Abstract
Objective: To assess the scientific evidence on the effectiveness of early orthopedic treatment in Class III subjects.
Materials and Methods: A literature survey was performed by applying ...the Medline database (Entrez PubMed). The survey covered the period from January 1966 to December 2005 and used the Medical Subject Headings (MeSH). The following study types that reported data on the effects of Class III treatment with orthopedic appliances (facial mask, chincup, FR-3) on intermaxillary sagittal and vertical relationships were included: randomized clinical trials (RCTs), and prospective and retrospective longitudinal controlled clinical trials (CCTs) with untreated Class III controls.
Results: The search strategy resulted in 536 articles. After selection according to criteria for inclusion and exclusion, 19 articles qualified for the final review analysis. One RCT and 18 CCTs were retrieved.
Conclusion: The quality standard of the retrieved investigations ranged from low (four studies) to medium/high (five studies). Data derived from medium/high quality research described over 75% of success of orthopedic treatment of Class III malocclusion (RME and facial mask therapy) at a follow-up observation 5 years after the end of orthopedic treatment.
In low-and-middle income countries, corneal abrasions and ulcers are common and not always well managed. Previous studies showed better clinical outcomes with early presentation and treatment of ...minor abrasions, however, there have been no formal studies estimating the financial impact of early treatment of abrasions and ulcers compared to delayed treatment.
We used the LV Prasad Eye Institute's (LVPEI's) electronic health record system (eyeSmart) to estimate the impact of early presentation on clinical outcomes associated with abrasions and ulcers. 861 patients with corneal abrasion and 1821 patients with corneal ulcers were studied retrospectively, and 134 patients with corneal abrasion prospectively. A health economic model was constructed based on LVPEI cost data for a range of patient scenarios (from early presentation with abrasion to late presentation with ulcer).
Our findings suggest that delayed presentation of corneal abrasion results in poor clinical and economic outcomes due to increased risk of ulceration requiring more extensive surgical management, increasing associated costs to patients and the healthcare system. However, excellent results at low cost can be achieved by treatment of patients with early presentation of abrasions at village level health care centres.
Treatment of early minor corneal abrasions, particularly using local delivery of treatment, is effective clinically and economically. Future investment in making patients aware of the need to react promptly to corneal abrasions by accessing local healthcare resources (coupled with a campaign to prevent ulcerations occurring) will continue to improve clinical outcomes for patients at low cost and avoid complex and more expensive treatment to preserve sight.
This research was funded by the Medical Research Council, grant MR/S004688/1.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Multimodal neuroimaging features provide opportunities for accurate classification and personalized treatment options in the psychiatric domain. This study aimed to investigate whether brain features ...predict responses to the overall treatment of schizophrenia at the end of the first or a single hospitalization. Structural and functional magnetic resonance imaging (MRI) data from two independent samples (N = 85 and 63, separately) of schizophrenia patients at baseline were included. After treatment, patients were classified as responders and non‐responders. Radiomics features of gray matter morphology and functional connectivity were extracted using Least Absolute Shrinkage and Selection Operator. Support vector machine was used to explore the predictive performance. Prediction models were based on structural features (cortical thickness, surface area, gray matter regional volume, mean curvature, metric distortion, and sulcal depth), functional features (functional connectivity), and combined features. There were 12 features after dimensionality reduction. The structural features involved the right precuneus, cuneus, and inferior parietal lobule. The functional features predominately included inter‐hemispheric connectivity. We observed a prediction accuracy of 80.38% (sensitivity: 87.28%; specificity 82.47%) for the model using functional features, and 69.68% (sensitivity: 83.96%; specificity: 72.41%) for the one using structural features. Our model combining both structural and functional features achieved a higher accuracy of 85.03%, with 92.04% responder and 80.23% non‐responders to the overall treatment to be correctly predicted. These results highlight the power of structural and functional MRI‐derived radiomics features to predict early response to treatment in schizophrenia. Prediction models of the very early treatment response in schizophrenia could augment effective therapeutic strategies.
By radiomics strategy, we established prediction models based on structural features and functional features extracted from multi‐modal magnetic resonance imaging (MRI) data of 148 schizophrenia patients collected from two independent samples. The model combining both structural and functional features achieved a prediction accuracy of 85.03% to the overall treatment response. Our results highlight the capability of structural and functional MRI‐derived radiomics features to predict early responses to the treatment in schizophrenia.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Growth: Sometimes a friend, sometimes an enemy Araujo, Eustaquio Afonso; McCray, Julie; Miranda, Gabriel Ferreira Pessoa Carvalho
Seminars in orthodontics,
06/2023, Volume:
29, Issue:
2
Journal Article
Peer reviewed
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•The CD4+/CD8+ ratio pre-treatment is the strongest predictor of immune recovery.•The immune benefits of early antiretroviral therapy might derive from higher pre- antiretroviral therapy CD4+/CD8+ ...ratios.•Treatment with integrase inhibitors might be related to earlier immune recovery.
We aimed to determine if starting antiretroviral therapy (ART) in the first 30 days after acquiring HIV infection has an impact on immunovirological response.
Observational, ambispective study including 147 patients with confirmed acute HIV infection (January/1995-August/2022). ART was defined as very early (≤30 days after the estimated date of infection), early (31-180 days), and late (>180 days). We compared time to viral suppression (viral load VL <50 copies/ml) and immune recovery (IR) (CD4+/CD8+ ratio ≥1) according to the timing and type of ART using survival analysis.
ART was started in 140 (95.2%) patients. ART was very early in 24 (17.1%), early in 77 (55.0%), and late in 39 (27.9%) cases. Integrase strand transfer inhibitor (INSTI)-based regimens were the most used in both the overall population (65%) and the very early ART group (23/24, 95.8%). Median HIV VL and CD4+/CD8+ ratio pre-ART were higher in the very early ART group (P <0.05). Patients in the very early and early ART groups and treated with INSTI-based regimens achieved IR earlier (P <0.05). Factors associated with faster IR were the CD4+/CD8+ ratio pre-ART (hazard ratio: 9.3, 95% CI: 3.1-27.8, P <0.001) and INSTI-based regimens (hazard ratio: 2.4, 95% CI: 1.3-4.2, P = 0.003).
The strongest predictors of IR in patients who start ART during AHI are the CD4+/CD8+ ratio pre-ART and INSTI-based ART regimens.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Enzyme replacement therapy (ERT) slows disease progression of Fabry disease (FD), especially when initiated before the onset of irreversible organ damage. However, with the clinically asymptomatic ...progression of renal, cardiac and cerebral disease manifestations spanning decades, optimal timing of ERT initiation remains unclear.
In this cross-sectional retrospective study, seven male FD patients with a classical disease phenotype (cFD) who started treatment with agalsidase-beta in childhood were evaluated after 10 years of treatment (median age at evaluation 24 years, range 14–26). Cardiac imaging (echocardiography and MRI), electrophysiological and biochemical data of these patients were compared to those of untreated male cFD patients (n = 23, median age 22 years, range 13–27).
Albuminuria was less common and less severe in treated patients (albumin to creatinine ratio, ACR 0–8.8 mg/mmol, median 0.4) compared to untreated patients (ACR 0–248 mg/mmol, median 3.7, p = 0.02). The treated group had a lower left ventricular mass, measured using echocardiography (median 80 g/m2 versus 94 g/m2, p = 0.02) and MRI (median 53 g/m2 versus 68 g/m2, p = 0.02). Myocardial fibrosis was absent in all included patients. eGFR was normal in all treated patients whereas 7/23 (30%) of untreated patients had abnormal eGFR. Cerebral manifestations did not differ.
Start of treatment with ERT before age 16, in male cFD patients is associated with reduced occurrence of renal and cardiac manifestations of FD, as assessed by intermediate endpoints. Confirmation that this approach delays or even prevents renal failure and cardiac events requires another decade of follow-up.
•Starting ERT early, before the age of 16, in male FD patients with a classical phenotype is associated with reduced risk and severity of albuminuria.•Starting ERT early, before the age of 16, in male FD patients with a classical phenotype slows down left ventricular hypertrophy.•This study provides clinical comparative evidence (early treated vs untreated) to support early start of ERT in male patients with classical FD.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The initial symptoms of cognitive dysfunction disease are insidious, and most of the cognitive dysfunction diseases will be in the stage of dementia with no effective treatment when the symptoms are ...discovered. Therefore, it is crucial to explore simple and easy-to-check warning signals of cognitive dysfunction diseases and carry out timely and effective interventions for the prevention and treatment of cognitive dysfunction diseases. A large number of studies have shown that sensory dysfunction is of great value in the early diagnosis, assessment and treatment of cognitive dysfunction. However, at present, cognitive function screening in China mostly relies on neuropsychological tests, highly sensitive sensory indicators such as smell and hearing were not included. This paper concluded that further detecting the sensory function status of the elderly on the basis of neuropsychological testing will greatly improve the accuracy of cognitive dysfunction disease screening, clarified the value of sensory dysfunct
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is an experimental interactive soft toy, looking like a panda, developed for young children. When touched on the paws or head (inputs), the toy can emit attractive responses such as colored ...lights and amusing sounds (outputs). +
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is wirelessly connected to a control tablet through which an adult caregiver can modify its input-output contingencies so as to produce different, rewarding response patterns using the same device. Given these features, we propose +
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as a potential novel tool to support the therapy of Autism Spectrum Disorder (ASD). The allure of the device could be exploited to capture the attention and encourage the social interaction of toddlers during play activities with therapists. In this pilot study, +
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was tested on two small groups of children aged 30–48 months, one group diagnosed with ASD and the second with Communication Disorder, a condition that often presents—especially at an early age—overlapping symptoms with ASD. The proposed play activities aimed to foster simple imitative behaviors and stimulate the engagement of the children. The results were compared with those of a previous test run on Typically Developed children. Preliminary observations, based on the analysis of video recordings, suggest that, on average, +
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is able to encourage a positive engagement and that different groups tend to manifest some different behaviors.
Spinal cord injury is a condition affecting the central nervous system, causing different levels of dysfunction below the point of nerve damage. A 50-year-old woman suffered a neck injury as a result ...of a car accident. After undergoing posterior cervical C3-C6 internal fixation with titanium plates on one side and C7 lamina decompression, the patient, who had been diagnosed with C3-C7 cervical disk herniation and spinal stenosis causing persistent compression of the spinal cord, was transferred to the rehabilitation department. After implementing the combined therapy of Virtual Reality-based arm and leg cycling along with transcutaneous electrical stimulation of the spinal cord, the patients experienced a notable enhancement in both sensory and motor abilities as per the ASIA scores. The patient's anxiety and depression were reduced as measured by the Hamilton Anxiety and Hamilton Depression Tests. As evaluated by the SCIM-III, the patient's self-reliance and capacity to carry out everyday tasks showed ongoing enhancement, leading to the restoration of their functionality. Hence, the use of Virtual Reality-based arm and leg cycling along with transcutaneous electrical spinal cord stimulation has potential to positively impact function in patients with spinal cord injury. However, as this is a case report, the small number of patients and the fact that the intervention was initiated early after the injury, we were unable to separate the recovery due to the intervention from the natural recovery that is known to occur in the initial weeks and months after SCI. Therefore, further randomized controlled trials with a large sample size is necessary.
It remains unknown if ultra-early (within 24 hours after onset) treatment can improve the prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate the ...effect of ultra-early treatment on functional outcomes and mortality in patients with poor-grade aSAH via a systematic review and meta-analysis.
We performed a literature search in the PubMed, MEDLINE, and Web of Science databases. Primary outcomes were death and functional outcome assessed at any time period. Secondary outcomes were the rebleeding rate before an aneurysm occlusion procedure and the incidence of intraoperative technique difficulty (ITD). The results are reported as odds ratio (OR) with 95% confidence interval (CI).
A total of 14 articles containing 1111 patients met our inclusion criteria and were included in our analysis. The pooled incidence was 47% (95% CI, 40%–54%) for favorable outcome across 13 studies, 26% (95% CI, 19%–32%) for mortality in 11 studies, 10% (95% CI, 3%–16%) for rebleeding in 5 studies, and 20% (95% CI, 10%–31%) for ITD in 5 studies after ultra-early treatment of poor-grade aSAH. Compared with delayed treatment (>24 hours), the ultra-early treatment failed to improve outcomes (OR, 1.23; 95% CI, 0.75–2.01; P = 0.40) or reduce mortality (OR, 0.84; 95% CI, 0.58–1.22; P = 0.45), but tended to prevent preoperative rebleeding (OR, 0.59; 95% CI, 0.32 to 1.07; P = 0.08) in 6, 4, and 4 case-control studies, respectively.
Our findings show no significant change both in functional outcome and mortality between ultra-early and delayed treatment although ultra-early treatment may be associated with lower rebleeding rate.
•This is the first meta-analysis investigating the effect of ultra-early (within 24 hours after onset) aneurysm occlusion treatment on functional outcomes and mortality in poor-grade aSAH.•The influence of ultra-early treatment on rebleeding and intraoperative technique difficulty was also analyzed.•Currently, this is the best evidence regarding the role of ultra-early treatment timing in poor-grade aSAH.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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