Objectives
To evaluate the effect of various titanium abutment modifications on the behaviour of peri-implant soft tissue healing, inflammation and maintenance.
Material and methods
An electronic ...database research until 30 April 2019 was performed. A meta-analysis (MA) for each outcome parameter was performed by using the random-effects models with the DerSimonian-Laird estimator.
Results
Ten studies were included in the present review. Four studies with a long follow-up (5–6 years) reported the outcomes in a heterogeneous way and were suitable for MA. Six studies (4 RCT, 2 CCT) including 118 patients and 182 implants dealing with a modified healing abutment surface and short follow-up were selected for MA. The MA for PI and BoP as outcome showed no significant differences between surfaces (PI:
P
= 0.091; BoP:
P
= 0.099). The MA for PD as outcome showed no significant differences between surfaces (
P
= 0.488). No statistical significance was found by evaluating each mixed-effects model for potential moderators (type of study, study design, number of implants, follow-up length). The other four studies with a longer follow-up (5–6 years) reported contradictory results depending on the surface treatment investigated.
Conclusions
Within their limits, the present findings suggest that peri-implant soft tissue may not be affected by the surface treatment of titanium abutments on the short term. Contrasting results are reported in longer follow-up periods depending on the technique used to modify the abutment.
Clinical relevance
Clinicians should carefully evaluate the use of a modified titanium surface in their practice. Even if no differences in terms of inflammation are present at short term, these findings need to be validated in long-term studies.
This pilot study was designed to develop a fully automatic and quantitative scoring system of B-lines (QLUSS: quantitative lung ultrasound score) involving the pleural line and to compare it with ...previously described semi-quantitative scores in the measurement of extravascular lung water as determined by standard thermo-dilution.
This was a prospective observational study of 12 patients admitted in the intensive care unit with acute respiratory distress and each provided with 12 lung ultrasound (LUS) frames. Data collected from each patient consisted in five different scores, four semi-quantitative (nLUSS, cLUSS, qLUSS, %LUSS) and quantitative scores (QLUSS). The association between LUS scores and extravascular lung water (EVLW) was determined by simple linear regression (SLR) and robust linear regression (RLR) methods. A correlation analysis between the LUS scores was performed by using the Spearman rank test. Inter-observer variability was tested by computing intraclass correlation coefficient (ICC) in two-way models for agreement, basing on scores obtained by different raters blinded to patients' conditions and clinical history.
In the SLR, QLUSS showed a stronger association with EVLW (R
= 0.57) than cLUSS (R
= 0.45) and nLUSS (R
= 0.000), while a lower association than qLUSS (R
= 0.85) and %LUSS (R
= 0.72) occurred. By applying RLR, QLUSS showed an association for EVLW (R
= 0.86) comparable to qLUSS (R
= 0.85) and stronger than %LUSS (R
= 0.72). QLUSS was significantly correlated with qLUSS (r = 0.772; p = 0.003) and %LUSS (r = 0.757; p = 0.005), but not with cLUSS (r = 0.561; p = 0.058) and nLUSS (r = 0.105; p = 0.744). Moreover, QLUSS showed the highest ICC (0.998; 95%CI from 0.996 to 0.999) among the LUS scores.
This study demonstrates that computer-aided scoring of the pleural line percentage affected by B-lines has the potential to assess EVLW. QLUSS may have a significant impact, once validated with a larger dataset composed by multiple real-time frames. This approach has the potentials to be advantageous in terms of faster data analysis and applicability to large sets of data without increased costs. On the contrary, it is not useful in pleural effusion or consolidations.
Background Lung ultrasonography (LUS) has been used for noninvasive detection of pulmonary edema. Semiquantitative LUS visual scores (visual LUS V-LUS) based on B lines are moderately correlated with ...pulmonary capillary wedge pressure (PCWP) and extravascular lung water (EVLW). A new computer-aided quantitative LUS (Q-LUS) analysis has been recently proposed. This study investigated whether Q-LUS better correlates with PCWP and EVLW than V-LUS and to what extent positive end-expiratory pressure (PEEP) affects the assessment of pulmonary edema by Q-LUS or V-LUS. Methods Forty-eight mechanically ventilated patients with PEEP of 5 or 10 cm H2 O and monitored by PCWP (n = 28) or EVLW (n = 20) were studied. Results PCWP was significantly and strongly correlated with Q-LUS gray (Gy) unit value ( r2 = 0.70) but weakly correlated with V-LUS B-line score ( r2 = 0.20). EVLW was significantly and more strongly correlated with Q-LUS Gy unit mean value ( r2 = 0.68) than with V-LUS B-line score ( r2 = 0.34). Q-LUS showed a better diagnostic accuracy than V-LUS for the detection of PCWP >18 mm Hg or EVLW ≥ 10 mL/kg. With 5-cm H2 O PEEP, the correlations with PCWP or EVLW were stronger for Q-LUS than V-LUS. With 10-cm H2 O PEEP, the correlations with PCWP or EVLW were still significant for Q-LUS but insignificant for V-LUS. Interobserver reproducibility was better for Q-LUS than V-LUS. Conclusions Both V-LUS and Q-LUS are acceptable indicators of pulmonary edema in mechanically ventilated patients. However, at high PEEP only Q-LUS provides data that are significantly correlated with PCWP and EVLW. Computer-aided Q-LUS has the advantages of being not only independent of operator perception but also of PEEP.
AIM To compare survival and recurrence after laparoscopic liver resection(LLR) and laparoscopic radiofrequency ablation(LRFA) for the treatment of small hepatocellular carcinoma(HCC).METHODS Between ...June 1, 2005 and November 30, 2010, 46 patients(62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR(n = 24), while those with poorer liver function and multiple tumors were referred for LRFA(n = 22), and they were then followed for similar durations(44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival(OS) and disease-free survival(DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group(LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS(LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules(LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS(hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2.CONCLUSION Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients.
Preoperative assessment is critical to decide the most adequate surgical strategy for oral squamous cell carcinoma (SCC). Magnetic resonance (MR) and intraoral ultrasonography (US) have been reported ...to be of great value for preoperative estimation of depth of invasion (DOI) and/or tumor thickness (TT). This review aims to analyze the accuracy of MR and intraoral US in determining DOI/TT in oral SCC, by assuming histological evaluation as the reference method.
The procedure was conducted following the modified 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We performed a systematic search of papers on PubMed, Scopus, Web of Science, and Cochrane Library databases until July 31st, 2019. For quantitative synthesis, we included nine studies (487 patients) focused on MR, and 12 (520 patients) focused on intraoral US. The Pearson correlation coefficient (
) between DOI/TT evaluated with MR or intraoral US was assumed as effect size. A meta-analysis (MA) for each study group (MR and US) was performed by using the random-effects models with the DerSimonian-Laird estimator and
-to-
transformation.
In the MA for MR studies, a high heterogeneity was found (
= 94.84%;
= 154.915,
< 0.001). No significant risk of bias occurred by evaluating funnel plot asymmetry (
= 0.563). The pooled (overall)
of the MR studies was 0.87 (95% CI from 0.82 to 0.92), whereas the pooled
-to-
transformed was 1.44 (95% CI from 1.02 to 1.85). In the MA for US studies a high heterogeneity was found (
= 93.56%;
= 170.884,
< 0.001). However, no significant risk of bias occurred (
= 0.779). The pooled
of the US studies was 0.96 (95% CI from 0.94 to 0.97), whereas the pooled
-to-
transformed was 1.76 (95% CI from 1.39 to 2.13). These outputs were confirmed in additional MA performed by enrolling only MR (
= 8) and US (
= 11) studies that evaluated TT.
MR and intraoral US seem to be promising approaches for preoperative assessment of DOI/TT in oral SCC. Remarkably, a higher pooled
and
-to-
transformed were observed in the intraoral US studies, suggesting that this approach could be more closely related to histopathological findings.
The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of ...patients are available.
This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry.
Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days,
< 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days,
< 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046-1.175,
= 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay.
Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.
Discriminating acute respiratory distress syndrome (ARDS) from acute cardiogenic pulmonary edema (CPE) may be challenging in critically ill patients. Aim of this study was to investigate if ...gray-level co-occurrence matrix (GLCM) analysis of lung ultrasound (LUS) images can differentiate ARDS from CPE. The study population consisted of critically ill patients admitted to intensive care unit (ICU) with acute respiratory failure and submitted to LUS and extravascular lung water monitoring, and of a healthy control group (HCG). A digital analysis of pleural line and subpleural space, based on the GLCM with second order statistical texture analysis, was tested. We prospectively evaluated 47 subjects: 16 with a clinical diagnosis of CPE, 8 of ARDS, and 23 healthy subjects. By comparing ARDS and CPE patients’ subgroups with HCG, the one-way ANOVA models found a statistical significance in 9 out of 11 GLCM textural features.
Post
-
hoc
pairwise comparisons found statistical significance within each matrix feature for ARDS
vs
. CPE and CPE
vs
. HCG (
P
≤ 0.001 for all). For ARDS
vs
. HCG a statistical significance occurred only in two matrix features (correlation:
P
= 0.005; homogeneity:
P
= 0.048). The quantitative method proposed has shown high diagnostic accuracy in differentiating normal lung from ARDS or CPE, and good diagnostic accuracy in differentiating CPE and ARDS. Gray-level co-occurrence matrix analysis of LUS images has the potential to aid pulmonary edemas differential diagnosis.
To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, ...with trans-esophageal echocardiography (TEE) as gold standard.
A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients.
As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view.
The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.
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