Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 7 Articles
Background: Total tooth loss (edentulism) can be a debilitating condition, impacting on ability to chew, speak and\ninteract with others. The most common treatment is with complete removable dentures, which may be successful,\nbut in the lower jaw, bone resorption that worsens over time makes denture-wearing difficult. Two dental implants\nin the mandible to retain the lower denture has been advocated as the gold standard of treatment, but has not\nbeen universally provided due largely to financial constraints and also patient fear. Mini implants (MI) are cheaper\nand less invasive than conventional implants (CI), but may not have equivalent longevity. Therefore, it is unknown\nwhether they represent a cost-effective treatment modality over time. The aim of this pilot randomised controlled\ntrial was to assess the feasibility of carrying out a trial on this cohort of patients, and to inform the study design of\na large multicentre trial.\nMethods: Forty-six patients were randomly allocated to receive either two mini implants or two conventional\nimplants in the mandible to retain their lower dentures. Quality of life (QoL) questionnaires, pain and anxiety scores,\nand an objective ââ?¬Å?gummy jellyââ?¬Â chewing test were carried out at multiple timepoints, along with detailed health\neconomics information. Implants were placed one-stage, and an early loading protocol was utilised. Patients were\nreviewed 8 weeks post-placement, and finally at 6 months. Implant failure, recruitment and retention rates were\nrecorded and analysed.\nResults: The pilot study demonstrated that it is possible to recruit, randomise and retain edentulous (mainly elderly)\npatients for an implant trial. We recruited to target and retention rates were acceptable. The large number of\nquestionnaires was onerous for participants to complete, but the distribution of scores and feedback from participants\nhelped inform the choice of primary and secondary outcomes in a full trial. The chewing test was time-consuming and\ninconsistent. Implant failure rate was low (1/46). The data on indirect costs gathered at every visit was viewed as\nrepetitive and unnecessary, as there was little or no change between visits.\nConclusions: The pilot study has shown that acceptable recruitment and retention rates are achievable in this population\nof patients for this intervention. The results provide valuable information for selection of outcome variables and sample size\ncalculations for future trials....
Background: The prognostic value of heart failure specific and global health status before and after left ventricular\nassist device (LVAD) implantation in the usual care setting is not well studied.\nMethods: We included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was measured\npre-operatively and 3 months post-LVAD using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol\nvisual analog scale (VAS). Primary outcomes were mortality/rehospitalization. Inverse propensity weighting was used to\nminimize bias from missing data.\nResults: Pre-operative global and heart failure-specific health status were very poor: KCCQ median 34.6 (IQR 21.4-50.5);\nVAS median 43 (interquartile range (IQR) 25ââ?¬â??65). Health status measures improved 3 months after LVAD placement:\nKCCQ median 69.3 (IQR 54.2-82.3); VAS median 75 (IQR 60ââ?¬â??85). Pre-operative health status was not associated with death\n(unadjusted HR for lowest vs. highest score quartiles: 1.09 (0.85-1.41) KCCQ; 1.12 (0.85-1.49) VAS) or rehospitalization\n(unadjusted HR 0.83 (0.72-0.96) KCCQ; 0.99 (0.85-1.16) VAS). Three-month KCCQ was associated with mortality\n(unadjusted HR 2.17 (1.47-3.21); VAS was not (1.43 (0.94-2.17). Three-month KCCQ added incremental discriminatory\nvalue to the HeartMate II Risk Score for death (c-stat 0.60 to 0.66); VAS did not (c-stat 0.59 to 0.60). Three-month health\nstatus was associated with rehospitalization (unadjusted HR 1.31 (1.15-1.57) KCCQ; 1.24 (1.05-1.46) VAS), but did not add\nincremental discriminatory value (c-stat 0.52 to 0.55 and 0.54, respectively).\nConclusions: These real-world data suggest that pre-operative health status has limited association with outcomes after\nLVAD. However, persistently low health status after surgery may independently signal higher risk for subsequent death.\nFurther study is needed to determine the clinical utility of routinely collected health status data after LVAD implantation....
Background: Adverse fibrotic remodeling is detrimental to myocardial health and a reliable method for monitoring\nthe development of fibrotic remodeling may be desirable during the follow-up of patients after heart transplantation\n(HTx). Quantification of diffuse myocardial fibrosis with cardiovascular magnetic resonance (CMR) has been increasingly\napplied and validated histologically in adult patients with heart disease. However, comparisons of CMR findings with\nhistological fibrosis burden in children are lacking. This study aimed to compare native T1 times and extracellular\nvolume fraction (ECV) derived from CMR with the degree of collagen on endomyocardial biopsy (EmBx), and to\ninvestigate the association between myocardial fibrosis and clinical as well as functional markers in children after HTx.\nMethods: EmBx and CMR were performed on the same day. All specimens were stained with picrosirius red. The\ncollagen volume fraction (CVF) was calculated as ratio of stained collagen area to total myocardial area on EmBx.\nNative T1 values and ECV were measured by CMR on a mid-ventricular short axis slice, using a modified look-locker\ninversion recovery approach.\nResults: Twenty patients (9.9 Ã?± 6.2 years of age; 9 girls) after HTx were prospectively enrolled, at a median of 1.3 years\n(0.02ââ?¬â??12.6 years) post HTx, and compared to 24 controls (13.9 Ã?± 2.6 years of age; 12 girls). The mean histological CVF\nwas 10.0 Ã?± 3.4%. Septal native T1 times and ECV were higher in HTx patients compared to controls (1008 Ã?± 32 ms vs\n979 Ã?± 24 ms, p < 0.005 and 0.30 Ã?± 0.03 vs 0.22 Ã?± 0.03, p < 0.0001, respectively). CVF showed a moderate correlation with\nnative T1 (r = 0.53, p < 0.05) as well as ECV (r = 0.46, p < 0.05). Native T1 time, but not ECV and CVF, correlated with\nischemia time (r = 0.46, p < 0.05).\nConclusions: CMR-derived fibrosis markers correlate with histological degree of fibrosis on EmBx in children after HTx.\nFurther, native T1 times are associated with longer ischemia times....
Background: Perioperative thermal disturbances during orthotopic liver transplantation (OLT) are common. We\nhypothesized that in patients undergoing OLT the use of a humidified high flow CO2 warming system maintains\nhigher intraoperative temperatures when compared to standardized multimodal strategies to maintain\nthermoregulatory homeostasis.\nMethods: We performed a randomized pilot study in adult patients undergoing primary OLT. Participants were\nrandomized to receive either open wound humidification with a high flow CO2 warming system in addition\nto standard care (Humidification group) or to standard care alone (Control group). The primary end point was\nnasopharyngeal core temperature measured 5 min immediately prior to reperfusion of the donor liver (Stage\n3 âË?â?? 5 min). Secondary endpoints included intraoperative PaCO2, minute ventilation and the use of vasoconstrictors.\nResults: Eleven patients were randomized to each group. Both groups were similar for age, body mass index,\nMELD, SOFA and APACHE II scores, baseline temperature, and duration of surgery. Immediately prior to reperfusion\n(Stage 3 âË?â?? 5 min) the mean (SD) core temperature was higher in the Humidification Group compared to the\nControl Group: 36.0 Ã?°C (0.13) vs. 35.4 Ã?°C (0.22), p = 0.028. Repeated measured ANOVA showed that core temperatures\nover time during the stages of the transplant were higher in the Humidification Group compared to the Control Group\n(p < 0.0001). There were no significant differences in the ETCO2, PaCO2, minute ventilation, or inotropic support.\nConclusion: The humidified high flow CO2 warming system was superior to standardized multimodal strategies in\nmaintaining normothermia in patients undergoing OLT. Use of the device was feasible and did not interfere with any\naspects of surgery. A larger study is needed to investigate if the improved thermoregulation observed is associated\nwith improved patient outcomes....
Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in\nkidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation.\nMethods. In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003\nto 2012 and having received cinacalcet up to kidney transplantation and/or thereafter. Results. Twenty-seven patients were included\nwith a mean follow-up of 2.9 �± 2.4 years. Twenty-one were already taking cinacalcet at the time of transplantation. Cinacalcet was\nstopped within the first month in 12 of these patients of which 7 had to restart therapy.Themain reason for restarting cinacalcet was\nhypercalcemia. Length of treatment was 23 �± 26 months.There were only 3 cases of mild hypocalcemia. There was no statistically\nsignificant association between baseline factors and cinacalcet status a year later. Conclusions. Discontinuing cinacalcet within the\nfirst month of kidney transplantation often leads to hypercalcemia. Cinacalcet appears to be an effective treatment of hypercalcemic\nhyperparathyroidism in kidney transplant recipients. Further studies are needed to evaluate safety and long-term benefits....
Background. Emerging evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with coronary artery diseases\nand arrhythmias. The FibroScan (Echosens, France), a widely available, noninvasive device, is able to detect liver fibrosis and\nsteatosis within this patient population. However, the FibroScan is currently contraindicated in patients with cardiac pacemakers\n(PM) or implantable cardioverter-defibrillators (ICD). Objective. To determine the safety profile of FibroScan testing in patients\nwith PM or ICD. Methods. Consecutive outpatients undergoing routine device interrogations at a tertiary level teaching hospital\nunderwent simultaneous liver stiffness measurements. PM or ICD performance data, device types, patient demographics, medical\nhistory, and previous laboratory and conventional liver imaging results were collected. Results. Analysis of 107 subjects with 33\ndifferent types of implanted cardiac devices, from 5 different companies (Medtronic, Sorin, ELA Medical, Boston Scientific, and\nSt. Jude), did not demonstrate any adverse events as defined by abnormal device sensing/pacing or ICD firing. This population\nincluded high risk subjects undergoing active pacing (...
Background: Passive transcutaneous osseointegrated hearing implant systems have become increasingly popular\nmore recently. The area over the implant is vulnerable due to vibration and pressure from the externally worn sound\nprocessor. Good perfusion and neural integrity has the potential to reduce complications. The authors� objective was to\ndetermine the ideal surgical exposure to maintain perfusion and neural integrity and decrease surgical time as a result\nof reduced bleeding.\nMethods: The vascular anatomy of the temporal-parietal soft tissue was examined in a total of 50 subjects. Imaging\ndiagnostics included magnetic resonance angiography in 12 and Doppler ultrasound in 25 healthy subjects to reveal\nthe arterial network. Cadaver dissection of 13 subjects formed the control group. The prevalence of the arteries were\nstatistically analyzed with sector analysis in the surgically relevant area.\nResults: The main arterial branches of this region could be well identified with each method. Statistical analysis showed\nthat the arterial pattern was similar in all subjects. The prevalence of major arteries is low in the upper posterior area\nthough large in proximity to the auricle region.\nConclusions: Diverse methods indicate the advantages of a posterior superior incision because the major arteries and\nnerves are at less risk of damage and best preserved. Although injury to these structures is rare, when it occurs, the\ndistal flow is compromised and the peri-implant area is left intact. Hand-held Doppler is efficient and cost-effective in\nfinding the best position for incision, if necessary, in subjects with a history of surgical stress to the retroauricular skin....
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