PIC0, RNC0) were subjected to SBS testing before thermocycling, and the other 14 (GLA1, FEL1, PIC1, RNC1) were tested after thermocycling (10,000 cycles). Data were analyzed by applying SPSS software (P < .05). The surfaces and fracture patterns of the specimens were examined using scanning electron microscopy (SEM).

RESULTS: Mean SBS values ranged from 14.09 ± 3.87 MPa (RNC1) to 40.82 ± 4.91 MPa (GLA0). Group GLA presented higher values than all other groups (P < .001). Groups FEL, PIC, and RNC showed no statistically significant differences between them. SBS decreased after thermocycling, but no significant impact was found. Every group exhibited a characteristic failure mode.

CONCLUSION: All digital veneering techniques sufficed to present clinically acceptable SBS values and might be viable alternatives in implant prosthetics. However, some have yet to demonstrate their long-term clinical suitability. At present, lithium disilicate-veneered zirconia abutments and monolithic lithium disilicate hybrid abutment crowns seem to present a proven and reliable restorative option.

PMID:36125877 | DOI:10.11607/ijp.7563

Int J Prosthodont. 2022 Jul-Aug;35(4):494-501. doi: 10.11607/ijp.8060.

ABSTRACT

PURPOSE: To investigate the precementation mean marginal gap, fracture resistance, and mode of failure of monolithic zirconia endocrowns cemented to endodontically treated molar teeth with butt joint porcelain margins and added ferrule preparation designs.

MATERIALS AND METHODS: A total of 20 mandibular molars were endodontically treated and prepared to receive endocrown restorations. The teeth were randomly divided into two groups: Group B had a butt joint porcelain margin, while Group F received additional axial reduction with a shoulder finish line that added ferrule. Monolithic zirconia endocrowns were milled, and the marginal gaps were measured at four locations prior to cementation with resin cement. All samples were subjected to thermocycling, followed by compressive static loading. The maximum load causing fracture and mode of failure were recorded.

RESULTS: The mean load to failure for Group B (5,616 ± 1,503 N) was not significantly different compared to Group F (5,762 ± 1,618 N) (P = .84). Both groups recorded high rates of irreparable fractures (P = .2699, df = 2). The mean marginal gap in Group B (48.20 ± 12.37 μm) was not statistically significantly different compared to Group F (45.14 ± 8.45 μm) (P = .527).

CONCLUSION: The addition of ferrule to the preparation design had no significant effect on the precementation mean marginal gap, fracture resistance, or mode of failure of monolithic zirconia endocrowns cemented to endodontically treated molar teeth. Monolithic zirconia endocrowns failed predominantly in an irreparable manner, but these failures were at high failure loads. The precementation mean marginal gap for both groups was small in comparison to other materials.

PMID:36125874 | DOI:10.11607/ijp.8060

Int J Prosthodont. 2022 Jul-Aug;35(4):487-493. doi: 10.11607/ijp.8010.

ABSTRACT

PURPOSE: To evaluate the effect of different cavity designs and cement types on the fracture resistance of monolithic zirconia inlay-retained fixed dental prostheses (IRFDPs).

MATERIALS AND METHODS: Four study models consisting of a second premolar, a missing first molar, and a second molar were used for the different cavity designs. Four different inlay cavity designs were prepared: DO-MO (disto-occlusal-mesio-occlusal cavity), MOD-MOD (mesio-occlusodistal-mesio-occlusodistal cavity), WDO-WMO (DO-MO with additional wings), and WMOD-WMOD (MOD-MOD with additional wings). A total of 64 epoxy resin models were produced and scanned individually. IRFDPs were then fabricated from monolithic zirconia using CAD/ CAM software. The bonding surface of the IRFDPs was airborne particle abraded (50-μm alumina/2 MPa), then cemented onto the epoxy resin models using two cementation protocols (n = 8 per group): (1) P = cemented with Panavia SA Cement Plus Automix; and (2) Z/C = cemented with MDP-containing primer (Z-Prime Plus) combined with Calibra Universal resin cement. All IRFDPs were fatigued through thermal aging (6,000 cycles/5°C to 55°C) and chewing simulations (600,000 cycles × 50-N load, 2.1 Hz). All IRFDPs were then subjected to a fracture resistance test using a universal testing machine with a crosshead speed of 0.2 mm/minute. Data were statistically analyzed using one- and two-way ANOVA and Bonferroni multiple comparisons test (P = .001).

RESULTS: The mean fracture load (N) of the designs were as follows: WMODWMOD = 1,111.1; WDO-WMO = 1,057.4; MOD-MOD = 725.6; DO-MO = 682.7. According to two-way ANOVA, the differences among the cavity designs were statistically significant (P < .05).

CONCLUSION: The cavity design of IRFDPs affected the fracture resistance. However, the fracture resistance of monolithic zirconia IRFDPs with any cavity design was enough to withstand expected posterior chewing forces.

PMID:36125873 | DOI:10.11607/ijp.8010

Int J Prosthodont. 2022 Jul-Aug;35(4):469-479. doi: 10.11607/ijp.7551.

ABSTRACT

PURPOSE: To evaluate the biaxial flexural strength of different porcelain-to-zirconia thickness ratios and bonding strategies of a stress-free bilayer CAD/CAM ceramic system.

MATERIALS AND METHODS: A total of 60 zirconia discs (diameter: 15 mm; thickness: 0.3 or 0.5 mm; n = 30 for each thickness) were divided into six groups (n = 10 each) according to porcelain-to-zirconia ratio and bonding strategy: VM/Zr (control): zirconia discs veneered with a feldspathic ceramic (VM 9, Vita) in 0.9-mm and 0.7-mm thicknesses using a conventional hand-layering technique; VB/Zr-SBU: zirconia discs airborne particle-abraded with 50-μm Al₂O₃ particles followed by an MDP primer application (Single Bond Universal, 3M) and bonded to the porcelain with a resin cement (Panavia F 2.0, Kuraray); and VB/Zr-RC: zirconia discs airborne particle-abraded with 30-μm silica-coated Al₂O₃ particles and silanized and bonded to the porcelain with the same resin cement. Before cementation, the VB (Vitablocs II) discs were etched with 5% hydrofluoric acid (60 seconds), followed by silane application. The bilayers (thickness = 1.2 mm) were loaded with 750 g while light curing the resin cement. Two porcelain-to-zirconia thickness ratios were evaluated: 0.9: 0.3 mm and 0.7: 0.5 mm. All groups were subjected to 106 mechanical cycles, followed by a biaxial flexural test. Data (MPa) were subjected to two-way analysis of variance (ANOVA), Tukey test (5%), and Weibull analyses.

RESULTS: Two-way ANOVA revealed that the factor porcelain-to-zirconia ratio (P = .0556) was not significant; however, the bonding strategy factor was statistically significant. Among the 0.5-mm zirconia groups, the VB/Zr-SBU group presented higher flexural strength (s) than the VM/Zr or VB/Zr-RC groups. Similar results were also found for the 0.3-mm zirconia groups, in which the VB/Zr-SBU group also presented higher strength than the others, which were similar in comparison (Tukey). The Weibull modulus was similar among the groups; however, the characteristic strength was significantly different (P = .000).

CONCLUSION: The zirconia bonding strategy with 50-μm Al²O³ airborne-particle abrasion, followed by a primer application, increases the flexural strength of a stress-free bilayer CAD/CAM ceramic system.

PMID:36125871 | DOI:10.11607/ijp.7551

Int J Prosthodont. 2022 Jul-Aug;35(4):460-468. doi: 10.11607/ijp.7703.

ABSTRACT

PURPOSE: To evaluate the effect of different luting techniques on the shear bond strength (SBS) of ultra-translucent multi-layered zirconia (UTML) after 24 hours and 1 year of water storage and to analyze the influence of primers on the wettability of the UTML MTU-6 surface.

MATERIALS AND METHODS: Four commercial resin cements were evaluated: Variolink Esthetic LC (Ivoclar Vivadent); RelyX Ultimate (3M); Estecem II (Tokuyama); and Panavia V5 (Kuraray Noritake). Panavia V5 was tested with and without Panavia V5 Tooth Primer (Kuraray Noritake). The SBS immediately after cement/primer application and after aging, scanning electron microscopy of the surfaces, and the contact angle of the primers on the UTML surfaces were analyzed.

RESULTS: At 24 hours, Panavia V5 with Tooth Primer exhibited the highest SBS. After 1 year, the SBS of Variolink Esthetic LC and Panavia V5 with Tooth Primer decreased, and RelyX Ultimate increased. There was no statistical difference between RelyX Ultimate and Panavia V5 with Tooth Primer at 1 year. For all groups, the rate of adhesive failures increased after 1 year. The highest contact angle was observed on the control (no primer) group, and the lowest contact angles were obtained when the YSZ surface was treated with Scotchbond Universal and the combination of Clearfil Ceramic Primer Plus and Tooth Primer.

CONCLUSION: Clinicians should prefer 10-MDP-based cementation systems that can be properly polymerized to achieve a stable long-term bond strength to YSZ restorations. Also, the use of ceramic primers improves the capability of the cement to establish an intimate contact with the intaglio of the restoration.

PMID:36125870 | DOI:10.11607/ijp.7703