Interventions for people with perceptual disorders after stroke: the PIONEER scoping review, Cochrane systematic review and priority setting project.

Background: Stroke often affects recognition and interpretation of information from our senses, resulting in perceptual disorders. Evidence to inform treatment is unclear. Objective: To determine the breadth and effectiveness of interventions for stroke-related perceptual disorders and identify priority research questions. Methods: We undertook a scoping review and then Cochrane systematic review. Definitions, outcome prioritisation, data interpretation and research prioritisation were coproduced with people who had perceptual disorders post stroke and healthcare professionals. We systematically searched electronic databases (including MEDLINE, EMBASE, inception to August 2021) and grey literature. We included studies (any design) of interventions for people with hearing, smell, somatosensation, taste, touch or visual perception disorders following stroke. Abstracts and full texts were independently dual reviewed. Data were tabulated, synthesised narratively and mapped by availability, sense and interventions. Research quality was not evaluated. Our Cochrane review synthesised the randomised controlled trial data, evaluated risk of bias (including randomisation, blinding, reporting) and meta-analysed intervention comparisons (vs. controls or no treatment) using RevMan 5.4. We judged certainty of evidence using grading of recommendations, assessment, development and evaluation. Activities of daily living after treatment was our primary outcome. Extended activities of daily living, quality of life, mental health and psychological well-being perceptual functional and adverse event data were also extracted. Results: We included 80 studies (n = 893): case studies (36/80) and randomised controlled trials (22/80). No stroke survivor or family stakeholder involvement was reported. Studies addressed visual (42.5%, 34/80), somatosensation (35%, 28/80), auditory (8.7%, 7/80) and tactile (7.5%, 6/80) perceptual disorders; some studies focused on 'mixed perceptual disorders' (6.2%, 5/80 such as taste-smell disorders). We identified 93 pharmacological, non-invasive brain stimulation or rehabilitation (restitution, substitution, compensation or mixed) interventions. Details were limited. Studies commonly measured perceptual (75%, 60/80), motor-sensorimotor (40%, 32/80) activities of daily living (22.5%, 18/80) or sensory function (15%, 12/80) outcomes. Cochrane systematic review: We included 18 randomised controlled trials (n = 541) addressing tactile (3 randomised controlled trials; n = 70), somatosensory (7 randomised controlled trials; n = 196), visual (7 randomised controlled trials; n = 225) and mixed tactile-somatosensory (1 randomised controlled trial; n = 50) disorders. None addressed hearing, taste or smell disorders. One non-invasive brain stimulation, one compensation, 25 restitution and 4 mixed interventions were described. Risk of bias was low for random sequence generation (13/18), attrition (14/18) and outcome reporting (16/18). Perception was the most commonly measured outcome (11 randomised controlled trials); only 7 randomised controlled trials measured activities of daily living. Limited data provided insufficient evidence to determine the effectiveness of any intervention. Confidence in the evidence was low-very low. Our clinical (n = 4) and lived experience (n = 5) experts contributed throughout the project, coproducing a list of clinical implications and research priorities. Top research priorities included exploring the impact of, assessment of, and interventions for post-stroke perceptual disorders. Limitations: Results are limited by the small number of studies identified and the small sample sizes, with a high proportion of single-participant studies. There was limited description of the perceptual disorders and intervention(s) evaluated. Few studies measured outcomes relating to functional impacts. There was limited investigation of hearing, smell, taste and touch perception disorders. Conclusion: Evidence informing interventions for perceptual disorders after stroke is limited for all senses. Future work: Further research, including high-quality randomised controlled trials, to inform clinical practice are required. Study registration: This study is registered as PROSPERO CRD42019160270. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128829) and is published in full in Health Technology Assessment; Vol. 28, No. 69. See the NIHR Funding and Awards Website for further award information.

After a stroke, individuals may have difficulty understanding information gathered through their sense of sight, hearing, smell, taste, touch or somatosensation (body position, temperature, etc.), known as perceptual problems. We estimate perceptual problems affect around 240,000 stroke survivors in the UK, limiting their ability to understand the world around them, affecting everyday activities and reducing quality of life. Healthcare professionals may offer different treatments; medicine, brain stimulation, or rehabilitation activities including puzzles, strategies or physical therapy. We wanted to find the best treatments for stroke-related perceptual problems. We searched for all research on sight, hearing, smell, taste, touch and somatosensation perceptual treatments to find out (1) how well they worked, (2) what the research means for stroke survivors and healthcare professionals and (3) what research is needed next. People with stroke-related perceptual problems and healthcare experts produced this research together. We found 80 studies, involving 893 stroke survivors, describing 93 treatments. Eighteen of these studies used higher-quality randomised controlled trial designs; 535 stroke survivors took part, testing 32 treatments. Randomised controlled trials are important as one-half of those involved receive treatment and one-half do not; they provide the best evidence about whether a treatment works. Most treatments were for visual or somatosensation problems. Each study was small, provided few details about the participants or their treatment, and tested very different treatments. Few measured the effect of treatment on everyday life: only seven measured stroke survivors' ability to take part in everyday activities. No trial asked stroke survivors about their experiences with the treatments offered. We do not have enough research to identify which treatments benefit the lives of people with stroke-related perceptual problems. We need more research into perceptual problems, especially the impact it has on stroke survivors' lives, as well as bigger studies into well-described treatments, that measure the impact of the treatment on people's lives.

Efficacy of a prototype inspiratory-synchronized small particle versus conventional vibrating mesh nebulizer during pediatric and neonatal mechanical ventilation.

BACKGROUND: An inspiration-synchronized vibrating mesh nebulizer (VMN) has been reported to improve aerosol delivery during adult mechanical ventilation. A prototype VMN generating smaller particles was developed. We aimed to compare the aerosol delivery efficiency of small-particle and conventional VMNs in inspiration-synchronized and continuous modes during neonatal and pediatric mechanical ventilation. METHODS: A critical care ventilator with heated humidified circuits connected to an endotracheal tube (ETT) and passive test lung was set to pediatric and neonate parameters. Albuterol (2.5 mg/ml, 1 ml) was administered using both small-particle and conventional VMNs in inspiration-synchronization and continuous modes. For the pediatric model, VMN was placed at the humidifier inlet, inspiratory limb at Y-piece, and between Y-piece and ETT (Y-ETT). For the neonatal model, VMN was placed at the humidifier inlet and between Y-ETT. Each setup was repeated five times. Albuterol collected on the filter distal to the ETT was eluted and assayed with UV spectrophotometry (276 nm). RESULTS: The inspiration-synchronized VMN generated higher inhaled doses compared to continuous VMN across all nebulizer placements, particle sizes, and aerosol generation models (all p < .05). The highest inhaled doses (42.2 ± 2.0% and 40.7 ± 1.0% for pediatric and neonate, respectively) were observed with the small-particle inspiration-synchronized VMN placed at Y-ETT. In the pediatric model, the inhaled dose with inspiration-synchronized conventional VMN was similar, independent of nebulizer placements (24.4 ~ 27.0%). In contrast, the inhaled dose was greatest with continuous VMN placed at the humidifier inlet. With the neonatal model, VMN placed at Y-ETT yielded higher doses than the humidifier inlet, and small-particle VMNs outperformed conventional VMNs across all settings (all p < .05). CONCLUSION: The prototype small-particle VMN positioned between Y-piece and ETT in an inspiration-synchronized mode optimized aerosol delivery during mechanical ventilation in both pediatric and neonatal models.

Mesh-associated pain syndrome: predictors for continence and prolapse mesh removal surgery in a single centre.

OBJECTIVE: Over the last two decades one of the main surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery was the insertion of non-absorbable mesh to restore continence and prolapse respectively. Over time complications arose including mesh-associated pain syndrome (MAPS), mesh exposure, mesh, erosion, chronic bladder/vaginal infections, and dyspareunia. Consequently, women chose surgical mesh removal to counter these problems. However, little is known about the demographics, medical co-morbidities, mesh types involved and the timing from mesh insertion to mesh removal. This retrospective study will look at which of these factors may be closely associated with mesh removal surgery. DESIGN: Retrospective evaluation. SETTING: Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Clinic at University College London Hospitals NHS Foundation Trust. POPULATION: All patients presenting to the FPMRS Clinic between June 2011 to December 2019, requesting mesh removal surgery with a history of MAPS and other mesh complications were included in this study. METHODS: Patient demographics including age, ethnicity, obstetric history, and medical co-morbidities; type of mesh/anatomical route used; onset of symptoms; and time from insertion to removal were recorded. MAIN OUTCOME MEASURES: Determination of correlation coefficients between patient demographics, patient reported symptoms and mesh removal surgery. RESULTS: Three hundred and forty-five women with a history of MAPS were included in the study. Women in the 40-60 year old cohort accounted for 54.4% of mesh removal surgery; 54.8% had a BMI under 30 and almost 90% were Caucasian. 96.5% had had children, with over 77% having had a vaginal delivery. 91.9% of patients reported other health conditions including 18.8% with a concomitant history of mental health problems and 15.4% with a history of heart disease. Over 80% of women undergoing mesh removal surgery had a continence mesh (49% retropubic and 32% obturator continence mesh) removed, whereas 20% had an abdominal prolapse and/or vaginal prolapse mesh removed. The average time from mesh insertion to mesh removal was seven years, with the prevalence of mesh removal surgery averaging 85% (range 50-100%) depending on the comorbidity determined. CONCLUSIONS: All women presented to the clinic with a history of MAPS and other comorbidities which may have influenced their decision to pursue mesh removal surgery. There were no specific predictors, other than chronic pain associated with mesh, determining which women underwent surgery, though those with continence mesh were more likely to do so.

Antibacterial Efficacy of Rotary and Reciprocating Instrumentation Techniques.

Objectives: To clinically evaluate the effectiveness of rotary (ProTaper Next [PTN]) and reciprocating (Wave One Gold [WOG]) instrumentation techniques in eliminating bacteria from the root canals of teeth with apical periodontitis during a single-visit root canal treatment. Materials and methods: Forty patients were randomly assigned to the WOG or PTN instrumentation techniques groups. A single-visit root canal treatment was performed on all the patients. In both groups, root canals were irrigated with 10 ml of sodium hypochlorite (NaOCl) and the final irrigation protocol was applied. Microbiological samples from the root canal were collected initially (Sample 1), after chemo-mechanical instrumentation (Sample 2), and after the final irrigation protocol (Sample 3). Quantification of bacteria at each stage of root canal treatment was performed using the culture method (colony-forming units [CFUs]), and bacterial species were identified using MALDI-TOF mass spectrometry. Results: There were 55 aerobic and anaerobic bacterial species identified. Chemo-mechanical root canal treatment with both instrumentation techniques and the final irrigation protocol significantly reduced the number of CFUs (p<0.001). There were no statistically significant differences in antibacterial efficacy between WOG and PTN groups (p>0.05). Conclusion: Although both root canal instrumentation techniques were highly effective in removing bacteria from the necrotic canals of teeth with chronic apical periodontitis, no complete eradication of bacteria was found in any sample.

Steroidal Anti-Inflammatory Drugs for Oral Surgery: A Systematic Review and Meta-Analysis.

Objectives: The aim of the present study was to investigate if there are differences in mitigation acute pain following oral surgery procedures within a hospital setting and regarding various medication regimens. Materials and methods: A systematic literature search was performed between the years 2013 and 2023, including the databases PUBMED, Cochrane and Scopus, to identify the clinical trials investigating the prescription of non-steroidal (NSAID's) anti-inflammatory drugs before or after an oral surgery. A meta-analysis with meta-regression model was employed on the primary and secondary outcomes, such as pain, swelling and trismus. Results: Thirty-six articles were included, 6 of them being retrospective and 30 prospective, with a higher proportion of women than men, at a ratio of 1.34:1 and an average age of 31.9 years. Drugs with medium duration of action demonstrated lower values for pain and swelling. Regarding these parameters, pain and swelling, propionic acid derivatives and acetic acid derivatives exhibited lower values respectively. Conclusions: The quality of evidence was low to very low- certainty. The meta-analysis suggests that postoperative pain, swelling and trismus following oral surgery management may be effectively treated with the following drugs: NSAID medium-duration action drugs; propionic acid derivatives for lower pain levels and acetic acid derivatives for lower swelling measures; and Ibuprofen 400mg every 8h for 3 days or less. Clinical Relevance: Anti-inflammatory and analgesic drugs are prescribed to prevent or treat dental pain. Ibuprofen 400mg was the most prescribed drug after or before an oral surgery procedure. However, the evidence is indirect and needs to be interpreted with caution.

Legal Dental Age Thresholds Estimation in Croatian Children and Adolescents: Accuracy of the Olze, Haavikko, and Demirjian Methods.

Objective: This study aimed to explore the accuracy of three established approaches for legal age threshold estimation in a Croatian sample. Materials and methods: Olze's third molar eruption stages, Haavikko stages, and Demirjian stages were applied in 583 orthopantomograms of Croatian children and adolescents aged 10.00-20.99 years old. The left mandibular second and third molar were assessed. Tooth formation and eruption chronology were established. Receiver operating characteristic (ROC) curves were performed to assess the classification ability of predictive variables for estimating 16- and 18-year-old thresholds. Results: Havikko stage, Demirjian stage and eruption stages in tooth 37 performed poorly for 16-year-old and 18-year-old thresholds. Tooth 38 provide value information for these two age thresholds estimation. For 16-year-old threshold, Haavikko Stage Rc and Demirjian Stage G both yielded Sp over 98% and Bayes PTP over 95% in both sexes. yielded Sp over 98% and Bayes PTP over 95% in both sexes. Eruption stage C yielded Sp over 98%, Bayes PTP over 96% in males, and lower in females (Sp 96.7%, Bayes PTP 88.2%). For 18-year-old threshold, Haavikko stage Ac and Demirjian stage H both yielded 100% Sp and Bayes PTP. Eruption stage D yielded Sp over 96%, Bayes PTP over 90% in both sexes, slightly higehr in females than males. Mean age of tooth 37 at Haavikko stage Ac, Demirjian stage F, H and eruption stage D was statistically lower in females (p<0,05). Conclusion: Croatian population-based data on dental maturity were presented. Haavikko stage Rc, Demirjian stage G, eruption stage C and respective advanced stages in tooth 38 are effective for 16-year-old threshold classification. Haavikko stage Ac, Demirjian stage H and eruption stage D are effective for 18-year-old threshold classification.

Differences between Doctors of Dental Medicine and Doctors of Medicine Awareness of Their Online Image and Perception Concerns: a Quantitative Cross-Sectional Study.

Background: Healthcare professionals (HCPs), including doctors of dental medicine (DMDs) and doctors of medicine (MDs), use social networking sites (SNSs) for personal and professional purposes. This study aims to: (i) explore DMDs and MDs awareness of their online presence, (ii) examine how frequently and for what reasons DMDs and MDs monitor their online images, (iii) determine the prevalence of finding inaccurate, incomplete, or unprofessional information about themselves, examine that experience, and investigate actions performed regarding unprofessional or embarrassing posted material, (iv) assess concerns about their own SNSs usage and the content they post. Methods: A cross-sectional study was conducted among DMDs and MDs in Croatia using a questionnaire. Results: Out of 1,013 participants, 753 were active SNS users. Facebook (91.6%) and Instagram (63.1%) were the predominant SNSs used. DMDs exhibited a significantly higher inclination to utilize SNSs for professional purposes than MDs. Both groups reported a high level of proficiency in using Facebook (M=3.2, SD=0.827) and Instagram (M=2.44, SD=1.162). Approximately 55.4% of the participants repored monitoring their online presence, typically once a year or less frequently. DMDs emphasized the completeness of posted information more than MDs (U=25,623.0, p=0.001). Their highest level of concern pertained to confidentiality breaches and inaccurate medical and dental information. There are similar results for MDs and DMDs for finding erroneous information posted on SNSs. Conclusions: This study offers insights into HCPs' online presence, and their concerns regarding SNS usage. It underscores the significance of e-professionalism, and provides recommendations for maintaining a positive online presence while mitigating potential risks.

Age Determination Based on Open Apex Measurement in the Developing Dentition: Comparing the Accuracy of the Belgrade Age Formula (BAF) with the European Formula on a Bosnian Children Population.

Objective: The aim was to test the Belgrade age formula based on the calculation of open apices of two permanent mandibular teeth on a Bosnian children population and compare its accuracy with European formula. Material and methods: We included 412 panoramic images of children (204 female and 208 male) 7 to 13 years of age. We assessed the performance of both methods (the European formula and the BAF) and compared their results in both sexes. Results: The results showed a high point of average understanding between the age estimated by chronological age and the European formula (ICC=0.927, 95% CI 0.904-0.944, p<0.001)., BAF also confirmed a high point of agreement with chronological age in boys (ICC=0.941, 95% CI 0.922-0.955, p<0.001) and girls (ICC=0.913, 95% CI 0.886-0.934, p<0.001). BAF was better than the European formula in estimating age in males (0.4448±0.9135 vs. 0.9807±0.9422). Conclusion: The Belgrade Age Formula (BAF) demonstrates comparable accuracy to the European formula for age determination in Bosnian children, while offering the advantage of being easier and faster to use. This makes the BAF a practical alternative in clinical and research settings where efficiency and reliability are essential.

The Impact of Different Irrigation Protocols on the Bond Strength of Self-Adhesive Resin Cement to Radicular Dentin.

Objective: The objective of the study was to investigate the influence of different irrigation protocols on the shear bond strength (SBS) of self-adhesive resin cement (SARC) on primed radicular dentin. Methods: Radicular dentin slabs (N=58) were embedded in acrylic. Subsequently, they were polished and randomly assigned to five experimental groups (N=8-12) and one control group, CG (N=8). Irrigation solutions used were 2.5% sodium hypochlorite (H), 17% ethylenediamine tetraacetic acid (EDTA), 9% etidronic acid with hypochlorite (HEDP), 0.9% saline solution (SS), and 2% chlorhexidine (CHX). Each experimental group underwent a different irrigation protocol for two minutes: 1) H/EDTA/H, 2) HEDP, 3) H/EDTA/CHX, 4) H/EDTA/SS and 5) HEDP/SS. The CG samples were not treated with any irrigation solution. After drying, the adhesive-enhancing primer (AEP) and dual-curing SARC were applied to the radicular dentin using molds corresponding to the Ultra Tester (Ultradent Products, South Jordan, USA). The specimens were stored at 37 °C in distilled water and broken after 10 days in shear mode. The results were analyzed using ANOVA and post-hoc Games-Howell test, α=0.05. Results: CG exhibited the highest SBS. With the exception of HEDP and HEDP/SS, all experimental groups showed significantly lower SBS compared to CG (p<0.05). Conclusions: HEDP appears to be an adequate solution for cleaning the root canal prior to dentin priming and fiber post cementation with SARC.

Evaluation of the Bond Strength between the Acrylic Teeth and Reinforced or Non-reinforced Complete Denture Base.

Objective: The aim of this study was to examine whether the method of surface treatment of the acrylic teeth and reinforcement of the denture base (carbon fibers) affect the reduction of stress concentration for gap initiation at the interface of acrylic teeth and denture base as a measure of bond strength. Materials and methods: Samples of cross-sections of acrylic teeth and denture base were isolated from four pairs of complete acrylic dentures (with and without reinforcement of the denture base) and were subsequently subjected to compressive loading in a universal testing machine simulating two different occlusions. Selected groups of acrylic teeth (central incisors, first premolars, and first molars) from complete dentures were treated in various ways (untreated, mechanical, chemical, and mechanical-chemical). The gap size at the interface of acrylic tooth and denture base was measured using a light inverted microscope on selected acrylic teeth of individual quadrants. The one-way analysis of variance was used to investigate the influence of denture base reinforcement and different methods of surface treatment of the acrylic tooth on bond strength at the level of statistical significance of p ≤ 0.001. Results: Microscopic analysis of gap size measured at five selected points at the interface between the acrylic teeth and the base of the complete denture ranged from 40 to 144 micrometers. The one-way analysis of variance showed a statistically significant difference between the arithmetic means of the measured gap sizes concerning different methods of surface treatment of the acrylic teeth. Conclusion: The fracture strength, or load-bearing capacity, of complete dentures reinforced with carbon fibers was increased compared to complete dentures with non-reinforced bases. Reduction in gap size at the interface between the acrylic teeth and the base of complete dentures was influenced by the mechanical-chemical treatment of the lower surface of acrylic teeth, while reinforcement of the complete denture base with carbon fibers had no effect on the bond strength.

Exploring the Root Canal Morphology of Third Molars in the Bosnia and Herzegovina Population.

Objective: The objective of this study was to evaluate the root canal morphology of third molars in the Bosnia-Herzegovina population. Materials and methods: A total of 241 extracted third molars (105 maxillary and 136 mandibular) were subjected to a clearing procedure. The specimens were categorized into ten groups based on the Alavi classification for maxillary third molars (MaxTMs), and six groups were based on the Gulabivala classification for mandibular third molars (ManTMs). Root canal type according to the Vertucci classification, the presence and position of lateral canals, and intercanal communication were analyzed using a stereomicroscope x15. Results: MaxTMs had three roots in 77.13% of the samples. Among MaxTMs, the most common morphology was three fused roots (33.33%) and Vertucci's type VIII (54. 28% of samples in Alavi's Group IV). 60.29% of ManTMs have two separate roots (Gulabivala's Groups II and III). The most prevalent types in mesial roots were type I (41.46% in Group II) and type IV (48.78% in Group III), although type I predominated in distal roots (91.24% and 100% in Groups II and III, respectively). Conclusion: Single-rooted third molars usually have a root canal morphology that is more favorable for endodontic treatment. In contrast, third molars with fused roots often have more complex root canal morphology.

A Molecular Urine Assay to Detect Recurrences During Surveillance of High-Risk Non-Muscle Invasive Bladder Cancer.

BACKGROUND: High-risk non-muscle invasive bladder cancer (HR-NMIBC) patients require long-term surveillance with cystoscopies, cytology and upper tract imaging. Previously, we developed a genomic urine assay for surveillance of HR-NMIBC patients with high sensitivity and anticipatory value. OBJECTIVE: We aimed to validate the performance of the assay in an unselected prospectively collected cohort of HR-NMIBC patients under surveillance. METHODS: We included patients from five centers and collected urine sample pairs (evening and morning urines) prior to cystoscopy. Mutation status (FGFR3/TERT) and methylation status (OTX1) was analyzed on DNA from voided urine specimens. A test was considered positive if≥1 alteration was detected in at least one urine sample. The primary endpoint was tumor recurrence. Sensitivity and specificity were determined. A generalized mixed effects model was used to adjust for within-patient correlation. Cox proportional hazard analyses with time-dependent covariates assessed the anticipatory effect of the urine assay. RESULTS: In total, 204 patients and 736 sample pairs were collected. Sixty-three recurrences were diagnosed for which we had concomitant assay results. On cross-sectional analyses, the assay detected 75% (95% CI 62.1% -84.7%) of recurrences, with a specificity of 70% (95% CI 66.4% -73.5%). Furthermore, mixed effects model analyses revealed OTX1 (p = 0.005) and TERT (p = 0.004) as significant predictors for disease recurrence. Median follow-up was 25.3 months (IQR 18.6-30.7). Twenty-nine tumors were diagnosed without concomitant urine samples, which included recurrences detected after urine collection ended. Longitudinal analyses showed that a positive urine assay predicted a recurrence over time (HR 3.5, p < 0.001). Furthermore, a recurrence during the study period was also a predictor for developing future recurrences (HR 2.1, p < 0.001). CONCLUSIONS: This study validates the performance of a previously developed urine assay in an unselected cohort of HR-NMIBC patients under surveillance. With a robust sensitivity/specificity and a strong anticipatory effect, this assay proves a useful adjunct ready for evaluation in a future randomized controlled trial.

Efficacy and safety of Optilume® Paclitaxel-coated urethral dilatation balloon in real-life: Experience in a Spanish Multicenter Study.

INTRODUCTION: The Optilume® Paclitaxel-coated urethral dilatation balloon is an alternative to conventional endoscopic treatments that combines mechanical dilatation with local delivery of paclitaxel. OBJECTIVE: To describe the success rate and analyze the safety of the device in real clinical practice. To evaluate possible predictors of treatment failure. MATERIALS AND METHODS: Retrospective multicenter study in patients diagnosed with urethral stricture and treated with an Optilume® balloon in routine clinical practice. Data were collected from flowmetry, questionnaires (PROM and IPSS) and cystoscopy before surgery, and 3, 6 and 12 months after the procedure, according to standard practice. Surgical success was defined as the absence of subsequent urethral manipulation and a Qmax > 10 ml/s. RESULTS: 238 patients treated with Optilume® in 12 Spanish hospitals between May 2021 and April 2024 were included in the study. Of these, 156 who had a minimum follow-up of 3 months, were analyzed. Median stricture length: 1.5 cm (0.5 - 5.3), mainly in bulbar urethra (87.7%). Of the total, 12.8% of patients had a history of pelvic radiotherapy, and 81.4% had undergone prior urethral manipulation. Postoperative complications were reported in 14.2% of the total. The treatment success rate was 73.8%, with a median follow-up of 8 months (5-12). No predictors of stricture recurrence were identified. Recurrence rates were higher in strictures located in the posterior versus anterior urethra (42.9% vs. 24.6%, p = 0.126). No significant differences were observed between patients with and without prior urethral manipulation. CONCLUSION: Treatment with Optilume® has been shown to be safe and effective in short-term routine clinical practice.

Long-term outcomes of transvaginal mesh surgery for pelvic organ prolapse at a single center in Japan.

OBJECTIVES: This study aimed to investigate the long-term effectiveness and safety of transvaginal mesh surgery for pelvic organ prolapse at a high-volume center in Japan. METHODS: Patients who underwent transvaginal mesh surgery between March 2010 and August 2015 were included and followed up for 5 years. As no mesh kits were available in our country, we used a self-cut polypropylene mesh (Japanese-style transvaginal mesh) for the procedures. Objective anatomical restoration and complications were evaluated during outpatient examinations. RESULTS: Overall, 711 patients were included in this study. Over 5 years, the recurrence rate of stage 2 or higher prolapse at the operated compartment was 8.6% (61 cases), whereas that at the other compartments was 12.8% (91 cases). The frequency of recurrence was highest at 3 months and decreased with each passing year in both compartments. During the follow-up period, 28 patients (three at the operated compartment and 25 at the other compartments) required reoperation owing to recurrence. Overall, there were 13 cases of mesh exposure (1.8%), including two (0.28%) in the bladder, 10 (1.4%) in the vagina, and one (0.14%) in the rectum. Urinary incontinence surgery was performed in 69 patients (9.7%) during the follow-up period. CONCLUSIONS: The frequencies of recurrence requiring reoperation and mesh-related complications were low, and vaginal mesh exposure was mostly asymptomatic. Therefore, the Japanese-style transvaginal mesh is safe and effective.

Thrombosis with thrombocytopenia syndrome following adenovirus vector-based vaccines to prevent COVID-19: Epidemiology and clinical presentation in Spain.

BACKGROUND: We describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain. METHODS: We included all venous or arterial thrombosis with thrombocytopenia following adenovirus vector-based vaccines (AstraZeneca or Janssen) to prevent COVID-19 disease between February 1st and September 26th, 2021. We describe the crude rate and the standardized morbidity ratio. We assessed the predictors of mortality. RESULTS: Sixty-one cases were reported and 45 fulfilled eligibility criteria, 82% women. The crude TTS rate was 4/1,000,000 doses and 14-15/1,000,000 doses between 30-49 years. The number of observed cases of cerebral venous thrombosis was 6-18 higher than the expected in patients younger than 49 years. Symptoms started 10 (interquartile range (IQR): 7-14) days after vaccination. Eighty percent (95% confidence interval (CI): 65-90%) had thrombocytopenia at the time of the emergency department visit, and 65% (95% CI: 49-78%) had D-dimer >2000 ng/mL. Patients had multiple location thrombosis in 36% and fatal outcome in 24% cases. A platelet nadir <50,000/µL (odds ratio (OR): 7.4; CI 95%: 1.2-47.5) and intracranial hemorrhage (OR: 7.9; IC95%: 1.3-47.0) were associated with fatal outcome. CONCLUSION: TTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or D-dimer increase.

Atrial Topology for a Unified Understanding of Typical and Atypical Flutter.

BACKGROUND: Macroreentry stands as the predominant mechanism of typical and atypical flutter. Despite advances in mapping, many aspects of macroreentrant atrial tachycardia remain unsolved. In this translational study, we applied principles of topology to understand the activation patterns, entrainment characteristics, and ablation responses in a large clinical macroreentrant atrial tachycardia database. METHODS: Because the atrium can be topologically seen as a closed sphere with holes, we used a computational fixed spherical mesh model with a finite number of holes to induce and analyze macroreentrant atrial tachycardia. The ensuing insights were used to interpret high-density activation maps, postpacing interval-tachycardia cycle length values (difference between postpacing interval and tachycardia cycle length), and ablation response in 131 cases of typical and atypical flutter (n=106 left atrium, n=25 right atrium). RESULTS: Modeling of macroreentrant atrial tachycardia revealed that reentry on closed surfaces consistently manifests itself as paired rotation and that an odd number of critical boundaries is mathematically impossible. Together with mathematical confirmation by the index theorem, this led to a unifying construct that could explain the number of loops, difference between postpacing interval and tachycardia cycle length values, and ablation outcomes (termination, no change, or prolongation in tachycardia cycle length) in all 131 cases. CONCLUSIONS: Combining topology with the index theorem offers a novel and cohesive framework for understanding and managing typical and atypical flutter.

No substantial neurocognitive impact of COVID-19 across ages and disease severity: a multicenter biomarker study of SARS-CoV-2 positive and negative adult and pediatric patients with acute respiratory tract infections.

BACKGROUND: Compared to intensive care unit patients with SARS-CoV-2 negative acute respiratory tract infections, patients with SARS-CoV-2 are supposed to develop more frequently and more severely neurologic sequelae. Delirium and subsequent neurocognitive deficits (NCD) have implications for patients' morbidity and mortality. However, the extent of brain injury during acute COVID-19 and subsequent NCD still remain largely unexplored. Body-fluid biomarkers may offer valuable insights into the quantification of acute delirium, brain injury and may help to predict subsequent NCD following COVID-19. METHODS: In a multicenter, observational case-control study, conducted across four German University Hospitals, hospitalized adult and pediatric patients with an acute COVID-19 and SARS-CoV-2 negative controls presenting with acute respiratory tract infections were included. Study procedures comprised the assessment of pre-existing neurocognitive function, daily screening for delirium, neurological examination and blood sampling. Fourteen biomarkers indicative of neuroaxonal, glial, neurovascular injury and inflammation were analyzed. Neurocognitive functions were re-evaluated after three months. RESULTS: We enrolled 118 participants (90 adults, 28 children). The incidence of delirium [85 out of 90 patients (94.4%) were assessable for delirium) was comparable between patients with COVID-19 [16 out of 61 patients (26.2%)] and SARS-CoV-2 negative controls [8 out of 24 patients (33.3%); p > 0.05] across adults and children. No differences in outcomes as measured by the modified Rankin Scale, the Short-Blessed Test, the Informant Questionnaire on Cognitive Decline in the Elderly, and the pediatrics cerebral performance category scale were observed after three months. Levels of body-fluid biomarkers were generally elevated in both adult and pediatric cohorts, without significant differences between SARS-CoV-2 negative controls and COVID-19. In COVID-19 patients experiencing delirium, levels of GFAP and MMP-9 were significantly higher compared to those without delirium. CONCLUSIONS: Delirium and subsequent NCD are not more frequent in COVID-19 as compared to SARS-CoV-2 negative patients with acute respiratory tract infections. Consistently, biomarker levels of brain injury indicated no differences between COVID-19 cases and SARS-CoV-2 negative controls. Our data suggest that delirium in COVID-19 does not distinctly trigger substantial and persistent subsequent NCD compared to patients with other acute respiratory tract infections. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04359914; date of registration 24-APR 2020.

Customized 3D-Printed Mesh, Membrane, Bone Substitute, and Dental Implant Applied to Guided Bone Regeneration in Oral Implantology: A Narrative Review.

Background: The new frontiers of computer-based surgery, technology, and material advances, have allowed for customized 3D printed manufacturing to become widespread in guided bone regeneration (GBR) in oral implantology. The shape, structural, mechanical, and biological manufacturing characteristics achieved through 3D printing technologies allow for the customization of implant-prosthetic rehabilitations and GBR procedures according to patient-specific needs, reducing complications and surgery time. Therefore, the present narrative review aims to elucidate the 3D-printing digital radiographic process, materials, indications, 3D printed manufacturing-controlled characteristics, histological findings, complications, patient-reported outcomes, and short- and long-term clinical considerations of customized 3D printed mesh, membranes, bone substitutes, and dental implants applied to GBR in oral implantology. Methods: An electronic search was performed through MEDLINE/PubMed, Scopus, BioMed Central, and Web of Science until 30 June 2024. Results: Three-dimensionally printed titanium meshes and bone substitutes registered successful outcomes in vertical/horizontal bone defect regeneration. Three-dimensionally printed polymeric membranes could link the advantages of conventional resorbable and non-resorbable membranes. Few data on customized 3D printed dental implants and abutments are available, but in vitro and animal studies have shown new promising designs that could improve their mechanical properties and tribocorrosion-associated complications. Conclusions: While 3D printing technology has demonstrated potential in GBR, additional human studies are needed to evaluate the short- and long-term follow-up of peri-implant bone levels and volumes following prosthetic functional loading.

Ni mesh-reinforced ultrasonic-assisted Cu/Sn58Bi/Cu joint performance: Experiments and first-principles calculations.

The Ni mesh was incorporated into the Cu/Sn58Bi/Cu bonding as a reinforcing skeleton to achieve an enhancement effect analogous to steel reinforcement in concrete. Ultrasonic-assisted soldering (UAS) improved the metallurgical bond among the solder, Ni mesh, and substrate. It facilitated the formation of (Cu, Ni)6Sn5 intermetallic compounds (IMCs) layers, increasing the joint strength. Observations indicated that ultrasonic treatment effectively refined the (Cu, Ni)6Sn5 grains and induced a uniform preferred orientation of ß-Sn and Bi grains in the joint matrix adjacent to the Ni mesh. The shear strength of the joint reached 72.23 MPa when the ultrasonic application was sustained for 15 s, achieving the fabrication of a high-strength point with low energy consumption. First-principles calculations have confirmed that changes in the Ni content within (Cu, Ni)6Sn5 IMCs improved the stability of the crystal structure. Furthermore, the variations in content could potentially improve the mechanical and electrical properties of the (Cu, Ni)6Sn5. Enhancements in ultrasonic efficiency and the reinforcement of IMC structures offer new avenues for research in green and high-performance electronic packaging material joining technologies.

Total and Simultaneous Coverage Repair for the Obturator Hernia and Groin Hernias With One Large Mesh: A Case Report.

Obturator hernia is a rare condition. Preoperative diagnosis is difficult to achieve because the hernia swelling is rarely palpable. Diagnosis is often delayed, and the hernia can become fatal if intestinal strangulation occurs, especially in older patients. Hesitation in the intervention will result in perforation, peritonitis, sepsis, and death. We herein report a case involving a Japanese woman in her 90s who visited our emergency room with nausea and right inner thigh pain. Computed tomography (CT) at onset revealed intestinal incarceration between the piriformis and external obturator muscles; therefore, a right-sided obturator hernia was diagnosed. Manual release of the incarceration, combined with echo probe manipulation and lower extremity movement, was successfully performed. The patient's pain was dramatically reduced, and emergency surgery was avoided. A prompt hernia release after reaching the correct diagnosis is very important for obturator hernia patients. Scheduled minimally invasive surgery (transabdominal pre-peritoneal repair, TAPP) was subsequently performed. Intraoperatively, a coexistence of ipsilateral femoral hernia was detected by laparoscope. Therefore, we tried to cover not only the obturator canal but also the subclinical coexistence of ipsilateral groin hernias. All four hernia orifices (obturator hernia orifice, internal inguinal hernia orifice, external inguinal hernia orifice, and femoral hernia orifice) were covered at the same time with a single large mesh of 15 × 10 cm. Reports detailing such approaches (total and simultaneous coverage of the obturator canal and myopectineal orifice with one rectangular mesh) are relatively rare in the literature.