Integrating a mouth opening assessment of virtual patients to prevent intraoperative challenges during treatment.

Template-guided implant surgery in the posterior region or zygomatic implant surgery using dynamic navigation systems is often hindered if a patient has limited mouth opening. To overcome the problem, the authors have proposed a novel digital protocol that integrates the use of a facial scan for the assessment of the maximal mouth opening of a virtual patient to assist in preoperative planning, thereby minimizing the likelihood of intraoperative obstruction of the surgical site. The proposed method is cost effective and can be easily used in clinical practice.

Accuracy assessment of dynamic navigation during implant placement: A systematic review and meta-analysis of clinical studies in the last 10 years.

OBJECTIVES: To evaluate the accuracy of dynamic computer-aided implant surgery (dCAIS) and compare it with static computer-aided implant surgery (sCAIS) and freehand implant placement (FH) in partially or fully edentulous patients. DATA: Studies that analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients. SOURCES: This meta-analysis included studies published in English and Mandarin Chinese from January 2013 to February 2023 from MEDLINE/PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure). STUDY SELECTION: Only clinical studies were included. Accuracy was the primary outcome. Seventeen studies met the inclusion criteria. A total of 2,025 implants were analyzed. Meta-regression was conducted to compare the six different navigation systems. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was adopted as a collective grading of the evidence. CONCLUSIONS: Dynamic navigation is a clinically reliable method for implant placement. Significantly lower angular deviation was observed for dCAIS compared to both sCAIS and FH, while significantly lower global platform and apex deviations were displayed between dCAIS and FH. Overall, dynamic navigation allowed for higher accuracy compared to both sCAIS and FH in a clinical setting; however, additional large sample RCT studies should be conducted, and patient-reported outcome measures (PROMs) reported. CLINICAL SIGNIFICANCE: This systematic review analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients compared with static navigation. The results demonstrated that dynamic navigation could decrease implant placement angular deviations.

Healthcare Costs Associated with Complications in Patients with Type 2 Diabetes among 1.85 Million Adults in Beijing, China.

We aimed to provide reliable regression estimates of expenditures associated with various complications in type 2 diabetics in China. In total, 1,859,039 type 2 diabetes patients with complications were obtained from the Beijing Medical Claim Data for Employees database from 2008 to 2016. We estimated costs for complications using a generalized estimating equation model adjusted for age, sex, and the incidence of various complications. The average total cost for diabetic patients with complications was 17.12 thousand RMB. Prescribed drugs accounted for 63.4% of costs. We observed a significant increase in costs in the first year after the onset of complications. Compared with costs before the incidence of complications, the additional costs per person in the first year and >1 year after the event would be 10,631.16 RMB and 1150.71 RMB for cardiovascular disease, 1017.62 RMB and 653.82 RMB for cerebrovascular disease, and 301.14 RMB and 624.00 RMB for kidney disease, respectively. The estimated coefficients for outpatient visits were relatively lower than those of inpatient visits. Complications in diabetics exert a significant impact on total healthcare costs in the first year of their onset and in subsequent years. Our estimates may assist policymakers in quantifying the economic burden of diabetes complications.

[Establishment and assessment of tibial osteoradionecrosis in rats].

PURPOSE: To establish a rat tibial osteoradionecrosis model and assess the model by observing clinical manifestation and histopathological examinations. METHODS: The right tibia of 6 Sprague Dawley (SD) rats (weighing 200-250 g) was irradiated by a linear accelerator (single fraction 15 Gy, total dose 60 Gy) every second week for four times. Hair and cutaneous changes of the irradiated region were observed one, two, three and four weeks after irradiation, respectively. Histopathological examination was employed to compare the bone tissue between the irradiated region and irradiation-free region. X-ray film was taken to evaluate the bone destruction. SPSS13.0 software package was used for statistical analysis. RESULTS: One week after irradiation, no significant change was observed in the irradiated region. However, the palm of the irradiated limb turned red remarkably in contrast with the opposite one. Two and three weeks after irradiation, trichomadesis was observed in the irradiated region. Four weeks after irradiation, complete trichomadesis and skin ulceration occurred in the irradiated region. In histopathological examinations, hematoxylin-eosin staining showed that bone mass including bone plate thickness, bone marrow cell, bone trabecula decreased significantly in the irradiated region compared with the control side. Moreover, significant bone destruction was found in irradiated group. CONCLUSIONS: We have successfully established a rat tibial model of osteoradionecrosis with radiation at dosage of 60 Gy divided into 4 times.

The road to effective tobacco control in China.

The non-communicable disease burden in China is enormous, with tobacco use a leading risk factor for the major non-communicable diseases. The prevalence of tobacco use in men is one of the highest in the world, with more than 300 million smokers and 740 million non-smokers exposed to second-hand smoke. In the past decade public awareness of the health hazards of tobacco use and exposure to second-hand smoke has grown, social customs and habits have changed, aggressive tactics used by the tobacco industry have been revealed, and serious tobacco control policies have been actively promoted. In 2014, national legislators in China began actively considering national bans on smoking in public and work places and tobacco advertising. However, tobacco control in China has remained particularly difficult because of interference by the tobacco industry. Changes to the interministerial coordinating mechanism for implementation of the WHO Framework Convention on Tobacco Control are now crucial. Progress towards a tobacco-free world will be dependent on more rapid action in China.

[An economic evaluation of low dose recombinant human tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism].

OBJECTIVE: To compare and evaluate the cost and effectiveness between recombinant human tissue-type plasminogen activator (rt-PA) 50 mg and 100 mg regimen for the treatment acute pulmonary thromboembolism (PTE). METHODS: Based on a randomized clinical trial data, 118 cases were enrolled, 65 cases in group 50 mg and 53 cases in group 100 mg, which showed the similar efficacy and safety of rt-PA 50 mg and 100 mg. Progressive improvement in pulmonary artery obstructions was found to be similarly significant in both treatment groups, but there was no significant differences between the two groups (89.1% vs 89.6%, chi(2) = 0.007, P = 0.936). The rates of adverse events in two groups were same as well (17% vs 32%, chi(2) = 3.704, P = 0.054). We compared the cost directly and the cost-effective rate of the two groups. Based the cost saving of individual patient, prevalence rate of acute PTE, and co-pay rate of reimbursement, we calculated the cost saving of societal and payer's perspective. RESULTS: The cost of group 50 mg is 6352 RMB/person, and the cost of group 100 mg is 12,704 RMB/person. The cost-effect rates of the two groups were 7129 and 14,179 separately. With the same effect, each patient in 50 mg group can save 7050 RMB. If the PTE patients in China were treated with rt-PA 50 mg instead of 100 mg, the society cost saving would be 443,604,624 RMB. CONCLUSION: rt-PA 50 mg/2 h regimen, compared with 100 mg/2 h, can not only provide similar efficacy and safety, but also show a good health economic saving.

[Cost-effectiveness analysis on compound anti-hypertensive tablets for primary hypertension].

OBJECTIVE: To compare the cost-effectiveness of two anti-hypertensive therapy regimens, Compound anti-hypertensive tablets and other common anti-hypertensive agents, in the treatment program of Primary Hypertension. METHODS: We conducted a cost-effectiveness analysis based on a community trial. Two communities' primary hypertensive patients were enrolled to receive different therapy drugs: Compound anti-hypertensive tablets (Group A) or other common anti-hypertensive agents (Group B). Blood pressure, medicine used, and adverse drug reactions were observed and recorded for one year, and then cost-effectiveness ratio of the two groups and incremental ratio were calculated. We considered a 30% drug price fluctuating load to make the sensitivity analysis. RESULTS: 2505 cases were enrolled with 1529 cases in group A and 976 cases in group B. The cost-effectiveness ratios were 418.1 and 1057.7 for Group A and B respectively while the incremental cost-effectiveness of Group B vs. Group A was 19 202.2. The results were insensitive to variation in the costs of drugs over clinically reasonable ranges. CONCLUSION: Compound anti-hypertensive tablets appeared to be relatively cost-effective when compared to common drugs for the treatment of primary hypertension.