bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment: systematic review of prospective randomized clinical trials
Authors: Abou ElReash Ashraf , Hamama Hamdi , Comisi John C. , Zaeneldin Ahmed , Xiaoli Xie
Published: July 2021

Background

Endodontic surgical procedures, when performed, require retrograde filling materials that are biocompatible, non-toxic, non-irritant, dimensionally stable, and ideally promote bone formation. Precise evaluation of retrograde filling materials in clinical trials is necessary to give holistic view for properties of material and potential outcome from its use. The purpose of this review is to evaluate the effect of retrograde material type and surgical techniques on the success rate of surgical endodontic retreatment.

Methods

An electronic search was performed in the time frame between 1st of January 2000 to 1st of September 2020 using database.

Sources

Web of Science, PubMed and redundant hand searches through their references. Seven inclusion–exclusion criteria were set for the selection and identification of relevant articles. Risk of bias was conducted for the included studies.

Results

Nine randomized clinical trials (RCTs) fulfilled the inclusion criteria for this systematic review. The outcome of this review revealed that none of the reviewed trials totally-fulfilled CONSORT 2010 criteria.

Conclusions

In light of the outcome of this review, there is no enough evidence to support the superiority of certain retrograde filling material or surgical technique over another in the success rate of surgical endodontics retreatment. The variety of methodologies and strategies, such as patient selection, the method of treatment and study analysis, led to doubtful credibility of the obtained clinical evidence. Further prospective randomized controlled clinical trials evaluating the specific effect of the various used materials are needed.
The future of physician advocacy: a survey of U.S. medical students
Authors: Chimonas Susan , Mamoor Maha , Kaltenboeck Anna , Korenstein Deborah
Published: July 2021

Background

Advocacy is a core component of medical professionalism. It is unclear how educators can best prepare trainees for this professional obligation. We sought to assess medical students’ attitudes toward advocacy, including activities and issues of interest, and to determine congruence with professional obligations.

Methods

A cross-sectional, web-based survey probed U.S. medical students’ attitudes around 7 medical issues (e.g. nutrition/obesity, addiction) and 11 determinants of health (e.g. housing, transportation). Descriptive statistics, Kruskal-Wallis tests, and regression analysis investigated associations with demographic characteristics.

Results

Of 240 students completing the survey, 53% were female; most were white (62%) or Asian (28%). Most agreed it is very important that physicians encourage medical organizations to advocate for public health (76%) and provide health-related expertise to the community (57%). More participants rated advocacy for medical issues as very important, compared to issues with indirect connections to health (p < 0.001). Generally, liberals and non-whites were likelier than others to value advocacy.

Conclusions

Medical students reported strong interest in advocacy, particularly around health issues, consistent with professional standards. Many attitudes were associated with political affiliation and race. To optimize future physician advocacy, educators should provide opportunities for learning and engagement in issues of interest.
Predicting clinical outcomes among hospitalized COVID-19 patients using both local and published models
Authors: Galanter William , Rodríguez-Fernández Jorge Mario , Chow Kevin , Harford Samuel , Kochendorfer Karl M. , Pishgar Maryam , Theis Julian , Zulueta John , Darabi Houshang
Published: July 2021

Background

Many models are published which predict outcomes in hospitalized COVID-19 patients. The generalizability of many is unknown. We evaluated the performance of selected models from the literature and our own models to predict outcomes in patients at our institution.

Methods

We searched the literature for models predicting outcomes in inpatients with COVID-19. We produced models of mortality or criticality (mortality or ICU admission) in a development cohort. We tested external models which provided sufficient information and our models using a test cohort of our most recent patients. The performance of models was compared using the area under the receiver operator curve (AUC).

Results

Our literature review yielded 41 papers. Of those, 8 were found to have sufficient documentation and concordance with features available in our cohort to implement in our test cohort. All models were from Chinese patients. One model predicted criticality and seven mortality. Tested against the test cohort, internal models had an AUC of 0.84 (0.74–0.94) for mortality and 0.83 (0.76–0.90) for criticality. The best external model had an AUC of 0.89 (0.82–0.96) using three variables, another an AUC of 0.84 (0.78–0.91) using ten variables. AUC’s ranged from 0.68 to 0.89. On average, models tested were unable to produce predictions in 27% of patients due to missing lab data.

Conclusion

Despite differences in pandemic timeline, race, and socio-cultural healthcare context some models derived in China performed well. For healthcare organizations considering implementation of an external model, concordance between the features used in the model and features available in their own patients may be important. Analysis of both local and external models should be done to help decide on what prediction method is used to provide clinical decision support to clinicians treating COVID-19 patients as well as what lab tests should be included in order sets.
Development and field testing of a patient decision aid for management of acute Achilles tendon rupture: a study protocol
Authors: Meulenkamp Brad , Brillinger Julia , Fergusson Dean , Stacey Dawn , Graham Ian D.
Published: July 2021

Background

Achilles tendon ruptures are common injuries in an otherwise healthy, active population. Several treatment options exist, with both surgical and non-surgical options. Each treatment option has a unique set of risks and harms, which may present patients with decisional conflict. The aim of the proposed study is to develop, alpha test and field test a patient decision aid for patients presenting with acute Achilles tendon ruptures.

Methods

This is a three-stage study protocol. First, we will assemble a multi-disciplinary steering group including patients, clinicians, educators, and researchers to develop the patient decision aid prototype using the Ottawa Decision Support Framework. Second, we will perform a mixed-methods alpha test of the decision aid prototype with patients and clinicians experienced in acute Achilles tendon ruptures. Outcomes measured will include acceptability and usability of the patient decision aid measured using validated outcome scales and semi-structured interviews. A minimum of three rounds of feedback will be obtained. Results will be analyzed using descriptive statistics, reviewed by the steering group, to guide revisions to decision aid prototype at each round. The third stage will be field testing the revised decision aid prototype in usual clinical care. A pre-/post-study will be performed with patients with acute Achilles tendon ruptures. Patients will be recruited from the emergency department and complete the pre-consultation decision aid prior to a one-week follow up with their surgeon. The primary outcome of field testing will be feasibility of implementing the decision aid in the clinical setting and will be measured with recruitment and completion metrics. Secondary outcomes include acceptability of the decision aid, knowledge, preparedness for decision making, and decisional conflict, measured using validated outcome measures. Statistical analysis will be performed using descriptive analysis for primary outcomes and a student t-test and Wilcoxon Rank-Sum test for secondary outcomes.

Discussion

This comprehensive study protocol outlines the development, alpha testing, and field testing of a patient decision aid for patients with acute Achilles tendon rupture. Systematic and transparent development and testing of patient decision aids is critical to improve decision aid quality.

Trial registration Not Applicable.
Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania
Authors: Mwansisya Tumbwene , Mbekenga Columba , Isangula Kahabi , Mwasha Loveluck , Pallangyo Eunice , Edwards Grace , Orwa James , Mantel Michaela , Mugerwa Micheal , Subi Leonard , Mrema Secilia , Siso David , Selestine Edna , Temmerman Marleen
Published: July 2021

Background

Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs.

Methods

A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ).

Results

In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1.

Conclusions

The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.
Patients’ and professionals’ perspectives on implementation of opportunistic salpingectomy: a mixed-method study
Authors: Gelderblom Malou E. , Van Lieshout Laura A. M. , Piek Jurgen M. J. , De Hullu Joanne A. , Hermens Rosella P. M. G.
Published: July 2021

Background

To prevent ovarian cancer, several international societies have issued guidelines which recommend to discuss opportunistic salpingectomy with women undergoing pelvic surgery after completion of childbearing. The opportunistic salpingectomy refers to the additional removal of Fallopian tubes during pelvic surgery for another indication to reduce the risk of developing ovarian cancer. These recommendations emphasize the importance of counselling on benefits and risks of opportunistic salpingectomy but offer no guidance on their implementation in daily practice. The lack of a tailored implementation strategy has resulted in a wide variation in current practice. To reduce this practice variation, we identified influencing factors on implementing opportunistic salpingectomy from patients’ and professionals’ perspectives.

Methods

We conducted a mixed-method study between 2019 and 2020 throughout the Netherlands. In a qualitative phase, we conducted interviews with gynecologic patients (N = 11) and their professionals (N = 20) to explore barriers and facilitators, using an interview guide. In the quantitative phase, we quantified these barriers and facilitators among patients who underwent a hysterectomy or sterilization and were counselled on the opportunistic salpingectomy (N = 77), and members of the Dutch Society of Obstetrics and Gynecology (N = 204), using questionnaires. For both phases, barriers and facilitators were classified into the following domains: innovation, patient, healthcare professional, social setting, organization, and economic and political context.

Results

For patients, main barriers were lack of knowledge about: the existence of the opportunistic salpingectomy (45%), size of the surgery (44%) and its associated possible disadvantages (37%). In addition, patients attributed their reluctance to concerns about the removal of healthy organs (46%). For professionals, main barriers were: patients’ lack of knowledge of the size of surgery (85%) and its associated possible disadvantages (77%), the gap in evidence on long term risks and benefits (43%), the lack of feasibility in certain patients and during vaginal surgery (66%). Both patients (41%) and professionals (67%) identified the need for counselling material as facilitator.

Conclusion

To reduce the variety in care regarding opportunistic salpingectomy, consensus and uniform counselling is needed. Including the opportunistic salpingectomy in gynecological guidelines and a decision aid for counselling could serve as tools to facilitate implementation.
Production of trans-cinnamic acid by whole-cell bioconversion from l-phenylalanine in engineered Corynebacterium glutamicum
Authors: Son Jaewoo , Jang Jun Hong , Choi In Hyeok , Lim Chang Gyu , Jeon Eun Jung , Bae Bang Hyun , Jeong Ki Jun
Published: July 2021

Background

trans-cinnamic acid (t-CA) is a phenylpropanoid with a broad spectrum of biological activities including antioxidant and antibacterial activities, and it also has high potential in food and cosmetic applications. Although significant progress has been made in the production oft-CA using microorganisms, its relatively low product titers still need to be improved. In this study, we engineeredCorynebacterium glutamicumas a whole-cell catalyst for the bioconversion ofl-phenylalanine (l-Phe) intot-CA and developed a repeated bioconversion process.

Results

An expression module based on a phenylalanine ammonia lyase-encoding gene fromStreptomyces maritimus(SmPAL), which mediates the conversion ofl-Phe intot-CA, was constructed inC. glutamicum. Using the strong promoter PH36and ribosome binding site (RBS) (in front of gene 10 of the T7 phage), and a high-copy number plasmid, SmPAL could be expressed to levels as high as 39.1% of the total proteins inC. glutamicum. Next, to improvet-CA production at an industrial scale, reaction conditions including temperature and pH were optimized;t-CA production reached up to 6.7 mM/h in a bioreactor under optimal conditions (50 °C and pH 8.5, using NaOH as base solution). Finally, a recycling system was developed by coupling membrane filtration with the bioreactor, and the engineeredC. glutamicumsuccessfully produced 13.7 mM oft-CA (24.3 g) from 18.2 mM ofl-Phe (36 g) and thus with a yield of 75% (0.75 mol/mol) through repetitive supplementation.

Conclusions

We developed a highly efficient bioconversion process usingC. glutamicumas a biocatalyst and a micromembrane-based cell recycling system. To the best of our knowledge, this is the first report ont-CA production inC. glutamicum, and this robust platform will contribute to the development of an industrially relevant platform for the production oft-CA using microorganisms.
Cobalt-doped bioceramic scaffolds fabricated by 3D printing show enhanced osteogenic and angiogenic properties for bone repair
Authors: Li Jungang , Zhao Chaoqian , Liu Chun , Wang Zhenyu , Ling Zeming , Lin Bin , Tan Bizhi , Zhou Linquan , Chen Yan , Liu Delong , Zou Xuenong , Liu Wenge
Published: July 2021

Background

The bone regeneration of artificial bone grafts is still in need of a breakthrough to improve the processes of bone defect repair. Artificial bone grafts should be modified to enable angiogenesis and thus improve osteogenesis. We have previously revealed that crystalline Ca10Li(PO4)7 (CLP) possesses higher compressive strength and better biocompatibility than that of pure beta-tricalcium phosphate (β-TCP). In this work, we explored the possibility of cobalt (Co), known for mimicking hypoxia, doped into CLP to promote osteogenesis and angiogenesis.

Methods

We designed and manufactured porous scaffolds by doping CLP with various concentrations of Co (0, 0.1, 0.25, 0.5, and 1 mol%) and using 3D printing techniques. The crystal phase, surface morphology, compressive strength, in vitro degradation, and mineralization properties of Co-doped and -undoped CLP scaffolds were investigated. Next, we investigated the biocompatibility and effects of Co-doped and -undoped samples on osteogenic and angiogenic properties in vitro and on bone regeneration in rat cranium defects.

Results

With increasing Co-doping level, the compressive strength of Co-doped CLP scaffolds decreased in comparison with that of undoped CLP scaffolds, especially when the Co-doping concentration increased to 1 mol%. Co-doped CLP scaffolds possessed excellent degradation properties compared with those of undoped CLP scaffolds. The (0.1, 0.25, 0.5 mol%) Co-doped CLP scaffolds had mineralization properties similar to those of undoped CLP scaffolds, whereas the 1 mol% Co-doped CLP scaffolds shown no mineralization changes. Furthermore, compared with undoped scaffolds, Co-doped CLP scaffolds possessed excellent biocompatibility and prominent osteogenic and angiogenic properties in vitro, notably when the doping concentration was 0.25 mol%. After 8 weeks of implantation, 0.25 mol% Co-doped scaffolds had markedly enhanced bone regeneration at the defect site compared with that of the undoped scaffold.

Conclusion

In summary, CLP doped with 0.25 mol% Co2+ ions is a prospective method to enhance osteogenic and angiogenic properties, thus promoting bone regeneration in bone defect repair.
A spotlight on lime: a review about adverse reactions and clinical manifestations due to Citrus aurantiifolia
Authors: Alessandrello Clara , Gammeri Luca , Sanfilippo Serena , Cordiano Raffaele , Brunetto Silvia , Casciaro Marco , Gangemi Sebastiano
Published: July 2021

Lime (Citrus aurantiifolia) is a plant belonging to the family of Rutaceae and to the genus Citrus. The fruit is widely used in the United States, Mexico, Southeast Asia, Latin America, but is increasingly widespread all over the world. It is used as a fresh fruit, in the preparation of foods, sweets and drinks and its oils are used in the cosmetic and pharmaceutical industry. The main adverse reactions to lime seem to be represented by contact dermatitis, allergic and phototoxic type. In the context of allergic forms, several allergens have been identified in the citrus family, the main one being limonene, but no noteworthy cross-reactivity has been identified. However, a case of fruit protein contact dermatitis has been described, showing sensitization to other fruits, such as kiwi, avocado, pineapple and apple. There are several molecules responsible for phototoxic reactions and mainly belonging to the coumarin and furocoumarins families. Reactions related to ingesting the fruit or inhaling pollen from the tree appear to be rare, as there are no known cases reported in the literature. The increasing diffusion of lime in Europe must pay attention to possible adverse reactions due to contact with this fruit, which seem destined to increase in future years. Further importance must be placed on patch tests and on the possibility of using alternative extracts to classic fragrance mixes.
Standard multiple imputation of survey data didn’t perform better than simple substitution in enhancing an administrative dataset: the example of self-rated health in England
Authors: Popham Frank , Whitley Elise , Molaodi Oarabile , Gray Linsay
Published: July 2021

Background

Health surveys provide a rich array of information but on relatively small numbers of individuals and evidence suggests that they are becoming less representative as response levels fall. Routinely collected administrative data offer more extensive population coverage but typically comprise fewer health topics. We explore whether data combination and multiple imputation of health variables from survey data is a simple and robust way of generating these variables in the general population.

Methods

We use the UK Integrated Household Survey and the English 2011 population census both of which included self-rated general health. Setting aside the census self-rated health data we multiply imputed self-rated health responses for the census using the survey data and compared these with the actual census results in 576 unique groups defined by age, sex, housing tenure and geographic region.

Results

Compared with original census data across the groups, multiply imputed proportions of bad or very bad self-rated health were not a markedly better fit than those simply derived from the survey proportions.

Conclusion

While multiple imputation may have the potential to augment population data with information from surveys, further testing and refinement is required.
An immunotherapeutic approach to decipher the role of long non-coding RNAs in cancer progression, resistance and epigenetic regulation of immune cells
Authors: Varier Krishnapriya M. , Dhandapani Hemavathi , Liu Wuling , Song Jialei , Wang Chunlin , Hu Anling , Ben-David Yaacov , Shen Xiangchun , Li Yanmei , Gajendran Babu
Published: July 2021

Immunotherapeutic treatments are gaining attention due to their effective anti-tumor response. Particularly, the revolution of immune checkpoint inhibitors (ICIs) produces promising outcomes for various cancer types. However, the usage of immunotherapy is limited due to its low response rate, suggesting that tumor cells escape the immune surveillance. Rapid advances in transcriptomic profiling have led to recognize immune-related long non-coding RNAs (LncRNAs), as regulators of immune cell-specific gene expression that mediates immune stimulatory as well as suppression of immune response, indicating LncRNAs as targets to improve the efficacy of immunotherapy against tumours. Moreover, the immune-related LncRNAs acting as epigenetic modifiers are also under deep investigation. Thus, herein, is a summarised knowledge of LncRNAs and their regulation in the adaptive and innate immune system, considering their importance in autophagy and predicting putative immunotherapeutic responses.
Differences in oxylipin profile in psoriasis versus psoriatic arthritis
Authors: Coras Roxana , Kavanaugh Arthur , Kluzniak Angela , Holt Dustina , Weilgosz Amy , Aaron Armando , Quehenberger Oswald , Ritchlin Christopher , Guma Monica
Published: July 2021

Background

Oxylipins are biological lipids that have been implicated in inflammation. We previously found that certain oxylipins correlated with clinical manifestations in psoriatic arthritis (PsA) patients. Here, we compare oxylipin profiles in PsA patients and those with psoriasis (PsO) without inflammatory arthritis to identify oxylipins that associate with specific disease manifestations to better understand disease pathogenesis and identify new biomarkers.

Methods

Consecutive patients with PsA (who met the CASPAR classification criteria for PsA) and PsO were recruited from the Rheumatology Outpatient Clinic. A thorough clinical examination was performed, including entheseal (Leeds enthesitis index (LEI)) and joint involvement (SJC/TJC 66/68). Patients were evaluated for pain and global disease activity on a visual analog scale (VAS) ranging from 0 to 100. This was followed by disease activity scores calculation: cDAPSA (Disease Activity Index for Psoriatic Arthritis) and Psoriasis Area and Severity Index (PASI). Serum oxylipins were determined by mass spectrometry and their association with clinical characteristics (PASI/LEI and cDAPSA) was analyzed using Metaboanalyst 4.0 and R version 3.6.1.

Results

Twenty PsO (average age 52 [10.8], 55% males) and 19 PsA patients (average age 60.5 [11.4], 63.1% males) were included. PsO patients had an average body mass index (BMI) of 33.7 (6.84) and an average PASI of 3.8 (4.2). PsA patients had an average BMI of 31.9 (5.6), TJC of 9.3 (10.41), SJC of 3.7 (4.23), with an average cDAPSA of 23.3 (11.4). 63.1% of PsA patients had enthesitis (average LEI 2.2 [3]) and the same percentage had psoriasis (average PASI 3(5]). Sera were analyzed for oxylipin levels. PsO and PsA patients with higher PASI score (> 2.5) had significantly lower serum concentrations of pro-inflammatory oxylipins, most of them arachidonic acid derived (AA). Oxylipin profiling did not associate with cDAPSA. Interestingly, several AA-derived oxylipins (5,15 di-HETE (5S,15S-dihydroxy-6E,8Z,10Z,13E-eicosatetraenoic acid), 5-oxoETE (5-Oxo-eicosatetraenoic acid), PGE2 (prostaglandin E2), 11bPGE2 (11 beta prostaglandin D2), and LTB4 (leukotriene B4)) were significantly increased in PsA patients with enthesitis compared to those without.

Conclusions

The AA-derived proinflammatory oxylipins were lower in both PsO and PsA patients with higher skin scores. Joint disease activity was not associated with the concentrations of oxylipins. Yet, enthesitis was associated with an increase of AA-derived pro-inflammatory oxylipins in PsA patients. Further studies are needed to determine whether oxylipin profiling can be a good biomarker of enthesitis in PsA patients.
Multispectral intravital microscopy for simultaneous bright-field and fluorescence imaging of the microvasculature
Authors: Janssen Barry G. H. , Najiminaini Mohamadreza , Zhang Yan Min , Omidi Parsa , Carson Jeffrey J. L.
Published: July 2021

Intravital video microscopy permits the observation of microcirculatory blood flow. This often requires fluorescent probes to visualize structures and dynamic processes that cannot be observed with conventional bright-field microscopy. Conventional light microscopes do not allow for simultaneous bright-field and fluorescent imaging. Moreover, in conventional microscopes, only one type of fluorescent label can be observed. This study introduces multispectral intravital video microscopy, which combines bright-field and fluorescence microscopy in a standard light microscope. The technique enables simultaneous real-time observation of fluorescently-labeled structures in relation to their direct physical surroundings. The advancement provides context for the orientation, movement, and function of labeled structures in the microcirculation.
Heterogeneity of government social spending in European Union countries
Authors: Korzeniowska Anna Magdalena
Published: July 2021

Social expenditure plays an important role in European Union (EU) countries. It improves the lives of citizens whose welfare is endangered due to poverty or illness. However, social expenditure represents a considerable share of the budgets of EU member states. Despite evident similarities in their levels of development, EU countries show apparent differences in social expenditure levels. Therefore, this work aims to determine the similarities and differences between EU countries in this regard. The analysis uses clustering methods, such as hierarchical cluster analysis and the k-means, to divide countries into homogeneous groups. The research demonstrates significant differences between EU countries in the years 2008–2018, which resulted in a low number of objects (countries) in the identified groups. In the case of 6 out of 28 countries, it was not possible to assign them to any group. The research proves that EU countries should take more care when organising their social policy, taking into consideration cultural and social factors.
Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis
Authors: Ku Eu Jeong , Yoo Won Sang , Lee Eun Kyung , Ahn Hwa Young , Woo Seung Hoon , Hong Jun Hwa , Chung Hyun Kyung , Park Jin-Woo
Published: July 2021

Context

Because subclinical hyperthyroidism increases the risk of osteoporosis and fractures, concerns are growing about the long-term skeletal safety of TSH suppression therapy after total thyroidectomy in patients with differentiated thyroid cancer (DTC).

Objective

We aimed to determine the effect of TSH suppression therapy on bone mineral density (BMD) in DTC patients.

Methods

We searched PubMed, Embase, the Cochrane library, and other sources. Eligible observational studies included DTC patients who underwent TSH suppression therapy and BMD measurement. Two independent reviewers extracted data on the studies’ characteristics and outcomes and determined their risk of bias. Data were extracted from each study for postmenopausal/premenopausal women’s and men’s lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD and summed using a random-effects meta-analysis model. The weighted mean differences with 95% CIs are expressed for the differences in outcome measurements between groups.

Results

Seventeen studies (739 patients and 1085 controls) were included for quantitative analysis. In postmenopausal women, TSH suppression therapy showed a significant decrease in LS BMD (-0.03; -0.05, -0.02), and a similar trend was seen in TH. In premenopausal women, TSH suppression therapy significantly increased LS BMD (0.04; 0.02, 0.06) and FN BMD (0.02; 0.01, 0.04). In men, there was no significant association between TSH suppression therapy and BMD at any site compared with the controls.

Conclusion

Evidence from observational studies suggests that postmenopausal women treated with TSH suppression therapy are at risk for lower BMD. Attention should be paid to long-term skeletal safety in DTC survivors.
Associations of Body Mass Index and Waist Circumference in Young Adulthood with Later Life Incident Diabetes
Authors: Nair Nandini , Vittinghoff Eric , Pletcher Mark J , Oelsner Elizabeth C , Allen Norrina B , Ndumele Chiadi E , West Nancy A , Strotmeyer Elsa S , Mukamal Kenneth J , Siscovick David S , Biggs Mary L , Laferrère Blandine , Moran Andrew E , Zhang Yiyi
Published: July 2021

Context

The independent contribution of young adult exposure to overweight and obesity to later-life incident diabetes is not well studied.

Objective

To assess the associations of exposures to elevated body mass index (BMI) and waist circumference (WC) in young adulthood (ages 18-39 years) with incident diabetes later in life (≥40 years).

Design

Pooled data from 6 US prospective cohorts (Atherosclerosis Risk in Communities Study, Cardiovascular Risk Development in Young Adults Study, Cardiovascular Health Study, (4) Framingham Heart Study Offspring Cohort, (5) Health, Aging and Body Composition Study, and (6) Multi-Ethnic Study of Atherosclerosis.

Setting

Population-based cohort studies.

Participants

30 780 participants (56.1% female, 69.8% non-Hispanic white) without a diagnosis of diabetes by age 40.

Interventions

We imputed BMI and WC trajectories from age 18 for every participant and estimated time-weighted average exposures to BMI or WC during young adulthood and later life.

Main Outcome Measure(s)

Incident diabetes defined as fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, or use of diabetes medications.

Results

During a 9-year median follow-up, 4323 participants developed incident diabetes. Young adult BMI and WC were associated with later-life incident diabetes after controlling for later-life exposures [hazard ratios (HR) 1.99 for BMI ≥ 30 kg/m2 and 2.13 for WC > 88cm (women)/>102cm (men) compared to normal ranges]. Young adult homeostatic model of insulin resistance mediated 49% and 44% of the association between BMI and WC with later-life incident diabetes. High-density lipoproteins and triglycerides mediated a smaller proportion of these associations.

Conclusions

Elevated BMI and WC during young adulthood were independently associated with later-life incident diabetes. Insulin resistance may be a key mediator.
Associations Between Diabetes and Idiopathic Pulmonary Fibrosis: a Study-level Pooled Analysis of 26 Million People
Authors: Li Chenyu , Xiao Yang , Hu Jingyi , Hu Zhuowei , Yan Jianru , Zhou Zhiguang , Mei Zubing
Published: July 2021

Context

Diabetes mellitus (DM) is a systemic disease characterized by chronic hyperglycemia associated with inflammation and oxidative stress, and the lung may be a target organ of diabetic microvascular damage. Several studies have indicated a positive association between idiopathic pulmonary fibrosis (IPF) and diabetes with controversial findings.

Objective

Primary outcomes were to compare the prevalence of DM among individuals with IPF to non-IPF controls, and the prevalence of IPF among individuals with DM to non-DM controls.

Methods

Data sources include PubMed, EMBASE, and the Cochrane Library. Studies contained sufficient data to calculate the prevalence of DM among individuals with and without IPF, or the prevalence of IPF among individuals with and without DM. Two investigators independently identified eligible studies and extracted data. Pooled odds ratio (OR) with 95% CI was the summary effect measure.

Results

Eighteen studies including 26 410 623 individuals met the eligibility criteria, of whom 16 recruited people with IPF and 2 recruited people with DM. The OR of DM in IPF patients was 1.54 (95% CI, 1.30-1.84; P < .001) compared to that in non-IPF controls. However, compared with that in non-DM patients, the risk of IPF in DM patients was not found to be significantly reduced (OR: 0.89; 95% CI, 0.64-1.25; P = .497).

Conclusion

This meta-analysis suggests that people with IPF have 1.54 times increased odds of diabetes compared to non-IPF controls, while whether patients with DM have an increased risk of IPF is still controversial. Further large, prospective cohort studies investigating the prevalence of IPF in diabetic patients are warranted.
Predicting Early and Late Readmissions Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Authors: Moon Eui Whan , Wong Jolene Si Min , See Amanda Hui Min , Ong Whee Sze , Tan Chee Ann , Ong Chin-Ann Johnny , Chia Claramae Shulyn , Soo Khee Chee , Teo Melissa Ching Ching , Tan Grace Hwei Ching
Published: July 2021

Background

Postoperative readmissions not only burden the healthcare system but may also affect clinical outcomes of cancer patients. Despite this, little is known about readmissions after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), or their impact on survival outcomes.

Patients and Methods

A single-institution retrospective cohort study of CRS-HIPEC procedures from April 2001 and September 2019 was performed. Early readmission (ERA) was defined as hospitalization within 30 days of discharge post-CRS/HIPEC, while late readmission (LRA) was defined as hospitalization between day 31 and 90 after discharge. Patient demographic, oncological, and perioperative factors were analyzed to identify predictors of readmission, and comparison of survival outcomes was performed.

Results

Overall, 342 patients who underwent CRS-HIPEC were included in the study. The incidence of ERA and LRA was 18.5% and 7.4%, respectively. High-grade postoperative complication was the only independent predictor of ERA (HR 3.64, 95% CI 1.47–9.02), while comorbid hypertension (HR 2.71, 95% CI 1.17–6.28) and stoma creation (HR 2.83, 95% CI 1.23–6.50) were independent predictors for LRA. Patients with readmission had significantly worse disease-free survival than patients who had no readmission (NRA) (LRA 1.1 years, ERA 1.2 years, NRA 1.8 years, p = 0.002), and patients with LRA had worse median overall survival (2.1 years) than ERA patients (3.3 years) or patients without readmission (4.4 years) (p < 0.001).

Conclusions

Readmission following CRS-HIPEC is associated with adverse survival outcomes. In particular, LRA may portend worse prognosis than ERA.
Controversial Areas in Axillary Staging: Are We Following the Guidelines?
Authors: Armani Ava , Douglas Sasha , Kulkarni Swati , Wallace Anne , Blair Sarah
Published: July 2021

Background

Sentinel lymph node biopsy (SLNB) has been the standard of care for clinically node-negative women with invasive breast cancer (IBC); however, there is less agreement on whether to perform SLNB when the risk of metastasis is low or when it does not affect survival or locoregional control.

Methods

An Institutional Review Board-approved survey was sent to members of the American Society of Breast Surgeons asking in which scenarios surgeons would recommend SLNB. Descriptive statistics and multivariable analysis were performed using SPSS software.

Results

There was a 23% response rate; 68% identified as breast surgical oncologists, 6% as surgical oncologists, 24% as general surgeons, and 2% as other. The majority practiced in a community setting (71%) versus an academic setting (29%). In a healthy female with clinical T1N0 hormone receptor-positive (HR+) IBC, 83% favored SLNB if the patient was 75 years of age, versus 35% if the patient was 85 years of age. Academic surgeons were less likely to perform axillary staging in a healthy 75-year-old (odds ratio [OR] 0.51 [0.32–0.80], p = 0.004) or a healthy 85-year-old (OR 0.48 [0.31–0.74], p = 0.001). For DCIS, 32% endorsed SLNB in women undergoing lumpectomy, with breast surgical oncologists and academic surgeons being less likely to endorse this procedure (OR 0.54 [0.36–0.82], p = 0.028; and OR 0.53 [0.34–0.83], p = 0.005, respectively).

Conclusions

Despite studies showing that omitting SLNB in older patients with HR+ IBC does not impact regional control or survival, most surgeons are still opting for axillary staging. In addition, one in three are performing SLNB for lumpectomies for DCIS. Breast surgical oncologists and academic surgeons were more likely to be practicing based on recent data and guidelines. Practice patterns are changing but there is still room for improvement.
Sustainable oral healthcare and the environment: mitigation strategies
Authors: Martin Nicolas , Smith Lucy , Mulligan Steven
Published: July 2021

Carbon emissions and single-use plastics (SUPs) are the main forms of environmental pollution relating to waste arising from oral healthcare. Ownership of this problem is shared with the whole supply chain, from manufacturing to distribution, procurement, clinical use and finally, waste management. Mitigation strategies focus on the individual stakeholders in the supply chain, including the provision of clinical care. Key to this is establishing a baseline analysis of the nature and the size of the problem through life cycle assessments (LCAs). Reduction of CO2 emissions, other associated environmental impacts and plastic waste is considered through remote clinical consultations, recycling, patient education and the provision of high-quality care to achieve high impact environmentally sustainable outcomes.

CPD/Clinical Relevance: Environmentally sustainable oral healthcare requires the combined efforts of all stakeholders across the supply chain. The provision of good oral healthcare can deliver environmentally sustainable outcomes from a reduced need for interventions.
Minimally invasive management of erosive tooth surface loss using a combined direct and indirect approach: a case report
Authors: Pirmohamed Salman
Published: July 2021

This article describes the management of a patient with generalized (primarily erosive) tooth surface loss. It specifically looks at minimally invasive techniques using improvements in material science to achieve this in an efficient and predictable manner within a general dental practice setting.

CPD/Clinical Relevance: The use of minimally invasive techniques within a general dental practice setting are highlighted.
Cleft lip and palate in general dental practice: filling in the gaps
Authors: Reddy Sharan , Liu Catherine , Vaidyanathan Mina , Bhujel Nabina
Published: July 2021

Cleft lip and palate (CLP) is the most common of craniofacial anomalies in humans. CLP results from disruption of embryonic processes during orofacial development; while syndromic clefts may have clearer aetiology, non-syndromic clefts are heterogeneous in aetiology. It is important for GDPs to understand the classification of CLP and the structure of centralized cleft centres in order to communicate with cleft teams. This article aims to clarify the role of GDPs within cleft management and discusses challenges in maintaining oral health in this group of patients, including increased risk of dental caries and periodontal disease, dental anomalies and psychosocial considerations.

CPD/Clinical Relevance: The GDP should be responsible for maintaining good oral health for the patient with cleft lip and palate, focusing on prevention from a young age and restorative work if needed.
Get Smart – technological innovations in endodontics part 2: case-difficulty assessment and future perspectives
Authors: Shah Pratik Kamalkant , Zhang Qianni , Chong Bun San
Published: July 2021

Given the importance of risk management to avoid mishaps, to achieve a quality result and to ensure a favourable outcome, challenging endodontic cases are best treated by clinicians with the appropriate level of training and experience. Digital and technological innovations in endodontics have led to the development of web-based and smartphone-compatible case-difficulty assessment tools that can help less-experienced dentists identify endodontic management complexities. These interactive tools may also be used for other applications, including primary and secondary care triage, research and dental education. Similarly, advances such as artificial intelligence and mixed reality technologies, are predicted to also benefit endodontics and help support dentists in the management of complex endodontic cases.

CPD/Clinical Relevance: Digital and technological developments may help improve the management and treatment of endodontic cases.
Can implant-retained overdenture components cause damage to the opposing natural dentition?
Authors: Razaghi Nahal , Hughes Mike , Patel Mital
Published: July 2021

This clinical case series highlights an under-reported and often unidentified complication of implant-retained overdentures that may leave patients with a risk of long-term discomfort and preventable damage to the opposing dentition. A variety of cases is discussed to demonstrate potential problems and symptoms that can flag up signs of parafunctional habits in implant patients, and how these can be managed successfully.

CPD/Clinical Relevance: Implant-retained overdentures provide a significant improvement in quality of life; however, careful patient assessment and management is essential to ensure the components do not cause damage to the opposing dentition.
The twin-block appliance for correction of class II division 1 malocclusion
Authors: Salloum Erfan , Millett Declan T , McIntyre Grant T
Published: July 2021

The twin-block appliance is a widely used functional appliance for the correction of Class II division 1 malocclusion in growing children and adolescents. This article outlines the indications and case assessment, the steps in clinical management and appliance design. Evidence regarding the mode of action, effects and prediction of treatment outcome of the twin-block appliance for Class II division 1 malocclusion are also presented.

CPD/Clinical Relevance: The twin-block appliance is a widely used functional appliance in the UK for the correction of Class II division 1 malocclusion in growing children and adolescents.
Making an open-tray implant or abutment-level impression technique easier
Authors: Ikram Javed , Essa Nabeel
Published: July 2021

Various methods exist for taking implant impressions. The open-tray or pick-up impression technique is one of the conventional methods for transferring the impression coping from the implant to the impression. In this method, a window directly above the implant is made in a stock or custom tray to allow access to the impression coping. Traditionally, the window is either left open, or closed with melted wax or foil. This technique tip describes a modification to create a stable and secure seal over the opening using rayon-based adhesive tapes. The benefits of this modification over the conventional open-tray technique are due to the enhanced adhesive quality of the materials to metal or plastic. Because there is less chance of impression material leaking from the tray window into the mouth, it is more comfortable for patients and less messy for clinicians. The benefit of this method over the closed-tray technique is the ability to feel for the head of the impression coping at the same time as making sure the impression material is in good contact with the underlying structures. It is easy to use, and efficient in terms of time and cost.
Error analysis of the generalized low-rank matrix approximation
Authors: Soto-Quiros Pablo
Published: July 2021

In this paper, we propose an error analysis of the generalized low-rank approximation, which is a generalization of the classical approximation of a matrix $A\in\mathbb{R}^{m\times n}$ by a matrix of a rank at most $r$, where $r\leq\min\{m,n\}$.
Development of socio-economic gaps in children’s language skills in Germany
Authors: Schneider Thorsten , Linberg Tobias
Published: July 2021

Gaps in language skills by socio-economic status (SES) are already evident before school entry, and these gaps may change over time. After discussing mechanisms of cumulative advantages (‘Matthew effects’) and compensatory effects as well as the relevance of cultural capital and child-related activities in families, this paper tests mechanisms behind changing SES gaps in language skills from age five to nine in Germany. Analysing data from the German National Educational Panel Study with growth curve models, we find widening SES gaps in children’s vocabulary. Children of mothers with low educational attainment show a far below-average increase in skills. The findings are in line with cumulative advantage by status, although initial skills predict their growth over time as well. There are no signs of any type of compensatory effects. Reading aloud to children appears to substantially impact and mediate SES differences in vocabulary progress.
Lifetime-tunable green room temperature phosphorescence of carbon dots by the multi-step modification
Authors: Huang Jinshu , Zhu Jinyang , Yang Gang , Zhu Yongsheng , Xu Xiumei , Pan Gencai
Published: July 2021

As an emerging class of luminescent materials, Carbon dots (CDs) have attracted tremendous attention in the metal-free room temperature phosphorescence (RTP) material, but the methods to enhance the emission intensity and prolonging the lifetime of RTP CDs were seldom reported. Herein, we developed a method to improve the emission intensity and increase the lifetime of green RTP CDs. The RTP lifetime of CDs has been extended about 12-fold (from 45 to 550 ms) through introducing polymer and the secondary modification of urea realized by means of heat treatment. Moreover, the emission intensity of RTP CDs has been increased about 20 times. It has been found that the improvement of RTP lifetime and emission intensity is benefited from the decreasing vibration and rotation of the excited triplet species, thus suppressing the non-radiative transitions. Furthermore, the prepared CDs with strong RTP both exhibit great potential in light-emitting diodes and anti-counterfeiting application.