Definitive Treatment Plan Research Articles

Diagnostic Accuracy of Ultrasound in Evaluation of Obstructive Jaundice with MRCP as a Gold Standard

Abstract Background MRCP has high sensitivity for CBD stones, strictures and malignancies in cases of obstructive jaundice especially cases with suspicion (clinical/CBD-IHBR dilatation on USG). As MRCP has more diagnostic accuracy compared to ultrasound in detecting the cause of obstruction in cases of obstructive jaundice, USG may be considered as an initial screening test and MRCP for definitive treatment planning. The limitation of the study is the small sample size. Objective To evaluate cross sectional retrospective study was done From June 2021 to June 2022 on 31 patients (17 females and 14 males) presenting with obstructive jaundice were referred from Internal Medicine, General Surgery and Clinical Oncology Department to Diagnostic Radiology Department in Ain Shams University hospitals, MRCP were done for all the patients and then Abdominal US examination were performed and then comparison between US & MRCP result were done. Results The US has sensitivity of 100.0%, specificity of 100.0% and accuracy of 100.0 % in detection of level of obstruction and also has sensitivity of 71.0% and accuracy of 71.0% in detecting cause of obstruction taking MRCP as a gold standard. Conclusion MRCP is an excellent tool for detecting the cause of obstructive jaundice, Use of MRCP could therefore spare the patients from invasive preoperative endoscopic procedures and it can also most likely reduce overall surgical costs. We propose MRCP as the method of choice for the diagnostic imaging of obstructive jaundice.

Audit of a Revised Pathway Aimed at Expediting Diagnosis and Treatment for Suspected Achilles Tendon Rupture

Treatment outcomes for Achilles tendon ruptures depend upon prompt diagnosis and management. A local study in 2018 highlighted inefficiencies in patient management, and a revised protocol was introduced allowing investigation and referral to be initiated by other healthcare professionals. This retrospective audit evaluates the impact of this on the timescale from presentation to treatment. It analyzes all suspected Achilles tendon ruptures within one District General Hospital from April 2021 to March 2022. Data regarding patient timelines was compared to the 2018 study. Over 12 months, 99 patients were referred to Virtual Fracture Clinic, 87.8% (n = 87) of which had a complete or partial tear on ultrasound scan (USS). In comparison to 2018, the average time from presentation to USS request reduced from 2.9 to 1.1 days (p < .01). 95% were scanned within one week of USS request and 31.3% within 48 hours (81% and 18%, previously). The average time from USS request to scan went from 6.8 to 3.2 days (p < .01). The time from presentation to treatment decision reduced from 10.9 to 6.2 days (p < .01) and the percentage of patients with a definitive treatment plan within one week increased from 34.5% to 74.2% (p < .01). Patients required 0.8 fewer appointments (p < .01) giving an estimated total saving of $10,110 ($128 per patient) during the analyzed period. The Achilles Tendon Rupture Pathway has significantly improved the proportion of patients undergoing USS within 48 hours and receiving a treatment decision within one week. This study demonstrates an efficient, cost-saving and replicable pathway for Achilles tendon ruptures.

Deep learning based automatic segmentation of the Internal Pudendal Artery in definitive radiotherapy treatment planning of localized prostate cancer

Background and purposeRadiation-induced erectile dysfunction (RiED) commonly affects prostate cancer patients, prompting clinical trials across institutions to explore dose-sparing to internal-pudendal-arteries (IPA) for preserving sexual potency. IPA, challenging to segment, isn't conventionally considered an organ-at-risk (OAR). This study proposes a deep learning (DL) auto-segmentation model for IPA, using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) or CT alone to accommodate varied clinical practices. Materials and methodsA total of 86 patients with CT and MRI images and noisy IPA labels were recruited in this study. We split the data into 42/14/30 for model training, testing, and a clinical observer study, respectively. There were three major innovations in this model: 1) we designed an architecture with squeeze-and-excite blocks and modality attention for effective feature extraction and production of accurate segmentation, 2) a novel loss function was used for training the model effectively with noisy labels, and 3) modality dropout strategy was used for making the model capable of segmentation in the absence of MRI. ResultsTest dataset metrics were DSC 61.71 ± 7.7 %, ASD 2.5 ± .87 mm, and HD95 7.0 ± 2.3 mm. AI segmented contours showed dosimetric similarity to expert physician’s contours. Observer study indicated higher scores for AI contours (mean = 3.7) compared to inexperienced physicians’ contours (mean = 3.1). Inexperienced physicians improved scores to 3.7 when starting with AI contours. ConclusionThe proposed model achieved good quality IPA contours to improve uniformity of segmentation and to facilitate introduction of standardized IPA segmentation into clinical trials and practice.

Effectiveness of Photobiomodulation Alone and 0.5% Nanocurcumin Gel with Photobiomodulation in Treating Myogenous Temporomandibular Disorders: Protocol for a Randomised Clinical Trial

Introduction: Temporomandibular Disorders (TMD) encompass a variety of clinical dysfunctions affecting the Temporomandibular Joint (TMJ), masticatory muscles, and nearby tissues. Pain typically originates from the muscles associated with the functional movements of these structures. Low-level Laser Therapy (LLLT) has been used in TMD patients to control inflammation and disrupt the stress-pain-stress cycle. Curcuma longa is a significant plant in Asia used for medicinal purposes. Curcumin (diferuloylmethane) is a hydrophobic bioactive compound commonly found in the rhizome of C. longa. Considerable attention has been given in recent years to its various pharmacological actions. The available research has shown significant potential in inflammation control, with nanorange preparations of curcumin (Nanocurcumin) enhancing the pharmacological actions and benefits of curcumin, which were not markedly achievable before. Need for the study: The TMDs are among the most common types of disorders associated with orofacial pain. Conditions originating from stress related to the joint often impact the associated muscles, initiating the stress-pain-stress cycle. As TMDs do not have a definitive treatment plan, further research is needed regarding the treatment associated with TMDs. Aim: To assess the effectiveness of photobiomodulation alone and 0.5% nanocurcumin gel with photobiomodulation in treating myogenous TMDs. Methodology: In the present randomised clinical trial, 44 patients with myogenous TMDs will be included. The patients will be divided into two groups: Group A will receive laser applications at the trigger zones, and Group B will receive the application of 0.5% nanocurcumin gel along with laser at the trigger zones. Patients will be assessed for jaw opening, Beck’s Anxiety Inventory, and Visual Analogue Score after four weeks.

Clinical and Histomorphological Features of Cutaneous Adnexal Neoplasms: A Series of Eighteen Cases

Cutaneous Adnexal Neoplasms (CAN) are rare skin tumours with varied morphology that are often misdiagnosed clinically. The definitive diagnosis of these tumours can only be made by Histopathology (HP) based on their appendage differentiation. Though rare in occurrence, diagnosing these tumours is of prime importance, as they can mimic primary cutaneous carcinomas, cutaneous metastasis of a primary tumour, or can serve as markers of internal malignancy. Excision is mostly curative in benign tumours, and wide local excision needs to be performed to prevent recurrences. The aim of the present case series study was to investigate the histopathological spectrum of different CANs based on their appendage differentiation in a hospital-based study. A retrospective analysis was conducted over a period of 4.5 years, and all CAN cases diagnosed on HP were classified according to their appendage differentiation. The concordance between histopathological diagnosis and clinical diagnosis was calculated. Additionally, the frequency distribution of CAN in relation to demographic data was analysed. In the present case series, 18 cutaneous adnexal tumours were reported, showing a female predominance. The majority of the tumours 12 (66.67%) cases were observed in the head and neck region and exhibited a predominance of sweat gland differentiation 12 (66.67%) cases. The most common CANs were eccrine spiradenoma and pilomatrixoma, with 3 (16.67%) cases each. Sebaceous carcinoma and a rare case of Malignant Proliferating Trichilemmal Tumour (MPTT) accounted for 2 (11.11%) cases, being the only malignant tumours reported. The present study demonstrated only concordance of 4 (22.22%) cases between clinical and HP diagnosis. Therefore, the present series emphasises the importance of appendage differentiation in HP, which plays a crucial role in the definitive diagnosis, treatment planning and prognosis in CAN.

Posterior tibial nerve electrical stimulation in chronic constipation: a systematic review and meta-analysis.

A systematic review and meta-analysis were performed to investigate posterior tibial nerve electrical stimulation application methods in patients with chronic constipation. Posterior tibial nerve electrical stimulation is a management procedure for chronic constipation. A comprehensive search was conducted on Ovid, PubMed, Scopus, ProQuest, Web of Science, and The Cochrane Library based on the PICO formation of the study. All randomized controlled trials and quasi-experimental studies in which patients with chronic constipation were treated with transcutaneous tibial nerve stimulation (TTNS) or percutaneous tibial nerve stimulation (PTNS) were included in this study. Two independent reviewers screened all titles, abstracts, and full texts. The selected studies' quality was assessed critically using the Joanna Briggs Institute checklists. The data synthesis was conducted using Review Manager Software. Out of 1016 records, 11 studies were included in this study. The results showed that TTNS was effective in improving constipation symptoms (SMD: -1.52, CI 95%: -2.81 to -0.22, p< 0.0001) and reducing defecation time of patients with chronic constipation (SMD: -0.86, CI 95%: -1.60 to -0.13, p= 0.17). Additionally, PTNS was found to improve the quality of life of these patients (SMD: -1.32, CI 95%: -2.05 to -0.59, p< 0.00001). Both TTNS and PTNS can be effective interventions for chronic constipation. To suggest a definitive and standard treatment plan, further research is needed to determine optimal parameters for TTNS and PTNS applications.

The interplay between crystallinity and the levels of Zn and carbonate in synthetic microcalcifications directs thyroid cell malignancy.

One of the key challenges in diagnosing thyroid cancer lies in the substantial percentage of indeterminate diagnoses of thyroid nodules that have undergone ultrasound-guided fine-needle aspiration (FNA) biopsy for cytological evaluation. This delays the definitive diagnosis and treatment plans. We recently demonstrated that hydroxyapatite microcalcifications (MCs) aspirated from thyroid nodules may aid nodule diagnosis based on their composition. In particular, Zn-enriched MCs have emerged as potential cancer biomarkers. However, a pertinent question remains: is the elevated Zn content within MCs a consequence of cancer, or do the Zn-enriched MCs encourage tumorigenesis? To address this, we treated the human thyroid cancer cell line MDA-T32 with synthetic MC analogs comprising hydroxyapatite crystals with varied pathologically relevant Zn fractions and assessed the cellular response. The MC analogs exhibited an irregular surface morphology similar to FNA MCs observed in cancerous thyroid nodules. These MC analogs displayed an inverse relationship between Zn fraction and crystallinity, as shown by X-ray diffractometry. The zeta potential of the non-Zn-bearing hydroxyapatite crystals was negative, which decreased once Zn was incorporated into the crystal. The MC analogs were not cytotoxic. The cellular response to exposure to these crystals was evaluated in terms of cell migration, proliferation, the tendency of the cells to form multicellular spheroids, and the expression of cancer markers. Our findings suggest that, if thyroid MCs play a role in promoting cancerous behavior in vivo, it is likely a result of the interplay of crystallinity with Zn and carbonate fractions in MCs.

Spontaneous coronary artery dissection and fibromuscular dysplasia: insights into recent developments.

Spontaneous coronary artery dissection (SCAD), an uncommon cause of acute coronary syndrome, continues to be a poorly understood disease predominantly affecting females. It is characterized by an abrupt separation in the coronary arterial wall due to intramural bleeding. Fibromuscular dysplasia (FMD) is a non-atherosclerotic arteriopathy manifesting in medium and small-sized arteries. It is a concomitant disease found among SCAD patients. In some studies, FMD prevalence in SCAD patients ranges between 25%-86%, which can be explained through varying screening techniques or modalities. The potential association has been elucidated in some studies; notably, not only has a genetic link been recently delineated between SCAD and FMD, but there is data to suggest that FMD not only can predispose to SCAD but can also be a potential predictor of its recurrence. However, a clear-cut correlation between the two has still not been established due to conflicting reports in the literature. To further dive into its pathology, it is crucial to highlight the importance of systematic screening in SCAD in order to identify associated risk factors and to be used as a method of FMD detection in such patients. Together, the two pathologies pose unique challenges in understanding its pathophysiology, diagnosis and management, as there is no clear evidence of a definitive treatment plan for patients with SCAD and FMD. A potentially beneficial modality of management is physical exercise, which is currently understudied in the long-term approach to treatment for patients with concomitant SCAD and FMD. Limited research in this field brings disadvantages to the understanding of the association between these two diseases, in order to give rise to better management recommendations. This mini-review aims to highlight the recent developments in the association between SCAD and FMD, its potential genetic association and some insights in screening, diagnosis, and management.

Orthodontic treatment of an open bite after splint therapy for a patient with idiopathic condylar resorption

In the treatment of orthodontic patients with idiopathic condylar resorption, symptoms of temporomandibular joint disorders and constantly changing occlusions caused by an instability of mandibular position make it difficult for orthodontists to confirm definitive orthodontic diagnosis and treatment plans. Therefore, these patients' temporomandibular joint (TMJ) structures need to be stabilized with splint therapy before active tooth movement to identify and maintain the true mandibular position. For some idiopathic condylar resorption patients, orthognathic surgery can cause further resorption on the vulnerable condyles of the mandible; thus, effective orthodontic camouflage treatment after joint stabilization should be considered. During the orthodontic camouflage treatment, adverse loads on the TMJ structures, which could change the position of condyles, should be avoided, and TMJ-friendly mechanics must be applied.

α-Fetoprotein, α-Fetoprotein-L3, and Des-γ-Carboxy Prothrombin Stratify Hepatocellular Carcinoma Treatment Response and Progression Risk

Background & AimsAssessing aggressive biology at early-stage HCC diagnosis remains challenging. Alpha-fetoprotein (AFP) is the only clinical biomarker of aggressive HCC. In this study, AFP, Lens culinaris agglutinin-reactive AFP (AFP-L3), and des-γ-carboxy prothrombin (DCP) were measured at diagnosis prior to transplant evaluation and first cycle liver-directed therapy (LDT). MethodsThe prospective cohort included 207 patients who received LDT as a bridge/downstage to transplant or definitive treatment plan between 2016 and 2022. Plasma AFP, AFP-L3, and DCP levels were measured at diagnosis and analyzed with other factors associated with treatment response and time-to-progression (TTP). ResultsBiomarker phenotyping revealed 41% were triple negative, 30% expressed multiple biomarkers, and 12% express all three biomarkers. The biomarker profile was associated with target/overall response rate and TTP (P < 0.001). Profiling stratified 1-year progression risk in non-transplant candidates, driven by co-expression of AFP and DCP in multivariate analysis controlling for tumor burden and staging. ConclusionThe biomarker panel at diagnosis established prognosis for LDT response and stratified 1-year HCC progression risk. AFP, AFP-L3, and DCP profiling isolated aggressive HCC biology at diagnosis and may have important implications in post-LDT surveillance and transplant wait time.

The Added Diagnostic Value of Transcatheter CT Hepatic Arteriography for Intraprocedural Detection of Previously Unknown Colorectal Liver Metastases During Percutaneous Ablation and Impact on the Definitive Treatment Plan

PurposeThis study assessed the diagnostic value of CT hepatic arteriography (CTHA) for the intraprocedural detection of previously unknown colorectal liver metastases (CRLM) and the impact on the definitive treatment plan.Materials and MethodsAll patients treated with CTHA-guided percutaneous ablation for CRLM between January 2012 and March 2022 were identified from the Amsterdam Colorectal Liver Met Registry (AmCORE). Radiology reports of the ablative procedure and follow-up imaging were reviewed to see if (a) previously unknown CRLM were detected intra-procedurally and if (b) new CRLM, potentially missed on CTHA, appeared within 6 months following the procedure; three abdominal radiologists re-reviewed the baseline CTHA scans of these patients with early recurrence. To ratify immediate ablations of concomitantly detected CRLM, the upper limit of false positives was predefined at 10%.ResultsOne hundred and fifty-two patients were included. With CTHA, a total of 17 additional tumours in 15 patients were diagnosed and treated immediately, two representing disappeared tumours following systemic chemotherapy. Compared to the conventional contrast-enhanced (ce)CT, ceMRI and 18F-FDG PET-CT, adding CTHA was superior for the detection of CRLM (P < .001). Within 12 months of follow-up 121, new CRLM appeared in 49/152 patients (32.2%); retrospective blinded assessment revealed 56 to already be visible on the baseline CTHA scan (46%); four lesions without substrate on follow-up scans were considered false positives (n = 4/60; 7%). Arterial ring enhancement was the most frequently reported imaging characteristic (n = 45/60; 75%).ConclusionThe subsequent use of CTHA has added value for the detection of previously unknown and vanished CRLM. Taking into account the low number of false positives (7%) and the favourable safety profile of percutaneous ablation, we believe that immediate ablation of typical ring-enhancing supplementary tumours is justified and sufficiently validated.Level of EvidenceLevel 3; individual cross-sectional study with consistently applied reference standard and blinding.

Outcomes of Transarterial Embolisation (TAE) vs. Transarterial Chemoembolisation (TACE) for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Although hepatocellular carcinoma is increasingly common, debate exists surrounding the management of patients with unresectable disease comparing transarterial embolisation (TAE) or transarterial chemoembolisation (TACE). This study aimed to compare the outcomes of patients receiving TAE and TACE. A systematic review was performed using PubMed, Medline, Embase, and Cochrane databases to identify randomised controlled trials (RCTs) until August 2021. The primary outcome was overall survival (OS) and the secondary outcomes were progression-free survival (PFS) and adverse events. Five studies with 609 patients were included in the analysis. There was no statistically significant difference in the OS (p = 0.36) and PFS (p = 0.81). There was no difference in OS among patients treated with a single TACE/TAE versus repeat treatments. Post-procedural adverse effects were higher in the TACE group but were not statistically significant. TACE has comparable long-term survival and complications profile to TAE for patients with HCC. However, the low-to-moderate quality of current RCTs warrants high-quality RCTs are necessary to provide enough evidence to give a definitive answer and inform treatment plans for the future.

Spinal Dorsal Intradural Arteriovenous Fistulas: Natural History, Imaging, and Management.

In this review, we describe the pathophysiology, diagnosis, and treatment of spinal dorsal intradural arteriovenous fistulas (DI-AVFs), focusing on novel research areas. DI-AVFs compose the most common subgroup of spinal arteriovenous lesions and most commonly involve the thoracic spine, followed by lumbar and sacral segments. The pathogenesis underlying DI-AVFs is an area of emerging understanding, thought to be attributable to venous congestion and hypertension that precipitate ascending myelopathy. Patients with DI-AVFs typically present with motor, sensory, or urinary dysfunction, although a wide swath of other less common symptoms has been reported. DI-AVFs can be subdivided by spinal region, which in turn is associated with 4 distinct clinical phenotypes: craniocervical junction (CCJ), subaxial cervical, thoracic, and lumbosacral. Patients with CCJ and lumbosacral DI-AVFs have particularly interesting presentations and treatment considerations. High-value diagnostic findings on MRI include flow voids, missing-piece sign, and T2-weighted intramedullary hyperintensity. However, digital subtraction angiography is the gold standard for diagnosis and localization of DI-AVFs and for definitive treatment planning. Surgical disconnection of DI-AVFs is almost universally curative and frontline treatment, especially for CCJ and lumbosacral DI-AVFs. Endovascular techniques evolve in promising ways, such as improved visualization, distal access, and liquid embolic techniques. The pathophysiology of DI-AVFs is better understood using newly identified radiologic diagnostic markers. Despite new techniques and devices introduced in the endovascular field, surgery remains the gold-standard treatment for DI-AVFs.

Comparison of the Proposed Treatment Plan Based on the Factors Affecting the Degree of Treatment Difficulty in Impacted Maxillary Canines with Their Definitive Treatment Plan

Background and Objective: Determining the exact position of the impacted maxillary canine during its orthodontic treatment using cone beam computed tomography (CBCT) can help select the most appropriate treatment plan. The present study aimed to compare the proposed treatment plan for impacted maxillary canines based on the factors affecting the degree of treatment difficulty in impacted maxillary canines with their definitive treatment plan using CBCT. Materials and Methods: In this retrospective cross-sectional study, 120 CBCT images were assessed. These images were taken from patients with impacted maxillary canines whose treatments were terminated. To investigate the severity of maxillary canine impaction factors, including the type of impaction, position of canine, distance to the occlusal plane, distance to the midline, and width of follicular space, were measured using CBCT. Ten orthodontists were asked to determine the type of treatment plan proposed for the patient. Then, they determined the degree of difficulty of each measured factors using numbers 1 to 10. Then, the relationship between the specified difficulty number for each factor and the proposed treatment plan was evaluated, and at the end, the relationship between the type of proposed treatment plan and the patient's actual treatment plan was measured. Results: A total of 26 men and 94 women with a mean age of 18.85 ± 6.5 participated in the present study. A significant relationship was observed between the variables of age, transverse to midline, and the type of impaction, with the type of treatment. Conclusion: Although the findings of this study showed a low inter-observer agreement on severity degree concerning the width of follicular space, the inter-observer agreement on severity degree with the other factors was high.

68Ga-PSMA-11 patients with newly diagnosed and recurrent prostate cancer (Firefly Study): Preliminary results.

54 Background: A primary challenge facing oncologists is the accurate identification of the source of the rising PSA in the recurrent disease setting and the failure of proper staging at the time of initial therapy. PSMA imaging allows for progress in this regard, however access remains an issue. As such, we designed the Firefly study to offer PSMA imaging to patients between May 2021 and May 2022, to better characterize their disease. Methods: This is a phase II expanded access intermediate sized clinical trial using 68Ga-PSMA-11 (Telix Pharma cold kit) under Tulane’s own Investigational New Drug (IND). Clinical trial information: NCT04854369. Two cohorts are utilized, recurrent disease with a PSA &gt; 0.2 or &gt; 2.0 post-radiation, and newly diagnosed high risk or oligo-metastatic patients as assessed by conventional imaging. Between May 2021 and May 2022, a total of 90 patients were enrolled. The study was designed for a maximum of 300 patients but was terminated when access to insurance approved PSMA scans was available. Patients received 1.8–2.2 MBq/kg body weight with 68Ga-PSMA-11 (per EANM guidelines). The lower and upper limits of the dose were set to 3 to 7 mCi respectively. Primary Objective(s): Utilize 68Ga-PSMA-11 PET to define uptake location for localization of prostate cancer metastatic sites in patients prior to initial therapy, and in both local recurrences and metastatic sites in patients with recurrent disease after initial therapy. Secondary Objectives: To assess the therapeutic consequences of 68Ga-PSMA-11 PET/CT imaging in prostate cancer patients with and without prior treatment. Results: Of the 90 patients enrolled 81 were in the recurrent disease cohort and nine had newly diagnosed disease. Of the 81 patients with recurrent disease; 30 were known metastatic and were scanned with the intention of application for expanded access to 177Lu-PSMA-617, 8 received radiation for their oligometastases, 12 received a combination of radiation and initiation of hormone therapy, 13 continued surveillance, 5 were sent for salvage therapy, 13 were treated with novel hormones. Of the 9 patients with newly diagnosed disease all of them were negative for metastasis on conventional imaging. However, when scanned with 68Ga-PSMA-11, 7/9 had a positive PSMA scan. A lesion in the prostate was identified in 2/7 patients, 2/7 were found to have de novo metastatic disease to the lymph nodes and 3/7 were found to have bone metastasis. All these patients were treatment naïve and 5/7 had changes to their planned definitive treatment plan based on these results, as high-risk patients found to have previously unidentified de novo metastatic disease. Conclusions: Further analysis of the data is planned to complete secondary objectives; however, this study demonstrates the potentially meaningful impact of PSMA imaging for patient treatment planning and individualized care. Clinical trial information: NCT04854369 .

How to interpret a negative high-resolution pulse oximetry in hospitalized patients screened for obstructive sleep apnea: an exploratory analysis.

Obstructive sleep apnea (OSA) is a highly prevalent disorder that often is unrecognized. Recently, a novel protocol for screening hospitalized patients for OSA resulted in early initiation of positive airway pressure (PAP) therapy and early post-discharge follow-up. The protocol utilizes a combination of high-resolution pulse oximetry (HRPO) and home sleep apnea tests (HSATs); the former has been well-validated in previous studies against HSAT and polysomnography. While a definitive treatment plan can be generated for patients with a positive HRPO for OSA, it is less clear how best to manage patients with a negative HRPO. A retrospective analysis of a registry of patients screened for OSA was conducted. Consecutive patients with HRPO-derived ODI (oxygen desaturation index) < 5/h who underwent same-night HRPO and HSAT were identified. The demographic and clinical characteristics of patients with ODI < 5/h and AHI (apnea hypopnea index) < 5/h were compared with patients with ODI < 5/h and AHI ≥ 5/h. The analysis revealed 190 patients with ODI < 5/h. Only 23 (12%) of these patients had AHI ≥ 5/h. When compared with patients who had ODI < 5/h and AHI < 5/h, there was no difference in most testing and patient characteristics. However, antiplatelet use and total time in minutes with saturation < 88% greater than 100min were associated with a higher likelihood of discordant ODI and AHI. HRPO-derived ODI has a low rate of false negativity. Clinicians should be aware of the possibility of a false negative ODI for patients with antiplatelet use and time with saturation < 88% greater than 100min and antiplatelet therapy.

Factors affecting the reduction rate of odontogenic cysts after decompression based on 3-dimensional volumetric analysis.

This study aimed to investigate the potential factors that could affect the reduction rate of odontogenic cysts following decompression using cone-beam computed tomography (CBCT) for 3-dimensional volumetric analysis. The study sample consisted of CBCT images of 41 individuals who underwent decompression of odontogenic cysts at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, between 2010 and 2022. Preoperative and postoperative CBCT results were collected, and a volumetric analysis was conducted to evaluate the differences in the reduction rate and the percentage of volume reduction of cystic lesions based on different parameters. Correlations between these parameters were analyzed to determine associations. In this study, the average time of decompression for odontogenic cysts was 316 days. Males demonstrated a higher reduction rate than females (P<0.05). The reduction rate was directly proportional to initial cyst volume, with higher reduction rates for cysts with large initial volume than those with small initial volume (P<0.05). Spearman's rank correlation coefficient indicated a weak positive correlation between the initial cyst volume and the duration of decompression. Additionally, a strong positive correlation was observed between the initial volume and the reduction rate. Knowledge of the reduction rate of odontogenic cysts is vital for surgeons to evaluate the duration of decompression before enucleation and to determine a definitive treatment plan. Sex and initial lesion volume had significant effects on the reduction rate.

Endoscopic biopsy of pineal tumors: two burr hole trans-foramen of Monro approach and endonasal trans-tuber cinereum approach.

The pineal region is a challenging area for neurosurgeons due to its innate anatomical features, such as its deep location, surrounding large draining veins, and adjacent critical neural structures. There is a high proportion of malignant tumors in the pineal gland, especially in children, and they are frequently accompanied by obstructive hydrocephalus. These cases require that surgical procedures can make a pathological diagnosis to guide further treatment strategies and immediately resolve increased intracranial pressure. Simultaneous endoscopic third ventriculostomy and biopsy have been regarded as the first-line surgical intervention before establishing a definite treatment plan. However, it is not always successful because various factors affect the surgical procedures, such as the location and extent of the tumor, degree of ventriculomegaly, location and size of the massa intermedia, and size of the foramen of Monro. Here, we briefly reviewed the points to be considered in endoscopic biopsy of pineal tumors and introduced an alternative surgical procedure, the endoscopic endonasal trans-tuber cinereum approach, to surmount the anatomical hurdles.

Telemedicine evaluation of new head and neck patients at a tertiary academic clinic during the coronavirus disease 2019 pandemic

Introduction Coronavirus disease 2019 accelerated the use of virtual visits within health care. We examined the utility of telemedicine for conducting visits in a tertiary head and neck practice. Methods A retrospective study was conducted on patients presenting via video to a tertiary-level head and neck clinic between January 2020 and December 2020. Patient demographics were collected in addition to visit indication, diagnostic imaging/tests at the time of visit, and post-visit plan. Visits were deemed successful if evaluation by video was sufficient in determining a clinical plan and did not require deferment of recommendations for subsequent in-person consult visits and/or work-up (labs, imaging). Logistic regression was performed to identify variables that served as significant predictors of successful video visits. Results A total of 124 video visits were reviewed. Video visits were successful for the initial evaluation 88.7% of the time (n = 110). Computerized tomographic scans were the most available diagnostic test, available for 54% of patients (n = 67), followed by biopsy report 30.6% (n = 38). Visit indication had a statistically significant effect on whether a treatment plan could be made (p = 0.024). For new patients with parotid masses (n = 42), definitive treatment plans could be made 97.6% of the time (n = 41). Patients presenting with an indication of thyroid mass (odds ratio: 0.19 (confidence interval: 0.00072–0.50), p = 0.018) and other neck mass (odds ratio: 0.035 (confidence interval: 0.0014, 0.90), p = 0.043) were at significantly lesser odds than parotid patients to have a successful video visit. Discussion In this study, virtual visits were successful for a high percentage of head and neck visits, particularly among patients seeking evaluation for parotid-related concerns.

The Fixed/Removable Interface: A Case Report

An 86 year old lady presented with numerous missing teeth, failing restorations, unstable dentures and a fractured provisional crown on her upper left canine. After a thorough pre-operative assessment and diagnostic planning, provisional restorations were provided to help the definitive treatment planning. The prosthodontic treatment involved fixed prostheses in the maxillary arch, followed by maxillary and mandibular tooth and mucosa supported cobalt chromium removable prostheses. This was provided at an increased occluso-vertical dimension in centric relation. CPD/Clinical Relevance: This article illustrates techniques to optimize removable partial prostheses by using abutment teeth to their full potential.