Ultrasound Examination to Visualize and Trace Sinus Tracts of Endodontic Origin

IntroductionThe detection of a tooth with a sinus tract (ST) of endodontic origin and its pathway are conventionally assessed with a periapical radiograph and a gutta-percha cone introduced into its stoma. The aim of this study was to evaluate the possibility to detect STs and trace their route using ultrasound real-time examination.MethodsTwo calibrated examiners performed echography on 10 patients who had a lesion of apical periodontitis (AP) and ST and 10 patients in the control group with AP without an ST recruited in 2 endodontic practices. They also traced the pattern of the STs with a computer program. The images were then submitted to 2 calibrated and blinded observers who were asked to describe the presence of AP and ST and to trace it with the same program. The data obtained were compared with the clinical and radiographic diagnosis of ST. For sensitivity, specificity, accuracy, and positive and negative predictive values, the receiver operating characteristic curve and Fisher exact test were used (P < .05).ResultsInterobserver agreement was high as was the diagnostic accuracy of the ultrasound examination of STs (mean value = 97.5%), and the Fisher exact test showed statistical significance (P < .05). High sensitivity and a negative predictive value and 100% specificity and a positive predictive value were also obtained. The application of the 3-dimensional mode further enabled the reconstructions of the more complex paths, and the implementation with color power Doppler disclosed the vascularity surrounding the STs.ConclusionsThe ultrasound examination is a technique feasible to describe and trace the STs of endodontic origin.     

Replacing HMG/FSH by low-dose HCG to complete corifollitropin alfa stimulation reduces cost per clinical pregnancy: a randomized pragmatic trial

Research questionThe cost of IVF treatment remains high, among other factors because of the medication needed for ovarian stimulation. This study investigated the effect of using low-dose human chorionic gonadotrophin (HCG) for the second phase of follicular maturation after corifollitropin alfa induction, to replace the more expensive, either recombinant or human menopausal gonadotrophin (HMG), on the cost of ovarian stimulation.DesignOne hundred and five patients were randomly divided into two groups: patients in the HCG group (n = 50) received low-dose HCG from Day 7 until the diameter of at least three follicles reached 17 mm or more, while patients in the FSH group (n = 55) received conventional ovarian stimulation with highly purified HMG injections.ResultsThe clinical pregnancy rate in the HCG group was 38% higher than in the FSH group (number needed to treat, NNT = 13). The cost per pregnancy needed for ovarian stimulation was reduced from €4902 in the FSH group to €2684 in the HCG group. Hence, the cost of ovarian stimulation medication to obtain 10 pregnancies using the conventional FSH protocol is sufficient to attain 18 pregnancies when applying the low-dose HCG protocol.ConclusionThis study provides evidence that using HCG instead of HMG/FSH for ovarian stimulation results in a significant reduction in the cost of IVF with, at least, an equivalent pregnancy rate.     

Meeting 24-hour movement guidelines: Their relationships with overweight and obesity among Chinese children with autism spectrum disorder

BackgroundCanada's and Australia's 24-hour movement guidelines for children and youth provide daily recommendations for physical activity (PA), screen time (ST), and sleep for optimal health. Previous studies have examined the associations between meeting these 24-hour movement guidelines and overweight and obesity among children without disabilities. Less is known about potential associations between the 24-hour movement behaviors and the weight status of children with disabilities.Therefore, the purpose of this study was to examine whether meeting movement behavior recommendations (i.e. ≥ 60 min of Moderate-to-vigorous activity [MVPA] per day, ≤ 2 h of recreational ST per day, and 9–11 h of sleep for those aged 5–13 years [or 8–10 h for children aged 14–17 years]), and combinations of these recommendations, are associated with overweight and obesity in Chinese children with ASD.MethodParticipants were 99 children with autism spectrum disorder (ASD) 7–17 years old recruited from one Chinese special school. MVPA and nightly sleep duration were measured using 24-hour wrist-worn accelerometer. ST was reported by parents by using reliable and valid items derived from the Health Behavior in School-aged Children (Chinese version). A series of binary logical regression analyses were performed for analysis.ResultsOnly 16.2% met all the three movement behavior recommendations. The proportions of children with ASD who met the recommendation for PA, ST, and sleep were 32.3%, 52.5%, and 65.7%, respectively. The children with ASD who met the MVPA (OR = 0.37, 95% CI: 0.15–0.94), MVPA + Sleep (OR = 0.27, 95% CI: 0.09–0.81), and all three 24-hour movement guidelines (OR = 0.14, 95% CI: 0.03–0.77), had significantly lower odds ratios for overweight/obesity than those who did not meet the respective recommendations.ConclusionsMeeting the MVPA, MVPA + Sleep, and all three of the guidelines was associated with lower odds ratios for overweight and obesity in children with ASD, and MVPA was the single most important activity for weight control among this population. Therefore, meeting the 24-hour movement guidelines, especially the MVPA guideline should be considered an effective intervention and can inform the design of strategies and policies for the prevention of overweight and obesity in children with ASD.     

Comparative analysis of methods for automatic detection and quantification of microvolt T-wave alternans

Microvolt T-wave alternans (TWA), consisting of every-other-beat changes in ECG T-wave morphology, is an index of susceptibility to malignant ventricular arrhythmias, requiring automatic techniques to be identified. Five of these, namely, fast-Fourier-transform spectral method (FFTSM), complex-demodulation method (CDM), modified-moving-average method (MMAM), Laplacian-likelihood-ratio method (LLRM) and adaptive-match-filter method (AMFM), were applied here to simulated and sample clinical data. The aim was to compare individual methods ability to properly identify stationary and time-varying TWA, avoiding false-positive detections. The MMAM provided false-positive TWA when applied to simulated ECGs affected by amplitude variability, but TWA. Stationary TWA was properly quantified by the MMAM and, occasionally, underestimated by all other methods. The AMFM properly identified time-varying TWA. By contrast, the FFTSM detected not-stationary TWA as stationary, the MMAM introduced a time-delay in the estimated TWA-amplitude signal, while the CDM and LLRM were reliable only in the presence of slow-varying TWA. Altogether, the AMFM accomplished the best compromise between the needs to avoid false-positive TWA and to detect and characterize true-positive TWA. Results of our simulation approach were useful to explain different TWA levels measured by each competing methods applied to sample Holter ECGs from healthy subjects and coronary artery disease patients.     

A novel nomogram to predict low anterior resection syndrome (LARS) after ileostomy reversal for rectal cancer patients

Background and aimLow anterior resection syndrome (LARS) in patients undergoing low or ultra-low anterior resection (LAR) is a common problem and significantly impacts the quality of life. Patients with an ileostomy after LAR are more likely to develop LARS. However, there hasn't been a model predicting LARS occurrence in these patients. This study aims to construct a nomogram to predict the probability of LARS occurrence in patients with temporary ileostomy and guide preventive strategies before reversal.Methods168 patients undergoing LAR with ileostomy from one center were enrolled as the training cohort, and 134 patients of the same inclusion criteria from another center were enrolled as the validation cohort. The training cohort was screened for risk factors for major LARS using univariate and multivariate logistic regression. The nomogram was constructed using the filtered variables, the ROC curve was used to describe the model's discrimination, and the calibration was used to describe the accuracy.ResultsThe optimal cut-off value for stoma closure time was 128 days. Three risk factors were identified using logistic regression analysis: preoperative radiotherapy (OR = 3.038, [95%CI 1.75–5.015], P = 0.005), stoma closure time (OR = 2.298, [95%CI 1.088–4.858], P = 0.029) and pN stage (OR = 1.739, [95%CI 1.235–3.980], P = 0.001). A nomogram was constructed based on these three variables and showed good performance predicting major LARS after stoma reversal. The area under the curve (AUC) was 0.827 in the training group and 0.821 in the validation group; The calibration curve suggested good precision in both groups.ConclusionsThis novel nomogram can accurately predict the probability of major LARS occurrence after ileostomy reversal for rectal cancer patients. This model can help screen ileostomy patients with high risks and guide individualized preventive strategies before stoma reversal.