Aim
This systematic review and network meta‐analysis synthesizes the available clinical evidence concerning efficacy with respect to plaque scores following a brushing action with ...oscillating‐rotating (OR) or high‐frequency sonic (HFS) powered toothbrushes (PTB) compared with a manual toothbrush (MTB) as control.
Material and methods
Databases were searched up to 1 August 2021, for clinical trials that evaluated the efficacy of a PTB with OR or HFS technology compared with an MTB on plaque removal after a single‐brushing action and conducted with healthy adult patients. Meta‐analysis (MA) and a network meta‐analysis (NMA) were performed.
Results
Twenty‐eight eligible publications, including 56 relevant comparisons, were retrieved. The overall NMA results for the mean post‐brushing score showed a statistically significant difference for the comparison between an OR PTB and an MTB (SMD = −0.43; 95% CI −0.696;−0.171). The change in plaque score data showed a significant effect of a PTB over an MTB and OR over HFS. Based on ranking, the OR PTB was highest, followed by the HFS PTB and the MTB.
Conclusion
Within the limitations of the present study design, based on the outcome following a single‐brushing action, it can be concluded that for dental plaque removal, there is a high certainty for a small effect of a PTB over an MTB. This supports the recommendation to use a powered toothbrush for daily plaque removal. There is moderate certainty for a very small benefit for the use of a powered toothbrush with an OR over an HFS mode of action.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Sustainable dairy production requires farms that are economically viable, environmentally sound and socially acceptable. A low environmental impact of milk production is not necessarily associated ...with an economically viable farm. To gain insight into a possible “trade-off” between economic and environmental sustainability, the relation between the environmental and economic indicators of dairy farms was quantified, and farm characteristics that influence this relation were identified. Economic and environmental indicators were quantified for 119 specialized dairy farms in 2005, based on data from the Dutch Farm Accountancy Data Network (FADN). Economic indicators used were: gross value added expressed per kg fat-and-protein-corrected milk (FPCM) or expressed per unit of labour, i.e. labour productivity. Environmental indicators used were: land use per kg FPCM, energy use per kg FPCM, global warming potential per kg FPCM, eutrophication and acidification potential per kg FPCM or per ha of land. Environmental indicators were deduced from a life cycle assessment. High labour productivity on dairy farms was associated with low on-farm energy use, total and on-farm land use, total and on-farm global warming potential, and total and off-farm acidification potential per kg FPCM. High labour productivity, however, was associated also with high on-farm eutrophication and acidification potential per hectare. From partial least squares regression analysis, it was concluded that relations between economic and environmental indicators were affected mainly by milk production per ha, annual milk production per cow, farm size, and amount of concentrates per kg FPCM. An increase in annual milk production per cow, for example, not only increased labour productivity, reduced energy use and global warming potential per kg FPCM but also, in the case of an unchanged stocking density, increased eutrophication and acidification per ha. To be economically and environmentally sustainable, animal production in the Netherlands, therefore, should focus on high animal productivity, i.e. high annual milk production per cow and efficient use of feed per kg milk, and moderate stocking density, provided that a good animal welfare standard is guaranteed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Follow-up care after treatment for colorectal cancer (CRC) is increasingly focused on health-related quality of life (HRQoL) and functional outcomes. The Assessment of Burden of ColoRectal Cancer ...(ABCRC)-tool is developed to measure these outcomes and support patient-oriented care. The tool comprises items assessing burden of disease and lifestyle parameters. It consists of a generic module combined with one of the three CRC specific modules. The objective of this study is to assess the construct validity and reliability of the items of the ABCRC-tool.
Patients who were receiving follow-up care after surgical CRC treatment were invited to complete the ABCRC-tool together with other validated patient-reported outcome measures (PROMs). Construct validity was assessed by testing expected correlations between items of the ABCRC-tool and domains of other PROMs and by examining predefined hypotheses regarding differences in subgroups of patients. Patients completed the ABCRC-tool twice, with 8 days apart, to evaluate its reliability.
In total, 177 patients participated (64% male) with a mean age of 67 years (range 33–88). The colon, rectum and stoma module were completed by subsequently 89, 53 and 35 patients. Most items correlated as expected with anticipated domains of the EORTC QLQ-C30 or EORTC QLQ-CR29 (all p-values <0.05). Furthermore, the ABCRC-tool could discriminate between subgroups of patients. The intraclass correlation coefficient (ICC) was good (>0.70) for most items, indicating good reliability.
The ABCRC-tool is a valid and reliable instrument that is ready for use in a clinical setting to support personalized follow-up care after CRC treatment.
•The ABCRC-tool is an innovative tool to guide colorectal cancer survivorship care•The ABCRC-tool measures burden of disease visualizes results with treatment advice•177 Patients participated to assess the validity and reliability of the ABCRC-tool•The ABCRC-tool is a valid and reliable instrument•The ABCRC-tool is ready for use in the clinic to support patient-oriented care
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Rituximab, a monoclonal antibody directed against the B-lymphocyte antigen CD20, has shown promise in several autoimmune disorders. Pulmonary alveolar proteinosis (PAP) is an autoimmune disorder ...characterised by autoantibodies to granulocyte-macrophage colony-stimulating factor (GM-CSF). An open-label, proof-of-concept phase II clinical trial was conducted in 10 PAP patients. The intervention consisted of two intravenous infusions of rituximab (1,000 mg) 15 days apart. Bronchoalveolar lavage (BAL) fluid and peripheral blood samples were collected. The primary outcome was improvement in arterial blood oxygenation. Both arterial oxygen tension and alveolar-arterial oxygen tension difference in room air improved in seven out of the nine patients completing the study. Lung function and high-resolution computed tomography scans, which were secondary outcomes, also improved. Peripheral blood CD19+ B-lymphocytes decreased from mean ± sem 15 ± 2% to <0.05% (n = 10) 15 days post-therapy. This decrease persisted for 3 months in all patients; at 6 months, CD19+ B-cells were detected in four out of seven patients (5 ± 2%). Total anti-GM-CSF immunoglobulin (Ig)G levels from baseline to 6 months were decreased in BAL fluids (n = 8) but unchanged in sera (n = 9). In this PAP cohort: 1) rituximab was well-tolerated and effectively ameliorated lung disease; and 2) reduction in anti-GM-CSF IgG levels in the lung correlated with disease changes, suggesting that disease pathogenesis is related to autoantibody levels in the target organ.
Production of milk causes environmental side effects, such as emission of greenhouse gases and nutrient enrichment in surface water. Scientific evidence that shows differences in integral ...environmental impact between milk production systems in the Netherlands was underexposed. In this paper, two Dutch milk production systems, i.e. a conventional and an organic, were compared on their integral environmental impact and hotspots were identified in the conventional and organic milk production chains. Identification of a hotspot provides insight into mitigation options for conventional and organic milk production. Data of commercial farms that participated in two pilot-studies were used and refer to the year 2003. For each farm, a detailed cradle-to-farm-gate life cycle assessment, including on and off farm pollution was performed. Results showed better environmental performance concerning energy use and eutrophication potential per kilogram of milk for organic farms than for conventional farms. Furthermore, higher on-farm acidification potential and global warming potential per kilogram organic milk implies that higher ammonia, methane, and nitrous oxide emissions occur on farm per kilogram organic milk than for conventional milk. Total acidification potential and global warming potential per kilogram milk did not differ between the selected conventional and organic farms. In addition, results showed lower land use per kilogram conventional milk compared with organic milk. In the selected conventional farms, purchased concentrates was found to be the hotspot in off farm and total impact for all impact categories, whereas in the selected organic farms, both purchased concentrates and roughage were found to be the hotspots in off farm impact.
We recommend to improve integral environmental performance of milk production by: (1) reducing the use of concentrates ingredients with a high environmental impact, (2) decreasing the use of concentrates per kilogram of milk, and (3) reducing nutrient surpluses by improving farm nutrient flows.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
BACKGROUND: Epidemiological studies have shown that both the estrogen dose and progestogen type of oral contraceptives contribute to the increased risk of thrombosis in oral contraceptive users. ...Thrombin generation-based activated protein C (APC) sensitivity is a global test for the net prothrombotic effect of oral contraceptives and predicts the thrombotic risk. Our objective was to test the usefulness of sex hormone-binding globulin (SHBG) as a marker for the thrombotic risk of an oral contraceptive. METHODS: We measured SHBG and APC resistance in 156 healthy users of various types of oral contraceptives. RESULTS: Users of oral contraceptives with a moderately increased risk of thrombosis (gestodene and desogestrel pills) had higher SHBG levels than users of low-risk oral contraceptives containing levonorgestrel. Similarly, for higher doses of estrogen in oral contraceptives we found higher SHBG levels. Women using oral contraceptives with the highest thrombotic risk (cyproterone acetate pills) rendered the highest SHBG levels. Users of oral contraceptives containing gestodene, desogestrel or cyproterone acetate were more resistant to APC than users of levonorgestrel pills. SHBG levels were positively associated with the increased APC resistance. CONCLUSIONS: Our findings support the hypothesis that the effect of an oral contraceptive on SHBG levels might be a marker for the thrombotic risk.
Keloid pathogenesis and treatment AL-ATTAR, Ali; MESS, Sarah; THOMASSEN, John Michael ...
Plastic and reconstructive surgery (1963),
2006, 2006-Jan, 2006-01-00, Volume:
117, Issue:
1
Journal Article
Peer reviewed
Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood.
Using original and current literature in this field, this ...comprehensive review presents the major concepts of keloid pathogenesis and the treatment options stemming from them.
Mechanisms for keloid formation include alterations in growth factors, collagen turnover, tension alignment, and genetic and immunologic contributions. Treatment strategies for keloids include established (e.g., surgery, steroid, radiation) and experimental (e.g., interferon, 5-fluorouracil, retinoid) regimens.
The scientific basis and empiric evidence supporting the use of various agents is presented. Combination therapy, using surgical excision followed by intradermal steroid or other adjuvant therapy, currently appears to be the most efficacious and safe current regimen for keloid management.
This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations ...on plaque scores and parameters of gingival health in adult patients.
PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate.
Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group.
Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Purpose
Although physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscal tear, 24% still opt for meniscal surgery.
The aim was to identify those ...patients with a degenerative meniscal tear who will undergo surgery following physical therapy.
Methods
The data for this study were generated in the physical therapy arm of the ESCAPE trial, a randomized clinical trial investigating the effectiveness of surgery versus physical therapy in patients of 45–70 years old, with a degenerative meniscal tear. At 6 and 24 months patients were divided into two groups: those who did not undergo surgery, and those who did undergo surgery. Two multivariable prognostic models were developed using candidate predictors that were selected from the list of the patients’ baseline variables. A multivariable logistic regression analysis was performed with backward Wald selection and a cut-off of
p
< 0.157. For both models the performance was assessed and corrected for the models’ optimism through an internal validation using bootstrapping technique with 500 repetitions.
Results
At 6 months, 32/153 patients (20.9%) underwent meniscal surgery following physical therapy. Based on the multivariable regression analysis, patients were more likely to opt for meniscal surgery within 6 months when they had worse knee function, lower education level and a better general physical health status at baseline. At 24 months, 43/153 patients (28.1%) underwent meniscal surgery following physical therapy. Patients were more likely to opt for meniscal surgery within 24 months when they had worse knee function and a lower level of education at baseline at baseline. Both models had a low explained variance (16 and 11%, respectively) and an insufficient predictive accuracy.
Conclusion
Not all patients with degenerative meniscal tears experience beneficial results following physical therapy. The non-responders to physical therapy could not accurately be predicted by our prognostic models.
Level of evidence
III.
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EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
Marker-by-treatment analyses are promising new methods in internal medicine, but have not yet been implemented in orthopaedics. With this analysis, specific cut-off points may be obtained, ...that can potentially identify whether meniscal surgery or physical therapy is the superior intervention for an individual patient. This study aimed to introduce a novel approach in orthopaedic research to identify relevant treatment selection markers that affect treatment outcome following meniscal surgery or physical therapy in patients with degenerative meniscal tears.
Methods
Data were analysed from the ESCAPE trial, which assessed the treatment of patients over 45 years old with a degenerative meniscal tear. The treatment outcome of interest was a clinically relevant improvement on the International Knee Documentation Committee Subjective Knee Form at 3, 12, and 24 months follow-up. Logistic regression models were developed to predict the outcome using baseline characteristics (markers), the treatment (meniscal surgery or physical therapy), and a marker-by-treatment interaction term. Interactions with
p
< 0.10 were considered as potential treatment selection markers and used these to develop predictiveness curves which provide thresholds to identify marker-based differences in clinical outcomes between the two treatments.
Results
Potential treatment selection markers included general physical health, pain during activities, knee function, BMI, and age. While some marker-based thresholds could be identified at 3, 12, and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times.
Conclusion
This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. However, this study may serve as an exemplar for other orthopaedic trials to investigate the heterogeneity in treatment effect. It will help clinicians to quantify the additional benefit of one treatment over another at an individual level, based on the patient’s baseline characteristics.
Level of evidence
II.
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EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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