Mechanical versus manual cardiopulmonary resuscitation (CPR): an umbrella review of contemporary systematic reviews and more.

BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) can restore spontaneous circulation (ROSC) and neurological function and save lives. We conducted an umbrella review, including previously published systematic reviews (SRs), that compared mechanical and manual CPR; after that, we performed a new SR of the original studies that were not included after the last published SR to provide a panoramic view of the existing evidence on the effectiveness of CPR methods. METHODS: PubMed, EMBASE, and Medline were searched, including English in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) SRs, and comparing mechanical versus manual CPR. A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) and GRADE were used to assess the quality of included SRs/studies. We included both IHCA and OHCA, which compared mechanical and manual CPR. We analyzed at least one of the outcomes of interest, including ROSC, survival to hospital admission, survival to hospital discharge, 30-day survival, and survival to hospital discharge with good neurological function. Furthermore, subgroup analyses were performed for age, gender, initial rhythm, arrest location, and type of CPR devices. RESULTS: We identified 249 potentially relevant records, of which 238 were excluded. Eleven SRs were analyzed in the Umbrella review (January 2014-March 2022). Furthermore, for a new, additional SR, we identified eight eligible studies (not included in any prior SR) for an in-depth analysis between April 1, 2021, and February 15, 2024. The higher chances of using mechanical CPR for male patients were significantly observed in three studies. Two studies showed that younger patients received more mechanical treatment than older patients. However, studies did not comment on the outcomes based on the patient's gender or age. Most SRs and studies were of low to moderate quality. The pooled findings did not show the superiority of mechanical compared to manual CPR except in a few selected subgroups. CONCLUSIONS: Given the significant heterogeneity and methodological limitations of the included studies and SRs, our findings do not provide definitive evidence to support the superiority of mechanical CPR over manual CPR. However, mechanical CPR can serve better where high-quality manual CPR cannot be performed in selected situations.

The Advances and Utility of Artificial Intelligence and Robotics in Regional Anesthesia: An Overview of Recent Developments.

The integration of artificial intelligence (AI) and robotics in regional anesthesia has brought about transformative changes in acute pain management for surgical procedures. This review explores the evolving landscape of AI and robotics applications in regional anesthesia, outlining their potential benefits, challenges, and ethical considerations. AI-driven pain assessment, real-time guidance for needle placement during nerve blocks, and predictive modeling solutions for nerve blocks have the potential to enhance procedural precision and improve patient outcomes. Robotic technology aids in accurate needle insertion, reducing complications and improving pain relief. This review also highlights the ethical and safety considerations surrounding AI implementation, emphasizing data security and professional training. While challenges such as costs and regulatory hurdles exist, ongoing research and clinical trials demonstrate the practical utility of these technologies. In conclusion, AI and robotics have the potential to reshape regional anesthesia practice, ultimately improving patient care and procedural accuracy in pain management.

Experimental study on penetration of dental implants into the maxillary sinus at different depths.

OBJECTIVE: The purpose of this study was to investigate the effect of the dental implant penetration into the maxillary sinus cavity in different depths on implant and sinus health in a dog model. MATERIALS AND METHODS: The study sample included eight titanium dental implant placed in four female dogs immediately after extraction of the first maxillary molar in the palatal socket and assigned into four groups according to the protruding of implant tips (control group A = 0 mm, and study groups B, C, and D with protrusion of 1, 2, and 3 mm, respectively). The bone blocks of the implants were harvested 5 months postoperatively and evaluated by cone beam computed tomography (CBCT) and histological analysis. RESULTS: The whole groups showed no signs of inflammation during the 5-month period of the study. The tips of the implants in group B with penetrating depths of 1 mm were found to be fully covered with newly formed bone. The tips of the implants in group C with penetrating depths of 2 mm were exposed in the sinus cavity and showed partially new bone coverage, while depths of 3 mm in group D were found to have no bone formation and the dental implant fixture sites were communicated with the sinus cavity. No significant differences were found among the groups regarding implant stability. CONCLUSION: Despite the protrusion extents, penetration of dental implant into the maxillary sinus with membrane perforation does not compromise the sinus health and the implant in canine.

Biological roles of KGF, CTGF and TGF-ß in cyclosporine-A- and phenytoin- induced gingival overgrowth: A comparative experimental animal study.

OBJECTIVE: To identify the possible biological roles of keratinocyte growth factor (KGF), connective tissue growth factor (CTGF) and transforming growth factor-ß (TGF-ß) in cyclosporine-A (CsA) and phenytoin (PNT)-induced gingival overgrowth (GO) and to correlate them with each other. METHODS: Sixty adult male albino rats were selected and divided into 3 equal groups. Group I rats received no treatment. Group II rats were administrated CsA for 7 weeks. Group III were administrated PNT for the same period. Rats were euthanized at the end of the experiment and routine tissue processing was carried out. The obtained specimens were stained with H&E, KGF, CTGF and TGF-ß antibodies. RESULTS: One-way MANOVA test for KGF, CTGF and TGF-ß revealed an overall significant difference between the different groups (P<0.001). LSD post hoc test for multiple comparisons revealed a significant difference between each two groups. Two-tailed Pearson correlation for group II revealed non-significant weak positive correlations between KGF & CTGF and between CTGF & TGF-ß. Non-significant weak negative correlation was found between KGF & TGF-ß. Meanwhile, group III revealed non-significant weak positive correlation between KGF & TGF-ß and between CTGF & TGF-ß. Significant moderate positive correlation was found between KGF & CTGF. CONCLUSION: The findings of the present study indicated that KGF, CTGF and TGF-ß have biological roles in progression of CsA- and PNT- induced GO. KGF plays a greater role in CsA- induced GO than in PNT- induced GO. Meanwhile, CTGF and TGF-ß play a role in PNT- induced GO greater than in CsA- induced GO.