Intergroup Comparison Research Articles

Is Vibration Anesthesia Effective and Safe for Pain Reduction in Botulinum Toxin Injection? A Randomized Split-Face Controlled Trial and Cadaver Experiment.

Pain is an important issue in botulinum toxin injection. Vibration anesthesia is a noninvasive way for pain alleviation, but few study reported its use during botulinum toxin injection. To investigate whether vibration anesthesia is effective and safe for pain reduction during botulinum toxin injection for masseter reduction. A randomized split-face controlled trial was performed in patients who required masseter reduction. Vibration anesthesia was randomly administered on either side. Study outcomes were pain scores on a visual analog scale, duration of effect, satisfaction, and complications. Intergroup comparison and linear regression analyses were performed. In a total of 216 patients, the pain score on the vibration side (2.97 ± 1.44) was significantly lower than that on the non-vibration side (4.72 ± 2.13) (p < 0.0001), with a higher proportion of mild pain. Linear regression showed that history of injection, more injection points and doses increased the pain, while 2 ml syringe reduced the pain compared to 1ml syringe. Side effects were found in 19 patients and 21 sides (7%), but were not associated with vibration. High satisfactions were reported. Cadaver experiment confirmed that vibration did not alter the diffusion radius and depth of injection. Vibration anesthesia could significantly relieve the pain during botulinum toxin injection for masseter reduction, while did not affect adverse effect and effect duration. Therefore, we recommended the use of vibration anesthesia, larger syringe size, and less injection points to improve patient experience and satisfaction.

Educational effectiveness of remote training with smart glasses for impression-taking.

To compare the educational outcomes of remote instruction (RI) in impression-taking using smart glasses with those of face-to-face instruction (FI) and paper-based self-learning (SL) and analyze the educational effects, aiming to develop a remote clinical training strategy. Participants were recruited from among the dental residents who were trained in the first-year clinical program at the university hospital in 2023. The participants were divided into three groups as the original skill level was equal, and the groups were assigned RI, FI, printed guidance, and SL. All the participants took impressions of the jaw models attached to the mannequin using alginate impression material. Next, assigned instructions were provided. Then again, the trainees took impressions of the jaw models. The pre- and postinstruction impressions of each participant were evaluated, and the change in the impression score was statistically analyzed. The pre- and postinstruction scores of the trainees in the RI and FI groups showed a significant increase (p<0.05), whereas no significant difference was observed in the score changes in the SL group. In the intergroup comparisons, the score changes of the RI and FI groups were greater than those of the SL group, although no significant difference was found between the score changes of the RI and FI groups (p<0.05). RI in impression-taking using smart glasses has a greater educational effectiveness than paper-based SL. It has also been suggested that RI can have educational efficacy similar to FI.

Effect of maxillary molars distalization using clear aligners and fixed orthodontic appliances on the positional and dimensional temporomandibular joint parameters: a three-dimensional comparative study.

The use of clear aligners (CAs) for orthodontic treatment has substantially increased in recent decades. However, limited empirical evidence exists regarding their potential effects on the temporomandibular joint (TMJ). The aim of this study was to assess the effect of maxillary molar distalization on the positional and dimensional TMJ parameters between CAs and conventional fixed orthodontic appliances (FAs) in skeletal class II malocclusion. This is a retrospective cohort study examined 70 adult patients with skeletal class II malocclusion with similar baseline characteristics based on American Board of Orthodontics (ABO) discrepancy index scores. The patients were treated by maxillary distalization movement by CAs or FAs, of which there were two equal groups of 35 patients were included in each group. CBCTs on TMJs were performed before and after treatment through Anatomage Invivo Dental 6.0. The measured parameters included inclination, position, condyle and articular fossa dimensions, and the volumetric joint spaces. In both groups, linear measurements of the maxillary molar position revealed significant improvement after treatment (P < 0.001). Regarding TMJ parameters, intra-group comparisons revealed significant changes in FA group in the anterioposterior condylar inclination and condylar position across the three planes. Additionally, the pretreatment-centric condylar position in the glenoid fossa was 45.7% and 40% in the CA and FA groups, respectively. After treatment, these percentages changed to 51.4% and 31.4%, respectively. In inter-group comparisons, significant changes were noted in the mediolateral condylar position, which was more inward in the FA group than the CA group. The FA group had more significant dimensional and positional changes in the mandibular condyle than the CA group; nevertheless, the changes are considered clinically negligible.

Effectiveness of Kabat Technique versus Mirror Book Therapy on clinical and electrophysiological parameters in patients with Bell’s palsy: a comparative interventional study

Abstract Background Bell’s palsy significantly impacts facial function, aesthetics, and quality of life. Objective To compare the effects of the Kabat Technique (KT) and Mirror Book Therapy (MBT) on clinical and electrophysiological parameters in patients with Bell’s palsy. Methods This randomized controlled trial included 31 patients divided into two groups: KT (n = 16) and MBT (n = 15). Both groups received their respective interventions (6 days/week for 3 weeks) in addition to conventional physiotherapy. Sunnybrook Facial Grading Score and Nerve Conduction Test (amplitude and latency of frontalis, nasalis, and mentalis muscles) were assessed pre- and post-intervention. Results Statistical analysis (SPSS v20) revealed significant intragroup improvements in all outcome measures (p &lt; 0.05). Intergroup comparison showed MBT had superior improvements in amplitude of frontalis and reduced latency of nasalis. Both groups demonstrated significant improvement in the Sunnybrook grade shift. Conclusion This study suggests that KT and MBT, combined with conventional physiotherapy, positively impact clinical and electrophysiological parameters in Bell's Palsy patients. MBT showed superior results in select Nerve Conduction Test parameters.

Preoperative total parathyroid volume is an independent marker to predict recurrence for secondary hyperparathyroidism

Purpose This study aimed to explore the value of preoperative total parathyroid volume (TPV) as a marker for predict recurrence of renal secondary hyperparathyroidism (SHPT). Methods We identified 28 patients with recurrence and 128 without recurrence who underwent total parathyroidectomy with autotransplantation (tPTX + AT) at our institution between 2015 and 2022. The TPV and postoperative recurrence information of the patients were recorded. Within the intergroup comparison, data obtained from the recurrence and non-recurrence groups were evaluated using the t-test. Univariate and multivariate analyses were performed according to the regression model to determine factors that were significant in predicting postoperative recurrence. The cutoff value of TPV was determined using a receiver operating characteristic (ROC) curve. Results The mean TPV of recurrence and no-recurrence groups were 2.99 ± 1.52 cm3 and 1.73 ± 1.19 cm3, respectively (p = 0.007). In univariate analysis, female sex, total parathyroid volume > 1.99 cm3, serum PTH > 928.37 pg/mL and p > 1.59 mmol/L were independent factors for SHPT recurrence. In multivariable analysis, TPV > 1.99 cm3, serum parathyroid hormone (PTH) > 928.37 pg/mL and p > 1.59 mmol/L were independent factors for SHPT recurrence. The ability of TPV to distinguish between recurrence and non-recurrence was evaluated using the ROC curve. The cutoff value of TPV was estimated as 2.65 cm3. With this value, sensitivity was found as 60.70%, specificity was 89.80%, and AUC was 0.80 (p < 0.001, confidence interval =0.719–0.882). Conclusion According to the data in this study, it can be said that TPV can be used to distinguish recurrence from no-recurrence. Most importantly, TPV can be used to identify SHPT recurrence.

The effect of lumbar multifidus muscle degeneration on upper lumbar disc herniation

PurposeThis study aimed to investigate the effect of lumbar multifidus muscle (MF) degeneration on upper lumbar disc herniation (ULDH).MethodsThis study used 3.0T magnetic resonance imaging (MRI) T2 axial weighted images to retrospectively analyze 93 ULDH patients and 111 healthy participants. Sixty-five pairs of participants were included in this study using propensity score matching (PSM). Cross-sectional area, fat infiltration area, anteroposterior diameter (APD), lateral diameter (LD), cross-sectional area of the bilateral multifidus muscles at the corresponding level, intervertebral disc area at the corresponding section, and visual analog scale (VAS) score for low back pain (LBP). For inter-group comparisons, we used the t-test, analysis of variance (ANOVA), Mann–Whitney U test, Kruskal–Wallis test, chi-square test, or Fisher's exact test, according to the type of data. We used Pearson correlation analysis to study the correlation between the VAS score and related indicators, and established a predictive model for upper lumbar disc herniation using the receive operative characteristic (ROC) curve analysis method. Finally, univariate and multivariate logistic regression analyses were performed to establish a predictive model for the risk of high lumbar disc herniation.ResultsWe compared the fat areas at the lumbar vertebral levels L1/2, L2/3, and L3/4, as well as the left lateral diameter (LD) (MF), L1/2 left lumbar multifidus muscle index (LMFI), and L1/2 total fat infiltration cross-section area (TFCSA), and found significant differences between the case and control groups (P &amp;lt; 0.001). Furthermore, we observed a significant positive correlation (P &amp;lt; 0.05) between the VAS scores and multiple muscle indicators. Additionally, we developed ROC prediction models to assess the risk of lumbar intervertebral disc protrusion at the L1/2, L2/3, and L3/4 levels, with the results identifying L1/2 TFCSA, L2/3 TFCSA, and L3/4 relative psoas major muscle cross-section area (rPMCSA) as the most predictive indicators. Finally, univariate and multivariate logistic regression analyses showed that the L1/2 rPMCSA, L2/3 TFCSA were significantly associated with the risk of lumbar intervertebral disc protrusion in both models.ConclusionDegeneration of the MF is significantly correlated with the occurrence of ULDH, and the larger the area of fat infiltration in the MF, the more obvious the lower back pain in ULDH patients. In addition, TFCSA can serve as an indicator of the occurrence of ULDH.

Association Between Sarcopenia and Acupressure Testing in Older Adults Requiring Long-Term Care

Background and Objectives: This study analyzed the relationship between pressure pain test outcomes and sarcopenia in elderly patients and explored possible clinical applications. Materials and Methods: The participants included 143 older adults requiring long-term care who could be diagnosed with sarcopenia. Along with sarcopenia diagnosis, the participants underwent acupressure testing symmetrically at nine sites (occiput, lower cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteus, greater trochanter, and knee), totaling 18 sites. The analyses included comparisons of sarcopenia status and total tender points between the groups and a multivariable analysis. The association between sarcopenia and the number of tender points were examined based on correlations between the number of tender points and grip strength, walking speed, and skeletal muscle mass index (SMI). Intergroup comparisons and multivariable analysis of tender points with and without sarcopenia were performed to investigate specific tender points associated with sarcopenia. Results: An independent association was observed between sarcopenia and the number of tender points (p = 0.001). Furthermore, the number of tender points was correlated with grip strength (ρ = −0.536, p &lt; 0.001), walking speed (ρ = −0.200, p = 0.028), and SMI (ρ = −0.394, p &lt; 0.001). The supraspinatus (p = 0.029, 95% confidence interval: 1.221–35.573) and lower cervical (p = 0.039, 95% confidence interval: 1.050–7.245) regions were identified as specific tender points. Conclusions: In older adult patients requiring long-term care, sarcopenia is associated with an increased number of tender points throughout the body, with the supraspinatus and lower cervical regions potentially being specific tender points. Acupressure testing for tenderness may be a useful assessment parameter in sarcopenia patients.

Fracture strength of direct occlusal veneers with different short fiber-reinforced composite cores and veneering materials: an in-vitro study

ObjectiveThe objective of this study is to evaluate the effectiveness of two different viscosities of short fiber-reinforced composite resin (SFRC) cores and two different viscosities of veneering composite resins on the fracture strength of direct occlusal veneers.Materials and methodsOne maxillary premolar was virtually prepared for an occlusal veneer and printed into resin dies. In total, (n = 48) resin dies were printed and assigned into three groups according to the type of core material of the occlusal veneer; mono-structured without a SFRC core, a high viscosity SFRC core, and a low viscosity SFRC core. Each group was re-divided into two subgroups (n = 8) according to the veneering composite resin; packable composite resin and injectable composite resin. Mono-structured and bi-structured direct occlusal veneers were fabricated on the resin dies using the mentioned core and veneering materials with the occlusal replica technique. Fracture strength was evaluated using a universal testing machine and the mode of failure was inspected. Statistical analysis to compare the core and veneering materials was performed using independent t test (P ≤ 0.05) and one-way ANOVA followed by tukey’s post hoc test (Pa ≤ 0.0166) when appropriate. Interactions between subgroups were tested using two-way ANOVA, and one-way ANOVA was used to compare all subgroups followed by tukey’s post hoc test (Pa ≤ 0.0033). Intergroup comparison between failure modes were performed using chi square test (Pa ≤ 0.0033).ResultsThe presence of a SFRC core significantly improved the fracture strength of the specimens. There was no significant difference between the fracture strength of high viscosity SFRC and low viscosity SFRC cores. Specimens veneered with injectable composite resin had significantly superior fracture strength compared to packable composite resin. Additionally, there was a weak correlation between fracture strength and mode of failure.ConclusionShort fiber reinforced composite resin significantly increases the fracture strength of direct occlusal veneers. Injectable composite resin has significantly higher fracture strength than packable composite resin as veneering materials of direct occlusal veneers.Clinical relevanceBi-structured direct occlusal veneers fabricated of injectable composite resin with low viscosity SFRC cores can withstand high masticatory forces in stress-bearing areas.

Comparative evaluation of two audio sensory methods on oral hygiene maintenance in visually impaired children.

To evaluate and compare the efficacy of manual toothbrush, audio-tactile performance (ATP) method, and musical toothbrush on plaque control and oral hygiene maintenance in visually impaired children. The current observational study included 60 visually impaired children aged 9-16years who were randomly divided into 3 groups, each with 20 children receiving oral hygiene instructions in different modes: Group 1 (Control) manual toothbrush, Group 2 (ATP) audio-tactile performance method with a manual toothbrush, and Group 3 musical toothbrush. Both manual (groups 1 and 2) and musical toothbrushes (Group 3) were changed after 3months for better efficiency. Oral hygiene index simplified (OHI-S) and Rustogi Modified Navy Plaque Index (RMNPI) plaque scores were recorded at baseline, at the end of 1, 3, and 6months. The collected data were statistically analysed using SPSS version 21. The intra- and inter-group comparisons were analysed using one-way ANOVA, and the multiple group comparisons were analysed using the Tukey HSD test. In intragroup comparisons from baseline to 6months, both OHI-S and RMNPI plaque scores were reduced for group 3, only OHI-S plaque scores were reduced for group 2. Intergroup comparisons revealed a statistically high significant difference in OHI-S plaque scores from baseline to 6months and RMNPI plaque scores from 1 to 6months. The motivation and education with musical toothbrushes and audio-tactile performance (ATP) method could aid in the improvement of oral hygiene maintenance of visually impaired children.

Retention rate of giomer S-PRG filler containing pit and fissure sealant applied with or without etching: a randomized clinical trial

BackgroundPit and fissure sealant is a micro-invasive modality for treating deep and retentive pits and fissures to prevent and/or stop occlusal caries. Every effort needs to be done to enhance sealant retention and survival. The aim of this research is to assess the retention rate of giomer S-PRG filler containing pit and fissure sealant applied with or without etching.MethodsOverall, 52 patients were included in this trial and they were allocated randomly in 2 groups (n = 26). Group 1 (control group) received giomer sealant (Beautisealant, Shofu, Kyoto, Japan) without an etching step, and group 2 (intervention group) received the same but with a separate preparatory etching step before the sealant application. The retention rate of the sealant was assessed over one year at 3 months, 6 months, and 12 months. Intergroup comparison between categorical variables was done using the chi square test, while intragroup comparison was done using Cochran’s q test followed by multiple comparisons. Relative risk was used to evaluate the clinical significance. Survival rate was analyzed using Kaplan-meier and Log-rank test.ResultsIntergroup comparison between both techniques revealed statistically significant difference within different follow up periods (P < 0.05). Intragroup comparison within both giomer sealant with etching group and giomer sealant without etching group revealed statistically significant difference between different follow-up periods (P < 0.001). There was 69% less risk for total loss or partial loss of giomer sealant with etching when compared to giomer sealant without etching after 12 months.ConclusionAn initial preparatory step of etching to the enamel surface is crucial before giomer sealant application to enhance its bonding, increase its retention and promote its survival.Trial registrationTrial registration ClinicalTrials.gov, NCT04929782. Registered 14 July 2024 - Retrospectively registered, https://clinicaltrials.gov/study/NCT06509451

Effect of Cryotherapy and Occlusal Reduction on Postoperative Endodontic Pain in Mandibular First Molars with Symptomatic Apical Periodontitis: A Prospective, Parallel, Double-Blinded Randomized Controlled Trial.

This study aimed to compare the intensity of postoperative pain following the final rinse using cold saline compared with room temperature saline and occlusal reduction. A prospective, parallel, double-blinded randomized controlled trial was conducted on 69 first mandibular molars diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Single-visit root canal treatment was performed; access cavity preparations and chemomechanical preparations were carried out using the ProTaper Gold rotary system under copious irrigation using 3% sodium hypochlorite and 17% EDTA. The patients were divided into three groups (n = 23): control group: room temperature saline (25°C) final rinse without occlusal reduction; cryotherapy group: cold saline (2.5-4°C) final rinse without occlusal reduction; and occlusal reduction group: room temperature saline with occlusal reduction. Pain scores were recorded using the visual analog scale preoperatively and postoperatively via telephone at 6, 24, 48, 72 hours, and 7 days intervals. Age data were analyzed using one-way analysis of variance followed by Tukey's post hoc test. Pain score data were analyzed using Kruskal-Wallis' test followed by Dunn's post hoc test for intergroup comparisons and Friedman's test followed by Nemenyi's post hoc test for intragroup comparisons. Correlations were analyzed using Spearman's rank-order correlation coefficient. The significance level was set at p < 0.05 within all tests. Cryotherapy reduced postoperative pain compared with the control group with a statistically significant difference at 24 hours only (p = 0.016). At other intervals, no statistically significant difference in pain score was measured between all three groups (p > 0.05). After 7 days, all patients recorded a zero pain score. Cryotherapy was as effective as the occlusal reduction in reducing postoperative pain in cases of symptomatic irreversible pulpitis with symptomatic apical periodontitis, significantly more than the control group.

Natural Course of the Maxillary Sinus Fungus Ball: Results From Seoul National University Hospital Healthcare Center.

The frequency of paranasal sinus fungus balls, a common form of rhinosinusitis, has increased. Although treatment and causative factors have been well investigated, the evolving nature of the fungal balls remains unelucidated. This study aimed to investigate and analyze the changing patterns of fungus balls. This retrospective study analyzed data from 35 participants selected from a pool of 41,497 patients who underwent brain magnetic resonance imaging (MRI) at a large health care center. The extent of the fungus balls was evaluated by grading them from 1 to 4 based on the MR images. The changing process of the fungus ball was analyzed based on demographics, interval between the MRI scans, comorbidities, and specific dental interventions. The fungus ball grades showed significant progression over time. In the analysis of 29 sinuses with initially low-grade (grades 0, 1, and 2) fungus balls, 15 sinuses showed a grade change <2 (no/minimal change group), whereas 14 sinuses showed grade changes of ≥2 (substantial change group). Intergroup comparison showed that only the interval between the initial and final MRI scans differed significantly (p = 0.008). However, factors, such as age, sex, comorbidities, and history of dental procedures, did not differ significantly between the two groups. This study shows the extent of change in fungus balls, primarily over time. These results offer critical insights into the natural course and progression of the maxillary sinus fungus ball. 4 Laryngoscope, 2024.

An in vitro comparison of the fracture resistance of MOD inlay restorations using different lithium disilicates

Objective: The objective of this study was to evaluate and compare the fracture resistance of MOD inlay preparations restored with two different lithium disilicate glass ceramics. Materials and Methods: Standardized MOD inlay cavities were prepared on 64 human permanent premolar teeth and divided into two groups to be restored with lithium disilicate glass-ceramic materials, i.e. Group I with IPS e.max Press HT and Group II with Shofu Vintage LD Press T. The fracture resistance was assessed using a universal testing machine and recorded in Newtons (N). Statistical analysis was done using SPSS software (Version 17.0, IBM, USA). P &lt;0.05 was set as a statistically significant level. Unpaired Student’s t-test was used to compare the fracture resistance values of both groups. Results: The mean fracture resistance value obtained for Group I (IPS e.max Press HT) was 565.04 N while that obtained for Group II was 732.75 N. Statistically significant difference was found in this intergroup comparison (P = 0.002). Conclusion: The fracture resistance of MOD inlay preparations restored with Vintage LD Press T (Shofu) was significantly higher than those restored with IPS e.max Press HT (Ivoclar Vivadent).

The association between eye movement characteristics and cognitive function in adolescents with major depressive disorder

ObjectiveThis study aims to explore the relationship between eye movement characteristics and cognitive function in adolescents with major depressive disorder (MDD). MethodEyeLink 1000 eye tracker was used to obtain eye movement data in free-viewing and smooth pursuit tasks. Chi-square test and Mann-Whitney test were used for inter-group comparison of demographic and clinical data. Spearman correlation was used to analyze the correlation between eye movement characteristics and cognitive function. ResultsAdolescents with MDD showed lower saccade amplitude in the free-viewing task and more fixations and saccades in the smooth pursuit task. In the free-viewing task, fixation count, saccade duration and saccade speed were found to be positively correlated with immediate memory and attention; fixation duration was negatively correlated with immediate memory. In the smooth pursuit task, saccade count was positively correlated with the faux pas test; fixation duration and saccade duration were significantly correlated with memory and attention. ConclusionAdolescents with MDD showed abnormalities in several indices of eye movement, and altered eye movement variables were also correlated with cognitive deficits. Eye-tracking technology helps illustrate the diverse cognitive strategies employed by individuals during cognitive tasks, allowing researchers to explore subtle differences in cognitive processes.

Effects of propolis supplementation on prooxidant-antioxidant balance, oxidative stress biomarkers, and body composition in obese patients with NAFLD: A double-blind randomized controlled clinical trial

Background: Oxidative stress is one of the main hits in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Propolis (PRP), a natural substance made by bees from plant extracts, has been reported to have antioxidant properties. The present clinical trial investigated the effect of Iranian PRP on prooxidant-antioxidant balance (PAB), oxidative stress biomarkers, and body composition in obese patients with NAFLD. Methods: In the present double-blind, randomized controlled clinical trial, 44 obese patients with NAFLD were randomly allocated to either Iranian PRP (1500 mg/d) or placebo (1500 mg/d) accompanied by a calorie-restricted diet (CRD) for eight weeks. PAB, oxidative stress biomarkers, and body composition were assessed at baseline and the end of the study. Results: There was a significant reduction in PAB levels over the trial in both groups. However, the between-group difference was not significant at the endpoint. At the end of the study, the inter-group comparison showed a significant decrease in serum glutathione peroxidase level in the placebo group compared to the PRP group after adjusting for confounding variables based on models 1 (P=0.027) and 2 (P=0.028). No significant within- or between-group differences in other studied oxidative stress biomarkers were found. Moreover, no between-group differences were observed for body composition and dietary intakes of energy and antioxidant micronutrients. Conclusion: Iranian PRP supplementation (1500 mg/d) for eight weeks could prevent the reduction of glutathione peroxidase levels compared to the control group. However, it could not affect other oxidative stress biomarkers, body composition, or dietary intakes of energy and antioxidant micronutrients.

Comparison of static and dynamic balance performances of sports science students by gender

Background and Study Aim. Static and dynamic balance performance are fundamental skills that can exhibit significant differences between genders and are critically important in motor skills and sports science. The aim of this study was to compare the static and dynamic balance performance of sports science students by gender. Material and Methods. Ten male students (age: 22.70 ± 1.33 years) and ten female students (age: 23.00 ± 1.05 years) studying in the sports science faculty voluntarily participated in the study. The Biodex Balance System (BBS, Biodex Medical Systems Inc., Shirley, NY) was utilized to assess balance performance. Independent samples t-test and paired t-test were conducted for analysis using SPSS. Results. In intergroup comparisons, static and dynamic balance performances were similar between genders, with a significant difference found only in the S-APSI parameter (p = 0.021). Among male participants, a significant difference was observed in the S-MLSI parameter (p = 0.015), while no significant differences were found in the other parameters. For female participants, dynamic balance performance significantly outperformed static performance (OSI p = 0.018, APSI p = 0.035, MLSI p = 0.046). Apart from anterior-posterior balance outcomes, no significant differences were observed between males and females in the other parameters. It was also evident that female participants exhibited significantly superior dynamic balance performance compared to static performance. Conclusions. Understanding gender differences in balance performance is crucial for creating effective training programs in sports education. By recognizing these differences, trainers can develop strategies that better meet the specific needs of male and female athletes. This approach can help enhance overall athletic performance.

Mild intracerebral bleeding does not adversely affect survival and neurological outcome of surgical therapy for left-sided infective endocarditis

Abstract Background Intracerebral bleeding (IB) is a serious condition that requires increased attention and has implications for treatment options. For patients with infective endocarditis (IE), current guidelines recommend postponing surgery if IB is present. IB can be classified into four relevant groups (following European Cooperative Acute Stroke Study and Heidelberger Bleeding classification): hemorrhagic transformation (HT) 1 and 2, and parenchymal hemorrhage (PH) 1 and 2. PH2 is the only IB with neurological deterioration. These classifications were originally introduced for stroke patients following thrombolysis but without IE. The hypothesis tested in our study is that IB may influence IE treatment and thus outcome. Method Patients were retrospectively identifyied who were operated for left-sided IE, neuroradiologists re-evaluated and classified preoperative cerebral imaging for any IB. Outcome was quantified using the modified Rankin score (mRS), and mRS were extracted from the patients’ hospital chart at admission and by follow-up telephone call (FU), also including mortality. To ensure that the influence of IB was comparable, patients with IB (IB+) were propensity matched (EuroScore 2, Charlson Comorbidity Index, C-reactive protein; nearest neighbor match) to patients without IB (IB-) who also received surgical IE therapy. All IB+ patients underwent a careful risk-benefit analysis before therapy. Results Of 286 consecutive patients (January 2015 - November 2022) operated for left-sided IE, 36 had IB (65±13 years, 26% female): 11 with HT1, 9 with HT2, 8 with PH1, and 8 with PH2. These patients were matched with 36 operated IB- patients. Survival analysis showed no overall effect of IB+ vs. IB- (p = 0.112, 95% CI of hazard ratio was 0.246-1.243 vs. 0.709-3.572). Although there was no effect of IB on survival in the mild IB subgroup (HT1/2, Figure A), there was a difference in patients with severe IB (PH1/2) with less survival in IB+ (Figure B). Neurological outcome (ΔmRS) showed an effect of IB grade in the two-way ANOVA analysis (p = 0.029). Intergroup comparison showed a significantly better outcome for IB- (vs. IB+) in the PH2 subgroup (p = 0.034), but not in other subgroups. For all groups, the mean ΔmRS for IB+ was 1.1±1.6 vs. 0.70±1.4 for IB- (p = 0.256). The mean FU time was 2.6±2.1 years. Conclusion In patients operated for left-sided IE, mild IB did not affect survival or neurological outcome. In the more severe forms of IB, i.e. PH1 and PH2, survival was less favorable compared to matched controls. Furthermore, we observed a difference in neurological outcome in patients with severe IB. Thus, surgical therapy of left-sided IE should be avoided in patients with severe IB, whereas we can add evidence to the safety of surgical therapy in mild IB. Therefore, we recommend regular assessment of the degree of IB in such patients.Figure

Comparison of aging of nonextraction treated and normal untreated occlusions: 40-year follow up

The objective of this study was to compare the aging changes of the dental arches in patients treated without extractions and untreated normal occlusion subjects after a four-decade follow-up. This retrospective study evaluated two groups: The Treated Group (Group T) comprised 16 patients (6 male; 10 female) presenting with Class I or Class II malocclusions treated orthodontically without extractions. Dental models were evaluated 3 stages: T1 (pretreatment, 13.20 years), T2 (posttreatment, 15.07 years) and T3 (long-term posttreatment, 50.32 years). The Untreated Group (Group UT) consisted of 22 untreated normal occlusion individuals. The dental casts were evaluated at the ages of 13.32 (T1), 17.82 (T2) and 60.95 years (T3). The dental casts were digitized and the irregularity index, intercanine, interpremolar and intermolar widths, overjet and overbite, arch length and perimeter were measured. Intergroup comparisons were performed with independent t tests (P < 0.05). From T1 to T2, the treated group showed maxillary and mandibular crowding and overjet decrease and a maxillary interpremolar and intermolar width increase compared to the untreated group. From T2 to T3, a greater maxillary and mandibular crowding increase and a greater arch length decrease were observed in the treated group compared to the normal occlusion subjects. Overbite increased in the treated group and decreased in the untreated group. The maturational changes of treated patients were different from untreated normal occlusion subjects. Relapse might have contributed for the greater changes observed in incisor crowding and arch length observed in orthodontically treated patients. The aging changes of untreated normal occlusions and nonextraction treated patients, after a four-decade follow-up, proved to be different, indicating that relapse of orthodontic treatment played a role in aging changes of treated patients.

Comparative Analysis of Respiratory and Functional Outcomes in Children Post-Fontan Procedure Versus Healthy Peers.

Studies have shown that respiratory muscle training enhances functional capacity and pulmonary function in Fontan patients. However, diaphragm muscle characteristics in Fontan children have not been fully elucidated. The aim of this study was to compare respiratory function, maximal and submaximal functional capacities, and quality of life, as well as to assess diaphragm mobility and thickness, between Fontan patients aged 8 to 12years and healthy individuals. This cross-sectional study included 45 children-27 Fontan patients, Fontan Group (FG) and 18 healthy control Group (CG) subjects. Different examinations were performed: spirometry was used to analyze pulmonary volume and capacity; manovacuometry was used to determine respiratory muscle strength; chest ultrasound was used to determine diaphragm muscle characteristics; cardiopulmonary exercise and the six-minute walk test (6MWT) wereused to determine functional capacity; the AUQEI questionnaire was used to determine quality of life. Descriptive analysis and intergroup comparisons were performed for all the data. Compared with the CG, the FG exhibited impaired pulmonary function and reduced functional capacity. Significant differences in median values were noted for forced expiratory volume in one second (FEV1): 2.39L/min, p = 0.002; forced vital capacity (FVC): 1.73 vs. 3.06L/min, p = 0.002; maximal inspiratory pressure: - 73 vs. - 117cmH2O, p = 0.007; absolute peak VO2: 1.09 vs. 1.51L/min, p < 0.001; relative peak VO2: 31.9 vs. 42.5mL/kg/min, p = 0.003; and 6MWT distance: 420 vs. 586m, p < 0.001. Diaphragmatic thickness, mobility and quality of life were similar between the groups. Despite the reduced functional capacity, impaired pulmonary volume and capacity, and respiratory muscle weakness of the FG compared to those of the CG, the diaphragm characteristics and quality of life were similar between the groups.

STEM ATTITUDE DISPARITY: THE IMPACT OF LEARNING EXPERIENCES IN VOCATIONALLY-ORIENTED POLYTECHNIC AND UNIVERSITY ON STUDENTS’ SELF-EFFICACY, EXPECTANCY-VALUE, AND CAREER INTEREST

Learning experiences are widely recognized as crucial in developing students’ attitudes towards science, technology, engineering and mathematics. Vocationally-oriented polytechnics and universities provide distinct learning experiences that may significantly influence students’ STEM self-efficacy, expectancy-value and career interest. The study explores how the unique learning experiences shape students' STEM attitudes among 487 students during their fourth semester at vocationally-oriented polytechnic and university. The S-STEM survey was adopted as the measurement instrument. The result showed that university students displayed a more favorable overall STEM attitude compared to students enrolled in vocational-oriented polytechnic. University students demonstrated greater STEM self-efficacy than polytechnic students, but no significant difference in STEM expectancy-value was detected between the two groups. From the perspective of inter-group comparison, university education consistently fostered students a heightened sense of STEM self-efficacy, expectancy-value and career interest in science, whereas vocationally-oriented polytechnic education boasted its unique strengths in cultivating robust attitudes and career interests towards science and engineering/technology. However, students in both institutions exhibited a relatively less positive attitude towards learning mathematics. The findings highlight the importance of learning experiences in shaping students' STEM attitudes and career interests. Keywords: career interest, expectancy-value, learning experiences, self-efficacy, STEM attitude