Preoperative risk assessment does not allow to predict root filling length using machine learning: A longitudinal study.

OBJECTIVES: First we aimed to identify significant associations between preoperative risk factors and achieving optimal root filling length (RFL) during orthograde root canal treatments (RCT) and second to predict successful RFL using machine learning. METHODS: Teeth receiving RCT at one university clinic from 2016-2020 with complete documentation were included. Successful RFL was defined to be 0-2mm of the apex, suboptimal RFL >2mm or beyond the apex. Logistic regression (logR) was used for association analyses; logR and more advanced machine learning (random forest (RF), support vector machine (SVM), decision tree (DT), gradient boosting machine (GBM) and extreme gradient boosting (XGB)) were employed for predictive modeling. RESULTS: 555 completed RCT (343 patients, female/male 32.1/67.9%) were included. In our association analysis (involving the full dataset), unsuccessful RFL was more likely in undergraduate students (US): OR 2.74, 95% CI [1.61, 4.75], p < 0.001), teeth with indistinct canal paths (OR 11.04, [2.87, 44.88], p < 0.001), root canals reduced in size (OR 2.56, [1.49, 4.46], p < 0.01), retreatments (OR 3.13, [1.6, 6.41], p < 0.001). Subgroup analyses revealed that dentists were more successful in mitigating risks than undergraduate students. Prediction of RFL on a separate testset was limitedly possible regardless of the machine learning approach. CONCLUSIONS: Achieving RFL is depending on the operator and several risk factors. The predictive performance on the technical outcome of a root canal treatment utilizing ML algorithms was insufficient. CLINICAL SIGNIFICANCE: Preoperative risk assessment is a relevant step in endodontic treatment planning. Single radiographic risk factors were significantly associated with achieving (or not achieving) optimal RFL and showed higher predictive value than a more complex risk assessment form.

Effects of cervical cerclage on cervical length and the impact of changes in cervical length on pregnancy prognosis.

OBJECTIVE: To identify any cervix-related morphological and functional marker that can be correlated with pregnancy prognosis in patients who have undergone cerclage for cervical incompetence. DESIGN: An observational and prospective study. SETTING: Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (UNIFESP-EPM). METHODS: Patients with cervical incompetence who underwent cervical cerclage using a modified version of the McDonald procedure during or before the 22nd week of pregnancy. The patients were examined by transvaginal ultrasound in the preoperative period, the immediate postoperative period, and between 20 and 24 weeks, 24 weeks + 1 day and 28 weeks, and 28 weeks + 1 day and 32 weeks. Cervical length and the presence of funneling were evaluated during all examinations. Changes in cervical length, presence or absence of funneling, percent increase or decrease in cervical length, and cervical length of less than established values (.

Taking the next step forward - Diagnosing inherited infantile cholestatic disorders with next generation sequencing.

Identifying rare genetic forms of infantile cholestasis is challenging due to their similar clinical presentation and their diverse etiology. After exclusion of common non-genetic causes a huge list of rare differential diagnosis remains to be solved. More than 90 genes are associated with monogenic forms of infantile cholestasis, thus preventing routine genetic workup by Sanger sequencing. Here we demonstrate a next generation sequencing approach to discover the underlying cause in clinically well characterized patients in whom common causes of infantile cholestasis have been excluded. After validation of the analytical sensitivity massive parallel sequencing was performed for 93 genes in six prospectively studied patients. Six novel mutations (PKHD1: p.Thr777Met, p.Tyr2260Cys; ABCB11: p.Val1112Phe, c.611+1G > A, p.Gly628Trpfs*3 and NPC1: p.Glu391Lys) and two known pathogenic mutations were detected proving our multi gene panel for infantile cholestasis to be a sensitive and specific method overcoming the complexity of the phenotype-based, candidate gene approach. Three exemplary clinical cases of infants with cholestasis are presented and discussed in the context of their genetic and histopathological findings (autosomal recessive polycystic kidney disease, atypical PFIC and Niemann-Pick syndrome type C1). These case reports highlight the critical impact of integrating clinical, histopathological and genetic data during the process of multi gene panel testing to ultimately pinpoint rare genetic diagnoses.

Renal allograft recipients fail to increase interferon-γ during invasive fungal diseases.

Invasive fungal diseases are a major cause of death in renal allograft recipients. We previously reported that adjunctive recombinant human interferon-γ therapy has clinical utility for invasive fungal diseases after renal transplantation. We have now developed a rapid peripheral blood-based quantitative real-time PCR assay that enables accurate profiling of cytokine imbalances. Our preliminary studies in renal transplant patients with invasive fungal diseases suggest that they fail to mount an adequate interferon-γ response to the fungal infection. In addition, they have reduced IL-10 and increased TNF-α when compared to stable renal transplant patients. These preliminary cytokine profiling-based observations provide a possible explanation for the therapeutic benefit of adjunctive human interferon-γ therapy in renal allograft recipients with invasive fungal diseases.

Техническое руководство по эпидемиологическому надзору за болезнями, связанными с водой

Руководство призвано помочь государствам – Сторонам Протокола по проблемам воды и здоровья, являющегося приложением к Конвенции 1992 года по охране и использованию трансграничных водотоков и международных озер, в создании и/или укреплении своих систем своевременного обнаружения и раннего оповещения, в разработке плана действий в чрезвычайных ситуациях, в создании и укреплении потенциала для принятия ответных мер в случае вспышек заболеваний, связанных с водой, в соответствии со статьей 8 Протокола. В данном руководстве проанализированы основные угрозы здоровью, связанные с водоснабжением и водоотведением, содержится упоминание фундаментальных концепций эпидемиологии и эпидемиологического надзора за заболеваниями, а также даны рекомендации в отношении сбора и анализа данных. Руководство поможет странам в успешной реализации их усилий по обеспечению национальной и международной безопасности общественного здоровья в соответствии с требованиями Международных медико-санитарных правил (2005 г.). Стороны Протокола одобрили данное руководство в ноябре 2010 г.

Technical guidance on water-related disease surveillance

This guidance is intended to assist the countries that are Parties to the Protocol on Water and Health, and other countries in establishing and/or strengthening their detection and early warning systems, contingency plans and capacity to respond to outbreaks of water-related disease. The guidance reviews the main threats to health related to water services, recalls basic concepts of epidemiology and disease surveillance, and advises on data management and analysis. It will therefore also support countries’ efforts towards national and international health security, in line with the International Health Regulations (2005). The Parties to the Protocol approved this guidance in November 2010.

Perceptions of water, sanitation and health: a case study from the Mekong Delta, Vietnam.

In the Mekong Delta in the south of Vietnam about 5.7 million people lack access to safe drinking water and 10 million people in rural areas live without adequate sanitation. Between May and August, 2007 a survey was carried out in An Bin, a peri-urban ward in the Mekong Delta, to gain insight into water, sanitation and health as well as to health-related hygiene behaviour. The study employed a combination of quantitative (standardized questionnaire) and qualitative (focus group discussions, semi-structured interviews) methods. The most important features in the choice of drinking water sources are matters of hygiene and the taste of the water. The majority (74%) of the 120 households surveyed indicated their ownership of a sanitation facility, but the fish pond toilet (64%) which is predominantly utilized is considered to be unimproved sanitation. The local peri-urban population link water and hygiene to health, but sanitation instead to environmental pollution. This and other outcomes lead to the assumption that people have a basic knowledge of proper hygiene behaviour. However, hygiene measures such as hand washing are put into practice in an untimely manner, most likely due to a misconception of risks and/or a lack of background knowledge of cause-effect relationships as well as ingrained habits.

The human ecology of malaria in a highland region of South-West Kenya.

OBJECTIVE: This study assessed interactions between human beings and their immediate micro-ecological environment with regard to malaria transmission at the household level. METHODS: Malaria cases and their controls were sampled from a local health care facility. A spot check of potential risk factors for malaria around the subjects' dwelling places was done. A standardized questionnaire was administered to investigate human behavior that could lead to increased risk of malaria. RESULTS: Outdoor activities at night, living in houses with eaves, keeping cattle close to human dwellings and presence of stagnant water around the homesteads were associated with increased risk of malaria. CONCLUSION: Living in houses with open eaves and being out at night were found to influence malaria incidences at household level.

Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density.

The relationship between the bone mineral density (BMD) and Charcot arthropathy is unclear. Prospectively, 55 consecutive diabetic patients presenting with a Charcot arthropathy of the foot or ankle were classified as having a fracture, dislocation, or a combination fracture-dislocation pattern of initial destruction. In these groups we used dual-energy x-ray absorptiometry to compare the peripheral bone of the affected and unaffected limbs. The clinical data relating to diabetes and related major comorbidities and the site of the arthropathy (ankle, hindfoot, midfoot, forefoot) were also compared. There were 23 patients with a fracture pattern, 23 with a dislocation pattern, and nine with a combination. The age-adjusted odds ratio for developing a Charcot joint with a fracture pattern as opposed to a dislocation pattern in patients with osteopenia was 9.5 (95% confidence interval 2.4 to 37.4; p = 0.0014). Groups also differed as to the site of the arthropathy. Fracture patterns predominated at the ankle and forefoot whereas dislocations did so in the midfoot. Diabetic Charcot arthropathy of the foot and ankle differs according to the pattern of the initial destruction. The fracture pattern is associated with peripheral deficiency of BMD. The dislocation pattern is associated with a normal BMD.

Emerging food-borne zoonoses.

Diarrhoeal diseases, almost all of which are caused by food-borne or waterborne microbial pathogens, are leading causes of illness and death in less developed countries, killing an estimated 1.9 million people annually at the global level. Even in developed countries, it is estimated that up to one third of the population are affected by microbiological food-borne diseases each year. The majority of the pathogens causing this significant disease burden are now considered to be zoonotic. The occurrence of some of these zoonotic pathogens seems to have increased significantly over recent years. The factors involved in such increases have not been well studied, but they are generally agreed to include changes in animal production systems and in the food production chain. Both types of changes can cause corresponding changes in patterns of exposure to the pathogens and the susceptibility pattern of the human population. This paper will not attempt a more in-depth analysis of such factors. The authors briefly describe five of the most important emerging food-borne zoonotic pathogens: Salmonella spp., Campylobacter spp., enterohaemorrhagic Escherichia coli, Toxoplasma gondii and Cryptosporidium parvum. The paper does not include a full description of all important emerging food-borne pathogens but instead provides a description of the present situation, as regards these globally more important pathogens. In addition, the authors describe each pathogen according to the new framework of a Food and Agriculture Organization (FAO)/World Health Organization (WHO) microbiological risk assessment, which consists of hazard identification and characterisation, exposure assessment and risk characterisation. Moreover, the authors provide a brief account of attempts at risk mitigation, as well as suggestions for risk management for some of these pathogens, based on thorough international FAO/WHO risk assessments. The authors emphasise the importance of science-based programmes for the continued reduction of pathogens at relevant points of the 'farm-to-fork' food production chain, as this is the only sustainable basis for further reducing risks to human health in the area of preventable food-borne diseases.

GIS-based analysis of drinking-water supply structures: a module for microbial risk assessment.

Water-related infections constitute an important health impact world-wide. A set of tools serving for Microbial Risk Assessment (MRA) of waterborne diseases should comprise the entire drinking-water management system and take into account the Hazard Analysis and Critical Control Point (HACCP) concept which provides specific Critical Control Points (CCPs) reflecting each step of drinking-water provision. A Geographical Information System (GIS) study concerning water-supply structure (WSS) was conducted in the Rhein-Berg District (North Rhine-Westphalia, Germany). As a result, suitability of the existing water databases HYGRIS (hydrological basis geo-information system) and TEIS (drinking-water recording and information system) for the development of a WSS-GIS module could be demonstrated. Spatial patterns within the integrated raw and drinking-water data can easily be uncovered by GIS-specific options. The application of WSS-GIS allows a rapid visualization and analysis of drinking-water supply structure and offers huge advantages concerning microbial monitoring of raw and drinking water as well as recognition and investigation of incidents and outbreaks. Increasing requests regarding health protection and health reporting, demands for a better outbreak management and water-related health impacts of global climate change are major challenges of future water management to be tackled with methods including spatial analysis. GIS is assumed to be a very useful tool to meet these requirements.

Radiographic analysis of a cemented titanium alloy femoral component.

Proximal femoral cortical bone remodeling was evaluated radiographically about a 1 piece cemented titanium alloy femoral prosthesis implanted with modern cement techniques and was compared with one described previously in which early cement techniques and a stainless steel stem were used. Two hundred twenty-six total hip replacements (196 patients) were observed for an average of 6.3 years (range, 5-10 years). Analysis of all hips revealed that the ratio of cortical thickness to that of the overall femoral bone diameter did not change significantly about the periprosthetic bone throughout the length of the study. Cortical hypertrophy and atrophy occurred at rates similar to those seen with the early cement techniques. Distal fusiform cortical hypertrophy and the formation of osteosclerotic (reactive) lines at the bone cement interface occurred at approximately half the rate using modern cement techniques. In addition, cortical atrophy was associated with the formation of these reactive lines, the occurrence of osteolytic lesions, and progressive bone cement interface radiolucencies. Although periprosthetic cortical atrophy occurred at rates similar to those reported previously, important differences were noted between the findings of this study and the earlier study; these differences most likely were a result of cement technique or the prosthesis.

Application of ambulatory infusion devices in infusional cancer chemotherapy: a model for nursing management.

Optimal support of the patient receiving infusional cancer chemotherapy (ICC) in the home setting is partially dependent on the provision of an infusional device that offers minimal complexity and maximal reliability and safety. The selection of the appropriate device is vital to positive patient outcomes and to the comfort level of both patient and care providers. This article presents issues and considerations in the selection of infusion devices and the nursing role in the management of patients utilizing such devices. Aspects of nursing management are presented from the perspective of The Cancer Center of Boston (TCC) model.

Options for venous access in ambulatory care: issues in selection and management.

As advances in VAD technology continue, the biggest challenge becomes the ability to stay abreast of all the emerging devices and the evolutions in management and care. Various resources are available which provide guidelines and standards to enable providers in the care of patients with VADs (see Table 6). It is incumbent upon caregivers to disseminate information as it is gained through observations and experience with VADs. The literature must remain current and accessible to all caregivers in order to ensure optimal management of patients with VADs.

Patellofemoral complications following total knee arthroplasty. Effect of a lateral release and sacrifice of the superior lateral geniculate artery.

Between 1987 and 1989, 1,205 Anatomic Graduated Component (AGC, Biomet, Warsaw, IN) total knee arthroplasties were performed by three surgeons using the same prosthesis and same technique. Four hundred twenty-eight total knee arthroplasties (35%) had lateral releases; in 107 (75%) of these, the superior lateral geniculate artery was saved. Lateral release had no effect on patellar subluxation, dislocation, or loosening, but was associated with significantly more patellar fractures. Conversely, patellar radiolucency was more common in knees without a lateral release. Furthermore, saving the superior lateral geniculate artery during a lateral release had no effect on patellar dislocation, radiolucency, loosening, or fracture.

Outcome of the contralateral hip following total hip arthroplasty for osteoarthritis.

One thousand one hundred and sixteen patients who underwent unilateral total hip arthroplasty osteoarthritis between 1970 and 1980 were examined for development, progression, and total hip arthroplasty in the contralateral joint. At the time of the original surgery, 452 patients were diagnosed with bilateral osteoarthritis and 664 had a normal contralateral hip. The probability of osteoarthritis progressing in the contralateral joint is 78.6% at 10 years, with the chance of arthroplasty being 53.8%. The probability of a hip diagnosed as normal developing osteoarthritis is 36.5% at 10 years, with an 8.3% chance of requiring total hip arthroplasty.

Web-based delivery and open-architecture database support in the ITreS Counselor Information System.

ITreS is a prototype information system for substance abuse counselors and clinicians. ITreS integrates client records, on-line screening and assessment instruments, and knowledge bases into a single integrated system. This paper discusses two aspects of the development of ITres: the use of the World Wide Web as a development and delivery environment and the use of an attributed translation-based data model to integrate data from various sources into a single client record.

Intracranial meningioma with positive progesterone receptors. A case report.

A patient with a headache and seizures in the second trimester of her fifth pregnancy was diagnosed as having an intracranial meningioma. She underwent pregnancy termination followed by craniotomy and removal of the tumor one week later. She recovered fully. The final pathology report confirmed the diagnosis of meningioma, progesterone receptor positive.