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Introduction: Upper gastrointestinal bleeding (UGIB) is among the most common causes of morbidity and mortality worldwide, accounting for major resource allocation and increasing incidence. This study aimed to evaluate the severity of non-variceal bleeding in patients at risk of bleeding through the use of NSAIDs, oral anticoagulants, and antiplatelet therapy. Material and Method: The study included 296 patients admitted in the Gastroenterology Department of the Municipal County Emergency University Hospital, Timisoara, between 01.01.2018 and 01.04.2020, and diagnosed via gastroscopy with non-variceal gastrointestinal bleeding. The patients were divided among four groups based on their use of different drugs known to induce UGIB, i.e., aspirin and clopidogrel, NOACs, NSAIDs, and anti-vitamin K drugs, respectively. Statistical analyses were performed based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables with pairwise comparisons based on Bonferroni adjusted significance tests. Results: The results showed several parameters having statistical significance among the different groups of patients. Patients on NOACs had statistically significant lower hemoglobin levels, lower hematocrit values, lower erythrocytes, lower RDW and higher fibrinogen levels compared to patients on VKA. Discussion: Surprisingly, the results from our study suggest that the use of NOACs was associated with a higher risk of bleeding when compared to VKA, which differs from the existing literature. Conclusions: One of the important factors causing upper non-variceal bleeding can be iatrogenic, either due to antiplatelet drugs or anticoagulants, to which NSAID treatment is additionally associated for various reasons. In our study, the use of NOACs seemed to have a more severe bleeding spectrum with higher morbidity compared to VKA. [ABSTRACT FROM AUTHOR]

(1) Background: The relationship between sleep bruxism (SB) and psychological distress has been investigated in numerous studies and is heterogeneous. Different diagnostic procedures have been applied to determine SB. The aim of this study was to directly compare the association between psychological distress and SB diagnosed by different accepted methods. (2) Methods: Data of N = 45 subjects were analyzed, including group comparisons and correlation analyses. Following diagnostic methods for the determination of SB were used in one sample: self-report, clinical assessment, polysomnography with audio–video recording and a novel diagnostic sheet with analyzing software. Psychological distress was measured using the global severity index (GSI) of the Symptom Checklist-90-Standard (SCL-90-S). (3) Results: The GSI did not differ significantly between subjects with and without SB, regardless of the underlying diagnostic classification (p > 0.05). In-depth correlation analyses of self-report and clinical data revealed a weak-to-medium correlation with the GSI (r = 0.12–0.44). Due to non-normally distributed data, a test of statistical significance was not possible. Variables of instrumental methods such as the SB index (amount of SB activity per hour) of polysomnography (PSG) showed almost no correlation with psychological distress (r = −0.06–0.05). (4) Conclusions: Despite these limitations, the results provide an indication that the choice of diagnostic procedure may elucidate the variance in the correlation between SB and psychological distress. [ABSTRACT FROM AUTHOR]

(1) Background: The aim of this prospective study was to evaluate measurement software in comparison with manual measurements using inter-observer and intra-observer variability on radiographs in the preoperative planning of total knee arthroplasty. (2) Methods: Two independent observers retrospectively measured the mechanical lateral proximal femoral angle (mLPFA), the mechanical lateral distal femoral angle (mLDFA), the joint line convergence angle (JLCA), the mechanical medial proximal tibial angle (mMPTA), the mechanical lateral distal tibial angle (mLDTA), the hip–knee angle or mechanical tibial–femoral axis angle (HKA), and the anatomical–mechanical angle (AMA) on 55 long-leg anteroposterior radiographs manually twice, followed by measurements using dedicated software. Variability between manual and computer-aided planning was assessed, and all measurements were performed a second time after 14 days in order to assess intra-observer variability. (3) Results: Concerning intra-observer variability, no statistically significant difference was observed regarding the software-based measurements. However, significant differences were noted concerning intra-observer variability when measuring the mLDFA and AMA manually. Testing for statistical significance regarding variability between manual and software-based measurements showed that the values varied strongly between manual and computer-aided measurements. Statistically significant differences were detected for mLPFA, mLDFA, mMPTA, and mLPTA on day 1, and mLPFA, mMPTA, and mLPTA on day 15, respectively. (4) Conclusions: Preoperative planning of leg axis angles and alignment using planning software showed less inter- and intra-observer variability in contrast to manual measurements, and results differed with respect to manual planning. We believe that the planning software is more reliable and faster, and we would recommend its use in clinical settings. [ABSTRACT FROM AUTHOR]

In particular, the data allow us to calculate the I p i -value, which is defined as " I the probability under a specified statistical model that a statistical summary of the data would be equal to or more extreme than its observed value i " [[1]], and practically reflects the degree of data compatibility with the null hypothesis. (2) " I p-values do not measure the probability that the studied hypothesis is true, or the probability that the data were produced by random chance alone. i " They can only tell us how consistent the data are with the null hypothesis. Conventionally, if the I p i -value is lower than the 0.05 significance level, we reject the null hypothesis and accept the alternative hypothesis. At the beginning of our research training, we learned about hypothesis testing, I p i -values, and statistical inference. [Extracted from the article]

Background: This randomized clinical trial was conducted to assess whether sleep bruxism (SB) is associated with an increased rate of technical complications (ceramic defects) in lithium disilicate (LiDi) or zirconia (Z) molar single crowns (SCs). Methods: Adult patients were classified as affected or unaffected by SB based on structured questionnaires, clinical signs, and overnight portable electromyography (BruxOff) and block randomized into four groups according to SB status and crown material (LiDi or Z): LiDi-SB (n = 29), LiDi-no SB (n = 24), Z-SB (n = 23), and Z-no SB (n = 27). Differences in technical complications (main outcome) and survival and success rates (secondary outcomes) one year after crown cementation were assessed using Fisher's exact test with significance level α = 0.05. Results: No technical complications occurred. Restoration survival rates were 100% in the LiDi-SB and LiDi-no SB groups, 95.7% in the Z-SB group, and 96.3% in the Z-no SB group (p > 0.999). Success rates were 96.6% in the LiDi-SB group, 95.8% in the LiDi-no SB group (p > 0.999), 91.3% in the Z-SB group, and 96.3% in the Z-no SB group (p ≥ 0.588). Conclusions: With a limited observation time and sample size, no effect of SB on technical complication, survival, and success rates of molar LiDi and Z SCs was detected. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of a new, highly flexible radiofrequency (RF) coil system for imaging patients undergoing MR simulation. Methods: Volumetric phantom and in vivo images were acquired with a commercially available and prototype RF coil set. Phantom evaluation was performed using a silicone-filled humanoid phantom of the head and shoulders. In vivo assessment was performed in five healthy and six patient subjects. Phantom data included T1-weighted volumetric imaging, while in vivo acquisitions included both T1- and T2-weighted volumetric imaging. Signal to noise ratio (SNR) and uniformity metrics were calculated in the phantom data, while SNR values were calculated in vivo. Statistical significance was tested by means of a non-parametric analysis of variance test. Results: At a threshold of p = 0.05, differences in measured SNR distributions within the entire phantom volume were statistically different in two of the three paired coil set comparisons. Differences in per slice average SNR between the two coil sets were all statistically significant, as well as differences in per slice image uniformity. For patients, SNRs within the entire imaging volume were statistically significantly different in four of the nine comparisons and seven of the nine comparisons performed on the per slice average SNR values. For healthy subjects, SNRs within the entire imaging volume were statistically significantly different in seven of the nine comparisons and eight of the nine comparisons when per slice average SNR was tested. Conclusions: Phantom and in vivo results demonstrate that image quality obtained from the novel flexible RF coil set was similar or improved over the conventional coil system. The results also demonstrate that image quality is impacted by the specific coil configurations used for imaging and should be matched appropriately to the anatomic site imaged to ensure optimal and reproducible image quality. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the porosity distribution of BioRoot RCS/single gutta-percha point root-canal fillings performed by a general dental practitioner and endodontist. Fourteen plastic models of maxillary premolars with two roots were selected and shaped with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into two experimental groups. A total of 14 canals in each group were obturated by two different operators with one HyFlex EDM size 40 gutta-percha point and BioRoot RCS sealer. The specimens were scanned with a high-resolution micro-computed tomography scanner, and the porosity of the fillings at the coronal, middle, and apical thirds of the root canals was qualified and quantified. The differences between groups and root-canal thirds were compared using Mann–Whitney, Friedman, and Wilcoxon tests with the significance level set at p < 0.05. The highest number of pores was observed in the apical third of root-canal fillings in both groups; however, the porosity distribution between the two groups was not significantly different in the apical and middle thirds (p > 0.05). Statistically significant differences were determined only in the coronal third (p < 0.05). The predominance of open pores was detected in all root-canal thirds and groups, with no significant differences in the number of open pores between the coronal and middle thirds (p > 0.05). [ABSTRACT FROM AUTHOR]

The reliability of relaxation time measures in synthetic magnetic resonance images (MRIs) of homemade phantoms were validated, and the diagnostic suitability of synthetic imaging was compared to that of conventional MRIs for detecting ischemic lesions. Phantoms filled with aqueous cupric-sulfate (CuSO4) were designed to mimic spin-lattice (T1) and spin-spin (T2) relaxation properties and were used to compare their accuracies and stabilities between synthetic and conventional scans of various brain tissues. To validate the accuracy of synthetic imaging in ischemic stroke diagnoses, the synthetic and clinical scans of 18 patients with ischemic stroke were compared, and the quantitative contrast-to-noise ratios (CNRs) were measured, using the Friedman test to determine significance in differences. Results using the phantoms showed no significant differences in the interday and intersession synthetic quantitative T1 and T2 values. However, between synthetic and referenced T1 and T2 values, differences were larger for longer relaxation times, showing that image intensities in synthetic scans are relatively inaccurate in the cerebrospinal fluid (CSF). Similarly, CNRs in CSF regions of stroke patients were significantly different on synthetic T2-weighted and T2-fluid-attenuated inversion recovery images. In contrast, differences in stroke lesions were insignificant between the two. Therefore, interday and intersession synthetic T1 and T2 values are highly reliable, and discrepancies in synthetic T1 and T2 relaxation times and image contrasts in CSF regions do not affect stroke lesion diagnoses. Additionally, quantitative relaxation times from synthetic images allow better estimations of ischemic stroke onset time, consequently increasing confidence in synthetic MRIs as diagnostic tools for ischemic stroke. [ABSTRACT FROM AUTHOR]

On magnetic resonance (MR) imaging, Modic type 1 (MT1) endplate changes and infectious spondylodiscitis share similar findings. Therefore, this study investigated vertebral bone marrow and endplate changes to enable their differentiation. The lumbar spine MR examinations of 91 adult patients were retrospectively included: 39 with MT1; 19 with early spondylodiscitis without abscess; and 33 with advanced spondylodiscitis with abscess. The assessment included percentage of bone marrow edema on sagittal short tau inversion recovery images, and the signal ratio of edema to unaffected bone and endplate contour (normal; irregular, yet intact; blurred; destructive) on sagittal unenhanced T1-weighted images. Differences were tested for statistical significance by Chi-square test and mixed model analysis of variance. The MR diagnostic accuracy in differentiating MT1 and spondylodiscitis was assessed by cross-tabulation and receiver-operating characteristic analysis. The endplate contours, edema extents, and T1-signal ratios of MT1 (extent, 31.96%; ratio, 0.83) were significantly different (p < 0.001) from early spondylodiscitis (56.42%; 0.60), and advanced spondylodiscitis (91.84%; 0.61). The highest diagnostic accuracy (sensitivity, 94.87%; specificity, 94.23%; accuracy, 94.51%) in identifying MT1 was provided by an irregular, yet intact endplate contour. This may be a useful MR feature for the differentiation between MT1 and spondylodiscitis, particularly in its early stage. [ABSTRACT FROM AUTHOR]

Increasing gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million gabapentinoid-involved visits (aged 18–64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; Ptrend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the gabapentinoids. Most (96.6%) of the gabapentinoid visits did not have an approved indication for gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, gabapentinoid use increased substantially, commonly prescribed by primary care physicians. [ABSTRACT FROM AUTHOR]

Manual Lymphatic Drainage (MLD) appears to stimulate lymphatic contraction, aid in the development of secondary derivation pathways, and stimulate the appearance of collateral pathways that could function as the main drainage routes of the limb in case of lymphedema. Through stretching, call up maneuvers are used to stimulate lymphangion reflex contraction and, therefore, lymphatic function. The aim was to describe the presence of areas and pathways of collateral lymphatic drainage under basal conditions and to determine, using Indocyanine Green (ICG) lymphography, whether an increase in these pathways occurs after 30 min of manual lymphatic stimulation with only call up maneuvers according to the Leduc Method®®. In this prospective analytical study (pretest–posttest), the frequency of presentation of areas and collateral lymphatic pathways was analyzed in 19 patients with secondary lymphedema of the upper limb after breast cancer using an infrared camera. Analyses were completed at three time points: after ICG injection, at baseline (pretest), and after the application of MLD (post-test). The Leduc Method maneuvers were applied to the supraclavicular and axillary nodes, chest, back, Mascagni, and Caplan pathways. The areas visualized in the pretest continued to be visible in the posttest. Additional pathways and fluorescent areas were observed after the maneuvers. The McNemar test showed statistical significance (p = 0.008), the odds ratio was infinite, and the Cohen's g value was equal to 0.5. Manual stimulation by call up maneuvers increased the observation frequency of areas and collateral lymphatic pathways. Therefore, ICG lymphography appears to be a useful tool for bringing out the routes of collateral bypass in secondary lymphoedema after cancer treatment. [ABSTRACT FROM AUTHOR]