Oral functioning after open versus closed treatment of unilateral condylar neck or base fractures: a two‐center controlled clinical trial

alexandrossfakianakis shared this article with you from Inoreader Oral functioning after open versus closed treatment of unilateral condylar neck or base fractures: a two‐center controlled clinical trial via Journal of Oral Rehabilitation Abstract Background Oral functioning and rehabilitation in patients after condylar trauma can be measured by objective functional outcomes and patient-reported outcomes. The similarities or differences between these outcomes may contribute to the decision if open treatment (OT) or closed treatment (CT) will obtain the most advantageous results. Objectives The aim of this study was to compare OT versus CT for unilateral condylar mandibular neck or base fractures in a two-center controlled clinical trial by objective functional outcomes and patient-reported outcomes measured at six weeks and six months follow-up. Additionally, these outcomes were compared within each group. Methods Patients were enrolled between January 2017 and November 2019. In one center patients received OT by extra-oral open reduction and internal fixation. In another center patients received CT by maxillomandibular fixation. Objective measurements included the mixing ability test (MAT) and mandibular active range of motion (ROM). Patient-reported outcomes included the mandibular function impairment questionnaire (MFIQ) and visual analogue scale (VAS) for pain. Independent t-tests and Mann-Whitney U tests were used to determine differences between the treatment groups at six weeks and six months follow-up. Paired t-tests and Wilcoxon Signed Rank tests were used to determine differences within each group. Results Thirty-three patients were enrolled. No differences were found between the groups treated with OT or CT for MAT, ROM, MFIQ and VAS. Both groups showed functional improvement. Conclusion Good objective functional outcomes and patient-reported outcomes were achieved with both OT and CT in patients with unilateral condylar mandibular neck or base fractures. View on Web

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Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux

alexandrossfakianakis shared this article with you from Inoreader Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux via Clinical Otolaryngology Abstract Objective Transnasal esophagoscopy (TNE) in the awake patient and esophagogastroduodenoscopy (EGD) in sedation are both used in the assessment of laryngopharyngeal reflux (LPR). The objective of this study was to compare these two endoscopic methods in contributing to the diagnosis of LPR. Methods This study included 54 patients presenting with signs and symptoms suspicious for LPR, which were examined both by TNE and EGD. The contribution of each method to the diagnosis of LPR was evaluated separately and then compared with each other. Results In detecting LPR, TNE showed a significant higher sensitivity (94% vs. 60%) and accuracy (93% vs. 59%) than EGD, but their specificity was equal (50% each). The most common pathologic findings in both methods were a hiatal hernia (70% vs 48%) and gaping cardia (69% vs 24%), followed by peptic esophagitis (41% vs 24%). Conclusion The value of EGD is limited in the workup of LPR, as sedation tends to mask the subtle findings in this kind of reflux disease. View on Web

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The maximum phonation time as marker for voice treatment efficacy: a network meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader The maximum phonation time as marker for voice treatment efficacy: a network meta‐analysis via Clinical Otolaryngology ABSTRACT Purpose There is a diversity in treatment approaches for voice therapy in which aerodynamic treatment effects between the approaches are lacking. The evidence of voice treatments on the maximum phonation time (MPT) was quantified using the statistical approach of a network meta-analysis (NMA). Data sources Three databases and manual search from inception to November 2021 were evaluated. Study selection Studies were considered which were reports of randomized controlled/clinical trials (RCT) evaluating the efficacy of a specific voice therapy treatment using MPT as an outcome measure in adult participants with voice disorders. Studies were excluded if participants had been diagnosed with neurological-motor-speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological, or technical instrumental treatments were used. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension Statement guidelines were followed. Two reviewers independently screened citations, extracted data and assessed risk of bias using PEDro scale. Random effects model was used for meta-analysis. Results We identified finally 12 RCT studies (treatment groups n=285, and control group without an intervention n=62). Eight interventions were evaluated. The only effective intervention with a significant effect was Vocal Function Exercises (VFE) (mean pre-post difference 6.16 sec, 95% confidence interval, 1.18 sec to 11.13 sec). Conclusions and Relevance VFE effectively improved MPT from pre- to post-treatment in comparison with other voice interventions which were identified in the present NMA. Further high-quality intervention studies with large samples sizes, multidimensional measures, and homogeneous groups of dysphonia are needed to support evidence-based practice in laryngology. This article is protected by copyright. All rights reserved. View on Web

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Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials

alexandrossfakianakis shared this article with you from Inoreader Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials via Clinical Otolaryngology Abstract Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). Methods The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18-March-2022. The included studies were evaluated for risk of bias. The efficacy endpoints were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Five RCTs comprising 380 patients (desmopressin=191 patients and placebo=189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n=5 RCTs, MD=–37.97 ml, 95% CI [–56.97, –18.96], p<0.001), 5-point Boezaart scores (n=2 RCTs, MD=–0.97, 95 CI [–1.21, –0.74], p<0.001), and 10-point Boezaart scores (n=2 RCTs, MD= –3.00, 95% CI [-3.61, -2.40], p<0.001) were significantly reduced in favor of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n=5 RCTs, MD=–3.73 min, 95% CI [–14.65, 7.18], p=0.50). No patient in both groups developed symptomatic hyponatremia (n=3 RCTs, 194 patients) or thromboembolic events (n=2 RCTs, 150 patients) Conclusion Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS. View on Web

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higher female risk for adult glioma associated with variants in the region of CCDC26

alexandrossfakianakis shared this article with you from Inoreader Australian genome-wide association study confirms higher female risk for adult glioma associated with variants in the region of CCDC26 via Neuro-Oncology Advance Access Abstract Background Glioma accounts for approximately 80% of malignant adult brain cancer and its most common subtype, glioblastoma, has one of the lowest 5-year cancer survivals. Fifty risk-associated variants within 34 glioma genetic risk regions have been found by genome-wide association studies (GWAS) with a sex difference reported for 8q24.21 region. We conducted an Australian GWAS by glioma subtype and sex. Methods We analysed genome-wide data from the Australian Genomics and Clinical Outcomes of Glioma (AGOG) consortium for 7,573,692 single nucleotide polymorphisms (SNPs) for 560 glioma cases and 2,237 controls of European ancestry. Cases were classified as glioblastoma, non-glioblastoma, astrocytoma or oligodendroglioma Logistic regression analysis was used to assess the associations of SNPs with glioma risk by subtype and by sex. Results We replicated the previously reported glioma risk associations in the regions of 2 q33.3 C2orf80, 2q37.3 D2HGDH, 5p15.33 TERT, 7p11.2 EGFR, 8q24.21 CCDC26, 9p21.3 CDKN2BAS, 11q21 MAML2, 11q23.3 PHLDB1, 15q24.2 ETFA, 16p13.3 RHBDF1, 16p13.3 LMF1, 17p13.1 TP53, 20q13.33 RTEL and 20q13.33 GMEB2 (P<0.05). We also replicated the previously reported sex difference at 8q24.21 CCDC26 (P=0.0024) with the association being nominally significan t for both sexes (P<0.05). Conclusions Our study supports a stronger female risk association for the region 8q24.21 CCDC26 and highlights the importance of analysing glioma GWAS by sex. A better understanding of sex differences could provide biological insight into the cause of glioma with implications for prevention, risk prediction and treatment. View on Web

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ALT in Pediatric High-Grade Gliomas Can Occur without ATRX Mutation and is Enriched in Patients with Pathogenic Germline MMR Variants

alexandrossfakianakis shared this article with you from Inoreader ALT in Pediatric High-Grade Gliomas Can Occur without ATRX Mutation and is Enriched in Patients with Pathogenic Germline MMR Variants via Neuro-Oncology Advance Access Abstract Background To achieve replicative immortality, most cancers develop a telomere maintenance mechanism, such as reactivation of telomerase or alternative lengthening of telomeres (ALT). There are limited data on the prevalence and clinical significance of ALT in pediatric brain tumors, and ALT-directed therapy is not available. Methods We performed C-circle analysis (CCA) on 579 pediatric brain tumors that had corresponding tumor/normal whole genome sequencing through the Open Pediatric Brain Tumor Atlas (OpenPBTA). We detected ALT in 6.9% (n=40/579) of these tumors and completed additional validation by ultrabright telomeric foci in situ on a subset of these tumors. We used CCA to validate TelomereHunter for computational prediction of ALT status and focus subsequent analyses on pediatric high-grade glioma (pHGG) Finally, we examined whether ALT is a ssociated with recurrent somatic or germline alterations. Results ALT is common in pHGG (n=24/63, 38.1%), but occurs infrequently in other pediatric brain tumors (<3%). Somatic ATRX mutations occur in 50% of ALT+ pHGG and in 30% of ALT- pHGG. Rare pathogenic germline variants in mismatch repair (MMR) genes are significantly associated with an increased occurrence of ALT. Conclusions We demonstrate that ATRX is mutated in only a subset of ALT+ pHGG, suggesting other mechanisms of ATRX loss of function or alterations in other genes may be associated with the development of ALT in these patients. We show that germline variants in MMR are associated with development of ALT in patients with pHGG. View on Web

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Molecular heterogeneity of pediatric choroid plexus carcinomas determines the distinctions in clinical course and prognosis

alexandrossfakianakis shared this article with you from Inoreader Molecular heterogeneity of pediatric choroid plexus carcinomas determines the distinctions in clinical course and prognosis via Neuro-Oncology Advance Access Abstract Background Choroid plexus carcinomas (CPCs) are rare aggressive pediatric tumors of the brain with no treatment standards. Genetic profiling of CPCs is often confined to possible association with Li–Fraumeni syndrome, though only about a half of CPCs develop from syndromic predispositions. Whole-chromosome gains and losses typical of CPCs reflect genomic instability of these tumors, but only partially explain the aggressive clinical course. Methods This retrospective study enrolled 25 pediatric patients with CPC, receiving treatment between January 2009 and June 2022. Molecular genetic testing was performed for 20 cases with available tumor tissue and encompassed mutational status, chromosomal aberrations and gene expression profiles. We analyzed several factors presumably influencing the outcomes, including molecular profiles and clinical parameters. The median follow-up constituted 5.2 years (absolute range 2.8–12.6 years ). Results All studied CPCs had smooth mutational profiles with the only recurrent event being TP53 variants, either germline or somatic, encountered in 13 cases. Unbalanced whole-chromosome aberrations, notably multiple monosomies, were highly typical. In seven tumors, chromosome losses were combined with complex genomic rearrangements: segmental gains and losses or signs of chromothripsis. This phenomenon was associated with extremely low 5-year survival: 20.0±17.9% vs. 85.7±13.2%; p=0.009. Transcriptomically, the cohort split into two polar clusters Ped_CPC1 and Ped_CPC2 differing by survival: 31.3±17.8% vs. 100%; p=0.012. Conclusion CPCs split into at least two molecular subtypes distinguished both genomically and transcriptomically. Clusterization of the tumors into Ped_CPC1 and Ped_CPC2 significantly correlates with survival. The distinct ion may prove relevant in clinical trials for dedicated and patient-oriented optimization of clinical protocols for these rare tumors. View on Web

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Impact of SARS-CoV-2 variants on inpatient clinical outcome

alexandrossfakianakis shared this article with you from Inoreader Impact of SARS-CoV-2 variants on inpatient clinical outcome via Clinical Infectious Diseases Advance Access Abstract Background Prior observation has shown differences in COVID-19 hospitalization risk between SARS-CoV-2 variants, but limited information describes hospitalization outcomes. Methods Inpatients with COVID-19 at five hospitals in the eastern United States were included if they had hypoxia, tachypnea, tachycardia, or fever, and SARS-CoV-2 variant data, determined from whole genome sequencing or local surveillance inference. Analyses were stratified by history of SARS-CoV-2 vaccination or infection. The average effect of SARS-CoV-2 variant on 28-day risk of severe disease, defined by advanced respiratory support needs, or death was evaluated using models weighted on propensity scores derived from baseline clinical features. Results Severe disease or death within 28 days occurred for 977 (29%) of 3,369 unvaccinated patients and 269 (22%) of 1,230 patients with history of vaccination or prior SARS-CoV-2 infection. Among unvac cinated patients, the relative risk of severe disease or death for Delta variant compared to ancestral lineages was 1.30 (95% confidence interval [CI] 1.11-1.49). Compared to Delta, this risk for Omicron patients was 0.72 (95% CI 0.59-0.88) and compared to ancestral lineages was 0.94 (95% CI 0.78-1.1). Among Omicron and Delta infections, patients with history of vaccination or prior SARS-CoV-2 infection had half the risk of severe disease or death (adjusted hazard ratio 0.40, 95% CI 0.30-0.54), but no significant outcome difference by variant. Conclusions Although risk of severe disease or death for unvaccinated inpatients with Omicron was lower than Delta, it was similar to ancestral lineages. Severe outcomes were less common in vaccinated inpatients, with no difference between Delta and Omicron infections. View on Web

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Polycaprolactone versus collagen membrane and 1‐year clinical outcomes: A randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader Polycaprolactone versus collagen membrane and 1‐year clinical outcomes: A randomized controlled trial via Clinical Implant Dentistry and Related Research Abstract Background Polycaprolactone (PCL) is a synthetic aliphatic polyester widely used in biomedical applications with biodegradability in the body and promotes cell proliferation and differentiation. A newly developed bilayered PCL membrane was developed for possibly being used as a membrane in guided bone regeneration (GBR). Purpose To compare the clinical efficacy between a newly developed bilayered PCL membrane with a Cytoplast™ RTM collagen membrane for GBR with simultaneous implant placement. Materials and Methods Twenty-four patients were randomized to PCL or RTM group, and a total of 24 dental implants were placed. Primary outcomes were patient mean buccal bone thickness (BBT) immediately postimplantation and at 6 months using cone-beam CT and soft tissue surface dimensional changes (STC) at crown insertion, 6 months, and 1 year after loading using intraoral scanner. Secondary outcomes included success rate, clinical parameters, healing index, implant stability, pink esthetic score, and marginal bone levels. Results The percentage of reduced BBT at 6 months was 32.38%, 25.94%, and 23.96% in the test group and 34.42%, 14.75%, and 6.34% in the control group at the corresponding levels. The mean difference of changed BBT associated with PCL membrane, when compared to collagen membrane, at 6 months was −0.02 ± 0.18 mm (95% confidence interval [CI]: −0.40 to 0.35), 0.29 ± 0.28 mm (95% CI: −0.29 to 0.87), and 0.62 ± 0.38 mm (95% CI: −0.17 to 1.42) at 0, 2, and 4 mm from implant shoulder. Minimal loss of STC was observed in both groups up to 1 year of loading. The mean difference loss of surface dimensional change associated with PCL membrane, when compared to collagen membrane, at 1 year of loading was 0.31 ± 0.19 mm (95% CI: −0.07 to 0.70), 0.22 ± 0.26 mm (95% CI: −0.33 to 0.76), and 0.17 ± 0.30 mm (95% CI: −0.45 to 0.78) at 0, 2, and 4 mm from implant shoulder. None of these differences were statistically significant (unpaired t-test, degrees of freedom [df] = 22; p > 0.05). Conclusion Within the limits of this trial, both barrier membranes resulted in comparable outcomes for GBR with implant placement after 1 year in function. Further research is necessary with a larger sample size. View on Web

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Comparison of 4‐ or 6‐implant supported immediate full‐arch fixed prostheses: A retrospective cohort study of 217 patients followed up for 3–13 years

alexandrossfakianakis shared this article with you from Inoreader Comparison of 4‐ or 6‐implant supported immediate full‐arch fixed prostheses: A retrospective cohort study of 217 patients followed up for 3–13 years via Clinical Implant Dentistry and Related Research Abstract Purpose Choosing four or six implants to support immediate full-arch fixed prostheses (FAFPs) is still controversial worldwide. This study aims to analyze and compare the long-term results of All-on-4 and All-on-6. Materials and Methods This retrospective cohort study enrolled 217 patients rehabilitated with 1222 implants supporting 271 FAFPs, including 202 prostheses supported by 4 implants (All-on-4 group) and 69 prostheses supported by 6 implants (All-on-6 group), and followed up for 3–13 years. Implant survival, prosthesis survival, complications, and implant marginal bone loss (MBL) were evaluated and compared between two groups. Patient characteristics including age, gender, jaw, opposite dentition condition, smoking habit, bruxism, bone quantity and quality, cantilever length (CL), prosthesis material, and oral hygiene were analyzed to assess their influence on the clinical results of the two groups. Six surgeons and three prosthodontists who performed FAFPs more than 5 years were invited for questionnaires, to assess patient- and clinician-related influences on implant number. Result In general, All-on-4 group indicated no significant difference with All-on-6 group in the implant survival (implant-level: hazard ratio [HR] = 1.0 [95% confidence interval (CI): 0.8–1.2], P = 0.96; prosthesis-level: HR = 0.8 [95% CI: 0.3–1.8], P = 0.54), prosthesis survival (odds ratio [OR] = 0.8 [95% CI: 0.3–2.8], P = 0.56), biological complications (OR = 0.9 [95% CI: 0.5–1.8], P = 0.78), technical complications of provisional prosthesis (OR = 1.3 [95% CI: 0.7–2.3], P = 0.42), technical complications of definitive prosthesis (OR = 1.1 [95% CI: 0.6–2.2], P = 0.33) and the 1st, 5th, and 10th year MBL (P = 0.65, P = 0.28, P = 0.14). However, for specific covariates, including elderly patients, opposing natural/fixed dentition, smoking, bruxism, long CL, low bone density, and all acrylic provisional prostheses, All-on-6 was more predictable in some clinical measurements than All-on-4. The implant prosthodontists and the medium-experienced clinicians showed significant preference for All-on-6 (P < 0.05). Conclusion Based on this study, the long-term clinical results showed no significant difference between All-on-4 and All-on-6 groups in general. However, for some specific characteristics, All-on-6 seemed to be more predictable in some clinical measurements than All-on-4. For the clinicians' decision-making, medium-experienced clinicians and the implant prosthodontists showed significant preference for All-on-6. View on Web

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