The impact of magnification on undergraduate dental students' performance during cavity preparations: A systematic review.

PURPOSE/OBJECTIVES: Loupe magnification is a commonly utilized tool within dental education due to its proposed benefits of improving working posture, visual acuity, and procedural quality. Although procedural quality has been researched at the graduate level, literature encompassing the undergraduate level remains scarce. Therefore, this systematic review aims to critically assess the available literature to ascertain the effects of loupe magnification on the performance of undergraduate dental students' cavity preparations. MATERIALS AND METHODS: A systematic search was conducted across electronic databases, including PubMed, MEDLINE via Ovid, The Cochrane Library for Cochrane Reviews, and Scopus, to identify relevant studies published from inception to February 15, 2023. We included English language studies that evaluated the effect of loupe magnification on the performance of undergraduate dental students in cavity preparations. RESULTS: In total, six studies fulfilled the inclusion criteria. The outcomes assessed encompassed tooth preparation accuracy. Of these six articles, one was conducted on endodontic access cavity preparations, four on restorative cavity preparations, and one on nonstandard cavity preparation designs performed on acrylic blocs. Four articles determined that loupes positively impacted undergraduate students' performance in cavity preparations, while two articles established no significant difference in performance between loupes and naked-eye cavity preparations. CONCLUSION: This systematic review suggests that loupe magnification positively impacts undergraduate dental students' performance in cavity preparations. However, the heterogeneity of the studies and the variations in methodologies limit the ability to draw definitive conclusions.

An assessment of factors associated with early postoperative stiffness in arthroscopic rotator cuff repair.

BACKGROUND: Postoperative stiffness affects up to 20% of patients following arthroscopic rotator cuff repair. Recent evidence indicates that early postoperative stiffness may associated with lower retear rates. This study aimed to identify the independent predictors of early postoperative stiffness. METHODS: A retrospective cohort study of 1526 rotator cuff repairs was performed. Range of motion at 6-week postop was used to identify stiff patients. Stiffness was defined as external rotation <27.5o or forward flexion <145o . Multiple logistic regression analysis was used to identify the independent predictors of 6-week stiffness. RESULTS: The independent predictors for external rotation stiffness at 6-week postop were more recent cases (Wald = 60), restricted preoperative external rotation (Wald = 36), younger age (Wald = 21) and poorer surgeon-ranked tissue quality (Wald = 15). The independent predictors for forward flexion stiffness were more recent cases (Wald = 101), restricted preoperative forward flexion (Wald = 16) and external rotation (Wald = 13) and female patients (Wald = 12). All patients that developed early postoperative stiffness had recovered range of motion by 6 months to preoperative levels (P < 0.0001). A significantly greater proportion of younger patients (40-49) developed postoperative stiffness when compared to older patients aged 50-59 (P < 0.0062), 70-79 (P < 0.0126) and 80-89 (P < 0.004). Patients that retore had significantly greater average 6-week postoperative range of motion. CONCLUSIONS: Patients earlier in the study were found to have greater postoperative range of motion, which coincided with a more aggressive rehabilitation program with less immobilization. Thus, the data supports the hypothesis that a temporary period of shoulder stiffness facilitates tendon repair and ultimately a better outcome post rotator cuff repair.

Determinants of Operative Time in Arthroscopic Rotator Cuff Repair.

Arthroscopic rotator cuff repairs have been reported to take between 72 and 113 min to complete. This team has adopted its practice to reduce rotator cuff repair times. We aimed to determine (1) what factors reduced operative time, and (2) whether arthroscopic rotator cuff repairs could be performed in under 5 min. Consecutive rotator cuff repairs were filmed with the intent of capturing a <5-min repair. A retrospective analysis of prospectively collected data of 2232 patients who underwent primary arthroscopic rotator cuff repair by a single surgeon was performed using Spearman's correlations and multiple linear regression. Cohen's f2 values were calculated to quantify effect size. Video footage of a 4-min arthroscopic repair was captured on the 4th case. Backwards stepwise multivariate linear regression found that an undersurface repair technique (f2 = 0.08, p < 0.001), fewer surgical anchors (f2 = 0.06, p < 0.001), more recent case number (f2 = 0.01, p < 0.001), smaller tear size (f2 = 0.01, p < 0.001), increased assistant case number (f2 = 0.01, p < 0.001), female sex (f2 = 0.004, p < 0.001), higher repair quality ranking (f2 = 0.006, p < 0.001) and private hospital (f2 = 0.005, p < 0.001) were independently associated with a faster operative time. Use of the undersurface repair technique, reduced anchor number, smaller tear size, increased surgeon and assistant surgeon case number, performing repairs in a private hospital and female sex independently lowered operative time. A <5-min repair was captured.

Biomechanical Comparison of Synthetic Polytetrafluoroethylene (PTFE) vs Human Dermal Allograft (HDA), 2 vs 3 Glenoid Anchors, and Suture vs Minitape in Superior Capsule Reconstruction.

Background: Superior capsule reconstruction (SCR) is an option for the treatment of massive, irreparable rotator cuff tears. However, which materials yield the strongest constructs remains undetermined. Purposes: We sought to investigate whether SCR with polytetrafluoroethylene (PTFE) or human dermal allograft (HDA), 2 or 3 glenoid anchors, and suture or minitape resulted in better failure load properties at the patch-glenoid interface. Methods: We conducted a biomechanical study in 30 glenoid-sided SCR repairs in Sawbones models divided into 5 groups. Each was pulled to failure to assess mode of failure, peak load (N), stiffness (N/mm), yield load (N), peak energy (N m), and ultimate energy (N m). The 5 groups were as follows: group 1-PTFE, 2 anchors, and suture; group 2-PTFE, 2 anchors, and minitape; group 3-HDA, 2 anchors, and suture; group 4-HDA, 2 anchors, and minitape; group 5-PTFE, 3 anchors, and minitape. Results: Repairs failed by button-holing of suture/minitape. Group 5 had greater peak load, stiffness, yield load, and peak energy (384 ± 62 N; 24 ± 3 N/mm; 343 ± 42 N; 4 ± 2 N m) than group 3 (226 ± 67 N; 16 ± 4 N/mm; 194 ± 74 N; 2 ± 1 N m) or group 4 (274 ± 62 N; 17 ± 4 N/mm; 244 ± 50 N; 2 ± 1 N m) and greater ultimate energy (8 ± 3 N m) than all other groups. Conclusions: This biomechanical study of SCR repairs in Sawbones models found that yield load was greater in PTFE than HDA, 3 anchors were better than 2, and minitape was no better than suture.

Stiffness and arthroscopic rotator cuff repair: a literature review.

Background and Objective: Tendon retear is the most common complication following rotator cuff repair surgery. Understanding the factors that are associated with greater risks of retear is important so surgeons can provide accurate prognostic information to patients. Advanced age and larger tear size have been shown to be associated with greater risk of retear at 6 months using multiple logistic regression analysis. Stiffness is the second most common complication, however recent evidence suggests that early postoperative stiffness may be associated with a more robust healing response. Thus, this paper aims to critically review the independent predictors of retear in rotator cuff repair patients. Methods: Literature review was conducted using electronic databases from their dates of inception. Key Content and Findings: There are multiple factors that affect rotator cuff repair integrity detailed in the literature. Tear size appeared to be the most important predictor of retear following rotator cuff repair. Postoperative stiffness at 6 and 12 weeks after surgery appears to be a factor associated with more intact repairs at 6 months. Shoulder stiffness tends to resolve within 6 months following the operation. This protective effect persists up to 5 years postoperatively. Conclusions: Shoulder stiffness may be an important protective factor against rotator cuff retear which requires further investigation from future studies. It is important to determine the relative importance of stiffness when compared to known important factors such as tear size with regards to its effect on rotator cuff repair integrity.

Tear Size and Stiffness Are Important Predictors of Retear: An Assessment of Factors Associated with Repair Integrity at 6 Months in 1,526 Rotator Cuff Repairs.

This study aimed to identify whether early postoperative shoulder stiffness is associated with improved healing following rotator cuff repair, and if so, how this factor might interact with other factors known to affect rotator cuff repair integrity. Methods: We conducted a retrospective analysis of prospectively collected data from 1,526 primary arthroscopic rotator cuff repairs. Six-week range of motion was assessed to determine shoulder stiffness, and repair integrity was evaluated at 6 months by ultrasound. Multiple logistic regression analysis was used to identify variables that affected retear, and receiver operating characteristic (ROC) curve analysis was used to evaluate predictive thresholds for retear. Results: Tear-size area was the most accurate predictor of retear (area under the curve [AUC] = 0.77; 95% confidence interval [CI] = 0.72 to 0.81), followed by 6-week passive external rotation (AUC = 0.67; 95% CI = 0.63 to 0.72), 6-week passive forward flexion (AUC = 0.67; 95% CI = 0.62 to 0.72), age (AUC = 0.65; 95% CI = 0.60 to 0.70), tear type (partial-thickness versus full-thickness) (AUC = 0.65; 95% CI = 0.61 to 0.69), and hospital type (public versus private) (AUC = 0.43; 95% CI = 0.37 to 0.49). Patients with smaller tears, reduced 6-week passive external rotation, reduced 6-week passive forward flexion, younger age, partial-thickness tears, and operations performed in a private day surgery or hospital setting were more likely to have an intact rotator cuff repair at 6 months. The AUC of this curve was 0.84 (95% CI = 0.80 to 0.87), which indicates that this combination of factors can accurately predict 84% of retears. Reduced range of motion at 6 weeks was associated with improved repair integrity for patients with tears of >1 to 6 cm2; however, this effect was less pronounced in tears of ≤1 cm2 or >6 cm2. Conclusions: Early postoperative stiffness following arthroscopic single-row, inverted-mattress rotator cuff repair at 6 weeks was associated with an intact repair at 6 months. The protective effects of postoperative stiffness and tear size were additive. The chance of retear in patients with a tear of ≤1 cm2 and external rotation of ≤27° at 6 weeks was 1%, while those with tears of >6 cm2 and external rotation of >27° had a 40% chance. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

18 F-FDG PET and PET/CT as a diagnostic method for Ewing sarcoma: A systematic review and meta-analysis.

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of 18 -fluorodeoxyglucose-positron emission tomography (18 F-FDG PET) and PET/computed tomography (PET/CT) in imaging primary and metastatic lesions in Ewing sarcoma (ES). METHODS: PubMed, Cochrane, Scopus, and Web of Science were searched for relevant studies. Data concerning 18 F-FDG PET/CT diagnostic accuracy were extracted and then analyzed using Open Meta-analyst software. Reported diagnostic accuracy outcomes included sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR), and diagnostic odds ratio. RESULTS: Thirty-one studies with a total of 735 patients were included in this meta-analysis. The sensitivity and specificity of 18 F-FDG PET/CT were: 92.6% and 74.1% for total ES lesions, 96.7% and 68.3% for ES primary lesions, 76.1% and 92.4% for lung metastasis, 83.9% and 93.2% for bone metastasis, and 89.9% and 92.6% for ES recurrence, respectively. CONCLUSION: 18 F-FDG PET/CT is sensitive and accurate in diagnosing, staging, and detecting the recurrence of ES compared with non-PET imaging. It has high accuracy for diagnosing recurrence of ES in bone metastases; however, CT remains a superior diagnostic method for detecting lung metastasis.

Meta-Analysis of Neoadjuvant Immunotherapy for Patients with Resectable Non-Small Cell Lung Cancer.

PURPOSE: Immunotherapy has created a paradigm shift in the treatment of metastatic non-small cell lung cancer (NSCLC), overcoming the therapeutic plateau previously achieved by systemic chemotherapy. There is growing interest in the utility of immunotherapy for patients with resectable NSCLC in the neoadjuvant setting. The present systematic review and meta-analysis aim to provide an overview of the existing evidence, with a focus on pathological and radiological response, perioperative clinical outcomes, and long-term survival. METHODS: A systematic review was conducted using electronic databases from their dates of inception to August 2021. Pooled data on pathological response, radiological response, and perioperative outcomes were meta-analyzed where possible. RESULTS: Eighteen publications from sixteen studies were identified, involving 548 enrolled patients who underwent neoadjuvant immunotherapy, of whom 507 underwent surgery. Pathologically, 52% achieved a major pathological response, 24% a complete pathological response, and 20% reported a complete pathological response of both the primary lesion as well as the sampled lymph nodes. Radiologically, 84% of patients had stable disease or partial response. Mortality within 30 days was 0.6%, and morbidities were reported according to grade and frequency. CONCLUSION: The present meta-analysis demonstrated that neoadjuvant immunotherapy was feasible and safe based on perioperative clinical data and completion rates of surgery within their intended timeframe. The pathological response after neoadjuvant immunotherapy was superior to historical data for patients who were treated with neoadjuvant chemotherapy alone, whilst surgical and treatment-related adverse events were comparable. The limitations of the study included the heterogenous treatment regimens, lack of long-term follow-up, variations in the reporting of potential prognostic factors, and potential publication bias.

Systematic Review of Neoadjuvant Immunotherapy for Patients With Non-Small Cell Lung Cancer.

There is a paucity of robust clinical evidence for the role of neoadjuvant immunotherapy in patients with resectable non-small cell lung cancer. The primary aim of the study was to identify the available data on the feasibility, safety and efficacy of neoadjuvant immunotherapy. A systematic review was conducted using electronic databases. Relevant studies were identified according to predefined selection criteria. Five relevant publications on 4 completed trials were identified. In most studies, >90% of patients were able to undergo surgery within the planned timeframe after neoadjuvant immunotherapy. There was a high incidence of open thoracotomy procedures, either planned or converted from a planned minimally invasive approach. Mortality ranged from 0 to 5%, but none of the reported deaths were considered directly treatment-related. Morbidities were reported according to adverse events related to neoadjuvant systemic therapy, and postoperative surgical complications. Survival outcomes were limited due to short follow-up periods. Major pathologic response ranged from 40.5 to 56.7%, whilst complete pathologic response of the primary tumor ranged from 15 to 33%. Radiological responses were reported according to RECIST criteria and fluorodeoxyglucose-avidity. This systematic review reported safe perioperative outcomes of patients who underwent resection following neoadjuvant immunotherapy. However, there was a relatively high incidence of open thoracotomy procedures, partly due to the technical challenges associated with increased fibrosis and inflammation of tissue, as well as the more advanced stages of disease in patients enrolled in the studies. Future studies should focus on identifying predictors of pathological response.