Influence of digital implant analog design on the positional trueness of an analog in additively manufactured models: An in‐vitro study

alexandrossfakianakis shared this article with you from Inoreader Influence of digital implant analog design on the positional trueness of an analog in additively manufactured models: An in‐vitro study via Clinical Implant Dentistry and Related Research Abstract Background Limited evidence exists regarding the accuracy of implant analog position in printed models, particularly when implant analogs with varying designs are used. Purpose To evaluate the effect of digital implant analog (DIA) design on the trueness of their position in additively manufactured digital implant models (DIMs) and to compare with that of a conventional implant analog in a stone cast. Materials and Methods A dentate maxillary model with a conventional implant analog (Nobel Biocare Implant Replica 4.3 mm CC RP) at left second premolar site was digitized by using a laboratory scanner (3Shape D2000) and a (SB) scan body to generate the master standard tessellation language (STL) file (M0). 12 custom trays were fabricated on M0 file and conventional polyvinylsiloxane impressions of the model were made. All impressions were poured after inserting conventional implant analogs (Nobel RP Implant Replica) (Group A). Model was then digitized with an intraoral scanner (TRIOS 3) and the same SB, and DIMs with three different DIA designs (Nobel Biocare [Group B], Elos [Group C], and NT-trading [Group D]) were generated (Dental System-Model Builder). 12 DIMs of each design were additively manufactured and corresponding DIAs were inserted. All models were digitized by using the same laboratory scanner and SB, and these STLs were transferred to a 3D analysis software (Geomagic Control X), where t he STL files of the models were superimposed over M0. Linear and 3D deviations at three selected points on SB (implant-abutment connection, most cervical point on SB, and most coronal point on SB) as well as angular deviations on two planes (buccolingual and mesiodistal) were calculated. Analysis of variance (ANOVA) and Bonferroni corrected t-tests were used to analyze the trueness of implant analog positions (α = 0.05). Results The interaction of main effects significantly affected linear (p < 0.001) and angular deviations (p = 0.020). At point 1, group D had higher deviations than groups A and B (p ≤ 0.015). In addition, groups A and D had higher deviations than group B at point 4 (p < 0.001). While group C had similar linear deviations to those of other groups at point 1 and point 4 (p ≥ 0.192), the differences among test groups at point 2 were nonsignificant (p ≥ 0.276). Group B had lower angular deviations than groups C (p = 0.039) and D (p = 0.006) on buccolingual plane. Conclusions Analog design affected the trueness of analog position as proprietary, pressure/friction fit DIA (group B) had higher linear trueness than screw-retained DIA (Group D) and conventional implant analog (group A). In addition, pressure/friction fit DIA had the highest angular trueness among tested DIAs. View on Web

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Less is More: A 7-day course of antibiotics is the evidence-based treatment for Pseudomonas aeruginosa Ventilator-associated Pneumonia

alexandrossfakianakis shared this article with you from Inoreader Less is More: A 7-day course of antibiotics is the evidence-based treatment for Pseudomonas aeruginosa Ventilator-associated Pneumonia via Clinical Infectious Diseases Advance Access View on Web

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Clinical, Virologic, and Immunologic Evaluation of Symptomatic Coronavirus Disease 2019 Rebound Following Nirmatrelvir/Ritonavir Treatment

alexandrossfakianakis shared this article with you from Inoreader Clinical, Virologic, and Immunologic Evaluation of Symptomatic Coronavirus Disease 2019 Rebound Following Nirmatrelvir/Ritonavir Treatment via Clinical Infectious Diseases Advance Access Abstract BackgroundNirmatrelvir/ritonavir, the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) protease inhibitor, reduces the risk of hospitalization and death by coronavirus disease 2019 (COVID-19) but has been associated with symptomatic rebound after therapy completion. Methods Six individuals with relapse of COVID-19 symptoms after treatment with nirmatrelvir/ritonavir, 2 individuals with rebound symptoms without prior antiviral therapy and 7 patients with acute Omicron infection (controls) were studied. Soluble biomarkers and serum SARS-CoV-2 nucleocapsid protein were measured. Nasal swabs positive for SARS-CoV-2 underwent viral isolation and targeted viral sequencing. SARS-CoV-2 anti-spike, anti–receptor-binding domain, and anti-nucleocapsid antibodies were measured. Surrogate viral neutralization tests against wild-type and Omicron spike protein, as well as T-cell stimulation assays, were performed. Results High levels of SARS-CoV-2 anti-spike immunoglo bulin G (IgG) antibodies were found in all participants. Anti-nucleocapsid IgG and Omicron-specific neutralizing antibodies increased in patients with rebound. Robust SARS-CoV-2–specific T-cell responses were observed, higher in rebound compared with early acute COVID-19 patients. Inflammatory markers mostly decreased during rebound. Two patients sampled longitudinally demonstrated an increase in activated cytokine-producing CD4+ T cells against viral proteins. No characteristic resistance mutations were identified. SARS-CoV-2 was isolated by culture from 1 of 8 rebound patients; Polybrene addition increased this to 5 of 8. Conclusions Nirmatrelvir/ritonavir treatment does not impede adaptive immune responses to SARS-CoV-2. Clinical rebound corresponds to development of a robust antibody and T-cell immune response, arguing against a high risk of disease progression. The presence of infectious virus supports the need for isolation and assessment of longer treatm ent courses.Clinical trials registration. NCT04401436. View on Web

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Safety of trastuzumab deruxtecan: A meta‐analysis and pharmacovigilance study

alexandrossfakianakis shared this article with you from Inoreader Safety of trastuzumab deruxtecan: A meta‐analysis and pharmacovigilance study via Journal of Clinical Pharmacy and Therapeutics The most common adverse events (AEs) of trastuzumab deruxtecan were gastrointestinal and hematologic toxicity, but most were mild. Attention should be paid on interstitial lung disease (ILD) as well as decreased ejection fraction. Abstract What Is Known and Objective This study aimed to explore the safety profile of trastuzumab deruxtecan (T-DXd, formerly DS-8201a) using multi-source medical data. Methods We explored trastuzumab deruxtecan related adverse events (AEs) in clinical trials available in ClinicalTrials.gov and electronic databases (MEDLINE, EMBASE and PubMed) up to July 16, 2022. Meta-analysis was performed by using incidence rate with 95%CIs. In the pharmacovigilance study of FDA Adverse Event Reporting System (FAERS), the reporting odds ratio (ROR) and the medicines and healthcare products regulatory agency (MHRA) methods were used to analyse the real-world AEs (up to June 28, 2022). Results and Discussion A 8 clinical trials enrolled 1457 patients were included. The most common AEs of any grade were gastrointestinal disorders and blood and lymphatic system disorders. The most common AE of grade 3 or higher was neutropenia (21.4%, 95%CI: 14.7%–28.1%, I 2 = 91%). The incidence of interstitial lung disease (ILD) and decreased left ventricular ejection fraction were 10.9% (95%CI: 7.2%–14.5%, I 2 = 82%) and 1.2% (95%CI: 0.7%–2.2%, I 2 = 98%), respectively. A total of 1244 AE reports were identified in the pharmacovigilance study. Gastrointestinal toxicity (ROR = 21.65), myelosuppression (ROR = 36.88), interstitial lung disease (ROR = 50.30), pneumonitis (ROR = 36.59), decreased ejection fraction (ROR = 16.08), and taste disorder (ROR = 14.06) mentioned in the instructions showed strong signals. Also, ascites (ROR = 14.90), lung opacity (ROR = 78.80), pulmonary fibrosis (ROR = 5.59), and increased KL-6 (ROR = 1761.97), which were not mentioned in the instructions, showed strong signals. What Is New and Conclusion Trastuzumab deruxtecan was well tolerated, and more attention should be paid on ILD as well as decreased ejection fraction. View on Web

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Acinetobacter baumannii: Pathogenesis, virulence factors, novel therapeutic options and mechanisms of resistance to antimicrobial agents with emphasis on tigecycline

alexandrossfakianakis shared this article with you from Inoreader Acinetobacter baumannii: Pathogenesis, virulence factors, novel therapeutic options and mechanisms of resistance to antimicrobial agents with emphasis on tigecycline via Journal of Clinical Pharmacy and Therapeutics This article summarizes the microbiological and virulence traits in A.baumannii. In addition, in this study, the mechanisms of resistance to tigecycline have been comprehensively investigated and novel therapeutic strategies have been expressed. Abstract What is known and objective Acinetobacter baumannii is one of the most important nosocomial pathogens with the ability to cause infections such as meningitis, pneumonia, urinary tract, septicaemia and wound infections. A wide range of virulence factors are responsible for pathogenesis and high mortality of A. baumannii including outer membrane proteins, lipopolysaccharide, capsule, phospholipase, nutrient- acquisition systems, efflux pumps, protein secretion systems, quarom sensing and biofilm production. These virulence factors contribute in pathogen survival in stressful conditions and antimicrobial resistance. Comment According to the World Health Organization (WHO), A. baumannii is one of the most resistant pathogens of ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, A. baumannii, Pseudomonas aeruginosa and Enterobacter spp.). In recent years, resistance to a wide range of antibiotics in A. baumannii has significantly increased and the high emergence of extensively drug resistant (XDR) isolates is challenging. Among therapeutic antibiotics, resistance to tigecycline as a last resort antibiotic has become a global concern. Several mechanisms are involved in tigecycline resistance, the most important of which is RND (Resistance-Nodulation-Division) family efflux pumps overexpression. The development of new therapeutic strategies to confront A. baumannii infections has been very promising in recent years. What is new and conclusion In the present review we highlight microbiological and virulence traits in A. baumannii and peruse the tigecycline resistance mechanisms and novel therapeutic options. Among the novel therapeutic strategies we focus on combination therapy, drug repurposing, novel antibiotics, bacteriophage therapy, antimicrobial peptides (AMPs), human monoclonal antibodies (Hu-mAbs), nanoparticles and gene editing. View on Web

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Pediatric vs Adult Septoplasty Revision Rates

alexandrossfakianakis shared this article with you from Inoreader Pediatric vs Adult Septoplasty Revision Rates via JAMA Otolaryngology–Head & Neck Surgery Online First This cohort study used data from the IBM MarketScan Commercial Database to compare rates of revision surgery among pediatric vs adult patients undergoing septoplasty. View on Web

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BMI and Venous VTE Rates in Patients on Standard Chemoprophylaxis Regimens After H&N Surgery

alexandrossfakianakis shared this article with you from Inoreader BMI and Venous VTE Rates in Patients on Standard Chemoprophylaxis Regimens After H&N Surgery via JAMA Otolaryngology–Head & Neck Surgery Online First This cohort study assesses whether there is an association bet ween body mass index (BMI) and postoperative venous thromboembolism (VTE) and hematoma rates in patients treated with prophylactic enoxaparin 30 mg twice daily. View on Web

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Association of Apnea vs Hypopnea Predominance With Pediatric Sleep Apnea Outcomes

alexandrossfakianakis shared this article with you from Inoreader Association of Apnea vs Hypopnea Predominance With Pediatric Sleep Apnea Outcomes via JAMA Otolaryngology–Head & Neck Surgery Online First This case-control study assesses the association between basel ine apnea-predominant or hypopnea-predominant obstructive sleep apnea on polysomnography and quality of life outcomes in children managed by watchful waiting with supportive care or adenotonsillectomy. View on Web

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Active Surveillance for PTMC warranted for the UK population?

alexandrossfakianakis shared this article with you from Inoreader Active Surveillance for PTMC warranted for the UK population? via Clinical Otolaryngology Abstract Background The incidence of thyroid cancer is increasing globally due to the increase in detection of subclinical, low volume papillary thyroid microcarcinomas (PTMC) (<1cm). Several international groups have recommended an active surveillance approach for this low-risk disease. In contrast to many other countries, the UK's approach to thyroid nodules is to avoid detection of incidental lesions where appropriate. Objective This study aims to establish the proportion of patients with thyroid cancer in the UK that would benefit from active surveillance. Design, participants, and outcome measures Individuals with PTMC in NHS Lothian from 2009-2020 were reviewed from a local thyroid cancer database. The mode of detection of PTMC and proportion of patients who might benefit from active surveillance were established. Results From 651 individuals with differentiated thyroid cancer managed over 12-year period, 185 individuals with PTMC were identified (28.4%). The majority of PTMC 151/185 (81.6%) were either diagnosed post-operatively following thyroidectomy for benign disease or with nodal disease. Only 24 individuals with PTMC were identified following palpable thyroid nodule, incidental finding on imaging and surveillance screening. Therefore, when the indication for surgery was considered, only 24/651 (3.7%) patients were identified pre-operatively and would therefore be realistic candidates for active surveillance. Conclusion Less than 4% of patients with thyroid cancer in the UK would be appropriate for active surveillance. Rather than developing programs to deal with this minority of patients, focus should be maintained on minimizing detection of these low-risk cases. View on Web

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Differentiation of eosinophilic and non‐eosinophilic chronic rhinosinusitis on preoperative computed tomography using deep learning

alexandrossfakianakis shared this article with you from Inoreader Differentiation of eosinophilic and non‐eosinophilic chronic rhinosinusitis on preoperative computed tomography using deep learning via Clinical Otolaryngology Abstract Objective This study aimed to develop deep learning (DL) models for differentiating between eosinophilic chronic rhinosinusitis (ECRS) and non-ECRS (NECRS) on preoperative CT. Methods A total of 878 chronic rhinosinusitis (CRS) patients undergoing nasal endoscopic surgery at Renmin Hospital of Wuhan University (Hubei, China) between October 2016 to June 2021 were included. Axial spiral CT images were pre-processed and used to build the dataset. Two semantic segmentation models based on U-net and Deeplabv3 were trained to segment the sinus area on CT images. All patient images were segmented using the better-performing segmentation model and used for training and testing of the transferred efficientnet_b0, resnet50, inception_resnet_v2, and Xception neural networks. Additionally, we evaluated the performances of the models trained using each image and each patient as a unit. The precision of each model was assessed based on the receiver operating characteristic curve. Further, we analyzed the confusion matrix and accuracy of each model. Results The Dice coefficients of U-net and Deeplabv3 were 0.953 and 0.961, respectively. The average area under the curve and mean accuracy values of the four networks were 0.848 and 0.762 for models trained using a single image as a unit, while the corresponding values for models trained using each patient as a unit were 0.893 and 0.853, respectively. Conclusion Combining semantic segmentation with classification networks could effectively distinguish between patients with ECRS and those with NECRS based on preoperative sinus CT images. Furthermore, labeling each patient to build a dataset for classification may be more reliable than labeling each medical image. This article is protected by copyright. All rights reserved. View on Web

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