bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study
Authors: Roldán-Sarmiento Paola , Lam-Chung César Ernesto , Hinojosa-Amaya José Miguel , Morales-García Mariana , Guillén-Placencia María Fernanda , Pérez-Flores Greta E , León-Suárez Andrés , León-Domínguez Jefsi , Balbuena-Álvarez Salvador , Nava de la Vega Alfredo , Pérez-Guzmán Citlalli Mireya , Gómez-Sámano Miguel Ángel , Enríquez-Estrada Víctor , Gómez-Pérez Francisco J , Cuevas-Ramos Daniel 
Published: October 2020

Abstract

Context
Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population.

Objective
This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortality.

Design
We conducted a longitudinal cohort study in a 3rd level specialty center, from 1979 to 2018, in patients with CD.

Results
From 1375 cases with a pathology diagnosis of pituitary adenoma, 191 cases had the confirmed diagnosis of CD (14%). A total of 172 patients completed follow-up, with a mean age at diagnosis of 33 ± 11 years, female predominance (n = 154, 89.5%), majority of them with microadenoma (n = 136, 79%), and a median follow-up of 7.5 years (2.4–15). Eighteen patients (10.5%) died, 8 of them (44%) were with active CD, 8 (44%) were under remission, and 2 (11%) were under disease control. Estimated all-cause SMR = 3.1, 95% confidence interval (CI) 1.9–4.8, P &lt; 0.001. Cardiovascular disease was the main cause of death (SMR = 4.2, 1.5–9.3, P = 0.01). Multivariate Cox regression models adjusted for potential cofounders showed that diabetes (HR = 5.2, IC 95% 1.8–15.4, P = 0.002), high cortisol levels after 1600 hours at diagnosis (3.4, 2.3–7.0, P = 0.02), and active CD (7.5, 3.8–17.3, P = 0.003) significantly increased the risk of mortality.

Conclusions
Main cause of CD mortality was cardiovascular disease. Main risk factors for mortality were uncontrolled diabetes, persistently high cortisol levels after 1600 hours at diagnosis, and active disease at last follow-up.
Association of Thyroid Hormone Therapy with Mortality in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis
Authors: Peng Carol Chiung-Hui , Huang Huei-Kai , Wu Brian Bo-Chang , Chang Rachel Huai-En , Tu Yu-Kang , Munir Kashif M 
Published: October 2020

Abstract

Context
Benefits of thyroid hormone therapy on mortality in adults with subclinical hypothyroidism remain undetermined.

Objective
To summarize the impact of thyroid hormone therapy on mortality in adults with subclinical hypothyroidism.

Data Sources
PubMed, Embase, Scopus, Web of Science, and Clinicaltrials.gov from inception until April 25, 2020.

Study Selection
Studies comparing the effect of thyroid hormone therapy with that of placebo or no therapy in adults with subclinical hypothyroidism on all-cause and/or cardiovascular mortality.

Data Extraction
Two reviewers independently extracted data and performed quality assessments. Random-effects models for meta-analyses were used.

Data Synthesis
Five observational studies and 2 randomized controlled trials with 21 055 adults were included. Overall, thyroid hormone therapy was not significantly associated with all-cause (pooled relative risk [RR] = 0.95, 95% confidence interval [CI]: 0.75-1.22, P = .704) or cardiovascular (pooled RR = 0.99, 95% CI: 0.82-1.20, P = .946) mortality. Subgroup analyses revealed that in younger adults (aged &lt;65-70 years), thyroid hormone therapy was significantly associated with a lower all-cause (pooled RR = 0.50, 95% CI: 0.29-0.85, P = .011) and cardiovascular (pooled RR = 0.54, 95% CI: 0.37-0.80, P = .002) mortality. However, no significant association between thyroid hormone therapy and mortality was observed in older adults (aged ≥65-70 years).

Conclusions
Use of thyroid hormone therapy does not provide protective effects on mortality in older adults with subclinical hypothyroidism. However, thyroid hormone therapy for subclinical hypothyroidism may show benefits on morality in adults aged &lt;65 to 70 years.
Antifibrogenic Activities of CYP11A1-derived Vitamin D3-hydroxyderivatives Are Dependent on RORγ
Authors: Janjetovic Zorica , Postlethwaite Arnold , Kang Hong Soon , Kim Tae-Kang , Tuckey Robert C , Crossman David K , Qayyum Shariq , Jetten Anton M , Slominski Andrzej T 
Published: October 2020

AbstractPrevious studies showed that noncalcemic 20(OH)D3, a product of CYP11A1 action on vitamin D3, has antifibrotic activity in human dermal fibroblasts and in a bleomycin mouse model of scleroderma. In this study, we tested the role of retinoic acid-related orphan receptor γ (RORγ), which is expressed in skin, in the action of CYP11A1-derived secosteroids using murine fibroblasts isolated from the skin of wild-type (RORγ +/+), knockout (RORγ -/-), and heterozygote (RORγ +/-) mice. CYP11A1-derived 20(OH)D3, 20,23(OH)2D3, 1,20(OH)2D3, and 1,20,23(OH)3D3 inhibited proliferation of RORγ +/+ fibroblasts in a dose-dependent manner with a similar potency to 1,25(OH)2D3. Surprisingly, this effect was reversed in RORγ +/- and RORγ -/- fibroblasts, with the most pronounced stimulatory effect seen in RORγ -/- fibroblasts. All analogs tested inhibited TGF-β1-induced collagen synthesis in RORγ +/+ fibroblasts and the expression of other fibrosis-related genes. This effect was curtailed or reversed in RORγ -/- fibroblasts. These results show that the antiproliferative and antifibrotic activities of the vitamin D hydroxy derivatives are dependent on a functional RORγ. The dramatic changes in the transcriptomes of fibroblasts of RORγ -/- versus wild-type mice following treatment with 20(OH)D3 or 1,20(OH)2D3 provide a molecular basis to explain, at least in part, the observed phenotypic differences.
Robotic-assisted total knee arthroplasty demonstrates decreased postoperative pain and opioid usage compared to conventional total knee arthroplasty
Authors: Bhimani Samrath J. , Bhimani Rohat , Smith Austin , Eccles Christian , Smith Langan , Malkani Arthur 
Published: October 2020

AimsRobotic-assisted total knee arthroplasty (RA-TKA) has been introduced to provide accurate bone cuts and help achieve the target knee alignment, along with symmetric gap balancing. The purpose of this study was to determine if any early clinical benefits could be realized following TKA using robotic-assisted technology.MethodsIn all, 140 consecutive patients undergoing RA-TKA and 127 consecutive patients undergoing conventional TKA with minimum six-week follow-up were reviewed. Differences in visual analogue scores (VAS) for pain at rest and with activity, postoperative opiate usage, and length of stay (LOS) between the RA-TKA and conventional TKA groups were compared.ResultsPatients undergoing RA-TKA had lower average VAS pain scores at rest (p = 0.001) and with activity (p = 0.03) at two weeks following the index procedure. At the six-week interval, the RA-TKA group had lower VAS pain scores with rest (p = 0.03) and with activity (p = 0.02), and required 3.2 mg less morphine equivalents per day relative to the conventional group (p < 0.001). At six weeks, a significantly greater number of patients in the RA-TKA group were free of opioid use compared to the conventional TKA group; 70.7% vs 57.0% (p = 0.02). Patients in the RA-TKA group had a shorter LOS; 1.9 days versus 2.3 days (p < 0.001), and also had a greater percentage of patient discharged on postoperative day one; 41.3% vs 20.5% (p < 0.001).ConclusionPatients undergoing RA-TKA had lower pain levels at both rest and with activity, required less opioid medication, and had a shorter LOS.
Endodontic Risk Management: A Dento -Legal Perspective
Authors: Patel Shreeti , D'Cruz Len 
Published: October 2020

This article provides an overview of some of the issues in the assessment and management of endodontic patients which may lead to dento-legal problems. It covers assessment, the appropriate use of radiographs, special tests and the importance of following the correct consent process. It outlines why record-keeping is particularly important, and looks at problems that occur, such as perforation, fractured instruments and hypochlorite accidents. SUMMARY In common with other areas of dentistry there are risks in delivering endodontic treatment in general practice. Successful endodontic treatment combines a predictable technique, an understanding of ones limitations and excellent communication with patients. It must be remembered that complaints are not often about the treatment itself, but more commonly, due to the management of he patient. A happy patient is usually one that is no longer in pain.
Meeting Patient and Professional Needs: Views of Stakeholders on a Training Initiative for Dwsis in Endodonti CS in London
Authors: Al-Haboubi Mustafa , Newton Paul , Gallagher Jennifer E 
Published: October 2020

Background and aims A pilot scheme was established across London to train NHS primary dental care practitioners to provide endodontic treatment of moderate difficulty. It was co-led by the former London Deanery (Health Education England: North West London) and local NHS commissioners. This research aimed to explore key stakeholders’ perceptions about the purpose of the initiative, its advantages, disadvantages and future implications. Methods Nineteen semi-structured interviews were conducted with stakeholders (commissioners and providers of the educational initiative; commissioners and providers of care, including trainees, principal dentists and specialists) involved in establishing, running and participating in the initiative and wider endodontic service provision in London. Interviews were based on a topic guide informed by the literature, and a workshop involving the London trainees. Interviews were recorded, transcribed and analysed using framework methodology. Results The project was perceived as supporting four key areas: addressing services, improving quality/outcomes, delivering education and enhancing professional status. There was evidence that dentists were harnessing health policy in facilitating ‘reprofessionalisation’ of dentistry with the creation of dentists with enhanced skills (DwSIs). Learning outcomes from the pilot were related to the accreditation of the participants, service tariffs, reimbursement for endodontic treatment on the NHS, and the need for continuity within and between services across the dental system. Uncertainty about funding and the changes within the NHS were among the concerns expressed regarding the future of the initiative. Conclusion The findings of this research suggest that extending the skills of primary care practitioners may contribute to the reprofessionalisation of dentistry, which has much to contribute to patient care and the development of an integrated and accessible dental care system of quality, with improved outcomes for patients. The implications for health policy and further research are discussed.
The use of Miniscrews in Orthodontics: A Review of Selected Clinical Applications
Authors: Mizrahi Eliakim 
Published: October 2020

This paper provides a brief review of the history and development of mini screws and presents its structural features, with particular reference to the screw sizes relevant to clinical orthodontics, site selection and the different placement techniques. It covers the clinical applications of miniscrews, incorporating the principle of direct and indirect anchorage as well as the use of intraoral auxiliaries for distal movement of molars. The role of palatal miniscrews for retraction of anterior teeth, and when used in combination with buccal miniscrews for intrusion of buccal teeth is also covered along with the possible causes of miniscrew failure. Finally, a conclusion is put forward that the use of miniscrews in orthodontics has a valid clinical basis and will enhance the scope of orthodontic practice.
The Emergency Dental Appointment: Restorative Emergencies Part 1 – Tooth Related Problems
Authors: Rodriguez Jose M , Kalsi Harpoonam , Bavisha Kalpesh , Darbar Ulpee 
Published: October 2020

Dental emergencies affect a large proportion of the population. While there is ample information in the literature on how to manage medical emergencies in dental practice, there is little information on common dental emergencies and how to manage them. In the UK, the 2009 Adult Dental Health Survey reported 9% of dentate adults reporting pain at their clinical examination.1 The prevalence of non-pain related restorative dental emergencies is estimated to be higher, and will be a common presenting situation in the dental clinic. Often these unplanned events cause difficulties for dental practitioners, who are already constrained by time, to fit in these patients and manage them. Over and above this, the increasing life spans, retention of teeth into later life and finite life of dental restorations all add to the challenges encountered by the dental practitioner. Prompt and effective management of these conditions often leads to optimising patient experience, but also offers better outcomes. This two-part series provides an overview of the more common dental emergencies encountered by the dental practitioner and their management. Paper 1 focuses on the management of common tooth-related emergencies and includes non-odontogenic and odontogenic pain. Paper 2 focuses on the management of osseointegrated dental implant related emergencies.
Minimum Intervention (Ml) Oral Healthcare Delivery Implementation – Overcoming the Hurdles
Authors: Banerjee Avijit 
Published: October 2020

The United Nations Minamata Convention aims to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds. In those 55 countries signed up to it to date (the convention came into force in those countries on 16 August 2017), dental caries management has been thrust indirectly into the limelight once again via the resulting phase down and ultimately, phase out of dental amalgam as a restorative material.20 It is interesting how the dental profession has become fixated on the notion of a post-amalgam world, with significant efforts concentrating on trying to develop the perfect amalgam substitute restorative material to be used to 'treat’ caries. However, on more detailed examination of the treaty, it is abundantly clear that the United Nations and the WHO, at a global level, appreciates the significant concerns over the lack of an appropriate strategy of preventing this most prevalent of non-communicable diseases known to humankind in the modern world.1–4 Ml oral healthcare is very much now on this global agenda, with developing links between dental caries, general social health determinants and other health and social sectors, and will therefore help drive oral health change with implementation strategies at the population and individual level while also developing sustainable workforce development models globally. Even though minimally invasive surgical skills, procedures and materials need to be developed and taught, the principle consideration should be given as to how “all stakeholders can incite preventive behaviour change in all stakeholders.” This is the biggest challenge in delivering better oral health to current and future generations. The quest continues…
A Person-Centred Approach to Holistic Assessment
Authors: Mills Ian James 
Published: October 2020

Holistic assessment is an important aspect of providing high quality care focused on meeting a patient's individual needs. A holistic assessment should take into consideration the overall health of the patient, including their physical, psychological, social and spiritual wellbeing. This paper aims to clarify the meaning of 'holistic’ in relation to dentistry and describes how this relates to treating the person as a whole, rather than be aligned to any particular treatment philosophy. The importance of a person-centred approach in undertaking a holistic assessment is highlighted. A brief overview of the relational aspects of person-centred care (PCC) is provided and it is suggested that four key dimensions of PCC should be considered as important factors in holistic assessment: connection, caring attitude, communication and control.
Human Factors in Dentistry
Authors: Horton Michael A 
Published: October 2020

The term “human factors” has been batted around in the healthcare setting, and more recently in relation to dentistry. You may think this doesn't relate to you, but in reality, human factors encompass every member of the team in every process and procedure we carry out. It is by recognising that human factors exist that we also recognise that as professionals we cannot be perfect all the time. Recognising and attempting to mitigate those errors forms a fundamental part of human factors. In our everyday life we make numerous errors which have little consequence normally, but they are all the result of human factors. If we translate the causes of these to healthcare, then to be distracted, to change routine or not make a list, for example, has consequences that may be much more serious.
Grey Matters: 2006 and All That
Authors: Rattan Raj , D'Cruz Len 
Published: October 2020

The article is intended to put the current NHS dental contract in England into context and identify areas where there has been confusion about interpretation of certain clauses. The article describes these as grey areas and provides a rationale for logically interpreting these issues, such as urgent treatment, mixing NHS and private treatment and defining what a course of treatment is. These are the views of the authors based on significant personal experience of the contract, both as practitioners and as dento-legal advisers.
Accuracy of Intra-oral Scans Compared to Conventional Impression in Vitro
Authors: Haddadi Yasser , Bahrami Golnosh , Isidor Flemming 
Published: October 2020

AIM The purpose of the present study was to assess the accuracy of intra-oral scans and conventional impression measured at various points on a single tooth preparation. Methods Ten conventional silicone impressions, and ten intra oral-scans using eight different digital intra oral digital scanners were taken of a prepared master tooth. The conventional impressions were directly digitised using a laboratory scanner. Each scan/impression was superimposed on a high-accuracy digital model of the prepared master tooth. For each superimposition, the deviation from the prepared master tooth was measured at six points on four two-dimensional cross-sections. Data was analysed using two-way analysis of variance (ANOVA). Results Most intra oral scanners had lower accuracy at the preparation margin compared to smooth surfaces. When only conventional impression and the latest intra oral scanners of various manufacturers are considered, the mean discrepancy at the preparation margin was 50μm (SD 16) for conventional impression, 15μm (SD 4) for Trios 3, 26μm (SD 4) for LAVA TDS, 29μm (SD 7) for CEREC Omnicam, 30μm (SD 6) for CS 3600 and 64μm (SD 7) for GC Aadva. The increased accuracy of Trios 3 was statistically significant (p<0.05). Conclusions At the preparation margin, Trios 3 performed significantly better than conventional impression and the other intra oral scanners. LAVA TDS, CEREC Omnicam and CS3600 showed similar accuracy at the margin, yet better than conventional impression and GC Aadva.
The Management of Drug-Influenced Gingival Enlargement
Authors: Zoheir Noha , Hughes Francis J. 
Published: October 2020

Introduction Drug-influenced gingival enlargement (DIGE) is a reaction to specific medications, namely phenytoin, ciclosporin and calcium channel blockers. DIGE is encountered increasingly in clinical practice due to the widespread use of calcium channel blocker drugs particularly. Approaches to its management are discussed in this review. Methods Narrative review of the literature and discussion of clinical implications. Findings Management of DIGE involves nonsurgical treatment and may require surgical reduction of the overgrown gingival tissues. Management is complicated by the difficulties in achieving adequate plaque control, given the unfavourable contour of the enlarged gingival tissues, and the high frequency of recurrence of DIGE after surgical management. Replacing the drug involved can be very beneficial in selected cases, but the management of the underlying medical condition limits its application. The decision to replace a drug is not the responsibility of the dental practitioner, but the patient's physician may make it after consultation. Conclusions Management of DIGE can be challenging and may require close co-operation between the dental practitioner and a hygienist, a periodontist and the patient's physician. Long term supportive maintenance programmes need to be in place for optimal outcomes.
Efficient tandem organic light-emitting diodes with non-doped structures
Authors: Qin Yue , Liu Chen-Yang , Li Rui-Qing , Wang Jiong , Lu Ya-Nan , Chen Yue-Hua , Wang Yu-Zhu , Xu Ya-Nan , Zhang Xin-Wen , Huang Wei 
Published: October 2020

Highly efficient tandem organic light-emitting diodes (TOLEDs) were achieved based on a non-doped charge generation unit (CGU) consisting of LiF/Al/C60/4,4’,4”-tris(N-3-methylphenyl-N-phenyl-amino) triphenylamine (m-MTDATA) and ultrathin emitting layers. The current–voltage characteristics of the CGU devices and electron-only devices and the capacitance–voltage characteristics of the CGU-based capacitance devices were characterized to explore the charge generation and injection mechanisms. The charge generation process occurs at the interface of C60/m–MTDATA through electron transferring from the highest occupied molecular orbital of m-MTDATA to the lowest unoccupied molecular orbital of C60. It is found that the thinner C60 layer contributes to efficient electron injection. Under the optimal structure, the blue TOLEDs exhibit a maximum current efficiency (

C
E

max

) of 43.3 cd/A. The

C
E

max

and maximum external quantum efficiency (

E
Q
E

max

) of the white TOLEDs reach 84.6 cd/A and 26.7%, respectively.