Non-randomized Controlled Study Research Articles

Abstract 97: Association Between Use Of A Flying Intervention Team Versus Patient Interhospital Transfer And Longterm Clinical Outcome Among Patients With Acute Ischemic Stroke And Large Vessel Occlusion In Non-urban Germany

Background and Aims: Use of a Flying Intervention Team has shown to significantly reduce time to endovascular thrombectomy compared to interhospital transfer. Aim of this study is to determine whether this new system of care is also associated with improved long-term outcome. Methods: This is a non-randomized controlled intervention study comparing two systems of care in alternating weeks. Thirteen telemedicine assisted primary stroke centers in a non-urban region in Germany participated. Acute ischemic stroke patients for whom the decision to pursue thrombectomy had been made, were either treated by a Flying Intervention Team (an interventionist and a nurse flown by a dedicated helicopter to the primary stroke center to perform thrombectomy on site), or were transferred to the closest referral center. Enrollment was between 2018-02-01 and 2019-10-24. In this secondary analysis, results of the modified Rankin Scale (mRS), Barthel Index, and mortality rate after 12 months were compared between groups. Results: Among 146 patients included, 70 received flying team care and 76 were transferred. Functional outcome (ordinal mRS) after 12 months was significantly improved in the FIT group (acOR, 1.96; 95% CI [1.05-3.69]; p = 0.036). No significant differences were found for Barthel Index in surviving patients and mortality rate. Conclusion: Deployment of a Flying Intervention Team was associated with significantly improved functional outcome at 12 months. FIT should be considered as a system of care for primary stroke centers with adequate infrastructure and sufficient experience in stroke management onsite.

Clinical outcomes and higher order aberrations of wavefront-guided LASIK versus SMILE for correction of myopia: A systemic review and meta-analysis.

To systematically evaluate the clinical effect of wavefront-guided laser in situ keratomileusis (WFG-LASIK) and small incision lenticule extraction (SMILE) in terms of refractive errors and high-order aberrations. A systematic literature search of PubMed, EMBASE, the Cochrane Library, Web of Science and China National Knowledge Internet was performed to identify studies evaluating the clinical outcomes of SMILE and WFG-LASIK ended in May 2022. Meta-analyses were performed according to the PRISMA guidelines. The risk of bias of the RCTs was evaluated using the Cochrane Handbook criteria, and the quality of the non-randomised controlled studies was assessed using the Newcastle-Ottawa Scale. In total, 1385 eyes (SMILE group, 750 eyes; WFG-LASIK group, 635 eyes) from 12 studies were included. The meta-analysis demonstrated that spherical aberration was smaller in the SMILE group than in the WFG-LASIK group (standardised mean difference [SMD]: -0.34, 95% confidence interval [CI]: -0.47, -0.22; p< 0.00001), and that the postoperative values of vertical coma (SMD: 0.83; 95% CI: 0.63, 1.03; p< 0.00001) and trefoil (SMD: 0.37; 95% CI: 0.02, 0.72; p=0.04) were higher in the SMILE group compared to the WFG LASIK group. There were no significant differences in the clinical outcomes and the values of induced total higher order aberrations between the WFG-LASIK and SMILE groups (SMD: 0.05; 95% CI: -0.09, 0.19; p=0.47). Both SMILE and WFG-LASIK were found to be safe, effective, and predictable. SMILE may induce more vertical coma and trefoil, whereas WFG LASIK may induce more spherical aberrations, but no significant differences were found in the total higher order aberrations between SMILE and WFG-LASIK.

Final analysis of a prospective controlled trial of the efficacy of uracil and tegafur/leucovorin for stage II colon cancer with risk factors for recurrence using propensity score-based methods (JFMC46-1201).

117 Background: The usefulness of adjuvant chemotherapy for stage II colon cancer with high-risk factors for recurrence has not been established. Methods: This was a prospective, non-randomized controlled study based on patients’ selection of treatment options, including randomized therapeutic decision-making. High-risk factors were defined as having at least one of the following factors: T4, perforation/penetration, poorly differentiated adenocarcinoma/mucinous carcinoma, and &lt; 12 dissected lymph nodes. UFT (300 mg/m2/day) plus LV (75 mg/day) were orally administered for 6 months after surgery. The primary endpoint was disease-free survival (DFS) after adjusting for risk factors using propensity sore matching (1:2) and inverse probability of treatment weighting (IPTW) in the non-randomized arm. The secondary endpoints were overall survival (OS) and safety. Results: 1902 (98%) and 36 (2%) patients were enrolled in the non-randomized and randomized arms, respectively between May 2012 and April 2016. There were too few patients in the randomized arm and these were therefore excluded from the analysis. Eligible patients were divided into two groups: A, patients who selected surgery alone (n = 641); B, patients who selected UFT/LV treatment (n = 1239). Of the eligible patients, 402 in group A and 804 in group B were propensity score-matched. The 5-year DFS rate (95% confidence interval) was significantly higher in group B (76.3% [73.1-79.1]) than in group A (68.8% [63.9-73.2]) {hazard ratio [HR] 0.66 [0.51–0.84, P = 0.0008]}. The 5-year OS rates were not significantly different between group B and group A [HR 0.74 (95% CI 0.50–1.10, P = 0.1391)]. Using IPTW, significantly higher 5-year DFS [HR 0.71 (95% CI 0.59–0.86, P = 0.0006)] and overall survival [HR 0.66 (95% CI 0.49–0.90, P = 0.0122)] rates were observed in group B compared with group A. Multivariate analysis revealed that male sex, over 70 years old, T4, &lt; 12 dissected lymph nodes, and no adjuvant chemotherapy were significant risk factors for recurrence. Conclusions: Adjuvant chemotherapy with UFT/LV significantly improves DFS. Oral UFT/LV as adjuvant chemotherapy shows efficacy with an acceptable safety profile for stage II colon cancer with risk factors. Clinical trial information: UMIN000007783 .

Psychosocial interventions to support retirement well-being and adjustment: a systematic review

ABSTRACT Objective Adjustment to retirement is heterogeneous in nature, and for some, but not all individuals, may require well-being support. However, limited information is available on the types of psychosocial interventions that can be effective during this time of transition with pre-retirees or retirees. This review identified psychosocial interventions with adults before and during retirement, and their effectiveness in maintaining or increasing well-being. Method Following PRISMA guidelines, a multi-database systematic literature review, with a two-stage screening process, was conducted utilising narrative synthesis. Records were independently screened by two screeners against set inclusion and exclusion criteria. Results Two thousand four hundred and thirty-six records were identified for screening with 20 studies found eligible for final review. These included seven randomised controlled trial studies (RCT), six non-randomised quasi-experimental controlled studies, and seven single group pre/post intervention studies. Interventions covered cognitive behavioural therapy (CBT), positive psychology, mentoring, family therapy and others. Conclusions The review highlighted the benefits of psychosocial support to adults’ well-being before and after they retire, especially with participation in group-based programs utilising elements of CBT. There was also evidence for well-being maintenance with longer running interventions. Results should be considered in the development of future psychosocial interventions to support individuals during this important life phase in older adulthood.

Innovative Pedagogical Strategies in Health Professions Education: Active Learning in Dental Materials Science.

Dental materials science education is frequently delivered via traditional didactic lectures in preclinical dental programs. This review aimed to appraise the current evidence on innovative pedagogical strategies in teaching dental materials science courses. English-language articles on teaching methods for dental materials science published between January 1990 to October 2022 were searched in nine online databases (Google Scholar, PubMed, Web of Science [WoS], Science Direct, Cochrane Library, EBSCO, LILACS, Open Grey, and EMBASE) according to PRISMA guidelines. The risk of bias (RoB) was assessed using the Cochrane RoB-2 and ROBIN-I tools, whereas the level of evidence was determined based on the OCEBM guidelines. Only 12 primary studies were included. Two randomized studies (RCTs) were deemed as being of "some concern", and one showed a high risk of bias (RoB). Three non-randomized controlled studies (NRS) demonstrated a moderate RoB, whereas the remaining seven were low. Most studies were ranked at Levels 2 and 3 of evidence. Several innovative pedagogical strategies were identified: flipped classrooms, clinical-based learning, computer-assisted learning, group discussion, microteaching with the BOPPPS (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) model, and game-based learning. The evidence suggested that students generally showed positive perceptions toward these pedagogical strategies. Dental educators should revise their current undergraduate dental materials science curricula and integrate more effective teaching methods.

Cardiac Behavior and Heart Rate Variability in Elderly Hypertensive Individuals during Aerobic Exercise: A Non-Randomized Controlled Study.

High blood pressure is an important public health problem due to its high prevalence, the difficulty to control it, and its high contribution to morbidity. A series of changes may be linked to the aging process, compromising cardiac conduction, and reducing cardiovascular baroreceptor function. Advancing age promotes a decline in heart rate variability and this decrease can increase the probability of cardiovascular disease. The aim of this study was to analyze the autonomic modulation of heart rate in hypertensive elderly individuals during and after a session of aerobic exercise, and to compare it with elderly individuals without cardiovascular or metabolic disease. Our study was a non-randomized controlled study with hypertensive elderly (HBP group) and elderly without cardiovascular and/or metabolic diseases (control group). Data on blood pressure and heart rate variability (HRV) were collected before, during, and after 30 min of aerobic physical exercise on a treadmill. There was a reduction in HF (ms2) and SD1 (ms) in the 5 min of recovery for the elderly in the control group. The elderly in the control group also had greater RMSSD and SD1 30 min post-exercise when compared to the initial mins of recovery. We concluded that there was no difference in autonomic modulation and global heart rate variability between elderly individuals without cardiovascular and metabolic diseases and hypertensive individuals after a bout of aerobic exercise. Elderly individuals without metabolic diseases showed a decrease in parasympathetic modulation and global variability between the time of rest and 5 min of recovery. However, up to 30 min of post-exercise recovery, they restored parasympathetic activity.

Four-Dimensional Superimposition Techniques to Compose Dental Dynamic Virtual Patients: A Systematic Review

Four-dimensional virtual patient is a simulation model integrating multiple dynamic data. This study aimed to review the techniques in virtual four-dimensional dental patients. Searches up to November 2022 were performed using the PubMed, Web of Science, and Cochrane Library databases. The studies included were based on the superimposition of two or more digital information types involving at least one dynamic technique. Methodological assessment of the risk of bias was performed according to the Joanna Briggs Institute Critical Appraisal Checklist. Methods, programs, information, registration techniques, applications, outcomes, and limitations of the virtual patients were analyzed. Twenty-seven full texts were reviewed, including 17 case reports, 10 non-randomized controlled experimental studies, 75 patients, and 3 phantoms. Few studies showed a low risk of bias. Dynamic data included real-time jaw motion, simulated jaw position, and dynamic facial information. Three to five types of information were integrated to create virtual patients based on diverse superimposition methods. Thirteen studies showed acceptable dynamic techniques/models/registration accuracy, whereas 14 studies only introduced the feasibility. The superimposition of stomatognathic data from different information collection devices is feasible for creating dynamic virtual patients. Further studies should focus on analyzing the accuracy of four-dimensional virtual patients and developing a comprehensive system.

A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty

Abstract Background Integrated care may improve outcomes for older people living with frailty. We aimed to assess the effectiveness of a new, anticipatory, multidisciplinary care service in improving the wellbeing and quality of life (QoL) of older people living with severe frailty. Methods A community-based non-randomised controlled study. Participants (≥65 years, electronic Frailty Index ≥0.36) received either the new integrated care service plus usual care, or usual care alone. Data collection was at three time points: baseline, 2-4 weeks, and 10-14 weeks. The primary outcome was patient wellbeing (symptoms and other concerns) at 2-4 weeks, measured using the Integrated Palliative care Outcome Scale (IPOS); the secondary outcome was QoL, measured using EQ-5D-5L. To test duration of effect and safety, wellbeing and QoL were also measured at 10-14 weeks. Descriptive statistics were used to characterise and compare intervention and control groups (eligible but had not accessed the new service), with t-test, Chi-Square, or Mann-Whitney U tests (as appropriate) to test differences at each time point. Generalised linear modelling, with propensity score matching, was used for further group comparisons. Data were analysed using STATA v17. Results 199 intervention and 54 control participants were recruited. At baseline, intervention and control groups were similar in age, gender, ethnicity, living status, and body mass index, but not functional status or area deprivation score. At 2-4 weeks, wellbeing had improved in the intervention group but worsened in the control (median IPOS -5 versus 2, p&lt;0.001). QoL improved in the intervention group but was unchanged in the control (median EQ-5D-5L 0.12, versus 0.00, p&lt;0.001). After adjusting for age, gender, and living status, the intervention group had an average total IPOS score reduction at 2-4 weeks of 6.34 (95% CI: -9.01: -4.26, p&lt;0.05); this improvement was sustained, with an average total IPOS score reduction at 10-14 weeks of 6.36 (95% CI: -8.91:-3.80, p&lt;0.05). After propensity score matching based on functional status/area deprivation, modelling showed similar results, with a reduction in IPOS score at 2-4 weeks in the intervention group of 7.88 (95% CI: -12.80: -2.96, p&lt;0.001). Conclusions Our findings suggest that the new, anticipatory, multidisciplinary care service may have improved the overall wellbeing and quality of life of older people living with frailty at 2-4 weeks and the improvement in wellbeing was sustained at three months. Ethics approval NHS Research Ethics Committee 18/YH/0470 and IRAS-250981. Trial registration The trial was retrospectively registered at the International Standard Randomised Controlled Trial Number (ISRCTN) registry (registration date: 01/08/2022, registration number: ISRCTN10613839).

Digital Health Interventions in Patient Management Following Acute Coronary Syndrome: A Meta-Analysis of the Literature.

Acute coronary syndrome patients should be closely followed-up to maintain optimal adherence to medical treatments and to reduce adverse events. Digital health interventions might provide improved outcomes for patient care by providing closer follow- up, compared to standard care. Thus, in this meta-analysis, we aimed to evaluate the effect of digital health interventions on follow-up in acute coronary syndrome patients. We searched medical databases to obtain all relevant studies comparing digital health interventions with standard care in acute coronary syndrome patients. After reviewing all eligible studies, a meta-analysis was conducted with the remaining 11 randomized controlled studies and 2 non-randomized controlled studies. A modified Jadad scale and Newcastle-Ottawa scale were used to assess the quality of the publications for randomized controlled studies and non-randomized controlled studies, respectively. This meta-analysis consisted of 7657 patients. The all-cause mortality rate was 49% lower in the digital health intervention cases, compared to those who received standard care [relative risk (RR) = 0.51 (0.37; 0.70), P <.01]. There was a significant decrease in systolic blood pressure in the digital health interventions group, compared to the standard care group [mean difference = -5.28 (-9.47; -1.08), P =.01]. The rate of nonadherence to anti-aggregant drugs was 69% lower in the digital health interventions than in the standard care group [RR = 0.31 (0.20; 0.46), P <.01]. Also, nonadherence rates for statin and beta-blockers were lower in the digital health interventions group. The risk of rehospitalization was observed to be 55% less in the digital health interventions patients, compared to the standard care group [RR = 0.45 (0.30; 0.67), P <.01]. Digital health interventions can be effective in follow-up for secondary prevention in acute coronary syndrome patients.

Comparison of Clarus and Optomap Ultra-Widefield Imaging Systems before and after EVO-ICL Implantation in High Myopia

Introduction: The aim of this study was to investigate the features of imaging differences between Clarus and Optomap ultra-widefield imaging systems after implantable collamer lens (ICL) implantation. Methods: This was a non-randomized controlled study. Ninety-two eyes of 46 consecutive patients were enrolled. Full-scale ophthalmological examinations were conducted preoperatively. All patients underwent Clarus (CLARUS 500; Carl Zeiss, Dublin, USA) and Optomap (Daytona; Optos, UK) ultra-wide imaging sequentially under the same circumstance preoperatively and 1 month after EVO-ICL implantation. A single image was acquired from each. Dx was defined as the distance between the upper furcation of the central retinal artery and the central fovea of macula. Pixels of the optic cup and disc and Dx as well as the optic cup/disc ratio were calculated and compared on each machine before and after surgery. Results: All surgeries were uneventful without complications. Safety and efficacy indices were both 100% at 1 month. Values of both optic cup and disc areas were in decrease after surgery with statistically significant differences (p < 0.001), while the cup/disc ratio remained the same (Clarus mean of differences = −0.0028, p = 0.83; Optomap mean of differences = −0.0016, p = 0.76). Dx of images captured with either machine was statistically significantly decreased (p < 0.001). Differences of both optic cup (p = 0.057) and disc (p = 0.041) areas of Clarus were more obvious than that of Optomap, while only the latter was with statistical significance. Difference of Dx of Clarus was statistically significantly larger than Optomap. Conclusions: Display ranges tend to be broadened after EVO-ICL implantation in both Clarus and Optomap ultra-widefield imaging systems, while Clarus shows a wider display range of the two, which encourages the application of Clarus when it comes to the detection of more peripheral retinal lesions.

Baby Finger Toothbrush as an Innovative Alternative for Finger Method of Teeth Cleaning to Improve Oral Hygiene in Rural India

Background: Most of the rural Indian population cleans the teeth with their finger and they find it difficult to switch to a manual toothbrush. To continue their legacy of cleaning the teeth with their finger, we conducted a study with a baby finger toothbrush, which is used by inserting an index finger for brushing the baby’s teeth. Objective: The objective of this study was to compare the efficacy of a baby finger toothbrush with teeth cleaning method using finger. Materials and Methods: Sixty adults who cleaned their teeth with their fingers were divided into two groups. Those participants who were willing to use baby finger toothbrushes were included in Group A and the remaining participants were part of Group B. A nonrandomized controlled trial study design was used. Group A Participants were asked to use baby finger toothbrushes for 15 days. The oral hygiene index-simplified (OHI-S) was recorded for both the groups on day 1 and after 15 days. We then compared the oral hygiene status for those who use baby finger toothbrush with those who clean the teeth using finger. Results: OHI-S was significantly higher in the participants cleaning teeth with their fingers compared to the participants using baby finger toothbrush after 15 days. It showed that using a baby finger toothbrush is more effective than using your fingers to improve oral hygiene. Participants who used the baby finger toothbrush had the median OHI-S of 1.33, which is close to a good OHI-S (good-OHI-S = 0.0–1.2) and indicates that baby finger toothbrush was able to maintain “Fair” oral hygiene. Conclusion: To improve oral hygiene in rural India, where most individuals clean teeth with their fingers, a baby finger toothbrush can be used as an improvised method of tooth cleaning.

Effect of Different Occlusal Tooth Forms of Mandibular Overdenture Retained by an Immediate Loaded Single Implant on the Masticatory Efficiency and Oral Health-Related Quality of Life.

To study the masticatory efficacy and oral health-related quality of life (OHRQoL) of participants wearing a mandibular overdenture retained by an immediate loading single implant with different occlusal tooth forms. For this nonrandomized controlled trial study, 27 edentulous participants were selected and randomly divided into three groups (n = 9) based on occlusal tooth forms of the mandibular implant overdenture (MIOD). Group I: participants received an MIOD with an anatomical tooth form; Group II: participants received an MIOD with a semianatomical tooth form; and Group III: participants received an MIOD with a nonanatomical tooth form. For each participant, a single implant (screw root form) was inserted into the midline of the mandibular ridge to support the MIOD. For each group, the masticatory efficiency was evaluated after 3 months, and the OHRQoL of the participants was evaluated after 3 and 6 months. One-way ANOVA and post hoc Tukey's test were used for data analysis (P < 0.05). The masticatory efficiency of the anatomic and semianatomic tooth forms was higher than that of the nonanatomic (P < 0.05). Moreover, the improvement in the participants' OHRQoL in the anatomic group was more significant than that of other groups (P < 0.05). There was a greater improvement in masticatory efficiency and participants' OHRQoL when fitted with an anatomic tooth form mandibular overdenture retained by an immediate loading single implant than with a semianatomic or nonanatomic tooth form.

Comparative Study Between Pedicled Latissimusdorsi Flap Reconstruction And Traditional Conservative Breast Surgery in Upper Outer Quadrant Breast Cancer

Background:Oncoplastic breast surgery (OPS)has developed as an extension of breast conserving surgery (BCS) in an effort to improve esthetic and functional outcome following surgery for breast cancer (BC). This study evaluatedthe benefits of reconstruction using the latissimusdorsi(LD) flap, as compared with local tissue displacement.Methods: This was a comparative non-randomized control study on patients after excision of the malignant mass from the upper outer quadrant BC. The two groups were classified into Group A: reconstruction by local tissues displacement, and Group B: reconstruction by pedicledLD flap.The two techniques were compared regarding history, examination finding, intraoperative and post-operative complications.Results:there was no significant difference between group A and B regarding their age, BMI, distance between tumor, NACandpostoperative complications. Tumor size was larger in group B,there was a significant longer operative time,increased blood loss and longer time to recoveryin group B than group A.Conclusion: OPS with breast reconstruction using the pedicledLD flap accompanied with better intra and postoperative outcomes.

Bone Turnover Markers Changes Induced by Plateletpheresis May Be Minimized with Oral Supplementation of Calcium, Minerals, and Vitamin D before the Procedures: A Non-Randomized, Controlled Study.

Apheresis allows the collection of specific blood components but changes serum calcium (Ca), magnesium (Mg), copper (Cu), zinc (Zn), and hormones involved in bone metabolism due to citrate infusion. We assessed the effect of oral supplementation of calcium, vitamin D, and minerals as pills or an enriched diet before plateletpheresis donation on levels of divalent cations, hormones, and bone turnover markers that may prevent metabolic changes. Methods: Non-randomized controlled study including 134 donors. Serum parathyroid hormone (PTH), Ca, Mg, Zn, Cu, osteocalcin (OC), vitamin D, and type-1 collagen C-terminal telopeptide (CTX-1) levels were measured at baseline and post-procedure. Donors were divided into four groups: supplemented with calcium carbonate and vitamin D (cal + vitd); those receiving calcium, minerals, and vitamin D (cal + vitd + min); those receiving a calcium-rich diet (diet) and a control group (control). Results: PTH levels increased >1-fold, whereas tCa, tMg, Zn, Cu, iCa, iMg, and vitamin D levels decreased immediately after apheresis amongst donors of any group; when these levels were measured two weeks later, donors in the calcium-vitd and cal + vitd + min groups returned to basal values; donors in the cal + vitd + min group were the only group that kept their levels of OC and CTX unchanged at the different study times. Conclusions: Bone turnover markers changes induced by plateletpheresis may be minimized with oral supplementation of calcium, minerals, and vitamin D two days before the procedures.

Management of Children with Speech Disorders via Transcranial Magnetic Stimulation: Non-Randomized Controlled Study

Background. Speech development impairment is urgent and common problem in pediatric neurology. Transcranial magnetic stimulation (TMS) is one of the promising treatment variants for children with speech disorders. Objective. The aim of the study is to evaluate efficacy and safety of the developed approaches to TMS usage in the management of children with speech disorders. Methods. It was non-randomized controlled study. It included 46 children with speech disorders aged from 3 to 6.5 years. All children were divided into two groups comparable by gender and age: 26 children of the treatment group received TMS course, 20 children of the control group received treatment with hopantenic acid. All patients with speech disorders underwent psychological and pedagogical evaluation of speech and cognitive development, electroencephalography (EEG) before and after treatment. Moreover, comparative analysis of TMS and nootropic therapy efficacy was carried out. Specialized examination of speech and cognitive development was also performed via E.A. Strebeleva method for psychological and pedagogical diagnosis of children development. Furthermore, we carried out side reactions / adverse events registration according to patients and/or their parents complaints confirmed by physical examination, patient’s behavior observation, data from specially developed questionnaire for assessing child’s behavior and well-being (filled up by parents). Finally, we evaluated brain bioelectric activity recorded by EEG. Results. The study results have shown that it is possible to achieve significant positive dynamics in cognitive and speech development in preschool children with speech disorders in both groups (TMS course and medical treatment). But hereby, TMS treatment has demonstrated significantly higher positive dynamics in two out of the three evaluated parameters. There were no cases of adverse events in TMS group leading to early course discontinuation. Conclusion. TMS is non-invasive and safe method for treatment of children with speech disorders. This study has demonstrated the efficacy of the method in the field of personalized management of children with impaired speech and cognitive development.

Effect of psychosocial interventions on risky driving behaviours among offender drivers by using simulated and real driving: study protocol for a non-randomised controlled trial

BackgroundRisky driving behaviour including anger while driving has led to millions of global road traffic crashes, thousands of mortalities and injuries. These losses are much more in middle-income countries, such...

Meta-Analysis of Effectiveness and Safety of Botulinum Toxin in the Treatment of Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) is characterized by pain, limited range of motion, swelling, skin changes, vasomotor instability, and patchy bone demineralization. Conservative management strategies for CRPS include physical and occupational therapy, psychosocial and behavioral therapy, and pharmacotherapy. However, some patients still experience CRPS symptoms after receiving conventional treatments. Therefore, botulinum toxin (BoNT) has been applied to patients with CRPS in several trials considering its analgesic effect in musculoskeletal and neuropathic pain; however, the results were controversial. We conducted the study to explore the effectiveness and safety of BoNT in patients with complex regional pain syndrome (CRPS). A search was performed using the following electronic databases up to 19 October 2022: PubMed, Embase, and Cochrane Library. We included both randomized controlled trials and nonrandomized controlled studies involving patients with complex regional pain syndrome managed with botulinum toxin. Cochrane risk-of-bias tool and Joanna Briggs Institute Critical Appraisal Checklist were used for quality assessment for randomized controlled trials and quasi-experimental studies. Only randomized controlled trials entered the meta-analysis. The primary outcome was the visual analogue scale of pain presented as a weighted mean difference (WMD) and 95% confidence interval (CI). The secondary outcome was the risk of adverse events presented as an odds ratio (OR) with 95% CI. We analyzed eight articles with 176 patients, including three randomized controlled trials with 62 participants. The age of the patients ranged from 23.8 to 51 years old. The duration of the disease ranged from 2.2 to 11.8 years. The proportion of females ranged from 16.6% to 100%. The route of administration of BoNT included: (1) lumbar sympathetic block (LSB), (2) intramuscular injection, (3) subcutaneous or intradermal injection (SC/ID). Improvement in pain was revealed in six studies, and adverse events were all self-limited and temporary. Meta-analysis revealed a significant reduction in pain at the first follow-up between 3 weeks to 1 month after intervention (WMD, -1.036, 95% CI, -1.673 to -0.400) but not at the second follow-up between 2 to 3 months after treatment (WMD, -0.895, 95% CI, -2.249 to 0.458). Subgroup analyses between LSB and SC/ID were nonsignificant at both follow-up periods (p = 0.422, 0.139). The risk of adverse events was similar between the BoNT and control group (OR, 0.698, 95% CI, 0.136 to 3.581). In conclusion, BoNT may be effective and safe for alleviating pain in patients with CRPS. However, we could not draw definite conclusions due to small sample size and high between-study heterogeneity. The limited number of participants may conceal the possibility of serious adverse events. Further large-scale randomized controlled trials are warranted to delineate the role of BoNT in CRPS.

Virtual and Augmented Reality versus Traditional Methods for Teaching Physiotherapy: A Systematic Review.

The use of virtual worlds in health-related education is increasingly popular, but an overview of their use in physiotherapy education is still needed. The aim of this review was to analyse the use of virtual and augmented reality (VR/AR) compared to traditional methods for teaching physiotherapy. A systematic review was performed up to October 2022 in PubMed, Web of Science, Scopus, CINAHL, and PsycInfo. The quality appraisal and risk of bias were assessed by the Joana Briggs Institute checklist and the Cochrane Collaboration's RoB Tool 2.0, respectively. A total of seven randomised and non-randomised controlled studies were included, involving 737 students. VR/AR-based teaching approaches included simulation and virtual worlds, and were conducted through immersive head-mounted displays, AR-based applications, and 3D visualisations. Three studies were focused on teaching anatomy content, two on clinical decision making skills, and the rest were focused on pathology, physiotherapy tasks or exercise performance, and movement analysis of lower limbs. Inconclusive results were found in terms of learning satisfaction and academic performance, showing VR/AR-based teaching models to be equally effective as traditional methods for teaching physiotherapy. We encourage researchers and teachers to include games in their VR/AR-based teaching approaches to enhance interaction and active learning in physiotherapy education.

Acupuncture for Adult Obstructive Sleep Apnea or Obstructive Sleep Apnea-Hypopnea Syndrome: A Review of the China National Knowledge Infrastructure Database

The purpose of this study was to analyze acupuncture treatment methods and acupoints used to treat obstructive sleep apnea (OSA) or obstructive sleep apnea-hypoapnea syndrome (OSAHS). The data were retrieved from January 2010 to May 2022 from the China National Knowledge Infrastructure database. The search terms included “adult,” “obstructive sleep apnea,” “obstructive sleep apnea hypoapnea syndrome,” “acupuncture,” and “electro-acupuncture.” Clinical trials for acupuncture treatment of OSA or OSAHS were included in this review (4 non-randomized controlled studies, 1 was a case report, and 10 randomized controlled studies). For OSA and OSAHS treatment, the acupoints that were most frequently used included REN23, LU7, ST40, EX9, LI11, and DU20. Compared with the control or Western treatment group, the treatment outcome measures of participants in the acupuncture treatment group significantly improved. In some studies, participants in the acupuncture group did not have side effects and the treatment was cost-effective. The data analyzed in this review suggest that acupuncture is an effective treatment for OSA or OSAHS.

Immediate versus delayed implant placement in the esthetic zone: a prospective 3D volumetric assessment of peri-implant tissue stability

PurposeTo evaluate the volumetric stability of peri-implant soft and hard tissue prospectively, this study compared immediate versus delayed implants placed in the anterior esthetic region.MethodsThis non-randomized controlled clinical study included 25 patients, who received an immediate (type 1) or a delayed (type 4) implant placement for the replacement of a single anterior tooth. The anterior maxillae were intraorally scanned at three timepoints: before surgery (S0), 6 months (S1), and 12 months (S2) after surgery. A specific region of interest (ROI), divided into marginal and apical regions, was determined and superimposed for volumetric changes analysis. At 6 and 12 months, the probing depth (PD), bleeding/suppuration on probing (BOP/SUP), modified plaque index (PI), keratinized mucosa (KM) width, mucosal recession (MR), and implant stability (PTV) by means of periotest were recorded.ResultsBetween S0–S2, tissue surrounding immediate implants was reduced in 0.37 ± 0.31 mm, whereas delayed implants gained 0.84 ± 0.57 mm mean tissue volume. Peri-implant tissue loss at type 1 implants occurred primarily in the marginal section of the ROI (0.42 ± 0.31 mm), whereas tissue gain at type 4 implants occurred mainly in the apical section (0.83 ± 0.51 mm). These values were significantly different between both groups for the entire ROI (p = 0.0452) and the marginal region (p = 0.0274). In addition, the mean buccal KM width around type 1 implants was significantly wider in comparison with the type 4 implants group after 12 months (p = 0.046). There were no significant differences between groups regarding PD, BOP/SUP, or PTV.ConclusionsThe results suggest that type 1 implants placed in the esthetic region experience more tissue loss than type 4 implants, thus marginal tissue remodeling should be considered for planning immediate implants placement in the anterior maxillae.Graphical