Virtual occlusion in orthognathic surgery

Fully digital occlusion planning in orthognathic surgery – A crossover study

Introduction: Right Ventricular (RV) function is a strong predictor of outcome in many Cardiovascular Diseases, but its significance is often neglected. Right Ventricle (RV) dysfunction may be secondary to Left Ventricle (LV) dysfunction as a consequence of “Ventricular Interdependence. Tricuspid Annular Plane Systolic Excursion (TAPSE) is an Echocardiographic measure that allows us to assess Right Ventricular systolic function and it correlates well with reference techniques like Cardiac Magnetic Resonance Imaging. Echocardiographic recording of the Tricuspid Annular Plane Systolic Excursion (TAPSE) has been recommended for assessing Right Ventricular function in cardiac patients. As RV dysfunction is associated with high in-hospital morbidity and mortality, early reorganization of RV dysfunction is warranted in patients with or without LV dysfunction. Objective: Our objective was to demonstrate the relationship of TAPSE, as a predictor of RV Systolic Function with Left Ventricular Systolic Function. Method: This was a cross –sectional study in patients undergoing comprehensive Transthoracic Echocardiography for any indication. From April 2022 to March 2023 we prospectively enrolled 100 adult (from 30 to age 103years) of both sexes who presented to the Cardiology Clinic of LABAID Cardiac Hospital. We performed a complete Transthoracic Echocardiography study. Assessed LV systolic function by conventional method. We additionally measured TAPSE in 2-dimensional M-mode Echocardiograms from the apical 4- chamber view, positioning the cursor on the lateral Tricuspid Annulus near the free RV wall and aligning it as close as possible to the apex of the heart. The mean values were taken by at least 2 measurements for reducing inter-observer and intra-observer variability’s. Values of TAPSE as a predictor of RV Systolic Function were correlated with Left Ventricular Systolic Function. Patients with confirmed congenital & Valvular heart disease were excluded. Results: Mean TAPSE values were (19.15±3.87mm) irrespective of LVEF, with no significant differences between sexes, (18.45±3.801 mm) in male , (19.94±3.853 mm) in female (P=.056). TAPSE value was (22.00±1.581 mm) in person with normal LVEF & (16.77±2.455 mm) in person with reduced LVEF (P<.001). A statistically significant positive correlation of LVEF (r=.813) and significant negative correlation of EPSS (r=-.639) were observed with TAPSE (p<0.001). But no significant correlation of TAPSE was found between age (r=-.185), gender (r=.192) & RVIDd (r= -.063) (p >0.05). Multivariate analysis confirmed these correlations and the interactions between variables. Graph of estimated population-based TAPSE values adjusted by LV function was provided. Conclusion: We determined the values of TAPSE in patients with or without LV systolic dysfunction and assessed relationship of these values with LVEF. TAPSE is predictive of RV Systolic function & correlated significantly with LV systolic function. The TAPSE measurement is simple & reproducible. This observation could guide decision making in daily clinical practice. Bangladesh Crit Care J March 2024; 12 (1): 11-17

Esophageal chromoendoscopy in Barrett's esophagus: “cons”

OP0159 Microscopic Gut Inflammation in SPA is A Prognostic Factor for Initiation of Anti-TNF Therapy in Daily Practice

Chemotherapy-induced peripheral neuropathy (CIPN) may negatively influence multiple myeloma (MM) patients' health-related quality of life (HRQOL). Dose modification is the only way to minimize CIPN. To measure CIPN in daily practice, the Indication for Common Toxicity Criteria (CTC) Grading of Peripheral Neuropathy Questionnaire (ICPNQ) was developed which can be completed within five minutes by the patient. The aims of this study were to (1) perform a psychometric evaluation of the ICPNQ and (2) examine the prevalence of CIPN and its influence on HRQOL in population-based MM patients. One hundred fifty-six MM patients, diagnosed between 2000 and 2014, completed the ICPNQ, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy 20 (EORTC QLQ-CIPN20), and EORTC QLQ-C30 (65% response). The psychometric analyses showed a Cronbach's alpha of 0.84, 0.74, and 0.61 for, respectively, the sensory, motoric, and autonomic subscales of the ICPNQ. Test-retest reliability and construct validity were good for all subscales. Overall, 65% of patients reported grade 2-3 neuropathy according to the ICPNQ. Patients with the highest CTC grades (grade 2 with neuropathic pain and grade 3 (38%)) according to the ICPNQ reported significantly worse scores on all EORTC QLQ-CIPN20 subscales compared to patients with lower CTC grades (p≤0.002). In addition, they reported statistically significant and clinically relevant worse HRQOL scores on almost all EORTC QLQ-C30 subscales. CIPN is a common side effect in MM patients, which has a negative impact on HRQOL. The ICPNQ is a valid instrument to distinguish the highest CIPN CTC grades from the lower CTC grades necessary to decide on dose modifications of chemotherapy in daily clinical practice.

Remote monitoring of patients with implantable cardioverter-defibrillators: Can results from large clinical trials be transposed to clinical practice?

BackgroundThe planification of radiation therapy (RT) for pancreatic cancer (PC) requires a dosimetric computed tomography (CT) scan to define the gross tumor volume (GTV). The main objective of this study was to compare the inter-observer variability in RT planning between the arterial and the venous phases following intravenous contrast.MethodsPANCRINJ was a prospective monocentric study that included twenty patients with non-metastatic PC. Patients underwent a pre-therapeutic CT scan at the arterial and venous phases. The delineation of the GTV was performed by one radiologist (gold standard) and two senior radiation oncologists (operators). The primary objective was to compare the Jaccard conformity index (JCI) for the GTVs computed between the GS (gold standard) and the operators between the arterial and the venous phases with a Wilcoxon signed rank test for paired samples. The secondary endpoints were the geographical miss index (GMI), the kappa index, the intra-operator variability, and the dose-volume histograms between the arterial and venous phases.ResultsThe median JCI for the arterial and venous phases were 0.50 (range, 0.17–0.64) and 0.41 (range, 0.23–0.61) (p = 0.10) respectively. The median GS-GTV was statistically significantly smaller compared to the operators at the arterial (p < 0.0001) and venous phases (p < 0.001), respectively. The GMI were low with few tumors missed for all patients with a median GMI of 0.07 (range, 0-0.79) and 0.05 (range, 0-0.39) at the arterial and venous phases, respectively (p = 0.15). There was a moderate agreement between the radiation oncologists with a median kappa index of 0.52 (range 0.38–0.57) on the arterial phase, and 0.52 (range 0.36–0.57) on the venous phase (p = 0.08). The intra-observer variability for GTV delineation was lower at the venous phase than at the arterial phase for the two operators. There was no significant difference between the arterial and the venous phases regarding the dose-volume histogram for the operators.ConclusionsOur results showed inter- and intra-observer variability in delineating GTV for PC without significant differences between the arterial and the venous phases. The use of both phases should be encouraged. Our findings suggest the need to provide training for radiation oncologists in pancreatic imaging and to collaborate within a multidisciplinary team.

In thelast few decades, the roles of cardio-oncology and cardiovascular geneticsgained more and more attention in research and daily clinical practice, shaping a new clinical approach and management of patients affected by cancer and cardiovascular disease. Genetic characterization of patients undergoing cancer treatment can support a better cardiovascular risk stratification beyond the typical risk factors, suchas contractile function and QT interval duration, uncovering a possible patient’s concealed predisposition to heart failure, life threatening arrhythmias and sudden death. Specifically, an integrated cardiogenetic approach in daily oncological clinical practice can ensure the best patient-centered healthcare model, suggesting, also the adequate cardiac monitoring timing and alternative cancer treatments, reducing drug-related complications. We report the case of a 14-month-old girl affected by neuroblastoma, treated by cisplatin, complicated by cardiac arrest. We described the genetic characterization of a Ryanodine receptor 2 (RYR2) gene mutation and subsequent pharmacogenomic approach to better shape the cancer treatment.

The frailty index (FI) is commonly used to estimate frailty in end-stage kidney disease (ESKD) patients. The Clinical Frailty Scale (CFS) is a less time-consuming alternative. We aimed to determine the test performance of the CFS for pre-dialysis and dialysis patients and patients receiving conservative therapy from the Dialysis Centre Apeldoorn. In this cross-sectional study, haemodialysis, peritoneal dialysis, pre-dialysis patients and patients receiving conservative therapy from the Dialysis Centre Apeldoorn were included and subjected to frailty assessment. Nephrologists not familiar with the CFS completed the frailty score after medical consultation. The sensitivity, specificity and area under the curve (AUC) of the CFS were determined. The FI was used as the gold standard. Included were 144 patients, of whom 60 (41.7%) were considered frail according to the FI. The mean age was 67.4±13.5years and 56 (38.9%) were female. The cut-off point of the CFS for 'vulnerable' (CFS ≥4) had a sensitivity of 63.3%, a specificity of 81.0% and an AUC of 0.72. The cut-off point of the CFS for 'frail' (CFS ≥5) had a sensitivity of 50.0%, a specificity of 91.7% and an AUC of 0.71. The CFS is a quick and easy-to-use tool for the determination of frailty in ESKD patients with a high prevalence of frailty. Nevertheless, the sensitivity of the CFS in the present study was considered too low to implement into daily clinical practice. The sensitivity might be increased by training nephrologists in the use of the CFS.

Mammographic density estimation: Comparison among BI-RADS categories, a semi-automated software and a fully automated one

Lung ultrasound can detect hidden lung congestion in hemodialysis (HD) patients, even though they present no symptoms of hypervolemia. The 28-zone protocol is the one mainly assessed in the majority of studies. However, it is quite time consuming, making its integration into daily clinical practice difficult. Alternative approaches have been proposed that require fewer scanning zones. This systematic review used various combinations of the following keywords: "Lung ultrasound", "Hemodialysis", "Scanning protocols", "Scanning zones", "28-points", and "28-zones" via PubMed's and Google Scholar's search engines. Six relevant studies were obtained, five of which refer to the adult population and one to children. Initially, the first published study compared the 28-zone protocol to the 8-zone protocol, while three studies compared the 28-zone protocol to the 8-zone, 6-zone, and 4-zone protocols. Another study compared the 16-zone protocol to the 12-zone and 8-zone protocols. Finally, one study compared the 28-zone protocol to the 8-zone protocol in children. There are several alternatives in the literature for applying abbreviated versions of the 28-zone protocol to save time in daily clinical practice. However, none of these protocols provide the same accuracy as the 28-zone protocol. Therefore, it should be preferred when the clinical question regarding pulmonary congestion remains. Further multicenter studies are required to determine whether any shorter version of the 28-zone protocol can sufficiently replace it in daily clinical practice.

Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management.

Histological remission [HR] is a potential treatment target in ulcerative colitis [UC]. Limited 'real world' data are available on the reliability of histological scoring when assessing minimal histological inflammation. The aim of this study was to investigate the reliability of UC histological scores in colonic biopsies showing mucosal healing [MH] and limited histological inflammation, and to compare the 'daily practice' histological assessment with expert reviews by gastrointestinal [GI] pathologists. We performed a retrospective single-centre study. Colonic biopsies from UC patients with MH [Mayo score ≤ 1] were included. All biopsies assessed in daily practice were reassessed by three blinded GI pathologists using three histological scores (Geboes score [GS], Riley score [RS], Harpaz [Gupta] Index [HGI]) and a global visual scale [GVS]. We evaluated inter- and intra-observer variation between GI pathologists and correlations between scores including the initial histological assessment using Cronbach's alpha and Spearman rho analysis. In total, 270 biopsies from 39 UC patients were included. The inter-observer concordance for all histological indexes was substantial to almost perfect [GS 0.84; HGI 0.61; GVS 0.74, RS 0.91]. Correlation between the RS and GS was almost perfect [R = 0.86], but we found no correlation between the primary histological assessment and reassessment by GI pathologists. Current UC histological scores reliably assess limited histological inflammation in UC patients. The discrepancy between the initial histological assessment and the reassessment by dedicated GI pathologists suggests a gap between daily practice and academic expertise. This issue may limit the implementation of HR as a treatment target for UC in daily practice.

Efficacy and Safety of Complete Intraureteral Stent Placement versus Conventional Stent Placement in Relieving Ureteral Stent Related Symptoms: A Randomized, Prospective, Single Blind, Multicenter Clinical Trial.

Objective. Capsule endoscopy (CE) is most commonly performed to evaluate obscure gastrointestinal bleeding (GIB). However, at present the role of CE in patients with obscure-overt GIB especially during daily clinical practice is unknown. The aim of the present study was to investigate the diagnostic yield and the impact of CE on the management of patients with obscure-overt GIB. Material and methods. Between January 2007 and December 2011 we prospectively included all patients with obscure-overt GIB who underwent CE after negative bidirectional endoscopy. CE findings revealing the cause of bleeding, type of therapeutic intervention and clinical variables associated with positive CE and recurrence of GIB were evaluated. Results. One hundred and eighteen patients with a median age of 66 years (range 8–89 years) were enrolled in the final analysis. The overall diagnostic yield of the CE was 66.9%. The most common findings were angiodysplasias (33.1%), followed by ulcer (23.7%), and tumors (6.8%). Age (p = 0.001) and cardiovascular disease (p = 0.007) were significant clinical variables predicting the higher incidence of angiodysplasias. Specific therapeutic interventions were undertaken in 54 patients with positive CE (68.4%). Recurrence of GIB was observed in one patient with negative CE (2.6%) and 16 patients with positive CE (20.3%). Univariate and multivariate analysis showed high age and no therapeutic intervention as significant factors associated with recurrent bleeding. Conclusions. CE represents a promising diagnostic method in the investigation of obscure-overt GIB, with significant impact on its clinical management in daily clinical practice.