Comparative Assessment of Clinical and Predicted Treatment Outcomes of Clear Aligner Treatment: An in Vivo Study.

OBJECTIVE: The objective of this clinical study was to assess the predicted software models and clinical models and to compare the stage models of both the groups so as to evaluate the efficacy of tooth movement with clear aligner. METHODS: The sample size included 10 cases with mild anterior crowding treated with aligner therapy. The predicted software models were superimposed on the clinical stereolithography (STL) models at various stages by using the MeshLab software. The predicted software models showing orthodontic tooth movement were compared with the actual movement achieved clinically. RESULTS: The results of the present study have shown that when a comparison was made on the basis of irregularity scores in both the groups, it was seen that the irregularity score was higher at 2.55 at T4, 1.65 at T6, and 1.0 at T8 in the clinical STL group at each stage, whereas it was 2.0 at T4, 0.90 at T6, and 0.25 at T8 in the software model group. In addition, in comparing the mean accuracy of these three stages, the analysis of data showed that the mean accuracy is 62.5% at T4, 68.8% at T6, and 78.1% at T8. CONCLUSION: The predicted software models do not accurately reflect the patient's tooth position. There is an overestimation by predicted software as compared with actual clinically achieved tooth position. There is a need of overcorrection to be built in the treatment planning stage itself and execution of the anticipated end result.

Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective.

RATIONALE: Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management. OBJECTIVES: The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH. METHODS: We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening. MEASUREMENTS AND MAIN RESULTS: In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%. CONCLUSIONS: HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax.

Chest pain unit using thrombolysis in myocardial infarction score risk stratification: an impact on the length of stay and cost savings.

BACKGROUND: Despite the fact that studies have demonstrated cost-effectiveness of chest pain observation units (CPOUs) in emergency departments, they have not been widely implemented. Thrombolysis in Myocardial Infarction (TIMI) score is an easy and reliable tool, but none of the prior studies have used it for risk stratification in CPOUs. We propose to study the impact of CPOU using TIMI risk stratification model on the length of stay (LOS) and cost savings. METHODS: We studied 777 patients with chest pain admitted to our hospital from July 2010 to June 2011. The patients with a TIMI score of 0 to 2 were observed for 12 hours, those with a score of 3 to 4 were observed for 20 hours, and the ones with a score >4 were deemed appropriate for admission. We calculated the cost differences between the actual admissions and the CPOU. RESULTS: A total of 39.1% of patients had a TIMI score of 0, 31.1% had a TIMI score of 1, 18.1% had a TIMI score of 2, 9.2% and 2.5% had TIMI scores of 3 and 4, respectively. The expected LOS based on this model was 418.5 days versus the actual LOS of 1324 days. The cost of CPOU was estimated to be $1,979,977. However, the actual cost was $3,216,809. Hence, the annual cost savings were estimated to be $1,236,832. CONCLUSION: CPOU using TIMI score is an easy and reliable risk stratification tool for patients with chest pain in the emergency department and can significantly reduce the LOS, hence saving millions of dollars in this economic crisis.

Healing assessment of osseous defects of periapical lesions with use of freeze dried bone allograft.

OBJECTIVES: The aim of this study was to save endodontically failed teeth with periapical pathosis by surgery. Elimination of the periapical pathology and to evaluate the clinical and radiological efficiency of freeze dried bone allograft in bony defects. MATERIALS AND METHODS: Ten patients were included in this study with established periapical pathology with the need for periapical surgery after failed endodontic therapy. Surgery was decided after the cessation of acute symptoms. Patients on regular medications for known medical complications were excluded from the study. A full thickness flap or modified Leubke-ochsecnbein was raised depending upon the size and location of the lesion. Thorough periapical curettage was performed to remove the pathological tissue surrounding the apices and the root of the tooth. The graft material was mixed with patient's venous blood drawn earlier from a peripheral vein to make it more cohesive. The graft material mixed with blood was then carefully packed with light pressure into the defect. The flap was replaced. All the patients received broad spectrum antibiotics one day before and five days after surgery. The cases were followed up with clinical and radiological examination and were recalled at intervals of 1 month, 3 months and 5 months postoperatively to assess the condition of the periapical area. RESULTS: In all the ten cases at the end of 1st month postoperatively a well defined border separating the host bone from the graft material indicating simultaneous resorption of the graft. This resorption continued at 3 months follow up indicating continued graft resorption and also increasing radioopacity, haziness indicating bone regeneration. Eight of the ten patients could be evaluated at the end of fifth month and radiographs showed increase in radioopacity and reduction in size of periapical radiolucency as well as normal trabecular pattern of the bone. CONCLUSION: The results demonstrate successful use of FDBA in the treatment of osseous defects of periapical lesions associated with failed endodontically treated teeth.

Clinical correlation of multiple biomarkers for risk assessment in patients with acute coronary syndrome.

OBJECTIVE: Biochemical markers are useful for the prediction of future cardiovascular events in patients with non-ST-segment elevation acute coronary syndrome (ACS). The independent as well as the combined prognostic value of elevated troponin-T, high-sensitivity C-reactive protein (hs-CRP), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) on the Thrombolysis In Myocardial Infarction (TIMI) risk score and on the short-term prognosis were evaluated in a cohort of ACS patients. METHODS AND RESULTS: In an unselected, heterogeneous group of 80 patients with ACS (i.e., unstable angina [USA] or non-ST-elevation myocardial infarction [NSTEMI]), the levels of troponin-T, hs-CRP, and NT-pro-BNP were analyzed. The correlation between elevation of different biomarkers with TIMI risk score and their impact on 30-day major adverse cardiac events was sought. The levels of hs-CRP were significantly higher in patients who had angina as their predominant complaint (3.67 mg/dl vs. 1.67 mg/dl: p < 0.01), while levels of NT-pro-BNP was higher in those patients who had any element of heart failure at presentation (2616.39 pg/ml vs. 1068.3 pg/ml; p < 0.01). Troponin-T was highest in patients who had an element of both heart failure and angina at presentation (p < 0.01). The TIMI risk score expectedly had a positive and strong correlation with elevated troponin-T, but had no correlation with elevation of hs-CRP and NT-pro-BNP in isolation. However, when any two biomarkers were elevated, the patients were in the intermediate risk group as per TIMI risk score irrespective of troponin-T-elevation. When all the three biomarkers were elevated, the risk equaled the high-risk category of TIMI risk score. Elevated hs-CRP (3.40 mg/dl vs. 1.38 mg/dl; p < 0.001) and troponin-T (2.37 ng/ml vs. 1.23 ng/ml; p < 0.001) at baseline correlated independently with the occurrence of re-ischemia, while elevated NT-pro-BNP alone correlated significantly with the development of heart failure within 30 days of follow-up (4247.76 pg/ml vs. 1210.86 pg/ml; p < 0.01). The highest risk of death from any cardiovascular cause within 30 days of follow-up was significantly higher when all the three biomarkers were elevated. CONCLUSION: The use of NT-pro-BNP, hs-CRP, and troponin-T in combination appears to add critical prognostic insight to the assessment of patients with ACS.