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The effect of 9-mo of formulated whole egg or milk powder food products as meal/snack replacements on executive function in preadolescents: A randomized placebo controlled trial

Am J Clin Nutr. 2022 Sep 29:nqac281. doi: 10.1093/ajcn/nqac281. Online ahead of print.

ABSTRACT

BACKGROUND: Elevated brain choline is associated with better executive function in preadolescents. Manipulating dietary choline prospectively in preadolescents using egg supplementation could improve executive function via effects on brain cellular and neurotransmitter function.

OBJECTIVE: Test the 9-mo impact of egg supplementation on executive function. It was hypothesized that preadolescents who consumed meal/snack replacement products containing powder made from whole eggs would have the largest improvement in executive function after 9-mo compared to those consuming similar products with either added milk powder or gelatin as a placebo.

METHODS: A randomized, parallel groups, double-blinded, placebo-controlled trial design was used. The executive function of 122 preadolescents (58 females) aged 9-13 was analyzed before and after the 9-mo intervention. Primary outcomes were three National Institutes of Health Toolbox-Cognitive Battery measures of executive function: mental flexibility, working memory and selective attention/inhibitory control. Participants were randomized to consume food products with either: (i) whole egg powder, (ii) milk powder, or (iii) gelatin as a placebo, all matched on macronutrient content and used as replacements for commonly consumed foods (i.e., waffles, pancakes, macaroni and cheese, ice cream, and brownies). Hypothesis testing used mixed-effects models that included physical activity and sleep scores as covariates.

RESULTS: A statistically significant group by time interaction for selective attention and inhibitory control was found (p=0.049) for the milk group. This interaction resulted from no change for the placebo group and an improvement in selective attention and inhibitory control performance for the milk group by a T-score of 5.8; the effect size d was 0.44 standard deviation units. Other comparisons were statistically insignificant.

CONCLUSIONS: Consumption of foods with added milk powder as replacements for snacks or meals for 9-mo improves selective attention/inhibitory control in preadolescents. Replacement foods with added whole egg powder does not impact the 9-mo change in preadolescent executive function.This trial was registered at clinicaltrials.gov as NCT03739424.

PMID:36173384 | DOI:10.1093/ajcn/nqac281

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Which whitening toothpaste with different contents is more effective on color and bond strength of enamel?

J Esthet Restor Dent. 2022 Sep 29. doi: 10.1111/jerd.12968. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effects of six whitening toothpastes with different whitening ingredients as follows: abrasives, polyphosphates, activated charcoal and hydrogen peroxide on the color, and shear bond strength (SBS) of enamel.

MATERIALS AND METHODS: Thirty-five extracted human molars were sectioned in mesiodistal direction, providing 70 enamel specimens and randomly divided into seven groups having different whitening ingredients (n = 10). After baseline color measurements, the specimens were brushed three times daily for the 30 s. At the end of 2 weeks, spectrophotometric readings were repeated, and color change parameters were calculated. Then, composite cylinders were built on the enamel surfaces and the specimens were subjected to SBS test. Failure modes were determined under a stereomicroscope (×10). One specimen from each group was examined with scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis, Wilcoxon signed, one-way-ANOVA (p = 0.05).

RESULTS: Clinically acceptable color change was observed in all whitening toothpastes. There were no significant differences among the groups for Δa, ΔL, ΔE00 , and ΔWID (p > 0.05). The differences among the groups were not significant regarding SBS and failure mode distributions (p > 0.05). SEM findings were in line with the SBS test and failure mode distribution results.

CONCLUSIONS: All the tested whitening toothpastes showed similar and clinically acceptable efficacy on the color change of the enamel and led to comparable SBS values.

CLINICAL SIGNIFICANCE: The tested whitening toothpastes had an acceptable whitening efficacy and did not have a negative effect on the bond strength to the enamel.

PMID:36173366 | DOI:10.1111/jerd.12968

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Reliability and Value of 3D Sequential QUantitative T1 -T2 -T2 * MAppings (SQUMA) MR Multi-Parametric Imaging in Characterizing Carotid Artery Atherosclerosis

J Magn Reson Imaging. 2022 Sep 29. doi: 10.1002/jmri.28445. Online ahead of print.

ABSTRACT

BACKGROUND: T1 , T2 , and T2 * mappings are seldom performed in a single examination, and their values in evaluating symptomatic atherosclerosis are lacking.

PURPOSE: To perform three-dimensional (3D) quantitative T1 , T2 , and T2 * mappings (SQUMA) multi-parametric imaging for carotid vessel wall and evaluate its reliability and value in assessing carotid atherosclerosis.

STUDY TYPE: Prospective.

SUBJECTS: Eight healthy subjects and 20 patients with symptomatic carotid atherosclerosis.

FIELD STRENGTH/SEQUENCE: 3 T, SQUMA imaging T1 -, T2 -, and T2 *-mapping, multi-contrast vessel wall imaging including T1 – and T2 -weighted, time-of-flight, and SNAP sequences.

ASSESSMENT: SQUMA was acquired in all subjects and multi-contrast images were acquired in healthy subjects. T1 , T2 , and T2 * values and lumen area (LA), wall area (WA), mean wall thickness (MeanWT), and normalized wall index (NWI) of carotid arteries were measured. SQUMA and multi-contrast measurements were compared in healthy subjects and differences in SQUMA measurements between healthy subjects and patients were assessed. The discriminative value of SQUMA measurements for symptomatic vessel was determined.

STATISTICAL TESTS: Paired t or Wilcoxon signed-rank test, independent t or Mann-Whitney U test, area under the receiver operating characteristic curve (AUC), intraclass correlation coefficients, and Bland-Altman plots. Statistically significant level, P < 0.05.

RESULTS: There were no significant differences in LA (P = 0.340), WA (P = 0.317), MeanWT (P = 0.088), and NWI (P = 0.091) of carotid arteries between SQUMA and multi-contrast vessel wall images. The values of T2 (50.9 ± 2.9 msec vs. 44.5 ± 4.2 msec), T2 * (28.2 ± 4.3 msec vs. 24.7 ± 2.6 msec), WA (23.7 ± 4.6 mm2 vs. 36.2 ± 7.7 mm2 ), MeanWT (0.99 ± 0.05 mm vs. 1.50 ± 0.28 mm), and NWI (40.7 ± 3.0% vs. 53.8 ± 5.4%) of carotid arteries in healthy subjects were significantly different from those in atherosclerotic patients. The combination of quantitative T1 , T2 , and T2 * values and MeanWT showed greatest AUC (0.81; 95% CI: 0.65-0.92) in discriminating symptomatic vessels.

DATA CONCLUSION: Carotid MR 3D quantitative multi-parametric imaging of SQUMA enables acquisition of T1 , T2 , and T2 * maps, reliably measuring carotid morphology and discriminating carotid symptomatic atherosclerosis.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

PMID:36173363 | DOI:10.1002/jmri.28445

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Evaluation of the Relationship Between Head Trauma and Attention-Deficit/Hyperactivity Disorder in Primary School Children Admitted to the Emergency Department

Pediatr Emerg Care. 2022 Sep 30. doi: 10.1097/PEC.0000000000002854. Online ahead of print.

ABSTRACT

OBJECTIVE: Head trauma causes a significant number of deaths as well as temporary and permanent disabilities every year. In this study, the prevalence of attention-deficit/hyperactivity disorder (ADHD) in primary school children who visited the emergency department (ED) for mild head trauma and the role of ADHD in mild head trauma of this age group were investigated.

METHODS: It was performed with 134 children of primary school age (6-12 years) who were admitted to the ED with mild head trauma and 134 children (control group) who presented with complaints other than head trauma. Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was used to evaluate the children for suspected ADHD. According to this scale, some children were referred to the child and adolescent psychiatry department (CAPD) for further evaluation. At the CAPD outpatient clinics, the children who were referred from the ED were examined in detail according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for possible diagnosis of ADHD. After evaluation of their sociodemographic characteristics and the ADHD test scores that were recorded, the diagnosis of ADHD in these children was established or ruled out.

RESULTS: It was observed that 41 of the 134 children (30.60%) who presented to the ED with mild head trauma and 12 of the 134 children (8.96%) in the control group were diagnosed with ADHD (P = 0.0001). When ADHD is corrected for sex, 29 of the 41 cases (70.7%) diagnosed with ADHD were boys and 12 (29.3%) were girls (P = 0.000). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, when the patients who had been diagnosed with ADHD were grouped according to the ages of the children, no statistically significant difference was found between the groups in terms of ADHD (P = 0.097).

CONCLUSIONS: The prevalence of ADHD has been found to be higher in children of primary school age who present to the ED with mild head trauma. Hence, it can be deduced that the diagnosis of childhood ADHD increases the risk of presenting to the ED with head trauma. We believe that it is very important to keep the possible diagnosis of ADHD in mind and to refer that cases to the CAPD in case of high clinical suspicion, especially in primary school boys who are admitted to the ED with mild head trauma. We believe that in this way, morbidity and mortality due to head trauma in this age group can be significantly reduced.

PMID:36173338 | DOI:10.1097/PEC.0000000000002854

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Impact of Brazil’s Bolsa Família Programme on cardiovascular and all-cause mortality: a natural experiment study using the 100 Million Brazilian Cohort

Int J Epidemiol. 2022 Sep 28:dyac188. doi: 10.1093/ije/dyac188. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular disease (CVD) has a disproportionate effect on mortality among the poorest people. We assessed the impact on CVD and all-cause mortality of the world’s largest conditional cash transfer, Brazil’s Bolsa Família Programme (BFP).

METHODS: We linked administrative data from the 100 Million Brazilian Cohort with BFP receipt and national mortality data. We followed individuals who applied for BFP between 1 January 2011 and 31 December 2015, until 31 December 2015. We used marginal structural models to estimate the effect of BFP on all-age and premature (30-69 years) CVD and all-cause mortality. We conducted stratified analyses by levels of material deprivation and access to healthcare. We checked the robustness of our findings by restricting the analysis to municipalities with better mortality data and by using alternative statistical methods.

RESULTS: We studied 17 981 582 individuals, of whom 4 855 324 were aged 30-69 years. Three-quarters (76.2%) received BFP, with a mean follow-up post-award of 2.6 years. We detected 106 807 deaths by all causes, of which 60 893 were premature; and 23 389 CVD deaths, of which 15 292 were premature. BFP was associated with reductions in premature all-cause mortality [hazard ratio (HR) = 0.96, 95% CI = 0.94-0.98], premature CVD (HR = 0.96, 95% CI = 0.92-1.00) and all-age CVD (HR = 0.96, 95% CI = 0.93-1.00) but not all-age all-cause mortality (HR = 1.00, 95% CI = 0.98-1.02). In stratified and robustness analyses, BFP was consistently associated with mortality reductions for individuals living in the two most deprived quintiles.

CONCLUSIONS: BFP appears to have a small to null effect on premature CVD and all-cause mortality in the short term; the long-term impact remains unknown.

PMID:36172959 | DOI:10.1093/ije/dyac188

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Procedural Safety Comparison Between Transcarotid Artery Revascularization, Carotid Endarterectomy, and Carotid Stenting: Perioperative and 1-Year Rates of Stroke or Death

J Am Heart Assoc. 2022 Sep 29:e024964. doi: 10.1161/JAHA.121.024964. Online ahead of print.

ABSTRACT

Background Transcarotid artery revascularization (TCAR) was approved by the Food and Drug Administration in 2015 for patients with carotid artery stenosis. However, no randomized trial to evaluate TCAR has been performed to date, and previous reports have important limitations. Accordingly, we measured stroke or death after TCAR compared with carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Methods and Results We used the Vascular Quality Initiative registry to study patients who underwent TCAR, CEA, or TF-CAS from September 2016 to June 2021. Our primary outcomes were perioperative and 1-year stroke or death. We used logistic regression for risk adjustment for perioperative outcomes and Cox regression for risk adjustment for 1-year outcomes. We used a 2-stage residual inclusion instrumental variable (IV) method to adjust for selection bias and other unmeasured confounding. Our instrument was a center’s preference to perform TCAR versus CEA or TF-CAS. We performed a subgroup analysis stratified by presenting neurologic symptoms. We studied 21 234 patients who underwent TCAR, 82 737 who underwent CEA, and 14 595 who underwent TF-CAS across 662 centers. The perioperative rate of stroke or death was 2.0% for TCAR, 1.7% for CEA, and 3.7% for TF-CAS (P<0.001). Compared with TCAR, the IV-adjusted odds ratio of perioperative stroke or death for CEA was 0.74 (95% CI, 0.55-0.99) and for TF-CAS was 1.66 (95% CI, 0.99-2.79). Results were similar among both symptomatic and asymptomatic patients. The 1-year rate of stroke or death was 6.4% for TCAR, 5.2% for CEA, and 9.7% for TF-CAS (P<0.001). Compared with TCAR, the IV-adjusted hazard ratio of 1 year stroke or death for CEA was 0.97 (95% CI, 0.80-1.17), and for TF-CAS was 1.45 (95% CI, 1.04-2.02). IV analysis further demonstrated that symptomatic patients with carotid stenosis had the lowest 1-year likelihood of stroke or death with TCAR (compared with TCAR, symptomatic IV-adjusted hazard ratio for CEA: 1.30 [95% CI, 1.04-1.64], and TF-CAS: 1.86 [95% CI, 1.27-2.71]). Conclusions Perioperative stroke or death was greater following TCAR when compared with CEA. However, at 1 year there was no statistically significant difference in stroke or death between the 2 procedures. TCAR performed favorably compared with TF-CAS at both time points. Although CEA remains the gold standard procedure for patients with carotid stenosis, TCAR appears to be a safe alternative to CEA and TF-CAS when used selectively and may be useful when treating symptomatic patients.

PMID:36172943 | DOI:10.1161/JAHA.121.024964

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Prevalence, clinical presentation and MRI of intervertebral disc herniations in cats

J Feline Med Surg. 2022 Sep 29:1098612X221121893. doi: 10.1177/1098612X221121893. Online ahead of print.

ABSTRACT

OBJECTIVES: The aims of this study were to evaluate the prevalence and to describe the clinical and diagnostic imaging features of the different types of feline intervertebral disc herniation (IVDH).

METHODS: Medical records and imaging studies were retrospectively reviewed for cats diagnosed with IVDH between January 2008 and October 2020. Information obtained from the clinical records included signalment, clinical presentation, the presence of spinal hyperaesthesia and neurolocalisation. Diagnostic imaging findings, including type (ie, intervertebral disc extrusion [IVDE], intervertebral disc protrusion [IVDP] or acute non-compressive nucleus pulposus extrusion (ANNPE), site and number of IVDHs, were recorded. The association between breed, age, sex, duration and severity of neurological signs, the presence of spinal pain and MRI features was evaluated.

RESULTS: Forty-three cats were included. A total of 50 IVDHs were identified: 39 cats were diagnosed with a single IVDH and four with multiple IVDHs. The most common type of IVDH was ANNPE (n = 22), followed by IVDP (n = 19) and IVDE (n = 9). Neuroanatomical localisation included L4-S3 (n = 19/43), T3-L3 (n = 18/43) and C1-C5 (n = 6/43). Cats with a single IVDH were statistically significantly associated with a diagnosis of ANNPE (P = 0.023) compared with cats with multiple IVDHs affected by IVDP (P = 0.004). Males were more commonly affected by IVDE (P = 0.020) and females by ANNPE (P = 0.020). Cats with IVDP had a longer duration of clinical signs (P <0.001) than cats with ANNPE and demonstrated milder neurological deficits (P = 0.005). IVDEs were statistically significantly associated with spinal hyperaesthesia (P = 0.013), while ANNPEs were not (P = 0.014).

CONCLUSIONS AND RELEVANCE: ANNPE, IVDP and IVDE are each associated with distinctive clinical scenarios. Thoracolumbar and mid-to-caudal lumbar regions are the most affected, followed by the cranial cervical spine segment.

PMID:36172921 | DOI:10.1177/1098612X221121893

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Bibliometrics to improve our patients’ care!

Eur J Paediatr Dent. 2022 Sep;23(3):173. doi: 10.23804/ejpd.2022.23.03.01.

ABSTRACT

Bibliometrics is the statistical analysis of scientific publications and trends on a given topic. The use of bibliometric indicators is based on the fact that academic publishing is an essential outcome of research activity, as advancement of science and treatments increases with dissemination of knowledge. Therefore, investigation in our specific field is obligatory, as learning what the current lines of research are can help us to properly orient our research in the coming years. A soon-to-be-published paper analyses 3,027 articles that have appeared in the leading journals of Paediatric Dentistry included in the Journal Citation Reports (JCR): Pediatric Dentistry, the International Journal of Pediatric Dentistry, the European Journal of Paediatric Dentistry and the Journal of Clinical Pediatric Dentistry considering all issues and all articles published from 2008 to 2020. The most frequently addressed topic is surgery (23.4%), which more generally includes pulp treatment, conservative treatments and the use of dental materials (operative dentistry), while the second most discussed topic is prevention (13.2%), followed by oral pathology (10.6%). Subject matters covered less frequently include early childhood caries (ECC) (2.5%) and occlusion (2.7%). In terms of study types, research articles are the most frequently published (74.2%). Among them, the most common study design is observational studies (61.1%), followed by cross-sectional studies (36.9%) and case-control studies (11.9%). With regard to experimental studies, randomised controlled trials (RCTs) are the most common type (11.6%). The number of case series has fallen sharply over time, from 20% 10 years ago to 5% today. Another striking point is that two journals, the International Journal of Pediatric Dentistry and the European Journal of Paediatric Dentistry, have published more than half of the world’s output. By looking at the nationality of the authors, it is apparent that research frequently takes place within limited geographical areas, a sign that collaboration between different countries is struggling to take off. Despite the fact that prevention is the second most common topic among the articles analysed in the study-both in absolute terms and also taking into account dental journals focused on different specialties-it still does not play the prominent role it deserves. It is important to emphasise the need for further investigation into the prevention of dental diseases in young patients, as the desired oral health objectives have not yet been achieved. The early identification of risk indicators and the implementation of preventive oral health campaigns aimed at the paediatric population can reduce or prevent the progression of caries, and related expenditures for the replacement of missing teeth at a later age. A final consideration is how interesting it would be to analyse how many of the paediatric medical journals publish papers and articles on paediatric dentistry, as this is in fact another crucial step towards ensuring good oral health for all our young patients!

PMID:36172914 | DOI:10.23804/ejpd.2022.23.03.01

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Prevention of malocclusion and the importance of early diagnosis in the Italian young population

Eur J Paediatr Dent. 2022 Sep;23(3):178-182. doi: 10.23804/ejpd.2022.23.03.02.

ABSTRACT

AIM: Malocclusion is an alteration of the normal relationships between skeletal, muscle and dental structures that can lead to impaired functionality as well as aesthetic alteration of the stomatognathic system. Functional alteration can affect various aspects, ranging from chewing ability to respiratory disorders. Paediatricians and dentists are called to prevent and diagnose these conditions as early as possible in order to preserve the patient’s health. The purpose of this research is to study the incidence of malocclusion and its relationship with Obstructive Sleep Apnea Syndrome (OSAS) in a young population. Also, the role of paediatricians and dentists in prevention and early diagnosis of this condition was evaluated METHODS: An anonymous survey was given through Google form to 300 Italian children (139 males and 161 females) from different private dental practices in Italy. No personal information that identifies the individuals was collected, and the data was analysed in aggregate form only. All data was collected and statistically analysed.

CONCLUSION: The data highlight the patients’ good attitude towards dental check-ups, which help to intercept malocclusions. Unlike the past, the knowledge of the importance of oral health and dental occlusion is high among young patients, parents and paediatricians. This study underlines the role of paediatricians as key players in the prevention of dental health problems.

PMID:36172913 | DOI:10.23804/ejpd.2022.23.03.02

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Incidental findings of the nose and paranasal sinuses in orthodontic patients in the age of development: a retrospective study on CBCTs

Eur J Paediatr Dent. 2022 Sep;23(3):189-193. doi: 10.23804/ejpd.2022.23.03.04.

ABSTRACT

AIM: Nowadays, the use of CBCT in orthodontics and paediatric dentistry is constantly increasing. Since it allows a precise 3D visualisation of the entire head, CBCT can be used to identify alterations and pathologies of the jaws, but also of the sinonasal complex. Despite that, literature lacks studies focusing on the sinonasal complex of healthy orthodontic paediatric patients. Therefore, the aim of this cross-sectional retrospective study is to analyse the prevalence of incidental findings and anatomic variations of the nose and paranasal sinuses in orthodontic patients in the age of development.

METHODS: The 61 CBCTs that respected all inclusion criteria (patient’s age under 15 years old and CBCT scans showing the entire sinonasal complex, data in DICOM format) were searched for: nasal septum deviation, Onodi cells, Haller cells, concha bullosa, sinus underdevelopment, sinus mucosal thickening, sinus cysts or polypoid formations. CBCTs were evaluated by two different orthodontists and their findings were then compared and statistically analysed.

CONCLUSION: Considered the high prevalence of incidental findings, prescription of a CBCT to paediatric patiens seems crucial in order to to detect conditions that would require referral to a specialist.

PMID:36172912 | DOI:10.23804/ejpd.2022.23.03.04