Volume Preservation Research Articles

Impact of photobiomodulation in alveolar ridge preservation and implant stability after a dental extraction: a systematic review.

The bone volume preservation after dental extraction is challenging in case of implant rehabilitation for functional and aesthetics results. Photobiomodulation (or LLLT) is used in medicine for its properties of accelerating the healing process. The aim of the systematic review was to determine if the use of photobiomodulation had an impact on implant stability and on alveolar bone healing, either in quality or in quantity. A systematic review following the PRISMA guidelines was conducted on the databases PubMed, Science Direct, Scopus and Google Scholar. The review was registered on Prospero under the number CRD42023467581. 414 articles were screened, of which 12 were selected for the review. In 10 of the 12 articles, LLLT seemed to show a positive impact on bone healing and implant stability. Regarding alveolar preservation, 6 out of 8 studies found statistically significant results. Regarding implant stability, 3 out of the 4 articles found a statistically significant impact of photobiomodulation versus control group. Despite the great heterogeneity of the studies, some LLLT protocols seemed consensual: the use of a Ga-Al-As laser with an emission over 800nm with a continuous emission consisting of 3 to 4 sessions each with a duration of 4 to 5min, on a sole application point. The use of photobiomodulation seemed to inhance the alveolar bone healing after a dental extraction, and the implant stability in case of immediate extraction-implantation. Further randomized controlled trials with a placebo group seem mandatory to corroborate the results.

Study of malleus as a prognostic indicator on hearing outcomes after tympanomastoid surgery: A prospective observational study

Tympanomastoid surgery comprises a range of surgeries (cortical, radical, modified radical). Pre-operative auditory deficit in a patient with cholesteatoma may be correlated with ossicular chain status. The incus is often expected to be eroded, which may not be true for the malleus. The presence of malleus and it’s significance on the post-operative needs to be studied further. The purpose of our study is to determine the effect of intraoperative status of malleus on the post-operative hearing outcomes of patients undergoing canal wall-down mastoidectomy. A prospective observational study of 24 patients was conducted, where pre-operatively pure tone audiometry (PTA) was performed. Intraoperatively, the status of malleus was noted. Canal wall down mastoidectomy was done. Post-operative PTA was recorded after 3 months and both audiograms compared. An air bone gap (ABG) of less than 20dB post-operatively was considered significant functional improvement. In patients with a preserved malleus, mean improvement was 25.2dB (±9.8), whereas patients in whom malleus was remove had mean 16.8dB (±10.49) improvement. Similar results were found by Lu et al, Blom et al and Haberman et al. Haberman et al theorised the concentration of sound waves and preservation of middle ear volume as a contributing factor to the results. Hence it was concluded that relatively better post-operative audiological outcomes were obtained when malleus was present/preserved intraoperatively.

Practical Approach to Reporting Based on the International System for Serous Fluid Cytopathology.

The International System for Serous Fluid Cytopathology (TIS) is intended for reporting cytological specimens from serous cavities: pleural, abdominal and pericardial cavities. TIS is being adopted into practice in cytology laboratories worldwide. In this system, there are six diagnostic categories: non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, malignant-primary and malignant-secondary. Malignant-primary category almost always implies malignant mesothelioma and malignant-secondary usually refers to metastasis from carcinoma but also to involvement of serous cavity by haematolymphoid and other malignancies. When evaluating effusion cytological specimen adequacy, the factors that must be considered are sample volume, cellular content and cellular preservation. In the diagnostic analysis and interpretation, it is helpful to consider systematically all basic cytomorphological components in a sample. The basic components are architecture, cell populations, cell size, cytoplasm, nuclei and background elements. One important requirement for a successful evaluation of an effusion cytological specimen is sufficient clinical and radiological information in a referral. Clinical information may guide ancillary testing. In the present review, we provide a practical and educational approach to reporting serous effusion cytology based on the TIS.

Current status of autologous breast reconstruction in Argentina.

Although the most common procedure for breast reconstruction in Argentina is tissue expansion and implant devices, autologous tissue is frequently utilized. Deep inferior epigastric artery perforator flap (DIEP) is the gold standard for autologous breast reconstruction and, whenever possible, it is the first option. However, there are clinical or other circumstances, when a local or vicinity flaps for autologous reconstruction is preferred, even if exists a surgical and hospital facility for doing microsurgical procedures. The purpose of this manuscript is to describe our experience with the use of local and vicinity flaps for volume and surface replacement in different requirements-autologous breast reconstructions post oncologic resections, volume replacement in weight loss patients and implant-explantation cases. We have utilized the modification of latissimus dorsi musculocutaneous flap (LD) described by Hammond with excellent results and high patient satisfaction. Thoraco-dorsal artery perforator flap is indicated on skin sparing mastectomies (SSMs), immediate reconstruction of the nipple areolar complex and simultaneous coverage of an implant or tissue expander, in irradiated or to be irradiated patients. Lateral intercostal artery perforator (LICAP) flap has gained popularity because the unique position of the perforator at the lower lateral corner of the breast. It allows harvesting immediate vicinity tissue and easy rotation to the breast mound. We have used a modification towards the lateral thoracic wall of the anterior intercostal artery perforator flap for volume reconstruction after implant explantation.in patients who required volume preservation. Medial intercostal artery perforator flap is advantageous whenever the sub-mammary tissue can be used deepithelialized for volume reconstruction with a medial base. The same submammary area harvested as a medially based flap can be irrigated by the LICAP as a reverse LICAP flap that might be designed toward any direction from the piercing point of its perforator. The rest of the donor areas described for breast autologous reconstruction are rarely reported. When surgical facilities and adequate surgical teams are available, the lower abdominal wall is the main donor area, and DIEP, the most common technique utilized.

The use of plasma exchange with albumin replacement in the management of Alzheimer's disease: a scoping review.

AD is a progressive neurodegenerative disorder causing significant cognitive decline and impaired daily functioning. Current treatments offer only modest relief, and many amyloid-targeting therapies have failed, prompting exploration of alternative approaches such as PE with albumin replacement. This scoping review systematically maps the literature on PE with albumin replacement in AD management, focusing on outcomes, methodologies, and reported benefits and risks. A comprehensive search in PubMed, supplemented by reference scanning and hand-searching, identified studies involving PE with albumin replacement in AD patients. Data charting and critical appraisal were conducted using standardized tools. Seven primary studies from the AMBAR (Alzheimer Management by Albumin Replacement) trial met the inclusion criteria, consistently reporting improvements in cognitive function, positive neuroimaging results, and favorable neuropsychiatric outcomes. For instance, one study found a significant slowing of cognitive decline (p < 0.05) among patients receiving PE with albumin replacement. Another study showed better preservation of hippocampal volume and improved brain perfusion metrics in the treatment group (p < 0.05). The intervention was generally well-tolerated with manageable side effects. PE with albumin replacement is a promising therapeutic approach for AD, warranting further investigation to confirm its efficacy and safety across broader settings. https://osf.io/v6dez/?view_only=1cd9637e7e0347d39713bf19aac0dfe8.

Ice vests extend physiological work time while wearing explosive ordnance disposal protective clothing in hot and humid conditions

BackgroundExplosive ordnance disposal (EOD) technicians may be required to work in hot, humid environments while wearing heavy protective clothing. We investigated the ability of an ice vest to attenuate physiological strain and subsequently extend work tolerance. MethodsEight male participants (24.3 ± 4.1 yr, 51.9 ± 4.6 mL kg−1 min−1) walked (4.5 km h−1) in simulated hot and humid conditions (35 °C; 50% relative humidity). Participants wore either an EOD suit (CON) or EOD and ice vest (IV). Heart rate, core and skin temperature were recorded continuously. ResultsParticipants walked longer in IV compared to CON (8.1 ± 7.4 min, p < .05). Over 90% of trials were terminated based on participants reaching 90% of their maximum heart rate. IV resulted in cooled skin (p < .001) and a physiologically negligible change in core temperature (p < .001). A condition by time interaction was identified for heart rate (p < .001), with a lower rate of rise in the IV condition. ConclusionsThe cardiovascular inefficiency that limited performance was attenuated in the IV condition. The ice vest facilitated heat loss from the periphery; thus, the observed reduction in heart rate may reflect the preservation of central blood volume. The results identify the efficiency of a simple, inexpensive ice vest to assist EOD technicians working in the heat.

Functional outcomes in robot-assisted partial nephrectomy with three-dimensional images reconstructed from computed tomography: a propensity score-matched comparative analysis.

Our objective was to investigate the long-term functional outcomes of robot-assisted partial nephrectomy (RAPN) combined with three-dimensional (3D) imaging. The 3D images, reconstructed using computed tomography, were introduced in RAPN procedures. The demographic, oncological, functional, and volumetric outcomes of 296 patients who underwent RAPN with and without 3D imaging between 2013 and 2021 were analyzed retrospectively. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. After matching, 71 patients were allocated to each group. In the 3D RAPN (3DRPN) group, functional outcomes significantly improved: the number of patients with over 90% estimated glomerular filtration rate (eGFR) preservation rate (40 vs. 43, P = 0.044), eGFR preservation rate (88.0% vs. 91.6%, P = 0.006), the number of patients with chronic kidney disease (CKD) upstaging (26 vs. 13, P = 0.023), and split renal function preservation rate (operated kidney: 84.9% vs. 88.5%, P = 0.015). The 3DRPN group showed superiority in terms of >90% eGFR preservation (P = 0.010), CKD upstaging-free survival rates (P < 0.001), and volumetric outcomes (excess parenchymal volume: 27.9 vs. 17.7mL, P = 0.030; parenchyma volume preservation rate: 81.6% vs. 88.8%, P = 0.006). Three-dimensional imaging was positively associated with eGFR preservation (P = 0.023, odds ratio: 2.34) and prevention of CKD upstaging (P = 0.013, odds ratio: 2.90). In this study, RAPN combined with 3D imaging underscored the preservation of eGFR > 90% and the prevention of CKD upstaging by improving the preservation rate of renal parenchyma and split renal function.

An efficient volume-preserving binary filter for additive manufacturing in topology optimization

Topology optimization faces challenges concerning grey transition regions, manufacturability and computational efficiency. This article introduces an approach called the volume-preserving binary (VPB) filter. This novel sensitivity/density filter, based on a determinant-based matrix approach, efficiently detects grey elements and produces completely binary designs. The VPB filter addresses volume preservation by accurately expressing the volume-preserving condition, i.e. the volume before filtering equals the volume of solid materials after filtering. Comparison with other filtering methods, including the volume-preserving Heaviside filter and the Heaviside projection, illustrates the superior clarity and speed of the VPB filter. It reduces the number of iterations required for topology optimization, from hundreds or thousands to only tens of iterations, making it a promising solution for practical applications where manufacturability and computational efficiency are principal. Examples on compliance optimization, compliant mechanisms and heat conduction demonstrate the VPB filter's effectiveness in providing satisfactory solutions while perfectly preserving the length scale.

Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation: protocol for a multicenter clinical trial

BackgroundIn standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation.MethodsThis multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization.DiscussionWe aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients.Trial registrationThe Research Ethics Committee (CEIm) of the Fundació Unió Catalana d’Hospitals approved the study (CEI 22/67 and 23/26). Registered at ClinicalTrials.gov in August 2023. Identifier: NCT05526053.

Discrete element model for effective electrical conductivity of spark plasma sintered porous materials

AbstractThis paper aims to analyse electrical conduction in partially sintered porous materials using an original resistor network model within discrete element framework. The model is based on sintering geometry, where two particles are connected via neck. Particle-to-particle conductance depends on neck size in sintered materials. Therefore, accurate evaluation of neck size is essential to determine conductance. The neck size was determined using volume preservation criterion. Additionally, grain boundary correction factor was introduced to compensate for any non-physical overlaps between particles, particularly at higher densification. Furthermore, grain boundary resistance was added to account for the porosity within necks. For numerical analysis, the DEM sample was generated using real particle size distribution, ensuring a heterogeneous and realistic microstructure characterized by a maximum-to-minimum particle diameter ratio of 15. The DEM sample was subjected to hot press simulation to obtain geometries with different porosity levels. These representative geometries were used to simulate current flow and determine effective electrical conductivity as a function of porosity. The discrete element model (DEM) was validated using experimentally measured electrical conductivities of porous NiAl samples manufactured using spark plasma sintering (SPS). The numerical results were in close agreement with the experimental results, hence proving the accuracy of the model. The model can be used for microscopic analysis and can also be coupled with sintering models to evaluate effective properties during the sintering process.

Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients.

Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes. Fifteen hemodialysis patients were examined in a single-blind, randomized, controlled, crossover study. Participants underwent a 4-h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre- and post-hemodialysis. With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (-4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post-hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: -2.9 (-5.3; -0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly. The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate.

Vestibular Function is Associated with Prefrontal and Sensorimotor Cortical Gray Matter Volumes in a Cross-Sectional Study of Healthy, Older Adults

Background The vestibular system is associated with alterations in the structure and function of the central nervous system. Yet, whether age-related vestibular loss is related to volume loss in the cerebral cortical areas that have been reported to receive vestibular input remains unknown. In this cross-sectional study of 117 healthy, older adults from the Baltimore Longitudinal Study of Aging, we examine the relationships between age-related vestibular functions and the gray matter volumes of the prefrontal cortex and its subregions and of the sensorimotor cortex—regions known to process vestibular information. Methods T1-weighted MRI scans were automatically segmented using MRICloud. Log-linear multiple regression was used to investigate the relationships between average regional volume and vestibular function, adjusting for age, sex, and intracranial volume. Permutation testing was used for hypothesis testing, and bootstrapping was used to estimate confidence intervals. Results We found that age-related changes in vestibular end-organ function are associated with differentially altered gray matter volumes in the prefrontal and sensorimotor cortices, with many findings persisting when considering left (or right) side only. Concomitant with age-related, global brain atrophy, lower canal and utricular function were associated with additional volume atrophy of the prefrontal cortex and middle frontal gyrus, respectively. Lower saccular and utricular function were associated with the preservation of the volumes of the sensorimotor cortex and the pole of the superior frontal gyrus, respectively, against age-related, global brain atrophy. Canal and utricular function were not associated with the volumes of the sensorimotor cortex, and saccular function was not associated with the relative volumes of the prefrontal cortex. Conclusion Together, these findings of relative volume preservation or additional atrophy suggest that vestibular function may play a role in the resilience to or magnification of global age effects on cerebral cortical structure.

Markerless liver online adaptive stereotactic radiotherapy: feasibility analysis

Objective. Radio-opaque markers are recommended for image-guided radiotherapy in liver stereotactic ablative radiotherapy (SABR), but their implantation is invasive. We evaluate in this in-silico study the feasibility of cone-beam computed tomography-guided stereotactic online-adaptive radiotherapy (CBCT-STAR) to propagate the target volumes without implanting radio-opaque markers and assess its consequence on the margin that should be used in that context. Approach. An emulator of a CBCT-STAR-dedicated treatment planning system was used to generate plans for 32 liver SABR patients. Three target volume propagation strategies were compared, analysing the volume difference between the GTVPropagated and the GTVConventional, the vector lengths between their centres of mass (l CoM), and the 95th percentile of the Hausdorff distance between these two volumes (HD95). These propagation strategies were: (1) structure-guided deformable registration with deformable GTV propagation; (2) rigid registration with rigid GTV propagation; and (3) image-guided deformable registration with rigid GTV propagation. Adaptive margin calculation integrated propagation errors, while interfraction position errors were removed. Scheduled plans (PlanNon-adaptive) and daily-adapted plans (PlanAdaptive) were compared for each treatment fraction. Main results. The image-guided deformable registration with rigid GTV propagation was the best propagation strategy regarding to l CoM (mean: 4.3 +/− 2.1 mm), HD95 (mean 4.8 +/− 3.2 mm) and volume preservation between GTVPropagated and GTVConventional. This resulted in a planning target volume (PTV) margin increase (+69.1% in volume on average). Online adaptation (PlanAdaptive) reduced the violation rate of the most important dose constraints (‘priority 1 constraints’, 4.2 versus 0.9%, respectively; p < 0.001) and even improved target volume coverage compared to non-adaptive plans (PlanNon-adaptive). Significance. Markerless CBCT-STAR for liver tumours is feasible using Image-guided deformable registration with rigid GTV propagation. Despite the cost in terms of PTV volumes, daily adaptation reduces constraints violation and restores target volumes coverage.

Is 3D Volumetric Evaluation Consistent with Postoperative Renal Parenchymal Preservation in Open and Robot-Assisted Laparoscopic Partial Nephrectomy?

Introduction: To evaluate by using 3D renal volumetric assessment and compare renal parenchymal preservation between patient who underwent open partial nephrectomy (OPN) and robot assisted laparoscopic partial nephrectomy (RALPN). Methods: We retrospectively reviewed the records of the patients to evaluate the effect of OPN (23 patients) or RALPN (19 patients) partial nephrectomy on renal parenchymal preservation. The CT or MRI were examined using 3D-Slicer image processing software. The tumor volume and preoperative and postoperative non-tumor bearing parenchymal volumes were evaluated with the segmentation. The preoperative and postoperative parenchymal volumes, serum creatinine levels, and estimated glomerular filtration rates (eGFRs) were compared between the surgical techniques. Results: The data of 42 patients were included in the final analysis. The patient and tumor characteristics were similar between the two groups. Postoperative renal parenchymal volumetric changes were seen similar between groups. Although the serum creatinine levels and eGFRs did not change postoperatively in the RALPN group (P = .145 and P = .085, respectively), creatinine increased while eGFR decreased in the OPN group (P = .003 and P = .002, respectively). Conclusions: Our analysis showed that RALPN could be considered similar to OPN in terms of parenchymal volume preservation, but the rate of parenchymal volume preservation was not associated with the change in functional parameters. These results should be supported by further research.

Effect of postoperative intermittent boluses of subcostal quadratus lumborum block on pulmonary function recovery and analgesia after gastrectomy: a randomized controlled clinical trial

BackgroundFollowing the gastrectomy, the reduction in pulmonary function is partly attributed to postoperative pain. Subcostal quadratus lumborum block (QLB) has recently emerged as a promising component in multimodal analgesia. We aimed to assess the impact of intermittent boluses of subcostal QLB on pulmonary function recovery and analgesic efficacy after gastrectomy. MethodsSixty patients scheduled for gastrectomy were randomly assigned to either control group (multimodal analgesia) or intervention group (intermittent boluses of subcostal QLB plus multimodal analgesia). Two primary outcomes included the preservation of forced expiratory volume in the first second (FEV1) and the pain scores (0-10 cm visual analog score) on coughing 24 h postoperatively. We assessed the pulmonary function parameters, pain score, morphine consumption and number of rescue analgesia at a 24-h interval up to 72 h (Day1, Day2, Day3 respectively) as secondary outcomes. Results59 patients were analyzed in a modified intention-to-treat set. The preservation of FEV1 (median difference: 4.0%, 97.5% CI: −5.7 to 14.9, P = 0.332) and pain scores on coughing (mean difference: 0.0 cm, 97.5% CI: −1.1 to 1.2, P = 0.924) did not differ significantly between two groups. In the intervention group, the recovery of forced vital capacity (FVC) was faster 72 h after surgery (interaction effect of group*(Day3-Day0): estimated effect (β) =0.30 L, standard error (SE) =0.13, P = 0.025), pain scores at rest were lower in the first 3 days (interaction effect of group*(Day1-Day0): β = − 0.8 cm, SE = 0.4, P = 0.035; interaction effect of group*(Day2-Day0): β = − 1.0 cm, SE = 0.4, P = 0.014; and interaction effect of group*(Day3-Day0): β = − 1.0 cm, SE = 0.4, P values = 0.009 respectively), intravenous morphine consumption was lower during 0–24 h (median difference: −3 mg, 95% CI −6 to −1, P = 0.014) and in total 72 h (median difference: −5 mg, 95% CI −10 to −1, P = 0.019), and the numbers of rescue analgesia was fewer during 24-48 h (median difference: 0, 95% CI 0 to 0, P = 0.043). Other outcomes didn't show statistical differences. ConclusionPostoperative intermittent boluses of subcostal QLB did not confer advantages in terms of the preservation of FEV1 or pain scores on coughing 24 h after gastrectomy. However, notable effects were observed in analgesia at rest and FVC recovery.

Physical training attenuates systemic cytokine response and tissue damage triggered by apical periodontitis

Apical periodontitis (AP) is a condition characterized by inflammatory and infectious components in the tooth canal. AP affects periradicular tissues and has systemic repercussions. Physical exercise is a structured activity that requires cardiorespiratory function, and can modulate the inflammatory profile in pathological conditions. As a result, this study aimed to determine the effects of aerobic physical training (PT) on the alveolar bone with and without AP, and its systemic inflammatory repercussions. AP was induced in the mandibular first molars, and PT was performed on a treadmill for five consecutive days over four weeks, with progressive increases in speed and activity time. Blood samples were collected to determine serum cytokine levels using immunoassays, and alveolar bone samples were collected for histopathological evaluation, lesion volume and microarchitecture assessment using computed microtomography. Animals with AP had increased pro-inflammatory cytokines levels compared to those without AP; however, these levels were attenuated or restored by PT. Compared to the AP group, the AP + PT group had a smaller lesion volume and greater preservation of the bone trabeculae in the remaining alveolar bone surrounding the lesion. In overall, PT minimized the severity of AP proving to be a valid strategy for individuals undergoing endodontic treatment.

Parenchymal volume preservation during partial nephrectomy: improved methodology to assess impact and predictive factors.

To rigorously evaluate the impact of the percentage of parenchymal volume preserved (PPVP) and how well the preserved parenchyma recovers from ischaemia (Recischaemia) on functional outcomes after partial nephrectomy (PN) using an accurate and objective software-based methodology for estimating parenchymal volumes and split renal function (SRF). A secondary objective was to assess potential predictors of the PPVP. A total of 894 PN patients with available studies (2011-2014) were evaluated. The PPVP was measured from cross-sectional imaging at ≤3 months before and 3-12 months after PN using semi-automated software. Pearson correlation evaluated relationships between continuous variables. Multivariable linear regression evaluated predictors of ipsilateral glomerular filtration rate (GFR) preserved and the PPVP. Relative-importance analysis was used to evaluate the impact of the PPVP on ipsilateral GFR preserved. Recischaemia was defined as the percentage of ipsilateral GFR preserved normalised by the PPVP. The median tumour size and R.E.N.A.L. nephrometry score were 3.4 cm and 7, respectively. In all, 49 patients (5.5%) had a solitary kidney. In all, 538 (60%)/251 (28%)/104 (12%) patients were managed with warm/cold/zero ischaemia, respectively. The median pre/post ipsilateral GFRs were 40/31 mL/min/1.73 m2, and the median (interquartile range [IQR]) percentage of ipsilateral GFR preserved was 80% (71-88%). The median pre/post ipsilateral parenchymal volumes were 181/149 mL, and the median (IQR) PPVP was 84% (76-92%). In all, 330 patients (37%) had a PPVP of <80%, while only 34 (4%) had a Recischaemia of <80%. The percentage of ipsilateral GFR preserved correlated strongly with the PPVP (r = 0.83, P < 0.01) and loss of parenchymal volume accounted for 80% of the loss of ipsilateral GFR. Multivariable analysis confirmed that the PPVP was the strongest predictor of ipsilateral GFR preserved. Greater tumour size and endophytic and nearness properties of the R.E.N.A.L. nephrometry score were associated with a reduced PPVP (all P ≤ 0.01). Solitary kidney and cold ischaemia were associated with an increased PPVP (all P < 0.05). A reduced PPVP predominates regarding functional decline after PN, although a low Recischaemia can also contribute. Tumour-related factors strongly influence the PPVP, while surgical efforts can improve the PPVP as observed for patients with solitary kidneys.

Effect of Customized and Prefabricated Healing Abutments on Peri-Implant Soft Tissue and Bone in Immediate Implant Sites: A Randomized Controlled Trial

This study aimed to evaluate the effect of customized healing abutments compared to prefabricated healing abutments in immediate implant sites. Twelve patients requiring single immediate implant placement were divided into two groups: a prefabricated group received prefabricated titanium healing abutments, and a customized group received a polyetheretherketone (PEEK) customized healing abutments fabricated based on the individuals’ digital impressions. Outcomes, including peri-implant horizontal and vertical soft tissue alteration, bone level change, volume change, pain score, and pink esthetic score (PES) change, were evaluated at the 1-, 4-, and 6-month follow-ups compared to pre-extraction teeth. At the 1- and 4-month follow-ups, the customized group had a significantly lower buccal volume variation (BVv). At the 6-month follow-up, neither group showed any significant difference in the marginal bone change; however, the customized group had a significantly lower PES change and a lower pain score. In the anterior and premolar regions, the customized group showed the preservation of peri-implant buccal horizontal soft tissue and buccal volume, while in the molar regions, the preservation of papilla height and midfacial height was observed. The morphology of the customized healing abutment demonstrated a better trend in preservation of peri-implant soft tissue, esthetic outcomes, and lower patient discomfort in immediate implant sites.

Functional recovery after partial nephrectomy in a solitary kidney

ObjectivesPartial nephrectomy (PN) is the reference standard for renal mass in a solitary kidney (RMSK), although factors determining functional recovery in this setting remain poorly defined. Patients/MethodsSingle center, retrospective analysis of 841 RMSK patients (1975–2022) managed with PN with functional data, including 361/435/45 with cold/warm/zero ischemia, respectively. A total of 155 of these patients also had necessary studies for detailed analysis of parenchymal volume preserved. Acute kidney injury (AKI) was classified by RIFLE (Risk/Injury/Failure/Loss/Endstage). Recovery-from-ischemia (Rec-Ischemia) was defined as glomerular filtration rate (GFR) saved normalized by parenchymal volume saved. Logistic regression identified predictive factors for AKI and predictors of Rec-Ischemia were analyzed by multivariable linear regression. ResultsOverall, median preoperative GFR was 56.7 ml/min/1.73m2 and new-baseline and 5-year GFRs were 43.1 and 44.5 ml/min/1.73m2, respectively. Median follow-up was 55 months; 5-year dialysis-free survival was 97%. In the detailed analysis cohort, a primary focus of this study, median warm (n = 70)/cold (n = 85) ischemia times were 25/34 minutes, respectively; and median preoperative, new-baseline and 5-year GFRs were 57.8, 45.0, and 41.7 ml/min/1.73m2, respectively. Functional recovery correlated strongly with parenchymal volume preserved (r = 0.84, p < 0.001). Parenchymal volume loss accounted for 69% of the total median GFR decline associated with PN, leaving only 3 to 4 ml/min/1.73m2 attributed to ischemia and other factors. AKI occurred in 52% of patients and the only independent predictor of AKI was ischemia time. Independent predictors of reduced Rec-Ischemia were increased age, warm ischemia, and AKI. ConclusionThe main determinant of functional recovery after PN in RMSK is parenchymal volume preservation. Type/duration of ischemia, AKI, and age also correlated, although altogether their contributions were less impactful. Our findings suggest multiple opportunities for optimizing functional outcomes although preservation of parenchymal volume remains predominant. Long-term function generally remains stable with dialysis only occasionally required.

Correlation of Scalar Cochlear Volume and Hearing Preservation in Cochlear Implant Recipients with Residual Hearing.

Preservation of residual hearing is one of the main goals in cochlear implantation. There are many factors that can influence hearing preservation after cochlear implantation. The purpose of the present study was to develop an algorithm for validated preoperative cochlear volume analysis and to elucidate the role of cochlear volume in preservation of residual hearing preservation after atraumatic cochlear implantation. Retrospective analysis. Tertiary referral center. A total of 166 cochlear implant recipients were analyzed. All patients were implanted with either a MED-EL (Innsbruck, Austria) FLEXSOFT (n = 3), FLEX28 (n = 72), FLEX26 (n = 1), FLEX24 (n = 41), FLEX20 (n = 38), or FLEX16 (n = 11, custom made device) electrode array through a round window approach. Main outcome measures: Cochlear volume as assessed after manual segmentation of cochlear cross-sections in cone beam computed tomography, and preservation of residual hearing 6 months after implantation were analyzed. The association between residual hearing preservation and cochlear volume was then assessed statistically. Rapid and valid cochlear volume analysis was possible using the individual cross-sections and a newly developed and validated algorithm. Cochlear volume had the tendency to be larger in patients with hearing preservation than in those with hearing loss. Significant correlations with hearing preservation could be observed for the basal width and length of the basal turn. Preservation of residual hearing after cochlear implantation may depend on cochlear volume but appears to be influenced more strongly by other cochlear dimensions.