Tag: pubmed

J Endovasc Ther. 2023 Nov 7:15266028231209236. doi: 10.1177/15266028231209236. Online ahead of print.

ABSTRACT

OBJECTIVE: The article aimed to compare the efficiency and safety of atherectomy plus balloon angioplasty (BA) with BA alone for the treatment of infrapopliteal arterial disease.

METHODS: According to the inclusion and exclusion criteria, PubMed, Embase, and Cochrane Library database were searched for studies comparing atherectomy plus angioplasty and angioplasty alone in treating infrapopliteal artery lesions until November 2022. The endpoints included technical success, primary patency, clinically-driven target lesion revascularization (CD-TLR), periprocedural complications, distal embolization, target limb major amputation, and all-cause mortality.

RESULTS: Ten studies met the requirements of our meta-analysis, including 7723 patients in the atherectomy plus BA group and 2299 patients in the BA alone group. The meta-analysis showed that atherectomy plus BA was associated with reduced CD-TLR (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.34, 0.78, p=0.002) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12-month follow-up. No statistically significant difference was found in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. Subgroup analysis found a higher rate of primary patency at 6 and 12 months (6 months: OR: 2.26, 95% CI: 1.11, 4.60, p=0.02; 12 months: OR: 2.38, 95% CI: 1.16, 4.86, p=0.02), and lower rates of CD-TLR (OR: 0.45, 95% CI: 0.25, 0.82, p=0.009) and target limb major amputation (OR: 0.43, 95% CI: 0.19, 1.01, p=0.05) at 12 months in patients treated with atherectomy plus drug-coated balloon (DCB) but not in patients treated with atherectomy plus plain old balloon angioplasty (POBA).

CONCLUSIONS: This meta-analysis suggests that compared with BA alone, atherectomy plus BA may reduce the need for CD-TLR and the incidence of target limb major amputation at 12-month follow-up in the treatment of infrapopliteal artery occlusive lesions, even though there are no significant advantages in technical success, primary patency, periprocedural complications, distal embolization, or all-cause mortality. To go further, atherectomy plus DCB shows significant benefits in primary patency, CD-TLR, and target limb major amputation rate but atherectomy plus POBA does not’. However, due to the limitations of this article, more randomized controlled trials (RCTs) are needed to confirm these conclusions.

CLINICAL IMPACT: According to our research, atherectomy combined with BA has the advantages of higher primary patency rate, lower CD-TLR and target limb significant amputation rate in treating infrapopliteal artery occlusive lesions, which may replace the current mainstream surgical method —BA alone. For the clinician, although the surgery may take longer, it will significantly improve the prognosis and quality of life of patients and hold considerable significance for the management of patients with infrapopliteal arterial disease. Based on the characteristics of infrapopliteal artery disease, this study explored the feasibility of atherectomy combined with BA for infrapopliteal artery disease. Moreover, we found that atherectomy combined with DCB had better clinical efficacy, which should be the innovation of this study.

PMID:37933456 | DOI:10.1177/15266028231209236

Vet Comp Oncol. 2023 Nov 7. doi: 10.1111/vco.12940. Online ahead of print.

ABSTRACT

Quality of life (QOL) in dogs with cancer is a key consideration in the assessment of cancer treatment options. Despite interest in dietary strategies to improve management of oncology patients, there have been very few clinical studies showing the impact of diet on adverse effects of chemotherapy in dogs. This study was a randomised, controlled, double-blinded, multicenter clinical trial to investigate a high-protein, increased-fibre diet supplemented with omega-3 fatty acids, for dogs with cancer undergoing standard-of-care chemotherapy. Client-owned dogs with newly diagnosed grade 2 or higher mast cell tumours (or non-resectable/incompletely resected tumours) or multicentric lymphoma were randomised to receive the test diet (n = 24) or control diet (n = 21) for 8 weeks. Primary outcomes were QOL assessments, faecal scores, and blood concentrations of C-reactive protein and monocyte chemoattractant protein-1. Of 12 QOL parameters, 10 significantly improved from baseline to Week 8 in the test group compared with one in the control group. However, differences between the two groups were only statistically significant for ‘frequency of signs of illness’ (P = .009). There were no significant differences in the incidence of any adverse events, including gastrointestinal adverse events or clinically significant differences in laboratory parameters or faecal scores between the two groups. The absence of an observed negative impact of the test diet, combined with the magnitude of QOL improvements associated with the diet, suggest that a larger trial is warranted.

PMID:37933436 | DOI:10.1111/vco.12940

Nutr Clin Pract. 2023 Nov 6. doi: 10.1002/ncp.11089. Online ahead of print.

ABSTRACT

BACKGROUND: Early recognition of sarcopenia in hemodialysis (HD) patients will be of great importance in preventing adverse outcomes and improving the quality of life in these patients. The main goal of this study was to evaluate the diagnostic accuracy of calf circumference (CC) measurement in detecting sarcopenia among CKD patients undergoing maintenance HD.

METHODS: This cross-sectional study included 52 patients (53 ± 17 years) who were currently in a maintenance HD. Muscle strength was evaluated using handgrip strength, and smooth muscle mass index (SMI) was assessed through bioelectrical impedance analysis, and CC was measured at the widest part of the calf with the foot pressed against a hard surface.

RESULTS: Out of the total patient population, sarcopenia was identified in 32.7% (n = 17). The two groups were comparable in terms of age, weight, and height, but the median body mass index of sarcopenic group was statistically lower than nonsarcopenic group (21.6 kg/m² [18.9-24.6] vs 24.7 kg/m² [21.4-27.3]. The sarcopenic group had a substantially smaller CC than the nonsarcopenic group (30.0 cm [26.5-32.0] vs 31.5 cm [30.3-34.8], P = 0.013; respectively). In the regression analysis, CC was found to be independently associated with post-HD SMI (P < 0.001; odds ratio, 1.938; and 95% CI, 1.020-2.856). CC was positively but weakly correlated with handgrip strength, however strong and significant correlation was found between CC and SMI (r = 0.277, P = 0.047 and r = 0.733, P < 0.001; respectively). A CC of 31 cm or less predicted confirmed sarcopenia in HD patients (area under the curve = 0.709, P = 0.006, specificity = 0.556, sensitivity = 0.765).

CONCLUSIONS: Low muscle mass and potentially low muscle strength in HD patients can be accurately identified through the use of CC measurements. Specifically, a CC measurement below 31 cm has found to be a useful indicator to identify individuals on maintenance HD.

PMID:37933421 | DOI:10.1002/ncp.11089

Clin Oral Implants Res. 2023 Nov 6. doi: 10.1111/clr.14208. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to develop a structured light scanning system with a planar mirror to enhance the digital full-arch implant impression accuracy and compare it with photogrammetry and intraoral scanner methods.

MATERIAL AND METHODS: An edentulous maxillary stone cast with six scan bodies was scanned as the reference using a laboratory scanner. Three scanning modalities were compared (n=10): (1) self-developed structured light scanning with a mirror (SSLS); (2) intraoral scanner (IOS); and (3) photogrammetry system (PG). The scanners were stopped for 1 minute after each scan. Six scan bodies were analyzed within each scan model. Linear deviations between the scan bodies (1-2, 1-3, 1-4, 1-5, and 1-6) and 3D mucosal deviations were established. The overall deviation was calculated as the mean of all linear deviations. “Trueness” represented the discrepancy between the test and reference files, while “precision” denoted the consistency among the test files. Kruskal-Wallis and Mann-Whitney U tests were used for statistical analyses.

RESULTS: Significant overall linear discrepancies were noted among the SSLS, PG, and IOS groups (p<.001). SSLS showed the best overall trueness and precision (6.6, 5.7 μm), followed by PG (58.4, 6.8 μm) and IOS (214.6, 329.1 μm). For the 3D mucosal deviation, the trueness and precision (p<.001) of the SSLS group were significantly better than those of the IOS group.

CONCLUSIONS: The SSLS exhibited higher accuracy in determining the implant positions than the PG and IOS. Additionally, it demonstrated better accuracy in capturing the mucosa than IOS.

PMID:37933413 | DOI:10.1111/clr.14208

Pediatrics. 2023 Nov 7:e2023061305. doi: 10.1542/peds.2023-061305. Online ahead of print.

ABSTRACT

BACKGROUND: Relationships between social drivers of health (SDoH) and pediatric health outcomes are highly complex with substantial inconsistencies in studies examining SDoH and extracorporeal membrane oxygenation (ECMO) outcomes. To add to this literature with emerging novel SDoH measures, and to address calls for institutional accountability, we examined associations between SDoH and pediatric ECMO outcomes.

METHODS: This single-center retrospective cohort study included children (<18 years) supported on ECMO (2012-2021). SDoH included Child Opportunity Index (COI), race, ethnicity, payer, interpreter requirement, urbanicity, and travel-time to hospital. COI is a multidimensional estimation of SDoH incorporating traditional (eg, income) and novel (eg, healthy food access) neighborhood attributes ([range 0-100] higher indicates healthier child development). Outcomes included in-hospital mortality, ECMO run duration, and length of stay (LOS).

RESULTS: 540 children on ECMO (96%) had a calculable COI. In-hospital mortality was 44% with median run duration of 125 hours and ICU LOS 29 days. Overall, 334 (62%) had cardiac disease, 92 (17%) neonatal respiratory failure, 93 (17%) pediatric respiratory failure, and 21 (4%) sepsis. Median COI was 64 (interquartile range 32-81), 323 (60%) had public insurance, 174 (34%) were from underrepresented racial groups, 57 (11%) required interpreters, 270 (54%) had urban residence, and median travel-time was 89 minutes. SDoH including COI were not statistically associated with outcomes in univariate or multivariate analysis.

CONCLUSIONS: We observed no significant difference in pediatric ECMO outcomes according to SDoH. Further research is warranted to better understand drivers of inequitable health outcomes in children, and potential protective mechanisms.

PMID:37933403 | DOI:10.1542/peds.2023-061305

J Clin Exp Dent. 2023 Oct 1;15(10):e842-e849. doi: 10.4317/jced.60340. eCollection 2023 Oct.

ABSTRACT

BACKGROUND: Obesity is a prevalent chronic condition affecting children and adults worldwide, and it seems to influence the timing of tooth eruption. The aim of this study was to assess the as-sociation between weight status at age 12 and the eruption of permanent teeth at ages 12 and 14-15 among schoolchildren from southern Brazil.

MATERIAL AND METHODS: A cross-sectional survey was conducted in Porto Alegre, southern Brazil, and included a representative sample of 1,528 12-year-old schoolchildren. After 2.5 years, 801 individuals were reexamined. Baseline data collection included a questionnaire, the record-ing of anthropometric measures (height and weight), and clinical examination to register the number of erupted permanent teeth. At follow-up, the eruption stage of second perma-nent molars was recorded. Statistical analysis used Poisson regression.

RESULTS: Overweight and obese individuals were 32% and 88% more likely to have com-plete permanent dentition at age 12, respectively (overweight, PR=1.32, 95%CI=1.13-1.55; obese, PR=1.88, 95%CI=1.75-2.02). Obese 12-year-olds were more likely to present erupt-ed #17, #27, #37, and #47 at age 12 and to present completely erupted second molars at age 14-15 than normal weight ones.

CONCLUSIONS: This population-based study found a significant association between over-weight/obesity at age 12 and early tooth eruption at ages 12 and 14-15 among schoolchil-dren from southern Brazil. Key words:Tooth eruption, Obesity, Permanent teeth, Epidemiology.

PMID:37933401 | PMC:PMC10625687 | DOI:10.4317/jced.60340

J Clin Exp Dent. 2023 Oct 1;15(10):e821-e826. doi: 10.4317/jced.60856. eCollection 2023 Oct.

ABSTRACT

BACKGROUND: To evaluate three-dimensionally the upper airway (UA) of class III adults with different facial patterns.

MATERIAL AND METHODS: A cross-sectional study was conducted, in which cone-beam computed tomography (CBCT) images from a private clinic in Viña del Mar, Chile were evaluated. The sample consisted of CBCT images of 59 skeletal class III subjects (33 females and 26 males, mean age 24.7 years) in which the vertical facial pattern was determined using the Vert index, and the minimum cross-sectional area and total volume of the UA were measured. The minimum cross-sectional area variable was analyzed by ANOVA and the total volume was analyzed by Kruskal-Wallis test. Statistical analyses were performed with JASP 0.13.1 software at p=0.05.

RESULTS: The sample included images of 21 brachyfacial, 14 mesofacial and 24 dolichofacial subjects. The mean minimum cross-sectional area of the sample was 591.78 mm2 +/- 149.38 mm2 (minimum=352.00 mm2; maximum=971.00 mm2), being greater in brachyfacial than in dolichofacial and mesofacial subjects, however, these differences were not significant (p=0.147). The mean total volume of the sample was 13.40 +/- 4.69 cm3 (minimum=7.16 cm3; maximum=25.66 cm3), being greater in brachyfacial than in dolichofacial and mesofacial subjects, however, these differences were not significant (p=0.353).

CONCLUSIONS: Considering the limitations of the present study, the vertical facial pattern does not appear to significantly influence upper airway measurements in skeletal class III adults. Key words:Airway, cephalometry, cone-beam computed tomography, facial pattern, malocclusion, Angle class III.

PMID:37933396 | PMC:PMC10625683 | DOI:10.4317/jced.60856

J Clin Exp Dent. 2023 Oct 1;15(10):e835-e841. doi: 10.4317/jced.60980. eCollection 2023 Oct.

ABSTRACT

BACKGROUND: This study evaluates the remineralization potential of enamel after bioactive glass (BAG) air abrasion, using Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy Analysis (SEM-EDS), Electron Probe Microanalysis (EPMA), and Atomic Force Microscopy (AFM).

MATERIAL AND METHODS: Forty extracted human third molars were divided into four groups with ten samples each. Three groups were subjected to a demineralizing solution of 2.2 mM calcium chloride, 2.2 mM monopotassium phosphate, and 0.05 mM acetic acid, adjusted to a pH of 4.4 using 1 M potassium hydroxide at an intraoral temperature of 37°C for 96 hours. Of the three groups, two were subjected to air abrasion with BAG. One of the air abrasion groups was then further remineralized in 1.5 mM calcium chloride, 0.9 mM sodium phosphate, and 0.15 M potassium chloride, adjusted to a pH of 7.0 at 37°C. The teeth were then evaluated via SEM-EDS and EPMA to measure the calcium-to-phosphorous (Ca:P) ratios, and the surface morphology was investigated using AFM.

RESULTS: A measurable decrease in the Ca:P ratio was found after demineralization, which subsequently increased after remineralization. A thin layer of demineralized enamel was removed by the BAG air abrasion. AFM image analysis showed the presence of pits on the surface, which decreased in depth after demineralization, and further after BAG abrasion. Remineralized samples, in contrast, showed a slight increase in pit depth. While the observation of remineralization was statistically significant throughout our study, we could not find any evidence for BAG retention on the surface of the enamel.

CONCLUSIONS: It is demonstrated that BAG, when delivered via air abrasion, indeed contributes to remineralization of the enamel; however, it does not seem to be a direct result of the presence of retained glass beads on the enamel surface. Given the increase of the Ca:P ratio after remineralization, a possible therapeutic benefit was observed, potentially reducing the probability of fractures in weakened enamel. Key words:Enamel, Demineralization, Remineralization, White Spot Lesions, Bioactive Glass, Air Abrasion, Energy Dispersive X-ray Spectroscopy, Electron Probe Microanalysis, Atomic Force Microscopy, Ca:P ratio, surface morphology.

PMID:37933395 | PMC:PMC10625686 | DOI:10.4317/jced.60980

Orphanet J Rare Dis. 2023 Nov 6;18(1):346. doi: 10.1186/s13023-023-02965-2.

ABSTRACT

BACKGROUND: Little is known about employment status, occupation, and disposable income in adults with NF1.

METHODS: From the Danish National Patient Registry and database of two national Centers for Rare Diseases, we identified 1469 adults with NF1, who were matched to 11,991 randomly selected population comparisons on sex and birth year and month. Annual information on employment, occupation and disposable income was ascertained from national registries in 1980-2019.

RESULTS: Adults with NF1 had a lower odds ratio (OR) for employment [OR 0.71, 95% confidence interval (CI) 0.61-0.83] and higher OR for health-related unemployment (OR 2.94, 95% CI 2.16-3.96) at age 30 years than population comparisons, which persisted at age 40 and 50 years. Somatic diagnoses were associated with a higher OR for health-related unemployment in adults with NF1 than in the population comparisons. Adults with NF1 had a slightly lower disposable income, with a 14% (0.82-0.89) reduction observed among the youngest birth cohort. Furthermore, adults with NF1 were less likely to be in a high skilled occupation at ages 30, 40 and 50 years.

CONCLUSION: Adults with NF1 have a lower employment rate, which was mainly due to health-related reasons and a slightly lower disposable income than adults without NF1. Thus, anticipation guidance for employment should be part of the management of NF1 families.

PMID:37932779 | DOI:10.1186/s13023-023-02965-2

Subst Abuse Treat Prev Policy. 2023 Nov 6;18(1):64. doi: 10.1186/s13011-023-00577-4.

ABSTRACT

BACKGROUND: Opioid-related overdose deaths remain a common cause of death in many settings, and opioid maintenance treatment is evidence-based for the treatment of opioid use disorders. However, access to such treatment varies and is limited in many settings.

METHODS: The present study examines the longitudinal effects of a regional patient choice reform which substantially increased availability to opioid maintenance treatment in one Swedish county, starting from 2014. A previous follow-up, limited in time, indicated a possible effect on mortality from this intervention, demonstrating a lower increase in overdose deaths than in counties without this reform. The present study follows overdose deaths through 2021, and compares the intervention county to the remaining parts in the country, using death certificate statistics from the national causes of death register.

RESULTS: The present study does not demonstrate any significant difference in the development of overdose mortality in the county where this reform substantially expanded treatment access, compared to other counties in the country.

CONCLUSIONS: The study underlines the importance to maintain extensive efforts against overdose deaths over and above the treatment of opioid use disorders, such as low-threshold provision of opioid antidotes or other interventions specifically addressing overdose risk behaviors.

PMID:37932776 | DOI:10.1186/s13011-023-00577-4