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Frontiers in Veterinary Science 2024To develop and evaluate the safety and accuracy of an open, end-on fluoroscopic guided (EOFG) drill hole position technique in canine cadaveric spinal surgery, in...
OBJECTIVE
To develop and evaluate the safety and accuracy of an open, end-on fluoroscopic guided (EOFG) drill hole position technique in canine cadaveric spinal surgery, in comparison to a traditional free-hand (FH) drilling technique.
STUDY DESIGN
Cadaveric comparison study.
ANIMALS
Canine cadaveric vertebral columns ( = 4).
METHODS
Computed tomography (CT) scans were performed for planning. Ideal implant purchase depth and angulations were determined from previously published data. Plans for end-on fluoroscopic guided drill holes included angled reconstructions in thick slab mode to mimic fluoroscopic images. Following surgical preparation of T8 to S2, holes were drilled by one of two experienced surgeons randomized evenly by operated side, surgeon, and technique. C-arm fluoroscopy was utilized for the end-on technique. CT was repeated after the procedures. Safety was determined categorically using a modified Zdichavsky classification and "optimal" placement was compared between techniques. Continuous data for drill-hole accuracy was calculated as angle and depth deviations from the planned trajectories. Data sets were analyzed at both univariable and multivariable levels with logistic regression analysis.
RESULTS
Drill hole safety was categorized as optimal (modified Zdichavsky classification 1) in 51/60 (85%) of drill holes using EOFG and 33/60 (55%) using FH ( < 0.001) techniques. There were no "unsafe" holes (modified Zdichavsky classification 3a). Optimal drill hole placement was significantly associated with the EOFG technique and use of the largest cadaver, and was significantly less likely within the thoracic region. Mean angle and depth deviations were significantly lower with the EOFG technique. Angle deviations were significantly lower for EOFG in the lumbar region, whereas bone purchase deviations were significantly lower for EOFG in both the thoracic and lumbar regions. The mean time taken to drill the hole was significantly longer for the EOFG technique.
CONCLUSION
Optimal drill hole placement was significantly more likely with the EOFG technique and improved the accuracy of bone purchase in the thoracic region.
CLINICAL SIGNIFICANCE
The EOFG technique shows promise for translation into a clinically setting, potentially improving implant purchase and therefore stabilizing construct strength, whilst potentially reducing the likelihood of neurovascular injury and need for surgical revision.
PubMed: 38938915
DOI: 10.3389/fvets.2024.1419521 -
International Journal of Paediatric... Jun 2024To compare two cone beam computed tomography (CBCT) analysis techniques for measuring tertiary dentin (TD) volume, density, and root length increase, after indirect pulp...
BACKGROUND AND AIM
To compare two cone beam computed tomography (CBCT) analysis techniques for measuring tertiary dentin (TD) volume, density, and root length increase, after indirect pulp therapy (IPT) in young permanent teeth with conventional periapical radiographs.
DESIGN
Comparative study design: Sixty-nine CBCT scans were taken initially (T1) and after 1 year (T2) of IPT. New CBCT analysis technique A, standardization, segmentation, and registration of T1 and T2 scans were performed using ITK-SNAP and 3D Slicer CMF to measure TD volume (mm), density (gray-level intensity), and root length increase (mm). In the traditional CBCT analysis technique B, analyses were conducted using the In-Vivo software to calculate TD thickness (mm), radiodensity (HU%), and root length increase (mm). Paired t-test and the intraclass correlation coefficient were calculated to compare and assess the reliability of all techniques.
RESULTS
No significant difference between the two techniques existed in the measurement of TD mineral density (Mean [SD]:A = 22.4 [15.4]; B = 24.4 [15.4]; p = .47). Technique A resulted in significantly higher root length increase values (Mean [SD]: A = 1.3 [0.6]; B = 1.1 [0.5]; p = .03). The two techniques showed acceptable reliability levels (0.76-0.99).
CONCLUSION
CBCT analysis techniques yielded similar findings for mineral density. The new CBCT volumetric analysis technique, although more laborious, produced higher values for root length increase, and allowed for measurement of dentin volume.
PubMed: 38937920
DOI: 10.1111/ipd.13232 -
International Orthodontics Jun 2024Gingival phenotype (GP) is regarded as a valuable indicator for forecasting the probability of attaining favourable aesthetic and functional results with orthodontic...
AIM
Gingival phenotype (GP) is regarded as a valuable indicator for forecasting the probability of attaining favourable aesthetic and functional results with orthodontic treatment. This study aimed to investigate the accuracy and reproducibility of cone beam computed tomography (CBCT) for assessing gingival thickness (GT) in both arches compared to the transgingival probing method. The secondary objective was to determine the optimal cut-off values for GT using CBCT.
METHODS
This cross-sectional study was conducted where GP was determined based on the probe transparency method (TRAN). The GT measurements were obtained by both methods at 2mm from the free gingival margin (FGM) for all teeth anterior to the first molar. The data was statistically analysed using intraclass correlation coefficient (ICC), Bland-Altman plots, and receiver operating characteristic (ROC) curves. The statistical significance level was set at a P-value<0.05.
RESULTS
The study included 60 subjects (1200 teeth). The mean GT in both the maxillary (1.14±0.17mm) and mandibular (0.94±0.15mm) arches was significantly greater (P<0.05) for the transgingival probing method than for the CBCT method. As shown in the Bland-Altman plot, the bias between the two methods was greater in the maxillary jaw (0.060; 95% CI: 0.044 to 0.076) and in individuals with a thick GP (0.096; 95% CI: 0.082 to 0.109). The optimal values for GT measurements were 1.15mm for the maxillary jaw, 1.02mm for the mandibular jaw, 1.02mm for males, and 1.09mm for females.
CONCLUSIONS
CBCT exhibited notable precision in diagnosing GT, while demonstrating minimal disparities compared to the conventional transgingival probing technique, particularly evident in thin GPs, and in the mandibular dental arch. The constraints associated with the utilization of CBCT were observed in the maxillary arch and in cases with thick GP.
PubMed: 38936246
DOI: 10.1016/j.ortho.2024.100892 -
Journal of Psychiatric Research Jun 2024Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder associated with brain differences in children, but not in adults. A combined evaluation...
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder associated with brain differences in children, but not in adults. A combined evaluation of the regional brain differences could improve statistical power and, consequently, allow the detection of possible effects in adults. Thus, our aim is to verify whether Neuroimaging Association Scores (NAS) are associated with adulthood ADHD and clinical trajectories of the disorder in midlife. Clinical and neuroimaging data were collected for 121 subjects with ADHD (mean age: 47.1 ± 10.5; 43% male) and 82 controls (mean age: 38.2 ± 9.0; 54.9% male). Cases were assessed seven and thirteen years after baseline diagnosis, and their clinical trajectories were classified as stable if they fulfilled ADHD diagnosis in all assessments or unstable if they presented remission and recurrence of symptoms. Neuroimaging data were acquired in the last clinical assessment (thirteen years after baseline) and NAS were calculated as a weighted sum of the associations previously reported by meta-analyses for three types of structural brain modalities: cortical thickness, cortical surface area, and subcortical volume. The NAS for cortical surface area was higher in cases compared to controls. No association was found for NAS and number of symptoms of ADHD or clinical trajectories. The fact that differences were restricted to ADHD diagnostic status suggests a susceptibility effect that is not extended to subtle aspects of the disorder. Our results also suggest that evaluating overall effects may have advantages especially when applied to adult ADHD samples.
PubMed: 38936238
DOI: 10.1016/j.jpsychires.2024.06.025 -
Journal of Behavioral Addictions Jun 2024Changes in brain structural connections appear to be important in the pathophysiology of substance use disorders, but their role in behavioral addictions, such as...
BACKGROUND
Changes in brain structural connections appear to be important in the pathophysiology of substance use disorders, but their role in behavioral addictions, such as gambling disorder (GD), is unclear. GD also offers a model to study addiction mechanisms without pharmacological confounding factors. Here, we used multimodal MRI data to examine the integrity of white matter connections in individuals with GD. We hypothesized that the affected areas would be in the fronto-striatal-thalamic circuit.
METHODS
Twenty individuals with GD (mean age: 64 years, GD duration: 15.7 years) and 40 age- and sex-matched healthy controls (HCs) underwent detailed clinical examinations together with brain 3T MRI scans (T1, T2, FLAIR and DWI). White matter (WM) analysis involved fractional anisotropy and lesion load, while gray matter (GM) analysis included voxel- and surface-based morphometry. These measures were compared between groups, and correlations with GD-related behavioral characteristics were examined.
RESULTS
Individuals with GD showed reduced WM integrity in the left and right frontal parts of the corona radiata and corpus callosum (pFWE < 0.05). WM gambling symptom severity (SOGS score) was negatively associated to WM integrity in these areas within the left hemisphere (p < 0.05). Individuals with GD also exhibited higher WM lesion load in the left anterior corona radiata (pFWE < 0.05). GM volume in the left thalamus and GM thickness in the left orbitofrontal cortex were reduced in the GD group (pFWE < 0.05).
CONCLUSIONS
Similar to substance addictions, the fronto-striatal-thalamic circuit is also affected in GD, suggesting that this circuitry may have a crucial role in addictions, independent of pharmacological substances.
Topics: Humans; Male; Middle Aged; Gray Matter; White Matter; Gambling; Female; Magnetic Resonance Imaging; Aged; Multimodal Imaging; Frontal Lobe; Thalamus
PubMed: 38935433
DOI: 10.1556/2006.2024.00031 -
International Urology and Nephrology Jun 2024The study aims to determine the possible improvement in cortical transit time (CTT) after surgery in infants with antenatally diagnosed ureteropelvic junction...
PURPOSE
The study aims to determine the possible improvement in cortical transit time (CTT) after surgery in infants with antenatally diagnosed ureteropelvic junction obstruction (UPJO), and investigate the correlation of CTT with preoperative renal function and parenchymal thickness.
PATIENTS AND METHODS
Medical charts of 32 antenatally diagnosed children with UPJO operated on between 2014 and 2021 were reviewed. Patients' demographics, preoperative and postoperative anteroposterior diameter (APD), parenchymal thickness (PT) ratio, differential renal function (DF), drainage patterns and CTT were compared to determine operative benefit. Preoperative CTT of each patient was also grouped as severely delayed (> 6 min) and moderately delayed (3-5 min) and compared. The correlation between the preoperative CTT and preoperative DF and PT ratio was investigated.
RESULTS
The median age of the patients was 8.8 months (1-24 months). The CTT (mean: 6.8 ± 3.0 min) was prolonged before surgery and was significantly improved (mean 4.6 ± 1.0 min) after the operation (p < 0.001). A significant negative correlation was detected between the CTT and preoperative DF and between the CTT and preoperative PT ratio. Preoperative DF was found significantly impaired in patients within the severely prolonged CTT group compared to those within the moderately prolonged CTT group. Significant improvement in DF was detected in patients in the severely prolonged CTT group after surgery.
CONCLUSION
CTT is a parameter to prove relief of obstruction in patients with antenatally diagnosed UPJO after surgery. CTT is negatively correlated with preoperative DF and PT ratio. Severely prolonged CTT may be considered to be an indication of early surgical intervention.
PubMed: 38935321
DOI: 10.1007/s11255-024-04131-4 -
International Ophthalmology Jun 2024To evaluate the agreement between the Goldman applanation tonometer (GAT), Tono-Pen, and noncontact tonometer (NCT) in the measurement of intraocular pressure (IOP) in... (Comparative Study)
Comparative Study
BACKGROUND
To evaluate the agreement between the Goldman applanation tonometer (GAT), Tono-Pen, and noncontact tonometer (NCT) in the measurement of intraocular pressure (IOP) in pseudophakic children.
METHODS
The medical records of nonglaucomatous pseudophakic children between 2009 and 2019 were retrospectively analyzed. A total of 46 eyes of 23 patients operated for bilateral pediatric cataract were included in the study. The patients' mean age was 13.4 ± 4.1 years. Central corneal thickness (CCT) and IOP values measured with the GAT, Tono-Pen, and NCT were recorded. Agreement between the tonometers was evaluated by intraclass correlation coefficients (ICC) and the Bland-Altman method.
RESULTS
The mean IOP of the 46 eyes included in the study was measured as 13.7 ± 2.3 mm Hg with the GAT, 16.0 ± 2.3 mm Hg with NCT, and 16.5 ± 2.3 mm Hg with the Tono-Pen (p < 0.001). There is no statistical difference between NCT and Tono-Pen measurements, while GAT measurements were significantly lower than those of the NCT and Tono-pen. ICC values showed fair agreement between NCT and Tono-Pen (ICC = 0.720), whereas there was poor agreement between GAT and NCT (ICC = 0.501) and Tono-pen (ICC = 0.314).
CONCLUSIONS
With all devices included in the study, thicker corneas were associated with higher IOP measurements. Although there was moderate agreement between the NCT and Tono-Pen, there was a statistically significant difference in the IOP values provided by the three devices. Our results suggest these devices should not be used interchangeably.
Topics: Humans; Intraocular Pressure; Tonometry, Ocular; Female; Male; Retrospective Studies; Child; Pseudophakia; Adolescent; Reproducibility of Results; Child, Preschool; Cornea
PubMed: 38935310
DOI: 10.1007/s10792-024-03210-w -
Ophthalmology Jun 2024To review the evidence on the safety and effectiveness of epithelium-off corneal collagen cross-linking (CXL) for the treatment of progressive corneal ectasia.
PURPOSE
To review the evidence on the safety and effectiveness of epithelium-off corneal collagen cross-linking (CXL) for the treatment of progressive corneal ectasia.
METHODS
A literature search of the PubMed database was most recently conducted in March 2024 with no date restrictions and limited to studies published in English. The search identified 359 citations that were reviewed in abstract form, and 43 of these were reviewed in full text. High-quality randomized clinical trials comparing epithelium-off CXL with conservative treatment in patients who have keratoconus (KCN) and post-refractive surgery ectasia were included. The panel deemed 6 articles to be of sufficient relevance for inclusion, and these were assessed for quality by the panel methodologist; 5 were rated level I, and 1 was rated level II. There were no level III studies.
RESULTS
This analysis includes 6 prospective, randomized controlled trials that evaluated the use of epithelium-off CXL to treat progressive KCN (5 studies) and post-laser refractive surgery ectasia (1 study), with a mean postoperative follow-up of 2.4 years (range, 1-5 years). All studies showed a decreased progression rate in treated patients compared with controls. Improvement in the maximum keratometry (Kmax) value, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) was observed in the treatment groups compared with control groups. A decrease in corneal thickness was observed in both groups but was greater in the CXL group. Complications were rare.
CONCLUSIONS
Epithelium-off CXL is effective in reducing the progression of KCN and post-laser refractive surgery ectasia in most treated patients with an acceptable safety profile.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found after the references.
PubMed: 38935041
DOI: 10.1016/j.ophtha.2024.05.006 -
JACC. Heart Failure Jun 2024Cardiac allograft vasculopathy is characterized by increased coronary intimal thickness and is a leading cause of death in heart transplant (HTx) recipients despite the...
BACKGROUND
Cardiac allograft vasculopathy is characterized by increased coronary intimal thickness and is a leading cause of death in heart transplant (HTx) recipients despite the routine use of statins. The experience with inhibitors of proprotein convertase subtilisin-kexin type 9 in HTx recipients is limited. Our hypothesis was that lowering cholesterol with the proprotein convertase subtilisin-kexin type 9inhibitor evolocumab would reduce coronary intimal thickness in these patients without compromising safety.
OBJECTIVES
This double blind, randomized trial was conducted to test whether evolocumab reduces the burden of cardiac allograft vasculopathy.
METHODS
Patients who had received a cardiac allograft at one of the Nordic transplant centers within the prior 4 to 8 weeks were randomized to monthly subcutaneous injections of evolocumab 420 mg or matching placebo. The primary endpoint was the baseline-adjusted maximal intimal thickness as measured by intracoronary ultrasound after 12 months' treatment.
RESULTS
The trial enrolled 128 patients between June 2019 and May 2022. Matched pairs of coronary ultrasound images were available for 56 patients assigned to evolocumab and 54 patients assigned to placebo. At 12 months, the adjusted mean difference in the maximal intimal thickness between the 2 arms was 0.017 mm (95% CI: -0.006 to 0.040; P = 0.14). The mean reduction in low-density lipoprotein cholesterol with evolocumab compared with placebo was 1.11 mmol/L (95% CI: 0.86-1.37 mmol/L). The use of evolocumab was not associated with an increase in adverse events.
CONCLUSIONS
Twelve months of treatment with evolocumab substantially reduced low-density lipoprotein cholesterol but did not reduce maximal coronary intimal thickness in HTx recipients. (Cholesterol Lowering With EVOLocumab to Prevent Cardiac Allograft Vasculopathy in De-novo Heart Transplant Recipients [EVOLVD]; NCT03734211).
PubMed: 38934968
DOI: 10.1016/j.jchf.2024.04.026 -
Knee Surgery, Sports Traumatology,... Jun 2024This study aims to assess the functional outcomes based on restoring the anterior compartment after total knee arthroplasty (TKA).
PURPOSE
This study aims to assess the functional outcomes based on restoring the anterior compartment after total knee arthroplasty (TKA).
METHODS
This retrospective study included 96 primary TKAs performed between 2021 and 2022. Functional positioning principles were applied using an image-based robotic-assisted system. The mean age was 69.2 ± 7.9 years. Knee Society Score (KSS), Kujala score, Forgotten Joint Score (FJS) and knee flexion were collected preoperatively and at 1 year. The depth difference between native and prosthetic trochlea was measured to assess anterior compartment restoration at full extension, 30°, 70° and 90° flexion. The global anterior compartment restoration combined the anterior compartment restoration and the patellar thickness restoration.
RESULTS
The trochlear offset was mostly understuffed after TKA compared to the native anatomy, mainly for medial and lateral condyles at 30° and 70° of flexion. The global anterior compartment restoration was understuffed in full extension (-0.7 mm ± 2), at 30° (-4.4 mm ± 2) and 70° of flexion (-3.6 mm ± 2.5). At 90°, the global anterior compartment restoration was overstuffed (2.2 mm ± 1.8). Functional scores were not significantly influenced by the anterior compartment stuffing at 0° and 30° (n.s.). The anterior compartment overstuffing at 70° and 90° was associated with decreased KSS function score (p = 0.009) and flexion (p = 0.04).
CONCLUSION
Moderate anterior understuffing was frequently observed after TKA performed with functional positioning and an image-based robotic-assisted system. This understuffing did not influence the functional outcomes. The overstuffing of the anterior compartment led to a reduction in KSS function score and flexion measurements at 1 year.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
PubMed: 38932605
DOI: 10.1002/ksa.12337