Broad Spectrum Of Indications Research Articles

Intraoral Ultrasonography for the Exploration of Periodontal Tissues: A Technological Leap for Oral Diagnosis.

Periodontal disease is an infectious syndrome presenting inflammatory aspects. Radiographic evaluation is an essential complement to clinical assessment but has limitations such as the impossibility of assessing tissue inflammation. It seems essential to consider new exploration methods in clinical practice. Ultrasound of periodontal tissues could make it possible to visualize periodontal structures and detect periodontal diseases (periodontal pocket measurement and the presence of intra-tissue inflammation). Clinical Innovation Report: An ultrasound probe has been specially developed to explore periodontal tissues. The objective of this clinical innovation report is to present this device and expose its potential. Various immediate advantages favor using ultrasound: no pain, no bleeding, faster execution time, and an image recording that can be replayed without having to probe the patient again. Ultrasound measurements of pocket depth appear to be as reliable and reproducible as those obtained by manual probing, as do tissue thickness measurements and the detection of intra-tissue inflammation. Ultrasound seems to have a broad spectrum of indications. Given the major advances offered by ultrasound imaging as a complementary aid to diagnosis, additional studies are necessary to validate these elements and clarify the potential field of application of ultrasound imaging in dentistry.

Zirconia Ceramics.

Zirconia ceramics have become popular among other dental ceramics thanks to their biological, mechanical, optical, and aesthetic properties. CAD/CAM (computer-aided design/ computer-aided manufacturing) technology improvement has played a vital role in the increased popularity of zirconia ceramics; easy computer manipulation significantly expanded the possibility of using different types of restorations. Zirconia ceramics have a broad spectrum of indications in prosthetic dentistry, from simple restorations to complex structures supported by dental implants. A good orientation in the classification, features, and manipulation of zirconia ceramics is the main key to success.

IMiDs Augment CD3-Bispecific Antibody-Induced CD8+ T-Cell Cytotoxicity and Expansion by Enhancing IL2 Production.

Although CD3-bispecific antibodies have shown promising activity in the treatment of hematological cancers, insufficient T-cell costimulation may limit long-term responses. Immunomodulatory drugs (IMiDs), routinely used in treating multiple myeloma, possess pleiotropic antimyeloma properties and have been described to enhance T-cell responses similar to costimulatory signaling and may therefore have synergistic effects when combined with T-cell bispecifics. In this report, we demonstrate that IMiDs substantially enhance tumor cell killing induced by CD3 bispecifics and increase CD8+ T-cell proliferation and expansion. We further show that the beneficial effects of IMiDs on T-cell function and expansion are mediated by enhanced IL2 production by CD4+ T cells. Our studies provide mechanistic insight into the costimulatory properties of IMiDs and support combination treatments with T-cell agonist therapies in a broad spectrum of indications.

Comparative Outcomes and/or Complications Following Ventriculoperitoneal versus Lumboperitoneal Shunts: A Scoping Review

Cerebrospinal fluid (CSF) diversion procedure in the form of ventriculoperitoneal shunt (VPS) has been performed for over a century and is a well-established method for treating hydrocephalus. With the passage of time and the availability of better technology, several other CSF diversion modalities developed with variable risks and benefits. Lumboperitoneal shunt (LPS) is a close and safe contestant for the VP shunt procedure and is regarded as an alternative treatment modality for hydrocephalus. The present scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A literature search for the study was performed on PubMed, COCHRANE, SCOPUS and ScienceDirect (from inception to 7 July 2022). Those studies that were published in the English language with a report on comparison between VPS and LPS for the management of hydrocephalus were included in the review process. Those studies that do not have comparative outcomes, case reports, letters, reviews, preclinical studies, conference reports and non-human studies were excluded from the study. Search results showed 134 records; after removing the duplicates and excluding 12 studies with reasons, five studies were included in the present review. Several complications were described in patients who underwent either VP Shunt or LP Shunt surgery. Although communicating hydrocephalus forms one of the most significant subgroups of patients in neurosurgical practice and VP and LP shunt procedures are also widely performed, the literature review shows limited comparative efficacy. In addition, the reported studies have a broad spectrum of indications, disease conditions and complications with a heterogeneous patient population. To further develop the high level of evidence, there is a need for well-designed prospective protocols to help us develop uniform and practical guidelines. In the present review, we looked into the common complications, including shunt malfunction, shunt infection, subdural haematoma, shunt obstruction and shunt migration between two groups.

Minimal-invasive Vorfußchirurgie: Konzept und Techniken

Minimally invasive surgery (MIS) has advanced to an established approach in the correction of all deformities of the forefoot. For the first ray the minimally invasive chevron and Akin osteotomy (MICA) shows very good clinical results and provides a broad spectrum of indications in comparison to the classical chevron osteotomy. The minimally invasive treatment of hallux rigidus also seems to achieve comparable results to the open techniques, although the surgical indications must be thoroughly evaluated. Lesser toe deformities are often easier to treat with minimally invasive osteotomy, capsule release and tendon lengthening than with complex open procedures and usually do not require any internal fixation material. Compared to the classical Weil osteotomy, distal metatarsal osteotomy shows areduced rate of cock-up deformities and does not require internal fixation. In relation to open procedures, minimally invasive approaches should be accepted as avaluable addition and alternative to the classical open techniques due to the reduced rate of wound healing disorders and postoperative pain.

Neurodevelopmental outcomes after prenatal exposure to anaesthesia for maternal surgery: a propensity-score weighted bidirectional cohort study.

Up to 1% of pregnant women undergo anaesthesia for non-obstetric surgery. This study investigated neurodevelopmental outcomes after prenatal anaesthesia for maternal surgery. A bidirectional cohort study of children born between 2001 and 2018 was performed: neurodevelopmental outcomes of children who had received prenatal anaesthesia for maternal surgery were prospectively compared with unexposed children, with exposure status being assessed retrospectively. Children exposed to anaesthesia for obstetric and fetal surgery were excluded. The primary outcome was the global executive composite of the behaviour rating inventory of executive function score. Our secondary outcomes were: total problems; internalising problems and externalising problems derived from the child behaviour checklist; psychiatric diagnoses; and learning disorders. In 90% of exposed children, there was a single mean (SD) antenatal anaesthesia exposure lasting 91(94) min. There was a broad spectrum of indications, with abdominal surgery being most frequent. Parents of 129 exposed (response rate 68%) and 453 unexposed (response rate 63%) children participated. There were no arguments for non-response bias. After propensity weighting, there were no statistically significant differences in primary outcome, with a weighted mean difference (95%CI) of exposed minus unexposed children of 1.9 (-0.4-4.2), p = 0.10; or any of the secondary outcomes. Sensitivity analyses confirmed the robustness. Exploratory analyses, however, showed significant differences in certain subgroups for the primary outcome, (e.g. for intra-abdominal surgery, exposure duration > 1 h) and some cognitive subdomains (e.g. working memory and attention). This bidirectional cohort study, the largest investigation on the subject to date, has found no evidence in the general population for an association between prenatal exposure to anaesthesia and impaired neurodevelopmental outcomes.

Social Investment (in Wellbeing?)

This article outlines social investment and the wellbeing approach. It discusses how these frameworks have evolved and argues for a hybrid approach, one drawing on the insights of both a broad spectrum of indicators and detailed distributional evidence.

Exploring the Potential of Eltrombopag: Room for More?

Since its introduction in clinical practice, eltrombopag (ELT) has demonstrated efficacy in heterogeneous clinical contexts, encompassing both benign and malignant diseases, thus leading researchers to make a more in-depth study of its mechanism of action. As a result, a growing body of evidence demonstrates that ELT displays many effects ranging from native thrombopoietin agonism to immunomodulation, anti-inflammatory, and metabolic properties. These features collectively explain ELT effectiveness in a broad spectrum of indications; moreover, they suggest that ELT could be effective in different, challenging clinical scenarios. We reviewed the extended ELT mechanism of action in various diseases, with the aim of further exploring its full potential and hypothesize new, fascinating indications.

Expanding Horizons in Complement Analysis and Quality Control.

Complement not only plays a key role in host microbial defense but also modulates the adaptive immune response through modification of T- and B-cell reactivity. Moreover, a normally functioning complement system participates in hematopoiesis, reproduction, lipid metabolism, and tissue regeneration. Because of its powerful inflammatory potential, multiple regulatory proteins are needed to prevent potential tissue damage. In clinical practice, dysregulation and overactivation of the complement system are major causes of a variety of inflammatory and autoimmune diseases ranging from nephropathies, age-related macular degeneration (AMD), and systemic lupus erythematosus (SLE) to graft rejection, sepsis, and multi-organ failure. The clinical importance is reflected by the recent development of multiple drugs targeting complement with a broad spectrum of indications. The recognition of the role of complement in diverse diseases and the advent of complement therapeutics has increased the number of laboratories and suppliers entering the field. This has highlighted the need for reliable complement testing. The relatively rapid expansion in complement testing has presented challenges for a previously niche field. This is exemplified by the issue of cross-reactivity of complement-directed antibodies and by the challenges of the poor stability of many of the complement analytes. The complex nature of complement testing and increasing clinical demand has been met in the last decade by efforts to improve the standardization among laboratories. Initiated by the IUIS/ICS Committee for the Standardization and Quality Assessment in Complement Measurements 14 rounds of external quality assessment since 2010 resulted in improvements in the consistency of testing across participating institutions, while extending the global reach of the efforts to more than 200 laboratories in 30 countries. Worldwide trends of assay availability, usage, and analytical performance are summarized based on the past years’ experiences. Progress in complement analysis has been facilitated by the quality assessment and standardization efforts that now allow complement testing to provide a comprehensive insight into deficiencies and the activation state of the system. This in turn enables clinicians to better define disease severity, evolution, and response to therapy.

Benefits, safety and side effects of tumescent local anesthesia in dermatologic surgery in infants.

Tumescent local anesthesia (TLA) plays an important role in dermatosurgical procedures. TLA has several benefits such as long-lasting anesthesia, reduced bleeding during surgery and the avoidance of general anesthesia-associated complications. Convenience and a favorable risk profile along with a broad spectrum of indications are further reasons why TLA is increasingly applied in infants as well. There are not only a variety of indications for surgical excisions in infancy, such as congenital nevi, but also substantial benefits when performing these excisions at an early age. These include the smaller size of the lesions as well as the unproblematic wound healing and tissue regeneration in infancy. Nevertheless, several aspects need to be considered when applying TLA in infants including dosing, altered plasma protein binding and the need for adequate and long-lasting pain control.

Fracture of the Leg While Sleeping: Drug-Induced Somnambulism in Adulthood

Somnambulism has a low prevalence, but its intriguing features occasionally cause it to become the focus of scientific interest. Although it mostly occurs in childhood and ceases spontaneously in the majority of cases, sometimes it can persist or reactivate in adulthood. This reactivation tends to be associated with the use of certain medications. Some antipsychotic medications and antidepressants have already been proved to reactivate childhood somnambulism, and some studies have suggested that β-blockers, mostly propranolol, may also play a role. Our study presents the case of a 30-year-old female patient whose past medical history is significant for childhood somnambulism. Four months prior to her presentation to our sleep clinic, she was put on antithyroid medication and propranolol for tachycardia. At the same time her childhood somnambulism reactivated and she fractured her leg during a sleepwalking episode. Polysomnography did not detect any abnormalities. When propranolol was withdrawn, she experienced immediate symptomatic relief. The professional literature we found and analysed and the case we presented both suggest that propranolol with its broad spectrum of indications can trigger somnambulism, especially if it already occurred in the patient’s past medical history. As a result, we recommend listing somnambulism as a potential side effect of propranolol and treating childhood sleepwalking as an absolute contraindication of propranolol.

The use of (newer) antipsychotics in bipolar inpatients over a 17-year observation period

Antipsychotics (AP) are commonly used in the treatment of bipolar disorder. They cover a broad spectrum of indications including acute psychotic, manic and depressive symptoms, and maintenance treatment. This study evaluates the changes in prescribing patterns of first-generation antipsychotics (FGA) and second-generation AP at Innsbruck University Hospital for the treatment of bipolar inpatients between 1999 and 2016. In this retrospective chart review, we included adult patients with a diagnosis of bipolar affective disorder (ICD 9: F296; ICD 10: F31) who were admitted as inpatients at the Department for Psychiatry and Psychotherapy between 1999 and 2016 for more than 7 days. The study was approved by the local ethics committee. The complete medical histories were searched retrospectively for the prescription of psychotropic medications at the time of discharge, with a special focus on APs. We found a significant increase in the use of atypical AP, mainly attributable to the prescription of quetiapine for all types of episodes, followed by aripiprazole for manic and as add-on therapy for depressive episodes. The prescription rate of clozapine decreased significantly. The prescription rate of FGA showed a small but not significant decrease for the treatment of manic and mixed episodes, and a significant decrease for depressive episodes. These trends apparently mirror in part the evidence base for the use of AP, but also illustrate that clinicians still appreciate the effectiveness of FGA despite their inferior tolerability profile.

CAUDAL EPIDURAL ANESTHESIA IN PEDIATRIC PATIENTS

Caudal epidural block is the most widely used regional anesthetic technique in children. Its popularity in pediatric anesthesia is mainly due to its broad spectrum of indications, high success rates, and a relative low incidence of complications. The caudal epidural block is generally used for not only lower abdominal or lower extremity surgery but also for upper abdominal surgery via administration of adjuncts such as morphine, which has hydrosoluble potential. The indications, contraindications and technique of caudal epidural block are presented.

The Role of Popular Participation in the Implementation Quality of Rural Guide Plans )Case Study: Sistan Border Region)

Purpose: This study intended to analyze the role and function of public participation in the quality of the implementation of guide plans in the villages of the border region of Sistan. Design/methodology/approach: This is a descriptive and analytical research. In this regard, a broad spectrum of indicators was determined and studied within the framework of field studies (completing the household questionnaire, interviewing local experts and experts of the Housing Foundation, and filling out forms of field observations) to achieve the desired goal. The Analytic Hierarchy Process (AHP) and statistical and spatial analyses were employed to analyze the information. They were performed using Expert Choice, SPSS and ArcGIS. In statistical analyses, the regression model and Pearson correlation coefficient were employed. Findings: Results confirmed that 53 percent of the villages under study were at a suitable or relatively suitable level with respect to the quality of executing guide plan, and the level of public participation in the implementation of guide plan was at an average level or higher in 60 percent of the villages. Results of statistical analyses also indicated that there was a significant relationship between the participation level in the villages and the quality level of the implementation of guide plan. Research limitations/implications: Active cooperation of the authorities in five counties in Sistan region modified many of the existing limitations in carrying out this research. Nevertheless, the vast expanse of the study region and the difficulty in accessing the sample villages on the one hand and the need to complete the various questionnaires and field observation forms considered for this research on the other hand caused numerous difficulties and hardships and prolonged the implementation of the research. Practical implications: It is necessary that the Housing Foundation study the extent of participation of rural people and the required strategies for expanding public participation and take suitable measures prior to the implementation of guide plans. For this purpose, considering the effective role village managers, members of the Islamic Council of villages and local experts play in enhancing participation of rural people in the implementation of guide plans, the existing potentials in villages must be utilized. Originality / Value: Considering the role and function of public participation in upgrading the quality of executing guide plans, the need for preparing the suitable groundwork for maximizing public participation in the implementation of this plan is emphasized.

Sectoral Greenhouse Gas Emission Mitigation Possibilities. Why Broad Spectrum of Indicators is Applied

Greenhouse gas (GHG) emissions from agriculture account for 10% of total greenhouse gas emissions in the European Union (EU). Mitigation potential of agriculture can be obtained from enhancement of avoidance and reduction of GHG emissions through management of land and livestock. The share of emissions from agriculture in different EU member states (EU MS) varies considerably in accordance with the significance and comparative magnitude of the agricultural sector. On a regular basis, EU MS data are collated regarding progress in development of agriculture and emission mitigation, using different indicators. The aim of this study is to analyse existing indicators used for the evaluation of impacts of agriculture on environment and propose a tool for assessment of GHG emissions mitigation measurements and assist stakeholders in decision making regarding production of agricultural products with a high added value. The research gives insight on how to achieve climate friendly agriculture. The proposed indicators can be used to evaluate GHG emissions mitigation measurements in agriculture.

Telemedical support for prehospital Emergency Medical Service (TEMS trial): study protocol for a randomized controlled trial

BackgroundIncreasing numbers of emergency calls, shortages of Emergency Medical Service (EMS), physicians, prolonged emergency response times and regionally different quality of treatment by EMS physicians require improvement of this system. Telemedical solutions have been shown to be beneficial in different emergency projects, focused on specific disease patterns. Our previous pilot studies have shown that the implementation of a holistic prehospital EMS teleconsultation system, between paramedics and experienced tele-EMS physicians, is safe and feasible in different emergency situations. We aim to extend the clinical indications for this teleconsultation system. We hypothesize that the use of a tele-EMS physician is noninferior regarding the occurrence of system-induced patient adverse events and superior regarding secondary outcome parameters, such as the quality of guideline-conforming treatment and documentation, when compared to conventional EMS-physician treatment.Methods/designThree thousand and ten patients will be included in this single-center, open-label, randomized controlled, noninferiority trial with two parallel arms. According to the inclusion criteria, all emergency cases involving adult patients who require EMS-physician treatment, excluding life-threatening cases, will be randomly assigned by the EMS dispatching center into two groups. One thousand five hundred and five patients in the control group will be treated by a conventional EMS physician on scene, and 1505 patients in the intervention group will be treated by paramedics who are concurrently instructed by the tele-EMS physicians at the teleconsultation center. The primary outcome measure will include the rate of treatment-specific adverse events in relation to the kind of EMS physician used. The secondary outcome measures will record the specific treatment-associated quality indicators.DiscussionThe evidence underlines the better quality of service using telemedicine networks between medical personnel and medical experts in prehospital emergency care, as well as in other medical areas. The worldwide unique EMS teleconsultation system in Aachen has been optimized and evaluated in pilot studies and subsequently integrated into routine use for a broad spectrum of indications. It has enabled prompt, safe and efficient patient treatment with optimized use of the “resource” EMS physician. There is, however, a lack of evidence as to whether the advantages of the teleconsultation system can be replicated in wider-ranging EMS-physician indications (excluding life-threatening emergency calls).Trial registrationClinicalTrials.gov, identifier: NCT02617875. Registered on 24 November 2015.

MEASURING MACROECONOMIC INSTABILITY: A CRITICAL SURVEY ILLUSTRATED WITH EXPORTS SERIES

AbstractFor at least 40 years, the analysis of the causes and consequences of macroeconomic instability has greatly deepened our understanding of the handicaps faced by developing countries. This concern on economic instability is evidenced by a broad spectrum of indicators, based on the deviation of observed values of a given economic aggregate from its reference or trend value. In general, the choice of this or that indicator is not discussed advocating that the resulting instability indicators are closely correlated. Focusing on measurements of instability in export revenue data for 134 countries from 1970 to 2005, this paper finds that this assertion may be true for variance‐based indicators, measuring the average magnitude of deviations from the trend. However, great discrepancies may arise between different measures of the asymmetry or of the occurrence of extreme deviations around the trend when different trend computation methods are used. Our purpose is, therefore, to invite further discussions regarding the use of these indicators, and to highlight the different dimensions of instability, which have been so far unheeded by the economic literature.

Social Capital in 2009: An Index for the Netherlands

This paper integrates a set of independent social capital indicators into one index by using structural equation modeling (SEM) based on partial least squares estimation (PLS). The social capital index consists of two dimensions: participation and trust. In each of the two dimensions, three levels are distinguished: social (micro), organizational (meso), and political (macro). The main objectives of the index are to: (1) provide a coherent overview of social capital in the Netherlands; (2) monitor social capital over time; and (3) compare subpopulations.A broad spectrum of indicators is included, however, these are only weakly correlated and consequently treated as distinct. Therefore, traditional index development methods such as factor analysis and reflective modeling cannot be applied. Consequently, formative modeling in which the indicators are specified as causes rather than as effects is used. We employ the Permanent Survey on Living Conditions 2009 (POLS), administered face-to-face to 7,560 respondents in the Netherlands. We find that the index predicts well-being and health, which demonstrates nomological validity. Subsequently, bootstrapping is conducted to test the robustness of the index.

Endothelialisation of Cardiovascular Implants ? A Matter of Concern

Cardiovascular implants have been introduced into clinical practice for a broad spectrum of indications. Devices can be implanted at almost every location throughout the cardiovascular system. Beside the surgical route, many other ways and methods have been developed for bringing the implant to its destiny in the human body. Heart surgeons, vessel surgeons, neurosurgeons, radiologists, cardiologists and pediatric cardiologists routinely perform implantations of a large variety of devices into blood vessels or into the heart.

Developing a Social Capital Index for the Netherlands

This paper integrates a set of independent social capital indicators into one index by using structural equation modeling (SEM) based on partial least squares estimation (PLS). The social capital index consists of two dimensions: participation and trust. In each of the two dimensions, three levels are distinguished: social (micro), organizational (meso), and political (macro). The main objectives of the index are to: (1) provide a coherent overview of social capital in the Netherlands; (2) monitor social capital over time; and (3) compare subpopulations. A broad spectrum of indicators is included, however, these are only weakly correlated and consequently treated as distinct. Therefore, traditional index development methods such as factor analysis and reflective modeling cannot be applied. Consequently, formative modeling in which the indicators are specified as causes rather than as effects is used. We employ the Permanent Survey on Living Conditions 2009 (POLS), administered face-to-face to 7,560 respondents in the Netherlands. We find that the index predicts well-being and health, which demonstrates nomological validity. Subsequently, bootstrapping is conducted to test the robustness of the index. And the 2009 index is replicated based on the 2010 POLS data. The replication shows that the 2009 model is relatively stable and results are robust. Finally, the model is extended by including volunteering and informal help, which changes the model but the results remain largely the same. This index, which is shown to be valid and robust, contributes to a further understanding of the concept of social capital.