Tag: pubmed

Spine J. 2023 Sep 1:S1529-9430(23)03365-X. doi: 10.1016/j.spinee.2023.08.019. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is the leading surgical treatment for cervical radiculopathy. However, ACDF surgery has been suggested for to accelerate the degeneration of the adjacent cervical discs, which causes so-called adjacent segment disease (ASD). Over the past two decades, total disc replacement (TDR)/cervical disc arthroplasty (CDA) has become an increasingly common method for treating degenerative cervical diseases. The rationale is that a synthetic disc prosthesis may preserve motion at the operated level, which is expected to lead to reduced stress on the other cervical levels and thus decrease the risk of developing ASD. However, since the method was first introduced in the early 2000s, the long-term outcome after it is still not completely understood.

PURPOSE: Our goal was to compare the long-term outcomes of TDR and ACDF procedures.

STUDY DESIGN: Retrospective case-control study.

PATIENT SAMPLE: All patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 (38 patients) and matched control patients who underwent ACDF during this period (76 patients) for degenerative disc disease.

OUTCOME MEASURES: The primary outcome measure was the rate of reoperations and further cervical surgeries. Secondary outcome measures included neck symptoms (Neck Disability Index, or NDI), health-related quality of life (EQ-5D-3L), satisfaction with the surgery, radiological outcomes, and employment status.

METHODS: The medical records of all patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 and those of the matched control patients were analyzed retrospectively. Questionnaires were sent to all available patients at the end of the follow-up (median 14 years) to evaluate their employment status, levels of satisfaction with the surgery, current neck symptoms, and health-related quality of life. Radiological outcomes were evaluated from the cervical plain radiographs, which were taken either at the end of the follow-up as a part of the present study or earlier on for other clinical reasons, but at least two years after index surgery.

RESULTS: The total rate of reoperations and further cervical surgeries during the follow-up of a median of 14 years was 7/38 (18%) in the TDR group and 6/76 (8%) in the ACDF group (p = 0.096, ns.). TDR patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group (11% vs. 1.3%, p=0.026). None of the TDR patients underwent further cervical surgery more than six years after index surgery, whereas 5/6 (83%) of the reoperated ACDF patients were reoperated after that time. There were no significant differences in the NDIs between the patient groups. The employment rate and health-related quality of life were slightly higher in the TDR group, but the differences were statistically non-significant. TDR was significantly better at maintaining the angular range of motion at the operated level, and the fusion rate was significantly lower among this group.

CONCLUSIONS: There were no significant differences in the long-term outcomes of ACDF and TDR when measured by reoperation rates, employment status, NDI, EuroQoL, and satisfaction with surgery. Reoperation rate and, on the other hand, employment rate and health-related quality of life, were higher in the TDR group, but the differences were statistically non-significant. However, TDR patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group. Randomized long-term studies in which these methods are compared are needed to further clarify the differences between them.

PMID:37660896 | DOI:10.1016/j.spinee.2023.08.019

Spine J. 2023 Sep 1:S1529-9430(23)03370-3. doi: 10.1016/j.spinee.2023.08.020. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: In contrast to cervical discectomy and fusion, total disc replacement (TDR) aims at preserving the motion at the treated vertebral level. Spinal motion is commonly evaluated with the range of motion (ROM). However, more qualitative information about cervical kinematics before and after TDR is still lacking.

PURPOSE: The aim of this in vitro study was to investigate the influence of cervical TDR on ROM, instantaneous centers of rotation (ICR) and three-dimensional helical axes.

STUDY DESIGN: An in vitro study with human spine specimens under pure moment loading was conducted to evaluate the kinematics of the intact cervical spine and compare it to cervical TDR.

METHODS: Six fresh frozen human cervical specimens (C4-5, median age 28 years, range 19-47 years, two female and four male) were biomechanically characterized in the intact state and after implantation of a cervical disc prosthesis (MOVE-C, NGMedical, Germany). To mimic in vivo conditions regarding temperature and humidity, water steam was used to create a warm and humid test environment with 37°C. Each specimen was quasistatically loaded with pure moments up to ±2.5 Nm in flexion/extension (FE), lateral bending (LB) and axial rotation (AR) in a universal spine tester for 3.5 cycles at 1 °/s. For each third cycle of motion the ROM was evaluated and an established method was used to determine the helical axis and COR and to project them into three planar X-rays. Statistical analysis was conducted using a Friedman-test and post hoc correction with Dunn-Bonferroni-tests (p < 0.05).

RESULTS: After TDR, total ROM was increased in FE from 19.1° to 20.1°, decreased in LB from 14.6° to 12.6° and decreased in AR from 17.7° to 15.5°. No statistical differences between the primary ROM in the intact condition and ROM after TDR were detected. Coupled rotation between LB and AR were also maintained. The position and orientation of the helical axes after cervical TDR was in good agreement with the results of the intact specimens in all three motion directions. The ICR in FE and AR before and after TDR closely matched, while in LB the ICR after TDR were more caudal. The intact in vitro kinematics we found also resembled in vivo results of healthy individuals.

CONCLUSION: The results of this in vitro study highlight the potential of artificial cervical disc implants to replicate the quantity as well as the quality of motion of the intact cervical spine.

CLINICAL SIGNIFICANCE: Physiological motion preservation was a driving factor in the development of cervical TDR. Our results demonstrate the potential of cervical TDR to replicate in vivo kinematics in all three motion directions.

PMID:37660895 | DOI:10.1016/j.spinee.2023.08.020

Spine J. 2023 Sep 1:S1529-9430(23)03363-6. doi: 10.1016/j.spinee.2023.08.018. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is a commonly-performed and generally well-tolerated procedure used to treat cervical disc herniation. Rarely, patients require discharge to inpatient rehab, leading to inconvenience for the patient and increased healthcare expenditure for the medical system.

PURPOSE: The objective of this study was to create an accurate and practical predictive model for, as well as delineate associated factors with, rehab discharge following elective ACDF.

STUDY DESIGN: This was a retrospective, single-center, cohort study.

PATIENT SAMPLE: Patients who underwent ACDF between 2012 and 2022 were included. Those with confounding diagnoses or who underwent concurrent, staged, or non-elective procedures were excluded.

OUTCOME MEASURES: Primary outcomes for this study included measurements of accuracy for predicting rehab discharge. Secondary outcomes included associations of variables with rehab discharge.

METHODS: Current Procedural Terminology codes identified patients. Charts were reviewed to obtain additional demographic and clinical characteristics on which an initial univariate analysis was performed. Two logistic regression and two machine learning models were trained and evaluated on the data using cross validation. A multimodel logistic regression was implemented to analyze independent variable associations with rehab discharge.

RESULTS: 466 patients were included in the study. The logistic regression model with minimum corrected Akaike information criterion score performed best overall, with the highest values for area under the receiver operating characteristic curve (0.83), Youden’s J statistic (0.71), balanced accuracy (85.7%), sensitivity (90.3%), and positive predictive value (38.5%). Rehab discharge was associated with a modified frailty index of 2 (p = 0.007), lack of home support (p = 0.002), and having Medicare or Medicaid insurance (p = 0.007) after correction for multiple hypotheses.

CONCLUSIONS: Non-medical social determinants of health, such as having public insurance or a lack of support at home, may play a role in rehab discharge following elective ACDF. In combination with the modified frailty index and other variables, these factors can be used to predict rehab discharge with high accuracy, improving the patient experience and reducing healthcare costs.

PMID:37660894 | DOI:10.1016/j.spinee.2023.08.018

J Shoulder Elbow Surg. 2023 Sep 1:S1058-2746(23)00639-0. doi: 10.1016/j.jse.2023.07.039. Online ahead of print.

ABSTRACT

BACKGROUND: Anatomic and reverse total shoulder arthroplasty (aTSA, rTSA) are well-established treatments for patients with primary osteoarthritis and an intact cuff. However, it is unclear whether aTSA or rTSA provide superior outcomes in patients with preoperative external rotation (ER) weakness.

METHODS: A retrospective review of a prospectively collected shoulder arthroplasty database was performed between 2007-2020. Patients were excluded for preoperative diagnoses of nerve injury, infection, tumor, or fracture. Analysis included 333 aTSAs and 155 rTSAs performed for primary cuff-intact osteoarthritis with 2-year minimum follow-up. Defining preoperative ER weakness as strength ≤7.2 pounds, 3 cohorts were created and matched: 1) weak aTSAs (n = 74) vs normal aTSAs (n = 74), 2) weak rTSAs (n = 38) vs normal rTSAs (n = 38), and 3) weak rTSAs (n = 60) vs weak aTSAs (n = 60). We compared ROM, outcome scores, strength, complications, and revision rates at latest follow-up.

RESULTS: Despite weak aTSAs having poorer preoperative strength in FE and ER (P<.001), neither of these deficits persisted postoperatively compared to the normal cohort. Likewise, weak rTSAs had poorer preoperative strength in FE and ER, overhead motion, and Constant, SPADI, and UCLA scores (P<.029). However, no statistically significant differences were found between preoperatively weak and normal rTSAs. When comparing weak aTSA versus weak rTSA, no differences were found in preoperative and postoperative outcomes, proportion of patients achieving the MCID and SCB, and complication and rate of revision surgery.

CONCLUSION: In preoperatively weak patients with cuff-intact primary osteoarthritis, aTSA leads to similar postoperative strength, ROM, and outcome scores compared to patients with normal preoperative strength, indicating preoperative weakness does not preclude aTSA use. Furthermore, patients who were preoperatively weak in ER demonstrated improved postoperative rotational motion after undergoing aTSA and rTSA, with both groups achieving the MCID and SCB at similar rates.

PMID:37660887 | DOI:10.1016/j.jse.2023.07.039

J Dent. 2023 Sep 1:104684. doi: 10.1016/j.jdent.2023.104684. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to verify the non-inferiority of Endocem MTA Premixed and Well-Root PT, compared with ProRoot MTA in the pulpotomy of primary molars. In addition, we tried to determine the factors that affect the prognosis of pulpotomy in primary molars.

METHODS: This randomized clinical trial enrolled 158 molars of 52 children; 153 teeth were finally included and divided into three groups: ProRoot MTA (n = 50), Endocem MTA Premixed (n = 53), and Well-Root PT (n = 50). Clinical and radiographic follow-up was performed at 3, 6, and 12 months postoperatively and at the last visit post-treatment. Data were analyzed using the Fisher’s exact test, Cox regression analysis, and the Kaplan-Meier survival curve method.

RESULTS: The success rates in the ProRoot MTA, Endocem MTA Premixed, and Well-Root PT were 92%, 84.9, and 82%, respectively. The cumulative survival rates did not differ significantly among the materials. Among the investigated variables, only ΔF and ΔF max significantly affected the success rates. In the multivariate survival tree model, significant unfavorable survival was observed when the ΔF value was -14.4 or less (hazard ratio, 7.56; P = 0.0295).

CONCLUSIONS: Considering the clinical effectiveness of Endocem MTA Premixed and Well-Root PT and the operational convenience as a premixed type, they can be used as advantageous materials in the pulpotomy of primary molars in pediatric patients. The QLF method is a useful diagnostic method that can establish treatment plans and determine the prognosis of pulpotomy based on the ΔF value in primary molars.

CLINICAL SIGNIFICANCE: Endocem MTA Premixed and Well-Root PT can confer high success rates and are non-inferior to ProRoot MTA in pulpotomy for primary molars. We also showed that QLF technology can be applied to predict the success/failure and prognosis of pulpotomies in primary molars.

PMID:37660882 | DOI:10.1016/j.jdent.2023.104684

Environ Res. 2023 Sep 1:117062. doi: 10.1016/j.envres.2023.117062. Online ahead of print.

ABSTRACT

Psoriasis is one of the most common immune-mediated inflammatory diseases (IMIDs). Living in a rural environment during childhood is associated with a decreased risk of certain IMIDs, like asthma, in adulthood. However, its role in other IMIDs, such as psoriasis is still unclear. To evaluate the relationships between different factors related to the environment during childhood and the risk of psoriasis in adulthood we conducted a study in E3N, a French prospective cohort composed of 98 995 women. During the 1990-2018 follow-up of 72 154 study participants, we identified 1967 incident cases of psoriasis from self-reports in self-administered structured questionnaires. During the 2004-2018 follow-up of 67 917 study participants, 188 moderate-to-severe cases of psoriasis were identified through self-reports and from data from a drug reimbursement database. We fitted Cox proportional hazards regression models with age as the time scale and adjusted for putative confounders (aHRs). We found inverse associations with risk of psoriasis for rural birthplace [aHR: 0.89 (95%CI: 0.79-0.96)] and for having farming parents [aHR: 0.84 (95%CI: 0.72-0.97)]. For moderate-to-severe psoriasis we found a nominally similar inverse association with rural birthplace but not with having farming parents. Our results suggest that an exposure to a rural environment during childhood may be associated with a reduced risk of psoriasis. These findings may help to improve our understanding of the pathogenesis of psoriasis.

PMID:37660877 | DOI:10.1016/j.envres.2023.117062

Sci Total Environ. 2023 Sep 1:166780. doi: 10.1016/j.scitotenv.2023.166780. Online ahead of print.

ABSTRACT

BACKGROUND: Growing studies have focused on the effects of ambient air pollution on thyroid hormones (THs), but the results were controversial. Therefore, a systematic review and meta-analysis was conducted by pooling current evidence on this association.

METHODS: Four databases were searched for studies examining the associations of particulate matter [diameter ≤10 μm (PM₁₀) or ≤2.5 μm (PM_2.5)] and gaseous [sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), carbon monoxide (CO)] pollutants with THs levels. Random effects models were used to pool the changes in THs levels with increasing air pollutant concentrations. Subgroup analyses were constructed by region, design, sample size, pollutant concentrations, evaluated methods, and potential risk exposure windows.

RESULTS: A total of 14 studies covering 357,226 participants were included in this meta-analysis. The pooled results showed significant associations of exposure to PM_2.5, PM₁₀, NO₂, SO₂, and CO with decreases in free thyroxine (FT4) with percent changes (PC) ranging from -0.593 % to -3.925 %. PM_2.5, NO₂, and CO were negatively associated with levels of FT4/FT3 (PC: from -0.604 % to -2.975 %). In addition, results showed significant associations of PM_2.5 with hypothyroxinemia and high thyroid-stimulating hormone (TSH). Subgroup analyses indicated that PM_2.5 and NO₂ were significantly associated with FT4 in studies of Chinese, and similar significant findings were found in studies of PM_2.5 and FT4/FT3 in areas with higher concentrations of air pollutants and larger samples. PM_2.5 exposure in the first trimester was found to be associated with lower FT4 levels in pregnant women.

CONCLUSION: Our findings suggest that exposure to air pollution is associated with changes in THs levels. Enhanced management of highly polluted areas, identification of harmful components and sources of PM, and protection from harmful exposures in early pregnancy may be of great public health importance for the population’s thyroid function.

PMID:37660827 | DOI:10.1016/j.scitotenv.2023.166780

Gynecol Oncol. 2023 Sep 1;177:117-124. doi: 10.1016/j.ygyno.2023.08.013. Online ahead of print.

ABSTRACT

OBJECTIVE: In 2014, the World Health Organization introduced a new histologic classification by dividing primary mucinous ovarian carcinoma (PMOC) into two: expansile (ES) or infiltrative subtypes (IS). This study investigated the clinical implications of these histological subtypes on survival outcomes.

METHODS: Data from 131 patients with PMOC who underwent primary surgery between 2003 and 2021 were analyzed. The patients baseline characteristics, surgical and pathological information were collected. Survival outcomes were calculated, while factors affecting them were also investigated.

RESULTS: During 55.9 months of median follow-up, 27 (20.6%) patients experienced recurrence and 20 (15.3%) died. Among 131 patients, 113 patients were classified into 87 (77%) ES and 26 (23%) IS after a slide review. Advanced stage, lymph node involvement, and residual tumors after surgery were more common in the IS, showing poorer prognosis. In multivariate analyses, advanced stage and residual tumors after surgery were associated with worse survival, while the IS showed no statistical significance. In subgroup analysis for stage I disease, survival did not vary between subtypes. Nevertheless, patients in the IS group who underwent fertility-sparing surgeries demonstrated a 5-year progression-free survival (PFS) rate of 83.3%, significantly lower than patients without fertility preservation, irrespective of histologic subtypes (5-year PFS rate: 97.9%; P = 0.002 for the ES, 5-year PFS rate: 100%; P = 0.001 for the IS).

CONCLUSIONS: The IS of PMOC had poorer survival outcomes and a higher proportion of advanced-stage tumors. Although its independent prognostic significance remains uncertain, adjuvant chemotherapy should be considered for patients with fertility preservation in the IS group.

PMID:37660413 | DOI:10.1016/j.ygyno.2023.08.013

Br J Radiol. 2023 Sep 3:20220598. doi: 10.1259/bjr.20220598. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study is to present the clinical and imaging findings of 16 patients with intraventricular pilocytic astrocytomas.

METHODS: Sixteen patients with histopathological diagnosis of intraventricular pilocytic astrocytoma between February 2016 and January 2022 were evaluated retrospectively. Imaging and clinical findings of the patients, as well as ADC measurements were analyzed.

RESULTS: Of 16 patients, 8 (%50) were male and 8 (%50) were female. The mean age of the patients was 20,8 years (2-44 years range). The most common symptoms in the patients were headache and ataxia. The mean long-axis size of lesions was found to be 48.19 ± 21.59 (range, 15-92 mm). Nine out of 16 lesions (56.2%) were located in the fourth ventricle. The majority of the lesions were iso-hypointense in T1W and hyperintense in T2W images. The mean ADC value of PAs was 1.57 × 10^-3±0.2 mm²/s, while the mean thalamic ADC and white matter ADC values were found to be 0.78 × 10-3±0.04 mm² and s 0.76 × 10-3±0.06 mm² / s, respectively. There was a statistically significant difference between the ADC values obtained from the solid components of the lesions and the thalami/white matter (p < 0.001).

CONCLUSIONS: PAs often originate from midline structures, however, they can also be located intraventricularly. Although intraventricular pilocytic astrocytomas are frequently seen in pediatric population, it should be kept in mind that they can also be seen in adults, albeit rarely.

ADVANCES IN KNOWLEDGE: PA should be considered in the differential diagnosis of intraventricular neoplasms in case of high ADC values.

PMID:37660368 | DOI:10.1259/bjr.20220598

Int J Dent Hyg. 2023 Sep 3. doi: 10.1111/idh.12727. Online ahead of print.

ABSTRACT

OBJECTIVES: Learning styles have been studied in dental and generational research, but research has been limited with Millennial and Generation Z dental hygiene students. The purpose of this quantitative comparative study was to determine if and to what extent there was a difference between Generation Z and Millennial dental hygiene students’ preferred learning styles.

METHODS: First- and second-year dental hygiene students attending three programs located in Southern California were invited to participate in the study. Additional participants were recruited through dental hygiene social media sites. The 44 item Felder-Soloman Index of Learning Styles (ILS) was administered via an online survey platform. Millennial and Generation Z participants were compared on the four dimensions of the ILS: active/reflective, sensing/intuitive, visual/verbal, and sequential/global. The data were analysed using descriptive statistics and the independent samples t-test.

RESULTS: A total of 150 dental hygiene students agreed to participate; Millennials (n = 61), Generation Z (n = 89). There was no significant difference between Millennial and Generation Z students in the active/reflective, sensing/intuitive, or sequential/global dimensions (p > 0.05); both cohorts preferred the active, sensing, and sequential learning styles. There was a statistically significant difference in the visual/verbal dimension with Millennials indicating a significantly greater preference for the visual learning style than Generation Z (p = 0.04).

CONCLUSION: There may be differences between the learning styles of Millennial and Generation Z dental hygiene students. The finding that Generation Z students differ significantly from Millennials on the visual-verbal dimension may indicate a shift toward the verbal dimension learning style that needs further study.

PMID:37660363 | DOI:10.1111/idh.12727