Comparison between Different Combinations of Alendronate, Platelet-rich Fibrin, Hydroxyapatite in Bone Regeneration in Endodontic Surgeries Using Cone-beam Computed Tomography.

AIM: To compare different combinations of alendronate, platelet-rich fibrin (PRF), and hydroxyapatite in bone regeneration in endodontic surgeries using cone-beam computed tomography (CBCT). METHODS AND SUBJECTS: During this study, 28 patients were selected who were found to have pathology in the periapical area in the anterior region, The study subjects were categorized into four categories, each consisting of seven subjects, Category one-there was no placement of any material; category two-PRF; category three-hydroxyapatite along with PRF; category four-alendronate along with PRF, Root canal treatment followed by endodontic surgery in each patient was carried out, Volumetric analysis of the lesions was carried out before surgery and 12 months after surgery using CBCT, Analysis of variance (ANOVA) test and Tukey post-hoc test were used for statistical analysis. RESULTS: There was a maximum change in the volume of lesions in the study subjects in which PRF was used along with hydroxyapatite in comparison to other combination of materials, There was no significant difference when PRF was placed along with alendronate in comparison to study subjects when PRF was placed alone, The difference was not significant when PRF was placed in defects of bone in comparison to study subjects when no materials were placed in the defects of bone. CONCLUSION: It can be concluded from the current research that PRF along with hydroxyapatite is a better option for the healing of defects of bone in surgeries performed in the area around the root apex in endodontic patients, But further studies should be carried out with a large sample size and for a longer duration. CLINICAL SIGNIFICANCE: It is a very important consideration that there should be healing of the lesion after surgery around the root apex by actual bone regeneration, The healing of the larger lesions does not take place easily as compared with the lesions having a small size, This is because there is healing by secondary intention where there is formation of scar instead of actual healing by formation of bone, There are several methods by which proper bone regeneration can be obtained.

Comparison between Different Shades of Monolithic Zirconia over Microhardness and Water Solubility and Sorption of Dual-cure Resin Cement.

AIM AND OBJECTIVE: To compare the different shades of monolithic zirconia over microhardness and water solubility and water sorption of dual-cure resin cement. MATERIALS AND METHODS: Eighty specimens were included in the study. They were categorized into four categories having 20 samples each. Category one: No ceramic disks were present in the control group; the cement was directly activated. Category two: Curing of the resin cement with one shade of monolithic zirconia topping. Category three: Curing of the resin cement with an overlaying layer A monolithic zirconia version with two shades. Category four: Curing of the resin cement with an overlaying layer A three-tone monolithic zirconia version. In each category, two subgroups were further created (n = 10). One subgroup consisted of conventional dual-cure resin-based cement, while the other subgroup consisted of self-adhesive dual-cure resin-based cement. Vickers microhardness, water solubility, and water sorption of resin cement sorption were precisely measured after 24 hours of storage in an incubator at 37°C. The statistical analysis was undertaken with the help of statistical tests like two-way analysis of variations (ANOVA), one-way ANOVA, independent t-tests, Tukey's test, and Tamhane's T2 test. The p ≤0.05 was considered statistically significant. RESULTS: Microhardness was more excellent in conventional dual-cure resin-based cement in comparison with self-adhesive dual-cure cement. At the same time, the water solubility and water sorption were lower in conventional dual-cure resin-based cement than self-adhesive dual-cure resin cement. The effect of shade of monolithic variant of zirconia was significant over the microhardness of both dual-cure resin-based cement; however, the impact was nonsignificant over the water solubility and water sorption of the resin-based resin cement. Further, it was also observed that the use of a monolithic variant of zirconia led to a decrease in microhardness of both dual resin-based cement in comparison to the condition when no ceramics were used. CONCLUSION: The effect of shade of monolithic variant of zirconia was statistically significant over the microhardness of both dual-cure resin-based cement; however, the result was not significant over the water solubility and water sorption of the resin-based cement. The use of a monolithic variant of zirconia led to a decrease in the microhardness of both dual resin-based cement compared to the condition when no ceramics were used. CLINICAL SIGNIFICANCE: The quantity of polymerization in resin-based cement affects their clinical effectiveness for a more extended period. It is believed that the measurement of microhardness is a reliable and straightforward process for evaluating the amount of polymerization of resin-based cement. Very few studies have been conducted in the past to compare the shades of monolithic zirconia over the microhardness, water solubility, and water sorption of the dual-cure resin-based cement.

Perioperative Stroke and Readmissions Rates in Noncardiac Non-Neurologic Surgery.

BACKGROUND AND AIM: Perioperative stroke is a feared and potentially disastrous complication of surgery. Postdischarge care, specifically hospital readmissions, can significantly impact postsurgical recovery and provides a useful metric for quality care. Our primary aim was examining 30-day readmissions for patients who had a perioperative stroke undergoing noncardiac non-neurosurgery. METHODS: We analyzed data from the State Inpatient Database, a database of community hospital discharges, in California between 2008 and2011. Surgical patients undergoing one of the 10 highest-volume procedures were included; patients less than 18 years old, undergoing pregnancy-related procedures, or who died in-hospital were excluded. Our dataset covariates included demographic and clinical variables, comorbidities, and discharge location. After running an initial bivariate analysis using Chi-square and t-tests and testing for multicollinearity, logistical models were run to calculate adjusted odds ratios and confidence intervals for readmission predictors. RESULTS: 30-day readmissions for patients with perioperative stroke (n = 1613) occurred at a rate of 21.08% (340 patients), compared to 6.29% (63,856 patients) for patients without perioperative stroke (adjusted OR = 1.40, 95% CI 1.23-1.59, P < .0001). Demographic predictors of 30-day readmissions included male sex and African-American race. Clinical predictors of 30-day readmissions included several comorbidities (i.e. liver disease, hypertension), and discharge to a postacute care facility. Key 30-day readmission diagnoses for perioperative stroke patients included septicemia, stroke, aspiration pneumonitis, and urinary tract infections. CONCLUSIONS: Patients with perioperative stroke have high 30-day readmissions rates. A number of demographic and clinical factors increase readmission risk in this population. Further research is warranted to better support patients with perioperative stroke undergoing care transitions.

Math anxiety and executive function: Neural influences of task switching on arithmetic processing.

Math anxiety (MA) is associated with negative thoughts and emotions when encountering mathematics, often resulting in under-performance on math tasks. One hypothesized mechanism by which MA affects performance is through anxiety-related increases in working memory (WM) load, diverting resources away from mathematical computations. We examined whether this effect is specific to WM or whether the impact of MA extends to an overall depletion of executive function (EF) resources. In this fMRI experiment, we manipulated two separate factors known to impact EF demands-task-switching (TS) and increased WM load-in order to evaluate how MA relates to behavioral performance and neural activity related to mathematical calculations. Relative to a difficult non-math task (analogies), we observed MA-related deficits in math performance and reduced neural activity in a network of regions in the brain associated with arithmetic processing. In response to TS demands, higher levels of math anxiety were associated with a pattern of avoidance and disengagement. When switching from the control task, high math anxiety (HMA) was associated with disengagement from math trials, speeding through these trials, and exhibiting reduced neural activity in regions associated with arithmetic processing. The effects of math anxiety and WM were most pronounced at the lowest levels of WM load. Overall, the results of this study indicate that the effects of MA are broader than previously demonstrated and provide further insight into how EF deficits in MA might impact recruitment of neural resources that are important for successful math computations.

Cone-beam Computed Tomographic Evaluation of the Anatomical Changes of Temporomandibular Joint Use of Pre-post Dentures: A Time-control Study.

AIM AND OBJECTIVE: The growth of the temporomandibular joint (TMJ) gets affected by multiple factors like aging, occlusion state, and by the movement of the jaw while masticating and swallowing. Radiographic imaging is often utilized as a vital diagnostic adjunct in the evaluation of certain examinations of the TMJ. MATERIALS AND METHODS: In this in vivo study, 30 male participants with mean age 55 years, having edentulous maxillary and mandibular arches from the Outpatient Department of Prosthodontics, were randomly selected. Group I (n = 30) patients who were edentulous for the last 4-5 years but without wearing dentures. Whereas group II (n = 30) patients who were edentulous for the last 4-5 years but were wearing dentures for this period. Maxillary and mandibular dentures were fabricated and delivered to subjects. Subjects were subjected to the TMJ analysis with the help of CBCT. Radiological images of dentomaxillofacial structures were analyzed by a specialist with a dual monitor inside a darkened silent room. On the monitor, three times measurements were recorded followed by calculation of mean value. The recordings were taken on both sides and thus, 210 sites were analyzed altogether, followed by the statistical analysis using SPSS software version 15.0. RESULTS: The mean ages of group I and II were 59.00 ± 6.74 and 58.27 ± 6.75 years, respectively. The intra- and intergroup comparisons were done using a one-sample t-test. Differences in mean intercondylar width in groups I and II were not found to be statistically significant. The difference in mean length of glenoid fossa was not statistically significant at any of the above observation periods. A continuous decline in mean length of glenoid fossa was observed with time in both groups. The range of change in articular eminence length was found to be statistically significant for both the groups (p < 0.05). CONCLUSION: This study shows that the articular eminence flattening is correlated with age; on the other hand, the rate of deformation was found significantly more in total edentulous subjects as compared to subjects having normally maintained occlusion. The anatomical changes inside the TMJ have been much greater expressed within the completely edentulous subjects in whom the angle of sagittal condyle path declines and so does the articular eminence height. CLINICAL SIGNIFICANCE: It is essential to provide the edentulous patient with early prosthetic and occlusal rehabilitation after extractions to prevent the anatomical changes in TMJ.

The HOPE Pilot Study: Harnessing Patient-Reported Outcomes and Biometric Data to Enhance Cancer Care.

PURPOSE: Integrating patient-reported outcomes (PROs) into clinical practice is an increasingly promising strategy for improving patients' symptoms, communication, and clinical outcomes. The objective of the current study was to assess the feasibility, acceptability, and perceived effectiveness of a mobile health intervention that was designed to collect PROs and activity data as a measure of health status. PATIENTS AND METHODS: This work was a pilot intervention with 10 patients with gynecologic cancers who received palliative chemotherapy. The HOPE (Helping Our Patients Excel) study used wearable accelerometers to assess physical activity and the Beiwe research platform to collect PROs, stratify patient responses by risk, provide tailored symptom management, and notify patients and clinicians of high-risk symptoms. Feasibility and acceptability were assessed through enrollment and adherence rates, and perceived effectiveness was evaluated by patients and oncologists at study completion. RESULTS: The approach-to-consent rate was 100%, and participants were 90% and 70% adherent to the wearable accelerometers and smartphone surveys, respectively. Participants' mean daily step count was 3,973 (standard deviation [SD], 2,305 steps) and increased from week 1 (mean, 3,520 steps; SD, 1,937 steps) to week 3 (mean, 4,136 steps; SD, 1,578 steps). Active monitoring of participants' heart rates, daily steps, and PROs throughout the study identified anomalies in participants' behavior patterns that suggested poor health for two patients (20%). Patients and clinicians indicated that the intervention improved physical activity, communication, and symptom management. CONCLUSION: A mobile health intervention that collects PROs and activity data as a measure of health status is feasible, acceptable, and was perceived to be effective in improving symptom management in patients with advanced gynecologic cancers. A larger, multisite, randomized clinical trial to assess the efficacy of the HOPE intervention on patients' symptoms, health-related quality of life, clinical outcomes, and health care use is warranted.