Nocturnal Blood Pressure Estimation from Sleep Plethysmography Using Machine Learning.

BACKGROUND: Elevated nocturnal blood pressure (BP) is a risk factor for cardiovascular disease (CVD) and mortality. Cuffless BP assessment aided by machine learning could be a desirable alternative to traditional cuff-based methods for monitoring BP during sleep. We describe a machine-learning-based algorithm for predicting nocturnal BP using single-channel fingertip plethysmography (PPG) in healthy adults. METHODS: Sixty-eight healthy adults with no apparent sleep or CVD (53% male), with a median (IQR) age of 29 (23-46 years), underwent overnight polysomnography (PSG) with fingertip PPG and ambulatory blood pressure monitoring (ABPM). Features based on pulse morphology were extracted from the PPG waveforms. Random forest models were used to predict night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: Our model achieved the highest out-of-sample performance with a window length of 7 s across window lengths explored (60 s, 30 s, 15 s, 7 s, and 3 s). The mean absolute error (MAE ± STD) was 5.72 ± 4.51 mmHg for SBP and 4.52 ± 3.60 mmHg for DBP. Similarly, the root mean square error (RMSE ± STD) was 6.47 ± 1.88 mmHg for SBP and 4.62 ± 1.17 mmHg for DBP. The mean correlation coefficient between measured and predicted values was 0.87 for SBP and 0.86 for DBP. Based on Shapley additive explanation (SHAP) values, the most important PPG waveform feature was the stiffness index, a marker that reflects the change in arterial stiffness. CONCLUSION: Our results highlight the potential of machine learning-based nocturnal BP prediction using single-channel fingertip PPG in healthy adults. The accuracy of the predictions demonstrated that our cuffless method was able to capture the dynamic and complex relationship between PPG waveform characteristics and BP during sleep, which may provide a scalable, convenient, economical, and non-invasive means to continuously monitor blood pressure.

Should the vent hole of posterior implant crowns be placed on the lateral surface? An in vitro study of the hydrodynamic feature of cement extrusion and retention ability.

Although placing a vent hole on the occlusal surface of the implant crown can reduce cervical marginal cement extrusion, it has disadvantages. Transferring the hole to the buccal or lingual surface of the posterior implant crown could therefore be an alternative solution. This study investigated the effect of transferring the vent hole to the lateral side of the implant posterior crown on the hydrodynamics of excess cement extrusion and the crown's retention ability. Specially fabricated posterior implant crowns were divided into five groups: crowns with an occlusal hole (OH), occlusal lateral hole (OLH), middle lateral hole (MLH), cervical lateral hole (CLH), and no hole (NH). Each set of implant analog-abutment-crown specimens was wrapped in a polymethylacrylate base. The base of the implant crown was divided into four 90-degree quadrants along the diagonal of the square base with a pen mark. Cement was used to bond the crowns and the abutments, and the weight of cement extrusions at the vent holes and the abutment cervical margins were calculated. The distribution of cement extrusion at the margin was photographed in each quadrant, and the areas of surface coverage of cement extrusion were compared with ImageJ software. Retentive strength was measured as the dislocation force using a universal testing machine. One-way analysis of variance was used for result analysis. The cervical marginal cement extrusions of crowns with lateral holes (OLH, MLH, and CLH) were significantly less than that of NH crowns (P<0.05), but more than that of OH crowns (P<0.05). Subgroup analysis among the lateral hole groups indicated that the higher the position of the lateral hole, the lower the weight of the cement extrusion, and the smaller the total distribution area of cement extrusion. The cement extrusion distribution area was larger in the quadrant with the hole than in those opposite and next to the hole. Retention strength comparison indicated no significant difference between crowns with NH, OH, or lateral holes. Transferring the vent hole of the posterior implant crown to the lateral side could reduce cement extrusion at the cervical margin while reducing retention strength deterioration and the esthetic drawbacks caused by occlusal hole opening.

Evaluation of sealing efficacy and removal convenience of sealing materials for implant abutment screw access holes.

BACKGROUND: Sealing materials are used to fill abutment screw access holes (SAH) to prevent microleakage and protect the central screws in oral implant restoration. However, thus far, no consensus has been reached on sealing material selection. In this study, a comparison of the sealing efficacy and removal convenience of different sealing materials for cement-retained implant restoration was conducted. METHODS: Various sealing materials were classified into five groups, namely, gutta-percha (GP), temporary restorative paste (TRP), vinyl polysiloxane (VPS), polytetrafluoroethylene (PTFE) tape, and onlay resin (OR), and 35 sets of analog-abutments were allocated into five groups of seven specimens. A sealing efficacy test was conducted using a modified dye-penetration method, in which a lower absorbance indicated better sealing efficacy. For the removal-convenience test, the materials were removed from each SAH after solidification, and the retrieval time was recorded. RESULTS: On days 1 and 10, PTFE exhibited the highest absorbance value with significant differences compared to the other groups. On day 30, TRP and PTFE showed significantly higher absorbance values than GP, VPS, and OR, but no significant difference was detected between TRP and PTFE (p = 0.424). The absorbance values of TRP and PTFE from days 1, 10, and 30 showed significant intragroup differences, while those of the other groups did not. In terms of the removal convenience on days 1, 10, and 30, VPS achieved the best performance, followed by PTFE, OR, TRP, and GP. CONCLUSION: Within the limitations of this experiment, VPS and OR showed better sealing efficacy against microleakage and a more convenient removal than the other materials; thus, VPS and OR are recommended for clinical use.