Clinical Performance Research Articles

A 3-year clinical evaluation of endocrown restorations with two different materials using the computer-aided design/ computer-aided manufacture system

ObjectiveTo compare the clinical efficacy of resin nanoceramic and zirconia-reinforced lithium silicate ceramic endocrowns in the treatment of endodontically treated teeth by assessing the clinical performance of restorations fabricated using a chairside computer-aided design/computer-aided manufacturing (CAD/CAM) system. Materials and methodsNinety endocrown restorations were fabricated on endodontically treated teeth using a CAD/CAM system. Fifty-two restorations were fabricated using Lava Ultimate blocks (LU, 3 M Espe, Seefeld, Germany) and 38 restorations were fabricated using Celtra Duo blocks (CD, Dentsply Sirona, York, PA, USA). The performance of the endocrown restorations was evaluated over a 3-year period using the modified United States Public Health Service (USPHS) criteria by two calibrated evaluators. The data were analyzed using Chi-square (x2) and Fisher exact tests (p < 0.05). ResultsThe restoration survival rates in the two groups were 82.7 % (LU) and 86.8 % (CD) (p = 0.6). Twelve restorations failed (8 LU, 4 CD) due to debonding (n = 4, 2 LU, 2 CD), ceramic fracture (n = 2, 1 LU, 1 CD), tooth fracture (n = 5, 4 LU, 1 CD), and secondary caries (n = 1, 1 LU) during the follow-up period. There was no statistically significant difference between the two materials according to the modified USPHS criteria (p > 0.05). ConclusionResin nanoceramic and zirconia-reinforced lithium silicate ceramic endocrown restorations fabricated using a chairside CAD/CAM system demonstrated acceptable clinical performance in the treatment of endodontically treated teeth. Clinical SignificanceResin nanoceramic and zirconia-reinforced lithium silicate ceramics are potential alternative materials for the chairside fabrication of endodontically treated teeth.

Validation of Neutrophil gelatinase-associated lipocalin (NGAL) for Diabetes-associated Acute Kidney Injury

Abstract Introduction/Objective This study aimed to evaluate the analytical and clinical performance of the BioPorto NGAL Test on the Beckman Coulter AU480 to correlate plasma neutrophil gelatinase-associated lipocalin levels (pNGAL) with clinical progression and severity of diabetes-associated acute kidney injury (AKI) with hospitalized patients at an East Central Georgia Medical Center Methods/Case Report Analytical validation of the BioPorto NGAL Test was carried out on the AU480 and was based on imprecision, limit of blank, limit of detection, functional sensitivity, carryover, and specificity. Clinical validation studies included 45 patients hospitalized between January and November 2023 with and without diabetes at risk for developing AKI. All patients’ pNGAL levels were measured at admission until 96 hours post admission. Receiver operating characteristics and likelihood ratio methods were used to determine optimal sensitivity, specificity, cutoff value, and the discriminatory power of pNGAL. Results (if a Case Study enter NA) The intra-assay and inter-assay imprecision percent relative standard deviation was between 0.8 (2.7%) and 3.7 (4.2%). The limit of blank and limit of detection of Bioporto NGAL was 2.2 ng/mL and 15.4 ng/mL, respectively. An analytical coefficient of variation of 20% corresponded to a pNGAL value of 9.9 ng/mL. The optimal cutoff value for pNGAL to predict AKI for patients with DM was 293 ng/mL, with a sensitivity of 80% and specificity of 87%; AUC: 0.85, p &amp;lt; 0.001. In a multivariate logistic regression model, pNGAL levels at 48 hours post admission were a risk factor for diabetes-associated AKI (OR 1.012, 95% CI:1.000 – 1.023; p = 0.051). Conclusion These results show that pNGAL levels at 48h are an independent risk factor for diabetes-associated AKI, and the optimal cutoff for this condition is 293 ng/mL. The optimal cutoff values for AKI for early diagnosis and risk stratification, along with its association with comorbidities, are important to improve patient outcomes and diagnosis accuracy.

Evolving interfaces: A comprehensive review of implant-abutment connections

Studying the implant-abutment connection is crucial, as it primarily determines the strength and stability of an implant-supported restoration, which, in turn, affects prosthetic stability. Traditionally, Brånemark's external hexagon has been used. However, significant complications such as abutment screw loosening, rotational misfit at the implant-abutment interface and microbial penetration have necessitated modifications of the external hexagon and led to the development of internal implant-abutment connection.This review outlines the evolution of various implant-abutment connections from the traditional external hexagon to advanced internal designs. Internal interface designs offer several advantages over the traditional approach. They reduce the vertical height platform for restorative components and distribute lateral loading deep within the implant. These designs also shield the abutment screw and provide long internal wall engagements that create a rigid, unified body resisting joint opening. Additionally, they feature wall engagement with the implant that buffers vibration, offer the potential for a microbial seal, and provide extensive flexibility. Importantly, they allow for the lowering of the restorative interface to the implant level for better aesthetics. These advancements have significantly enhanced the clinical performance and reliability of implant-supported restorations.

Effect of an Additional Hydrophobic Adhesive Layer Application on the Clinical Performance of Class V Resin Composite Restorations: An 18-month Randomized Clinical Trial.

This study aimed to evaluate the 18-month clinical performance of two different one-step adhesives that were applied alone or with an additional hydrophobic adhesive layer to noncarious cervical lesions. One hundred sixty teeth in 31 patients were included in the study. Each patient received at least four restorations. A 2-hydroxyethylmethacrylate (HEMA)-containing one-step self-etch adhesive (Clearfil S3 Bond Plus, Kuraray Noritake, Noritake, Japan) and a HEMA-free universal adhesive (G-Premio Bond) were applied to noncarious cervical lesions with or without additional hydrophobic adhesive (Heliobond) randomly. Teeth were restored with a nanohybrid composite. Restorations were evaluated according to FDI criteria at baseline, 6-, 12-, and 18-month recalls. Data were analyzed with the Kruskal-Wallis and the Friedman analysis of variance (ANOVA) tests (α=0.05). At 18 months, recall rates were 100%, and there was no significant difference between four different adhesive applications in terms of any criteria (p>0.05). The cumulative retention rates were 92.5%, 92.5%, 97.5%, and 100% for the restorations with one-step self-etch, one-step self-etch plus hydrophobic adhesive layer, a universal adhesive, and a universal adhesive plus hydrophobic adhesive layer, respectively. An additional hydrophobic adhesive layer was found to have no significant effect on the 18-month clinical performance of two different one-step adhesive systems with and without HEMA.

Evaluation of Glutathione (GSH) System in Porcine Saliva: Validation and Application of Colorimetric Method.

(1) Reduced glutathione (GSH) is considered the first line of antioxidant defense. During oxidative stress, it is oxidized to glutathione disulphide (GSSG). (2) A simple and quick spectrophotometric method based on sodium borohydride (NaBH4) as a reductant to measure the total and reduced GSH in porcine saliva was analytically validated and evaluated in two situations in this species: (a) in a physiological situation, involving sows during the late lactation and post-weaning periods, and (b) in a situation of sepsis in pigs experimentally induced by LPS administration. (3) The results of the analytical validation showed that the assay was precise and accurate in the porcine saliva samples. Higher total GSH and GSSG and lower reduced GSH were observed in the saliva of sows during the post-weaning period, as well as in pigs with experimentally induced sepsis. (4) In conclusion, the validated assay showed adequate analytical results and could be used to evaluate the GSH system of porcine saliva, as demonstrated during the clinical performance.

Surveillance Imaging and GAAD/GALAD Scores for Detection of Hepatocellular Carcinoma in Patients with Chronic Hepatitis.

Early detection of hepatocellular carcinoma (HCC) is crucial for improving survival in patients with chronic hepatitis. The GALAD algorithm combines gender (biological sex), age, α-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and protein induced by vitamin K absence or antagonist-II (PIVKA-II) for HCC detection. Similarly, the GAAD algorithm incorporates gender (biological sex), age, AFP, and PIVKA-II. This study aimed to assess the clinical utility of AFP-L3 in the GALAD algorithm and its potential synergies with ultrasound. We compared the clinical performance of GALAD with GAAD; AFP; AFP-L3; and PIVKA-II, with or without ultrasound, in Taiwanese adults. A total of 439 serum samples were analyzed using a Cobas® e 601 analyzer (healthy controls, n = 200; chronic liver disease controls, n = 177; HCC cases, n = 62). Performance was assessed through receiver operating characteristic curve analyses to calculate the area under the curve. The area under the curve for differentiating early-stage HCC from patients with chronic liver disease was optimal for PIVKA-II (84.9%), GAAD (79.8%), and GALAD (79.4%), with slightly improved performance for detecting all-stage HCC. Clinical performance was unaffected by disease stage or etiology. Sensitivity for early-stage HCC was highest for GAAD (57.6%) and GALAD (57.6%). Sensitivity for each strategy was further enhanced when combined with ultrasound, regardless of disease stage or etiology (P < 0.01). These findings indicate that the role of AFP-L3 in the GALAD algorithm is minimal, supporting the use of GAAD for HCC detection. A combination of GAAD, GALAD, or PIVKA-II with ultrasound may improve diagnostic efficiency compared with recommended strategies.

24 Months clinical prospective of proximal restorations with repeated preheating bulk fill composite up to ten cycles: randomized controlled trial

This study aimed to clinically evaluate the performance of non-preheated bulk fill resin composite in class II cavities versus one, five and ten-time preheating cycles at 68 °C. Eighty-four recruited participants were randomly allocated into four groups (21 patients per group). One posterior Bulk-fill proximal restoration was performed for each participant according to the preheating cycles where in group I; teeth were restored with non-heated resin composite, group II: One preheating cycle of composite syringe was performed prior restoration, and group III: five preheating cycles while for group IV: Ten preheating cycles were performed. These restorations were clinically evaluated at 6, 12, 18 and 24 months. Statistical analysis was performed using one way ANOVA, with set p-value < 0.05. The results revealed that there was perfect agreement between both observers and observations WK (95% CI) [0.908 (0.780:1.000)] and [0.940 (0.824:1.000)], respectively. All restorations showed acceptable clinical performance with alpha and bravo scores. No replacement was required for any restoration. No statistically significant differences were detected between the control and intervention groups across all parameters during the various evaluation stages. It could be concluded that the clinical performance of ten cycles of repeated preheated bulk fill resin composite was equivalent to that of non-preheating resin composites after 24 months follow-up period, with great improvement in manipulation. Preheating of resin composite could be performed up to ten cycles prior to placement without any clinical adverse consequences on the performance of the restoration.

The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial

BackgroundBurn wounds require optimal medical management due to associated psycho-emotional and socioeconomic impacts and severe pain. The use of synthetic and biological dressings improves healing and reduces burn wound complications. The present study aimed to compare the outcomes of using human amniotic membrane (hAM) dressings and conventional silver sulfadiazine (SSDZ) ointment dressings in the management of second-degree burn wounds.MethodsFifty patients who participated in this clinical trial were divided into two groups via simple randomization. All the enrolled patients, who had burnt in the last 24 h, had thermal damage mechanisms and were suffering from less than 20% second-degree heat-burn wounds on the skin surface. The target group (n = 25) was treated with hAM, and the control group (n = 25) was treated with SSDZ ointment. The researcher-designed checklist was used to determine the clinical performance in the follow-up assessments on days 7, 14, and 30.ResultsNo significant differences were detected in terms of sex, age, or percentage of burn wounds (p > 0.05). Wound epithelialization at days 7, 14, and 30, scar formation, wound pigmentation, pain severity, analgesia requirements, and hospital stay length (on day 30) were significantly lower in the target group (treated with hAM) than in the control group (treated with SSDZ ointment) (p < 0.05). However, treatment costs in the target group ($170) were significantly higher than those in the control group ($71) (p < 0.001).ConclusionDespite its higher cost, hAM, as a technology-based therapy dressing, demonstrates superiority over SSDZ ointment in terms of wound healing and pain management.

Clinical performance of a new lateral flow immunoassay for xylazine detection.

Xylazine is a potent sedative used in veterinary medicine. Recently, recreational drugs such as fentanyl havebeen found to contain xylazine, increasing the risk of respiratory depression and death. Despite a similar presentation to opioid overdose, patients who ingest xylazine donot respond to treatment with Narcan. Therefore, rapid detection of xylazine could improve patient management and prevent adverse outcomes. We evaluated the XYL500 one-step xylazine drug of abuse test for its ability to detect xylazine in 152 urine samples from patients on chronic opioid therapy for pain management or in treatment for substance use disorder. Results were compared to LC-MS/MS as the reference method. Precision, cross-reactivity, interference and stability studies were performed. Pooled patient samples were consistently negative or positive when tested five times on the same day and over three days of testing. The diagnostic sensitivity, specificity and accuracy of the XYL500 assay were 74, 98, and 82 % respectively, as compared with LC-MS/MS. XYL500 detected 77 of the 104 LC-MS/MS positive samples identified in our initial evaluation, including some that contained low levels of xylazine (n=8), <10 ng/mL. Minimal cross-reactivity with other opioid analgesics and commonly encountered drugs was seen with only one false positive result. Interferences by common urine contaminants were negligible. Specimens were stable up to 160 days refrigerated and up to 80 days at room temperature. XYL500 allows for rapid detection of xylazine, illustrating its utility in monitoring patients who ingested recreational drugs containing the additive, xylazine, and its potential to improve patient management.

Evaluation of the Clinical Impact of a Smartphone Application for Cataract Detection.

Background Approximately 10 million people in India suffer from bilateral blindness, with cataracts accounting for roughly 70% of these cases. However, there is a severe scarcity of ophthalmologists in India (12,000 across the country), which makes routine cataract screening very difficult, particularly in rural areas. To tackle this problem, we investigated the use of an artificial intelligence (AI)-based application for cataract screening at All India Institute of Medical Sciences (AIIMS), Bibinagar, that can be used by nursing officers and other healthcare professionals as a primary screening tool. Ophthalmologists from AIIMS Bibinagar additionally validate the results of this application. Purpose The aim of this study was to assess the clinical performance of a smartphone-based cataract screening application that uses an AI module to identify cataracts in photos taken with the device's camera. The study compared the application's results with diagnoses made by ophthalmologists using a slit lamp. Methods At AIIMS Bibinagar, 495 patients participated in a prospective clinical trial. The AI-based screening solution examined smartphone images that were taken in accordance with a set protocol to identify whether cataracts were present. The results of the application were then compared with the diagnoses made by ophthalmologists based on slit-lamp tests. Results The study included 990 eye images. The AI screening application demonstrated an overall accuracy of 90.01% for cataract detection. Specific metrics include a sensitivity of 89.50%, specificity of 89.73%, precision of 91.43%, and an F1 score of 90.36%. The positive predictive value (PPV) was approximately 91.3%, based on 485 true positives and 46 false positives. The negative predictive value (NPV) was approximately 87.6%, based on 402 true negatives and 57 false negatives. Conclusions The smartphone-based cataract screening application proves to be an effective tool for community-level cataract screening in remote areas where access to expensive equipment and specialized ophthalmic care is limited. Its high accuracy and efficiency make it a valuable option for low-resource settings and suitable for home screening, particularly in the post-COVID era.

Structural Analysis of Hyaluronic Acid Fillers Using Nuclear Magnetic Resonance: Implications for Quality Control and Clinical Performance.

Potential disruptions in the biocompatibility of hyaluronic acid (HA) fillers can arise with mono-linked 1,4-butanediol diglycidyl ether (BDDE) or unreacted (pendant) 1,4-butanediol di-(propan-2,3-diolyl) ether. Assessing the filler's degree of modification involves evaluating improperly cross-linked BDDE. This study analyzed commercially available HA fillers using nuclear magnetic resonance (NMR), focusing on key parameters, such as the degree of modification (MoD), the cross-linker ratio (CrR), and the degree of cross-linking. We assessed thirteen commercially available HA fillers using NMR. The samples were placed in an NMR instrument, and each sample was analyzed for 26 h, including MoD and CrR assessments. MoD 1H ranged from 17.065% to 2.239%, MoD 13C ranged from 12.567% to 1.947%, and CrR 13C ranged from 0.394 to 0.014. Significant distinctions were observed in the CrR 13C values when the MoD values of the products were similar. This study underscores the importance of considering the MoD and the CrR together to ensure optimal cross-linking and minimize the risks associated with residual BDDE impurities. Utilizing NMR for HA gel characterization provides valuable insights regarding product quality control, safety assessments, and clinical performance evaluations for esthetic interventions, contributing to filler product improvements. Further studies correlating NMR findings with real-world outcomes are essential for ensuring safety and efficacy.

Longitudinal Outcomes: Student Perceptions of a Third-Party-Resource-Based Pre-matriculation Module.

Medical school is grueling. Students are required to learn large amounts of subject matter in short periods of time, while also participating in extra-curricular activities to become well-prepared and future residents. While many third-party resources can aid students in navigating the curriculum, the process of assessing and selecting these tools can be time-consuming and frustrating. To address this challenge, a pre-matriculation module was developed to introduce students to various third-party resources, enabling them to identify their preferences and understand their learning styles before matriculation. Links to free trials were also provided. Additionally, a supplement to the module featured advice and strategies from top-quartile students (now Doctors of Osteopathic Medicine (D.O.s)) on how to succeed in the pre-clinical curriculum. The module included voice-over slide presentations that highlighted third-party resources, tips for using these resources effectively, and insights from contributors on succeeding in the pre-clinical phase. To assess the perceived efficacy of the program, surveys were administered to incoming first-year osteopathic medical students (OMS-1) students at several time points: before beginning the first semester and pre-matriculation module, immediately after completing the module, and at the end of the first semester. Further surveys were conducted at the end of the second, third, and fourth semesters. Statistical analysis of the survey data was performed to evaluate students' perceptions of the module's value. Results indicated that students perceived the pre-matriculation module as significantly contributing to their pre-clinical academic success. These findings suggest that early exposure to third-party learning resources and tailored guidance from successful peers may ease the transition into medical school and foster better academic outcomes. Future research should explore the long-term impact of such pre-matriculation interventions on clinical performance and overall medical education. Additionally, investigations into tailoring modules to different learning styles or specific specialties could further optimize the student experience and success in medical education.

Team-based learning in health professions education: an umbrella review

BackgroundTeam-Based Learning (TBL) has garnered considerable attention in education research. To consolidate the existing evidence, we conducted an umbrella review with four objectives: (a) to identify TBL review characteristics, (b) to synthesize findings from previous reviews regarding TBL effectiveness and outcomes, (c) to determine which student groups benefit most, and (d) to identify the most and least researched elements.MethodsThe Joanna Briggs Institute (JBI) methodology was followed: [1] Search strategy and literature search [2] Screening and Study Selection [3] Assessment of methodological quality [4] Data collection, and [5] Data summary. We utilized Endnote, Excel, and MAXQDA for efficient project management and analyzing data.ResultsAnalyzing twenty-three reviews spanning from 2013 to 2024, we found a peak in TBL research in 2022 including more than 312 unique primary studies involving more than 63,987 participants. Notably, the United States and China accounted for over 61% of the total primary articles focused on students from medicine, nursing, pharmacy, and dentistry. Evidence supports the superiority of TBL in enhancing cognitive outcomes. However, findings related to retention are mixed. Insufficient evidence exists to draw robust conclusions when comparing TBL with other active learning methods. TBL demonstrates favorable outcomes in terms of clinical performance and engagement. Non-technical skills show mixed results. Notably, TBL positively impacts self-study, learning ability, decision-making, and emotional intelligence. Faculty experiences reveal an initial increase in workload, but generally hold positive attitude. Faculty development remain limited in duration and scope. Freshmen, academically weaker students, undergraduates, Chinese female students, and nursing students appear to benefit most from TBL. Team formation and size are the most frequently studied elements.ConclusionTBL holds promise for improving learning outcomes, but ongoing investigation is essential to maximize its impact in diverse educational contexts. This umbrella review underscores the need for further research in specific areas i.e. effective pre-class learning methods and faculty workload.

High-Throughput Hybridization Assay as First-Line Diagnostic Test for Sarcomas: Clinical Assessment in a Tertiary Referral Center.

Sarcomas are rare and highly heterogeneous mesenchymal tumors with deceptive morphologic features that pose a challenge for precise diagnostics. Chromosomal rearrangements generating pathognomonic gene fusions are useful diagnostic markers, traditionally tested using single-plex standard of care assays with limited diagnostic yield. NanoString nCounter technology has emerged as a robust solution with multiplexing capabilities. To optimize NanoString effective coverage of specific entities and conduct a validation study to support its clinical implementation. We reconfigured a NanoString's codeset by including a set of probes for detecting gene fusion variants of solitary fibrous tumors, low-grade fibromyxoid sarcomas/sclerosing epithelioid fibrosarcomas, and undifferentiated small round cell sarcomas, totaling 188 probes. A technical validation study was conducted with 96 retrospective samples. Additionally, 76 prospective samples were evaluated to assess the assay's clinical performance. Both technical and clinical validation studies showed that NanoString's codeset reached >88% sensitivity and 100% specificity, compared with standard of care methods, and superior diagnostic yield as a first-line test. Our design enabled the detection of almost all fusion variants of NGFI-A binding protein 2 (NAB2) with signal transducer and activator of transcription 6 (STAT6) in solitary fibrous tumors, as well as cAMP responsive element binding protein 3 like 1/2 (CREB3L1/2) rearrangements in all low-grade fibromyxoid sarcoma/sclerosing epithelioid fibrosarcoma cases. Identification of specific gene fusions of undifferentiated small round cell sarcoma was also improved, but additional strategies are necessary to attain full coverage. The NanoString platform demonstrated good sensitivity, specificity, and superior diagnostic yield. It is a cost-effective assay with rapid turnaround time, low sample consumption, streamlined analysis, and easy customization. Therefore, it is a promising alternative first-line diagnostic tool for routine sarcoma testing.

Effective use of actifuse shape in spinal fusion: A retrospective chart review

Introduction: This study aimed to assess the safety and clinical performance of Actifuse Shape for spine surgery. Method: A retrospective real-world data study was conducted in two research sites in the U.S. Patient medical records had to show evidence of implantation with Actifuse Shape in 1-2 levels or 2 or more levels cervical (C2 or lower), in either posterolateral thoraco-lumbar or lumbar spine fusion procedures, among other eligibility criteria. All fusion assessments were completed using the Glassman 5 grade fusion scale. Results: Fifty-five (55) medical records were included in the full analysis set, and of these, 42 were eligible, achieving 97.6% bone fusion with a 95% CI (87.4%, 99.9%). Fusion success rates (Grade 4 or 5): 6 mo 72.7% (n=8/11), 12 mo 97.6% (n=41/42) and 24 mo 100% (n=49/49). No device-related adverse events were reported for Actifuse Shape. A “worst-case” imputation post hoc analysis was performed to take into account five patients who did not show evidence of fusion at 6 mo and were lost to follow up and were assumed to continue showing no evidence of fusion throughout the remaining study period. Forty-one out of 47 (87.2%) patients (95% CI: 74.3, 95.2) achieved successful fusion at 12 mo (±60 days) and 49/55 (89.1%) patients (95% CI: 77.8, 95.9) achieved successful fusion at 24 mo (+60 days). Conclusions: Actifuse Shape is safe and is associated with high rate of bony fusion when implanted as the primary bone graft substitute in spinal fusion surgeries.

Multi-analyte proteomic analysis identifies blood-based neuroinflammation, cerebrovascular and synaptic biomarkers in preclinical Alzheimer’s disease

BackgroundBlood-based biomarkers are gaining grounds for the detection of Alzheimer’s disease (AD) and related disorders (ADRDs). However, two key obstacles remain: the lack of methods for multi-analyte assessments and the need for biomarkers for related pathophysiological processes like neuroinflammation, vascular, and synaptic dysfunction. A novel proteomic method for pre-selected analytes, based on proximity extension technology, was recently introduced. Referred to as the NULISAseq CNS disease panel, the assay simultaneously measures ~ 120 analytes related to neurodegenerative diseases, including those linked to both core (i.e., tau and amyloid-beta (Aβ)) and non-core AD processes. This study aimed to evaluate the technical and clinical performance of this novel targeted proteomic panel.MethodsThe NULISAseq CNS disease panel was applied to 176 plasma samples from 113 individuals in the MYHAT-NI cohort of predominantly cognitively normal participants from an economically underserved region in southwestern Pennsylvania, USA. Classical AD biomarkers, including p-tau181, p-tau217, p-tau231, GFAP, NEFL, Aβ40, and Aβ42, were independently measured using Single Molecule Array (Simoa) and correlations and diagnostic performances compared. Aβ pathology, tau pathology, and neurodegeneration (AT(N) statuses) were evaluated with [11C] PiB PET, [18F]AV-1451 PET, and an MRI-based AD-signature composite cortical thickness index, respectively. Linear mixed models were used to examine cross-sectional and Wilcoxon rank sum tests for longitudinal associations between NULISA and neuroimaging-determined AT(N) biomarkers.ResultsNULISA concurrently measured 116 plasma biomarkers with good technical performance (97.2 ± 13.9% targets gave signals above assay limits of detection), and significant correlation with Simoa assays for the classical biomarkers. Cross-sectionally, p-tau217 was the top hit to identify Aβ pathology, with age, sex, and APOE genotype-adjusted AUC of 0.930 (95%CI: 0.878–0.983). Fourteen markers were significantly decreased in Aβ-PET + participants, including TIMP3, BDNF, MDH1, and several cytokines. Longitudinally, FGF2, IL4, and IL9 exhibited Aβ PET-dependent yearly increases in Aβ-PET + participants. Novel plasma biomarkers with tau PET-dependent longitudinal changes included proteins associated with neuroinflammation, synaptic function, and cerebrovascular integrity, such as CHIT1, CHI3L1, NPTX1, PGF, PDGFRB, and VEGFA; all previously linked to AD but only reliable when measured in cerebrospinal fluid. The autophagosome cargo protein SQSTM1 exhibited significant association with neurodegeneration after adjusting age, sex, and APOE ε4 genotype.ConclusionsTogether, our results demonstrate the feasibility and potential of immunoassay-based multiplexing to provide a comprehensive view of AD-associated proteomic changes, consistent with the recently revised biological and diagnostic framework. Further validation of the identified inflammation, synaptic, and vascular markers will be important for establishing disease state markers in asymptomatic AD.

Three-year clinical performance of direct restorations using low-shrinkage Giomer vs. nano-hybrid resin composite

ObjectivesThe objective of this investigation was to compare the clinical performance of a nano-hybrid resin composite and a low-shrinkage Giomer resin composite.Material and methodsIn total, 35 pairs of restorations were performed using either low-shrinkage Giomer (Beautifil II LS, Shofu Inc.) or nano-hybrid (Clearfil Majesty Posterior) resin composite in 35 patients by two operators using the relevant adhesives, i.e., FL-Bond II (Shofu Inc.) and Clearfil SE Bond (Kuraray), with the self-etching technique according to each manufacturer's instructions. Two clinicians assessed the restorations 2 weeks (baseline); 6 months; and 1, 2, and 3 years after the restorative procedures using FDI (World Dental Federation) criteria (Scores 1–5). Data were analyzed using the marginal homogeneity and McNemar tests. The survival rate was calculated using Kaplan–Meier survival analysis and the survival of the two groups was compared with the log-rank test (p = 0.05).ResultsThe mean observation period was 37.7 ± 6.8 months. All restorations completed their 3-year follow-up. The criteria were mainly rated with high (1 or 2) scores for quality in both groups. Only one restoration in the low-shrinkage Giomer resin composite group was accepted as a failure at the 2-year recall due to retention loss.ConclusionAt the 3-year follow-up, the performance of the restorations using the Giomer and the nano-hybrid resin composite were similar and clinically acceptable.Clinical relevanceThe low-shrinkage Giomer resin composite exhibited a similar clinical performance to the nano-hybrid resin composite after 3 years in service with both materials displaying minor surface deteriorations at the 3-year recall.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier: NCT02823769.

Recent Advances in Intraoral Scanners.

Intraoral scanners (IOSs) have emerged as a cornerstone technology in digital dentistry. This article examines the recent advancements and multifaceted applications of IOSs, highlighting their benefits in patient care and addressing their current limitations. The IOS market has seen a competitive surge. Modern IOSs, featuring continuous image capture and advanced software for seamless image stitching, have made the scanning process more efficient. Patient comfort with IOS procedures is favorable, mitigating the discomfort associated with conventional impression taking. There has been a shift toward open data interfaces, notably enhancing interoperability. However, the integration of IOSs into large dental institutions is slow, facing challenges such as compatibility with existing health record systems and extensive data storage management. IOSs now extend beyond their use in computer-aided design and manufacturing, with software solutions transforming them into platforms for diagnostics, patient communication, and treatment planning. Several IOSs are equipped with tools for caries detection, employing fluorescence technologies or near-infrared imaging to identify carious lesions. IOSs facilitate quantitative monitoring of tooth wear and soft-tissue dimensions. For precise tooth segmentation in intraoral scans, essential for orthodontic applications, developers are leveraging innovative deep neural network-based approaches. The clinical performance of restorations fabricated based on intraoral scans has proven to be comparable to those obtained using conventional impressions, substantiating the reliability of IOSs in restorative dentistry. In oral and maxillofacial surgery, IOSs enhance airway safety during impression taking and aid in treating conditions such as cleft lip and palate, among other congenital craniofacial disorders, across diverse age groups. While IOSs have improved various aspects of dental care, ongoing enhancements in usability, diagnostic accuracy, and image segmentation are crucial to exploit the potential of this technology in optimizing patient care.

Clinical performance evaluation of the BioFire Joint Infection Panel.

The BioFire Joint Infection (JI) Panel offers a significant advancement in the rapid diagnosis of joint infections by facilitating the simultaneous detection of multiple bacterial and fungal pathogens, as well as resistance markers, directly from synovial fluid samples. An article published in the Journal of Clinical Microbiology by Moran et al. (J Clin Microbiol 62:e00182-24, 2024, https://doi.org/10.1128/jcm.00182-24) presents both prospective and retrospective analyses of the panel's real-world clinical application. The study highlights the panel's benefits, such as its rapid turnaround time and ability to identify challenging pathogens, while also discussing its limitations, particularly in detecting certain off-panel organisms.

Development and validation of an instrument to evaluate the perspective of using the electronic health record in a hospital setting

BackgroundEvaluating healthcare information systems, such as the Electronic Health Records (EHR), is both challenging and essential, especially in resource-limited countries. This study aims to psychometrically develop and validate an instrument (questionnaire) to assess the factors influencing the successful adoption of the EHR system by healthcare professionals in Moroccan university hospitals.MethodsThe questionnaire validation process occurred in two main stages. Initially, data collected from a pilot sample of 164 participants underwent analysis using exploratory factor analysis (EFA) to evaluate the validity and reliability of the retained factor structure. Subsequently, the validity of the overall measurement model was confirmed using confirmatory factor analysis (CFA) in a sample of 368 healthcare professionals.ResultsThe structure of the modified HOT-fit model, comprising seven constructs (System Quality, Information Quality, Information technology Service Quality, User Satisfaction, Organization, Environment, and Clinical Performance), was confirmed through confirmatory factor analysis. Absolute, incremental, and parsimonious fit indices all indicated an appropriate level of acceptability, affirming the robustness of the measurement model. Additionally, the instrument demonstrated adequate reliability and convergent validity, with composite reliability values ranging from 0.75 to 0.89 and average variance extracted (AVE) values ranging from 0.51 to 0.63. Furthermore, the square roots of AVE values exceeded the correlations between different pairs of constructs, and the heterotrait-monotrait ratio of correlations (HTMT) was below 0.85, confirming suitable discriminant validity.ConclusionsThe resulting instrument, due to its rigorous development and validation process, can serve as a reliable and valid tool for assessing the success of information technologies in similar contexts.