Patient Discomfort Research Articles

Investigation of medication reviews and the identification of adverse drug reactions using machine learning algorithms

The social networks for medicine allow users to share reviews on the drugs they have used. The medical and pharmaceutical industries can be guided by the arrangement of patient reviews of medications into ratings, whether good or unfavourable and the identification of the medications that cause an (Adverse Drug Reaction) ADR to better understand the patient's discomfort or satisfaction with particular medications. Unexpected pharmacological reactions from patient to patient can be caused by side effects. Pharmaceutical firms that produce the pharmaceuticals that are recommended for the prevention and treatment of sickness, however, occasionally cause negative lateral effects and lateral-effects that result in the demise of people who take the drugs. Pharmaceutical companies disclose the majority of side effects constructed on experimental tribunals, just one, which a small number are recognized. For better pharmacological side-effect prediction, feature sets are examined. When comparing Side-effects, machine learning (ML) techniques are utilized to determine which classifier has the highest level of accuracy. The goal of this study is to forecast how adenosine receptor-interacting medicines and therapeutic candidates would behave. In order to shape a machine learning prototypical, we used four distinct categorization methods: Naive Bayes(NB), Random Forest (RF), Decision Tree (DT), and Support Vector Machine (SVM). We then associated the findings and selected the one that produced the best results. In contrast to prior studies, we trained our model to distinguish between medications that interact with adenosine receptors and those that do not by using the drug side effect integrated into the drug fingerprint as a feature. In order to determine which medicine is most desired (and has the fewest side effects) among numerous, we rated the pharmaceuticals that interact with adenosine receptors depending on adverse effects. This aids in drug development. Drug side effects are typically not included in existing datasets, which focus instead on medicines, targets, and their interactions. For better pharmacological side-effect prediction, feature sets are examined. A comparative examination of Side-effects is conducted using machine learning (ML) techniques in order to determine which classifier has the highest level of accuracy. Using machine learning procedures and natural language processing techniques, this research proposes a model to forecast drug side effects based on review analyses.

Navigating the landscape of periodontal and peri-implant microsurgery: A contemporary review

Periodontal and per-implant microsurgery have revolutionized the field of dental surgery, enabling precise and minimally invasive procedures with improved outcomes. The advent of microsurgical instruments, enhanced magnification systems, and specialized suturing techniques has allowed clinicians to achieve superior aesthetic and functional results while minimizing patient discomfort and morbidity. Furthermore, emerging technologies such as digital planning and guided surgery have complemented microsurgical techniques, enabling more predictable outcomes and patient-centered treatment approaches. The review aims to discuss the principles of microsurgery, including flap design, tissue handling, and suture placement, and explores their applications in the management of mucogingival defects and periimplantitis. Continued research and clinical advancements in this field are essential to further enhance treatment outcomes and refine surgical protocols for the benefit of patients and practitioners.

Robot-Assisted Radical Prostatectomy in PIRADS 5 Lesions Without Prior Biopsy: Is Biopsy Really Necessary in This Cohort?

Introduction: Conventionally, confirmation of clinically significant prostate cancer (csPCa) (Gleason grade group ≥ 2) involves an initial multiparametric magnetic resonance imaging (mpMRI) followed by biopsy. Prostate biopsy incurs inherent risks of infection, bleeding, patient discomfort, and a 6-week delay before robot-assisted laparoscopic radical prostatectomy (RALP). We explored the feasibility of immediate RALP in men with PIRADS 5 lesions without preceding biopsy. Methodology: After obtaining institutional review board approval, a prospective analysis was conducted on 235 patients with PIRADS 5 lesions on mpMRI from December 2018 to February 2023. Patients were divided into 2 groups as follows: Group NoBiopsy (biopsy not done before RALP, cases, n = 118) and Group YesBiopsy (biopsy done before RALP, controls, n = 117). Baseline preoperative, intraoperative, and postoperative parameters were analyzed. Functional outcomes were monitored at 1, 3-, 6-, 9-, and 12-months follow-up post-RALP. Statistical analysis was performed using SPSS and STATA. Results: Ninety-five percent of cases and 87.17% controls had csPCa on final pathology post-RALP. Multivariable analysis did not find significant association between biopsy status and csPCa. Abnormal digital rectal examination (DRE), family history, preoperative PSA, and MRI lesion volume predicted csPCa. Significant differences were observed in console time (NoBiopsy vs. YesBiopsy, 60 ± 10 vs. 70 ± 9 minutes, p < 0.001) and estimated blood loss (80 ± 20 vs. 100 ± 30 mL, p < 0.01) between groups. At 6 months post-RALP, 96% of men in Group NoBiopsy were continent, compared with 88% of men in Group YesBiopsy (p < 0.04). All men in the study cohort were continent (0 pads) at 12 months post-RALP. Ninety-eight percent of cases and 92% of controls at 9 months and 12 months, respectively, were able to have penetrative sex with or without PDE-5 inhibitors post-RALP. Conclusion: RALP without antecedent prostate biopsy in men with PIRADS 5 lesions demonstrated substantial csPCa detection rates and superior functional outcomes, warranting further validation.

Family-oriented care and health-related quality of life for women with gynaecological cancer: A cross-sectional mixed-method study.

This study aims to describe the experiences of women with gynaecological cancer regarding family-oriented care (FOC) and how they rated their health-related quality of life (HRQoL) using a 15D instrument (15D©). A cross-sectional mixed-method study. The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27). The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions. In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare. This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families. This study was prepared and reported according to the STROBE checklist. No patient or public contribution.

Efficacy of Lasers in Debonding Ceramic Brackets: Exploring the Rationale and Methods.

The development ofceramic brackets in orthodonticsthree decades agoemerged as a response to the increasingpatientdemand for less visible orthodontic appliances.While these brackets provide superior aesthetics, they are characterized by lower fracture toughness and higher bond strength in contrast to metal brackets. These properties present challenges during the debonding step, including the risk of enamel micro-fractures and cracks. Historically, various strategies have been developed to address challenges associated with debonding, reduce patient discomfort, and ensurethat the bondfailure site is confined to the bracket-adhesive interface. This included the use of specially designed debonding pliers, electrothermal debonding, ultrasonic technique, and chemical agents. Recently, there has been a shift towards utilizing different types of laser irradiation for this purpose. The burgeoning strategy, however, requires diligent scientific scrutiny to establish a standardized protocol with particular laser parameters and ultimately achieve the goal of enhancing the patient experience by reducing discomfort. This article offers a narrative review of laser-aided debonding of ceramic brackets, aimed at comparing different laser types, presenting their benefits and downsides, validating the efficiency of each method, and summarizing the published literature on this subject.It also provides insights for orthodontists on reducing patient discomfort that usually accompanies debonding ceramic brackets by delving into the science behindthe use oflasersfor this purpose.

Design and Development of Multi-Featured Medical Stretcher

The multi-featured medical stretcher represents a significant leap forward in patient care and hospital operations. Its innovative design combines various features aimed at enhancing both patient comfort and healthcare worker efficiency. At the core of its design is a commitment to making patient movement easier and safer. Through its adjustable height mechanism, the stretcher can be tailored to individual patient needs and seamlessly integrated into various medical procedures. This adaptability not only enhances patient comfort but also facilitates smoother transitions between different stages of care. Furthermore, the inclusion of storage compartments ensures that essential medical supplies are readily accessible, minimizing disruptions during patient transport and treatment. This organizational feature not only saves time but also contributes to a more efficient workflow for healthcare workers. Importantly, the stretcher's ability to move patients from stretcher to bed with minimal human assistance is a game-changer. By reducing the reliance on manpower for transfers, it streamlines hospital operations and minimizes the risk of patient discomfort or injury during movement. Overall, the multi-featured medical stretcher represents a significant advancement in hospital equipment, offering a comprehensive solution to the challenges associated with patient transport. Its integration of comfort-enhancing features and efficiency-boosting functionalities marks a substantial improvement in patient care delivery and contributes to a smoother and safer hospital environment for both patients and healthcare workers alike.

Low-dose dexmedetomidine sedation in patients undergoing electrophysiological study and ablation of supraventricular tachycardias in a same day setting

Abstract Background Catheter ablation for supraventricular tachycardias (SVT) can frequently cause patient discomfort, anxiety or pain. Through the years different drugs have been employed to provide an optimal sedation without interfere with inducibility of tachyarrhythmia. Moreover, the increasing number of patients with this clinical condition and the growing demand of catheter ablation, makes same day discharge mandatory. For this purpose, drugs that guarantee minimal sedation and reduce adverse events should be used. Dexedetomidine (DEX) is a selective alpha-2 agonist with analgesic and sedating effect without significant respiratory depression. Its electrophysiological effects include the sinus node and atrioventricular (AV) node depression and an increased atrial refractoriness. Albeit there is a reduction of side effects of most commonly used sedation drugs, data on the efficacy and safety profile of DEX during SVT ablation of adult patients are unclear and conflicting. Purpose The aim of this study was to assess whether optimal sedation and patient’s comfort can be achieved with a low-dose DEX without interfering with electrophysiological parameters during catheter ablation of SVT in adult population. Methods This is a single-center prospective study. Study population consisted of patients undergoing mapping and catheter ablation of SVT from January to September 2023 divided into DEX group (periprocedural infusion of Dexedetomidine 0.07-0.11 mcg/kg/h without loading dose) and non-DEX group (midazolam 1-2 mg periprocedural). Clinical and procedural data were recorded for all patients, as well as all measurements taken during electrophysiological study. Results The study population was predominantly female (60%) with a mean age of 56 ± 13.7 years. Hypotension occurred in only one patient, in the DEX group. No cases of desaturation were observed in both groups. Most of the induced tachyarrhythmias were the slow-fast type of atrioventricular nodal reentrant tachycardia (75%), whereas atrioventricular reentrant tachycardia and atrial tachycardia were less common (7.1% and 7.1%). No significant differences were recorded in relation to AV node refractoriness, atrial refractoriness, anterograde and retrograde conduction. (Table 1) Isoproterenol was required to induce tachyarrhythmia in both groups. Arrhythmia inducibility and aberrancy in tachycardia was not significantly influenced by DEX. The jump phenomenon was recorded more frequently in the DEX group (86.4% vs. 46.7%; p=0.004). The mean duration of the procedure did not differ between the two groups. All patients were discharged on the same day after 3 hours of observation. Conclusions The use of low-dose Dexedetomidine was succesful in improving periprocedural patient comfort, without reducing tachyarrhythmia inducibility or major electrophysiological parameters.

Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity

Atrial fibrillation and obesity are common, and both are increasing in prevalence. Obesity is associated with failure of cardioversion of atrial fibrillation using a standard single set of defibrillator pads, even at high output. To compare the efficacy and safety of dual direct-current cardioversion (DCCV) using 2 sets of pads, with each pair simultaneously delivering 200 J, with traditional single 200-J DCCV using 1 set of pads in patients with obesity and atrial fibrillation. This was a prospective, investigator-initiated, patient-blinded, randomized clinical trial spanning 3 years from August 2020 to 2023. As a multicenter trial, the setting included 3 sites in Louisiana. Eligibility criteria included body mass index (BMI) of 35 or higher (calculated as weight in kilograms divided by height in meters squared), age 18 years or older, and planned nonemergent electrical cardioversion for atrial fibrillation. Patients who met inclusion criteria were randomized 1:1. Exclusions occurred due to spontaneous cardioversion, instability, thrombus, or BMI below threshold. Dual DCCV vs single DCCV. Return to sinus rhythm, regardless of duration, immediately after the first cardioversion attempt of atrial fibrillation, adverse cardiovascular events, and chest discomfort after the procedure. Of 2079 sequential patients undergoing cardioversion, 276 met inclusion criteria and were approached for participation. Of these, 210 participants were randomized 1:1. After exclusions, 200 patients (median [IQR] age, 67.6 [60.1-72.4] years; 127 male [63.5%]) completed the study. The mean (SD) BMI was 41.2 (6.5). Cardioversion was successful more often with dual DCCV compared with single DCCV (97 of 99 patients [98%] vs 87 of 101 patients [86%]; P = .002). Dual cardioversion predicted success (odds ratio, 6.7; 95% CI, 3.3-13.6; P = .01). Patients in the single cardioversion cohort whose first attempt failed underwent dual cardioversion with all subsequent attempts (up to 3 total), all of which were successful: 12 of 14 after second cardioversion and 2 of 14 after third cardioversion. There was no difference in the rating of postprocedure chest discomfort (median in both groups = 0 of 10; P = .40). There were no cardiovascular complications. In patients with obesity (BMI ≥35) undergoing electrical cardioversion for atrial fibrillation, dual DCCV results in greater cardioversion success compared with single DCCV, without any increase in complications or patient discomfort. ClinicalTrials.gov Identifier: NCT04539158.

Point-of-care Ultrasound in Infectious Diseases: Current Insights and Future Perspectives.

Point-of-care ultrasound (POCUS) is a safe, noninvasive technique performed at the patient's bedside, providing immediate results to the operator. It complements physical examination and facilitates clinical decision-making. In infectious diseases, POCUS is particularly valuable, offering an initial assessment in cases of suspected infection. It often leads to an early tentative diagnosis enabling the prompt initiation of antimicrobial treatment without the delay associated with traditional radiology. POCUS provides direct visualization of affected organs, assists in evaluating fluid balance, and facilitates various interventions, all while reducing patient discomfort. For infectious disease specialists, becoming proficient in POCUS is a critical future challenge, requiring dedicated training for effective utilization.

Uncertainty-aware non-invasive patient–ventilator asynchrony detection using latent Gaussian mixture generative classifier with noisy label correction

AbstractPatient–ventilator asynchrony (PVA) refers to instances where a mechanical ventilator’s cycles are desynchronised from the patient’s breathing efforts, and may result in patient discomfort and potential ineffective ventilation. Typically, they are identified with constant monitoring by trained clinicians. Such expertise is often limited; therefore, it is desirable to automate PVA detection with machine learning methods. However, there are three major challenges to applying machine learning to the problem: data collected from non-invasive ventilation are often noisy, there exists high variability between patients or between setting changes, and manual annotations of PVA events are not always consistent. To produce meaningful inference from such noisy data, a model needs to not only provide a measure of uncertainty, but also take into account potential inconsistencies in the training signal it is based on. In this work, we propose a conditional latent Gaussian mixture generative classifier with noisy label correction, which is capable of capturing variations within and between classes, providing well-calibrated class probabilities, detecting unlikely input instances that deviates from training data, while also taking into account possible mislabelling of event classes. We show that our model is able to match the performance of a well-tuned gradient boosting classifier, but also produce better calibrated predictions and smaller performance variability between patients.

A Comparison Study on the Metabolites in PC-3, RWPE-1, and Chrysin-Treated PC-3 Cells

Prostate cancer is frequently diagnosed and the leading cause of death in men worldwide. Prostate-specific antigen (PSA) blood tests and biopsies are the primary methods for diagnosing prostate cancer; however, their accuracy is less than 50%. Therefore, there is a need to develop diagnostic tests that minimize patient discomfort during examination and adequate biomarkers that are more accurate, sensitive, and specific for the detection of prostate cancer. This study investigated the application of metabolomics to identify biomarkers in prostate cancer biofluids. In addition, changes in prostate cancer metabolite levels induced by chrysin, a natural anticancer compound, were evaluated and compared with those in non-treated prostate cancer cells. Gas chromatography-mass spectrometry (GC-MS)-based metabolomic profiling was performed to investigate the differences in metabolic alterations among prostate cancer, normal prostate, and chrysin-treated prostate cancer cells. Pairwise comparisons of the extracellular fluid metabolomes were performed using principal component analysis (PCA), partial least squares–discriminant analysis (PLS-DA), and Student’s t-test. The results revealed significantly different patterns among the metabolite groups, including alcohols, amino acids, carboxylic acids, organic acids, sugars, and urea. The RWPE-1- and chrysin-treated PC-3 (PC-3 Chr) cell groups showed similar tendencies for 23 metabolites, while the groups showed significant differences from the PC-3 group. Most amino acids showed higher concentrations in PC-3 cells than in the normal cell line RWPE-1 cells and PC-3 Chr cells. Our results revealed that GC-MS might be an effective diagnostic tool to detect prostate cancer and contribute to finding new tumor markers for prostate cancer as the basis for new ideas.

Validation of a New Ankle Brachial Index Measurement System Using Pulse Wave Velocity.

Peripheral artery disease (PAD) is a common circulatory disorder characterized by the accumulation of fats, cholesterol, and other substances in the arteries that restrict blood flow to the extremities, especially the legs. The ankle brachial index (ABI) is a highly reliable and valid non-invasive test for diagnosing PAD. However, the traditional method has limitations. These include the time required, the need for Doppler equipment, the training of clinical staff, and patient discomfort. PWV refers to the speed at which an arterial pressure wave propagates along the arteries, and this speed is conditioned by arterial elasticity and stiffness. To address these limitations, we have developed a system that uses electrocardiogram (ECG) and photoplethysmography (PPG) signals to calculate pulse wave velocity (PWV). We propose determining the ABI based on this calculation. Validation was performed on 22 diabetic patients, and the results demonstrate the accuracy of the system, maintaining a margin of ±0.1 compared with the traditional method. This confirms the correlation between PWV and ABI and positions this technique as a promising alternative to overcome some of the limitations of the conventional method.

Sven Ivar Seldinger (1921-1998): The Founding Father of Interventional Radiology.

Sven Ivar Seldinger, a Swedish radiologist, laid the cornerstone of modern interventional radiology in 1953 with the introduction of his innovative technique for catheter insertion. This technique, known as the Seldinger technique, represents a pivotal advancement in medical procedures, offering a safer, less invasive method for vascular access. The elegance and effectiveness of this technique not only refined angiography and other catheter-based interventions but also heralded the birth of interventional radiology as a major therapeutic specialty. This article delves into Seldinger's life, the genesis of his technique, its profound impact on medical practice, and his enduring legacy that continues to resonate across numerous medical specialties today. By pioneering minimally invasive approaches to treatment, Seldinger's innovation has significantly alleviated patient risk and discomfort, broadening the spectrum of therapeutic options available in modern medicine.

WHAT IS THE EXPERIENCE OF CARDIAC SURGERY PATIENTS REGARDING THE NURSING CARE THEY RECEIVE? SCOPING REVIEW

Abstract Introduction The patient experience is recognized as a key indicator of the quality of healthcare. Patients‘ expectations and experiences significantly influence health outcomes, including the effects of treatments in specialized settings, such as cardiac surgery. Cardiovascular disease is one of the world‘s major public health problems, and people who survive a heart attack become ‘chronically ill‘, resulting in economic costs to society. Aim The aim of this scoping review is to investigate and highlight the experiences of patients undergoing cardiac surgery, identifying which factors are considered significant and which have led to patient discomfort, in order to improve nursing care. Methods A scoping review was conducted in June and July 2023 and the scoping followed the guidelines outlined by Joanna Briggs Institute. The drafted review protocol is aligned with the PRISMA guidelines. The search for relevant articles was conducted using 6 databases (PubMed, Cinahl, Web of Science, PsycInfo, Scopus, Embase), and articles extracted from secondary bibliographies were also considered. All paper with a qualitative approach, as this is the methodology that provides the best understanding of the patient experiences about nursing care, written in Italian or in English, in the field of cardiac surgery and referring to the review question were included. Results The analysis of the qualitative data extracted from the 43 articles identified 4 themes – communication, perceived professionalism, nurse–patient relationship, patient needs, and criticality – and 43 subthemes, which were differentiated into 16 "positive" and 27 "negative" subthemes, depending on the meaning reported by patients. For each subtheme, the frequency of recurrence was calculated since they do not all have the same weight and recurrence. Conclusions This review has extrapolated from the patient experience which areas of nursing care are considered significant by patients and which need improvement and more attention. In order to increase personalized and patient–centered nursing care, it is now necessary to consider the experiences, and emotions of patients undergoing cardiac surgery to nip worries and anxieties in the bud, promote rapid recovery in the postoperative period, and foster improvement in the quality of nursing care.

Radiographic evaluation of hard tissue changes in open flap technique versus flapless technique for implant placement

Open flap technique allows the clinician to directly visualize the alveolar bone and assess bone morphology of the ridge.However, this technique is relatively invasive and causes patient discomfort and marginal bone loss due to decreased supraperiosteal blood supply whereas the Flapless technique is one of the latest minimally invasive surgical methods of implant placement without the need to raise a mucoperiosteal flap to overcome the bone resorption process. The present study was designed to evaluate the hard tissue changes in open flap technique versus flapless ṭechnique for implant placement at the different time interval. Minimum thirty edentulous sites from Out Patient Department, Department of Periodontology (IDST) were randomly allocated to the following two groups by the flip of coin: Group I - Implant with open flap technique (fifteen sites) and Group II - Implant with flapless technique (fifteen sites). Patients were evaluated radiographically for crestal bone loss (mesial and distal) at Baseline (Immediately after implant placement), At the time of prosthetic loading and 3 months after prosthetic loading in both the groups. The result of the present study revealed that Sites where implants were placed with flapless technique showed lesser mean crestal bone loss scores as compared to sites where implants were placed with open flap technique, although the difference was insignificant. It can be concluded that flapless procedure may be considered as a better treatment option as compared to implant placed with open flap technique in terms of minimal pain, inflammation and less crestal bone loss associated with flapless technique than open flap technique.

A prediction model of abnormal acid reflux in gastroesophageal reflux disease.

The measurement of esophageal acid exposure time (AET) using combined multichannel intraluminal impedance-pH (MII-pH) tests is the gold standard for diagnosing gastroesophageal reflux disease (GERD). However, this catheter-based 24-h test can cause considerable patient discomfort. Our aim is to identify factors affecting AET and to develop a scoring model for predicting AET abnormalities before conducting the MII-pH test. Of the 366 patients who underwent MII-pH test at two facilities in Japan and Vietnam, 255 patients who also had esophagogastroduodenoscopy and high-resolution manometry were included in this study. Logistic regression analysis was conducted using risk factors for AET>6% identified from a derivation cohort (n=109). A scoring system predicting AET>6% was then constructed and externally validated with a separate cohort (n=146). Three variables were derived from the prediction model: male gender, Hill grades III-IV, and weak mean distal contractile integrals. Based on these scores, patients were classified into low (0 point), intermediate (1-3 points), and high (4 points) risk groups. The probabilities of having an AET>6% were 6%, 34%, and 100% for these groups, respectively. A score of <1 excluded patients with abnormal AET, with a negative predictive value of 93.8% in the derivation cohort and 80.0% in the validation cohort. We derived and externally validated a prediction model for abnormal AET. This system could assist in guiding the appropriate treatment strategies for GERD.

Transperineal 3-Core Magnetic Resonance Imaging Ultrasound Fusion Targeted Plus Laterally 6-Core Systematic Biopsy in Prostate Cancer Diagnosis

IntroductionIt is important to explore strategies reducing the number of SB cores taken to minimize biopsy-related morbidity and patient's discomfort during biopsy. This study aims to optimize prostate biopsy procedures by reducing the number of systematic biopsy (SB) cores while preserving cancer detection rates in the era of combined biopsy. Patients and MethodsWe prospectively recruited patients with ≥1 magnetic resonance imaging (MRI) lesions and they underwent transperineal combined 12-core SB+3-core targeted prostate biopsy (TB, reference standard). New strategy was defined as a laterally 6-core SB+3-core TB. Patients were served as their own control. Detection rates for overall prostate cancer (PCa) and clinically significant PCa (csPCa) were compared among the standard SB, MRI-TB, 6-core SB +3-core TB, and reference standard. Pathology consistency was assessed using the Kappa test. ResultsA total of 204 men were included, of which 111 (54.41%) and 92 (45.10%) harbored overall PCa and csPCa. Referenced combined biopsy detected significantly 6.86% (P = .0005) or 4.90% (P = .0044) more csPCa than performing only SB or 3-core TB, but was comparable to the new biopsy strategy. (45.10% vs. 43.14%, P = .1336) Similar results persisted when limiting patients in biopsy-naïve men or stratified by Prostate Imaging Reporting and Data System scores, PSAD, and index lesion parameters. Additionally, performing 6-core SB+3-core TB demonstrated high consistency with reference standard in grade group distribution (Kappa coefficient: 0.952 for all, 0.961 for biopsy-naïve men) and achieved superior sensitivity of 95.7% (All: 95% CI: 89.2%-99.8%) and 96.9% (Biopsy-naïve: 95% CI: 91.1%-99.7%), respectively. ConclusionsThe 6-core SB+3-core TB approach maintains expected detection rates while reducing the total core count, offering a promising alternative to the reference standard, which may help to tailor transperineal combined biopsy procedures.

Safety of Magnetic Resonance Imaging in Orthopaedic Trauma Patients With External Fixation: A Two-Center Case Series.

To report on adverse events during magnetic resonance imaging (MRI) in patients with external fixators. . Retrospective case series. Two Level 1 trauma centers. Patients with external fixators on the appendicular skeleton or pelvis undergoing MRI between January 2005 and September 2023. Adverse events, defined as any undesirable event associated with the external fixator being inside or outside the MRI bore during imaging, including (subjective) heating, displacement or pullout of the external fixator, or early MRI termination for any reason. A total of 97 patients with 110 external fixators underwent at least one MRI scan with an external fixator inside or outside of the MRI bore. The median age was 51 years (interquartile range: 39-63) and 56 (58%) were male. The most common external fixator locations were the ankle (24%), knee (21%), femur (21%), and pelvis (19%). The median duration of the MRI was 40 minutes (interquartile range: 26-58), 86% was performed using 1.5-Tesla MRI, and 14% was performed using 3.0-Tesla MRI. Ninety-five percent of MRI was performed for the cervical spine/head. Two MRI scans (1.6%), one of the shoulder and one of the head and cervical spine, with the external fixator outside of the bore were terminated early because of patient discomfort. There were no documented events of displacement or pullout of the external fixator. These findings suggest that MRI scans of the (cervical) spine and head can be safely obtained in patients with external fixators on the appendicular skeleton or pelvis. Given the low numbers of MRI scans performed with the external fixator inside the bore, additional studies are necessitated to determine the safety of this procedure. The results from this study can aid orthopaedic surgeons, radiologists, and other stakeholders in developing local institutional guidelines on MRI scanning with external fixators in situ. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A Novel Design of Computer-Assisted 3D-Printed TMJ Arthrocentesis Guide (Technical Note).

Attempts of needle relocation and extension of the operation time are the most common cause of postoperative edema and swelling after temporomandibular joint arthrocentesis. To facilitate the placement of needles and decrease patient discomfort, a template-based technique that includes design of patient-specific guide was performed to direct access to the temporomandibular joint space for arthrocentesis.

Risk factors associated with the severity of pericoronitis of mandibular third molar.

The factors related to pericoronitis severity are unclear, and this study aimed to address this knowledge gap. In total, 113 patients with pericoronitis were included, and their demographic, clinical, and radiographic characteristics were recorded. The Patient-Clinician Pericoronitis Classification was used to score and categorize the severity of pericoronitis. Statistical analysis was conducted to examine the participants' characteristics, validity of the Patient-Clinician Pericoronitis Classification, and risk factors associated with the severity of pericoronitis. The demographic, clinical, and radiographic characteristics of males and females were similar, except for Winter's classification, pain, and intraoral swelling. The constructive validity of the Patient-Clinician Pericoronitis Classification was confirmed with three latent factors, including infection level, patient discomfort, and social interference. Ordinal logistic multivariate regression analysis revealed that upper respiratory tract infection was the sole risk factor associated with pericoronitis severity in males (odds ratio = 4.838). In females, pericoronitis on the right side (odds ratio = 2.486), distal radiolucency (odds ratio = 5.203), and menstruation (odds ratio = 3.416) were significant risk factors. This study demonstrated the constructive validity of the Patient-Clinician Pericoronitis Classification. Among females, pericoronitis in mandibular third molars on the right side with radiolucency in menstruating individuals was more severe. In males, upper respiratory tract infection was the sole risk factor associated with pericoronitis severity. Individuals with risk factors should be aware of severe pericoronitis in the coming future.