Search

Purpose: To evaluate the published literature on tooth--tissue supported removable partial dentures (RPDs) and determine the attachment system that provides the best clinical outcome. Materials and Methods: A comprehensive search of studies published up to November 2021 was performed in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The study protocol was approved and was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42021268449). The PICO question was, "What is the best attachment system used in Kennedy class I and II removable partial dentures?" Results: The search identified 871 articles, of which 21 met the inclusion criteria. The evaluation period in the studies ranged from 3 to 282 months. A total of 1,357 patients were included, of which 526 used prostheses with attachments. The mini SG attachment (extracoronal) was the most commonly used attachment, and the survival rate ranged from 37% to 98.1% in 10 studies, with no significant differences between the systems. Among the 10 studies selected for quantitative analysis, the meta-analysis revealed an overall failure rate of 16.6% (95% CI: 10.4% to 25.4%) and heterogeneity of I² = 65.725 (q value: 26.258, P = .002). Conclusions: Clinical studies comparing different attachment systems for rehabilitation are lacking. Our findings suggest that attachment-retained RPDs have good retention and better esthetics than conventional RPDs, and the extracoronal attachment system is the most viable choice for treatment at the free end. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical performance of CAD/CAM laminate veneers placed by a single operator and systematically evaluated for up to 10 years. Materials and Methods: A total of 197 laminate veneers fabricated using either feldspathic ceramics (VMII) or lithium disilicate ceramics (EmaxCAD) were followed up to 10 years in 32 patients. Technical, esthetic, and biologic findings of each restoration were evaluated using modified United States Public Health Service criteria. The survival and complication rates were assessed using Kaplan-Meier survival analysis and compared using log-rank test. Statistical significance was set at P < .05. Results: The estimated Kaplan-Meier survival rate was 91.9% after the mean observation period. According to the ceramic system used, the estimated Kaplan-Meier survival rate amounted to 92.7% for EmaxCAD and 89.1% for VMII. Survival rates were significantly affected by the location of veneer according to log-rank test (P < .05). A range of survival rates between 83.3% and 98.6% were observed based on the location of veneer. Conclusions: CAD/CAM laminate veneers milled from feldspathic or lithium disilicate ceramics have comparable long-term survival rates. Oral positioning affects the survival of veneers. Veneers of incisors have higher survival rates than the veneers of maxillary canines and premolars. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical survival and impact on oral health--related quality of life (OHRQoL) of immediate loading of implant-supported full-arch CAD/CAM--milled PMMA interim restorations. Materials and Methods: This was a practice-based prospective cohort study performed in a Portuguese dental clinic. Eleven patients received a total of 17 CAD/CAM fully implant-supported, screw-retained, full-arch restorations with milled PMMA and were followed up for 1 year. The primary outcome was prosthesis survival, determined with a modification of the California Dental Association score and a Kaplan-Meier survival function analysis. The secondary outcome was the patient quality of life, as defined by application of the OHIP-14-PT questionnaire and standardized effect size variation between two visits. Significance was set at 5%. Results: Survival probability at 12 months was 76%, complete fracture of the prosthesis occurred in 17.6% of the cases, and small fractures without lab involvement occurred in 5.9% of cases. There was a significant improvement in OHRQoL between visit 1 and visit 4. The mean difference and effect size for total OHIP-14-PT score were -32.91 ± 3.68 and 3.66 (95% CI -1.83 to -5.80) respectively (P < .001* Wilcoxon matched paired rank test). Conclusions: Fullarch implant-supported CAD/CAM--milled PMMA interim prosthesis seem to be a viable approach with good survival rate and great impact on patient OHRQoL. [ABSTRACT FROM AUTHOR]

Purpose: To assess the complications, satisfaction, and quality of life of patients rehabilitated with delayed and immediate loading of single crowns. Materials and Methods: An electronic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase databases up to February 2023. Only prospective studies and randomized and nonrandomized clinical trials comparing immediate and delayed loading were included. For the quantitative analysis, dichotomous and consistent variables were evaluated with a 95% confidence interval. Results: A total of 20 studies were evaluated. No statistically significant difference was observed between protocols: satisfaction (I²: 0%; P = .42), quality of life (I²: 0 %; P = .05), biologic complications (I²: 9%; P = .17), mechanical complications (I²: 58%; P = .84), and survival rate (I²: 0%; P = .38). The subgroup analysis showed significant differences only for marginal bone loss (MBL) when immediate implants were placed in the mandible (I²: 15%; P = .01) and posterior zone (I²: 0%; P = .001). Conclusions: Complications and patient-centered outcomes for immediate single-implant crowns were comparable to delayed loading. Scientific evidence showed no significant difference between loading protocols for survival rates. Note that several factors could interfere with the complication events, implant failures, and MBL. The subgroup analysis showed that only immediate implants placed in the posterior mandible had a higher and statistically significant mean MBL. [ABSTRACT FROM AUTHOR]

Fluctuations in energy gap and coupling constants between chromophores can play an important role in absorption and energy transfer across a collection of two-level systems. In photosynthesis, light-induced quantum coherence can affect the efficiency of energy transfer to the designated "trap" state. Theoretically, the interplay between fluctuations and coherence has been studied often, employing either a Markovian or a perturbative approximation. In this study, we depart from these approaches to incorporate memory effects by using Kubo's quantum stochastic Liouville equation. We introduce the effects of decay of the created excitation (to the ground state) on the desired propagation and trapping that provides a direction of flow of the excitation. In the presence of light-induced pumping, we establish a relation between the efficiency, the mean survival time, and the correlation decay time of the bath-induced fluctuations. A decrease in the steady-state coherence during the transition from the non-Markovian regime to the Markovian limit results in a decrease in efficiency. As in the well-known Haken–Strobl model, the ratio of the square of fluctuation strength to the rate plays a critical role in determining the mechanism of energy transfer and in shaping the characteristics of the efficiency profile. We recover a connection between the transfer flux and the imaginary part of coherences in both equilibrium and excited bath states, in both correlated and uncorrelated bath models. We uncover a non-monotonic dependence of efficiency on site energy heterogeneity for both correlated and uncorrelated bath models. [ABSTRACT FROM AUTHOR]

Purpose: To compare the peri-implant bone loss of mandibular complete-arch implant-supported fixed prostheses (FPSs) supported by three and four implants and to correlate with the size of the horizontal and vertical distal cantilever at prosthesis placement (T1) and after 1 year (T2). Materials and Methods: A total of 72 external hexagon (EH) type implants were placed in 20 participants. Of these, 24 supported an FPS with three implants (G3I) and 48 with four implants (G4I). The mandibular implants were named 1, 2, 3, and 4 according to their location in the arch, in a clockwise direction. Digital periapical radiographs were taken at times T1 and T2 for analysis and measurement of peri-implant bone loss. The horizontal and vertical distal cantilevers were measured with a digital caliper and correlated with peri-implant bone loss. Results: The survival rate of implants in G3I was 91.66%, and in G4I it was 97.91%. The mean bone loss in G3I was 0.88 ± 0.89 mm, and in G4I it was 0.58 ± 0.78 mm (P = .225). There was no correlation between distal horizontal cantilevers and bone loss in the studied groups, with G3I being -0.25 (P = .197) and G4I -0.22 (P = .129). Larger vertical cantilevers of implants 1 (P = .018), 3 (P =.015), and 4 (P = .045) correlated with greater bone loss in G4I. Conclusions: The number of implants in an FPS did not influence peri-implant bone loss after 1 year of follow-up. Larger vertical cantilevers influenced greater bone loss in complete-arch implant-supported fixed prostheses supported by four implants. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate how the crown-to-implant (C/I) ratio affects the loss of crestal bone at single-crown implants and bridges in patients with periodontal disease. Materials and Methods: A total of 39 patients treated for periodontitis were rehabilitated with 108 implant-supported single crowns and bridges. Each patient was examined over a 5- to 20-year period on a 3- to 6-month recall schedule. At each session, we recorded periodontal clinical parameters. In addition, intraoral radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. The study population was divided by anatomical C/I ratio (Group 1: C/I = 1, Group 2: C/I > 1). Results: Implants had a 96.2% 5-year survival rate and 92.6% 20-year survival rate. The overall prevalence was 10.1% for mucositis and 1.1% for peri-implantitis. The survival rate (P = .68), incidence of mucositis (P = .325), and incidence of peri-implantitis (P = .077) did not significantly differ in the group comparison. The mean annual peri-implant bone loss was 0.09 ± 0.41 mm and was not significantly different between the groups. Mean bone loss was not significantly different until the 10th year of observation, during which Group 2 presented significantly less bone loss. The correlation of annual bone loss and clinical C/I ratio showed a small but significant negative effect throughout the entire study period (R = -0.217; P < .01). Conclusions: Increased crestal bone loss was not observed with implants with higher C/I ratios, both anatomical and clinical, and they even showed signs of less crestal bone loss. [ABSTRACT FROM AUTHOR]

Objective: The evidence base for the use of space maintainers is relatively sparce despite being used for decades after the premature loss of primary molars. This study aims to increase the dental evidence base via investigating retrospectively the success rates of prefabricated fixed and removable space maintainers inserted from 2019 to 2021 and followed up until February 2023 at a specialized university clinic and to identify reasons for any reported minor and major failure. The authors hypothesized that there is no significant difference in failure rates between fixed and removable space maintainers inserted after the premature loss of a single primary molar per quadrant. Method and materials: Patients' digital records were searched yielding 645 space maintainers. After the application of inclusion criteria, 157 (67%) fixed prefabricated space maintainers in 112 children and 77 (33%) removable space maintainers in 61 children were analyzed for an average of 18.4 ± 9.5 months. Results: Kaplan-Meier survival analysis with Mantel-Cox statistics showed an overall cumulative survival time of 31.6 months (SE = 1.15, 95% CI = 29.4 to 33.9). Major failure occurred significantly more in removable maintainers (n = 40/67, 59.7%), mostly due to loss of the appliance, compared to fixed space maintainers (n = 27/67, 40.3%; P < .001). The present study indicates that space maintainers were mainly placed in young children with high caries experience, where treatment was mostly possible using advanced behavior management. Conclusions: Fixed space maintainers had a significantly lower failure rate than their removable counterpart. However, both require continual repairs, preservation, or even replacement till the eruption of the permanent tooth. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 2023 alone, its estimated that over 64,000 patients will be diagnosed with PDAC and more than 50,000 patients will die of the disease. Current guidelines recommend neoadjuvant therapy for patients with borderline resectable and locally advanced PDAC, and data is emerging on its role in resectable disease. Neoadjuvant chemotherapy may increase the number of patients able to receive complete chemotherapy regimens, increase the rate of microscopically tumor-free resection (R0) margin, and aide in identifying unfavorable tumor biology. To date, this is the largest study to examine surgical outcomes after long-duration neoadjuvant chemotherapy for PDAC. METHODS: Retrospective analysis of single-institution data. RESULTS: The routine use of long-duration therapy in our study (median cycles: FOLFIRINOX = 10; gemcitabine-based = 7) is unique. The majority (85%) of patients received FOLFIRINOX without radiation therapy; the R0 resection rate was 76%. Median OS was 41 months and did not differ significantly among patients with resectable, borderline-resectable, or locally advanced disease. CONCLUSIONS: This study demonstrates that in patients who undergo surgical resection after receipt of long-duration neoadjuvant FOLFIRINOX therapy alone, survival outcomes are similar regardless of pretreatment resectability status and that favorable surgical outcomes can be attained.

Purpose: To retrospectively determine the cumulative survival rate (CSR) and marginal bone level change (ΔMBL) around novel hybrid design tissue-level (TL) dental implants that support multiple-screw-retained restorations. Materials and Methods: Implant CSRs were analyzed at the implant and patient level using Kaplan-Meier estimates. ΔMBL was measured by comparing the periapical loading and follow-up visit radiographs using an improved standardized digital methodology based on image gray levels. ΔMBL outcomes were subject to linear mixed regression to identify potential risk factors. Results: A total of 301 TL implants in 69 patients with an average age of 62.6 ± 11.7 years (range: 36 to 87 years) at the time of implant placement were considered for the analysis. All 301 implants were successfully restored and loaded. The 54-month CSRs at the implant and patient levels were 98.9% (95% CI: 96.7 to 99.6) and 95.3% (95% CI: 86.1 to 98.5), respectively. ΔMBL after a mean follow-up of 22 ± 10.7 months after loading was 0.00 ± 0.57 mm. None of the implant sites showed marginal bone loss exceeding 1.5 mm. Multivariate regression analysis revealed a significant association between ΔMBL and the loading protocol (P = .027) but not between ΔMBL and age or transgingival height. Conclusions: The high CSRs and stable peri-implant marginal bone levels support the use of recent TL implants, which have a hybrid design inherited from the bone-level implant-abutment connection, as a suitable treatment option for restoring partially or fully edentulous patients with a good mid-term prognosis. These results should be complemented by further prospective studies in a real-world multicenter private practice setup that represents the daily realities of implant treatment. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared the fit and fracture load of temporary fixed partial prostheses fabricated by means of a conventional direct technique, milling or 3D printing. Topics covered include the strength of the fixed dental prostheses, the values of the fracture test, and the maximum mastication forces in the molar region.

Purpose: To review experimental peri-implantitis studies using rat models and summarize different peri-implantitis induction techniques and evaluate their effectiveness. Materials and Methods: Electronic searches were conducted by two independent examiners to address the following issues. Meta-analyses explored the marginal bone loss (MBL) of four types of peri-implantitis induction methods in rats. The detailed induction tactics--such as the implant design, implant size, surgical process, time cost, induction methods, and endpoint measurements--were summarized. Results: Of the 18 included studies, 38.9% of the studies placed implants at the maxillary first molar, and 44.4% placed them at the alveolar ridge region anterior to the maxillary first molar. As for the induction method, the numbers of published studies on ligature methods, bacterial inoculation, and bacterial lipopolysaccharide inoculation were equally high among all selected studies. The total implant survival rate at the end was 160 out of 213 implants (75.11%). Eight studies with high pooled heterogeneity (I2 = 98, P < .01) in the meta-analysis reported an overall MBL (µ-CT) of 0.47 mm (95% CI = 0.14 to 0.81). A subgroup analysis estimated an MBL of 0.31 mm (95% CI = 0.12 to 0.50) for bacterial inoculation and 0.66 mm (95% CI = 0.07 to 1.26) for the ligature method. Histopathologic analysis revealed that peri-implantitis in rats was similar to peri-implantitis lesions in humans. Conclusions: Implant placement at the maxillary first molar with bacterial inoculation and the silk ligature method to build peri-implantitis rat models is reliable to use for research on peri-implantitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Multidisciplinary heart team (HT) evaluation is recommended for patients with severe primary mitral regurgitation to optimize treatment decisions. However, its impact on patient outcomes remains unknown. We evaluated the impact of implementing mitral HT on patient survival. METHODS AND RESULTS: We conducted a retrospective cohort study of patients with new diagnoses of severe primary mitral regurgitation in a large healthcare network echocardiogram database between 2016 and 2020. We compared the incidence of multidisciplinary evaluation by structural cardiology and cardiac surgery services and 2-year survival before and after mitral HT implementation. The 1:1 propensity-score matching between pre- and post-mitral HT used Society of Thoracic Surgeons Predicted Risk of Mortality for mitral repair, age, sex, race, heart failure symptoms, inpatient setting, history of MI, and dementia as covariates. Logistic regression identified variables associated with the likelihood of undergoing multidisciplinary evaluation. Among 70 510 echocardiograms performed, 391 patients had severe primary mitral regurgitation (median age, 77 years; 46% women). Multidisciplinary evaluation increased from 29% to 89% (P

Chronic graft-versus-host-disease (cGVHD) is divided into two subtypes: classic (absence of acute GVHD features) and overlap cGVHD (ocGVHD), in which both chronic and acute GVHD clinical features are present simultaneously. While worse outcomes with ocGVHD have been reported, there are few recent analyses. We performed a secondary analysis of data from the ABA2 trial (N = 185), in which detailed GVHD data were collected prospectively and systematically adjudicated. Analyses included cumulative incidence of classic versus ocGVHD, their specific organ manifestations, global disease severity scores, non-relapse mortality (NRM), disease-free survival (DFS) and overall survival (OS) in these two cGVHD subtypes. Of 92 patients who developed cGVHD, 35 were classified as ocGVHD. The 1-year cumulative incidence, organ involvement, and global severity of classic and ocGVHD were similar between ABA2 patients receiving CNI/MTX+placebo and CNI/MTX+abatacept; thus, cohorts were combined for ocGVHD evaluation. This analysis identified ocGVHD as having significantly higher severity at presentation and at maximum global severity compared to classic cGVHD. OS and DFS were significantly lower for ocGVHD versus classic cGVHD. OcGVHD is associated with increased cGVHD severity scores, and is associated with decreased OS and DFS compared to classic cGVHD, underscoring the high risks with this cGVHD subtype.

Few studies have reported the outcomes of short implants with a follow-up time > 10 years. This retrospective study aimed to evaluate the long-term outcomes of short locking-taper implants supporting single crowns in the posterior region. Patients who received these supporting implants (≤ 8 mm) in the posterior region from 2008 to 2010 were included. The clinical and radiographic outcomes and patient satisfaction were recorded. A total of 18 patients with 34 implants were included. The cumulative survival rate was 91.4% and 83.3% at implant and patient levels, respectively. Tooth brushing habit and history of periodontitis were significantly associated with implant failure (P < .05). The median marginal bone loss (MBL) was 0.24 mm (IQR: 0.01 to 0.98 mm). Biologic and technical complications occurred in 14.7% and 17.8% of implants, respectively. The mean modified Sulcus Bleeding Index was 0.52 ± 0.63, and the mean peri-implant probing depth was 2.38 ± 0.79 mm. All patients were at least quite satisfied, with the majority of patients (88.9%) being fully satisfied with the treatment. Within the limitations of this study, the short locking-taper implants supporting single crowns in the posterior region achieved promising outcomes in the long-term follow-up. [ABSTRACT FROM AUTHOR]

Dental implants are currently the preferred choice to restore function and esthetics. Nonetheless, explantation is sometimes inevitable in cases with advanced bone loss, implant fracture, or improper implant position. This study aimed to propose an algorithm for reimplantation at sites of previous failure. There is limited evidence on the replacement of failed implants, most of which are case reports or clinical trials with a small number of patients. To the best of the authors' knowledge, this is the first study proposing a clinical-decision algorithm to help clinicians manage implant failures with new implants. There are a variety of reasons contributing to implant failure: The etiologic factor of failure and the morphology of the residual defect have paramount importance on implant removal techniques and subsequent treatment modalities. There is no consensus on a distinct protocol to replace failed implants. However, the clinicians and patients should know that placing a new implant in an area with a history of failure, regardless of early or late implant failure, may have a lower survival rate. [ABSTRACT FROM AUTHOR]

Purpose: Alveolar ridge split (ARS) is ridge augmentation to mitigate ridge width loss that typically follows tooth extraction. This study aimed to determine the efficacy of ARS on alveolar ridge horizontal dimensional changes and the survival rates of implants placed into the same sites. Materials and Methods: An electronic and manual search was conducted for English articles published up to January 1, 2021. The PICO (problem, intervention, comparison, outcome) model for quantitative studies was established to address the following two focused questions: (1) What are the effects of the ARS technique on increasing alveolar width and implant survival?; and (2) what are the factors that influence the efficacy of the ARS technique? The outcome measures in this systematic review and meta-analysis were mean alveolar ridge gain—horizontal (buccolingual) in millimeters from baseline (initial presentation) to final assessment (minimum of 12 weeks after ARS), implant survival rate, and patient-reported complication rate. The risk of bias was evaluated using the ROBINS-I assessment tool for non-randomized interventional studies. Weighted means were calculated, and pooled effects and 95% confidence intervals (95% CI) were depicted on forest plots. Publication bias was assessed by funnel plot and Rosenthal Statistics. A sensitivity analysis was undertaken to assess the primary outcome. Results: Overall, 35 studies met the inclusion criteria and were included in the systematic review. The mean alveolar ridge gain for ARS was 3.06 mm (95% CI: 3.01 to 3.12 mm). A mean gain of 2.99 mm (95% CI: 2.93 to 3.04 mm) was found after sensitivity analysis, excluding one article with a high risk of bias. There were no significant differences in ridge width in the group with bone graft (mean difference [95% CI] of 2.97 mm [2.91 to 3.03 mm]) and in the group without bone graft (mean difference [95% CI] of 3.06 mm [2.92 to 3.20 mm]). The ARS technique demonstrated a 98.17% implant survival rate in 4,446 implants, 4,103 of which were placed at the time of ARS with a 97.72% implant survival rate, and 343 placed in a delayed approach with a 99.14% implant survival rate. The risk of bias was low in 14.2%, low to moderate in 68.5%, moderate in 11.4%, and severe/moderate in 5.7% of the included studies. Conclusions: ARS shows a high implant survival rate in narrow alveolar ridges, adequate horizontal alveolar ridge dimensional gain regardless of adding grafting material, and minimal patient-reported complications. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is twice as common in Black individuals compared with in White individuals, and diabetes mellitus (DM) disproportionately affects Black patients. Although numerous studies have shown a correlation between DM and MM, this has not been studied in the context of race and in vivo mechanisms. We conducted a retrospective clinical study of 5383 patients with MM of which 15% had DM (White, 12% and Black, 25%). Multivariable Cox models showed reduced overall survival (OS) for patients with DM (hazard ratio, 1.27; 95% confidence interval, 1.11-1.47; P < .001). This appeared to be driven by a marked difference in OS between White patients with and without DM but not in Black patients. In contrast, obesity was associated with better OS in Black patients but not in White patients. To complement this analysis, we assessed MM growth in a genetically engineered immunocompromised nonobese diabetic (Rag1-/-/muscle creatinine kinase promoter expression of a human IGF1R [M] with a lysine [K] to arginine [R] point mutation) mouse model to evaluate the mechanisms linking DM and MM. MM.1S xenografts grew in more Rag1-/-/MKR mice and grew more rapidly in the Rag1-/-/MKR mice compared with in controls. Western blot analysis found that MM1.S xenografts from Rag1-/-/MKR mice had higher phosphorylated S6 ribosomal protein (Ser235/236) levels, indicating greater activation of the mammalian target of rapamycin pathway. Our study is, to our knowledge, the first to evaluate racial differences in DM prevalence and survival in MM, as well as the effect of DM on tumor growth in mouse models. Our results suggest that DM may contribute to the higher incidence of MM in Black patients; and to improve survival in MM, DM management cannot be ignored.

Objective: The correlation between crestal bone loss at teeth and probing pocket depth (PPD) has been established. Whether these findings can also be applied to implants is not known. The objective of this study was to determine the correlation between crestal bone loss and PPD at teeth and implants. Method and materials: Thirty-one periodontitis-susceptible patients were rehabilitated with fixed implant-supported single crowns and fixed partial dentures. Each patient was examined over a 5- to 20-year period in a 3- to 6-month strict recall program. At each session, periodontal clinical parameters were recorded at teeth and implants. In addition, standardized periapical radiographs were taken after superstructure insertion (baseline) and then at 1,3,5,10,15, and 20 years. Results: The survival rate of implants (94.0%) and teeth (97.3%) did not significantly differ in all patients after 20 years (P = .68). Almost all patients had a PPD >5 mm at implants and teeth throughout the observation period. The crestal bone loss at implants and teeth increased continuously, especially in patients with advanced periodontitis, without a correlation with PPD. A few patients (n = 5) had a PPD>5 mm and annual bone loss >0.2 mm at one implant, with a correlation between bone loss and PPD. Conclusion: In healthy implants and teeth, moderate crestal bone loss is present without correlation with PPD. A few patients showed progressive crestal bone loss at only one implant, with a correlation with PPD. [ABSTRACT FROM AUTHOR]

Purpose: To assess and compare the clinical outcomes of three different types of all-ceramic posterior monolithic tooth-supported crowns. Materials and Methods: A total of 71 patients received 90 all-ceramic crowns randomized to be either high-translucency zirconia (ZC), high-translucency zirconia with a partial buccal veneer (ZC-V), or lithium disilicate glass-ceramic (LDS). All treatments were performed by four general dentists who were blinded to the material used. Baseline and subsequent annual evaluations were based on modified California Dental Association (CDA) criteria. A questionnaire was used to include patient-reported outcomes and to compare them to the crown quality rating performed by dentists. Results: A total of 66 patients with 84 crowns were examined after 3 years. The survival rate was 98.8%. No crowns fractured during the observation period. One ZC-V crown failed due to loss of retention, and three complications were noted: loss of retention occurred in one ZC crown, and two ZC crowns needed to be endodontically treated. There was no significant difference between the different crowns regarding marginal integrity, surface, or anatomical form. Both patients and examining dentists rated the crowns favorably regarding esthetics, patients more than dentists. Conclusions: All crown types used show excellent and promising clinical outcomes from a short-term perspective. Patients and dentists rate the restorations favorably concerning esthetics and function. [ABSTRACT FROM AUTHOR]

Purpose: To assess the implant survival rate in mandibles reconstructed with free fibula flap after oral tumor resection after 1 year of prosthetic loading. A secondary objective was to compare immediate or delayed implant placement protocols in this population. Materials and Methods: Electronic and manual searches were performed on different databases for controlled and prospective trials that indicated implant survival rate. This systematic review followed PRISMA guidelines. Risk of bias was evaluated using Cochrane Collaboration tools. Meta-analyses heterogeneity source assessment and GRADE evaluation were performed among studies with identical follow-ups. Results: Among 305 primarily selected articles, 109 were eligible after reading the title and abstract, and 8 were included after full-text reading: 2 randomized controlled trials and 6 prospective studies comprising 140 patients and 507 implants. Meta-analyses estimated an overall survival rate of 97% (95% CI: 94% to 99%) after 1 year of prosthetic loading. The survival rate was 98% (95% CI: 94% to 100%) with immediate implantation and 97% (95% CI: 90% to 99%) with delayed implantation. Only 3 studies reported radiotherapy treatment, with no real impact on implant survival rate. Overall, 69% of tumors were benign. Conclusions: Implant placement in vascularized fibula flaps in the mandible is recommended for patients undergoing segmental mandibular reconstruction after tumor resection. Within the limitations of this study, no significant difference in survival rates was found between immediate and delayed implant placement. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the survival rate (primary outcome) and the marginal bone loss (secondary outcome) of the OsseoSpeed EV Implants (Astra Tech Implant System, Dentsply Sirona Implants; hereinafter EV implants) used in a wide range of clinical scenarios and followed up to 8 years in a nonuniversity setting. Materials and Methods: All EV implants consecutively placed from 2013 to 2021 in a private dental clinic were included, and medical and radiologic records were retrospectively investigated. Independent reviewers collected 11 data types as potential influencing variables and measured the mesial and distal marginal bone levels to the nearest 0.5 mm on available radiographs, either panoramic or periapical. Tables of descriptive statistics were made at implant and patient levels. Univariate and multiple Cox regression models were adjusted for clustering effects and determined the hazard ratio (HR) and odds ratio (OR) for each independent variable collected. Results: The study sample consisted of 597 EV implants and 235 patients. During a mean follow-up of 42.1 ± 23 months (range: 10 to 94 months), 44 implants were lost (7.4%)--34 early (5.7%) and 10 late (1.7%)--in 38 patients (16.1%). The overall survival rate (SR) was 92.6% (CI: 90.5% to 94.7%), and the proportion of patients with all their implants surviving was 83.8% (CI: 79.1% to 88.5%). At the end of the study, the probability of survival of an implant that did not fail early was 98.2% (CI: 97.1% to 99.3%). Implant-level analysis identified two significant variables: implant diameter (HR 0.37, P = .009**) and immediate postextraction placement (HR 2.35, P = .025*). At the patient level, bruxism (OR = 3.29; P = .009**), history of periodontitis (OR = 2.18, P = .030*), and the number of implants placed (OR = 1.43; P = .001**) were found to be statistically significant. After removing dropouts and early failures from a sample of 528 implants, 412 (78%) had a marginal bone loss (MBL) = 0 mm at the end of the observation time, and 106 surviving implants (22%) showed a mean MBL of 1.42 ± 1.08 mm (range: 0.25 to 6.75 mm). Conclusions: An overall medium-term SR of the EV implants was 92.6%. Four of five EV implants showed a mid-term MBL = 0 mm, and 91.86% of implants completed the observation period with an MBL < 2 mm. Thus, the EV implant system was shown to be a valid alternative for routine use in a nonuniversity setting. Clinicians should remember that there is no 100% implant survival in everyday practice and that bruxism, periodontitis, narrow-diameter implants, and immediate placement are risk factors for a higher failure rate. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 3-year success and survival rates of fixed prostheses supported by 4-mm extra-short implants splinted to 10-mm implants in patients with shortened maxillary arches and low maxillary sinus floors. Methods: A total of 11 patients with reduced alveolar bone heights due to low maxillary sinus floors received two or three titaniumzirconium tissue-level implants: one or two extra-short (4 mm) implants, and one implant 10 mm in length. After 6 months, prosthetic rehabilitation with splinted crowns connecting the 4- and 10-mm implants was performed. Follow-up visits and maintenance protocols were implemented every 4 to 6 months. Results: The 11 patients were treated with 11 10-mm implants and 17 4-mm implants. One extra-short implant failed and was removed before loading, and its planned design was modified from three splinted crowns to a bridge between the 10- and 4-mm implants. After 36 months, all (11/11) prosthetic rehabilitations connecting the 10-mm (11/11) and 4-mm (16/16) implants were functional. At the 10-mm implant sites, the median (interquartile range [IQR]) probing depth and marginal bone loss measured 2.9 mm (2.3 to 3.2) and 1.3 mm (1.0 to 1.5), respectively. At the 4-mm implant sites, the median (IQR) probing depth and marginal bone loss measured 2.9 mm (2.4 to 3.1) and 0.3 mm (0.1 to 0.5), respectively. Conclusion: Prosthetic rehabilitation with splinted crowns connecting 4-mm and 10-mm implants showed promising outcomes in shortened maxillary dental arches after 3 years. Additional studies are needed to further validate these findings. [ABSTRACT FROM AUTHOR]

Purpose: To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary. Materials and Methods: A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated. Results: A total of 35 studies were included in the metaanalysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%). Conclusions: ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications. [ABSTRACT FROM AUTHOR]

Breast cancer affects one in 8 females with a 5-year survival rate of 89%. Up to 72% of breast cancer survivors have trouble with activities of daily living (ADL) following treatment. Increased time-from-treatment improves some measures of function, yet ADL limitations persist. Therefore, this study assessed the effect of time-from-treatment on upper extremity kinematics during ADLs in breast cancer survivors. Twenty-nine female breast cancer survivors were divided into 2 groups: <1 year (n = 12) and 1–2 years (n = 17) from treatment. Kinematics were collected during 6 ADL tasks, and humerothoracic joint angles were quantified. A 2-way mixed analysis of variance assessed the effects of time-from-treatment and arm on maximum angles for each ADL. Decreased maximum angle existed for breast cancer survivors with increased time-from-treatment during all ADLs. Breast cancer survivors in the 1–2 years group used ∼28° to 32° lower elevation, ∼14° to 28° lower axial rotation, and ∼10° to 14° lower plane of elevation range across tasks. Decreased ranges of arm movement during ADLs with increased time-from-treatment may reflect compensatory movement strategies. Recognizing this shift in strategies and accompanying underlying disease progression can help inform responses to functional performance limitations in breast cancer survivors as delayed effects are present posttreatment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical results of single-tooth ceramic crowns in the posterior region produced from three different monolithic materials.Materials and Methods: A total of 36 posterior single-tooth crowns were fabricated from lithium silicate glass-ceramic (LSGC; n = 12), lithium disilicate glass-ceramic (LDGC; n = 12), and polymer-infiltrated ceramic network (PICN; n = 12) in 27 patients. Restorations were evaluated for prosthetic and periodontal criteria at baseline and after 6 and 12 months. Prosthetic evaluation was performed according to the Modified United States Public Health Service criteria, and probing depth (PD), clinical attachment level (CAL), gingival bleeding time index (GBTI), and gingival (GI) and periodontal indices (PI) were evaluated in the periodontal assessment. Friedman and Kruskal-Wallis tests were used for statistical analyses (P = .05).Results: All restorations were evaluated according to survival and success rates. No dropouts occurred. The survival rate of all three materials was 100% after 1 year. However, in the PICN group, a statistically significant difference was found between baseline (0) and 12 months for color match (from Alpha to Bravo) and surface texture (from Alpha to Charlie) (P < .001).Conclusion: Although long-term clinical follow-up periods are needed, all three ceramics showed clinically acceptable survival and success rates over 1 year. The ceramics evaluated in the present study could be preferred for single-tooth full-crown restorations in the posterior region. [ABSTRACT FROM AUTHOR]

Purpose: To assess marginal bone loss (MBL) and implant stability when implant site preparation is performed with conventional drilling and the osteotome technique in the posterior maxilla. Materials and Methods: In total, 30 patients (mean age: 46.97 + 7.48 years) receiving 60 implants were enrolled in this study. In each patient, implant site preparation was done using either conventional drilling (conventional group; n = 30) or the osteotome technique (osteotome group; n = 30). The implant sites were further divided into groups based on the implant length used (implant length < 10 mm, implant length = 10 mm). Marginal bone levels and implant stability quotient (ISQ) values were evaluated at the time of crown insertion and 1 year later. Independent t test and paired t test were used for intergroup and intragroup comparison, respectively. Results: The osteotome group showed statistically significant higher initial ISQ (ISQi) and final ISQ (ISQf) values (ISQi: 61 ± 3.6; ISQf: 64.08 ± 3.7) compared to the conventional group (ISQi: 58.01 ± 4.6; ISQf: 61.32 ± 4.8). Statistically significant higher mean MBL was noted in the conventional group (-0.33 ± 0.12 mm) compared to the osteotome group (-0.26 ± 0.10 mm). Higher MBL was noted in the osteotome group (-0.32 ± 0.09 mm) compared to the conventional group (-0.30 ± 0.14 mm) for implants shorter than 10 mm. For implants = 10 mm in length, significantly higher MBL was noted in the conventional group (-0.37 ± 0.09 mm) compared to the osteotome group (-0.19 ± .06 mm). Conclusions: Osteotome technique could be used as an alternative to conventional drilling, especially when implants longer than 10 mm are planned in the posterior maxilla. [ABSTRACT FROM AUTHOR]

Purpose: To report on the follow-up of two previously published RCTs on the performance of screw-retained monolithic zirconia restorations on titanium (ti)-base abutments based on either digital scans through intraoral optical scanning (IOS) or conventional impressions. Materials and Methods: A total of 54 patients receiving 89 restorations (44 solitary crowns [SC], 21 splinted crowns [2-FDP], and 24 three-unit fixed partial dentures [3-FDP]) were included for the 1- to 3-year follow-up period. Restoration survival and technical complications were documented. Results: In total, 50 patients with 84 restorations completed the 3-year follow-up. One 3-FDP from the digital group was lost. This resulted in a survival rate of 97.9% for the digital group and 100% for the conventional group and an overall survival rate of 98.8% for screw-retained monolithic zirconia restorations on implants after 3 years. There was no statistically significant survival difference between the digital and conventional restorations (P = .362). When evaluated separately, a 100% survival rate of SCs and 97.7% for 2-FDPs could be reported. One decementation and three screw loosenings occurred in the 1- to 3-year follow-up. The multiple-implant restorations showed higher (23.3%) complication rates at the restoration level than the SCs (4.9%) after 3 years of function (P = .026). Conclusions: Screw-retained monolithic zirconia restorations on ti-base abutments show promising survival rates after 3 years of function. Restorative complications in screw-retained monolithic zirconia restorations on Ti-base abutments are more likely to happen in the first year of function and are more common in multiple-implant restorations than SCs. The impression type (digital or conventional) does not seem to influence these results. [ABSTRACT FROM AUTHOR]

The cancer in lungs is termed as a severe disease that can lead to huge deaths globally. The timely identification can be useful to increase rate of survival. A Computed Tomography is used to identify position of tumor and discover level of cancer. The present study provides an innovative model with CT to identify lung cancer. The lung CT is used for analyzing the cancer levels. These images undergoes pre-processing wiener filter to eradicate the noise. Subsequently, the lung lobe segmentation is attained with LadderNet whose training is executed with Archimedes Flow Regime Optimization (AFRO). The detection of nodule is performed using grid based strategy followed by extraction of statistical, GLCM and texture features. Finally, lung cancer detection are performed using DBN and the hyper parameters of DBN are optimally fine tuned using devised AFRO. The AFRO-based DBN provided finest efficiency with accuracy of 95.8%, F-measure of 92.6% and precision of 93.6%.The finest outcomes revealed that the technique has feasible robustness in classifying the nodules. The technique poses the ability to help the radiologists to interpret the data more effective and distinguish the lung nodules with CT images. [ABSTRACT FROM AUTHOR]

In addition to considering the main effects, understanding gene‐environment (G × E) interactions is imperative for determining the etiology of diseases and the factors that affect their prognosis. In the existing statistical framework for censored survival outcomes, there are several challenges in detecting G × E interactions, such as handling high‐dimensional omics data, diverse environmental factors, and algorithmic complications in survival analysis. The effect heredity principle has widely been used in studies involving interaction identification because it incorporates the dependence of the main and interaction effects. However, Bayesian survival models that incorporate the assumption of this principle have not been developed. Therefore, we propose Bayesian heredity‐constrained accelerated failure time (BHAFT) models for identifying main and interaction (M‐I) effects with novel spike‐and‐slab or regularized horseshoe priors to incorporate the assumption of effect heredity principle. The R package rstan was used to fit the proposed models. Extensive simulations demonstrated that BHAFT models had outperformed other existing models in terms of signal identification, coefficient estimation, and prognosis prediction. Biologically plausible G × E interactions associated with the prognosis of lung adenocarcinoma were identified using our proposed model. Notably, BHAFT models incorporating the effect heredity principle could identify both main and interaction effects, which are highly useful in exploring G × E interactions in high‐dimensional survival analysis. The code and data used in our paper are available at https://github.com/SunNa‐bayesian/BHAFT. [ABSTRACT FROM AUTHOR]

Accurate segmentation of lesion areas in medical image analysis can assist clinicians develop more personalized treatment tools, improving treatment efficacy and survival rates. Furthermore, the single encoding structure within the U-shaped architecture limits the network's capacity to aggregate semantic information of various scales. In this paper, we propose a residual T-shaped network (RTNet) for medical image segmentation. The RTNet incorporates Multi-Level Feature Enhanced Residual Block (MFER Block) and attention gates into a T-shaped structure, making our network capture richer contextual information at multiple scales. First, by utilizing two sets of encoders with different structures, our network can extract image features at different scales. Secondly, the MFER Block is employed to combine and learn the feature representations from the encoders, facilitating more effective feature fusion. Finally, the attention gates fuse those feature maps obtained from each stage via skip connections, then they are concatenated by the decoder to generate the final feature map for segmentation. Experimental results show that, on the BUSI and ISIC2017 datasets, the IoU of our RTNet reached 67.39% and 84.39%, respectively; and the DSC score achieved 79.95% and 91.44%, respectively. Our network outperforms state-of-the-art models for medical image segmentation. [ABSTRACT FROM AUTHOR]

We propose a non-parametric approach to reduce the overestimation of the Kaplan-Meier (KM) estimator when the event and censoring times are independent. We adjust the KM estimator based on the interval-specific censoring set, a collection of intervals where censored data are observed between two adjacent event times. The proposed interval-specific censoring set adjusted KM estimator reduces to the KM estimator if there are no censored observations or the sample size tends to infinity and the proposed estimator is consistent, as is the case for the KM estimator. We prove theoretically that the proposed estimator reduces the overestimation compared to the KM estimator and provide a mathematical formula to estimate the variance of the proposed estimator based on Greenwood's approach. We also provide a modified log-rank test based on the proposed estimator. We perform four simulation studies to compare the proposed estimator with the KM estimator when the failure rate is constant, decreasing, increasing, and based on the flexible hazard method. The bias reduction in median survival time and survival rate using the proposed estimator is considerably large, especially when the censoring rate is high. The standard deviations are comparable between the two estimators. We implement the proposed and KM estimator for the Nonalcoholic Fatty Liver Disease patients from a population study. The results show the proposed estimator substantially reduce the overestimation in the presence of high observed censoring rate. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to provide benchmarks for the rates of complications by type of surgery performed. Study Design. Prospective multicenter database. Background. We have previously examined overall construct survival and complication rates for ASD surgery. However, the relationship between type of surgery and construct survival warrants more detailed assessment. Materials and Methods. Eight surgical scenarios were defined based on the levels treated, previous fusion status [primary (P) vs. revision (R)], and three-column osteotomy use (3CO): short lumbar fusion, LT-pelvis with 5 to 12 levels treated (P, R, or 3CO), UT-pelvis with 13 levels treated (P, R, or 3CO), and thoracic to lumbar fusion without pelvic fixation, representing 92.4% of the case in the cohort. Complication rates for each type were calculated and Kaplan-Meier curves with multivariate Cox regression analysis was used to evaluate the effect of the case characteristics on construct survival rate, while controlling for patient profile. Results. A total of 1073 of 1494 patients eligible for 2-year follow-up (71.8%) were captured. Survival curves for major complications (with or without reoperation), while controlling for demographics differed significantly among surgical types (P < 0.001). Fusion procedures short of the pelvis had the best survival rate, while UT-pelvis with 3CO had the worst survival rate. Longer fusions and more invasive operations were associated with lower 2-year complication-free survival, however, there were no significant associations between type of surgery and renal, cardiac, infection, wound, gastrointestinal, pulmonary, implant malposition, or neurological complications (all P > 0.5). Conclusions. This study suggests that there is an inherent increased risk of complication for some types of ASD surgery independent of patient profile. The results of this paper can be used to produce a surgery-adjusted benchmark for ASD surgery with regard to complications and survival. Such a tool can have very impactful applications for surgical decision-making and more informed patient counseling. Level of Evidence. Level III. [ABSTRACT FROM AUTHOR]

Background: Patients with relapsed primary mediastinal nonseminomatous germ cell tumor have low cure rates with salvage chemotherapy or surgery. The authors report survival outcomes of patients who received high‐dose chemotherapy (HDCT) and peripheral blood stem cell transplantation (PBSCT) at Indiana University. Methods: The prospectively maintained Indiana University germ cell tumor database identified 32 patients with primary mediastinal nonseminomatous germ cell tumor who progressed after first‐line cisplatin‐based combination chemotherapy and received HDCT and PBSCT between 2006 and 2021. Therapy included two consecutive courses of HDCT consisting of 700 mg/m2 carboplatin and 750 mg/m2 etoposide, each for 3 consecutive days, and each followed by PBSCT. A second course was not given if the patient experienced progressive disease or prohibitive toxicity. Progression‐free survival and overall survival were analyzed using the Kaplan–Meier method. Medians with 95% confidence intervals were also calculated along with 2‐year probabilities. Results: The median age at HDCT was 30 years (range, 18–61 years). With a median follow‐up of 4.7 years (range, 1–14 years), the 2‐year progression‐free survival rate was 31% (95% confidence interval, 16%–47%), and the 2‐year overall survival rate was 35% (95% confidence interval, 19%–52%). At last follow‐up, nine patients (28%) remained without evidence of disease, including two platinum‐refractory patients and two patients who were receiving HDCT as third‐line therapy. There were three treatment‐related deaths. Conclusions: Salvage HDCT and PBSCT is an active combination in patients who have relapsed primary mediastinal nonseminomatous germ cell tumor with curative potential and prolonged survival, including in platinum‐refractory and third‐line settings. The authors recommend this approach for initial salvage chemotherapy in this patient population. Patients who have relapsed primary mediastinal nonseminomatous germ cell tumors have poor outcomes with salvage chemotherapy. The authors report the results of high‐dose chemotherapy and peripheral blood stem cell transplantation, which permit more rapid succession to the subsequent cycle and potentially improved efficacy compared with historical regimens. [ABSTRACT FROM AUTHOR]

Measures to boost populations can help ensure population persistence in the short‐term while longer‐term conservation interventions take effect. Headstarting, involving the collection of wild early life‐stage individuals, rearing in captivity, and release into a new or existing population once independent, has recently been identified as a potential translocation technique to assist small breeding populations of waders declining due to low levels of productivity. However, the demographic rates of headstarted individuals have not been quantified, and their impact on target populations not understood, which is required to determine the efficacy of this technique as a tool for species recovery. Between 2017 and 2022, headstarting was trialled as a tool to supplement the critically small sub‐population of black‐tailed godwit (Limosa limosa limosa) breeding at the Ouse Washes, Eastern England. We demonstrate that a high survival rate for eggs and chicks can be achieved through artificial incubation and hand‐rearing, and that headstarting can substantially increase the overall productivity of a small population. Using survival analysis and mixed effects modelling, we show that apparent survival and breeding success of headstarted individuals is comparable to wild‐reared conspecifics. The survival rate of released birds was sufficient to significantly boost the breeding population, reaching over five times the number of breeding pairs at the release site during the trial. Providing demographic rates remain the same, the number of godwits breeding at the Ouse Washes is predicted to continue to increase moderately over the next 20 years. This study highlights the potential of headstarting to boost small populations of breeding waders, and demonstrates the value of this technique to assist with the recovery of threatened populations when there is a clear justification that headstarting can negate the effects of population limiting factors. [ABSTRACT FROM AUTHOR]

Radiotherapy is a crucial component in the holistic management of breast cancer, with approximately 60% of individuals diagnosed with breast cancer requiring this treatment. As the survival rate of individuals with breast cancer has significantly increased, there is a growing focus on the long‐term well‐being of patients. Proton therapy (PT) is a new and rapidly developing radiotherapy method. In comparison with conventional photon therapy, PT offers the benefits of decreased radiation toxicity and increased dosage in the designated region. This can extend patients' lifespan and enhance their overall well‐being. The present analysis examines the function of PT in diminishing the harmful effects of radiation in cases of breast cancer, while also providing a brief overview of the future potential and obstacles associated with PT for breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: To report the oncological outcomes and the tolerance between 6 instillations and more than 6 cycles of hyperthermic intravesical chemotherapy(HIVEC) in patients with non-muscle invasive bladder cancer(NMIBC). Methods: This is a multicenter retrospective study from a national database including 9 expert centers. All patients treated with HIVEC between 2016 and 2023 for NMIBC were included. Patients were classified into two groups according to the total number of HIVEC instillations, including induction plus maintenance. Kaplan-Meier curves were computed to present survival outcomes. Results: 261 patients with a median follow-up of 25.5 months were included. 199(76.2%) and 62(23.8%) were treated by 6 and more than 6 cycles of HIVEC, respectively. The 2-years RFS(40.2% vs. 34.4%,p = 0.3) and the 2-years PFS(86% vs. 87%,p = 0.85) were similar between group treated with 6 and more than 6 instillations. 2-years CSS and OS were also similar between both groups. Univariate Cox regression showed no association between the number of bladder instillation and RFS (HR = 1.2 95%CI[0.8–1.84], p = 0.3) or PFS (HR = 0.8 95%CI[0.29–2.02], p = 0.2). In the group treated with more than 6 cycles, 2-years RFS and 2-years PFS were similar between patients who received induction plus maintenance compared to those treated with induction only. Finally, hematuria and urinary burning were significantly higher in the group treated by more than 6 cycles (21% vs. 8.5%(p < 0.01),and 29% vs. 17% (p = 0.03), respectively). Serious side effects(grade ≥ 3) are rare(3.1%) and similar in both groups. Conclusions: Results show no significant difference in two years RFS, PFS, CSS and OS according to number of instillations received, while toxicity profile seems better in the group receiving six instillations only. [ABSTRACT FROM AUTHOR]

Background: Mesenchymal Stromal Cells (MSCs) are the preferred candidates for therapeutics as they possess multi-directional differentiation potential, exhibit potent immunomodulatory activity, are anti-inflammatory, and can function like antimicrobials. These capabilities have therefore encouraged scientists to undertake numerous preclinical as well as a few clinical trials to access the translational potential of MSCs in disease therapeutics. In spite of these efforts, the efficacy of MSCs has not been consistent—as is reflected in the large variation in the values of outcome measures like survival rates. Survival rate is a resultant of complex cascading interactions that not only depends upon upstream experimental factors like dosage, time of infusion, type of transplant, etc.; but is also dictated, post-infusion, by intrinsic host specific attributes like inflammatory microniche including proinflammatory cytokines and alarmins released by the damaged host cells. These complex interdependencies make a researcher's task of designing MSC transfusion experiments challenging. Methods: In order to identify the rules and associated attributes that influence the final outcome (survival rates) of MSC transfusion experiments, we decided to apply machine learning techniques on manually curated data collected from available literature. As sepsis is a multi-faceted condition that involves highly dysregulated immune response, inflammatory environment and microbial invasion, sepsis can be an efficient model to verify the therapeutic effects of MSCs. We therefore decided to implement rule-based classification models on data obtained from studies involving interventions of MSCs in sepsis preclinical models. Results: The rules from the generated graph models indicated that survival rates, post-MSC-infusion, are influenced by factors like source, dosage, time of infusion, pre-Interleukin-6 (IL-6)/ Tumour Necrosis Factor- alpha (TNF-α levels, etc. Conclusion: This approach provides important information for optimization of MSCs based treatment strategies that may help the researchers design their experiments. [ABSTRACT FROM AUTHOR]

Introduction. Thyroid cancer is the most common cancer in women in Ecuador. Objective. The aim of this study was to determine the demographics and clinical and treatment variables of patients with papillary or follicular thyroid cancer, referred to as differentiated thyroid cancer (DTC), treated at a third‐level hospital in Quito, Ecuador. Methods. We reviewed retrospectively the medical records of patients with DTC, who underwent surgical treatment, from 1990 to 2019. Data included demographics, pathological information, clinical stage, type of surgery, and radioactive iodine (RAI) adjuvant therapy. Patients were monitored for up to 29 years (median follow‐up time 6.9 years). Results. The corrected overall 5‐, 10‐, 20‐, and 30‐year survival rates (Kaplan–Meier) were 93%, 85%, 70%, and 63%, respectively. On univariate analysis, age, histological type, tumor grade, histological variants, capsular invasion, vascular invasion, tumor size, clinical stage, distant metastases at diagnosis, surgical margins, extrathyroidal invasion, radioactive iodine adjuvant treatment, and locoregional recurrence were found to be significant prognostic factors. In a multivariate analysis, the following independent variables: age over 55 years, extrathyroidal spread, metastasis at diagnosis, and stage II to IV raised the risk of death (hazard risk) (HR). Conclusions. Age over 55 years, extrathyroidal spread, metastasis at diagnosis, and advanced clinical stage were found to have a harmful prognosis and an increased risk of death in a series of Ecuadorian patients surgically treated for a DTC. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusions To investigate the influence of statins on the survival outcomes of patients with non‐muscle‐invasive bladder cancer (NMIBC) treated with adjuvant intravesical bacille Calmette‐Guérin (BCG) immunotherapy.A retrospective cohort of consecutive patients with NMIBC who received intravesical BCG therapy from 2001 to 2020 and statins prescription were identified. Overall survival (OS), cancer‐specific survival (CSS), recurrence‐free survival (RFS), and progression‐free survival (PFS) were analysed between the Statins Group vs No‐Statins Group using Kaplan–Meier method and multivariable Cox regression.A total of 2602 patients with NMIBC who received intravesical BCG were identified. The median follow‐up was 11.0 years. On Kaplan–Meier analysis, the Statins Group had significant better OS (P < 0.001), CSS (P < 0.001), and PFS (P < 0.001). Subgroup analysis indicated statins treatment started before BCG treatment had better CSS (P = 0.02) and PFS (P < 0.01). Upon multivariable Cox regression analysis, the ‘statins before BCG’ group was an independent protective factor for OS (hazard ratio [HR] 0.607, 95% confidence interval [CI] 0.514–0.716), and CSS (HR 0.571, 95% CI 0.376–0.868), but not RFS (HR 0.885, 95% CI 0.736–1.065), and PFS (HR 0.689, 95% CI 0.469–1.013).Statins treatment appears to offer protective effects on OS and CSS for patients with NMIBC receiving adjuvant intravesical BCG. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Although the incidence of isolated gastric varices type 1 (IGV1) bleeding is low, the condition is highly dangerous and associated with high mortality, making its treatment challenging. We aimed to compare the safety and efficacy of endoscopic clipping combined with cyanoacrylate injection (EC‐CYA) vs. transjugular intrahepatic portosystemic shunt (TIPS) in treating IGV1.In a single‐center, randomized controlled trial, patients with IGV1 bleeding were randomly assigned to the EC‐CYA group or TIPS group. The primary end‐points were gastric variceal rebleeding rates and technical success. Secondary end‐points included cumulative nonbleeding rates, mortality, and complications.A total of 156 patients between January 2019 and April 2023 were selected and randomly assigned to the EC‐CYA group (n = 76) and TIPS group (n = 80). The technical success rate was 100% for both groups. The rebleeding rates were 14.5% in the EC‐CYA group and 8.8% in the TIPS group, showing no significant difference (P = 0.263). Kaplan–Meier analysis revealed that the cumulative nonbleeding rates at 6, 12, 24, and 36 months for the two groups lacked statistical significance (P = 0.344). Similarly, cumulative survival rates at 12, 24, and 36 months for the two groups were not statistically significant (P = 0.916). The bleeding rates from other causes were 13.2% and 6.3% for the respective groups, showing no significant difference (P = 0.144). No instances of ectopic embolism were observed in either group. The incidence of hepatic encephalopathy (HE) in the TIPS group was statistically higher than that in the EC‐CYA group (P = 0.001).Both groups are effective in controlling IGV1 bleeding. Notably, EC‐CYA did not result in ectopic embolism, and the incidence of HE was lower than that observed with TIPS. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsPrevious studies have reported inconsistent results on the association between serum prealbumin level and survival outcomes in patients with gastric cancer. This meta-analysis aimed to determine the serum prealbumin level as a biomarker of survival outcomes in gastric cancer patients.Two independent reviewers conducted a thorough search of PubMed, Embase, and Web of Science databases until April 17, 2024. Studies reporting the association between serum prealbumin level and survival outcomes and presented the multivariable-adjusted relative risks for gastric cancer patients were included. The pooled HR and 95% CI were used to assess the strength of the association.Twelve studies, with a total of 9,351 patients were included in the meta-analysis. The combined data showed that low serum prealbumin level was associated with shorter overall survival (HR 1.65; 95% CI 1.42-1.91) and disease-free survival (HR 1.39; 95% CI 1.14-1.70). Subgroup analysis showed that low serum prealbumin level significantly predicted poorer overall survival, regardless of patients’ age, sample sizes, cutoff value for prealbumin level, and follow-up time.Low serum prealbumin level is an independent prognostic biomarker for shorter survival outcomes in patients with gastric cancer. Assessing serum prealbumin levels could potentially improve risk stratification for this disease. [ABSTRACT FROM AUTHOR]

Background: Sepsis poses a critical threat to hospitalized patients, particularly those in the Intensive Care Unit (ICU). Rapid identification of Sepsis is crucial for improving survival rates. Machine learning techniques offer advantages over traditional methods for predicting outcomes. This study aimed to develop a prognostic model using a Stacking-based Meta-Classifier to predict 30-day mortality risks in Sepsis-3 patients from the MIMIC-III database. Methods: A cohort of 4,240 Sepsis-3 patients was analyzed, with 783 experiencing 30-day mortality and 3,457 surviving. Fifteen biomarkers were selected using feature ranking methods, including Extreme Gradient Boosting (XGBoost), Random Forest, and Extra Tree, and the Logistic Regression (LR) model was used to assess their individual predictability with a fivefold cross-validation approach for the validation of the prediction. The dataset was balanced using the SMOTE-TOMEK LINK technique, and a stacking-based meta-classifier was used for 30-day mortality prediction. The SHapley Additive explanations analysis was performed to explain the model's prediction. Results: Using the LR classifier, the model achieved an area under the curve or AUC score of 0.99. A nomogram provided clinical insights into the biomarkers' significance. The stacked meta-learner, LR classifier exhibited the best performance with 95.52% accuracy, 95.79% precision, 95.52% recall, 93.65% specificity, and a 95.60% F1-score. Conclusions: In conjunction with the nomogram, the proposed stacking classifier model effectively predicted 30-day mortality in Sepsis patients. This approach holds promise for early intervention and improved outcomes in treating Sepsis cases. [ABSTRACT FROM AUTHOR]

The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly, driven by the COVID-19 pandemic. Despite its widespread adoption, neurological complications pose a significant risk, impacting both mortality and survivors' quality of life. Detecting these complications is challenging due to sedation and the heterogeneous nature of ECMO-associated neurological injury. Still, consensus of neurologic monitoring during ECMO is lacking since utilization and effectiveness of current neuromonitoring methods are limited. Especially in view of the heterogeneous nature of neurological injury during ECMO support an easily acquirable biomarker tracing neuronal damage independently from the underlying pathomechanism would be favorable. In a single-center prospective study on 34 severe acute respiratory distress syndrome (ARDS) patients undergoing ECMO, we explored the potential of serum neurofilament light chain levels (NfL) as a biomarker for neurological complications and its predictive power towards the overall outcome of ECMO patients. Individuals experiencing neurological complications (41%) demonstrated a notable rise in NfL levels (Tbaseline median 92.95 pg/ml; T24h median 132 pg/ml (IQR 88.6–924 pg/ml), p = 0.008; T7d median 248 pg/ml (IQR 157–1090 pg/ml), p = 0.001). Moreover, under ECMO therapy, these patients exhibited markedly elevated concentrations compared to those without neurological complications (T24h median 70.75 pg/ml (IQR 22.2–290 pg/ml), p = 0.023; T7d median 128 pg/ml (IQR 51.8–244 pg/ml), p = 0.002). There was no significant difference in the NfL dynamics between surviving patients and those who died during or shortly after ECMO therapy. While NfL indicates neuro-axonal damage during intensive care with ECMO therapy, we could not identify any correlation between survival outcome and the levels of NfL, indicating that NfL may not serve as a prognostic marker for survival. Nevertheless, additional studies involving a larger patient cohort are required. [ABSTRACT FROM AUTHOR]

The outcome of this study was to identify 9-year survivors of intertrochanteric fracture at each stage of chronic kidney disease (CKD) and to investigate the risk factors associated with mortality following surgery with proximal femoral nail anti-rotation (PFNA). 443 elderly intertrochanteric fractures underwent PFNA fixation were recruited. Mortality rate was identified until 9 years. We compared the survival time of hip fracture in each stage of CKD. A regression analysis was used to determine the association between risk factors and one-year mortality. The overall median survival time was 7.1 years. The Kaplan–Meier curve was significantly different in each CKD stage especially in CKD5. In addition, the incidence rate of mortality was highest in CKD 5 (17.4%) and the median survival time in CKD 5 was 3.3 years. The multivariate analysis demonstrated that heart disease, operative time > 60 min, presence of pulmonary embolism, and poor to fair Harris hip score were significantly increased mortality. CKD stage 5 is associated with the highest mortality rate and the shortest median time of survival during the 9-year follow up. Patients who have high risk should focus on long-term care planning, including the counseling for their healthcare providers and families. [ABSTRACT FROM AUTHOR]

Introduction: Patients with multiple myeloma (MM) face heightened infection susceptibility, particularly severe risks from COVID-19. This study, the first systematic review in its domain, seeks to assess the impacts of COVID-19 on MM patients. Method: Adhering to PRISMA guidelines and PROSPERO registration (ID: CRD42023407784), this study conducted an exhaustive literature search from January 1, 2020, to April 12, 2024, using specified search terms in major databases (PubMed, EMBASE, and Web of Science). Quality assessment utilized the JBI Critical checklist, while publication bias was assessed using Egger's test and funnel plot. The leave-one-out sensitivity analyses were performed to assess the robustness of the results by excluding one study at a time to identify studies with a high risk of bias or those that significantly influenced the overall effect size. Data synthesis involved fitting a random-effects model and estimating meta-regression coefficients. Results: A total of 14 studies, encompassing a sample size of 3214 yielded pooled estimates indicating a hospitalization rate of 53% (95% CI: 40.81, 65.93) with considerable heterogeneity across studies (I2 = 99%). The ICU admission rate was 17% (95% CI: 11.74, 21.37), also with significant heterogeneity (I2 = 94%). The pooled mortality rate was 22% (95% CI: 15.33, 28.93), showing high heterogeneity (I2 = 97%). The pooled survival rate stood at 78% (95% CI: 71.07, 84.67), again exhibiting substantial heterogeneity (I2 = 97%). Subgroup analysis and meta-regression highlighted that study types, demographic factors, and patient comorbidities significantly contributed to the observed outcome heterogeneity, revealing distinct patterns. Mortality rates increased by 15% for participants with a median age above 67 years. ICU admission rates were positively correlated with obesity, with a 20% increase for groups with at least 19% obesity. Mortality rates rose by 33% for the group of patients with at least 19% obesity, while survival rates decreased by 33% in the same group. Conclusion: Our meta-analysis sheds light on diverse COVID-19 outcomes in multiple myeloma. Heterogeneity underscores complexities, and study types, demographics, and co-morbidities significantly influence results, emphasizing the nuanced interplay of factors. [ABSTRACT FROM AUTHOR]

Objective: Meta-analysis was used to assess the efficacy and safety of ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma. Methods: Randomized controlled studies on ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma were searched in the databases of PubMed, Embase, Cochrane library, web of science with a search deadline of March 14, 2024. Data were analyzed using Stata 15.0. Result: Six randomized controlled studies involving 520 individuals were finally included, the results of meta-analysis showed that ultrasound-guided radiofrequency ablation combined with TACE can improve objective response rate [RR = 1.52, 95%CI (1.28, 1.81)], improve disease control rate [RR = 1.15, 95%CI (1.06, 1.24)], The survival rate [RR = 1.34, 95%CI (1.19,1.51)] did not increase adverse reactions [RR = 1.34, 95%CI (1.00,1.79)]. Conclusion: Based on the findings of the current study, ultrasound-guided radiofrequency ablation combined with TACE was found to improve the objective remission rate, disease control rate, and did not increase adverse events in patients with hepatocellular carcinoma. [ABSTRACT FROM AUTHOR]

The preservation of microorganisms is pivotal in microbiological practice. Currently, cryopreservation is assumed to be an effective and inexpensive approach for the storage of microorganisms, including bacteria. The key point of cryopreservation is optimal cryoprotectant selection. In the present study, different cryoprotectant compositions were tested for long-term storage of 15 Enterobacterales bacterial strains at − 20 °C. The survival rates of the bacterial strains were evaluated in four different cryoprotectant solutions containing 70% glycerin only (cryoprotectants 1 and 4), 10% dimethyl sulfoxide (DMSO) with 70% glycerin (cryoprotectant 2), and 10% DMSO (cryoprotectant 3). In addition, cryoprotectants 1 and 2 contained peptone and yeast extract as nutritional supplements. The general survival rates of the bacterial strains were evaluated after 12 months of storage. After 12 months, the survival rates of the different cryoprotectants were as follows: cryoprotectant 1—88.87%; cryoprotectant 2—84.85%; cryoprotectant 3—83.50%; and cryoprotectant 4—44.81%. Thus, the composition of cryoprotectant 1 (70% glycerin with nutrient supplements) was optimal for preserving 15 tested strains of the order Enterobacterales. Despite these findings, the biochemical properties of the tested strains changed after cryopreservation for 12 months in the presence of 1 or 3 cryoprotectants. Alterations in the biochemical profile could be related to changes in environmental conditions and cold adaptation. We assume that the composition of cryoprotectant 1 can be optimal for storing the order Enterobacterales at − 20 °C. However, further investigations are needed to elucidate the problem of cryopreservation and to support our assumption. [ABSTRACT FROM AUTHOR]