Significant Difference In Proportion Research Articles

Comparative Efficacy and Safety of Upadacitinib vs. Vedolizumab, Ustekinumab, and Tofacitinib After Induction and Maintenance for Ulcerative Colitis: Three Matching-Adjusted Indirect Comparisons.

Evidence on the comparative efficacy and safety of approved therapies for ulcerative colitis (UC) during induction and maintenance, including upadacitinib (UPA), vedolizumab (VEDO), ustekinumab (UST), and tofacitinib (TOFA), is limited. Using data from phase 3 trials, three placebo (PBO)-anchored matching-adjusted indirect comparisons of the efficacy and safety of UPA versus VEDO, UST, and TOFA (U-ACHIEVE and U-ACCOMPLISH, GEMINI-1, UNIFI, and OCTAVE induction and maintenance trials) have been conducted. Baseline characteristics from UPA trials were weighted separately to match each comparator trial. Induction responders were re-randomized to oral UPA 15 or 30mg, VEDO 300mg intravenously every 8weeks (Q8W), UST 90mg SC Q8W, or oral TOFA 5mg, or PBO in maintenance. Treat-through efficacy outcomes at weeks 44(UST)/46(VEDO)/52(UPA/TOFA) were adjusted by the likelihood of induction response and included clinical response, clinical remission, and endoscopic improvement. Safety outcomes included adverse events (AEs), serious AEs (SAEs), and AEs leading to discontinuation (except UPA vs. VEDO). Benefit-risk was assessed by numbers needed to treat (NNT)/harm, calculated as the inverse of the difference in proportions of patients achieving each efficacy/safety outcome for UPA versus comparator. The proportions of patients who demonstrated clinical response or endoscopic improvement was greater with UPA 15mg versus VEDO and TOFA (p<0.05). The proportions of patients demonstrating all treat-through efficacy outcomes were significantly greater with UPA 30mg versus VEDO, UST, or TOFA with NNTs 3.2-8.7. No significant differences in proportions of AEs, SAEs, and AEs leading to discontinuation were observed between the two doses of UPA and comparators. In patients with active UC, greater clinical efficacy, and similar safety after 1year of maintenance were observed with UPA versus VEDO, UST, and TOFA, suggesting a favorable benefit-risk profile for UPA. Despite matched baseline characteristics, differences in trial design and endpoints may persist.

The Relationship Between Compliance in Taking Anti Tuberculosis Drugs and the Results of Acid-Fast Bacteria (AFB) Examination as an Indicator of Recovery of TB Patients in Tanjung Pinang City in 2022-2023

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis with a treatment period of 6 to 8 months. Mycobacterium tuberculosis can become germ resistant or multidrug resistance (MDR) if you do not comply in taking anti-tuberculosis drugs (ATD), making this disease very difficult to cure. This research uses secondary data from the Tanjung Pinang City Population Control and Family Planning Health Service for 2022-2023. The aim is to determine the relationship between compliance in taking Anti-Tuberculosis Drugs (ATD) and the results of acid-fast bacteria (AFB) examinations of TB patients in Tanjung Pinang City. The research methodology was observational analytic using a cross-sectional design, with a total sampling technique from pulmonary TB patients with positive AFB, negative AFB with positive thorax and extrapulmonary, 252 TB patients. Data analysis used the Fisher Exact test with a confidence level of 95%. The results of data analysis showed that 91.3% of patients complied in taking drugs, and 87.3% recovered with negative AFB results. Fisher Exact analysis showed a significant difference in proportion between compliance in taking anti-tuberculosis drugs and the results of AFB examination of pulmonary TB patients with a p-value of 0.000 (p &lt; ∝0.05). The conclusion from this study is that there is a relationship between compliance in taking anti-tuberculosis drugs and the results of AFB examinations of pulmonary TB patients in Tanjung Pinang City in 2022-2023. Keywords: Pulmonary TB, ATD, (AFB), Ziehl Neelsen

Myosteatosis predicts bariatric surgery response: A longitudinal study in patients with morbid obesity.

Data on the preoperative factors for bariatric surgery response in patients with morbid obesity are limited, and there are no studies on the relationship between myosteatosis and surgery response. We investigated the preoperative factors determining bariatric surgery response and the impact of preoperative muscle fat infiltration on bariatric surgery response. This retrospective longitudinal cohort study included 125 individuals (37 men, 88 women) with morbid obesity who underwent bariatric surgery. Muscle fat infiltration (skeletal muscle fat index [SMFI]) was evaluated using computed tomography-based psoas muscle mass and density at the 4th lumbar level. A bariatric surgery response was defined as ≥50% excessive weight loss at one year postoperatively. Before bariatric surgery, the patient mean body weight and body mass index (BMI) were 107.0 kg and 39.0 kg/m2, respectively. After one year, the mean body weight was 79.6 kg. The mean excessive weight loss at one year was 75.6% and 102 (81.6%) patients were categorized as responders. There were no statistically significant differences in initial BMI, age, sex, or proportion of diabetes between responders and non-responders. Responders were more likely to have lower SMFI and triglyceride and glycated hemoglobin A1c levels than non-responders at baseline (P<0.05). Multiple logistic regression analysis showed that a lower baseline SMFI was associated with bariatric surgery response (odds ratio=0.31, 95% confidence interval=0.14-0.69, P=0.004). Preoperative myosteatosis may determine the response to bariatric surgery.

Ciliochoroidal Detachment After Intrascleral Lens Fixation Using the Yamane Technique.

The purpose of this study was to compare the incidence of ciliochoroidal detachment (CCD) after intrascleral lens fixation using the Yamane technique and other vitrectomy procedures. This retrospective study evaluated patients who underwent intrascleral lens fixation using the Yamane technique at Hiroshima University Hospital between March 2023 and February 2024 and who could be followed up for at least one month. Patients who underwent vitrectomy for macular disease without air-fluid exchange comprised the control group. The frequency of CCD was compared using anterior segment optical coherence tomography imaging. Forty-five eyes of 45 patients (26 men and 19 women, mean age 70.8 years) were included. There were no significant differences in the population means or proportions between the intrascleral fixation and control groups for age, sex ratio, right-to-left eye ratio, preoperative visual acuity, preoperative intraocular pressure (IOP), ocular axis, and corneal thickness. The population mean of IOP on the day after surgery was significantly lower in the Yamane intrascleral fixation group (8.4 mmHg) than in the control group (11.5 mmHg) (P < 0.05). There was no significant difference in the population proportions of CCD on the day after surgery between the Yamane intrascleral fixation group and the control group. However, the CCD incidence was 20 eyes (80%) for the Yamane intrascleral fixation group and 12 eyes (60%) for the control group, which was higher in the intrascleral fixation group. There was no significant difference in population means of IOP or population proportions of CCD at one week and one month. There was no significant difference in population proportions of CCD on the day after surgery, although the CCD rate for the Yamane intrascleral fixation group was higher, and the population mean of the IOP was significantly lower. The Yamane technique assumedly lowered IOP because of the stress placed on the ciliary body. One week after the procedure, the IOP in the intrascleral fixation group normalized.

Disparity in the effect of partial gravity simulated using a new apparatus on different rat hindlimb muscles

The days of returning to the Moon and landing on Mars are approaching. These long-duration missions present significant challenges, such as changes in gravity, which pose serious threats to human health. Maintaining muscle function and health is essential for successful spaceflight and exploration of the Moon and Mars. This study aimed to observe the adaptation of rat hindlimb muscles to partial gravity conditions by simulating the gravity of space (microgravity (µG)), Moon (1/6G), and Mars (3/8G) using our recently invented ground-based apparatus. A total of 25 rats were included in this study. The rats were divided into five groups: control (1G), sham (1G), simulated Mars (3/8G), simulated Moon (1/6G), and simulated Space (µG). Muscle mass, fiber proportion, and fiber cross-sectional area (CSA) of four types of hindlimb muscles were measured: gastrocnemius (GA), tibialis anterior (TA), extensor digitorum longus (EDL), soleus (Sol). Sol and GA exhibited the most significant alterations in response to the changes in gravity after 10 days of the experiment. A notable decline in muscle mass was observed in the simulated µG, Moon, and Mars groups, with the µG group exhibiting the most noticeable decline. In Sol, a noteworthy decline in the proportion of slow-twitch type I fibers, CSA of slow-twitch type I fibers, and average CSA of the whole muscle fibers was observed in the simulated groups. The GA red, mixed, and white portions were examined, and the GA mixed portion showed significant differences in fiber proportion and CSA. A notable increase in the proportion of slow-twitch type I fibers was observed in the simulated groups, with a significant decrease in CSA of type IIb. In EDL or TA, no discernible changes in muscle mass, fiber proportion, or fiber CSA were observed in any of the five groups. These findings indicate that weight-bearing muscles, such as Sol and GA, are more sensitive to changes in partial gravity. Furthermore, partial gravity is insufficient to preserve the normal physiological and functional properties of the hindlimb muscles. Therefore, targeted muscle interventions are required to ensure astronauts' health and mission success. Furthermore, these findings demonstrate the viability and durability of our ground-based apparatus for partial gravity simulation.

Comparison of two methods of measuring the urinary protein concentration for the determination of the urinary protein to creatinine ratio in various animal species.

Determination of the urinary protein-to-creatinine ratio (UPC) is an important tool in the quantification of proteinuria in animals. However, the result may be affected by the different methods of determining the urinary protein concentration. The aim of this study was to compare the turbidimetric method using benzethonium chloride and the colorimetric method using pyrogallol red in the measurement of the urinary protein concentration in dogs, cats, guinea pigs and horses. A total of 464, 192, 216 and 119 urine samples from dogs, cats, guinea pigs and horses were examined in the study, respectively. The group consisted of animals of both sexes and different ages, and, in the dogs and cats, it included both healthy animals and those with various health problems. In the group of horses and guinea pigs, only clinically healthy animals were included. A total of 347, 185, 103 and 100 samples from the dogs, cats, guinea pigs and horses were used in the statistical analysis; the other values were excluded as they were below the detection limit. According to the Passing-Bablok analysis, there was a significant constant and proportional difference in the horses. In the dogs, cats and guinea pigs, there was a significant constant difference, but no proportional difference. The Bland-Altman method showed significant bias between the two methods in the horses and cats, but not in the dogs and guinea pigs. In the dogs and cats, the agreement between the two methods was tested and expressed as Cohen's kappa (κ). In the cats, it was almost perfect for the proteinuric samples (κ = 0.823 3) and significant for the non-proteinuric samples (κ = 0.804 9). In the dogs, the agreement was significant for the non-proteinuric samples (κ = 0.621 5) and only moderate for the proteinuric samples (κ = 0.527 5). The influence of the method used to determine the urinary protein concentration should be taken into account when evaluating the UPC. Repeated examinations in one patient should be performed with the same method.

Proportion and risk factors of epiretinal membrane in residents of Brussels with versus without diabetes mellitus.

To compare the proportion of epiretinal membrane (ERM) between individuals with diabetes mellitus (DM) and without DM, who live in Brussels, to investigate possible risk factors for ERM formation and to compare the results with the ones of large population studies. Participants were divided into two groups; 99 patients with DM (group A) and 103 individuals without DM (group B). All participants underwent an undilated 7-field color fundus photography and a spectral domain optical coherence tomography (SD-OCT). Age, gender, race, type of diabetes, duration of medical treatment of diabetes, HbA1C rate, smoking, previous cataract surgery and educational level were investigated as possible risk factors. Epiretinal membrane was detected in 17.2% of group A and in 11.7% of group B participants. The difference is not statistically significant (χ2 (1) = 1.252, p = 0.263). The proportion of ERM was significantly associated with age in both groups (p = .009 and p < .001 respectively), as well as with smoking (p = .023) and previous cataract surgery (p = .028) in patients with DM. There is no statistically significant difference of ERM proportion between the two groups of the study. Age was recognized as a risk factor for both groups, while smoking and previous cataract surgery were identified as predictors only for diabetics.

(Relative) size matters: a content analysis of front-of-packaging cue proportions and hierarchies

PurposeFront-of-packaging (FOP) is a critical branding tool that uses “cues” to communicate product attributes and establish distinct brand images. This paper aims to understand how food brands utilize cues and their relative proportions to hierarchically communicate brand image and belonging to particular subcategories.Design/methodology/approachA content analysis is used for analysing 543 food FOPs sold in Australia (breakfast cereals, chips, snack bars). Samples are collected and classified into product sub-categories defined by ingredients, consumer-audience and retail placement. A novel 10 × 10 coding grid is applied to each FOP to objectively analyse cue proportion, with statistical comparison undertaken between sub-categories.FindingsResults reveal intrinsic cues are favoured over extrinsic cues, except for those in the eatertainment sub-category. Hierarchies are evidenced that treat product and branding cues as primary, with health cues secondary. Statistically significant differences in cue proportions are consistently evident across breakfast cereals, chips and snack-bar FOPs. Clear differentiation is evidenced through cue proportions on FOP for health/nutrition focused sub-categories and eatertainment foods.Originality/value“Cue utilization theory” research is extended to an evaluation of brand encoding (not consumer decoding). Design conventions reveal how cue proportions establish a dialogue of communicating brand/product image hierarchically, the trade-offs that occur, a “meso-level” to Gestalt theory, and achieving categorization through FOP cue proportions. Deeper understanding of packaging design techniques provides inter-disciplinary insights that extend consumer behaviour, retailing and design scholarship.

Fever of Unknown Origin (FUO) Criteria Influences Diagnostic Outcomes: A Systematic Review and Meta-Analysis.

BackgroundCriteria classifying fever of unknown origin (FUO) patients remains subject to discrepancies. A minimal standardized set of investigative tests serves as the foundation for the qualitative criteria, whereas quantitative incorporates the length of evaluation (7 or 3 days). A systematic review of studies would help physicians anticipate the frequency of illness types that could influence management. MethodsProspective studies published in Medline (PubMed), Embase, Scopus, and Web of Science databases from January 1, 1997, to July 31, 2022, were included. A meta-analysis estimated associated pooled proportions between these criteria and diagnostic outcomes adjusted to the International Classification of Diseases, 10th edition (ICD-10) definitions. ResultsFive qualitative studies corresponded to an increase of 15.3% (95% CI: 2.3-28.3%, p=0.021) in undiagnosed FUO proportions compared to eleven quantitative studies. Quantitative studies had 19.7% (95% CI: 6.0-33.4%, p=0.005) more in adjusted infectious disease proportions than qualitative studies. No significant differences in proportions between FUO defining criteria were noted for adjusted noninfectious inflammatory disorders (p=0.318), oncology (p=0.901), non-inflammatory miscellaneous disorders (p=0.321), diagnostic evaluation process, gross national income (GNI), or World Health Organization (WHO) geographic region. ConclusionsUse of either qualitative or quantitative FUO criteria was associated with a statistically significant risk of over- or under-estimating infectious diseases and undiagnosed illnesses when using an ICD-10 adjusted FUO five-category system. Clinicians should anticipate differences depending on which criteria are used. While further research is warranted, qualitative criteria provide the best framework for study comparisons.

Getting It Across the Finish Line: Publication Rates of Abstracts Presented at a Major Urologic Conference

ObjectiveTo identify characteristics of published manuscripts following a regional American Urological Association (AUA) meeting and recognize trends of publication rates over a 13-year timeframe. MethodsAbstract submissions to the Mid-Atlantic AUA (MA-AUA) conference from 2008 to 2020 were collected. Manuscripts were searched using abstract titles and authors in a standard fashion using PubMed, Google Scholar, and Google. Characteristic data was collected, including abstract type (podium or poster), abstract category, first author gender, manuscript publication date, and journal of publication. Univariate and multivariate analysis determined association of these variables with manuscript publication. Results1257 abstracts were presented between 2008 and 2020, of which 458 (36%) were published as manuscripts and 799 (64%) were not published. Of the published manuscripts, 55 (12%) were published prior to the conference date and 403 (88%) were published after. Our analysis was limited to the 403 manuscripts published post-meeting and the 799 abstracts that were not published, with N=1202. Amongst the 403 published post-meeting, the mean time to publication was 14.8 months ± 13.2 months. Podium presentations had a higher proportion of publications than those of posters (39.4% vs 30.5%, p=0.002). There was a statistically significant difference in proportion of publications between years (p=0.002). No association was noted between abstract first author gender and publication (38.7% male vs. 39.2% female, p=0.899). ConclusionsApproximately one-third of presented abstracts from a major urologic conference were published with an average time to publication of 15 months. Publication percentage varied significantly between different years. Podium presentations had a higher publication rate compared to non-podium abstracts.

The characteristics and risk of obesity central and concomitant impaired fasting glucose: Findings from a cross-sectional study.

Obesity is associated with concomitant chronic conditions. An early metabolic consequence of obesity is disruption of glucose and insulin homeostasis. One of the consequences is impaired fasting glucose (IFG). Visceral fat is metabolically more harmful than subcutaneous fat, but few information is available regarding the association between the risk of abnormal glucose in increased waist circumference. This study is based on a cross sectional of 1,381 population-based from Palembang, Indonesia. The eligibility requirements subject were to be older than 18 and consent to taking fasting glucose and lipid profile tests as well as physical exams measuring their body weight, height, blood pressure, abdominal circumference, and waist circumference. The number of subjects consisting of 798 noncentral obesity with normoglycemia, 376 central obesity with normoglycemia, and 207 central obesity with concomitant IFG. The prevalence central obesity with concomitant IFG was 35.51%. In subjects with central obesity, there were significant differences in proportions based on sex, age, marital status, education, and occupation. In multivariate analysis show that the risk factors that contribute to having a significant association with central obesity with concomitant IFG are sex (female), age (>40 years), blood pressure (hypertension), and HDL-C <50 mg/dL (p<0.001). The analysis also founded that there was a significant difference in the dietary pattern of sweet foods (p = 0.018), sweet drinks (p = 0.002), soft drinks (p = 0.001) and smoking habit (p<0.001) between subjects with obesity central and concomitant IFG compared to subjects with noncentral obesity. The majority of subjects with obesity central and concomitant IFG had consuming these risky foods >6 times/week. The prevalence of central obesity with IFG is quite high. There are significant differences in the characteristics, lipid profile, blood pressure, dietary pattern, and smoking habit of central obesity with concomitant IFG was confirmed in this population-based observational study.

RADT-09. IMMUNE RESPONSE IN DIFFUSE MIDLINE GLIOMA (DMG) FOLLOWING FLASH OR CONVENTIONAL RADIATION

Abstract BACKGROUND Diffuse Midline Glioma (DMG) is a fatal, unresectable, pediatric brain tumor with limited treatment options and a median survival of 9-15mths. As radiation therapy (RT) can only extend life by 3mths, novel RT techniques are needed, including ultra-high dose rate RT (FLASH). RT can stimulate immune responses in many cancers especially via type 1 interferon (IFN1) but the effect of RT on DMG is understudied as post treatment tissue is not readily available. METHODS We evaluated the effect of RT on immune response in an orthotopic syngeneic model of DMG, comparing FLASH, given at 90Gy/second, to conventional dose rate RT (CONV), given at 2Gy/min. We evaluated single-cell RNA sequencing (scRNA-seq) on CD45+ immune cells isolated from tumors 4 days post 15Gy FLASH or CONV RT and compared to unirradiated tumor (SHAM). We also performed flow cytometry on tumors at both day 4 and day 10 post-RT. RESULTS We find microglia (MG) are the most abundant immune cell type followed by non-resident myeloid cells including macrophages (MAC) and dendritic cells (DC). While there’s no significant difference in tumor growth or proportion of immune subtypes comparing FLASH, CONV and SHAM, we see similar IFN1 enrichment in MG comparing FLASH and CONV at day 4. Interestingly, at day 10 post-RT we observe higher IFN1 receptor (IFNAR1) by flow in MGs after CONV (p=0.016) and SHAM (p=0.040) compared to FLASH. At day 4 CONV shows higher IFN1 gene set enrichment in MACs and DCs compared to FLASH (both p&amp;lt;0.0001) as well as higher IFNAR1 in DCs comparing CONV to FLASH (p=0.0079), while day 10 post-RT shows equivalent IFNAR1 in MACs and DCs between dose rates. CONCLUSION Changes in DMG tumor immune microenvironment post-RT differ over time. Though both RT modalities increase IFN1, the timing of this response is dependent on both cell phenotype and dose.

The impact of different fixatives on immunostaining of lung adenocarcinomas in pleural effusion cell blocks.

Cell blocks (CBs) are widely used for biomarker analyses such as immunostaining. Although immunohistochemistry on formalin-fixed paraffin-embedded tissues is standardized, there are multiple preparation methods and fixatives for cytology. Our objective was to investigate the effect of different common fixatives on the immunoreactivity of pleural effusion CBs with metastatic lung adenocarcinomas. This prospective study included 24 malignant pleural effusions from different patients with lung adenocarcinoma. From each case, four identical CBs were fixed in 10% neutral buffered formalin, PreservCyt, CytoLyt, and CytoRich Red (only 17 of the cases), respectively. Samples containing <100 malignant cells were excluded. All CBs were stained with thyroid transcription factor 1 (TTF-1; clones 8G7G3/1 and SPT24), napsin A, claudin 4, CEA, CK7, and epithelial cell adhesion molecule (EpCAM; clones BS14, Ber-Ep4, and MOC-31). The fraction and intensity of stained cells were evaluated. Of the investigated markers, a significant difference in staining proportion was seen for TTF-1 clone 8G7G3/1 and EpCAM clone MOC-31, especially with cases being negative in CytoLyt (33.3% and 83.3% positive, respectively) and PreservCyt (62.5% and 83.3%) whereas being positive in CytoRich Red (76.5% and 94.1%) and formalin (both 95.8%). A significantly weaker intensity of staining was seen for all alcohol-based fixatives compared to formalin for TTF-1 clone 8G7G3/1, napsin A, and EpCAM clone MOC-31, whereas EpCAM clone Ber-Ep4 was significantly weaker only in PreservCyt compared with formalin. Immunocytochemical expression and concordance with formalin-fixed CBs differ depending on the used fixative as well as the antibody and clone, warranting investigation of the reliability of each biomarker for non-formalin-fixed cytology.

Cell-Mediated Immune Responses May Play Roles in Osteochondral Allograft Transplantation Osteointegration Failures.

Prolonged and incomplete osteochondral allograft (OCA) osteointegration is consistently cited as a major mechanism for OCA treatment failure. Subrejection immune responses may play roles in this mode of failure. Preimplantation OCA preparation techniques, including subchondral bone drilling, thorough irrigation, and autogenous bone marrow aspirate concentrate saturation, may dampen immune responses and improve OCA osteointegration. This study sought to further characterize potential immune system contributions to OCA transplantation treatment failures by analyzing donor-recipient ABO and Rh-factor mismatches and histological and immunohistochemical assessments of transplanted OCA tissues recovered from revision surgeries. Using a dedicated registry, OCA transplant recipients with documented treatment failures who met inclusion criteria (n = 33) as well as age-, body mass index-, and joint-matched patients with successful outcomes (n = 70) were analyzed to compare matched cohorts of patients with successful versus failed OCA transplantation outcomes. Tissues recovered from 18 failed OCA transplants and portions of 7 nonimplanted OCA controls were further analyzed to provide contributing evidence for potential immune response mechanisms. For patients analyzed, no statistically significant differences in proportions for treatment success versus failure based on mismatches for ABO type, Rh factor, or both were noted. Further, no statistically significant differences in proportions for histological immune response presence or absence based on mismatches for ABO type, Rh factor, or both were noted. Twelve (67%) of the failed OCA tissues contained lymphocyte aggregations in the subchondral bone, which were comprised of combinations of CD3 + , CD4 + , CD8 + , and CD20+ lymphocytes. The mechanisms of failure for these 12 OCA transplants involved insufficient OCA osteointegration. Results of this study suggest that T- and B-cell-mediated subrejection immune responses may play roles in OCA transplant treatment failures independent of donor-recipient blood type mismatch effects.

Influence of periodontal status on patients undergoing hematopoietic stem cell transplantation: A retrospective analysis

ObjectiveThis retrospective analysis aimed to evaluate the prevalence of periodontitis in patients undergoing hematopoietic stem cell transplantation, and investigate the effects of various periodontal statuses and risk factors on oral infection incidence. Study designMedical records of patients pre– and post–hematopoietic stem cell transplantation from June 2019 to October 2021were reviewed. The study examined the effort of different periodontal statuses on oral complications and infections in patients during transplantation. ResultsOf 549 transplant patients studied, 363 had periodontitis. Patients with or without periodontitis showed significant differences in mean age, male proportion, and mucositis incidence during transplantation (P < 0.05). Bacteremia rates were slightly higher in patients with periodontitis, but not significant. Male proportion, age, and hospitalization duration significantly increased with advancing periodontitis stages. Only two patients experienced periodontal complications, that were effectively managed and did not interfere in the grafting process. ConclusionPeriodontitis is prevalent in patients with hematopoietic diseases. Despite its association with oral mucositis, the occurrence of periodontal infection remains low and controllable.

Pediatric Congenital Anterior Skull Base Encephaloceles and Surgical Management: A Comparative Review of 22 Patients Treated Transnasally, Transcranially, or Combined Approach With a Review of the Literature.

Anterior basal encephaloceles are considered a rare entity and are often associated with midline cerebral abnormalities. Those with a large skull base defect and herniation of brain parenchyma in the neonate or young infant present unique challenges for surgical management. We analyzed the neurosurgical administrative and operative databases between 1986 and 2022 to determine clinical presentation, operative approach, and outcome of basal encephaloceles. Over the 36-year period, 27 pediatric anterior basal encephaloceles were managed, of which 22 had full documentation and images allowing comprehensive review. Mean age at presentation was 5 years (SD 4.94). The majority were transethmoidal encephaloceles (59%), followed by the transsphenoidal-sphenoethmoidal type (32%). Overall, 91% were managed surgically by a transcranial, endoscopic, or combined approach. Four children required subsequent procedures, predominantly for persistent cerebrospinal fluid leak. No significant differences in proportion of patients requiring interval/revision surgery after initial conservative, endoscopic endonasal, or transcranial surgery was identified. Neither age at surgery nor size of the defect on computed tomography scan was associated with the need for revision surgery. Size of cranial defect was significantly smaller in the endoscopic group ( P = .01). There was a historic tendency for younger children with larger defects to have a transcranial approach. With the addition of endoscopic skull base expertise, smaller defects in older children were more recently treated endoscopically. Basal encephaloceles are rare and complex lesions and are optimally managed within a skull base multidisciplinary team able to provide multiple approaches. Large skull base defects with brain parenchymal involvement often require a transcranial or combined transcranial-endoscopic approach.

Reliability of a face scanner in measuring the vertical dimension of occlusion

ObjectiveThis study evaluated the reliability of a face scanner in measuring the vertical dimension of occlusion (VDO). MethodsFully dentate volunteers (n = 20; mean-age = 30.0 ± 10.7 years) were recruited. Clinical facial measurements were obtained using a digital caliper and a face scanner (Obiscanner, Fifthingenium, Italy). The scans were imported into a mesh-processing software, and the distances were measured digitally. Measurements were obtained for each participant with the jaws positioned in maximal intercuspation (MI) and with increased vertical distances of 2, 4, and 6 mm. Vertical and horizontal measures were obtained using facial anatomical landmarks: Glabella (GL), Pronasale (PrN), Subnasale (SbN), inferior border of the right and left Alare, Labiale superius (Ls), right and left Cheilion (Ch), Soft Pogonion (SPg), right and left Tragus of the ear (Tr), for all selected vertical positions. Data analysis included intra-class correlation coefficient (ICC), pairwise comparison tests, Bland-Altman plots, and Passing-Bablok regression. Results120 VDO measurements (clinical=60, digital=60) were recorded by two independent evaluators. Mean differences between digital and clinical measurements ranged from 0.054 ± 0.14 mm to 0.203 ± 0.13 mm. All parameters were strongly correlated (r > 0.93; p < 0.001). ICC estimates revealed excellent reliability, and the measuring procedure yielded the same results on repeated trials irrespective of the raters and measurement methods. Bland-Altman plots revealed a difference, between digital and clinical measurements, of 1.7 % for the vertical measurements. Regression analysis revealed no significant proportional difference between the two methods, so both can be used interchangeably. ConclusionsThe findings of this study demonstrate that VDO can be measured accurately from face scans using 3D mesh-processing software and that even small changes in the VDO could be detected using the digital methods. Clinical SignificanceFindings provide evidence about the reliability of a digital method for jaw relation registrations and may be applied towards incorporating this method into clinical workflows for computer-aided-design/ computer-assisted-manufacturing (CAD-CAM) dentures.

Determination of anthropometric measurements and their application in the development of clothing sizing systems for women in the regions of the Republic of Croatia

Abstract The aim of this article is to determine the differences in the physical dimensions of the female body that form the basis of the clothing size system and compare their deviations within the three regions of the Republic of Croatia. Due to the changes in the dimensions and shape of the human body, there is a need to adjust clothing in order to achieve the best possible fit. A systematic consideration of the fit of clothing includes investigation of a number of elements and factors, especially those based on anthropometric knowledge. The results of anthropometric measurements performed on a representative sample determine the body dimensions of the measured population. By sorting and grouping the data of body measurements, clothing sizes are created, with significant differences in body shape and body proportions of individual population groups. In the clothing size system, individual body dimensions define the clothing size and form a scale determined by a norm that prescribes body shape based on two dimensions of girths, where the measurement of bust girth is the basic measurement, and the body height is the dependent variable. This research was carried out on a sample of 940 women from the region of Slavonia, 1,109 women from the region of Dalmatia, and 799 women from the City of Zagreb, classified into seven age groups. The statistical processing of the results, i.e., the method of principal components, the values of the observed body measurements, and the representation of certain categories of bust girth and body size in the measured population of each region were determined.

Complicated and Uncomplicated Isolated Abdominal Aortic Dissections Demonstrate Different Patient Characteristics and Outcomes

Isolated abdominal aortic dissection (IAAD) is a rare entity with poorly defined risk factors and wide variation in management. We set forth to compare patient characteristics, management, and outcomes of uncomplicated isolated abdominal aortic dissection (uIAAD) versus high risk and complicated isolated abdominal aortic dissection (hrcIAAD) to investigate whether these categories can be utilized to guide IAAD management and provide risk stratification for intervention. Retrospective chart review was performed to identify all patients with spontaneous IAAD at a tertiary health care system between 1996 and 2022. Demographics, comorbidities, factors relating to initial presentation including imaging findings, and dissection outcomes including long-term all-cause mortality and aortic-related mortality from time of dissection to final available record were abstracted. IAAD demonstrating rupture or malperfusion were designated as complicated, those with aortic diameter greater than 4cm on presentation or refractory pain were designated as high risk, and the remainder was designated as uIAAD. All variables were compared between hrcIAAD and uIAAD using Fisher's exact test, unpaired t-test, and Mann-Whitney U-test as appropriate. Over the study period, 74 patients presented with spontaneous IAAD (mean age 60±16years, 61% male) with postdissection follow-up records to an average of 6.8±5.8years. Of these, 76% presented with uIAAD versus 24% with hrcIAAD. hrcIAAD was diagnosed at a significantly younger age on average than uIAAD (52±14 vs. 62±16years, P=0.02), was less likely to present with concomitant hyperlipidemia (0% vs. 41%, P<0.01), coronary artery disease (6% vs. 47%, P<0.01), and prior smoking history (39% vs. 72%). hrcIAAD was more likely to present in patients with a genetic aortopathy (27% vs. 7%, P=0.03). Hypertension was not significantly different between groups. Patients with hrcIAAD were significantly more likely to present with extension into iliac arteries compared to uIAAD (61% vs. 18%, P<0.01). A much higher proportion of hrcIAAD required hospitalization compared to uIAAD (83% vs. 30%, P<0.01) and operative intervention (67% vs. 7%, P<0.01). While there was no significant difference in all-cause mortality between groups, there was a significant difference between aortic-related mortality which only occurred in those with hrcIAAD (28% vs. 0%, P<0.01). Comparison of long-term outcomes suggests that hrcIAAD is associated with increased hospitalization and need for operative intervention compared to uIAAD. Significant differences in atherosclerotic risk factors and proportions of connective tissue disease history between patients who present with hrcIAAD and uIAAD suggest that differences in underlying etiology are largely responsible for whether IAAD progresses towards rupture or has a more benign course and should be considered in risk stratification to guide more specific and targeted management of IAAD.

COVID-19 vaccine coverage, determinants and inequity amongst refugees and migrants in Pakistan: a cross-sectional study

ObjectiveMigrants and refugees are at a disadvantage in accessing basic necessities. The objective of this study is to assess the inequity in access, needs and determinants of COVID-19 vaccination among...