Acceptable Option Research Articles

Comparative efficacy of oral drugs for chronic radiation proctitis — a systematic review

BackgroundChronic radiation proctitis (CRP) is a long-term complication of pelvic radiotherapy that manifests as rectal bleeding, diarrhoea, fistula formation and obstruction. Treatments such as endoscopic argon plasma coagulation, hyperbaric oxygen therapy and rectal topical formalin have imposed a significant medical burden on CRP patients. In contrast, oral therapies offer a more accessible and acceptable option for managing CRP. Here, we conducted a systematic review of the efficacy of oral treatments for CRP to assess their potential as an effective and convenient treatment option for this condition.MethodsWe searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, China National Knowledge Infrastructure and Chinese VIP in February 2021. We included post-radiotherapy participants with CRP that compared oral medicine alone or in combination with other treatments versus control treatments. The primary outcomes were bleeding, diarrhoea and symptom score. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. The Cochrane risk-of-bias tool was used to assess the quality of the included studies.ResultsWe included 10 randomised controlled trials (RCTs) and 1 retrospective study with 898 participants. Three placebo-controlled trials evaluated the effects of oral sucralfate on CRP, with meta-analysis showing no significant different with placebo arm. Four trials on TCM demonstrated significant improvement of symptoms, especially for the 3 trials on oral TCM drinks. Retinyl palmitate and high-fibre diet were found to reduce rectal bleeding. The combination of oral pentoxifylline and tocopherol did not significantly change the process of CRP.ConclusionsOur study implies that oral TCM drinks, retinyl palmitate and a high-fiber diet showed significant improvement in CRP symptoms, but not with the combination of oral pentoxifylline and tocopherol. Further multicentre, larger-scale RCTs are needed to confirm the efficacy and safety of these treatments and optimize treatment strategies, ultimately improving the quality of life for patients with CRP.

ThTP3.8 Promoting Awareness and optimizing perioperative management for Jehovah's Witnesses (JW) patients: A Quality Improvement Project (QIP)

Abstract Aims The restriction in using blood products poses a unique challenge to healthcare providers during treatment of JW patients. Current trust guidelines cover the peri-operative aspects of the management. We carried out a QIP to review the awareness amongst clinicians of appropriate guidelines and protocols in managing this cohort of patients. Methods An online survey was sent out to clinicians of all grades within the Trust, asking specific questions related to the use of blood products and alternative options; awareness of protocols including who to contact for advice. Results Our results of 102 responses revealed, 76% clinicians were not familiar with the trust guidelines. There was a wide variation in the knowledge about blood products which could be used and 42% were not aware of acceptable alternative options. 68% were not sure whom to contact for advice in and out of hours. 20% knew how to update an alert on the online medical records to identify patents’ wish of refusal for use of blood products. 94% were unaware of any preoperative and consent checklist for blood products. 50% were aware of checking Advance Directive for Refusal of Treatment (ADRT). Conclusion This QIP highlighted the lacunae in the awareness of trust protocols amongst clinicians of all grades. We aim to provide support and alerts on our Trust Intranet for managing this cohort of patients. Our ultimate goal is to produce a uniform national protocol available to all hospitals in the UK.

Qualitative inquiry with persons with obesity about weight management in primary care and referrals.

Referrals to evidence-based weight management in the community-commercial sector are aligned with clinical recommendations but underutilized. This qualitative study explored patients' perceptions and expectations about obesity treatment in primary care and referral to community-commercial sector programs. Individual semi-structured interviews were conducted with a sample of US persons with obesity via telephone. Audiotape transcripts, interviewer notes, and independent review of data by two investigators allowed for data and investigator triangulation. Transcripts were analyzed using thematic analysis. Data saturation was reached with 30 participants who had a mean age of 41.6 years (SD 9.4), 37% male, 20% Black/African American and 17% Hispanic, 57% college educated, and 50% were employed full-time. Three primary themes emerged: (1) frustration with weight management in primary care; (2) patients expect providers to be better informed of and offer treatment options; and (3) opportunities and challenges with referrals to community-commercial programs. Patients expect that providers offer personalized treatment options and referrals to effective community-commercial programs are an acceptable option. If patient-level data are shared between clinical and community entities to facilitate referrals, then privacy and security issues need attention. Future research is needed to determine feasibility of implementing clinical to community-commercial referrals for obesity treatment in the United States.

Valve Sparing vs Composite Valve Graft Root Replacement: Propensity Score–Matched Analysis

BackgroundBoth valve-sparing root replacement and composite valve graft (CVG) are acceptable options in aortic root replacement. We compare outcomes of these 2 approaches and durability of the aortic valve. MethodsA consecutive 1635 patients without acute dissection underwent primary aortic root replacement from 1997 to 2022; 473 (29%) underwent valve-sparing root replacement, and 1162 (71%) received CVG. Propensity score matching was used to reduce baseline differences. ResultsThe CVG group was older (59 ± 14 years vs 49 ± 14 years; P < .001) with more comorbidities, such as hypertension (88.4% vs 66.4%; P < .001), diabetes (7% vs 1.7%; P < .001), ischemic heart disease (5.1% vs 1.3%; P = .001), pulmonary disease (6.6% vs 1.3%; P < .001), renal impairment (8.6% vs 1.3%; P < .001), class III-IV heart failure (35% vs 9.2%; P < .001), bicuspid aortic valves (44.8% vs 24.1%; P < .001), and severe aortic insufficiency (50.2% vs 13.2%; P < .001). Operative mortality was 0.4% (0% in valve sparing); incidence of major postoperative complications was 2.9% (3.6% vs 1.1%; P = .009). Ten-year survival was 93.1% (91.2% vs 97.7%; hazard ratio [HR], 1.7; 95% CI, 0.9-3.3; P = .120). Mean follow-up was 65 ± 60 months; aortic valve reoperations were similar (5.8% vs 5.7%; HR, 0.8; 95% CI, 0.4-1.4; P = .401). Recurrent moderate-severe aortic insufficiency was less prevalent in CVG (6.1% vs 11.1%; HR, 0.14; 95% CI, 0.07-0.27; P < .001). Propensity score matching identified 225 pairs. There was no difference in 10-year survival or reoperations. Recurrent moderate-severe aortic insufficiency was higher with valve sparing. ConclusionsBoth valve-sparing operations and CVG provide excellent early and late outcomes out to 10 years. Valve sparing is associated with a higher risk for development of aortic insufficiency but no difference in reoperations.

Real-world treatment patterns of subsequent therapy after palbociclib in patients with advanced breast cancer in Japan.

The optimal treatment following endocrine therapy (ET) plus a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) has not been established. We aimed to investigate treatment patterns and time to treatment failure (TTF) of subsequent therapy after palbociclib in a Japanese real-world setting. This retrospective observational study used de-identified data of patients with advanced breast cancer treated with palbociclib, using a nationwide claims database (April 2008 to June 2021). Measures included the type of subsequent therapies after palbociclib (endocrine-based therapy: ET alone, ET+CDK4/6i, and ET+mammalian target of rapamycin inhibitor [mTORi]; chemotherapy; chemotherapy+ET; and others) and their TTFs. The median TTF and 95% confidence interval (CI) were estimated using the Kaplan-Meier method. Of 1170 patients treated with palbociclib, 224 and 235 received subsequent therapies after first- and second-line palbociclib treatment, respectively. Among them, 60.7% and 52.8% were treated with endocrine-based therapies as first subsequent therapy, including ET+CDK4/6i (31.2% and 29.8%, respectively). The median TTF (95% CI) of ET alone, ET+CDK4/6i, and ET+mTORi as first subsequent therapy after first-line palbociclib were 4.4 (2.8-13.7), 10.9 (6.5-15.6), and 6.1 (5.1-7.2) months, respectively. No apparent relationship between the treatment duration of prior ET+palbociclib and subsequent abemaciclib was observed. This real-world study revealed that one-third of the patients received sequential CDK4/6i after ET+palbociclib, and treatment duration of ET+CDK4/6i following ET+palbociclib was the longest among the treatment options. Further data are awaited to determine whether ET+targeted therapy with CDK4/6i and mTORi provides acceptable treatment options following ET+palbociclib.

Feasibility of an intensive outpatient treatment program for posttraumatic stress disorder within the veterans health care administration.

Trauma-focused treatments for posttraumatic stress disorder (PTSD), such as Prolonged Exposure (PE) therapy and Cognitive Processing Therapy (CPT), are effective and supported by various Clinical Practice Guidelines; however, drop-out rates for the treatments are as high as 40% within clinical programs. One promising solution is delivering the evidence-based psychotherapies (EBPs) three or more times per week within an intensive outpatient program (IOP) for PTSD. The present study examined the feasibility and effectiveness of a relatively low-resourced PTSD IOP within a larger PTSD program at the Veterans Healthcare Administration. The intensive program offers two tracks (2 week or 4 week) grounded in the massed delivery of PE and CPT. Over a 12-month period, 351 veterans completed an assessment for PTSD and 172 started within one of the local PTSD programs (e.g., weekly, IOP, or residential). Results of the study demonstrated that the IOP is an acceptable (i.e., 87.3% completion rate) and effective (e.g., PTSD Checklist for Diagnostic and Statistical Manual [DSM-5] [PCL-5] decrease effect size d = 1.80) treatment option. There was also adequate demand for the program (e.g., 37.2% of patients engaged in care with the PTSD programs started the IOP), and the program was implemented with fidelity to the design. Taken together, the results of this study demonstrate that this low-resource IOP model is a promising approach to improve completion rates within the continuum of care for the treatment of PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Management and Outcomes of Femur Fractures in Patients with Duchenne Muscular Dystrophy

Background: Duchenne muscular dystrophy (DMD) is a severe, progressive X-linked recessive neuromuscular disorder characterized by muscle weakness and atrophy. Additionally, patients with DMD have significant reductions in bone mineral density compared to age-matched controls, which is exacerbated by concomitant steroid use. These findings dramatically increase fracture risk, which may irreparably decrease functional status. The aim of this case series is to examine outcomes of operative versus nonoperative management of femur fractures in this patient population.Methods: An IRB-approved retrospective chart review was completed for patients with DMD treated at a single institution for a femur fracture between 2013-2022. Patients were excluded for incomplete documentation, treatment initiation at an outside hospital, or diagnosis of a different muscular dystrophy. Demographic variables, treatment information, functional status, and adverse events were collected for each patient. Descriptive statistics were used to summarize demographic and outcome variables.Results: A total of 10 patients with 11 femur fractures were included for analysis. All patients were male with an average age of 12.7 years and clinical follow-up of 286 days. Five fractures in five patients underwent operative fixation (Group A), and six fractures in five patients underwent nonoperative management (Group B). In Group A, three patients were short-distance ambulators prior to injury, and all patients regained a similar functional status postoperatively. All three patients were treated with a locked intramedullary nail. One patient in Group B was a short-distance ambulator prior to injury; the remainder were nonambulatory. All patients in Group B were primary wheelchair users at final follow-up. There were no adverse events as a result of treatment in either group.Conclusion: Nonoperative management with cast immobilization remains an acceptable option for nonambulatory patients and those with minimally displaced fractures not amenable to surgical intervention. Surgical intervention is recommended for higher-functioning patients with the goal of restoring ambulatory status. Regardless of treatment modality, patients should receive aggressive physical therapy directed at early weight-bearing, range of motion, and mobilization to preserve strength, muscle mass, and mobility.Level of Evidence: Level IV case series Key Concepts•Management of femur fractures in Duchenne muscular dystrophy should account for fracture morphology as well as patient functional status.•Surgical management is safe and effective in promoting fracture union and preserving functional status.•Nonoperative management is preferred in nonambulatory patients and for minimally displaced fractures.

Diabetes and Ethnomedicine a Comprehensive Review of Scientific Literature on Traditional Medical Practices

Ethnomedicine, the traditional medical practices and beliefs of a particular cultural or ethnic group, may offer cost-effective and culturally acceptable treatment options for diabetes. Ethnomedicine encompasses various traditional healing practices, such as herbalism, acupuncture, and massage therapy. This article reviews the current evidence-based state of ethnomedicine for diabetes, focusing on the efficacy, safety, and mechanisms of action of selected ethnomedical interventions. The results indicate that some ethnomedical practices, such as herbal remedies and dietary interventions, may have beneficial effects on glycaemic control, insulin sensitivity, and oxidative stress in diabetes. However, the evidence is inconsistent and limited by methodological flaws, such as small sample size, lack of control group, and inadequate reporting. Moreover, some ethnomedical interventions may pose significant risks, such as drug interactions and adverse effects. Therefore, it is essential that patients consult with their healthcare provider before using any ethnomedical interventions for diabetes and that these interventions be rigorously evaluated using scientific methods.

Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan

BackgroundLaparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception. MethodsPatients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs. ResultsThe laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35−2.23]), reoperation (1.88 [0.24−14.9]), readmission for intussusception within 30 days (0.80 [0.12−5.30]) and 1 year (0.90 [0.28−2.93]), bowel resection (0.69 [0.46–1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50−1.90]), duration of anesthesia (difference, 11 [-1−24] minutes), postoperative length of stay (difference, −1.9 [-4.2−0.4] days), or total hospitalization costs (difference, 612 [ −746−1970] US dollars) between the groups. ConclusionsIn this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception. Levels of EvidenceLevel III.

Management of Very Distal Ulna Fractures: A Systematic Review.

To synthesize all-cause complications and reoperations data, as well as secondary clinical, functional and radiographic outcomes following the management of very distal ulna fractures (VDUFs) either nonoperatively or operatively. MEDLINE, Embase and Web of Science, were searched for English-language articles from inception to February 17, 2022. Studies reporting the nonoperative or operative management of VDUFs were eligible for inclusion. VDUFs were defined as either being Q2 to Q5 distal ulna fractures using the AO Comprehensive Classification of Fractures for distal ulna fractures associated with distal radius fractures or being amenable to characterization by Biyani et al.'s classification system for ulnar head, neck and metaphyseal fractures. Two reviewers independently extracted data from included studies. Study validity was assessed using the methodological index for non-randomized studies. Seventeen studies (512 VDUFs) were included for analysis. There were 209, 237 and 66 fractures in the nonoperative, ORIF and distal ulna resection groups, respectively. Descriptive statistics including weighted means, standard deviations and 95% confidence intervals were calculated. The treatment of VDUFs with either nonoperative management, ORIF or distal ulna resection may all be acceptable treatment options in specific patient populations. Nonoperative management of VDUFs is a promising treatment strategy even for complex fracture patterns in patients 65 years of age or older. Despite higher reoperation rates, ORIF may be considered for the younger, high-demand patient. Distal ulna resection presents with very favorable functional outcomes in patients 65 years of age or older presenting with a complex VDUF with the lowest reoperation rate across all groups.

Poster 254: Osteochondral Allograft Transplantation Using Dowell Technique for the Treatment of Steroid-Associated Osteonecrosis of the Femoral Condyles: Arthroplasty-Free Survival at 5 and 10 Years

Objectives: Steroid-associated osteonecrosis of the femoral condyles is a known complication of long- term or high dose steroid exposure. This is a not infrequent situation for patients with inflammatory conditions such as Lupus or Ulcerative Colitis and in patients with malignancies leukemia requiring bone marrow transplant. Historically, osteonecrosis was a contraindication for osteochondral allograft transplantation (OATS), however, recent evidence has indicated OATS maybe a durable treatment option. While results using the shell OATS technique has been reported in the steroid-associated osteonecrosis population, there is a dearth of information on the long-term survival for the newer dowel OATS technique. The aim of this study was to retrospectively analyze survival of OATS using the dowel technique for the treatment of steroid-associated osteonecrosis of the femoral condyles. Methods: Institutional database was queried to identify eligible patients. Inclusion criteria included diagnosis of aseptic or secondary osteonecrosis of the distal femur, osteochondral allograft transplantation surgical treatment, dowel OATS technique, and history of steroid use for a medical condition. Exclusion criteria included previous cartilage restoration or arthroplasty surgery and incomplete records. No age criteria were used to exclude patients. Patient charts were reviewed for demographic details, information about underlying pathologic condition and steroid exposure, surgical details, and revision OATS or conversation to arthroplasty. Primary outcomes were arthroplasty-free survival and revision-free survival. Results: 27 knees in 25 patients with an average age of 27.6 years (range 16-59 years) were identified with an average follow up of 6.2 years (range 0.7-22 years). Medical conditions included 10 malignancies (5 post-bone marrow transplant) and 13 autoimmune diseases. Distribution of osteonecrosis of the femoral condyles included 1 isolated medial condyle, 5 isolated lateral condyles, 21 medial and lateral condyles. All patients underwent dowel OATS technique. Patients received on average of 2.2 grafts (range 1-5 grafts) with an average combined graft area of 6.67 cm2 (range 1.5 to 20.4 cm2). 10 patients had concomitant procedures and 10 patients had supplemental graft fixation. All patients were treated between 2006 and 2020. Arthroplasty-free survival was 88%, 85%, 60% at 5, 8, 10 years. Revision OATS or arthroplasty free survival was 81%, 77%, 55% at 5, 8, 10 years. Graft failures included 1 revision OATS at 7.7 years secondary to cartilage delamination and 4 conversions to total knee arthroplasty at 1.6, 1.9, 8.7, 9.5 years. Conclusions: Osteochondral Allograft Transplantation is an acceptable and durable treatment option in patients with steroid-associated osteonecrosis with 88% arthroplasty-free survival at 5 years and 60% arthroplasty-free survival at 10 years. Future studies should capture patient reported outcomes and investigate factors leading to arthroplasty conversion such as age at time of OATS, etiology of osteonecrosis, extent of osteonecrosis. [Table: see text]

Functional preservation benefits of minimal surgery for extramammary Paget's disease.

As extramammary Paget's disease (EMPD) sometimes invades and metastasizes from the skin to the mucosa, radical surgical resection of these lesions is often difficult. The purpose of this study was to analyse the association between surgical margins and survival as well as the benefit of functional preservation over complete resection, in patients with EMPD. We retrospectively analysed 230 patients diagnosed with EMPD between 1969 and 2020. Patient and treatment characteristics were recorded. Since our centre is a specialized hospital and almost all patients were referred from other hospitals, we reviewed their referral letters. Prognostic factors and survival time were also analysed. Among 230 patients, 78 (33.9%) had positive margins. The presence of margin positive lesions increased the local recurrence rate but was not significantly correlated with survival. Of all the patients who had received a thorough explanation about the surgical procedure in the referring hospital, 43.8% were scheduled for surgeries that would result in functional impairment, and all of them had function-preserving surgeries at our hospital with a 10-year survival rate of 100%. Our result suggest that less invasive surgery preserves anogenital and urethral function may be an acceptable option for EMPD treatment.

Public response to decarbonisation through alternative shipping fuels

AbstractAlthough shipping is the most energy efficient method of transporting trade goods it is held accountable for 2–3% of global greenhouse gas (GHG) emissions. The shipping industry is exploring pathways to carbon–neutral fuels to help eliminate GHG emissions by 2050. To date research on alternative fuels has not considered public opinion; it remains unclear whether the public will support alternative shipping fuels, or whether public opposition might prevent or defer their deployment. To fill this knowledge gap and help the industry and policy makers arrive at publicly acceptable decisions, our research examines UK public perceptions of six shipping fuels using a mixed-method approach. Our findings reveal that biofuels and hydrogen are clearly favoured, owing to biofuel’s perceived low risk and hydrogen’s lack of negative by-products. Perceptions of liquid natural gas are somewhat positive, suggesting that it provides an acceptable near-term option while other fuels are developed. Despite lingering stigma, nuclear is preferred over the incumbent heavy fuel oil, though both are perceived negatively. However, the UK public strongly dislike ammonia, perceiving it as unproven, risky, and lacking availability. A third support use of alternative shipping fuels, with support greater from those living near ports—a “yes in my back yard” effect. The results demonstrate that different alternative fuels are likely to elicit different public reactions as they become more widely known and show how the overall evaluations arise from specific positive or negative associations with each fuel.

Dialyzer reprocessing: Considerations and pitfalls for effective and safe hemodialysis.

Dialyzer reprocessing for dialyzer reuse in the same patient has been developed since the early time in hemodialysis history to save cost and time related to reassembling the new dialyzer during that time. The procedure can reduce the first-use and allergic reactions from using incompatible cellulosic dialyzer membrane by altering some manufacturing chemicals. All of established literatures regarding recent dialyzer reprocessing methods and considerations were extensively reviewed and summarized. Dialyzer reprocessing can be performed by multiple protocols but involves common steps including bedside rinsing after use, cleaning, dialyzer testing to prevent excessive drop in dialyzer clearance and membrane integrity, high-level disinfection or sterilization either by chemicals or heat, storage, and preparation for subsequent dialysis session by adequate rinsing to reduce the residual reprocessing chemical to the safe level. Compared with the single-use strategy, evidence is conflicting for the mortality advantages or disadvantages of dialyzer reuse, with some showing increased mortality in patients receiving peracetic acid sterilization. Keys for the effective and safe dialyzer reuse involve strict adherence to specific manufacturer's protocol, adequate dialysis water quality complied with the Association for the Advancement of Medical Instrumentation standard, measurement of the total cell volume to prevent inadequate hemodialysis, and infectious control consideration. In the present era, single-use strategy is increasingly adopted due to the decreased cost for dialyzer manufacturing. Environmental concerns of higher solid waste from dialyzer disposal in single-use dialysis should be compared with the liquid waste from reprocessing chemicals along with plastic waste and cardboard in reuse dialysis. Dialyzer reprocessing with adequate regulation is considered as an acceptable option for cost-effective hemodialysis, compared with the single-use strategy.

Five years clinical outcome of maxillary mini dental implant overdenture treatment: A prospective multicenter clinical cohort study.

The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly. The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported. Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years. Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), corresponding to a cumulative failure rate of 23.2%. Prosthetic failure was observed in four patients due to implant loss and in two patients related to excessive one-piece implant ball attachment wear, making the 5-years prosthetic success 80.0%. The mean PPD and absence/presence of BoP for 149 implants at 5 years was 4.3 and 0.2 mm, respectively. Average mesial-distal-vestibular-palatal bone loss in the interval 2-5 years was 0.08 mm. No statistically significant difference in marginal MDI bone loss between male or female (p = 0.835), smoking and nonsmoking (p = 0.666) was observed. The five-years total measured CBCT interdental bone level (mesial and distal) correlates with the 5-years PPD (Pearson 0.434; p = 0.01). After 5 years, OHRQoL with the treatment procedure was assessed in 27/31 participants. Decreasing mean total OHIP-14 scores with improved OHRQoL, was observed in 27/31 participants, with values of 21.3 at baseline to 15.6 at the time of provisional loading which significantly (p = 0.006) decrease to 7.3 at the final prosthetic connection. The next 3-5 years further decrease was observed with 6.5 and 4.96, respectively. Maxillary MDIs for overdentures are an accessible and acceptable treatment option. Although after 5 years between one fifth and one fourth of the MDIs were lost, prosthetic success remains 80.0% and high OHRQoL could be achieved.

Functional Outcome for Fragment-Specific Fixation of Distal Radius Fracture – An Observational Study

Introduction: Fractures of the distal radius account for 14% of all fractures to the extremities and 17% of all fractures treated in emergency departments. Materials and Methods: An observational study was done with 62 cases of distal radius fracture from July 2021 to June 2022, where all patients with distal radius fracture more than 18 years of age with the physical fitness of surgery of both genders were included in this study. Patients with neurovascular injury and comatose patients were excluded from the study. All cases were fixed with fragment-specific fixation. The data collection instruments used were Constant–Murley score and QuickDASH score and were followed up for 12 months. Results: The mean age of the study participants was 39.90 ± 10.84 years. Around 45.2% were female and 54.8% were male. Around 74.2% had road traffic accident and 25.8% had slip and falls. Mean palmar flexion in degrees was 56.77 ± 3.51, mean dorsiflexion in degrees was 62.90 ± 3.21, mean radial flexion in degrees was 17.39 ± 3.11, and mean ulnar deviation in degrees was 23.77 ± 3.76. Around 71% had excellent results and 29% had good results. Conclusion: The use of distal radius plating in the treatment of fractures of the distal radius fractures of the wrist has been established as a good and acceptable treatment option.

Morbidly Obese Patients Undergoing Unicompartmental Knee Arthroplasty Compared to Total Knee Arthroplasty: A Retrospective Case-Controlled Analysis

BackgroundIn this study, we assess the effects that morbid obesity (body mass index (BMI) ≥ 40) has on: (1) Ninety-day medical complications and readmission rates; (2) costs of care and lengths of stay (LOS); and (3) 2-year implant complications in patients undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). MethodsA retrospective query of TKA and UKA patients were identified using a national database. Morbidly obese UKA patients were matched 1:5 to morbidly obese TKA patients by demographic and comorbidity profiles. Subgroup analyses were conducted using the same process between morbidly obese UKA patients and BMI <40 TKA patients, as well as to BMI <40 UKA patients. ResultsMorbidly obese patients who underwent UKA had significantly fewer medical complications, readmissions, and periprosthetic joint infections than TKA patients; however, UKA patients had greater odds of mechanical loosening (ML). The TKA patients had significantly longer LOS (3.0 versus 2.4 days, P < .001), as well as significantly greater costs of care than UKA patients ($12,869 versus $7,105). Morbidly obese UKA patients had similar rates of medical complications, and significantly lower readmissions, decreased LOS, and decreased costs when compared to TKA patients who had a BMI <40. ConclusionIn patients who have morbid obesity, complications were decreased in UKA compared to TKA. Moreover, morbidly obese UKA patients had lower medical utilizations and similar complication rates when compared to TKA patients with the recommended cutoff of BMI <40. However, UKA patients had greater rates of ML than TKA patients. A UKA may be an acceptable treatment option for unicompartmental osteoarthritis in morbidly obese patients.

Predicting vertical and shear ground reaction forces during walking and jogging using wearable plantar pressure insoles

BackgroundThe development of plantar pressure insoles has made them a potential replacement for force plates. These wearable devices can measure multiple steps and might be used outside of the lab environment for rehabilitation and evaluation of sport performance. However, they can only measure the vertical force which does not completely represent the vertical ground reaction force. In addition, they are not able to measure shear forces which play an import role in the dynamic performance of individuals. Indirect approaches might be implemented to improve the accuracy of the force estimated by plantar pressure systems. Research questionThe aim of this study was to predict the vertical and shear components of ground reaction force from plantar pressure data using recurrent neural networks. MethodsGround reaction force and plantar pressure data were collected from 16 healthy individuals during 10 trials of walking and five trials of jogging using Bertec force plates at 1000 Hz and FScan plantar pressure insoles at 100 Hz. A long short-term memory neural network was built to consider the time dependency of pressure and force data in predictions. The data were split into three subsets of train, to train the model, evaluate, to optimize the model hyperparameters, and test sets, to assess the accuracy of the model predictions. ResultsThe results of this study showed that our long short-term memory model could accurately predict the shear and vertical force components during walking and jogging. The predictions were more accurate during walking compared to jogging. In addition, the predictions of mediolateral force had higher error and lower correlation compared to vertical and anteroposterior components. SignificanceThe long short-term memory model developed in this study may be an acceptable option for accurate estimation of ground reaction force during outdoor activities which can have significant impacts in rehabilitation, sport performance, and gaming.

Update on antiadhesion barriers and therapeutics in gynecological surgery.

Postoperative adhesions remain a clinical challenge to both patients and providers, as they are associated with significant complications and a high economic burden. This article provides a clinical review of currently available antiadhesive agents and promising new therapies that have advanced past animal studies. Several agents have been investigated on their ability to reduce adhesion formation; however, there is no widely acceptable option. The few available interventions are barrier agents and while low-quality evidence suggests that they may be more effective than no treatment, there is no general agreement on their overall efficacy. There is an abundance of research on new solutions; however, their clinical efficacy is yet to be determined. Although a wide range of therapeutics have been investigated, majority are halted in animal models with only a select few being studied in humans and ultimately available in the market. Many agents have shown effectiveness in reducing adhesion formation, however, that has not been translated to improvement in clinically relevant outcomes; hence the need for high-quality large randomized trials.

Direkte Pulpaüberkappung bei asymptomatischen kariösen primären Molaren mit drei verschiedenen Pulpaüberkappungsmaterialien

Purpose: Τo assess the outcome of direct pulp capping in asymptomatic carious primary molars using three pulp capping materials. Methods: In this prospective clinical trial, carious primary molars free of irreversible pulp inflammation signs and symptoms, with negative pain history and pulp exposure following caries removal were included. Teeth were divided into groups: A: Ca(OH)2, B: Pure Portland cement®, C: Biodentine™. Following anaesthesia, isolation, caries removal, pulp exposure, hemorrhage control, pulp capping, additional lining in groups A, B, teeth were restored with composite resin. Descriptive statistics, Chi-squared and Fisher's exact tests, Kaplan-Meier survival curves, multivariable random effects Cox regression model were performed. Results: Sixty-six patients (25 girls, 41 boys) with mean age 7.2 (± 1.7) years participated. The mean follow-up time was 13 months. Seventy-nine primary molars were assigned to groups A (n = 27), B (n = 29), C (n = 23). The overall failure was 16 % and the distribution by group was: A: 5 teeth, B: 5 teeth, C: 3 teeth. No significant differences in failure rates between capping materials, tooth types, age bands and genders were identified. Conclusions: Direct pulp capping in asymptomatic carious primary molars may be an acceptable option, when treating an exposed pulp with bioceramic materials as pulp capping agents.