Post Hoc Research Articles

Association between body fat variation rate and risk of diabetic nephropathy - a posthoc analysis based on ACCORD database

BackgroundWeight control has consistently been regarded as a significant preventive measure against diabetic nephropathy. however, the potential impact of substantial fluctuations in body fat during this process on the risk of diabetic nephropathy remains uncertain. This study aimed to investigate the association between body fat variation rate and diabetic nephropathy incident in American patients with type 2 diabetes.MethodsThe study used data from the Action to Control Cardiovascular Risk in diabetes (ACCORD) trial to calculate body fat variation rates over two years and divided participants into Low and High groups. The hazard ratio and 95% confidence interval were estimated using a Cox proportional hazards model, and confounding variables were addressed using propensity score matching.ResultsFour thousand six hundred nine participants with type 2 diabetes were studied, with 1,511 cases of diabetic nephropathy observed over 5 years. High body fat variation rate was linked to a higher risk of diabetic nephropathy compared to low body fat variation rate (HR 1.13, 95% CI 1.01–1.26). Statistically significant interaction was observed between body fat variation rate and BMI (P interaction = 0.008), and high level of body fat variation rate was only associated with increased risk of diabetic nephropathy in participants with BMI > 30 (HR 1.34 and 95% CI 1.08–1.66).ConclusionsAmong participants with Type 2 Diabetes Mellitus, body fat variation rate was associated with increased risk of diabetic nephropathy. Furthermore, the association was modified by BMI, and positive association was demonstrated in obese but not non-obese individuals. Consequently, for obese patients with diabetes, a more gradual weight loss strategy is recommended to prevent drastic fluctuations in body fat.Trial registrationClinical Trials. gov, no. NCT000000620 (Registration Date 199909).Graphical

Interaction of Cognitive and Motivational Processes in Asymmetric Preferences for Gains and Losses

An experiment on repetitive decision-making was conducted to explore the interaction between cognitive and motivational processes in decision-making. The gain-loss framing of risky choice options was manipulated to investigate cognition, and participants’ chronic regulatory focus was measured to assess motivation. Risky choice demonstrated interactive effects between gain-loss framing and regulatory focus. Participants made less risky or riskier choices in the gain or loss condition, respectively. Furthermore, promotion or prevention-focused individuals chose the risky option more frequently in the gain or loss condition, respectively. The results for response times showed the main effects for the two factors, with no interaction. These results, along with supplementary post-hoc analyses, provide evidence that cognitive and motivational processes are simultaneously involved in risky decision-making.

Comparing the Accuracy of Conventional Gypsum and 3D-Printed Dental Casts Using Three-Dimensional Analysis.

Dental impressions and casts play a critical role in dental care, facilitating diagnoses and the fabrication of prostheses. Traditional methods of fabrication involve elastomeric materials that are more prone to errors and patient discomfort. Digital advancements offer promising alternatives, yet their accuracy and applicability to military dentistry remain under-explored. This study evaluates the accuracy of digital casts produced with material available in the Military Health System compared to conventional methods. Using a digital (n = 10) and analog (n = 10) methodology casts were fabricated from a reference cast (n = 1). The reference and cast samples were scanned with a reference scanner to generate stereolithography files. These files were used to generate full arch, single crown, fixed dental prosthesis, and inlay digital casts which were then compared using a three-dimensional (3D) comparison software to evaluate accuracy. Root mean square values were obtained, giving a quantitative evaluation of the deviation of each sample from the reference cast. Statistical analysis consisted of a Shapiro-Wilk and Levene test to account for homogeneity of variances in each group. An ANOVA and Tukey post-hoc test were used to determine differences in accuracy among the full arch and a two-way ANOVA and Tukey post-hoc test evaluated differences in trueness among the casts of the individual preparations. Analog full arch casts had an average root mean square of 106 ±19.18 µm when examining trueness and 12 ±2.58 µm for precision. Digital full arch casts had an average root mean square of 51.9 ±5.39 µm when examining trueness and 4.2 ±1.57 µm for precision. Overall digital casts surpassed analog counterparts in accuracy. Fixed dental prostheses were found to be the only group, which showed no statistically significant difference between digital and analog. These findings validate the potential of digital workflows in enhancing the speed and accuracy of dental care in the Military Health System, while underscoring the need for further exploration and refinement in specific clinical contexts.

Morphological Analysis and Bond Strength to Root Canal Dentin of Endodontically Treated and Retreated Teeth: An Ex Vivo Study.

To assess the bond strength and the hybrid layer (HL) micro-morphological characteristics at the cement-dentin interface (CD-i) between root canal walls and two adhesive resin cements [self-etch (SERc) and self-adhesive (SARc)] in root-canal-treated (RCT) and naturally aged retreated teeth (RCR-T). Vital (n = 16) and RCT (n = 16) teeth were, respectively, endodontically treated or retreated. Fiber posts were luted either with SERc (Clearfil Universal Bond Quick + DC Core Plus) or SARc (iCEM). Samples were then sectioned into 1 mm thick slices perpendicular to the fiber post and submitted to push-out bond strength test. Vital (n = 4) and RCT (n = 4) first maxillary molars were also selected and prepared to evaluate CD-i morphology through confocal laser scanning microscopy (CLSM). Three-way analysis of variance (ANOVA) and Tukey post-hoc tests were assessed to statistically analyze the obtained data (p 0.05). Bond strength was significantly jeopardized in retreated teeth and in the root apical half, while the cements had no significant influence. Most failures occurred between dentin and resin cement. HL thickness was also hindered in retreated teeth. iCEM produced a thinner HL compared to SERc. Resin tag formation was significantly hampered in the root apical half. SARc performed as well as SERc on aged RCT radicular dentin. Clinicians can rely on simplified one-step luting systems when adhesion is required in unfavorable substrates such as the root canal post space of aged RCT teeth.

Three-Dimensional Internal Voids and Marginal Adaptation in Deep Margin Elevation Technique: Efficiency of Highly Filled Flowable Composites.

To evaluate interfacial three-dimensional adaptation and internal voids of different flowable materials before and after cyclic fatigue in a simulated deep-margin elevation scenario. Eighty (n = 80) extracted premolars were selected and two Class II cavities were prepared. The mesial one with cervical margin 1 mm above the cementum-enamel junction (CEJ) and the distal one with cervical margin 1 mm below the CEJ. After performing adhesive procedures, specimens were divided into four groups according to the employed materials for 2 mm horizontal deep-margin relocation: nanohybrid composite (Clearfil ES2, Kuraray); conventional viscosity flowable composite (Tetric Flow, Ivoclar); medium viscosity flowable composite (Majesty ES2 Low Flow, Kuraray); high viscosity flowable composite (Majesty ES2 Super Low Flow, Kuraray). All restorations were finalized by oblique layering with nanohybrid composite (Clearfil ES2, Kuraray). To reveal interfacial and internal gap progression, specimens were scanned with a micro-CT (SkyScan 1172), before and after 500,000 cycles of mechanical chewing simulation (50 N, 1 Hz). Data were imported into Mimics software after smoothing and region growing. Only the 2 mm margin relocation volumes were considered. Obtained masks were analyzed for noise removal and volume calculation. At baseline, interfacial gap progression and internal voids, expressed in mm3, were collected and statistically analyzed with two-way ANOVA (α 0.05) for the variables substrate and restorative materials followed by Tukey post-hoc test. An additional two-way ANOVA test, followed by Tukey post-hoc test, was performed to evaluate variation in interfacial gap progression after mechanical aging. At baseline, the ANOVA test showed a significant difference for the variable restorative materials (p = 0.01). More specifically, the Tukey post-hoc test revealed that the highly filled medium viscosity composite performed better than the conventional viscosity composite at baseline for the interfacial gap. The internal voids ANOVA test at baseline reported no significant differences for the variable tested. Analysis of variance for internal gap progression after thermocycling showed no differences for both substrate and restorative material employed. Highly filled medium viscosity composite performed significantly better than the conventional viscosity flowable composite for what concern baseline interfacial gaps. Artificial aging with a chewing simulator and thermocycling did not affect interfacial gap progression on enamel and dentin. The tested restorative materials performed equally after aging.

Determining the Optimal Morphometry of Pedicle Screws in Lumbar and Thoracic Spine in the Iranian Population

Background: The improper length and direction of pedicle screw may also cause it to penetrate the adjacent organs. Unknowing the safe zone of dimensions and directions of the pedicles is essential to proper screw placement. Methods: The present study is a cross-sectional morphometric study on patients with spinal trauma referred to the neurosurgical department in 2021. The MARCO PACS software scale measured the CT scan images and included the vertebral left pedicle diameter, pedicle body distance, body aorta distance, pedicle diameter, height, and area. The entry point and direction of the pedicle screw were made with the “free-hand” method. Results: 301 patients were included, consisting of 113 females (37.5%) and 188 males (62.5%). The mean age of the participants was 42.87±12.3 years. “Among all T12 vertebra parameters, just body aorta distance was not significant between genders (p-value=0.311). The pedicle height and body aorta distance were lowest among 18-35 years patients (p-value=0.001) (p-value=0.003), respectively. Post-hoc analysis revealed a significant difference between 18-35 and 51-70 years for body aorta distance in the L1 vertebra (p-value=0.002). Conclusion: The present investigation has shown significant differences between genders for optimal left pedicle screw parameters, which should be considered before surgery.

Enhancing highland ecosystems in East Hararge, Ethiopia: evaluating intervention strategies for species diversity, soil organic carbon stock, and carbon sequestration

Forest loss and soil degradation pose significant challenges globally, particularly in developing nations like Ethiopia. Various intervention strategies have been implemented to rehabilitate degraded ecosystems. However, research gaps exist in understanding the most effective approaches, particularly in highland ecosystems. This study aimed to evaluate the effectiveness of different intervention strategies on species diversity and carbon stock in the West Hararghe zone, specifically at the Doba district Hades site. The data was collected from 5 February 2022 to 10 December 2022. The study area was characterized by systematic plots and transects to assess vegetation diversity and soil properties across four intervention categories: (physical; only soil and water conservation structures were used, enclosure; only animal and human interaction was restricted, biological; only different tree species were planted, biophysical; both soil water conservation and tree planting were used). Soil samples were collected at different depths, and biomass estimation was conducted using established formulas. Statistical analyses, including one-way ANOVA and post-hoc tests, were performed to test the level of significance. Biophysical interventions exhibited the highest species diversity index (SDI) (4.65 ± 1.21), followed by enclosure interventions (1.68 ± 0.58), while physical interventions recorded the lowest SDI (0.63 ± 0.18). Enclosure interventions led to the highest soil organic carbon (SOC) stocks at 40.13 t C ha−1, followed by biophysical interventions at 39.26 t C ha−1. Physical interventions resulted in the lowest SOC stocks at 23.9 t C ha−1, underscoring their potential for carbon sequestration. Biophysical interventions, which include both above-ground and below-ground biomass, showed significant carbon stock accumulation, totaling 173.8 t C ha−1 (39.26 t C ha−1 from SOC and 114.6 t C ha−1 from biomass), highlighting their effectiveness in enhancing ecosystem resilience. Other studies support these findings, underscoring the importance of context-specific approaches and long-term monitoring for sustainable land management. Enclosure and biophysical interventions emerge as promising strategies for enhancing species diversity and soil health, as well as promoting carbon sequestration in highland ecosystems. These findings emphasize the need for informed decision-making and community involvement in ecosystem restoration efforts to achieve meaningful and lasting impacts.

Prenatal maternal diabetes, comorbidities, and risk for neurodevelopmental impairment in the first two years.

Maternal diabetes is a known risk for neurodevelopmental delay in offspring, and often presents with comorbid metabolic conditions, such as obesity and hypertension. However, their combined effects on neurodevelopmental outcomes remain unclear. We investigated the independent and combined associations of maternal diabetes and comorbidities with the risk of neurodevelopmental delay in children aged 12 and 24 months. A prospective longitudinal cohort of children from Pregnancy during the COVID-19 Pandemic study. Neurodevelopmental screening at 12 and 24 months was conducted using the Ages and Stages Questionnaire, which assesses domain-specific development. Maternal diabetes was not associated with neurodevelopmental risks either at 12 or 24 months. However, in combined analyses, maternal diabetes and pre-pregnancy overweight were associated with an increased risk of neurodevelopmental delay in personal-social skills (odds ratio [OR], 1.75 [95%CI,1.01-3.01]) at 24 months, though not at 12 months. Maternal diabetes and pre-pregnancy obesity were also associated with an increased risk for neurodevelopmental delay in communication (OR, 1.71 [95%CI,1.01-2.82]) and personal-social skills (OR, 2.01 [95%CI,1.03-3.73]) at 24 months. Furthermore, maternal diabetes and hypertensive disorders of pregnancy (HDP) had higher rates of positive screening for delay in fine-motor skills (OR, 3.54 [95%CI, 1.28-8.41]) at 12 months but not at 24 months. Post-hoc analysis revealed an independent association of maternal pre-pregnancy obesity, but not overweight, with an increased risk of neurodevelopmental delay in communication, fine-motor, and personal-social skills (ORs ranging from 1.44 to 1.71) at 24 months but not 12 months. Similarly, there was an independent association of maternal HDP with an increased risk of neurodevelopmental delay in fine-motor and and personal-social skills (ORs ranging from 2.01 to 2.19) at 24 months. Maternal diabetes with comorbid conditions is likely to increase the risk of neurodevelopmental delay during infancy than individual exposure, suggesting the persistent influence of prenatal exposure on offspring neurodevelopment. 1. Identifying modifiable prenatal risk factors for neurodevelopmental impairment in offspring is crucial for targeted interventions and providing support to mothers during pregnancy, which can lead to improved child health outcomes. 2. Maternal diabetes was not associated with neurodevelopmental delays in children at 12 or 24 months. 3. Maternal diabetes in combination with pre-pregnancy overweight or obesity increased the risk of cognitive delay at 24 months. 4. Maternal pre-pregnancy obesity but not overweight, and hypertensive disorders of pregnancy independently increased risks of cognitive and motor delays at 24 months.

Highfield imaging of the subgenual anterior cingulate cortex in uni- and bipolar depression.

The subgenual Anterior Cingulate Cortex (sgACC), as a part of the Anterior Cingulate Cortex and the limbic system plays a crucial role in mood regulation. Previous structural and functional brain imaging studies of the sgACC have revealed alterations of Gray Matter (GM) volumes and Blood Oxygenation Level Dependent signals (BOLD) in patients with Major Depressive Disorder (MDD) and Bipolar Disorder (BD), suggesting potential biomarker traits for affective disorders. In this study we investigated the gray matter volume of the sgACC in 3 different patient groups: 40 MDD patients, of which 20 were medicated (MDDm) and 20 were unmedicated (MDDu), and 21 medicated BD patients, and compared them with 23 healthy volunteers. We examined GM volume alteration using high-resolution 7T Magnetic Resonance Imaging (MRI) which produced quantitative maps of the spin-lattice relaxation time (T1). T1 maps provide high contrast between gray and white matter, and at 7 Tesla voxels with submillimeter resolution can be acquired in a reasonable scan time. We developed a semi-automatic segmentation protocol based on refined landmarks derived from previous volumetric studies using quantitative T1 maps as raw input data for automatic tissue segmentation of GM, WM and CSF (cerebrospinal fluid) tissue. The sgACC ROI was then superimposed on these tissue probability maps and traced manually by two independent raters (F.B., M.M.) following our semi-automatic segmentation protocol. Interrater reliability was calculated on a subset of 10 brain scans for each hemisphere, showing an Intra-Class Correlation coefficient (ICC) r = 0.96 for left sgACC and r = 0.84 for right sgACC respectively. In summary, we have developed a reproducible and reliable semi-automatic segmentation protocol to measure gray matter volume in the sgACC. Based on previous findings from meta-analyses on morphometric studies of the sgACC, we hypothesized that patients with MDD would have lower gray matter sgACC volumes compared to healthy subjects. Post-hoc analysis revealed smaller subgenual volumes for the left hemisphere in both the medicated (MDDm) and non-medicated (MDDu) group versus healthy controls (p = .001, p = .008) respectively. For the right hemisphere, the (MDDu) and BD group exhibited significantly lower subgenual volumes than healthy controls (p < .001, p = .004) respectively. To our knowledge, this is the first morphometric MRI study using T1 maps obtained in high-resolution 7 Tesla MRI to compare MDD and BD patients with healthy controls.

Time to Publication in Medical Education Journals: An Analysis of Publication Timelines During COVID-19 (2019-2022).

COVID-19 changed scholarly publishing. Yet, its impact on medical education publishing is unstudied. Because journal articles and their corresponding publication timelines can influence academic success, the field needs updated publication timelines to set evidence-based expectations for academic productivity. This study attempts to answer the following research questions: did publication timelines significantly change around the time of COVID-19 and, if so, how? We conducted a bibliometric study; our sample included articles published between January 2018, and December 2022, that appeared in the Medical Education Journals List-24 (MEJ-24). We clustered articles into three time-based groups (pre-COVID, COVID-overlap, and COVID-endemic), and two subject-based groups (about COVID-19 and not about COVID-19). We downloaded each article's metadata from the National Library of Medicine and analyzed data using descriptive statistics, analysis of variance, and post-hoc tests to compare mean time differences across groups. Overall, time to publish averaged 300.8 days (SD = 200.8). One-way between-groups ANOVA showed significant differences between the three time-based groups F (2, 7473) = 2150.7, p < .001. The post-hoc comparisons indicated that COVID-overlap articles took significantly longer (n = 1470, M= 539; SD = 210.6) as compared to pre-COVID (n = 1281; M = 302; SD = 172.5) and COVID-endemic articles (n = 4725; M = 226; SD = 136.5). Notably, COVID-endemic articles were published in significantly less time than pre-pandemic articles, p < .001. Longer publication time was most pronounced for COVID-overlap articles. Publication timelines for COVID-endemic articles have shortened. Future research should explore how the shift in publication timelines has shaped medical education scholarship.

Utility of Reticulocyte Hemoglobin Equivalent in Screening for Iron Deficiency in Pregnancy.

Ferritin, commonly used for diagnosing iron deficiency (ID) in pregnancy, is limited by high cost and false elevations during inflammation. Reticulocyte hemoglobin equivalent (Ret-He), an alternative marker for ID, is unaffected by inflammation and analyzed on the same collection tube as the standard complete blood count (CBC). We aimed to determine the accuracy of Ret-He in detecting ID in pregnancy compared to ferritin in a U.S. This prospective cohort study enrolled 200 pregnant participants, recruited in any trimester if a CBC was drawn as part of routine prenatal care. For those who agreed to participate, Ret-He and ferritin were collected concurrently with the CBC. ID was defined as ferritin level below 30 ng/mL. Patients were classified into three groups based on hemoglobin and ferritin results to determine the severity of ID: no ID, ID alone, and ID anemia (IDA). Four participants with anemia but normal ferritin were excluded. Receiver operating curve analysis, including the area under the curve (AUC), was performed to assess the accuracy of Ret-He in detecting ID. A one-way ANOVA (analysis of variance) with post-hoc analysis was used to compare differences in Ret-He between the three groups of ID severity. The prevalence of ID in our cohort was 82% (161/196). The AUC for Ret-He was 0.65 (95% confidence interval: 0.55-0.75), indicating suboptimal discrimination between patients with and without ID. Ret-He was significantly different among the three groups (p < 0.001). In post-hoc analysis, Ret-He was significantly lower in the IDA group compared to the ID group (p < 0.001) but there was only a trend of lower Ret-He in the ID group compared to the non-ID group (p = 0.38). Ret-He has low accuracy in diagnosing ID in pregnancy. It may be useful in detecting severe ID resulting in anemia but not a mild iron-deficient state resulting in ID only. · The prevalence of ID in our cohort was 82%.. · Ret-He has low accuracy in diagnosing ID in pregnancy.. · Ferritin is preferable when readily available..

Equine exercise-induced pulmonary hemorrhage: the role of high left-heart pressures secondary to exercise-induced hypervolemia, and high inspiratory pressures.

Exercise-induced hypervolemia is normal in racehorses. Stress failure of the blood-gas barrier causes EIPH and occurs when the transmural pulmonary capillary (Pcap)-alveolar pressure difference (Ptm) exceeds the barrier's stress failure threshold. Why Pcap increases is incompletely understood. We hypothesized that alterations in blood volume (BV) affect left ventricular (LV) and pulmonary arterial wedge (PAW) pressures, and Pcap, and correspondingly affect EIPH severity. Six thoroughbreds with EIPH underwent treadmill exercise at the same speed (≈11.9m/s [11.1, 12.2]; median [IQR]) before (≈119%V̇O2max; B), 2hr after 14L depletion of blood (≈132%V̇O2max; D) and 2hr after reinfusing the blood (≈111%V̇O2max; R). LV, pulmonary arterial (PAP), PAW and intrapleural (Ppl) pressures were measured throughout exercise. Pcap = (PAP+PAW)/2 and Ptm = Pcap - Ppl. EIPH severity was assessed 60min post-exercise by tracheoendoscopy (EIPHgrade) and bronchoalveolar lavage erythrocyte count (BALRBC). A mixed-effect model and Tukey post-hoc test analyzed effects of BV changes on LV, PAW, Pcap, Ppl, Ptm and EIPH. p≤0.05 was significant. EIPH severity was affected by BV (EIPHgrade: p=0.01, BALRBC: p=0.003). Peak Ptm was not different between B (146mmHg [140; 151]) and R (151mmHg [137; 160]) but was lower for D (128mmHg [127; 130]; B: p=0.005, R: p=0.02). LV end diastolic pressure (LVED) was correlated with maxPcap (r2=0.52, p=0.001). Ppl was unaffected by changes in BV. Vascular pressures and Ppl fluctuated constantly during exercise and independently influenced Ptm. Circulating BV but not exercise intensity had a major effect on LVED, Pcap and Ptm, and was correlated with EIPH severity in thoroughbred racehorses (r2=0.48, p=0.001).

Long-term motor learning in focal hand dystonia

ObjectiveBecause focal hand dystonia usually occurs in the over-learned stage, it would be valuable to know long-term motor learning characteristics and underlying pathophysiological features that might predispose to dystonia. MethodsWe conducted a case-control exploratory study of 15 visits over 12 weeks in the non-affected hand of a 4-finger sequence of 8 key presses in eight patients with FHD compared with eight age- and sex-matched, healthy volunteers (HVs). We studied the behavioral data and the physiological changes of the brain, including motor cortical excitability and cortical oscillations. ResultsThere was no significant difference in the time to reach 100 % accuracy between FHD and HV during the 80-day follow-up period. There was a statistically significant difference in the accuracy of sequential finger movement tasks between patients with FHD compared with HVs over 12 weeks, but post-hoc analysis with multiple comparion correction did not show difference. There were no significant differences in recruitment curve changes and task-related power changes of alpha and beta bands. ConclusionOver 12 weeks, FHD have motor learning capacity comparable to HVs and do not show pathophysiological abnormalities. SignificanceFurther studies would be valuable with more patients, more extended periods of practice, and more detailed electrophysiological explorations.

Influence of Endodontic Cavity Design on Interfacial Voids, Class II Resin Composites Sealing Ability and Tooth Fracture Resistance: An In Vitro Study.

Objective: The aim of this in vitro investigation is to study the effect of endodontic cavity design on interfacial voids, class II resin composite sealing ability, and fracture resistance in mandibular premolars. Methods: A total of 48 single-rooted mandibular premolars received compound class II preparations with either traditional flare access cavities (group A) or contracted endodontic cavity preparations (group B). Each study group was subdivided according to the coronal restoration into two sub-groups as α and β. In the α group, a microhybrid composite was used after etch-and-rinse bonding technique using an MDP-containing universal adhesive. In the β group, a self-adhesive composite was used as coronal restoration after endodontic treatment (n = 12) for each subgroup. A micro-CT analysis was performed to assess the obturation interfacial voids and tracing of class II cervical interfacial adaptation. The tooth fracture resistance testing was then performed adding an extra group of 12 sound non-prepared teeth, which were tested as the control for fracture strength testing. A one-way ANOVA and post-hoc testing were used together with descriptive statistics for an analysis of the mean values of obturation interfacial voids. A two-way ANOVA was used to assess the fracture resistance test results, and to find the influence of endodontic access design and the type of composite material on the fracture resistance testing. Chi-square testing was employed to analyze the cervical interfacial seal of the class II restorations. Results: A one-way ANOVA revealed that there were no statistically significant differences between test groups in the amount of obturation interfacial voids (p > 0.05). There were no statistically significant differences between test groups in terms of cervical interfacial sealing ability (p > 0.05). A two-way ANOVA revealed that no statistically significant differences between test groups including the control group existed in terms of the fracture resistance testing (p > 0.05). Conclusions: Although it does not improve tooth fracture resistance, the contracted endodontic access cavity does not deteriorate the quality of obturation in terms of the interfacial porosity. The self-adhesive composite does not improve the efficiency of cervical interfacial adaptation or tooth fracture resistance regardless of the endodontic access cavity shape, yet it revealed a substantial load-bearing capacity.

Sanguineous cardiopulmonary bypass prime accelerates the inflammatory response during pediatric cardiac surgery.

The inflammatory response to cardiopulmonary bypass (CPB) in pediatric patients remains an unresolved challenge. Sanguineous CPB prime, composed of allogenic blood products, is one potentially important stimulus. This study aims to identify specific inflammatory mediators active in sanguineous CPB prime and their impact on the inflammatory response at CPB initiation. In a post-hoc analysis of a prospective observational cohort study (NCT05154864), where pediatric patients undergoing cardiac surgery with CPB were enrolled after informed consent, patients were grouped by CPB prime type (sanguineous vs crystalloid). Arterial samples were collected post-sternotomy as a baseline and again at CPB initiation from all patients. In the sanguineous group, CPB prime samples were also collected after buffered ultrafiltration but before CPB initiation. Luminex® measured concentrations of 24 inflammatory mediators for comparison between groups. Statistical analyses were by Mann-Whitney test and Wilcoxon signed-rank test. Data are presented as median [IQR]. Forty consecutive pediatric patients participated. The sanguineous group (n = 26) was younger (4.0 [0.2 - 6.0] vs 48.5 [39.0 - 69.5] months; p = 2.6 × 10-7) and smaller (4.9 [34 - 6.6] vs 17.2 [14.9 - 19.6] kg; p = 2.6 × 10-7) than the crystalloid group (n = 14). Despite this, baseline concentrations of 20 complement and cytokine concentrations were comparable between groups (p > 0.05) while four showed differences between groups (p < 0.05). The sanguineous prime contained supraphysiologic concentrations of complement mediators: C2, C3, C3a, C3b, and C5a. Correspondingly, upon CPB initiation, patients receiving sanguineous prime exhibited a significantly larger burden of C2, C3, C3b, C5, and C5a (p < 0.001) relative to the crystalloid group. Cytokine and chemokine mediators were present at trace levels in the sanguineous prime. Sanguineous prime contains activated complement that accelerates the inflammatory response at CPB initiation in neonates and infants. Immunomodulatory interventions targeting complement during CPB prime preparation could offer substantial benefits for these vulnerable patients.

Dissecting implicit food-related behaviors in Binge Eating Disorder and obesity: insights from a mobile approach-avoidance framework.

Bulimic episodes experienced by patients with Binge Eating Disorder (BED) might be sustained by an enhanced behavioral propensity to approach food stimuli. To test this hypothesis, automatic approach avoidance tendencies toward high-calorie foods (HCF), low-calorie foods (LCF), and neutral objects were assessed in a group of 23 patients with BED, and their performance was compared to the one of 17 patients with obesity without BED and a group of 32 normal weight participants. All participants performed a mobile approach-avoidance task in which they were required to approach and avoid different stimuli by respectively pulling their phone toward themselves or pushing it away. Reaction times were analyzed. Results showed a significant three-way interaction between group, type of movement and stimulus. Post-hoc analyses revealed that all the groups displayed an approach bias toward HCF. Patients with BED and healthy controls also displayed an approach bias toward LCF, a bias that was absent in obese individuals without BED. Moreover, patients with BED were faster in approaching food stimuli, both HCF and LCF, compared to healthy controls. These behavioral tendencies are quite consistent with the real-life attitudes of both BED patients and patients with obesity and might contribute to the maintenance of unhealthy eating habits such as binging in patients with BED and high-calorie diets in patients with obesity.

Hyperkalemia and maintenance of renin-angiotensin system inhibitor therapy after initiating SGLT-2 or DPP-4 inhibitors.

Post-hoc analyses of clinical trials suggest that sodium-glucose cotransporter-2 inhibitors (SGLT-2i) lower the risk of hyperkalemia and facilitate the use of renin-angiotensin system inhibitors (RASi) in people with type 2 diabetes. Whether this is also observed in routine care is unclear. We investigated whether SGLT-2i lowered the risk of hyperkalemia and RASi discontinuation as compared to dipeptidyl peptidase 4 inhibitors (DPP-4i). Using the target trial emulation framework, we studied adults with type 2 diabetes (T2D) who started SGLT-2i or DPP-4i in Stockholm, Sweden (2014-2021). The outcomes were incident hyperkalaemia (potassium>5.0 mmol/L), mild hyperkalemia (potassium>5-≤5.5mmol/L) and moderate to severe hyperkalemia (potassium>5.5mmol/L). Among RASi users, we studied time to RASi discontinuation through evaluation of pharmacy fills. Cox regression with inverse probability of treatment weighting was used to estimate per-protocol hazard ratios (HRs). 29 849 individuals (15 326 SGLT-2i and 14 523 DPP-4i initiators) were included (mean age 66 years, 37% women). About one third of participants in each arm discontinued treatment within a year. Compared with DPP-4i, SGLT-2i use was associated with a lower rate of hyperkalemia (HR 0.77; 95% CI: 0.64-0.93), including both mild (0.76; 0.62-0.93) and moderate/severe (0.53; 0.40-0.69) hyperkalemia events. Of 19.116 participants that used RASi at baseline, 7% discontinued therapy. Initiation of SGLT-2i vs. DPP-4i was not associated with the rate of RASi discontinuation (0.97; 0.83-1.14). Results were consistent in intention-to-treat analyses and across strata of age, sex, cardiovascular comorbidity, and baseline kidney function. In patients with diabetes managed in routine clinical care, the use of SGLT-2i was associated with lower rates of hyperkalemia compared with DPP-4i. Possibly because of a relatively high rate of treatment discontinuations, this was not accompanied by higher persistence on RASi therapy.

High efficacy of red light photodynamic therapy with 10 % aminolevulinic acid gel irrespective of the extent of keratinocyte atypia in actinic keratosis – exploratory post-hoc analysis of three pivotal phase III trials

BackgroundPrimary endpoints of clinical studies investigating treatments for actinic keratosis (AK) are mainly based on clinical evaluation, but a recent study showed that in AK, clinical classification according to Olsen and the extent of keratinocyte atypia do not necessarily correlate. The influence of the epidermal extent of atypia on treatment efficacy is usually not investigated and therefore remains largely unknown. ObjectiveTo evaluate whether the extent of keratinocyte atypia influences efficacy of photodynamic therapy (PDT) when treating AK. MethodsWe performed a post-hoc analysis of histological (keratinocyte intraepithelial neoplasia (KIN)), and clinical (Olsen) data of biopsied lesions of three pivotal studies evaluating PDT using 10 % aminolevulinic acid (ALA) gel or vehicle and narrow- or broad-spectrum red light lamps. ResultsOverall, 514 biopsied lesions were considered. Clearance rates after red light PDT with 10 % ALA gel were comparable for KIN I-III (88.2 %, 92.0 % and 87.9 %) and Olsen I-II lesions for any given lamp type. Generally, clearance rates were higher using narrow- compared to broad-spectrum lamps. For both lamp types, the variation in clearance rates from KIN I-III was low. Clearance was lower with vehicle. LimitationsVarying lesion numbers in the subgroups and a remaining risk of bias due to the biopsies are potential limitations. ConclusionOur results suggest that red light PDT with 10 % ALA gel is an effective treatment option for AK regardless of the extent of keratinocyte atypia.

Children with Cerebral Palsy Rehabilitation In-Session Engagement: Lessons Learnt from a Story Tool Training Program

ABSTRACT Rehabilitation aims to increase individuals’ ability to interact with their environment. Focusing on the paediatric context, rehabilitation is likely to optimise children’s development while improving and maintaining their functioning. However, children with neurodevelopmental disabilities, such as cerebral palsy, often show low engagement in rehabilitation sessions. This study aimed to assess the effectiveness of a narrative-based training program in increasing in-session engagement for children with cerebral palsy undergoing rehabilitation (i.e. targeting affective, behavioural, and cognitive dimensions). The study was conducted in three cerebral palsy rehabilitation centres and followed a one-group double-pre-test, one-post-test design. Fifteen children with cerebral palsy participated in the training program twice a week over nine weeks. The program aimed to promote children’s in-session engagement in rehabilitation through a story tool grounded in a self-regulation theory. Current data revealed the key effects of implementation time in the three dimensions of in-session engagement. Post-hoc tests of within-subjects indicated significant differences between pre-test 1 versus post-test and pre-test 2 versus post-test in the three dimensions of in-session engagement. This narrative-based intervention was a helpful tool promoting in-session affective, behavioural, and cognitive engagement in rehabilitation for this sample of children with cerebral palsy.

The Antifungal Effects of Hypericum perforatum Nanoemulsion against Candida albicans

Background Oral stomatitis is one of the common infections related to dentures (complete or partial), which is seen in the form of diffuse inflammation, mainly with Candida albicans. The aim of the present study was to investigate the antifungal effects of Hypericum perforatum nanoemulsion against Candida albicans. Materials and Methods The microdilution technique has been used in order to determine the antifungal effects of Hypericum perforatum nanoemulsion. The study has involved four groups: Hypericum perforatum oil, Hypericum perforatum nanoemulsion, distilled water as a negative control, and nystatin as a positive control. The first concentration of nanoemulsion in which no clear fungal growth was observed in the culture medium has been considered as the Minimum Inhibitory Concentration (MIC) and the first concentration in which the fungal growth was completely stopped and no fungal growth was observed in the culture medium has been considered as the Minimum Fungicide Concentration (MFC). One-way Analysis of Variance (ANOVA) has been employed to compare the results between the groups. Tukey's post-hoc test has been used to make comparisons between the groups. The significance level has been considered at less than 0.05. Results Both Hypericum perforatum oil and Hypericum perforatum nanoemulsion have been found to exhibit good antifungal activity against Candida albicans. The MIC and the MFC of the nanoemulsion form have been found to be lower than the non-nanoemulsion form (P&lt;0.05). Among the studied groups, the nystatin group had been found to have the best effect (P&lt;0.05). Conclusion Considering the different antifungal mechanisms and also the different resistance mechanisms of nystatin and Hypericum perforatum nanoemulsion, the prepared nanoemulsion can be used to treat and reduce the population of nystatin-resistant Candida albicans strain. However, the efficiency of these materials needs to be confirmed in larger studies on resistant strains.