Periodontal therapy for hopeless mandibular anterior teeth: a retrospective case report with a multidisciplinary approach and a 20-year follow-up

Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.

Long-term trends and response of wet ammonia deposition to changes in anthropogenic emissions in the Pearl River delta of China.

The Pearl River Delta (PRD) region has been identified as a significant hotspot of wet ammonium deposition. However, the absence of long-term monitoring data in the area hinders the comprehension of the historical trends and changes in wet NH4+-N deposition in response to emissions, which interferes with the ability to make effective decisions. This study has analyzed the long-term trends of wet NH4+-N deposition flux and has quantified the effect of anthropogenic emissions and meteorological factors at a typical urban site and a typical forest site in the PRD region from 2009 to 2020. It revealed a significant decreasing trend in wet NH4+-N flux in both the typical urban and forest areas of the PRD region, at -6.2%/year (p < 0.001) and -3.3%/year (p < 0.001), respectively. Anthropogenic emissions are thought to have contributed 47%-57% of the wet NH4+-N deposition trend over the past 12 years compared to meteorological factors. Meteorological conditions dominated the inter-annual fluctuations in wet NH4+-N deposition with an absolute contribution of 46%-52%, while anthropogenic emissions change alone explained 10%-31%. NH3 emissions have the greatest impact on the urban area among anthropogenic emission factors, while SO2 emissions have the greatest impact on the forest area. Additionally, precipitation was identified as the primary meteorological driver for both sites. Our findings also imply that the benefits of NH3 emissions reductions might not immediately emerge due to interference from weather-related factors.

Continuous Wireless Telemetric Measurement of Intraocular Pressure (IOP), Ocular Perfusion Pressure (OPP), and Cerebrospinal Fluid Pressure (CSFP) in Nonhuman Primates (NHPs).

Intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFP) telemetry in large animal models can be used to determine the exact IOP, CSFP, translaminar pressure, and translaminar pressure gradient exposure that each normal and treated eye is subjected to relative to its fellow eye. In this way, it is possible to determine the independent contributions of each of these parameters (mean and/or transient fluctuations) to the risk of both the onset and rate of progression of glaucoma. Importantly, we have shown that IOP and CSFP fluctuate continuously by up to 100% over the course of the day, so snapshot cage-side IOP measurements are unable to adequately capture the pressure in the eye; CSFP is not measurable noninvasively at all. Implementation of IOP and CSFP telemetry will allow us to precisely determine the pressure insult in each eye of each animal and thereby unravel the true mechanisms underlying pressure-induced damage to the retinal ganglion cells in glaucoma.

Quantitative impacts of meteorology and emissions on the long-term trend of O3 in the Yangtze River Delta (YRD), China from 2015 to 2022.

Extensive spatiotemporal analyses of long-trend surface ozone in the Yangtze River Delta (YRD) region and its meteorology-related and emission-related have not been systematically analyzed. In this study, by using 8-year-long (2015-2022) surface ozone observation data, we attempted to reveal the variation of multiple timescale components using the Kolmogorov-Zurbenko filter, and the effects of meteorology and emissions were quantitatively isolated using multiple linear regression with meteorological variables. The results showed that the short-term, seasonal, and long-term components accounted for daily maximum 8-hr average O3 (O3-8 hr) concentration, 46.4%, 45.9%, and 1.0%, respectively. The meteorological impacts account for an average of 71.8% of O3-8 hr, and the YRD's eastern and northern sections are meteorology-sensitive areas. Based on statistical analysis technology with empirical orthogonal function, the contribution of meteorology, local emission, and transport in the long-term component of O3-8 hr were 0.21%, 0.12%, and 0.6%, respectively. The spatiotemporal analysis indicated that a distinct decreasing spatial pattern could be observed from coastal cities towards the northwest, influenced by the monsoon and synoptic conditions. The central urban agglomeration north and south of the YRD was particularly susceptible to local pollution. Among the cities studied, Shanghai, Anqing, and Xuancheng, located at similar latitudes, were significantly impacted by atmospheric transmission-the contribution of Shanghai, the maximum accounting for 3.6%.

A methodological framework for estimating ambient PM2.5 particulate matter concentrations in the UK.

Scientific evidence sustains PM2.5 particles' inhalation may generate harmful impacts on human beings' health; therefore, their monitoring in ambient air is of paramount relevance in terms of public health. Due to the limited number of fixed stations within the air quality monitoring networks, development of methodological frameworks to model ambient air PM2.5 particles is primordial to providing additional information on PM2.5 exposure and its trends. In this sense, this work aims to offer a global easily-applicable tool to estimate ambient air PM2.5 as a function of meteorological conditions using a multivariate analysis. Daily PM2.5 data measured by 84 fixed monitoring stations and meteorological data from ERA5 (ECMWF Reanalysis v5) reanalysis daily based data between 2000 and 2021 across the United Kingdom were attended to develop the suggested approach. Data from January 2017 to December 2020 were employed to build a mathematical expression that related the dependent variable (PM2.5) to predictor ones (sea-level pressure, planetary boundary layer height, temperature, precipitation, wind direction and speed), while 2021 data tested the model. Evaluation indicators evidenced a good performance of model (maximum values of RMSE, MAE and MAPE: 1.80 µg/m3, 3.24 µg/m3, and 20.63%, respectively), compiling the current legislation's requirements for modelling ambient air PM2.5 concentrations. A retrospective analysis of meteorological features allowed estimating ambient air PM2.5 concentrations from 2000 to 2021. The highest PM2.5 concentrations relapsed in the Mid- and Southlands, while Northlands sustained the lowest concentrations.

Specialists Versus Trainees: Long-Term Secondary Deformity After Unilateral Cleft Lip Repair.

BACKGROUND: Unilateral cleft lip repair is a common procedure in plastic and reconstructive surgery to restore both function and aesthetics. The long-term outcomes of these surgeries can be influenced by various factors, including the experience and position of the surgeon performing the procedure. This study aims to investigate whether there is a significant difference in long-term secondary deformities based on whether the surgery was performed by a specialist or a trainee. METHODS AND MATERIALS: This is a retrospective cross-sectional study among unilateral cleft lip patients based on their data records. The study aims to assess the long-term secondary deformity in relation to the position of the surgeon (specialist or trainee) in patients who underwent unilateral cleft lip repair surgery at the Reconstructive Sciences Unit at Hospital Universiti Sains Malaysia (HUSM). RESULTS: Of the 50 patients, the majority (74%) were operated on by a specialist with more than five years of experience. Only 13 patients (26%) were operated on by trainees in the plastic and reconstructive surgery training program. Long-term secondary deformity had no significant relationship with the surgeon's position (chi-squared (χ2)(1) = 5.89, p = 0.08). CONCLUSION: Long-term secondary deformities were less likely following unilateral cleft lip repair performed by a specialist or senior surgeon. However, the relationship between these secondary deformities and the surgeon's position (specialist or trainee) was statistically insignificant. Therefore, this study urges trainees to be more involved in simple cleft surgeries to enhance their surgical skills and achieve the best outcomes.

Bioremediation of metal cyanide complexes from electroplating wastewater for long-term application using Agrobacterium tumefaciens SUTS 1 and Pseudomonas monteilii SUTS 2.

The purpose of this study was to investigate the optimum conditions, including aerobic and anoxic conditions, for operating a long-term bioreactor system to decrease the toxicity of industrial electroplating wastewater effluents containing metal cyanide using Agrobacterium tumefaciens SUTS 1 and Pseudomonas monteilii SUTS 2. The initial results revealed that bacteria performed better under aerobic conditions than under anoxic conditions. An aerobic bioreactor system was subsequently set up in a long-term study lasting 30 days under optimum operating conditions. Both mixed-culture bacteria and indigenous bacteria promoted the high-efficiency treatment of cyanide and metals in the first 7 days of the study. When the system had high removal rates, cyanide removal was greater than that of zinc, copper, nickel, and chromium (CN- > Zn > Cu > Ni > Cr), with removal efficiencies of 96.67%, 93.93%, 74.17%, 63.43%, and 44.65%, respectively, with residual concentrations of 0.15 ± 0.01, 0.24 ± 0.005, 0.03 ± 0.002, 18.41 ± 0.06 and 14.26 ± 0.15 mg/L, respectively. The cell concentration in the bioreactor increased to approximately 107 CFU/mL over 30 days from initial cell concentrations of 6.15 × 105 CFU/mL and 1.05 × 103 CFU/mL for the mixed culture and indigenous inoculation, respectively. These results implied that the bacteria were resistant to heavy metal toxicity. The addition of an appropriate carbon source with sufficient aeration to a bioreactor resulted in increased cyanide degradation.

Clinical efficacy of arthroscopic single-bundle versus double-bundle reconstruction of the posterior cruciate ligament: a retrospective study.

PURPOSE: To compare the functional and clinical outcomes of knee joints in patients over a 10-year period following posterior cruciate ligament (PCL) reconstruction with single-bundle versus double-bundle. METHODS: Patients who underwent PCL reconstruction were retrospectively analyzed. Based on the surgical approach, they were divided into the single-bundle reconstruction group and the double-bundle reconstruction group. Preoperative and postoperative Lysholm score, International Knee Documentation Committee (IKCD) score, and Tegner activity score were evaluated, and the stability of the joints was assessed using KT-2000 arthrometer. Radiographs were taken at the final follow-up to evaluate the progression of osteoarthritis. RESULTS: A total of 61 patients were included in the analysis: 26 in the double-bundle group and 35 in the single-bundle group. Baseline data were comparable between the two groups (P > 0.05). There were no significant differences between the two groups in preoperative Lysholm, IKDC score, and Tegner activity score. Postoperatively, these scores were significantly higher at two and ten years follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). There was no significant difference in side-to-side differences (SSD) at 30° and 90° of knee flexion preoperatively between the groups (P > 0.05). Postoperatively, SSD decreased significantly at the two year and ten year follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). For osteoarthritis progression, there were four cases of Kellgren-Lawrence grade ≥ II in the single-bundle group and three cases in the double-bundle group, with no significant difference in the progression of osteoarthritis between the groups (P > 0.05). CONCLUSION: Both single-bundle and double-bundle reconstructions for PCL result in good joint stability and mobility, with similar progression of osteoarthritis in long-term follow-up. LEVEL OF EVIDENCE: Level III.

Depressive symptoms and quality of life in patients with benign essential blepharospasm under long-term therapy with botulinum toxin.

Regular and long-term injections of botulinum toxin (BoNT) are considered the first line therapy for essential blepharospasm (BEB), but no data exists on the long-term effect of this therapy on depressive symptoms and quality of life. This study aims to prospectively evaluate the long-term effects of BoNT therapy on depressive symptoms as well as on daily activities, emotional well-being and quality of life using validated questionnaires (BEB-scale, Beck`s Depression Inventory (BDI)). 86 patients diagnosed with BEB were followed up for a median of 4 years. Clinical symptoms improved significantly after BoNT-injections. Everyday activities and subjective assessment of the overall situation improved gradually under long-term BoNT therapy. Significant correlations (p < 0.0001; r-values between 0.498 and 0.706) were found between the BDI and items of the BEB-scale. No significant antidepressive effect of long-term BoNT therapy was found with a low median BDI total score (5/max. 63), but up to 31.3% of BEB patients had a BDI score ≥ 11, indicating clinically relevant depressive symptoms. Of these, 65.4% had no known history of depression. Although, several studies reported an antidepressant effect of botulinum toxin injections in patients with major depression, this effect does not seem to be present in patients with BEB despite clinical improvement of symptoms. A high prevalence of previously undetected depressive symptoms was found in BEB patients. As this may influence BoNT therapy success, identifying potential depressive symptoms at the time of BEB diagnosis and initiating appropriate treatment seems important.

The impact of the multicomponent "Healthy and Vital" 3-month lifestyle intervention in health professionals: a single group pre-(multiple) post-study.

BACKGROUND: Working in healthcare often involves stressful situations and a high workload, and many healthcare workers experience burnout complaints or suffer from mental or physical problems. This also affects the overall quality of health care. Many previous workplace interventions focused on knowledge exchange instead of other health cognitions, and were not particularly effective. Multicomponent lifestyle interventions may offer the potential in improving lifestyle and well-being of healthcare professionals. This study aims to evaluate the impact of a multicomponent lifestyle intervention "Healthy and Vital" for healthcare professionals on several health-related outcomes. METHODS: A pre- (multiple) post-pilot study has been conducted using data from 2012 to 2018 to evaluate the lifestyle intervention in 126 female healthcare professionals. Measurements were conducted before, directly after the intervention (at 3 months), and 6 months after finishing the intervention (at 9 months). Participants filled out questionnaires and anthropometrics measurements were conducted by a dietitian. The intervention is based on the ASE-model, theory of planned behavior, and motivational interviewing techniques. The intervention included workshops related to stress, eating, sleep, and individual meetings with a dietitian. Multilevel linear mixed models with a random intercept and fixed slope were used to evaluate the impact on lifestyle self-efficacy, eating behavior, anthropometric outcomes and quality of life. RESULTS: Improvements were observed for lifestyle self-efficacy (total: beta= 1.32 95%CI 0.94;1.48, I know: beta= 1.19 95%CI 0.92;1.46, and I can: beta= 1.46 95%CI 1.19;1.73), eating behavior (emotional eating: beta=-0.33 95%CI-0.44;-0.23, external eating: beta=-0.35 95%CI -0.44;-0.26, and diet/restrictive behavior: beta= 0.41 95%CI 0.30;0.51), anthropometric outcomes (weight: beta=-5.03 95%CI -5.93;-4.12, BMI: beta=-1.873 95%CI -2.06;-1.41, waist circumference: beta=-6.83 95%CI -8.00;-5.65, and body fat percentage: beta=-1.80 95%CI -2.48;-1.17) and multiple outcomes of quality of life (physical functioning: beta= 4.43 95%CI 1.98;6.88, vitality: beta= 7.58 95%CI 4.74;10.42, pain: beta=4.59 95%CI 0.91;1.827, general health perception: beta= 7.43 95%CI 4.79;10.07, and health change: beta= 21.60 95%CI 16.41;28.80) directly after the intervention. The improvements remained after a six-month follow-up. CONCLUSIONS: Multicomponent interventions such as "Healthy and Vital" for healthcare professionals may be useful for improving the health of healthcare workers. More research using other designs with a control group, such as a stepped-wedge or RCT, is needed to verify our findings. TRIAL REGISTRATION: Retrospectively registered on May 1 2024 at the Open Science Framework Registries ( https://doi.org/10.17605/OSF.IO/Z9VU5 ).

Subsidized Versus Unsubsidized Senior Housing Communities in PA: A Window on Variation in Health, Function, and Access to Services in Old Age.

Introduction: Independent Living residences for older adults can be divided into two categories and require better definitions for research purposes; the purpose of this manuscript is to provide those definitions and explore variation in provided services and resident characteristics: (a) Subsidized age-based housing (55+) (Department of Housing and Urban Development (HUD) housing units for low-income adults), and (b) non-subsidized age-based housing. Methods: Residents in the two settings were compared: 37 subsidized locations (p = 289 residents) and 19 non-subsidized (p = 208). Aging support services in each housing type were quantified. Results: Subsidized residents are more likely to be female (84.6% vs. 70.2%, p = .0002) and have fair-poor health (36.5% vs. 12.5%, p < .0001), frequent pain (28.4% vs. 12.8%, p < .0001), and fair-poor mobility (37.5% vs. 23.5%, p = .0298). Non-subsidized locations are more likely to offer support services; on average, residents are older (mean age 83vs. 75; p < .0001) and white (97.6% vs. 69.2%, p < .0001). Conclusion: Significant differences exist between populations living in subsidized and non-subsidized housing, suggesting the effect of cumulative disadvantage over the lifespan; populations in poorer health have access to fewer services. Research is needed to explore generalizability on a national level.

Long-Term Association Between Patient-Reported Outcomes and Psychological Factors in Patients With a Distal Radius Fracture.

Purpose: The outcome after a distal radius fracture (DRF) is often evaluated with radiography, clinical examination, and patient-reported outcome measures. However, research has identified associations between psychological factors and outcomes after a DRF. A knowledge gap exists about psychological factors and their potential implications for long-term outcomes after a DRF. The aim of this study was to examine the long-term association between psychological factors and patient-reported outcomes. Methods: This multicenter investigation included patients aged 15-75 years with closed physes presenting with an acute DRF. Patients who completed a long-term follow-up (after 11-13 years) with patient-reported outcome measures were invited to participate in the study, and surveys measuring psychological factors were sent to the patients. Results: Two hundred and four patients (70%) completed the follow-up (mean [range] age at injury, 56 [18-75] years; 154 were females [75%]). Multivariable analysis showed that higher age, injury to the dominant hand, and greater pain catastrophizing were associated with an increase in scores on the Disabilities of the Arm, Shoulder, and Hand questionnaire. Conclusions: A decade after sustaining a DRF, patients with higher scores on the Pain Catastrophizing Scale reported inferior outcomes as measured by the Disabilities of the Arm, Shoulder, and Hand. The Pain Catastrophizing Scale accounts for 13% of the observed variance in Disabilities of the Arm, Shoulder, and Hand. Type of study/level of evidence: Therapeutic level IIb.

Association between female infertility and stroke mortality: evidence from the PLCO cancer screening trial.

Objective: While infertility affects about 15% of women during their reproductive years, its long-term impact on stroke mortality after this period remains unclear. This study aims to investigate the association between infertility and stroke mortality in women using data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial. Methods: We analyzed data from 75,778 female participants aged 55-74 years with a median follow-up of 16.84 years. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for stroke mortality, adjusting for potential confounders. Results: Among participants, 14.53% reported infertility. During follow-up, 1,159 women died from stroke. Compared to women without infertility, those with infertility had a higher risk of stroke mortality (HR 1.21, 95% CI 1.04-1.41, p = 0.016). This association remained statistically significant after adjusting for age, race, education level, marital status, smoking status, body mass index, history of hypertension, history of heart attack, history of diabetes mellitus, birth control pill use, hormone replacement therapy, endometriosis, first menstrual period and pregnancy history (HR 1.20, 95% CI 1.02-1.42, p = 0.029). Sensitivity and subgroup analyses yielded consistent results. Conclusion: The findings of this study indicate that infertility is associated with an increased risk of stroke mortality in women. Further research is needed to confirm these findings and elucidate the underlying mechanisms.

Impact of the Hospital Frailty Risk Score on Outcomes After Transcatheter Aortic Valve Replacement in Late Elderly Patients.

OBJECTIVES: Prognostic prediction using objective indices is needed to optimize the indications for transcatheter aortic valve replacement (TAVR). We evaluated the impact of the Hospital Frailty Risk Score (HFRS), an International Classification of Diseases (ICD)-based frailty index, on the prognosis after TAVR in the late elderly. METHODS: We identified patients aged ≥75 years undergoing TAVR from April 2014 to September 2020 from the Shizuoka Kokuho Database (SKDB). Cox logistic regression analysis was performed to examine predictors of long-term mortality. We also evaluated the relationship between HFRS categories (low risk: <5, intermediate risk: 5-15, high risk: >15) and functional decline. RESULTS: This study involved 607 patients (189 (31.1%) men) with a mean age of 85.0 years. During the median follow-up period of 20 months, survival significantly differed among HFRS categories (survival at two years; low (HFRS <5): 88.9%, intermediate (HFRS 5-15): 82.6%, high (HFRS >15): 67.7%; log-rank p = 0.002). In the multivariate regression model, male sex (hazard ratio (HR): 2.15, 95% confidence interval (CI): 1.42-3.24), preoperative care needs level of ≥3 (HR: 2.43, 95% CI: 1.17-5.06), and HFRS (HR: 1.07, 95% CI: 1.03-1.12) were significant predictors of mortality. Functional decline-free survival significantly differed among HFRS categories (event-free survival at two years; low: 79.4%, intermediate: 75.2%, high: 50.8%; log-rank p = 0.001). CONCLUSIONS: The HFRS is a predictor of long-term mortality after TAVR in the late elderly and is associated with postoperative functional decline. The HFRS can provide additional information for decision-making regarding treatment strategies for the late elderly.

Identification investigations: a collaborative approach to the resolution of long-term unidentified persons cases at the NYC Office of Chief Medical Examiner.

The New York City Office of Chief Medical Examiner (NYC OCME) investigates approximately 9 000-10 000 deaths every year, each of which necessitates a formal identification. Although standard identification protocols resolve the majority of these cases, there are still a substantial number of long-term unidentified persons cases that require a targeted investigation. This process involves not only the comprehensive review of all available postmortem data (e.g. scene findings, personal effects, autopsy findings, toxicology results, forensic anthropology reports, dental findings, fingerprints, forensic biology), but also the collection of antemortem data through focused informant interviews, analyzing casefiles and/or archival records, reviewing public missing person postings (e.g. National Missing and Unidentified Persons System (NamUs)), and collaborating with law enforcement and other agencies. This holistic approach to identification investigations is systematic yet flexible, allowing for the needs of each unidentified person and/or missing person case to be thoroughly assessed and efficiently addressed. These efforts have proven successful at NYC OCME, resulting in over 80 long-term unidentified persons identifications confirmed in the last 7 years, dating as far back as 1969. This paper provides a detailed breakdown of the NYC OCME framework for long-term unidentified persons investigations, citing multiple case studies to underscore how investigators utilize multiple lines of evidence to generate potential leads. Although each jurisdiction faces a unique set of demands and limitations, sharing these investigative strategies and perspectives may benefit practitioners contending with long-term unidentified persons cases and their inherent complexities. Key points: The NYC OCME oversees a large caseload of unidentified persons yet achieves a high rate of case resolution by applying a systematic and holistic investigation that involves a comprehensive review of postmortem data and the collection of antemortem data specific to a forensic identification.Analyzing multiple lines of postmortem biological and contextual evidence allows practitioners to hypothesize possible socioeconomic, cultural, and religious social identities that can be used to generate identification leads and inform comparisons to missing persons.Gathering as much detailed, accurate, and comprehensive antemortem data for a missing person is equally important when performing an identification comparison to a long-term unidentified persons (UP) and can better inform archival morgue records searches.

Efficacy of Long-Term Intensive Straw Phonation Exercise in Air for Hyperfunctional Voice Disorders: A Preliminary Study.

PURPOSE: Literature highlights the efficacy of prolonged use of straw phonation for vocally healthy individuals. Nevertheless, minimal studies have examined the prolonged use of single treatment in hyperfunctional voice disorders (HFVD), as straw phonation is used as physiological training to improve voice quality in these individuals. The present study aimed to investigate the long-term intensive training effect of straw phonation exercise in air (SPEA) for HFVD. METHOD: In a time series design, seven females with HFVD (mean age 42.28years) participated in SPEA for 12 long sessions (30 minutes/session) intensively trained for 3weeks (4days/week). The participant-recorded voice samples were analyzed for aerodynamic measures Aerodynamic Subglottic Pressure (ASP), Airflow Rate (AFR), glottal behavior measures Contact Quotient (CQ), Contact Quotient Range (CQR), acoustic measure Acoustic Voice Quality Index (AVQI), auditory-perceptual Consensus Auditory Perceptual Evaluation of Voice - Kannada (CAPE-V-K), and self-perceptual measure Voice Handicap Index - Kannada (VHI-K) at pre-therapy, mid-therapy, post therapy, and 1-month follow-up timelines. Related Friedman's two-way analysis of variance and post hoc Wilcoxon signed-rank test were used to analyze the change in outcome measures across therapy timelines. RESULTS: Significant reduction in ASP, CQR, AVQI, CAPE-V-K, and VHI-K measures from pre-therapy to post-therapy and follow-up timelines was observed. Although there was a decrease in AFR and CQ measures from pre therapy to post therapy and follow-up, no significant differences were observed. No significant changes were observed from pre therapy to mid-therapy in any outcome measures, indicating the need for extended therapy duration and regular practice. CONCLUSION: These findings provide preliminary evidence of implementing the long-term intensive training of SPEA for HFVD with the support of significant outcome measures at various therapy timelines.

Healthcare professionals' experience with nutritional care beyond formal quality systems - A qualitative study.

BACKGROUND: Numerous formal strategies, screening tools, and interventions have been used to prevent malnutrition in long-term care patients. Despite these efforts, the proportion of screened patients is low, and a large proportion are malnourished. Previous research has revealed that healthcare professionals use a broad approach in their nutritional care but has also emphasised the need for further investigation into these approaches. OBJECTIVE: To explore how healthcare professionals working in long-term care experience and apply nutritional care. DESIGN: A descriptive, exploratory, qualitative design containing 240 h of participant observation, 12 focus groups and 2 individual interviews. SETTING(S): Twelve nursing homes and home care units in three Norwegian municipalities. PARTICIPANTS: Participant observation of interactions between healthcare professionals and patients. Forty-three registered nurses participated in focus group or individual interviews. METHODS: The data were analysed using inductive thematic analysis. RESULTS: The analysis identified three themes: The first theme, limited significance of nutritional screening, showed that healthcare professionals experienced the limited value of nutritional screening, as it often did not capture patients' nutritional challenges. They also perceived nutritional screening as unsuitable for patients at the end of their lives, those with overweight-related complications, or undergoing rehabilitation. In addition, nutritional screening was perceived as something healthcare professionals did for their managers or administrators, not because it was crucial to providing good nutritional care. The second theme, provision of individualised food, captures the healthcare professionals' efforts in adapting and preparing food according to the patient's preferences. Facilitation to enable patients to make individual food choices and the use of food cards or lists were two approaches to individualising nutrition care. The third theme, making meals more than about food, elucidated how healthcare professionals used meals to help patients cope with their situations and experience social belonging. Conversations about or around meals were used to provide patients with a sense of belonging to their past or present situation. The meals were also used as a diversion strategy for patients with unrest, as arenas for daily activity training, and for meaningful social interactions between patients around the tables. CONCLUSIONS: Nutritional screening and prevention of malnutrition are only one part of healthcare professionals' nutritional care. Individualised food and meals that create coping, a sense of belonging, and social experiences are equally important parts of their care. Emphasising healthcare professional's person-centred approach to nutritional care would be beneficial, as it could strengthen and further develop long-term nutritional care services.

Long-term treatment results of pembrolizumab monotherapy: reconsideration of immune checkpoint inhibitor monotherapy.

Objective: The extended outcomes of the KEYNOTE-024 study demonstrated a favorable 5-year overall survival (OS) rate of 31.9%. The present study investigated the outcomes of pembrolizumab monotherapy for advanced or recurrent non-small cell lung cancer (NSCLC) at our institution. Patient: The long-term outcomes of 102 patients with advanced or recurrent NSCLC treated with pembrolizumab monotherapy between March 2017 and December 2022 were retrospectively assessed. Results: This study included a total of 102 patients [mean age: 72 ± 9.6 years (range: 41-91 years), male/female=77/25; performance status (PS; 0, 1, 2, 3, 4)=49/38/15/0/0; smokers=91 (89%), non-squamous cell carcinoma/squamous cell carcinoma=66/36, PD-L1 tumor proportion score (TPS) ≥50%/1-49%=80/22, positive for EGFR mutation=5, advanced/postoperative recurrence=51/51, treatment line: first/second or later=81/21, treatment courses: median 8 (range: 1-39), objective response rate/disease control rate=44%/55%, immune-related adverse events (irAEs): 47, 5-year OS=34%]. On univariate analysis, PS, PD-L1 TPS, and irAEs were significant prognostic factors. On multivariate analysis, histology, PD-L1 TPS, and irAEs were significant prognostic factors. Conclusion: Pembrolizumab monotherapy demonstrated promising treatment outcomes for advanced or recurrent NSCLC, as evidenced by the significant association of PD-L1 TPS with irAEs and prognosis, suggesting its potential as a beneficial therapeutic option.

Investigating the Correlation Between Long-Term Response in Patients with Metastatic HER2+ Breast Cancer and the Activity of Regulatory T Cells: A Retrospective Study.

Background: Trastuzumab is commonly utilized in the management of metastatic HER2-positive breast cancer. Our main goal was to examine the clinical outcomes and immune markers of patients who received trastuzumab and chemotherapy treatment. Methods: Between 1995 and 2012, a total of 98 patients diagnosed with metastatic HER2-positive breast cancer were retrospectively analyzed at Ege University Hospital and Tepecik Training and Research Hospital. The clinicopathological characteristics and clinical outcomes of the patients were assessed, and the associations between response rates, survival and the immune profiles of tumor infiltrating lymphocytes were statistically evaluated. Results: The average age of patients at the time of diagnosis was 50.1±10.3 (ranging from 30 to 79) years. The mean follow-up period for all patients was 97.9±53.8 months. Among the patients, complete response was observed in 24.5%, partial response in 61.2%, and stable disease in 8.2% of cases. The average progression-free survival was 50.3±26.9 months (ranging from 1 to 163 months), and the average overall survival was 88.8±59.4 months (ranging from 12 to 272 months). After analyzing all cases, it was found that patients who were younger (p=0.006), exhibited higher CD3-positivity (p=0.041), presented with higher FOXP3-positivity (p=0.025), showed complete or at least partial response to treatment (p=0.008), and experienced a long-term response to trastuzumab (and chemotherapy) treatment had longer survival (p=0.001). Conclusion: Patients with HER2-positive breast cancer, who initially respond positively to palliative trastuzumab and chemotherapy treatment, can achieve long-term tumor remission lasting for several years.

Present state and perceived future use of teledentistry in long-term care facilities in Japan: A cross-sectional study.

Objectives: Teledentistry could be effective in managing oral health through the provision of oral hygiene instruction and diagnostic services. This study aimed to assess the perception and usefulness of teledentistry in Japanese long-term care facilities. Methods: We conducted a questionnaire survey to compare related factors of the usefulness of teledentistry and identify issues in its implementation. We chose 1000 facilities using a stratified random sampling method. The questionnaires were sent to the facilities in August 2021 and collected in December of the same year. Responses to the questionnaire items regarding the usefulness of teledentistry for oral management were divided into three groups according to the answer: perceiving teledentistry as "useful," "not useful," or "neither," including facilities that do not currently use teledentistry. Results: In total, 26.1% (261) responded to the questionnaire, and among these, 184 facilities answered the question regarding the usefulness of teledentistry. Only two of these facilities implemented teledentistry. Facilities with dental hygienists (p = 0.040) and those that receive insured medical treatment: reimbursement for oral feeding maintenance II (p = 0.040) tended to perceive teledentistry as useful in the management of patients with coronavirus disease. The higher the number of services that responded to the question "what kind of services do you think can be provided via teledentistry?" the higher the percentage of "useful" responses. Conclusions: Although only a few facilities use teledentistry, many long-term care facilities perceive it as useful even without using it. The presence of dental hygienists and interprofessional work done with reimbursement for oral feeding maintenance II contributed to the perception of the usefulness of teledentistry in long-term care facilities.