Incidence and contributing factors of non-root canal treated teeth with chronic fatigue root fracture: A cross-sectional study.

BACKGROUND/PURPOSE: Chronic fatigue root fracture describes a root fracture in a non-root canal treated (non-RCT) tooth. This study aimed to report the incidence and contributing factors of non-RCT teeth with chronic fatigue root fracture in a Taiwanese population. METHODS: This cross-sectional study included teeth extracted at Taipei Veterans General Hospital in Taiwan between 2018 and 2019. The reasons for extractions were recorded and included vertical and horizontal root fractures (VRF and HRF). Comparisons of clinical factors between teeth with fatigue VRF and teeth with fatigue HRF were performed by chi-square or Fisher exact test, where appropriate. RESULTS: Of the 4207 extracted teeth examined, 263 (6.25%) had tooth fracture. Thirty-two non-RCT teeth had chronic fatigue root fracture, including 16 with VRF and 16 with HRF. The incidence was 0.76% (32/4207). The occurrence of chronic fatigue root fracture was higher in males (83.9%). The mean age of the 31 patients with chronic fatigue root fracture was 71.7 ± 13.1 years. More than half of these teeth had intact crowns with severe attrition. The fatigue VRF occurred more frequently in molars (P = 0.003), in roots with a long oval cross-section (P = 0.037), and in terminal teeth (P = 0.013) than the fatigue HRF. CONCLUSION: The incidence of chronic fatigue root fracture is 0.76%. Both VRF and HRF occur mainly in aged males, in posterior teeth with attrition, and in teeth without restoration. Tooth position, cross-section root morphology, and terminal tooth are contributing factors related to chronic fatigue root fracture.

Omnidirectional, thin metasurface exhibiting selective absorption for un-polarized broadband incidence.

Thin devices with large areas have strong and omnidirectional absorption over a wide bandwidth and are in demand for applications such as energy harvesting, structural color, and vehicle LiDAR (laser detection and ranging). Despite persistent efforts in the design and fabrication of such devices, the simultaneous realization of all these desired properties remains a challenge. In this study, a 190-nm-thick metasurface with an area of 3 cm2, incorporating dielectric cylinder arrays, a chromium layer, a silicon nitride (SiNx) layer, and an aluminum layer is theoretically and experimentally demonstrated. The developed device achieves an average absorptivity of ∼99% (97% in the experiment) in the entire visible spectrum 400-700 nm. Moreover, it exhibits strong absorption over a wide range of incident angles (∼91% and 90% at 60° in the calculation and experiment, respectively). Importantly, the feasibility of applying the developed metasurface absorber to solar thermophotovoltaics and vehicle LiDAR (laser detection and ranging) has been explored. Moreover, the photoresist can be replaced by other glues and easily scaled up to a large area using the roll-to-roll nanoimprinting process. With the excellent spectral properties and performance, this device is promising for large-area applications.

A retrospective cohort study on outcome and interactions among prognostic factors of endodontic microsurgery.

BACKGROUND/PURPOSE: Endodontic microsurgery (EMS) is a reliable treatment for teeth with non-healing apical periodontitis. This study evaluated the outcome of EMS with mineral trioxide aggregate as the retrograde filling material and identified potential prognostic factors associated with the EMS outcome. METHODS: Consecutive clinical and radiographic records of EMS performed in a teaching hospital from 2013 to 2017 were reviewed. Cases of root fracture, cemental tear, re-surgery, and incomplete records were excluded. After selection, 268 EMS-treated teeth with the follow-up period more than one year were included. Surgical outcome as success or failure was evaluated according to Molven's criteria. For analysis of potential prognostic factors, multivariate logistic regression was performed followed by bivariate chi-square tests. Stratified analysis was performed to understand the interactions between two prognostic factors. RESULTS: The overall EMS success rate was 89.9% in this study. Tooth type (anteriors vs. molars, odds ratio (OR) = 6.83, P = 0.001, anteriors vs. premolars, OR = 4.27, P = 0.010) and endodontic-periodontal (endo-perio) communicating defects (with vs. without, OR = 4.92, P = 0.005) both had a significant influence on the EMS outcome. The negative impact of endo-perio communicating defects was closely associated with tooth type. Premolars with endo-perio communicating defects had significantly higher rates of failure. CONCLUSION: The EMS outcome is significantly affected by the tooth type and endo-perio communicating defect. The presence of endo-perio communicating defects has a greater negative influence on the success rate for premolars than for anteriors and molars.

Appraising Psychiatric Care From a Different Angle: Occupational Therapy Activities and Cardiorespiratory Fitness for Inpatients With Chronic Mental Illness.

IMPORTANCE: People with chronic mental illness (CMI) are at high risk of poor cardiorespiratory fitness as a result of sedentary behavior and physical inactivity. Occupational therapy practitioners play a key role as advocates for positive lifestyle change for people with CMI. OBJECTIVE: To determine the relationships between occupational therapy activities and cardiorespiratory fitness among inpatients with CMI. DESIGN: This retrospective research included three phases: descriptive cohort, case-control, and cross-sectional studies. SETTING: Psychiatric inpatient facility. PARTICIPANTS: Inpatients with CMI, ages 18 to 65 yr (N = 325). OUTCOMES AND MEASURES: Data were collected over a 12-mo period. Each daily occupational therapy activity performed by participants was converted to energy expenditure (in kcal). Cardiorespiratory fitness was measured by means of the 3-Minute Step Test. RESULTS: After daily occupational therapy activities, significantly more participants increased cardiorespiratory fitness than declined (McNemar χ2 [1] = 29.18, p < .05). Prevocational activities and moderate- to high-intensity exercises met the optimal energy expenditure level (>352 kcal) necessary to achieve an increase in cardiorespiratory fitness. CONCLUSIONS AND RELEVANCE: Occupational therapists in psychiatric inpatient settings should prescribe individualized occupation-based or physical activities that meet the optimal daily energy expenditure for each client to improve their cardiorespiratory function. What This Article Adds: This study is one of the first attempts to explore cardiorespiratory fitness outcomes after daily occupational therapy activities for people with CMI. Physical benefits unfolded throughout psychiatric care, echoing the profession's stance on holistic practice.

Does irritable bowel syndrome increase the risk of interstitial cystitis/bladder pain syndrome? A cohort study of long term follow-up.

INTRODUCTION AND HYPOTHESIS: Interstitial cystitis/bladder pain syndrome (IC/BPS) and irritable bowel syndrome (IBS) often occur concomitantly without an obvious reason. It is important to determine the relationship between these related diseases. We aimed to determine whether IBS increase the risk of IC/BPS. METHODS: We identified newly diagnosed IBS patients between 2002 and 2013 from a nationwide database as the IBS cohort. Subjects diagnosed with IC/BPS before IBS were excluded. Cox's regression analysis with a hazard ratio (HR) of IC/BPS between IBS and the non-IBS cohort was applied to unmatched and matched (16 confounders of propensity scores) models. The time from diagnosis of IBS to IC/BPS was also calculated. RESULTS: In the unmatched group, which included 100,124 IBS (55% female) and 874,048 non-IBS patients, the IC/BPS adjusted HR was 1.292 (95% confidence interval [CI], 1.131-1.476;p < 0.0001) in the IBS cohort compared with the non-IBS cohort. In the matched group, there were 85,359 patients in each cohort, and the IC/BPS HR was 1.599 (95% CI, 1.344-1.903; p < 0.0001). The average numbers of years until the development of IC/BPS in the IBS cohort and non-IBS cohort were 4.60 ± 2.58 (n = 253) and 5.99 ± 3.49 (n = 295) years, respectively. CONCLUSIONS: IBS was shown to increase the risk of IC/BPS in this 12-year cohort study. The time from the diagnosis of IBS to IC/BPS was 5.35 ± 3.18 years. A common pathophysiology of IBS and IC/BPS is possible. Clinicians should be mindful of the association and promote collaborative care of these two elusive diseases.

Comparison of Cefepime-Cefpirome and Carbapenem Therapy for Acinetobacter Bloodstream Infection in a Multicenter Study.

Carbapenems are currently the preferred agents for the treatment of serious Acinetobacter infections. However, whether cefepime-cefpirome can be used to treat an Acinetobacter bloodstream infection (BSI) if it is active against the causative pathogen(s) is not clear. This study aimed to compare the efficacy of cefepime-cefpirome and carbapenem monotherapy in patients with Acinetobacter BSI. The population included 360 patients with monomicrobial Acinetobacter BSI receiving appropriate antimicrobial therapy admitted to four medical centers in Taiwan in 2012 to 2017. The predictors of 30-day mortality were determined by Cox regression analysis. The overall 30-day mortality rate in the appropriate antibiotic treatment group was 25.0% (90/360 patients). The crude 30-day mortality rates for cefepime-cefpirome and carbapenem therapy were 11.5% (7/61 patients) and 26.3% (21/80 patients), respectively. The patients receiving cefepime-cefpirome or carbapenem therapy were infected by Acinetobacter nosocomialis (51.8%), Acinetobacter baumannii (18.4%), and Acinetobacter pittii (12.1%). After adjusting for age, Sequential Organ Failure Assessment (SOFA) score, invasive procedures, and underlying diseases, cefepime-cefpirome therapy was not independently associated with a higher or lower 30-day mortality rate compared to that with the carbapenem therapy. SOFA score (hazard ratio [HR], 1.324; 95% confidence interval [CI], 1.137 to 1.543; P < 0.001) and neutropenia (HR, 7.060; 95% CI, 1.607 to 31.019; P = 0.010) were independent risk factors for 30-day mortality of patients receiving cefepime-cefpirome or carbapenem monotherapy. The incidence densities of 30-day mortality for cefepime-cefpirome versus carbapenem therapy were 0.40% versus 1.04%, respectively. The therapeutic response of cefepime-cefpirome therapy was comparable to that with carbapenems among patients with Acinetobacter BSI receiving appropriate antimicrobial therapy.

Transmitted plasmonic colors with different overlays utilizing the Fano-resonance.

This study develops a large-area pixelated filter that can achieve colors covering the entire visible range with a fixed period under normal incidence. Vivid colors as blue, green, and yellow (peak efficiency of ~60%) are experimentally achieved based on a Fano-resonance by altering the overlay's refractive index, which is highly sensitive to the surrounding material. Furthermore, the feasibility of using this device in large-area color printing and index sensors is discussed in detail, wherein a large-area (3 cm × 3 cm) logo and a figure of merit of 254 are achieved. Therefore, this developed structure can be regarded as an alternative to traditional periodic-dependent structure colors, which can also be performed as index sensors with high sensitivity.

Determinants of Free Fasciocutaneous Flap Outcomes in Partial Hypopharyngeal Defects.

BACKGROUND: Most of the patients with hypopharyngeal cancer are still diagnosed with advanced stage, and total or partial pharyngectomy with free flap reconstruction is the mainstay of treatment. The aim of this study was to find out the possible risk factors related to surgical complications after free fasciocutaneous flap reconstruction for partial pharyngeal defect and its sequelae in the follow-up. PATIENTS AND METHODS: We retrospectively reviewed the charts of patients with advanced hypopharyngeal cancer who received free fasciocutaneous flaps for partial pharyngeal defects reconstruction. From 2005 to 2015, 79 free fasciocutaneous flaps (59 free fasciocutaneous flaps and 20 anterolateral thigh flaps) were performed in our department. The risk factors for free flap outcome and complications were evaluated with multivariant linear regression model. RESULTS: The mean age of patients was 60.8 years with male predominance. The mean follow-up duration was 39.6 months. Most of the cases (97.5%) were in stage III or IV. Patients with comorbidities showed significant correlation to flap failure (95% confidence interval [CI] = 0.038 to 0.264, P = 0.10). Anastomosis style (end-to-side vs end-to-end) was the only operation-related factors significantly related to flap failure rate (18.8% vs 3.2%, 95% CI = 0.031 to 0.32, P = 0.18). Flap size was significantly associated with fistula formation (95% CI = -0.005 to 0.000, P = 0.38). CONCLUSIONS: In our experience, patients with comorbidities and end-to-side anastomosis illustrate significantly higher flap failure rate in free fasciocutaneous flap reconstruction of partial hypopharyngeal defect. Reconstruction with smaller flap size had higher possibility of fistula formation.

Omnidirectional broadband metasurface absorber operating in visible to near-infrared regime.

We present an omnidirectional broadband metasurface absorber whose dielectric-metal-dielectric layers are modulated by cylinder arrays. The simultaneous excitation of surface plasmon resonance and localized surface plasmon resonance affords an average optical absorption of 0.97 (0.9, experiment), with peak absorption up to 0.99 (0.984, experiment), for the wavelength range of 400-1100 nm, and absorption >0.93 (0.87, experiment) for incident angles up to 60°. The device, which is fabricated by continuously variable spatial frequency photolithography, outperforms previously reported absorbers in cost. Moreover, it exhibits considerably lower emissivity (weak absorption) in the mid-infrared range, which makes it promising for energy harvesting.

Will cesarean section increase the risk of interstitial cystitis/painful bladder syndrome?

AIMS: A high number of patients with interstitial cystitis/painful bladder syndrome (IC/PBS) have a history of pelvic surgeries, and cesarean section is one of the most common pelvic surgeries in women. This study aimed to investigate if cesarean section increases the risk of IC/PBS. METHODS: Women who exclusively gave birth through cesarean section or vaginal delivery were identified from a nationwide database between 2002 and 2013. All were followed up during the study period to detect the event of IC/PBS. The IC/PBS hazard ratio (HR) in the cesarean cohort was compared with the vaginal delivery cohort with and without matching for confounding factors. RESULTS: The unmatched group included 22 158 cesarean deliveries and 40 214 vaginal deliveries. The IC/PBS HR in the cesarean cohort compared with that in the vaginal delivery cohort was 1.370 (95% confidence interval [CI], 0.903-2.079; P = 0.139). In the matched group, 8368 women were matched in each cesarean and vaginal delivery cohort using propensity scores for age and comorbidities. The IC/PBS HR was 0.725 (95%CI, 0.358-1.471; P = 0.373). Both HRs in these two groups were not significantly different. The incidence density of IC/PBS in delivered women, non-delivery women, and the general female population were not significantly different either (0.310, 0.255, and 0.292 per 1000 person-years, respectively; P = 0.549). CONCLUSIONS: The risk of IC/PBS was not different between cesarean and vaginal delivery after controlling the confounding factors in this cohort study. Cesarean section has no causal effect on IC/BPS. Furthermore, delivery was not a risk factor for IC/PBS.

Polarization-dependent wide-angle color filter incorporating meta-dielectric nanostructures.

A metadielectric nanostructure with narrow cavities is proposed, behaving as a reflective color filter for TM-polarized light while as a broadband reflector for TE-polarized light. By varying the cavity depth or changing the incident light polarization, reflective colors of the proposed structure cover the entire visible spectrum conveniently. In particular, the reflections of this proposed structure show good angular tolerance up to 50° for both polarizations. Furthermore, it can display colors even with two grating slits, which shows high printing resolution up to 70555 dpi, having great potential for applications of a large area color imaging and anticounterfeiting devices.

Employment Outcomes After Vocational Training for People With Chronic Psychiatric Disorders: A Multicenter Study.

People with a chronic psychiatric disorder (CPD) have low employment rates worldwide. This multicenter retrospective cohort study examined the employment outcomes of an innovative in-house vocational training program for people with CPD in Taiwan and explored which program parameters significantly predicted outcomes. Data were retrieved from the records of 323 participants who completed the training program. Satisfactory employment rates were found at 1 (52.9%), 3 (60.4%), and 6 (65.6%) mo posttraining, and 38.7% of participants demonstrated high employment sustainability (employed throughout the first 6 mo posttraining). Three program parameters significantly predicted employment outcomes: (1) occupational therapists' pursuit of additional training or short-term apprenticeship pertinent to clients' job interests, (2) posttraining vocational counseling provided by community-based occupational therapists, and (3) the duration of 6 mo posttraining to allow clients to prepare for competitive employment. Occupational therapist-led in-house vocational training is a promising alternative to traditional vocational training for people with CPD.

Broadband, wide-angle, and polarization-independent metamaterial absorber for the visible regime.

Broadband metamaterial absorber (MA) in the whole visible regime has attracted an enormous amount of attention for its potential applications in thermophotovoltaic cells, thermal emitters, and other optoelectronic devices. Nonetheless, complicated device configuration is still involved in achieving broadband, polarization-independent MA and it results in a cost-ineffective fabrication process. In this paper, a novel MA composed of a periodic array of dielectric cylinder sandwiched by the non-noble metal of nickel (Ni) film is demonstrated. Experimental results show that the proposed MA exhibits strong absorptive behavior independent of polarization in the whole visible regime (400-700 nm). The absorption still remains 80% when the incident angle is 60°. The proposed fabrication method is well compatible with the conventional soft nano-imprinting lithography technique, thus it is economic and scalable for a large-format substrate. These results provide an alternative method for the realization of high-performance visible light absorber and offer new opportunities for potential applications in related fields.

Longitudinal perceptions of the side effects of chemotherapy in patients with gynecological cancer.

PURPOSE: This study aimed to assess the incidence and difference of side effects among six courses of chemotherapy (C/T) in gynecological cancer patients. METHODS: The study period was from Sep. 2010 to Dec. 2011 at the Kaohsiung Veterans General Hospital in Taiwan. The treating protocols, courses, and drugs of C/T in patient were considered according to the different malignant cancers and clinical conditions. The patient data of age, marriage status, education, religion, and experiences of C/T were collected. The patients' or their families' reported side effects of C/T were recorded daily from the beginning of C/T to the 10th day after C/T in each cycle and every course of C/T. RESULTS: Total 89 patients enrolled into the study received total 450 courses of C/T. The mean age was 54.52 ± 11.02. Ovarian cancer was the most common malignant disease (64.0%). The most often combination of drugs used was Taxol and carboplatin (40.9%). Patients complained peripheral numbness of limbs, with the highest incidence of 58.6%. The side effects with incidence about 50% were decreased fatigue (55.0%) and hair loss (49.9%). Other side effects with different levels of incidence were also noticed, such as lack of appetite, changes in taste, and muscle ache. The incidences of peripheral limb numbness and hair loss were increased with following courses of C/T. The high incidence of fatigue did not show variation between different courses of C/T. CONCLUSION: This study revealed the incidence of side effects and occurrence timing during C/T in patients with gynecological cancer. These data provide substantial information to patients and their families to understand the potential side effects of C/T courses, which might increase their compliance in receiving adjuvant C/T. Relieving the side effects in C/T would be important to improve their quality of daily life and treatment willingness.

Can a 10-Minute Questionnaire Identify Significant Psychological Issues in Patients With Temporomandibular Joint Disease?

PURPOSES: For patients with disc displacement disorders (DDDs), psychiatric illness increases the risk of worsening postsurgical pain, postoperative delirium, postoperative incomplete recovery, and worse postoperative life quality. This study provides a fast and practical protocol to evaluate psychological conditions of patients with DDDs of the temporomandibular joint (TMJ) in clinical care. MATERIALS AND METHODS: The populations under investigation in this cross-sectional study included patients with DDD who received treatment from October 2012 through June 2016. Variables included age, gender, education level, and TMJ (Axis I) and psychological (Axis II) evaluations. The 13-item protocol of Axis II evaluations contained a 5-item Brief Symptom Rating Scale (BSRS-5), a pain visual analog scale (VAS; 1 item), major life events (3 items), suicidal risk (3 items), and substance use (1 item). Analysis of variance, χ2 test, and multivariate logistic regression were used for analyses. RESULTS: Of 177 patients, 75.14% were women (mean age, 37.46 ± 14.06 yr). Pain VAS scores clearly supported the following ranking of psychosocial discomforts: disc displacement without reduction with limited opening (DDWORWLO) > disc displacement without reduction without limited opening > disc displacement with reduction. Pain VAS and BSRS-5 correlated with 5 variables in Axis I (trismus, acute TMJ pain, chronic awake bruxism, chronic sleep bruxism, and deep bite). The DDD study indicated that 9.6% of patients required urgent referrals to mental health resources (MHRs) for their moderate and high suicidal risk DDD and 77% required nonurgent referrals to MHRs for their psychiatric morbidity. CONCLUSIONS: This study found that patients with DDD showed a prevalence of suicidal ideation and mean BSRS scores that were higher for anxiety, hostility, depression, interpersonal hypersensitivity, and insomnia than in the general population. Patients with trismus or acute TMJ pain could have a higher pain VAS score; chronic awake bruxism could involve greater hostility and lower depression; chronic sleep bruxism could increase sensitivity to interpersonal interactions; and deep bite could involve a higher anxiety level. DDWORWLO produced the highest pain VAS score in patients with DDD. The 13-item Axis II evaluations can offer useful clues for oral and maxillofacial surgeons and other specialists to collaborate with MHRs.

Effect of Flat-Plane Splint Vertical Thickness on Disc Displacement Without Reduction: A Retrospective Matched-Cohort Study.

PURPOSE: The efficacy of occlusal splints for treating temporomandibular disorders (TMDs) remains controversial. This study aimed to evaluate and compare the effectiveness of flat-plane splints (FPSs) with a vertical thickness of 3 mm (VT3) and 5 mm (VT5) in treating disc displacement without reduction (DDWOR). MATERIALS AND METHODS: This retrospective matched-cohort study selected the study participants from 400 TMD patients treated in the Department of Oral and Maxillofacial Surgery of Tainan Sin-Lau Hospital, Tainan, Taiwan, between August 2013 and July 2015. The thickness of occlusal splints was the predictor variable. The outcome variables included joint crepitus sound, deviation of the mandible during opening, TMD-associated headache, myofascial pain with referral, temporomandibular joint (TMJ) arthralgia, and maximum assisted opening. The case and control groups were matched 1:1 by propensity scoring to ensure that there were no statistical differences in the categorical variables and continuous variables. The analysis used χ2 tests, t tests, and multiple regression analyses. RESULTS: We allocated 162 patients into 2 groups, with 81 patients each: VT3 group and VT5 group. Both VT3 FPSs and VT5 FPSs effectively improved the DDWOR. At 12 months after treatment, the VT5 group showed remarkable improvement in joint crepitus sound and TMJ arthralgia compared with the VT3 group. No statistical differences in other TMJ-associated symptoms such as deviation of the mandible during opening, TMD-associated headache, and myofascial pain with referral were observed between the 2 groups. CONCLUSIONS: Both VT3 and VT5 FPSs can effectively improve various clinical symptoms of DDWOR. We suggest that VT5 FPS treatment for at least 1 year is a suitable option for DDWOR patients with joint crepitus sound and TMJ arthralgia. For DDWOR patients without joint crepitus sound and TMJ arthralgia, there are no differences between the VT3 and VT5 FPSs.

Somatic symptoms are sensitive in predicting interstitial cystitis/bladder pain syndrome.

Objectives Somatic symptoms are somatic complaints accompanied by disproportionate thoughts, feelings, and behaviors related to such symptoms. The study investigated five International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses hallmarked by somatic symptoms. The study hypothesized an increased risk of interstitial cystitis/bladder pain syndrome in patients with somatic symptoms. Methods The raw data were obtained from a nationwide health insurance reimbursement database over a 12-year period from 2002 to 2013. The study followed a somatic symptoms cohort ( n = 34,393) and non-somatic symptoms cohort ( n = 637,999) for interstitial cystitis/bladder pain syndrome. Both cohorts were stratified into three subgroups based on propensity scores calculated by sex, age, and 17 comorbidities of interstitial cystitis/bladder pain syndrome. Results The incidence density of interstitial cystitis/bladder pain syndrome between the somatic symptoms cohort and non-somatic symptoms cohort was significantly different in the three subgroups (relative ratio [95% confidence interval], 2.14 [1.01, 4.53], 1.52 [1.47, 1.57], and 1.59 [1.28, 1.98], respectively). The adjusted hazard ratio for interstitial cystitis/bladder pain syndrome was significantly greater in the female-dominant and older age subgroups-subgroup 2 and subgroup 3 (adjusted hazard ratios, 1.47 [1.07, 2.01] and 1.72 [1.38, 2.16], respectively). Conclusion The longitudinal investigation identified a subsequent risk of interstitial cystitis/bladder pain syndrome in patients with somatic symptoms. Somatic symptoms might be linked to biological pathways that might increase the risk of interstitial cystitis/bladder pain syndrome, much like more traditional psychosocial factors.

Temporal relationship between dysthymia and temporomandibular disorder: a population-based matched case-control study in Taiwan.

BACKGROUND: Numerous studies have reported a relationship between depression and temporomandibular disorders (TMD), but the conclusions remain undefined. The aim of this article was to examine the temporal relationship between depression and TMD. METHODS: In this retrospective matched case-control study, we recruited all samples from a randomsample sub-dataset of one million insured individuals for the year 2005 (Longitudinal Health Insurance Database (LHID2005)). All beneficiaries were enrolled in the National Health Insurance (NHI) programme in Taiwan. We used propensity scoring and matched the case and control groups (1:1) by ten confounding factors to detect the effect of different types of depression on TMD. RESULTS: The positive correlative factors of TMD included the total number of times medical advice was sought for an unspecified anomaly of jaw size plus malocclusion (TTSMA-JS, p = 0.045), the total number of times medical advice was sought for an anxiety state (TTSMA-AS, p = 0.000), and the total number of times medical advice was sought for a panic disorder (TTSMA-P, p = 0.009). Dysthymia (synonymous with chronic depression) had an effect on TMD. The odds ratio (OR) of dysthymia for TMD measured by multiple logistic regression was 1.91 (p = 0.008) after adjusting for demographic factors, psychiatric comorbidities, and maxillofacial confounders. CONCLUSIONS: This study demonstrated the established temporal relationship between dysthymia and TMD. The inclusion of a psychiatrist on the TMD management team is appropriate.

A cohort study of interstitial cystitis/bladder pain syndrome and hysterectomy.

INTRODUCTION AND HYPOTHESIS: Symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS) are often confused with uterine conditions. Gynecologists may therefore recommend hysterectomy which was inappropriate for these patients. This study investigated whether IC/BPS increases the risk of hysterectomy in a large nationwide retrospective cohort study. METHODS: From the Longitudinal Health Insurance Database 2010 (LHID2010) in Taiwan, we identified women diagnosed with IC/BPS between 2002 and 2013. Those with a history of hysterectomy before IC/BPS diagnosis were excluded. All women were stratified into three subgroups (younger, middle, older age) based on the propensity scores of 15 confounding factors, including age and comorbidities. All were followed until the end of 2013 to detect the event of hysterectomy. The hazard ratio (HR) of hysterectomy in the IC/BPS cohort was compared with the non-IC/BPS cohort among the three subgroups by Cox regression after adjusting for confounding factors. RESULTS: In addition to the representative middle age, subgroup 2 had similar rates of comorbidities as the general population. The study was both externally and internally valid. The risk of hysterectomy in the IC/BPS cohort (n = 536) was significantly higher than in the non-IC/BPS cohort (n = 103846) in subgroup 2 (HR = 1.701, 95 % CI 1.056-2.740). The mean time to hysterectomy after diagnosis of IC/BPS was 2.97 years. CONCLUSIONS: In this nationwide study, we found that IC/BPS has a causal impact on hysterectomy in the middle-age subgroup in LHID 2010. The possibility of a woman having IC/BPS should be evaluated prior to hysterectomy to avoid inappropriate surgery.

Reducing Trismus After Surgery and Radiotherapy in Oral Cancer Patients: Results of Alternative Operation Versus Traditional Operation.

PURPOSE: In patients with oral cancer, trismus (maximum interincisal opening [MIO] <35 mm) can develop as a result of surgery and radiotherapy. The aim of this study was to provide an alternative operation to both eradicate oral cancer and prevent postsurgical trismus. MATERIALS AND METHODS: In our retrospective cohort study of oral cancer patients who underwent operations during 2010 to 2014, the predictor variable was the type of operation (alternative operation or traditional operation) and the outcome variable was MIO. All of the cases were allocated by 2 periods: the traditional operations were performed from 2010 to 2011, and the alternative operations were performed from 2011 to 2014. All patients received marginal mandibulectomy, anterolateral thigh free flap, and adjuvant radiotherapy or concurrent chemoradiotherapy. In addition to traditional marginal mandibulectomy, the alternative operation included ipsilateral coronoidectomy and myotomy of the temporalis muscle insertion, masseter muscle, and medial pterygoid muscle. MIO was measured at 10 time points. The adjusted variables included demographic data, diagnostic parameters, treatment, and response. RESULTS: Of the 36 male patients with oral cancer, 16 were placed in the alternative operation group (AOG; mean age, 53.5 ± 11.9 years) and 20 were placed in the traditional operation group (TOG; mean age, 50.7 ± 7.1 years). Regarding the outcome indicator of patient MIO, the preoperative MIO in the AOG was on average 7.5 mm shorter than that in the TOG (P < .01), but it was consistently superior to the MIO in the TOG after the operation. Multivariate analysis of variance showed that patients in the AOG were more likely to have postoperative non-trismus. CONCLUSIONS: The alternative operation exhibited superior postoperative MIO values and similar postoperative complication rates. For the prevention of trismus, it is practical to perform the combined operation simultaneously, cutting all ipsilateral jaw closing muscles and the coronoid process and eradicating the tumor.