The Mediating Effect of Insomnia on the Relationship between Panic Symptoms and Depression in Patients with Panic Disorder

BackgroundThis study aimed to determine if sleep disturbances may mediate the relationship between panic symptoms and depression in patients with panic disorder (PD).MethodsElectronic medical records were retrospectively reviewed for 110 consecutive patients with diagnosed PD in an outpatient clinic between October 2018 and December 2019. Measurements include the PD Severity Scale, Beck Depression Inventory-II (BDI-II) and Insomnia Severity Index (ISI). Statistical analyses were performed to assess any potential relationship between PD, insomnia and depression.ResultsOf the PD patients, 88 (80%) and 89 (80.9%) had comorbid depression (BDI-II ≥ 14) and insomnia (Korean version of the ISI ≥ 8), respectively. In a mediation model using insomnia as the mediating variable, the total effect of panic symptom severity on depression was significant (t = 7.23, P < 0.001). There were significant effects of panic symptoms on insomnia (t = 4.62, P < 0.001) and of insomnia on depression (t = 6.69, P < 0.001). The main effect of panic symptom severity on depression was also significant, after controlling for the effect of insomnia (t = 5.10, P < 0.001), suggesting partial mediation.ConclusionBoth depressive symptoms and insomnia are common in patients with PD and depression was partially mediated by insomnia in these patients. These results suggest that an intervention for insomnia in patients with PD might help prevent the development of depression.     

Deep-learning for predicting C-shaped canals in mandibular second molars on panoramic radiographs

Objective:The aim of this study was to evaluate the use of a convolutional neural network (CNN) system for predicting C-shaped canals in mandibular second molars on panoramic radiographs.Methods:Panoramic and cone beam CT (CBCT) images obtained from June 2018 to May 2020 were screened and 1020 patients were selected. Our dataset of 2040 sound mandibular second molars comprised 887 C-shaped canals and 1153 non-C-shaped canals. To confirm the presence of a C-shaped canal, CBCT images were analyzed by a radiologist and set as the gold standard. A CNN-based deep-learning model for predicting C-shaped canals was built using Xception. The training and test sets were set to 80 to 20%, respectively. Diagnostic performance was evaluated using accuracy, sensitivity, specificity, and precision. Receiver-operating characteristics (ROC) curves were drawn, and the area under the curve (AUC) values were calculated. Further, gradient-weighted class activation maps (Grad-CAM) were generated to localize the anatomy that contributed to the predictions.Results:The accuracy, sensitivity, specificity, and precision of the CNN model were 95.1, 92.7, 97.0, and 95.9%, respectively. Grad-CAM analysis showed that the CNN model mainly identified root canal shapes converging into the apex to predict the C-shaped canals, while the root furcation was predominantly used for predicting the non-C-shaped canals.Conclusions:The deep-learning system had significant accuracy in predicting C-shaped canals of mandibular second molars on panoramic radiographs.     

Synthetic magnetic resonance imaging for quantitative parameter evaluation of temporomandibular joint disorders

Objective:This study investigated the usefulness of quantitative parameters [longitudinal relaxation (T1), transverse relaxation (T2), and proton density (PD)] obtained with synthetic magnetic resonance imaging (MRI) in assessing the progression of temporomandibular joint (TMJ) disorders.Methods:For individual TMJ disorder diagnoses, the presence of disc displacement in MRI and the osseous change in cone-beam CT were investigated. Joints were classified into three stages: (1) silent stage, no disc displacement or osseous change; (2) incipient stage, presence of disc displacement and absence of osseous change; and (3) progressed stage, both disc displacement and osseous change. In synthetic MRI, the T1, T2, and PD values of the condyle bone marrow were measured simultaneously. The median T1, T2, and PD values were analyzed according to disc displacement, osseous changes, and joint stage.Results:Significant differences were observed in the T1 and PD values of joints with disc displacement or condylar osseous change compared to normal joints. The T1 and PD values also differed between the silent and progressed stages. The PD value differed between the silent and incipient groups, while the T2 value did not differ significantly among the three groups.Conclusion:The PD and T1 values of condylar bone marrow obtained from synthetic MRI can be used as sensitive indicators of TMJ disorder progression. The PD value of the bone marrow showed potential as a useful biomarker for recognizing the initial stages of TMJ disorders. Synthetic MRI is useful for the simultaneous acquisition of effective MRI parameters for evaluating TMJ disorders.     

Health-Related Quality-of-Life after Percutaneous Coronary Intervention in Patients with UA/NSTEMI and STEMI: the Korean Multicenter Registry

Compared with ST elevation myocardial infarction (STEMI), long-term outcomes are known to be worse in patients with unstable angina/non-STEMI (UA/NSTEMI), which might be related to the worse health status of patients with UA/STEMI. In patients with UA/NSTEMI and STEMI underwent percutaneous coronary intervention (PCI), angina-specific and general health-related quality-of-life (HRQOL) was investigated at baseline and at 30 days after PCI. Patients with UA/NSTEMI were older and had higher frequencies in female, diabetes and hypertension. After PCI, both angina-specific and general HRQOL scores were improved, but improvement was much more frequent in angina-related HRQOL of patients with UA/NSTEMI than those with STEMI (44.2% vs 36.8%, P < 0.001). Improvement was less common in general HRQOL. At 30-days after PCI, angina-specific HRQOL of the patients with UA/NSTEMI was comparable to those with STEMI (56.1 ± 18.6 vs 56.6 ± 18.7, P = 0.521), but general HRQOL was significantly lower (0.86 ± 0.21 vs 0.89 ± 0.17, P = 0.001) after adjusting baseline characteristics (P < 0.001). In conclusion, the general health status of those with UA/NSTEMI was not good even after optimal PCI. In addition to angina-specific therapy, comprehensive supportive care would be needed to improve the general health status of acute coronary syndrome survivors.     

Influence of Body Mass Index,Smoking, and Blood Pressure on Survival of Patients with Surgically-Treated,Low Stage Renal Cell Carcinoma: A 14-Year Retrospective Cohort Study

The association of body mass index, smoking, and blood pressure, which are related to the three well-established risk factors of renal cell carcinoma, and survival in patients with renal cell carcinoma is not much studied. Our objective was to evaluate this association. A cohort of 1,036 patients with low stage (pT1 and pT2) renal cell carcinoma who underwent radical or partial nephrectomy were enrolled. We retrospectively reviewed medical records and collected survival data. The body mass index, smoking status, and blood pressure at the time of surgery were recorded. Patients were grouped according to their obesity grade, smoking status, and hypertension stage. Survival analysis showed a significant decrease in overall (P = 0.001) and cancer-specific survival (P < 0.001) with being underweight, with no differences of smoking status or perioperative blood pressure. On multivariate analysis, perioperative blood pressure ≥ 160/100 mmHg (HR, 2.642; 95% CI, 1.221-5.720) and being underweight (HR, 4.320; 95% CI, 1.557-11.984) were independent predictors of overall and cancer-specific mortality, respectively. Therefore, it is concluded that being underweight and perioperative blood pressure ≥ 160/100 mmHg negatively affect cancer-specific and overall survival, respectively, while smoking status does not influence survivals in patients with renal cell carcinoma.     

Clinical applications of miniscrews that broaden the scope of non-surgical orthodontic treatment

Previously, in the case of malocclusion owing to skeletal discrepancy in adults, the amount of tooth movement was limited since there was no reliable skeletal anchorage device. The only way to treat this case was by repositioning the maxilla and mandible via orthognathic surgery, but most patients are reluctant to undergo surgery owing to the risk and expenses incurred. However, with the current introduction and use of miniscrews as temporary anchorage devices, the entire dental arch can be relocated to a target position without surgery, thus broadening the scope of non-surgical orthodontic treatment compared to the past. For a non-surgical approach to improve skeletal discrepancy, anteroposterior, vertical and transverse displacements of the dental arch are necessary. In this case, the localization of the centre of resistance of the whole arch must precede the appliance design with an appropriate biomechanical design. Especially, in the transverse dimension, the envelope of discrepancy is reportedly narrow, and the tooth movement must accompany the orthopaedic correction involving the midpalatal suture expansion. Recently, in adults with transverse maxillomandibular discrepancy, miniscrew-assisted rapid palatal expansion (MARPE) can be performed. Moreover, compared to surgically assisted rapid palatal expansion, MARPE reduces the cost to the patient and achieves clinically acceptable stable maxillary expansion. In this article, we will discuss the role of total arch movement and MARPE in widening the scope of non-surgical orthodontic treatment, despite the inherent limitations of miniscrews' mechanical aspects.     

Cervical lymph node metastasis in squamous cell carcinoma of the buccal mucosa: a retrospective study on pattern of involvement and clinical analysis

Background The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading. Material and Methods 254 patients with squamous cell carcinoma of the buccal mucosa treated with surgery first approach were analyzed retrospectively. The tumor size was noted from pre-operative CT Scans and were divided into early and advanced tumors. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels. Results Out of 254 patients (149 females, 105 males), 145 patients showed histo-pathologically proven metastatic deposits in one or more lymph nodes out of which there were 56 patients showing occult metastasis. 78/145 patients showed metastatic involvement of level IB and/or IA lymph nodes, 31 showed involvement of level II and/or I lymph nodes, 27 showed involvement of level III with or without involvement of level I and II and 9 showed metastasis to level IV and V lymph nodes with or without level I, II or III lymph nodes. Cervical lymph node metastasis had statistically significant association with tumor size with advanced tumors showing worse pattern of metastatic spread beyond level I and II lymph nodes. As the degree of differentiation of squamous cell carcinoma reduced, they were more prone for cervical metastasis with moderately and poorly differentiated squamous cell carcinoma showing higher involvement of level III, IV and V lymph nodes. Conclusions The majority of buccal mucosa cases showed metastasis to level I, II and III lymph nodes out of which level IB and/or IA was most frequently involved. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation. Key words:Oral squamous cell carcinoma (OSCC), cervical lymph node metastasis, histologic differentiation, locally advanced disease.