Reduce Patient Discomfort Research Articles

Design and Preliminary Evaluation of an Electromagnetically Actuated Soft-Tethered Colonoscope

Colorectal cancer (CRC) incidence has been steadily rising worldwide. Early screening and treatment by colonoscopy are critical in reducing both the incidence and mortality rate of CRC. The conventional flexible colonoscope (FC) requires high skills of the physicians and may lead to patient discomfort. Many novel techniques for colonoscopy have been developed, each of which has its own pros and cons. This paper proposes an electromagnetically actuated soft-tethered (EAST) colonoscope system to provide an alternative solution. The EAST colonoscope is competent in achieving complete functions of FC and reducing patient discomfort owing to the gentle interaction between the colonoscope and colon wall. Physical experimentation is conducted with a proof-of-concept actuation prototype to validate the feasibility of the EAST colonoscope. The experimental results show that the orientation can be controlled to follow the desired trajectories with a mean absolute error of 0.302 mm. Moreover, the system is demonstrated to achieve active locomotion and orientation in a colon phantom, while other operations such as insufflation, biopsy, and drug delivery are performed using a porcine colon, which indicates that the EAST colonoscope delivers high potentials in medical application.

Virtual planning and CAD/CAM-assisted distraction for maxillary hypoplasia in cleft lip and palate patients: Accuracy evaluation and clinical outcome

The aim of this prospective study was to report the experience with a specific guided distraction protocol for the treatment of CLP patients with severe midface hypoplasia.From January 2016 to April 2019, six consecutive, non-growing, CLP patients with maxillary hypoplasia underwent a specific distraction protocol based on the use of VSP, CAD/CAM-generated surgical splints, cutting guides, prebent internal maxillary distractors, early removal of distractors, and acute callus manipulation and fixation.STL files for VSP, using multislice CT scans taken preoperatively (T0) and 3 months after distractor removal (T1) were superimposed using the free software 3D Slicer and Geomagic Wrap to evaluate the accuracy of maxillary repositioning and assess 3D bone changes. Clinical outcome was evaluated at the 1-year follow-up (T2).The patients and surgeon were satisfied with the occlusal and aesthetic outcomes. A maximum difference of 2 mm between the VSP and the actual surgical outcome was chosen as the success criterion for accuracy. The average linear difference for selected points was <2 mm in four patients and >2 mm in two patients. The average distance of the postoperative maxilla from the VSP model was 2.28 mm (median 1.85), while the average forward movement of the maxilla was 10.18 mmThe protocol used is effective and accurate in the correction of severe maxillary hypoplasia in CLP patients. Early removal of the distractor and stabilization with plates reduces patient discomfort and does not jeopardize stability. This protocol should be reserved for complex cases due to the costs of the procedure, which are not negligible.

Comparison between conventional and digital impression techniques in prosthetic dentistry: a literature review

INTRODUCTION: In modern prosthetic dentistry, there are mainly two approaches when manufacturing any prosthetic restoration: conventional and digital. In these approaches, the methods for reproducing the prosthetic field can be divided into: conventional impression methods, digital impression methods, and combined impression methods. AIM: The aim of the present literature review is to identify the advantages and disadvantages of taking a digital impression over conventional impression, and to determine whether the digital impression is as accurate as a conventional one. MATERIALS AND METHODS: A total of 209 articles were analyzed. The electronic databases of ResearchGate, Embase, Google Scholar, PubMed, and Scopus were used. The search was limited to entire articles written in English and published in peer-reviewed scientific journals. RESULTS: The studied articles were published in the period from 1961 to 2019 and over 60% of them were in the last 10 years. Among these studies, 10 are previous literature reviews, 85 are in vivo clinical trials, 6 are randomized controlled/crossover studies, 11 are controlled comparative studies, 7 are clinical case reports, and 90 are in vitro comparative studies. CONCLUSION: The present study has its limitations due to the fact that it is a literature review. However, we can conclude that the digital impression technique has a number of advantages over the conventional impression technique, one of the most important of which is the reduced patient discomfort.

Preclinical evaluation of a regenerative immiscible bioglue for vesico-vaginal fistula

Currently, there are no clinically available tissue adhesives that work effectively in the fluid-rich and highly dynamic environments of the human body, such as the urinary system. This is especially relevant to the management of vesico-vaginal fistula, and developing a high-performance tissue adhesive for this purpose could vastly expand urologists’ surgical repertoire and dramatically reduce patient discomfort. Herein, we developed a water-immiscible mussel protein-based bioadhesive (imWIMBA) with significantly improved properties in all clinical respects, allowing it to achieve rapid and strong underwater adhesion with tunable rheological properties. We evaluated in vivo potential of imWIMBA for sealing thermally injured fistula tracts between the bladder and vagina. Importantly, the use of imWIMBA in the presence of prolonged bladder drainage resulted in perfect closure of the vesico-vaginal fistula in operated pigs. Thus, imWIMBA could be successfully used for many surgical applications and improve treatment efficacy when combined with conventional surgical methods. Statement of significanceVesico-vaginal fistula (VVF) is an abnormal opening between the bladder and the vagina, which is a stigmatized disease in many developing countries. Leakage of urine into internal organs can induce serious complications and delay wound repair. Conventional VVF treatment requires skillful suturing to provide a tension-free and watertight closure. In addition, there is no clinically approved surgical glue that works in wet and highly dynamic environments such as the urinary system. In this work, for potential clinical VVF closure and regeneration, we developed an advanced immiscible mussel protein-based bioglue with fast, strong, wet adhesion and tunable rheological properties. This regenerative immiscible bioglue could be successfully used for sealing fistulas and further diverse surgical applications as an adjuvant for conventional suture methods.

Effectiveness and safety of single transseptal ablation for atrial fibrillation in real-word practice.

BackgroundWe have previously reported that unilateral groin‐single transseptal (ST) ablation in patients with paroxysmal atrial fibrillation (AF) was safe and significantly reduced patient discomfort compared with bilateral groin‐double transseptal (DT) ablation.HypothesisIn the present study, we hypothesized that ST ablation would be as effective and safe as DT ablation in real‐world practice like previous study. Among the 1765 consecutive patients in the Yonsei AF ablation cohort from October 2015 to January 2020, 1144 patients who underwent radiofrequency ablation were included for the analysis. Among them, 450 underwent ST ablation and 694 underwent DT ablation.ResultsThe total procedure time, ablation time, and fluoroscopy time were longer in the ST group than in the DT group (p < .05 for all). The hospital stay after catheter ablation was 1.3 ± 1.1 days which was longer in DT group than ST group (p = .001). No significant difference was observed in the complication rate (p = .263) and AF‐free survival rate (log‐rank p = .19) between the groups. However, after excluding patients who used antiarrhythmic drugs when AF recurred, the AF‐free survival rates were lower in the DT group than in the ST group before and after propensity score matching (log‐rank p = .026 and .047, respectively).ConclusionAlthough the ST approach increases the procedure time compared with the DT approach owing to the need for more frequent catheter exchanges, the ST approach is a feasible and safe strategy for AF ablation in terms of rhythm outcomes and risk of complications.

Comparison of the accuracy of intraoral digital impression system and conventional impression techniques for multiple implants in the full-arch edentulous mandible

BackgroundSeveral impression techniques, especially in combination with computer-aided design and computer-aided manufacturing (CAD/CAM), are used in increasing the accuracy of dental implantology and decreasing patient discomfort. The study was designed to examine the accuracy of the digital impression (DI) of multiple implants with an intraoral scanner (IOS) and compared with that of a conventional impression (CI). Material and MethodsFour dental implants were placed in teeth area #33, #36, #43 and 46# of the mandibular full-arch model. The implanted model was replicated by IOS and CI after fitting of scannable abutments over the implant screws. Then, a small hole was made on the scan region (as a reference point). Two types of CI techniques were used; dual-phase (DP) and monophase (MP). Stone casts were produced through a conventional close tray impression technique using die stone. The casts were scanned with a laboratory scanner. DI was attained by scanning the implanted model with the IOS. The control sample was accomplished by scanning the implanted model directly with a laboratory scanner. Dimensional accuracy was calculated by measuring the distances between the reference points of four measuring parameters as follows; A-B, B-C, C-D, and A-D using CAD software. ResultsThe mean values and standard deviation between the four parameters of different impression techniques (CI and DI) and the control group showed convergent value. One-way ANOVA test showed all CI techniques, except IOS, showed a significant differences from the control group. ConclusionsCompared with CI, the IOS was more accurate because no differences were observed between its measurements and those of the control model. CI is simple and reduces patient discomfort when used in fabricating multiple implants and allowing communication with dental technicians. Key words:Dimension accuracy, conventional impressions, digital impressions, multiple implants.

Unilateral en-masse distalization of maxillary posterior teeth using miniplate

Traditional methods of distalization in maxillary arch require patient cooperation with headgear or elastics, which are awkward for the patient. Hence, numerous intraoral procedures have been offered to reduce patient discomfort. In continuance with such efforts, our aim is to present a successful method of unilateral en-masse distalization using miniplate. Treatment results were evaluated using lateral cephalogram and dental models. Findings suggested that miniplate is effective method of correcting unilateral Class II relationship.

Using injectable fillers for midface rejuvenation

Treatment aimed at preventing and reversing the facial aging process has grown in popularity. The aging midface is defined by classic deepening of the nasolabial folds, formation of marionette lines around the mouth, and significant atrophy of deep facial fat. While surgical options have been investigated with satisfactory and long-lasting results, nonsurgical alternatives such as soft tissue fillers are a safe and effective strategy for facial rejuvenation. This review focuses on a variety of injectable fillers available for the treatment of the aging midface, including hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and polymethyl methacrylate. Mechanism of action, relevant anatomy, indications/contraindications, technique, and any evidence of efficacy and safety are described. The benefits of injectable fillers include reduced patient discomfort and shorter recovery times. Understanding the advantages and limitations of injectable fillers for midface augmentation can allow providers to counsel and treat patients seeking care appropriately.

Diagnostic Yield of Incremental Biopsy Cores and Second Lesion Sampling for In-Gantry MRI-Guided Prostate Biopsy.

BACKGROUND. In-gantry MRI-guided biopsy (MRGB) of the prostate has been shown to be more accurate than other targeted prostate biopsy methods. However, the optimal number of cores to obtain during in-gantry MRGB remains undetermined. OBJECTIVE. The purpose of this study was to assess the diagnostic yield of obtaining an incremental number of cores from the primary lesion and of second lesion sampling during in-gantry MRGB of the prostate. METHODS. This retrospective study included 128 men with 163 prostate lesions who underwent in-gantry MRGB between 2016 and 2019. The men had a total of 163 lesions sampled with two or more cores, 121 lesions sampled with three or more cores, and 52 lesions sampled with four or more cores. A total of 40 men underwent sampling of a second lesion. Upgrade on a given core was defined as a greater International Society of Urological Pathology (ISUP) grade group (GG) relative to the previously obtained cores. Clinically significant prostate cancer (csPCa) was defined as ISUP GG 2 or greater. RESULTS. The frequency of any upgrade was 12.9% (21/163) on core 2 versus 10.7% (13/121) on core 3 (p = .29 relative to core 2) and 1.9% (1/52) on core 4 (p = .03 relative to core 3). The frequency of upgrade to csPCa was 7.4% (12/163) on core 2 versus 4.1% (5/121) on core 3 (p = .13 relative to core 2) and 0% (0/52) on core 4 (p = .07 relative to core 3). The frequency of upgrade on core 2 was higher for anterior lesions (p < .001) and lesions with a higher PI-RADS score (p = .007); the frequency of upgrade on core 3 was higher for apical lesions (p = .01) and lesions with a higher PI-RADS score (p = .01). Sampling of a second lesion resulted in an upgrade in a single patient (2.5%; 1/40); both lesions were PI-RADS category 4 and showed csPCa. CONCLUSION. When performing in-gantry MRGB of the prostate, obtaining three cores from the primary lesion is warranted to optimize csPCa diagnosis. Obtaining a fourth core from the primary lesion or sampling a second lesion has very low yield in upgrading cancer diagnoses. CLINICAL IMPACT. To reduce patient discomfort and procedure times, operators may refrain from obtaining more than three cores or second lesion sampling.

Influence of low-molecular-weight heparin injection sites on local bruising and pain: A systematic review and meta-analysis.

Subcutaneous administration of low-molecular-weight heparin (LMWH) may cause complications such as haematoma, bruising and pain at different injection sites. Several studies have been carried out to investigate whether bruising and pain depend on injection sites; however, the results have been conflicting, and a clear consistent conclusion has not been reached. The purpose of this systematic review and meta-analysis was to assess the incidence and severity of bruising and pain after subcutaneous injection of LMWH in different sites. Two reviewers independently searched the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI) databases for randomized controlled and self-controlled trials reporting side-effects from LMWH with different subcutaneous injection sites. Cochrane bias risk assessment tools and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the randomized controlled and self-controlled trials, respectively. Rev Man 5.3 software was used to analyse the data that were extracted after quality assessment to determine the incidence and severity of side-effects at different subcutaneous injection sites. A total of eleven studies were included in this analysis. The meta-analysis provided evidence that subcutaneous injection in the abdominal area had a lower incidence of bruising than that in the arm area (risk ratios: 0.76; 95% confidence interval: 0.64-0.90; I2 =52%, p<.05), but the difference in the bruising size between the two injection sites was marginally significant (standardized mean difference: 0.08; 95% confidence interval: -0.45 to 0.62; I2 =85%, p>.05). There was also no significant difference in the bruising size between subcutaneous injection in the abdominal area and subcutaneous injection in the thigh area (standardized mean difference: -0.16; 95% confidence interval: -0.34 to 0.22; I2 =32%, p>.05). Subcutaneous injections in the abdominal area had a lower severity of pain than injections in the arm area (risk ratios: 0.57; 95% confidence interval: 0.48-0.67; I2 =81%; p<.05), but no statistically significant difference was shown between the pain intensity in the abdominal and arm area (mean difference: -1.64; 95% confidence interval: -4.36 to 1.08; I2 =99%; p>.05). Subcutaneous injection of LMWH in the abdominal area could reduce the incidence of side-effects at the injection site and reduce patient discomfort. The abdomen is proposed as the first choice of injection site for LMWH. The findings provide useful information to nurses in clinical practice when choosing the subcutaneous injection site for LMWH.

Can Photons Pass through Primary Coatings Used to Treat Cutaneous Wounds?

To determine the transmittance spectrum of primary dressings commonly used in the treatment of cutaneous wounds to verify if there is a real need to remove them during photobiomodulation. Spectroscopic analysis was performed on 17 dressings using a spectrophotometer (USB 2000+; OceanOptics, Delray Beach, Florida). A piece of each dressing was inserted into a quartz cuvette; the reflection from the slide walls was corrected for using a 0.9% saline solution to completely fill the cuvette (baseline). The transmittance of each dressing was measured between 350 and 950 nm, and a transmittance table was created based on the main wavelengths used in photobiomodulation. Six dressings (Supriderme, Membracel, Cuticell Contact, UrgoTul, Tegaderm, and Opsite Flexigrid) have a transmittance greater than 50% in most of the spectral range and therefore may remain on wounds during irradiation. It may not always be necessary to remove a primary dressing when lasers or LED lights are used to treat wounds. It is the authors' hope that the results of this article will increase the effectiveness of both photobiomodulation and primary dressings and reduce patient discomfort as well as the cost of primary dressings via a reduction in unnecessary dressing changes.

Tarlov Cysts Misdiagnosed as Adnexal Masses in Pelvic Sonography: A Literature Review

Introduction: A Tarlov cyst (TC) is a perineural cyst filled with cerebrospinal fluid that originates from the dorsal ganglion or the spinal posterior nerve root. TCs are usually asymptomatic and incidentally found in the sacral region. Endopelvic extension of TCs is uncommon and can be misdiagnosed as an adnexal mass on gynecological ultrasound imaging.Methods: We performed a search for all clinical studies of TCs that mimicked adnexal masses that had been published through October 12, 2020. We placed no restrictions on language or year of publication in our search, and we performed searches with the following keywords: perineural cyst, Tarlov cyst, sclerotherapy, management, and prognosis. We included all misdiagnosed cases or cases considered as adnexal masses on pelvic sonography.Results: We identified 21 cases of TCs mimicking adnexal masses and conducted a comprehensive analysis of these 21 cases to assess the epidemiology, symptoms, initial diagnoses, provisional ultrasound diagnoses, confirmative modalities, sizes, locations, treatments, and outcomes. The 21 cases included 16 symptomatic cases (76%) and 5 cases with incidental findings (24%), and the average patient age was 41.3 years. The initial diagnosis was performed with ultrasonography in all cases. The most frequent misdiagnosis was unspecified adnexal mass. Confirmative diagnostic modalities were MRI only (67%), CT only (5%), and both MRI and CT (28%). Treatments were surgery (33%), conservative treatment (19%), percutaneous intervention (5%), and alcohol sclerotherapy (5%). In two symptomatic cases misdiagnosed as pelvic masses, cystectomy was performed and leakage of cerebrospinal fluid occurred, necessitating repair of the leak. In one of the asymptomatic patients, cauda equina syndrome occurred after alcohol sclerotherapy for misdiagnosed TC. However, the patient improved with no neurologic deficit after 18 months of conservative treatment.Conclusion: The possibility of large TCs should be considered when assessing adnexal masses in sonography. Since TCs can masquerade as pelvic masses, they should be considered if the mass appears tubular/cystic or multilocular/multiseptate, does not move with respiration, and originates from the sacrum in sonography with or without neurologic symptoms. Accurate diagnosis can prevent medical mismanagement and reduce patient discomfort.

3D printed auxetic nasopharyngeal swabs for COVID-19 sample collection

The COVID-19 pandemic has resulted in worldwide shortages of nasopharyngeal swabs required for sample collection. While the shortages are becoming acute due to supply chain disruptions, the demand for testing has increased both as a prerequisite to lifting restrictions and in preparation for the second wave. One of the potential solutions to this crisis is the development of 3D printed nasopharyngeal swabs that behave like traditional swabs. However, the opportunity to digitally conceive and fabricate swabs allows for design improvements that can potentially reduce patient pain and discomfort. The study reports the progress that has been made on the development of auxetic nasopharyngeal swabs that can shrink under axial resistance. This allows the swab to navigate through the nasal cavity with significantly less stress on the surrounding tissues. This is achieved through systematically conceived negative Poisson's ratio (−υ) structures in a biocompatible material. Finite element (FE) and surrogate modelling techniques were employed to identify the most optimal swab shape that allows for the highest negative strain (−εlat) under safe stress (σvon). The influence and interaction effects of the geometrical parameters on the swab's performance were also characterised. The research demonstrates a new viewpoint for the development of functional nasopharyngeal swabs that can be 3D printed to reduce patient discomfort. The methodology can be further exploited to address various challenges in biomedical devices and redistributed manufacturing.

Impact of Acoustic Noise Reduction on Patient Experience in Routine Clinical Magnetic Resonance Imaging

Acoustic noise emission from MRI scanners is considered a major factor of patient discomfort during routine MRI examinations. We prospectively evaluated the impact of acoustic noise reduction using software implementations in routine clinical MRI on subjective patient experience and image quality. Two-hundred consecutive patients undergoing one of four MRI examinations (brain, lumbar spine, shoulder, and knee) at a single center were prospectively randomized into two groups at a 1 to 1 ratio: standard MRI examination and MRI examination with acoustic noise reduction. After the examination, patients were asked to complete a questionnaire aimed at defining their subjective experience (primary endpoint). Two readers assessed subjective image quality of all patient studies in consensus (secondary endpoint). Nonparametric tests and logistic regression models were used for statistical analysis. Hundred-seventy-four patients were included in the final study. Patients in the intervention group felt less discomforted by the acoustic noise (p = 0.01) and reported increased audibility of music through the headphones (p = 0.03). No significant difference in subjective image quality was found. Our study indicates that the effects of acoustic noise reduction in routine clinical MRI can be translated into reduced patient discomfort from acoustic noise and improved audibility of music. Acoustic noise reduction thus significantly contributes to increased patient comfort during MRI examinations.

The Accuracy of Three Intraoral Scanners in the Oral Environment with and without Saliva: A Comparative Study

Background: with the emergence of technological innovations in the dental industry, one emerging trend has been the intraoral digitizing of patients by using intraoral scanning systems. Compared to taking conventional impressions, the use of intraoral scanners (IOS) is suitable for capturing direct optical impressions, helping to improve diagnostic efficacy, save time, reduce patient discomfort, and simplify clinical procedures. Intraoral scanning systems appear to have a high potential for providing guidance on proper standards of care. However, one main disadvantage is breathing and saliva secretion, which causes deviations, interfering with the applicability and accuracy of the optical impression. The aim of this study was to compare the validity and accuracy of three commercially available intraoral scanners, performing an analysis exploiting a wet model. Methods: an in vitro experimental study of four permanent teeth (two molars and two premolars) on the accuracy of copings obtained by subgingival preparations was performed, using an oral wet environment model. Two hundred and forty digital impressions were produced from three digital scanners using four samples. Descriptive analysis was performed using mean, standard deviation, and median. ANOVA and F-tests were performed to assess the amount of variability between the groups. For statistical analysis a 95% significance level was chosen. Results: all differences between groups were statistically significant. Conclusions: the present data implicate a huge impact of the oral biological fluids on the accuracy of digital impression to corresponding images, implying a failure of accurate impression under wetness conditions.

In dogs diagnosed with osteoarthritis, is meloxicam superior to carprofen for reducing patient discomfort?

PICO question&#x0D; In dogs diagnosed with osteoarthritis, is meloxicam superior to carprofen for reducing patient discomfort?&#x0D; &#x0D; Clinical bottom line&#x0D; Category of research question&#x0D; Treatment&#x0D; The number and type of study designs reviewed&#x0D; Only two papers have compared the efficacy between meloxicam and carprofen in the treatment of dogs diagnosed with osteoarthritis. Both of the papers were clinical, prospective and randomised trials.&#x0D; Strength of evidence&#x0D; Weak&#x0D; Outcomes reported&#x0D; One randomised controlled clinical trial compared the level of efficacy between meloxicam and carprofen in reducing pain and discomfort in dogs diagnosed with osteoarthritis1. Orthopaedic surgeons found dogs treated with either meloxicam or carprofen showed significant improvement in ground reaction forces (GRF). The study emphasised that dogs treated with meloxicam had GRF values that returned to normal baseline values, with owners also commenting on gait improvement. This study however, had a low sample size, did not use a validated metrology instrument for assessment by owners and the data used to assess GRF was not conclusive on all parameters to favour meloxicam.&#x0D; An additional study was evaluated but this also had very small case numbers, no control group and gave no detailed statistical analysis2. The paper descriptively suggests meloxicam to show a better response than carprofen but there was no scientific analysis or evidence to statistically support and validate this.&#x0D; Conclusion&#x0D; Both meloxicam and carprofen are validated as effective treatments for canine osteoarthritis but it cannot be suggested that meloxicam is superior to carprofen as the available evidence is weak. To accurately assess this, a future clinical study using validated metrology instruments, adequate sample sizes and proper statistical analysis is required.&#x0D; &#x0D; How to apply this evidence in practice&#x0D; The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.&#x0D; Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.&#x0D; &#x0D;

Spectral Analysis of Ultrasonic and Photo Acoustic Signals Generated by a Prototypal Fiber Microprobe for Media Characterization

Combination of photoacoustics and ultrasound can provide complemental features and mutual benefits, useful for a complete tissue characterization and consequently for early diagnosis or therapy monitoring. Furthermore, minimally invasive techniques are required both to reach organs or tissue not accessible and to reduce patient discomfort and costs. This work has tested a prototypal microprobe for media characterization analysing their optical and mechanical features. Two different transmitters compose the miniaturized probe: one for large bandwidth ultrasonic signals generation and one for guiding the laser light into tissue to photogenerate ultrasound. The aim is to evaluate the possibility of employing in the future this new type of microprobe to characterize internal tissue, combining ultrasound and photoacoustic investigations. A calibrated commercial hydrophone has been used to detect generated signals, with the aim to provide repeatable and reliable results. Dedicated test objects have been realized by using solutions of corn starch flour and of Chinese ink with different and calibrated dilutions. The spectral algorithm HyperSPACE (Hyper SPectral Analysis for Characterization in Echography), applied on ultrasonic and photoacoustic signals has allowed differentiating scatterers’ concentration and distribution.

Anticytokine Activity Enhances Osteogenesis of Bioactive Implants.

In dental clinical practice, systemic steroids are often applied at the end of implant surgeries to reduce postsurgical inflammation (tissue swelling, etc.) and to reduce patient discomfort. However, the use of systemic steroids is associated with generalized catabolic effects and with a temporarily reduced immunological competence. We hypothesize that by applying locally anticytokine antibodies (antitumor necrosis factor alpha and anti-interleukin-1 beta) together with a bioactive osteogenic implant at the time of the surgical intervention for the placement of a construct, we will be able to achieve the same beneficial effects as those using systemic steroids but are able to avoid the generalized antianabolic effects and the reduced immunocompetence effects, associated with the systemic use of steroids. In an adult rat model, a collagen sponge, soaked with the osteogenic agent bone morphogenetic protein-2, was used as an example for a bioactive implant material and was surgically placed subcutaneously. In the acute inflammatory phase after implantation (2 days after surgery) we investigated the local inflammatory tissue response, and 18 days postsurgically the efficiency of local osteogenesis (to assess possible antianabolic effects). We found that the negative control groups, treated postsurgically with systemic steroids, showed a significant suppression of both the inflammatory response and the osteogenetic activity, that is, they were associated with significant general antianabolic effects, even when steroids were used only at a low dose level. The local anticytokine treatment, however, was able to significantly enhance new bone formation activity, that is, the anabolic activity, over positive control values with BMP-2 only. However, the anticytokine treatment was unable to reduce the local inflammatory and swelling responses.

Practical Considerations for Radiologists in Implementing a Patient-friendly MRI Experience

For many patients, numerous unpleasant features of the magnetic resonance imaging (MRI) experience such as scan duration, auditory noise, spatial confinement, and motion restrictions can lead to premature termination or low diagnostic quality of imaging studies. This article discusses practical, patient-oriented considerations that are helpful for radiologists contemplating ways to improve the MRI experience for patients. Patient friendly scanner properties are discussed, with an emphasis on literature findings of effectiveness in mitigating patient claustrophobia, other anxiety, or motion and on reducing scan incompletion rates or need for sedation. As shorter scanning protocols designed to answer specific diagnostic questions may be more practical and tolerable to the patient than a full-length standard-of-care examination, a few select protocol adjustments potentially useful for specific clinical settings are discussed. In addition, adjunctive devices such as audiovisual or other sensory aides that can be useful distractive approaches to reduce patient discomfort are considered. These modifications to the MRI scanning process not only allow for a more pleasant experience for patients, but they may also increase patient compliance and decrease patient movement to allow more efficient acquisition of diagnostic-quality images.

Limited Sampling Strategies Supporting Individualized Dose Adjustment of Intravenous Busulfan in Children and Young Adults.

Therapeutic drug monitoring (TDM) for busulfan supports dose adjustment during conditioning for stem cell transplantation. The authors aimed to develop and validate limited sampling strategies (LSS) of 4-5 samples for a precise estimation of the area under concentration (AUC)-time curve of busulfan, in plasma as an alternative to an intensive sampling strategy (ISS) requiring 9-10 samples. ISS TDM data from 297 patients (≤18 years of age) were used. AUCLSS was calculated using the trapezoidal rule and multiple linear regression (MLR). Unlike more complex modeling methods, MLR does not require sophisticated software or advanced training of personnel. MLR coefficients were estimated in the development subset containing randomly selected 50% of the records and were then used to calculate the AUCLSS of the remaining records (the validation subset). The agreement between dose adjustment recommendations (DAR) based on ISS and LSS, in the validation subset, was evaluated by a Bland-Altman analysis. A DAR deviating from an ISS-based reference by <15% was deemed acceptable. Twelve LSSs were acceptable. Sampling at 0, 120, 180, and 240 minutes after the start of the second infusion (LSS15) yielded the best performance, with DAR deviating from the reference by <10% for 95% of cases; the AUCLSS was determined as follows: AUCLSS = 74.7954 × C(0) + 81.8948 × C(120) + 38.1771 × C(180) + 138.1404 × C(240) + 54.1837. This LSS and LSS13 performed similarly well in an independent external validation. MLR-based estimates of AUCLSS provide DARs that deviate minimally from the reference. LSSs allow the reduction of patient discomfort, a ∼50% reduction of TDM-related workload for nursing staff and blood loss and a ∼25% reduction in laboratory workload. These benefits may encourage wider use of busulfan TDM, supporting safe and efficacious personalized dosing.