Independent Investigators Research Articles

Further evidence confirms the association between smoking and dry socket: a motivational opportunity for tobacco cessation.

A systematic review and meta-analysis of observational studies. Electronic search included PubMed, Scopus, and Web of Science databases up to March 2022 using appropriate keywords. The review included all observational studies (case-control, cohort and cross-sectional studies) published in English after 2000, comparing the prevalence of dry socket between smokers and non-smokers after simple or surgical tooth extraction. Exclusion criteria included patients with other post-extraction complications, prevalence of different risk factors, and unrelated study designs (literature reviews, case reports, expert opinion, and conference reports). Two independent investigators screened the records (by title, abstract, and full text), and selected the eligible studies according to the predefined criteria. Collected data from each study included author name and country, year of publication, gender and age of patients, smoking status, inclusion and exclusion criteria, medical history and oral hygiene, prevalence of dry socket, type of tooth and extraction technique, symptoms and treatment. Risk of bias was assessed according to the (NHLBI, NIH) Quality Assessment Tool For Observational Cohort and Cross-Sectional Studies, while the level of evidence was assessed using the classification of the Oxford Centre for Evidence-Based Medicine levels for diagnosis. Two independent reviewers conducted the assessments, and any disagreements were addressed through discussion. Eleven studies from ten different countries representing a total of 10,195 patients (3007 smokers and 7188 non-smokers) were included in the final analysis. Nine studies were classified as having "good" quality and two as "intermediate," while all of the studies have the third or fourth level of evidence (through 5-graded scale). The prevalence of dry socket in smokers was about 13.2% (95% CI: 5.8-23.1%) and in non-smokers about 3.8% (95% CI: 2.1-6.0%). Meta-analysis showed that regular tobacco smoking was associated a more than 3-fold increase in the odds of dry socket after tooth extraction. Despite heterogeneity among the included studies (different age groups and types of teeth extracted), there was a consistent association between cigarette smoking and an elevated risk of developing dry socket post tooth extraction.

SAT418 Nurse-Led Care For Transgender And Gender Diverse Individuals: A Cross-Sectional Study Of International Context And Practice

Abstract Disclosure: D.L. Greenspan: None. B.P. White: None. E.G. Bobrowich: None. P. Carruthers: None. D. Ducar: None. C. Ernstsson: None. S. Barrett: None. A. Dwyer: None. Introduction: Gender minorities, including transgender and gender diverse (TGD) individuals face health disparities and significant barriers in accessing healthcare. Lack of access to providers knowledgeable in TGD health needs is the single greatest barrier to care. Existing literature on TGD care has almost exclusively focused on physicians and there is scant literature on the role of nurses. We aimed to describe exemplars of nurse-led TGD care internationally to better understand the structure, process, and outcomes of nurse-led TGD care as well as recommended best practices nurse-led TGD care. Methods: This descriptive cross-sectional study used a convenience sample of nurse-led TGD clinics drawn from international endocrine nursing organizations. Identified clinics completed an online survey based on the Donabedian Model of quality care (structure, process, outcome). ‘Structure’ included a description of health system, guidelines used by the clinic, team composition/organization, and contextual medico-legal issues. Process assessed nursing roles/activities and perceived promoters/barriers to TGD care. Outcomes were assessed by identifying metrics employed by the clinics. Two independent investigators reviewed survey responses and collated descriptive findings in tables, used thematic analysis to identify salient features and themes, and validated the synthesis with respondents.Results: Five established TGD clinics were identified from the United States (n=3), United Kingdom, and Sweden. Clinics were government funded (n=2), based within academic medical centers (n=2), and a free-standing community practice. Respondents included both registered nurses and advance practice nurses (nurse practitioners/nurse prescribers) who provide pediatric (n=2), adult (n=1), and care across the lifespan (n=2). Common ‘structure’ elements included: creating a welcoming environment, interprofessional team, and use of clinical guidelines. The ‘process’ of care was characterized by: commitment to a gender-affirming philosophy and person-centered care, emphasis on collaborative care/team communication, and dedicated time for case management. Few outcomes were measured (primarily client census). All clinics noted the importance of access to care, training clinicians/staff, and structured data collection methods as promoters of high-quality TGD care.Discussion: Findings suggest nurses play an important role in increasing access to gender-affirming and person-centered care. Nursing care emphasizes interprofessional collaboration, health promotion, empowerment, and patient advocacy. We identify promoters and best practices based on expert opinion - yet more work is needed to establish evidence-based practices and nurse-sensitive outcome measures for TGD care. Presentation: Saturday, June 17, 2023

Diagnosis and Management of Intrascrotal Nerve Tumors: A Systematic Review of the Literature.

Scrotal tumors of nerve origin are extremely rare and occur mostly in the extratesticular tissues of scrotum, such as the spermatic cord and epididymis. A systematic search of the literature in PubMed, Medline, and Google Scholar databases concerning intrascrotal nerve tumors was performed by 2 independent investigators. The systematic search retrieved 45 male adults, with a mean age of included patients at 43.9 ± 18.8 years. The majority of nerve tumors were extra-testicular (86.7%), and only 13.3% originated from the testis. Out of that, 51.1% of neoplasms were histologically proved as schwannomas, 44.4% as neurofibromatosis, and 4.4% as malignant peripheral nerve sheath tumors. The majority of patients presented with atypical symptoms such as scrotal swelling (51.1%), while only 4.4% of patients were asymptomatic. Ultrasonography is the diagnostic modality of choice (97.2%) for the detection of primary lesion, while magnetic resonance imaging and computed tomography comprise supplementary diagnostic tools. Surgical excision of the mass was the preferred type of surgery performed (75.6%), whereas orchiectomy was performed only in 22.2% of patients. Intrascrotal tumors of nerve origin are extremely rare neoplasms that present mainly in middle-aged males. Increased clinical suspicion is required for accurate diagnosis of this rare entity.

Reliability of shear-wave elastography in assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles.

To determine the reliability of shear-wave elastography (SWE)in assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in neutral head posture (NHP) or forward head posture (FHP). Sixteen healthy adults (mean age: 21.69±1.01years, 9 females) were included. SWE mode was chosen to measure the nuchal fascia shear modulus and muscle thickness was measured in B-mode. Measurements were collected by two independent investigators on two different days. The intraclass correlation coefficient (ICC) was used to measure the relative reliability, and the standard error of measurement (SEM) were used to measure the absolute reliability. Intra‑rater (ICC=0.63-0.89) and inter-rater (ICC=00.54-0.82) reliability for the nuchal fascia shear modulus were moderate to excellent. Intra‑rater (ICC=00.64-0.96) and inter-rater (ICC=00.48-0.86) reliability for upper cervical muscles thickness were moderate to excellent. The SEM percentage oscillated from 3.27% to 13.55%. There were significant differences(P<0.05) between NHP and FHP on nuchal fascia shear modulus, right side splenius capitis muscle thickness and left side semispinalis capitis muscle thickness, but no significant differences(P>0.05) were observed between the right and left sides. The upper cervical muscles thickness of males was significantly thicker(P<0.01) than females while no significant differences were observed (P>0.05) on the nuchal fascia shear modulus. Ultrasound-based SWE may be a reliable tool for assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in clinical practice. ChiCTR2200055736.

“Do I sound happy?” Acoustic characteristics of affective prosody in older adults

It is known that older adults have difficulty comprehending affective prosody. However, it is unclear how well they manipulate affective prosody to express emotion. Five older adults were recorded when they completed three speech tasks: (1) Talking about happy and sad life events; (2) Describing the Refused Umbrella pictures; (3) Explaining how to make a peanut butter and jelly sandwich. Two independent investigators listened to the recordings and parsed them into utterances considering pauses and connectivity. Afterwards, the investigators identified the primary emotion (i.e., happy, sad, neutral) in each utterance. The recordings were acoustically analyzed using Pratt for rate, pitch, and amplitude measures. The rate measures included speech and articulation rates and the pitch/amplitude measures contained initial, final, minimum, maximum f0/dB and the difference between the maximum and minimum f0/dB. Multivariate ANOVAs with Tukey post-hoc test were conducted to analyze the acoustic data. Among the acoustic measures, all rate and pitch measures were significantly different across the three emotions. However, none of the amplitude measures differed significantly. Research on production of affective prosody in healthy older adults has been scarce and this study may serve as a catalyst for further exploration in this area.

DPYD genotyping and 5-fluoropyrimidine toxicity: An overview of systematic reviews protocol

IntroductionThe increased risk of severe and life-threatening toxicity in patients with dihydropyridine dehydrogenase (DPD) deficiency, under treatment with fluoropyrimidines, has been widely studied. An up-to-date overview of systematic reviews summarizing existing literature can add value by highlighting most relevant information and supports decision-making regarding treatment in DPD deficient patients. The main objective of this overview of systematic reviews is to identify published systematic reviews on the association between germline variations in the DPYD gene and fluoropyrimidine toxicity. Methods and analysisThis protocol was developed following the Preferred Reported Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) checklist, and the overview of systematic reviews will be reported in accordance with the PRISMA statement. PubMed, Embase, Scopus, and the Cochrane Library will be searched from inception to 2023. Systematic reviews irrespective of study designs that analyze the association between germline variations in the DPYD and fluoropyrimidine toxicity will be considered. Methodological quality will be assessed using AMSTAR2 checklist (Measurement Tool to Assess Systematic Reviews 2). Two independent investigators will perform the study selection, quality assessment, and data collection. Discrepancies will be solved by a third investigator.Registration details: Registration number in PROSPERO: CRD42023401226.

Retrospective Clinical Evaluation of RMGIC/GIC Class V Restorations.

The aim of this retrospective study was to evaluate the clinical performance of glass-ionomer cement (GIC) and resin-modified glass-ionomer cement (RMGIC) materials in Class V carious cervical lesions restored by dental students. Ninety-six (96) restorations performed with either GIC (Fuji IX) (n = 39) or RMGIC (Fuji II LC) (n = 57) were evaluated using the modified USPHS criteria by two independent investigators at two follow-up evaluations (two years apart). The Fisher statistical test was used to compare USPHS criteria and examine significant differences, with a significance level set at p < 0.05. The Kaplan-Meier algorithm was used to calculate the survival probability. The overall success rate of Class V restorations was 72.9% at the second follow-up evaluation, with restorations ranging in age from 2.5 to 3.5 years. The RMGIC (Fuji II LC) restorations exhibited a significantly higher overall success rate compared to the GIC (Fuji IX) restorations (p = 0.0104). Significant differences were observed in retention (p = 0.0034) and color match (p = 0.0023).

Pharmacists' contribution to benzodiazepine deprescribing in older outpatients: a systematic review and meta-analysis.

Consolidated and reliable evidence regarding the effectiveness of pharmacist interventions for deprescribing benzodiazepines in older outpatients is lacking. This study evaluated and summarized the impact of pharmacist interventions on benzodiazepine deprescribing among older outpatients. A literaturesearch was conducted until August 2022 in PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials databases. The review included randomized controlled trials that assessed the impact of pharmacist interventions on deprescribing benzodiazepine in older outpatients. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment. Meta-analyses were conducted using random-effect models in the RStudio software. A total of 893 records were identified. Five studies, including 3,879 patients, met the inclusion criteria and were included in the systematic review. All five studies used health education as an intervention strategy, and three also conducted medication reviews. There was no evidence of the pharmacist's authority to modify prescriptions during benzodiazepine deprescribing. One study was classified as having a low risk of bias, whereas the other had some concerns or a high risk of bias. Three studies were included in the meta-analysis and a significant impact of pharmacist interventions on benzodiazepines deprescribing rates in older outpatients was observed (RR = 2.75 [95%CI 1.29; 5.89]; p = 0.04; I2 = 69%; low certainty of evidence). Pharmacists may contribute to deprescribing benzodiazepines in older outpatients. Further studies are needed to increase the reliability of these findings. PROSPERO registration number: CRD42022358563.

Molecular Diagnostic Yield of Exome Sequencing and Chromosomal Microarray in Short Stature

Currently, the diagnostic yield of exome sequencing (ES) and chromosomal microarray analysis (CMA) for short stature cohorts is uncertain. Despite previous studies reporting the widespread use of ES and CMA, a definitive diagnostic yield has not been established. To investigate the diagnostic yield of ES and CMA in short stature. A systematic literature search was conducted using relevant keywords in 3 databases (PubMed, Embase, and Web of Science) in February 2023. Eligible studies for meta-analysis were those that had at least 10 participants with short stature who were diagnosed using either ES or CMA and the number of diagnosed patients was reported. Of 5222 identified studies, 20 were eventually included in the study. Two independent investigators extracted relevant information from each study, which was then synthesized using proportional meta-analysis to obtain the overall diagnostic yield of ES and CMA. The primary outcome measure was to determine the overall diagnostic yield of ES and CMA. A subgroup meta-analysis was also performed to assess if the diagnostic yield varied depending on whether ES was used as a first-tier or last-resort test. Additionally, a meta-regression was carried out to investigate how the diagnostic yield varied over time. Twenty studies were included, comprising 1350 patients with short stature who underwent ES and 1070 patients who completed CMA. The overall diagnostic yield of ES among the cohorts and CMA among the cohorts was found to be 27.1% (95% CI, 18.1%-37.2%) and 13.6% (95% CI, 9.2%-18.7%), respectively. No statistically significant difference was observed between the first-tier (27.8%; 95% CI, 15.7%-41.8%) and last-resort groups (25.6%; 95% CI, 13.6%-39.6%) (P = .83) or in the percentage of positively diagnosed patients over time. No statistically significant difference was observed between the first-tier (27.8%; 95% CI, 15.7%-41.8%) and last-resort groups (25.6%; 95% CI, 13.6%-39.6%) (P = .83) or in the percentage of positively diagnosed patients over time. This systematic review and meta-analysis provides high-level evidence supporting the diagnostic efficacy of ES and CMA in patients with short stature. The findings serve as a solid reference for clinicians when making informed decisions about recommending these genetic tests.

Nociception assessment with videopupillometry in deeply sedated intensive care patients: Discriminative and criterion validations

BackgroundNociceptive assessment in deeply sedated patients is challenging. Validated instruments are lacking for this unresponsive population. Videopupillometry is a promising tool but has not been established in intensive care settings. Aim/ObjectiveTo test the discriminate validity of pupillary dilation reflex (PDR) between non-noxious and noxious procedures for assessing nociception in non-neurological intensive care unit (ICU) patients and to test the criterion validity of pupil dilation using recommended PDR cut-off points to determine nociception. MethodsA single-centre prospective observational study was conducted in medical–surgical ICU patients. Two independent investigators performed videopupillometer measurements during a non-noxious and a noxious procedure, once a day (up to 7 days), when the patient remained deeply sedated (Richmond Agitation–Sedation Scale score: −5 or −4). The non-noxious procedures consisted of a gentle touch on each shoulder and the noxious procedures were endotracheal suctioning or turning onto the side. Bivariable and multivariable general linear mixed models were used to account for multiple measurements in same patients. Sensitivity and specificity, and areas under the curve of the receiver operating characteristic curve were calculated. ResultsSixty patients were included, and 305 sets of 3 measurements (before, during, and after), were performed. PDR was higher during noxious procedures than before (mean difference between noxious and non-noxious procedures = 31.66%). After testing all variables of patient and stimulation characteristics in bivariable models, age and noxious procedures were kept in the multivariable model. Adjusting for age, noxious procedures (coefficient = −15.14 (95% confidence interval = −20.17 to −15.52, p < 0.001) remained the only predictive factor for higher pupil change. Testing recommended cut-offs, a PDR of >12% showed a sensitivity of 65%, and a specificity of 94% for nociception prediction, with an area under the receiver operating curve of 0.828 (95% confidence interval = 0.779–0.877). ConclusionsIn conclusion, PDR is a potentially appropriate measure to assess nociception in deeply sedated ICU patients, and we suggest considering its utility in daily practices. RegistrationThis study was not preregistered in a clinical registry. Tweetable abstractPupillometry may help clinicians to assess nociception in deeply sedated ICU patients.

Hall technique for the management of carious primary molar teeth among African children - a review

Background: Hall technique involves cementing preformed metal crowns or stainless steel crowns on the tooth with the use of luting glass ionomer cements, without the use of local anaesthesia, caries removal and tooth preparation of any kind. It can be an intervention to stop the progression of active untreated carious lesion in primary molar teeth among African children. This article reviews the available studies on Hall technique used for the management of carious primary molar teeth among African children. Method: An electronic literature search in Web of science, Scopus, PubMed, Google Scholar, African journals online, ResearchGate and Google was conducted in June, 2023 using the Population-Concept-Context framework. Search terms and keywords were combined by Boolean operators. Three independent investigators (research assistants) screened titles, abstracts and full text of publications. The inclusion criteria were original research articles, case report, case series related to Hall technique for the management of carious primary molar teeth studies conducted in African continent, published in English language and in electronic databases. Results: Four articles were included as they were assessed to meet the aim of the review. The study design of the articles was three randomised controlled clinical trial and one case report. One study was identified each from Egypt, Morocco, Nigeria and Sudan respectively. All the identified studies in African continent were hospital based. Conclusion: Hall technique can be an intervention for management of carious primary molar teeth in resource poor locality in Africa and globally. Studies on Hall technique for the management of carious primary molar teeth identified in Africa were few and restricted to few countries. IMC J Med Sci. 2024; 18(1):003. DOI: https://doi.org/10.55010/imcjms.18.003 *Correspondence:Obehi. O Osadolor, University of Nigeria Teaching Hospital, Ituku- ozalla, Enugu State, Nigeria. E-mail: osadolorobehi@yahoo.com

Quantitative Evaluation of Vocal Bowing Following Bilateral Thyroplasty in Age-Related Vocal Atrophy.

Age-related vocal atrophy (ARVA) is associated with vocal fold bowing, persistent glottal gap during phonation, and dysphonia. Bilateral medialization thyroplasty is sometimes performed in patients with ARVA to improve vocal fold closure and voice. We set out to quantify stroboscopic changes in vocal fold bowing, glottal closure, and abduction angle following bilateral thyroplasty and determine how these changes affect voice quality among patients with ARVA. Fifteen individuals with ARVA who underwent bilateral medialization thyroplasty were included in this study. Two independent investigators calculated bowing index (BI), normalized glottal gap area (NGGA), and maximum abduction angle from laryngostroboscopic exams using ImageJ™. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and patient-reported measures were collected before and after thyroplasty. Thyroplasty resulted in a 10-point improvement in overall CAPE-V (Mean dif -10; 95% CI -17, -3.3, p < 0.01) and VHI-10 (mean dif -3.8; 95% CI -9.8, 2.3, p = 0.19, n = 8). NGGA and BI significantly decreased following surgery (mean dif -78; 95% CI -155, -1.5, p = 0.05; and mean dif -2.1; 95% CI -2.4, -0.84, p < 0.01, respectively). BI correlated with CAPE-V scores (r = 0.66, 95% CI 0.22, 0.87, p < 0.01). When considering the normalized combined contributions of both NGGA and BI, there was a stronger correlation in CAPE-V scores (r = 0.87, 95% CI 0.50, 0.97, p < 0.01) compared with either measure alone. Thyroplasty resulted in a decrease in vocal fold bowing, glottal gap area, and CAPE-V scores in patients with ARVA. Correction of vocal bowing and glottal gap, following bilateral thyroplasty, improved voice measures following surgery. Quantitative evaluation of vocal fold morphology may be valuable when assessing the severity and treatment-response in patients with ARVA following bilateral thyroplasty. Laryngoscope, 134:835-841, 2024.

Meta‐analysis of the use of Ofatumumab in the treatment of relapsing‐remitting multiple sclerosis

AbstractBackgroundOfatumumab is the first monoclonal antibody developed specifically for treating relapsed multiple sclerosis (RMS). This disease (Multiple Sclerosis) includes relapsing–remitting multiple sclerosis (RRMS), a chronic autoimmune illness that affects the central nervous system (CNS), including the brain and spinal cord. The purpose of this study is to determine whether Ofatumumab is efficacious and safe in the treatment of relapsing–remitting multiple sclerosis.MethodsAn analysis of studies comparing Ofatumumab with placebo in people with relapsing‐remitting multiple sclerosis was done in accordance with PRISMA guidelines. We looked up information in MEDLINE, SciSearch, BIOSIS Previews, Derwent Drug File, Embase, and International Pharmaceutical Abstracts. In patients with relapsing–remitting multiple sclerosis, randomized double‐blind and non‐randomized trials contrasting Ofatumumab with placebo were found by two independent investigators. Utilizing Review Manager 5.4.1, data were examined. The main results were total gadolinium‐enhancing (Gd+) T1 lesions, annualized relapse rate, and new or expanding total T2 lesions. Secondary outcomes concentrated on general adverse events and adverse events related to infections.ResultsThree studies were included involving 334 patients, and the meta‐analysis indicated that Ofatumumab showed good efficacy and safety in patients with relapsing forms of multiple sclerosis. The annual rate of relapse was significantly reduced by Ofatumumab (OR 0.51; 95% CI 0.27, 0.98; P = 0.04). Ofatumumab reduced the number of gadolinium‐enhancing (Gd+) T1 lesions per scan (Mean difference −0.59; 95% CI −0.63, −0.55; P &lt; 0.05). Ofatumumab treatment decreased new or enlarging total T2 lesions significantly (Mean difference −1.03; 95% CI −1.29, −0.76; P &lt; 0.05). Infection‐related adverse effects were seen more frequently with Ofatumumab shown by the odd ratio 0.48; 95% CI 0.22, 1.04; P = 0.06. Infection is, thus, a major limitation to its use.ConclusionThe meta‐analysis indicated that Ofatumumab is efficacious and safe for patients with relapsing forms of multiple sclerosis.

Effect of exoskeleton robot-assisted training on gait function in chronic stroke survivors: a systematic review of randomised controlled trials

ObjectivesNumbers of research have reported the usage of robot-assisted gait training for walking restoration post-stroke. However, no consistent conclusion has been reached yet about the efficacy of exoskeleton robot-assisted training...

Impact of malocclusions on oral health-related quality of life among adolescents.

Systematic review and meta-analysis of randomized controlled trials, non-randomized and observational studies, and previous systematic reviews if matching PECOS strategy. The protocol of the study was registered on PROSPERO. An electronic search was conducted in the following five databases: The Cochrane Library, PubMed, Web of Science, Scopus, and CINAHL. The search was carried out to cover the literature up to June 15, 2022. In addition, ClinicalTrials.gov and PROSPERO were searched for detecting any relevant unpublished data and ongoing studies. The review was defined in PECOS format as follows: population (P), healthy adolescents (ASA Class I or II; age 10-19); Exposure (E), malocclusion and/or need of orthodontic therapy as determined by professionals utilizing validated standardized tools such as Index of Orthodontic Treatment Need, Index of Complexity, Outcome and Need, Peer Assessment Rating, Dental Aesthetic Index, or any well-described tool; comparison (C), no malocclusion and/or need of orthodontic therapy as determined by professionals utilizing validated standardized tools; outcome (O), self-reported oral health-related quality of life (OHRQoL) using validated tools; study design (S), randomized clinical trials, non-randomized/observational studies (prospective and cross-sectional studies with untreated/no-malocclusion controls), and previous systematic reviews if matching PECOS strategy. Studies assessing ASA Class III or higher, craniofacial conditions, previous or ongoing orthodontic or surgical treatment, and case studies were excluded. Screening and data extraction and management, risk of bias (RoB), and quality assessments were conducted by four independent investigators. RoB was assessed based on the guidelines of the Swedish Agency for Health Technology Assessment and Assessment of Social Services. A total of 13 studies (non-randomized studies of cross-sectional design) were included in the qualitative synthesis, of which, 4 studies were included in the quantitative synthesis. Meta-analysis showed that malocclusions (measured with DAI) in adolescents aged 11-14 years old have a negative impact on OHRQoL (measured with CPQ 11-14 short form) (number of studies = 4, rate ratio/prevalence ratio = 1.15, 95% confidence interval = 1.12-1.18, I2 = 0.03%, Q3 = 0.09, certainty level = moderate). Moderate level of evidence suggests that malocclusions in adolescents have a negative impact on the oral health-related quality of life.

Accuracy of Selective Enamel Etching: A Computer-assisted Imaging Analysis.

To assess the accuracy of selective enamel etching (SEE) in a laboratory setup simulating clinical conditions. A model with permanent human teeth was fabricated. It included a first mandibular molar with a mesio-occlusal-distal inlay preparation, a maxillary central incisor, and a canine with a class IV and class V cavity, respectively. Two dentists (with 1 year and 10 years work experience) repeatedly (n=10 per cavity) performed SEE with a custom gel that had identical rheological properties as a commercially available phosphoric acid etchant. An intraoral scanner was used for image acquisition. To assess the accuracy of SEE, special software was used (OraCheck, Cyfex, Zurich, Switzerland). Two independent investigators analyzed baseline scans and scans taken of the cavities while the gel was in place. The statistical analysis comprised t-tests, Pearson correlation, and analysis of variance (α=0.05). The level of accuracy, whose average values ranged from 61.1% to 87.0%, showed significant differences between teeth, with the highest level observed in the class V cavity, followed by the class II inlay preparation and the class IV cavity (p<0.001). Across the cavities, no significant correlation was observed between the application time and the accuracy of SEE (p=0.07). This laboratory study suggests that inadvertent conditioning of dentin adjacent to enamel may be common during SEE. Investigations involving larger samples of dentists are needed to corroborate this finding.

Morphological analysis of C2-C7 spinous process bifurcation in Chinese population: a study using three-dimensional reconstruction of computed tomography.

This study aimed to investigate the anatomical morphology of the C2 to C7 spinous process (SP) bifurcation (SPB) in the Chinese population and reveal its potential clinical significance. Measurement parameters of the three-dimensional (3D) reconstructions of neck computed tomography scans (n = 92 scans) were retrospectively analysed. The 3D reconstruction and measurements were performed using Mimics Research 19.0 and 3-Matic Research 11.0. Two independent investigators reviewed all the data, including parameters such as the length and angle of the SPB. The effects of age and sex were also analysed. We identified four morphological types of SPB: fully bifid (n = 252, 45.65%), partially bifid (n = 65, 11.78%), non-bifid (n = 226, 40.94%) and unilateral branch (n = 9, 1.63%). The Kappa coefficients indicated good inter-observer reproducibility (0.776), and the intraclass correlation coefficients (ICC) values demonstrated excellent intra-rater reliability (ICC = 0.9, p < 0.0001) in the classification and measurement of SPB parameters. The percentage of general bifid SP was more than 70% in C2-5 and about 21% in C6, while all C7 SPs presented non-bifid. Morphology was symmetrical in bifid and partially bifid SP, while unilateral SP was not. The classification system of SPB in this study proved consistent and reliable, despite the subjective bias. Identifying the cervical level by C6 bifurcation is unreliable, as nearly 80% of C6 SP is non-bifid. Our work provides an accurate and effective anatomical reference for SPB studies in the Chinese population.

MRI markers of adenomyosis severity associated with worse IVF/ICSI outcomes

Study objective: The aim of this study was to characterise the severity of adenomyosis on MRI in infertile women, and to assess if MRI characteristics of adenomyosis severity are associated with worse IVF/ICSI pregnancy outcomes versus male infertility controls. Materials and methods: This single-centre retrospective study was carried out at Catharina Hospital in Eindhoven, The Netherlands. The MRIs of 124 infertile women undergoing their first, fresh embryo transfer during IVF/ICSI, diagnosed with adenomyosis only ( N = 31), or combined adenomyosis and endometriosis ( N = 93) were assessed. Measurements of MRI adenomyosis features were performed by two independent investigators. IVF/ICSI outcomes (biochemical pregnancy (BP), ongoing pregnancy (OP) and live birth (LB)) of adenomyosis patients were compared to those of 889 male infertility controls. Results: Patients with adenomyosis had significantly worse IVF/ICSI outcomes compared to male infertility controls. When assessing individual MRI parameters, adenomyosis patients with a mean junctional zone (JZ) of &gt;12 mm, a JZ/Myometrium ratio of &gt;40%, presence of myometrial cysts and presence of endometriosis (specifically deep invasive endometriosis(DIE)) showed statistically significantly worse outcomes compared to patients with milder disease. Conclusion: The results of this retrospective study suggest that individual MRI markers for severe adenomyosis (mean JZ &gt; 12 mm, myometrial cysts), especially when combined with (severe) endometriosis, may be associated with fewer pregnancies during IVF/ICSI when compared to male infertility controls. Future prospective studies should investigate the prognostic potential of these markers for prediction of IVF/ICSI success.

Does invasive acupuncture improve postoperative ileus after colorectal cancer surgery? A systematic review and meta-analysis.

Postoperative ileus (POI) is one of the main complications after colorectal cancer (CRC) surgery, and there is still a lack of effective treatment. At present, the evidence for improvement of POI by invasive acupuncture (manual acupuncture and electroacupuncture, IA) is limited. This meta-analysis of randomized controlled trials (RCTs) aims to systematically review and evaluate the effect of IA in improving POI after CRC surgery. This meta-analysis was reported according to PRISMA statement and AMSTAR guidelines. The retrieval time was from the inception to February 2023. The RCTs were screened by searching the databases (PubMed, Ovid, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP Database, Sinomed Database, and WANFANG). Two independent investigators screened and extracted the data, assessed the risk of bias, and performed statistical analysis. The statistical analysis was carried out by RevMan5.3. The PROSPERO International Prospective Register of Systematic Reviews received this research for registration (CRD42023387700). Thirteen studies with 795 patients were included. In the primary outcome indicators: the IA group had shorter time to the first flauts [stand mean difference (SMD), -0.57; 95% CI, -0.73 to -0.41, p < 0.00001], shorter time to the first defecation [mean difference (MD), -4.92 h, 95% CI -8.10 to -1.74 h, p = 0.002] than the blank/sham stimulation (B/S) group. In the secondary outcome indicators: the IA group had shorter time to the first bowel motion (MD, -6.62 h, 95% CI -8.73 to -4.50 h, p < 0.00001), shorter length of hospital (SMD, -0.40, 95% CI -0.60 to -0.21, p < 0.0001) than the B/S group. In terms of the subgroup analysis: IA associated with enhanced recovery after surgery (ERAS) group had shorter time to the first flauts (MD, -6.41 h, 95% CI -9.34 to -3.49 h, p < 0.0001), shorter time to the first defacation (MD, -6.02 h, 95% CI -9.28 to -2.77 h, p = 0.0003) than ERAS group. Invasive acupuncture (IA) after CRC surgery, acupuncture or electricacupuncture with a fixed number of times and duration at therapeutic acupoints, can promote the recovery of POI. IA combined with ERAS is better than simple ERAS in improving POI. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=387700, identifier CRD42023387700.

Characteristics of corneal microcysts in Hong Kong children wearing orthokeratology

PurposeTo report the characteristics (prevalence, severity, and location) of corneal epithelial microcysts and investigate associated risk factors in children wearing orthokeratology (ortho-k) lenses. MethodNinety-five myopic children wearing ortho-k lenses (examined by one of three independent investigators from March to September 2020) were included in this retrospective cross-sectional study. Pertinent data at baseline before ortho-k treatment and at the aftercare visits (the first visit when the microcysts were observed for children with microcysts, and the last visit before October 2020 for children without microcysts) were retrieved and analysed. ResultsA microcystic response was observed in 52.6% of children wearing ortho-k lenses. Children with high myopia (≥ 5.00 D) had a higher prevalence (100.0%, 23/23) and severity (69.5% (16/23) > grade 2 Efron scale) compared to children with low myopia (≤ 4.00 D) (prevalence of 37.5% (27/72) and 7.0% (5/72) > grade 2, p < 0.001). Microcysts were predominantly (86.0%) observed in the region of the inferior pigmented arc, typically originating in the inferior mid-peripheral cornea, and expanding over time into a semi- or whole annulus. Baseline myopia and topographical change at the treatment zone centre were significantly greater (p < 0.05) in low myopic children with microcysts (univariate analyses). ConclusionsDuring the COVID-19 pandemic, probably due to lifestyle changes, microcysts were frequently observed in children wearing ortho-k lenses and were associated with higher baseline myopia. Practitioners should examine ortho-k wearers with caution using a slit lamp with high magnification and illumination, especially the mid-peripheral cornea. The use of highly oxygen permeable lenses and frequent aftercare are necessary for ortho-k wearers, especially those with higher myopia.