Enhancing the Opacity of Glass Ceramics by Applying Opaque Stains to the Intaglio Surface.

OBJECTIVE: The aim of this study was to assess the effect of opaque stain application to the intaglio surface of lithium disilicate glass ceramics on the masking ability of discolored substrates and bond strength to a resin-based luting agent (depending on etching time); the stain film-thickness was also assessed. MATERIALS AND METHODS: Ceramic specimens were produced with CAD-CAM blocks of lithium disilicate (IPS e.max CAD). Two opaque stains were tested at ceramic intaglio surface: opaque glassy stain for titanium frameworks (OP-ti) and low-fusion glassy stain for ceramic characterization (LFG-iv). Non-stained ceramic specimens served as controls. For optical and colorimetric analyses, A2-shaded ceramics of medium and low-translucencies were tested, in thicknesses of 1.0- and 1.5-mm (n = 10), with two coupling agents (non-shaded-glycerin and A2-shaded try-in paste). CIEDE2000 formula was used for calculation of translucency parameter (TP00) and color differences (ΔE00). Whiteness index for dentistry (WID) was also reported. ΔE00 were assessed over discolored substrates (tooth-shaded A2-reference, A4, C3, and C4; coppery metal, silvery metal, white zirconia, and PEEK). Microshear bond strength of stained and non-stained ceramic specimens to a resin-based luting agent was evaluated. Film-thickness of stains was assessed by scanning electron microscopy. RESULTS: The application of opaque stains to the intaglio surface of lithium disilicate ceramics resulted in significant reduction of TP00 (p < 0.001) and WID (p < 0.001) and differences in L*, C*, and ho color coordinates (especially with OP-ti) (p < 0.001). ΔE00 was significantly reduced in stained ceramic groups in comparison with the control, for all discolored substrates (p < 0.001). Acceptable color matching was obtained with stained ceramic specimens for all discolored substrates, depending on the type of stain, ceramic thickness, ceramic translucency, and coupling agent. The application of stains to the ceramic intaglio surface was not detrimental to bond strength to a resin-based luting agent, but depended on the time of hydrofluoric acid-etching (20 s for OP-ti and 60 s for LFG-iv) (p < 0.001). Film-thickness of stains presented mean values <70 µm. CONCLUSION: The application of opaque stains to the intaglio surface of lithium disilicate glass ceramics was effective to mask severely discolored substrates, presenting adequate bond strength to the luting agent and thin film-thicknesses. CLINICAL SIGNIFICANCE: For indirect restorations over severely discolored substrates, the application of opaque stain to the intaglio surface of lithium disilicate glass ceramic ensures acceptable color matching, with adequate bond strength to resin-based luting agents and clinically acceptable stain film-thickness.

Outcomes and Survival for Early-Stage Non-Small Cell Lung Cancer Following Wedge Resection or Lobectomy: A Propensity Score-Matched Analysis Using a Novel Peruvian Registry.

Background: Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables. Methods: This observational, analytical, longitudinal study used propensity score-matched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I-II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000-2020. After PSM, 650 cases were analyzed (resection, n=325; lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoregional-recurrence-free survival (LRFS). Results: The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011). Conclusion: Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.

Minimally Invasive Coronary Artery Bypass Grafting in a Low-Risk Asian Cohort: A Propensity-Score Matched Study.

INTRODUCTION: Minimally invasive coronary artery bypass grafting (MICS CABG) offers a new paradigm in coronary revascularization. This study aims to compare the outcomes of MICS CABG with those of conventional median sternotomy CABG (MS CABG) within a growing minimally invasive cardiac surgical program in Singapore. METHODS: Propensity matching produced 111 patient pairs who underwent MICS CABG or MS CABG between January 2009 and February 2020 at the National University Heart Centre, Singapore. Minimally invasive direct coronary artery bypass surgery patients were matched to single- or double-graft MS CABG patients (Group 1). Multivessel MICS CABG patients were matched to MS CABG patients with equal number of grafts (Group 2). RESULTS: Overall, MICS CABG patients experienced shorter postoperative length of stay (P<0.071). In Group 2, procedural duration (P<0.001) was longer among MICS CABG patients, but it did not translate to adverse postoperative events. Postoperative outcomes, including 30-day mortality, reopening for bleeding, new onset atrial fibrillation as well as neurological, pulmonary, renal, and infectious complications were comparable between MICS and MS CABG groups. CONCLUSION: MICS CABG is a safe and effective approach for surgical revascularization of coronary artery disease and trends toward a reduction in hospital stay.

Inequality of opportunity in the double burden of malnutrition in Mexico.

This paper proposes a pseudo-birth-cohort approach to deal with a lack of longitudinal data to measure health inequities over time. Using Roemer's framework for inequality of opportunity, this study measures ex-ante and ex-post inequalities in malnutrition, a concept that spans both sides of the nutrition continuum. The total contribution of observed circumstances and the direct contribution of observed efforts to the variation of malnutrition are disentangled for people born between 1983 and 1988 in Mexico. Results indicate that inequality of opportunity has been persistent across this 30-year lifespan for that cohort. Some evidence suggests that a lack of opportunities has been transmitted from parents to children and that people's circumstances account for most of the explained variation in the double burden of malnutrition. However, stratifying the analysis by sex shows that efforts account for more of the explained variation of inequality of opportunity for women in their middle adulthood than for men in most of the outcomes analyzed.

Clinical characteristics and prognostic analysis of metachronous bilateral breast carcinoma: a retrospective study based on propensity score matching.

BACKGROUND: To investigate clinical characteristics, treatment, outcomes, and prognostic risk factors of metachronous bilateral breast carcinoma (MBBC) and provide a theoretical basis for clinical management of MBBC. METHODS: This was a retrospective study. From January 1, 2010 to March 31, 2022, a total of 23,010 patients with breast cancer underwent surgical treatment at the Breast Center of the Fourth Hospital of Hebei Medical University, including 386 patients with MBBC. Propensity score matching (PSM) was performed on MBBC patients and unilateral breast cancer (UBC) patients in a 1:1 ratio, and 210 UBC patients and 210 MBBC patients were finally matched. Clinical medical records of all patients were collected, including age of onset, family history of breast cancer, tumor size, lymph node status, TNM stage, mode of surgery, menstruation, pathological type, immunohistochemical (IHC) typing, treatment, disease-free survival (DFS), and overall survival (OS). RESULTS: The result showed that age of onset of the second primary cancer (SPC) was significantly older than that of the first primary cancer (FPC) (P = 0.024). Baseline data from MPPC patients showed that the tumor size of FPC was significantly larger than that of SPC (P = 0.043), and the proportion of PR ( +) in FPC is significantly higher than that in SPC (P = 0.045). Among MBBC patients with FPC for estrogen receptor (ER) or progesterone receptor (PR) ( +) and Her-2 (-), clinical characteristics and treatment results showed that the proportion of PR ( +) in the drug-resistant group was significantly lower than that in the non-drug-resistant group. The 2-year OS rate of SPC in the drug-resistant group was significantly shorter than those of the non-drug-resistant group (78.9% vs 100%, P < 0.05). The result of PSM-based comparison between MBBC patients and UBC patients showed significantly lower proportion of MBBC patients with SPC received chemotherapy compared to UBC patients (P = 0.026), and there was no significant difference in OS and DFS between SPC course of MBBC patients and UBC patients (P > 0.05). The univariate analysis showed that high TNM stage was a risk factor for death and disease progression in MBBC patients, with the risk of death in stage III MBBC patients being about 5 times higher than that in stage I MBBC patients (HR = 4.97, 95%CI = 1.42-17.31, P = 0.012), and the risk of disease recurrence being about 3.5 times higher than that in stage I MBBC patients (HR = 3.55, 95%CI = 1.07-11.81, P = 0.039). CONCLUSION: In summary, this study presented clinical characteristics, treatment options, and outcomes of MBBC patients and patients with MBBC who were resistant to endocrine therapy have a worse SPC survival prognosis. The course of SPC in MBBC patients was similar to that of UBC in terms of prognosis and survival, which suggested that SPC can be treated according to UBC treatment regimen. High TNM stage was a prognostic risk factor for SPC patients.

Blood transfusion is correlated with elevated adult all-cause mortality and cardiovascular mortality in the United States: NHANES 1999 to 2018 population-based matched propensity score study.

BACKGROUND AND AIMS: The association of blood transfusion with an increase in medium- and short-term mortality in specific populations has been confirmed. However, the correlation between blood transfusion and long-term mortality in the general population remains unclear. This cohort study evaluated the correlation between blood transfusion and overall and cause-specific mortality in the general American adult population. METHODS: The authors utilized 10 sets of 2-year cycle data (1999-2018) from the National Health and Nutrition Examination Survey on the outcomes of adults who did and did not receive blood transfusions. Propensity score-matching (1:1) was performed based on age, sex, race, education level, marital status, poverty-income ratio, arteriosclerotic cardiovascular disease, cancer, anemia, hypertension, and diabetes status. After controlling for demographic characteristics and clinical risk factors, Cox regression analysis was performed to evaluate the correlation between blood transfusion and all-cause and cause-specific mortality. RESULTS: The study included 48,004 adult participants. The risk of all-cause mortality increased by 101 % with blood transfusion, and the risk of cardiovascular mortality increased by 165 %. After propensity score-matching, 6,116 pairs of cases were retained, and the risk of all-cause mortality increased by 84 % with blood transfusion, and the risk of cardiovascular mortality increased by 137 %. The sensitivity analysis results were robust. CONCLUSIONS: In the general American population, blood transfusion significantly impacts long-term all-cause and cardiovascular mortality and may be an unacknowledged risk factor for death. Thus, the effective management of blood transfusion in the general population may be beneficial.

Improved LINE-1 Detection through Pattern Matching by Increasing Probe Length.

Long Interspersed Element-1 (LINE-1 or L1) is an autonomous transposable element that accounts for 17% of the human genome. Strong correlations between abnormal L1 expression and diseases, particularly cancer, have been documented by numerous studies. L1PD (LINE-1 Pattern Detection) had been previously created to detect L1s by using a fixed pre-determined set of 50-mer probes and a pattern-matching algorithm. L1PD uses a novel seed-and-pattern-match strategy as opposed to the well-known seed-and-extend strategy employed by other tools. This study discusses an improved version of L1PD that shows how increasing the size of the k-mer probes from 50 to 75 or to 100 yields better results, as evidenced by experiments showing higher precision and recall when compared to the 50-mers. The probe-generation process was updated and the corresponding software is now shared so that users may generate probes for other reference genomes (with certain limitations). Additionally, L1PD was applied to other non-human genomes, such as dogs, horses, and cows, to further validate the pattern-matching strategy. The improved version of L1PD proves to be an efficient and promising approach for L1 detection.

Robotic versus laparoscopic gastrectomy for gastric cancer: A Western propensity score matched analysis.

BACKGROUND: Robot-assisted gastrectomy (RG) has been shown to be safe and feasible in the treatment of gastric cancer (GC). However, it is unclear whether RG is equivalent to laparoscopic gastrectomy (LG), especially in the Western world. Our objective was to compare the outcomes of RG and LG in GC patients. METHODS: We reviewed all gastric adenocarcinoma patients who underwent curative gastrectomy by minimally invasive approach in our institution from 2009 to 2022. Propensity score matching (PSM) analysis was conducted to reduce selection bias. DaVinci Si platform was used for RG. RESULTS: A total of 156 patients were eligible for inclusion (48 RG and 108 LG). Total gastrectomy was performed in 21.3% and 25% of cases in LG and RG, respectively. The frequency of stage pTNM II/III was 48.1%, and 54.2% in the LG and RG groups (p = 0.488). After PSM, 48 patients were matched in each group. LG and RG had a similar number of dissected lymph nodes (p = 0.759), operative time (p = 0.421), and hospital stay (p = 0.353). Blood loss was lower in the RG group (p = 0.042). The major postoperative complications rate was 16.7% for LG and 6.2% for RG (p = 0.109). The 30-day mortality rate was 2.1% and 0% for LG and RG, respectively (p = 1.0). There was no significant difference between the LG and RG groups for disease-free survival (79.6% vs. 61.2%, respectively; p = 0.155) and overall survival (75.9% vs. 65.7%, respectively; p = 0.422). CONCLUSION: RG had similar surgical and long-term outcomes compared to LG, with less blood loss observed in RG.

The visual and instrumental analyses of different single-shade resin composites / Análisis visual e instrumental de diferentes resinas compuestas omnicromáticas

Abstract The purpose of this study was to evaluate the color adaptation of single-shade resin composites applied to different tooth shades. A total of 108 class III preparations (n=6) were performed on the acrylic denture maxillary incisors (2mm depth and 2mm height). 5 single-shade resin composites (Vittra APS Unique, Omnichroma, ZenChroma, Clearfil Majesty ES-2 Universal, Charisma Topaz One) and 1 multishade resin composite (Estelite Asteria) were placed in the cavities and polished. I performed visual and instrumental color analyses. The CIEDE2000 formula was used to assess the shade differences (ΔE) between teeth and restorations. The obtained ΔE values were recorded and statistically analyzed. For the instrumental analysis, ZenChroma in A1 shade groups showed statistically significant higher differences (p<0.05). Among all tested materials, A3 shade groups showed lower ΔE values (p<0.05). For the visual analysis, there were no significant differences between materials and scores in A1 and A3 shade groups (p>0.05). There were statistically significant differences between the materials and the scores in A2 shade groups (p<0.05). As a result of this study, it was concluded that, making esthetic restorations with single-shade resin composites promises proper color adaptation, but their properties still need improvement. Single-shade resin composites can reduce chair-time and technical sensitivity with good color matching.

Resumen El objetivo de este estudio fue evaluar la adaptación del color de resinas compuestas omnicromáticas. Se realizaron un total de 108 preparaciones de clase III (n=6) en los incisivos superiores de prótesis acrílicas (2mm de profundidad y 2mm de altura). Se colocaron cinco resinas compuestas omnicromáticas (Vittra APS Unique, Omnichroma, ZenChroma, Clearfil Majesty ES-2 Universal, Charisma Topaz One), además de una resina multitono (Estelite Asteria) en las cavidades y se pulieron. Se realizó el análisis de color visual e instrumental. Se utilizó la fórmula CIEDE2000 para evaluar las diferencias de tono (ΔE) entre dientes y restauraciones. Los valores de ΔE obtenidos se registraron y analizaron estadísticamente. Para el análisis instrumental, ZenChroma en los grupos de color A1 mostró diferencias mayores estadísticamente significativas (p<0,05). Entre todos los materiales probados, los grupos de tonos A3 mostraron valores de ΔE más bajos (p<0.05). Para el análisis visual, no hubo diferencias significativas entre materiales y puntuaciones en los grupos de color A1 y A3 (p>0,05). Hubo diferencias estadísticamente significativas entre los materiales y las puntuaciones en los grupos de color A2 (p<0,05). Como resultado de este estudio, se concluyó que la realización de restauraciones estéticas con resinas compuestas omnicromáticas promueve una adecuada adaptación del color, pero aún necesitan mejorar sus propiedades. Las resinas compuetas omnicromáticas pueden reducir el tiempo de atención clínica y la sensibilidad técnica con una adecuada combinación de colores.

EEG alpha and theta time-frequency structure during a written mathematical task.

Since the first electroencephalogram (EEG) was obtained, there have been many possibilities to use it as a tool to access brain cognitive dynamics. Mathematical (Math) problem solving is one of the most important cortical processes, but it is still far from being well understood. EEG is an inexpensive and simple indirect measure of brain operation, but only recently has low-cost equipment (mobile EEG) allowed sophisticated analyses in non-clinical settings. The main purpose of this work is to study EEG activation during a Math task in a realistic environment, using mobile EEG. A matching pursuit (MP)-based signal analysis technique was employed, since MP properties render it a priori suitable to study induced EEG activity over long time sequences, when it is not tightly locked to a given stimulus. The study sample comprised sixty healthy volunteers. Unlike the majority of previous studies, subjects were studied in a sitting position with their eyes open. They completed a written Math task outside the EEG lab, wearing a mobile EEG device (EPOC+). Theta [4 Hz-7.5 Hz], alpha (7.5 Hz-13 Hz] and 0.5 Hz micro-bands in the [0.5 Hz-20 Hz] range were studied with a low-density stochastic MP dictionary. Over 1-min windows, ongoing EEG alpha and theta activity was decomposed into numerous MP atoms with median duration around 3 s, similar to the duration of induced, time-locked activity obtained with event-related (des)synchronization (ERS/ERD) studies. Relative to Rest, there was lower right-side and posterior MP alpha atom/min during Math, whereas MP theta atom/min was significantly higher on anteriorly located electrodes, especially on the left side. MP alpha findings were particularly significant on a narrow range around 10 Hz-10.5 Hz, consistent with FFT alpha peak findings from ERS/ERD studies. With a streamlined protocol, these results replicate previous findings of EEG alpha and theta activation obtained during Math tasks with different signal analysis techniques and in different time frames. The efficient application to real-world, noisy EEG data with a low-resolution stochastic MP dictionary shows that this technique is very encouraging. These results provide support for studies of mathematical cognition with mobile EEG and matching pursuit.

Hair-to-Hair Trichoscopy: An Objective Method to Assess Effectiveness of Botulinum Toxin in a Clinical Trial for Androgenetic Alopecia.

Introduction: Androgenetic alopecia (AGA) is the most common alopecia affecting both genders leading to a potential decrease in quality of life and self-esteem. A current concern in trichology is how to accurately measure clinical response in both daily medical practice and academic research. Hair-to-hair (H2H)-matching technology™ has recently emerged as a technique to evaluate variations in follicular units, hair shaft number, and thickness. This study aimed to describe the methodology employed in a clinical trial using this technology to test the efficacy of botulinum toxin (BT) for male AGA. Methods: This pilot study is a triple-blind, randomized, split scalp, placebo-controlled clinical trial. Patients enrolled were submitted to injections half of the scalp with 50 IU of BT and the other half with 1 mL of normal saline as a control. The trial involved three visits (weeks 0, 12, and 24) and 8 global clinical photographs followed by H2H-matching trichoscopy were captured before the injections at each visit. Paired t test analysis was employed for matched pairs of the following parameters: total hair count, the total number of terminal hair strands, average shaft thickness, and the number of hairs lost or gained during each visit. Then, the software compared the differences between the two sides (BT vs. placebo) per scalp zone and a long time. Conclusion: The combination of manually corrected image processing, follicular map, and H2H-matching technology™ appears to be the most precise way to evaluate changes in hair count and thickness over time. The design is reproducible and can help other researchers and dermatologists in their clinical practice to obtain reliable results in similar scientific research.

EEG signals from tinnitus sufferers at identifying their sound tinnitus.

The present database contains brain activity of subjective tinnitus sufferers at identifying their sound tinnitus. The main objective of this database is to provide spontaneous Electroencephalographic (EEG) activity at rest, and evoked EEG activity when tinnitus sufferers attempt to identify their sound tinnitus among 54 tinnitus sound examples. For the database, 37 volunteers were recruited: 15 ones without tinnitus (Control Group - CG), and 22 ones with tinnitus (Tinnitus Group - TG). For EEG recording, 30 channels were used to record two conditions: 1) basal condition, where the volunteer remained in a state of rest with the open eyes for two minutes; and 2) active condition, where the volunteer must have identified his/her sound stimulus by pressing a key. For the active condition, a sound-tinnitus library was generated in accordance with the most typical acoustic properties of tinnitus. The library consisted in ten pure tones (250 Hz, 500 Hz, 1 kHz, 2 kHz, 3 kHz, 3.5 kHz, 4 kHz, 6 kHz, 8 kHz, 10 kHz), a White Noise (WN), a Narrow Band noise-High frequencies (NBH, 4 kHz-10 kHz), a Narrow Band noise-Medium frequencies (NBM,1 kHz-4 kHz), a Narrow-Band noise Low frequencies (NBL, 250 Hz-1 kHz), ten pure tones combined with WN, ten pure tones superimposed with NBH, ten tones with NBM and ten pure tones combined with NBL. In total, 54 sound-tinnitus were applied for both groups. In the case of CG, volunteers must have identified a sound at 3.5 kHz. In addition to EEG information, a csv-file with audiometric and psychoacoustic information of volunteers is provided. For TG, this information refers to: 1) hearing level, 2) type of tinnitus, 3) tinnitus frequency, 4) tinnitus perception, 5) Hospital Anxiety and Depression Scale (HADS) and 6) Tinnitus Functional Index (TFI). For CG, the information refers to: 1) hearing level, and 2) HADS.

Evidence of precurrent responses expanding equivalence classes in a delayed matching-to-sample task.

Delayed matching to sample (DMTS) increases the probability of equivalence class formation. Precurrent responses can mediate the retention interval in DMTS trials and control the selection of comparisons. In human participants, precurrent responses usually consist of naming the experimental stimuli based on their similarities to meaningful stimuli with preexperimental history. We tested whether precurrents expand classes by serving as nodes between experimental and meaningful stimuli. A DMTS (2 s) was used throughout the entire experiment. Eleven undergraduates learned A1B1 and A2B2 relations and then were submitted to ArC trials that required them to answer math problems presented during the DMTS interval: when the sample was A1, the problems resulted in 12 and C1 was correct; when the sample was A2, they resulted in 9 and C2 was correct. Response-as-node tests assessed whether participants would relate B1 and C1 to the printed number 12 and B2 and C2 to the printed number 9. Ten participants responded accordingly to this pattern, showing that the responses to the problems expanded the classes. Parity tests using the words "even" and "odd" further confirmed this hypothesis. These results contribute to understanding why DMTS enhances equivalence performances. Implications of using this procedure in stimulus-equivalence studies are discussed.

One-point calibration and matrix-matching concept for quantification of potentially toxic elements in wood by LA-ICP-MS.

The aim of this work is to evaluate two quantitative methods, based on the external calibration applied in laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) analysis, known as (i) analytical curve and (ii) one-point calibration, using the concept of matrix matching to quantify three potentially toxic elements (PTEs) in wood samples. These can biologically register changes in the abiotic environment and be applied to monitoring climate change or environmental toxicity. In this case, standard sample preparation was evaluated to prepare the standard pellets using Pinus taeda species as a matrix-matching concept. Six pellets of P. taeda, with different Pb, Cd, and Ba concentrations, were prepared to build the analytical curve and one-point calibration strategies. The LA-ICP-MS parameters were optimised for 206Pb, 208Pb, 112Cd, 114Cd, 137Ba, and 138Ba isotope analysis in wood samples. The two calibration strategies provided 74-110% analytical recovery from certified reference materials and similar results to those obtained by ICP-MS through the acid digestion of environmental wood samples from São Paulo City (Brazil). This demonstrated the applicability of the one-point calibration strategy in quantifying PTEs in wood samples, which could be used with environmental analyses. Differences observed between the Ba isotope results obtained via LA-ICP-MS and ICP-MS quantification were related to sampling by LA-ICP-MS and the ICP-MS sample introduction, as well as to laser matrix and transport effects because of the difference between the wood species evaluated.

Minimally Invasive Coronary Artery Bypass Grafting in a Low-Risk Asian Cohort: A Propensity-Score Matched Study

ABSTRACT Introduction: Minimally invasive coronary artery bypass grafting (MICS CABG) offers a new paradigm in coronary revascularization. This study aims to compare the outcomes of MICS CABG with those of conventional median sternotomy CABG (MS CABG) within a growing minimally invasive cardiac surgical program in Singapore. Methods: Propensity matching produced 111 patient pairs who underwent MICS CABG or MS CABG between January 2009 and February 2020 at the National University Heart Centre, Singapore. Minimally invasive direct coronary artery bypass surgery patients were matched to single- or double-graft MS CABG patients (Group 1). Multivessel MICS CABG patients were matched to MS CABG patients with equal number of grafts (Group 2). Results: Overall, MICS CABG patients experienced shorter postoperative length of stay (P<0.071). In Group 2, procedural duration (P<0.001) was longer among MICS CABG patients, but it did not translate to adverse postoperative events. Postoperative outcomes, including 30-day mortality, reopening for bleeding, new onset atrial fibrillation as well as neurological, pulmonary, renal, and infectious complications were comparable between MICS and MS CABG groups. Conclusion: MICS CABG is a safe and effective approach for surgical revascularization of coronary artery disease and trends toward a reduction in hospital stay.

Blood transfusion is correlated with elevated adult all-cause mortality and cardiovascular mortality in the United States: NHANES 1999 to 2018 population-based matched propensity score study

Abstract Background and aims The association of blood transfusion with an increase in medium- and short-term mortality in specific populations has been confirmed. However, the correlation between blood transfusion and long-term mortality in the general population remains unclear. This cohort study evaluated the correlation between blood transfusion and overall and cause-specific mortality in the general American adult population. Methods The authors utilized 10 sets of 2-year cycle data (1999-2018) from the National Health and Nutrition Examination Survey on the outcomes of adults who did and did not receive blood transfusions. Propensity score-matching (1:1) was performed based on age, sex, race, education level, marital status, poverty-income ratio, arteriosclerotic cardiovascular disease, cancer, anemia, hypertension, and diabetes status. After controlling for demographic characteristics and clinical risk factors, Cox regression analysis was performed to evaluate the correlation between blood transfusion and all-cause and cause-specific mortality. Results The study included 48,004 adult participants. The risk of all-cause mortality increased by 101 % with blood transfusion, and the risk of cardiovascular mortality increased by 165 %. After propensity score-matching, 6,116 pairs of cases were retained, and the risk of all-cause mortality increased by 84 % with blood transfusion, and the risk of cardiovascular mortality increased by 137 %. The sensitivity analysis results were robust. Conclusions In the general American population, blood transfusion significantly impacts long-term all-cause and cardiovascular mortality and may be an unacknowledged risk factor for death. Thus, the effective management of blood transfusion in the general population may be beneficial.

Sociodemographic factors associated with knowledge and attitudes of Peruvian dental interns about dental shade selection.

BACKGROUND: The dentist should have a thorough knowledge of the science, protocols and procedures for dental shade selection in order to mimic dental tissue with restorative materials, respecting the individual needs and attitudes of each patient and providing them with a pleasant and esthetically acceptable appearance. The present study evaluated the knowledge and attitudes of dental interns from two Peruvian universities about dental shade selection and its relationship with sociodemographic factors. METHODS: The present cross-sectional and analytical study was carried out on Peruvian dental interns from the Universidad Nacional Federico Villarreal and the Universidad Privada de San Juan Bautista during May to June 2022. Two validated questionnaires on knowledge and attitudes about dental shade selection were used. A Poisson regression model with robust variance using the adjusted prevalence ratio (APR) was used to assess the influence of the variables: age group, sex, place of origin and type of university, considering a significance level of p<0.05. RESULTS: The results showed that 40.8% (95% CI: 34.0% - 47.6%) of the interns presented unfavorable attitudes while 90.1% (95% CI: 86.0% - 94.2%) presented insufficient knowledge. It was also found that dental interns under 29 years of age were 32% less likely to have unfavorable attitudes (APR = 0.68, 95% CI 0.48 - 0.96) and 11% more likely to have insufficient knowledge (APR = 1.11, 95% CI 1.01 - 1.24) about tooth shade selection compared to dental interns aged 29 years and older. Finally, women were 55% more likely to have unfavorable attitudes about tooth shade selection compared to men (APR = 1.55; 95% CI: 1.08 - 2.22). CONCLUSION: The majority of dental interns presented insufficient knowledge and less than half had unfavorable attitudes about dental shade selection. In addition, being a student under 29 years of age was a risk factor for presenting insufficient knowledge and at the same time constituted a protective factor for presenting unfavorable attitudes. Likewise, being a female student was a risk factor for presenting unfavorable attitudes about dental shade selection.

Cross-cultural measurement invariance evidence of individualism and collectivism: from the idiosyncratic to universal.

Introduction: Culture plays a fundamental role in shaping human behavior, with individualism and collectivism being key cultural dimensions. However, existing scales for measuring these constructs, such as the INDCOL scale, have demonstrated issues when applied in diverse cultural contexts. To address this, we present the translation and adaptation of the Mexican Vertical and Horizontal Individualism and Collectivism Scale (MXINDCOL) into English, aiming to identify both universal and culture-specific elements. Methods: Data were collected from 1124 participants (371 from the United States, 753 from Mexico) using the MXINDCOL and INDCOL scales. Propensity score matching was applied to balance demographic differences between the samples. Confirmatory Factor Analysis (CFA) assessed model fit, and cross-cultural measurement invariance was examined. Reliability, convergent and discriminant validity were also assessed. Results: The English-translated MXINDCOL scale demonstrated good model fit in both US and Mexican samples, outperforming the INDCOL scale. Reliability values were higher for the MXINDCOL scale compared to INDCOL. Cross-cultural measurement invariance was established, allowing for meaningful comparisons between the two cultures. US participants scored higher on vertical collectivism, while Mexican participants scored higher on horizontal collectivism and horizontal individualism. Discussion: The MXINDCOL scale offers a culturally sensitive measurement of individualism and collectivism, addressing issues found in existing scales. It provides a more accurate assessment of cultural orientations and enriches the understanding of cultural dimensions by incorporating idiosyncratic elements. Further research in diverse cultural contexts is recommended to validate and refine the scale, contributing to a more nuanced understanding of cultural variations in individualism and collectivism.

Effects of prophylactic red blood cell (RBC) transfusion with extended antigen matching on alloimmunization in patients with Sickle Cell Disease (SCD).

BACKGROUND: RBC alloimmunization remains a significant problem for many patients with SCD. To reduce alloimmunization some strategies have been implemented to provide limited or extended antigen matched RBC transfusions to patients with SCD who need chronic transfusion support. The aim of this study was to evaluate the effects of prophylactic RBC transfusion with extended antigen matching on alloimmunization in patients with SCD. METHODS: This is a 20-year retrospective study of patients with SCD transfused with RBCS that were prospectively matched for D, C, c, E, e, K, Fya/Fyb, Jka/Jkb and S antigens. Our study included 95 patients, and none had antibodies documented before their first transfusion. Patients and donors were phenotyped and molecular typing was performed in all patients who had recent transfusions or a positive direct antiglobulin test to predict their antigen profile. Unexpected antibodies to the Rh system, meaning anti-Rh antibodies in patients whose serologic phenotype was Rh positive, were investigated by molecular genotyping for RH variant alleles. RESULTS: During this study-period, 12 (12.6%) were alloimmunized and 83 (87.4%) were not. Among the 12 patients who alloimmunized, 7 (58.3%) developed antibodies to Rh antigens and 5 (41.7%) produced antibodies to low prevalence antigens. All patients who developed Rh antibodies had RH variant alleles. Autoantibodies were found in 16 (16.8%) transfused patients. CONCLUSION: SCD patients benefit from receiving prophylactic RBC transfusions with extended antigen matching, as demonstrated by the reduction on the rates of alloimmunization and the lack of antibodies to K, FY, JK and S antigens, however, this strategy does not avoid alloimmunization to Rh and low-prevalence antigens.