Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study

Background The aim of this study was to assess the accuracy of virtual planning of computer-guided surgery based on the actual outcomes of clinical dental implant placement. Methods This retrospective study enrolled patients among whom implant treatment was planned using computer-guided surgery with cone beam computed tomography (CBCT). The patients who received implant according to the guide with the flapless and flapped approach were classified as group 1 and 2, respectively, and the others who could not be placed according to the guide were allocated to the drop-out group. The accuracy of implant placement was evaluated with the superimposition of CBCT. Results We analyzed differences in the deviated distance of the entrance point and deviated angulation of the insertion of implant fixtures. With regard to the surgical approach, group 2 exhibited greater accuracy compared to group 1 in deviation distance (2.22 ± 0.88 and 3.18 ± 0.89 mm, respectively, P < 0.001) and angulation (4.27 ± 2.30 and 6.82 ± 2.71°, respectively, P = 0.001). The limitations of guided surgery were discussed while considering the findings from the drop-out group. Conclusions Computer-guided surgery demonstrates greater accuracy in implant placement with the flapless approach. Further research should be conducted to enhance the availability of guides for cases with unfavorable residual bone conditions.

Endoscopic Repair of Spontaneous Cerebrospinal Fluid Leaks in the Lateral Recess of the Sphenoid Sinus

Objective This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS). Study Design Retrospective study. Setting University hospital. Methods This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton’s types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated. Results The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group. Conclusions Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

The Effect of a Multimodal Occupational Therapy Program with Cognition-Oriented Approach on Cognitive Function and Activities of Daily Living in Patients with Alzheimer’s Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Non-pharmacological intervention, which includes a broad range of approaches, may be an alternative treatment for Alzheimer’s disease (AD). Multimodal non-pharmacological intervention alleviates cognitive dysfunction and the impairment of activities of daily living (ADL) in AD patients. However, it is still unclear which combination of non-pharmacological interventions is preferred. We selected a non-pharmacological intervention combined with occupational therapy (OT). We investigated the effect of a multimodal OT program with cognition-oriented approach on cognitive dysfunction and impairments of ADL in patients with AD. Four electronic databases were searched from January 2000 to August 2020. The studies were assessed for heterogeneity, quality assessment, effect size and publication bias. A total of seven randomized controlled trials examining multimodal OT programs with cognition-oriented approach in AD patients were included in the meta-analysis. Compared with the control group, the multimodal OT program with cognition-oriented approach group was statistically beneficial for cognitive dysfunction (95% CI: 0.25–0.91). However, compared with the control group, the multimodal OT program with cognition-oriented approach group tended to be beneficial for basic ADL, and instrumental ADL. These results suggest that the multimodal OT program with cognition-oriented approach might be the optimal multimodal non-pharmacological intervention for improving cognitive dysfunction in AD patients.

Ultrasound-guided supra-inguinal fascia Iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial

Background Hip fracture is common in older adults, and can cause severe post-fracture pain. Fascia iliaca nerve block has consequently been used for preoperative analgesia. Methods We performed a randomized, controlled, double-blind clinical trial and recruited older patients with hip fractures. These patients were randomized into two groups and received ultrasound-guided fascia iliaca compartment block using either the supra-inguinal approach (group F) or the classical approach (group C). Heart rate, blood pressure, and resting and exercising visual analog scales were recorded before the procedure and at 30 min, and 6, 12, and 24 h after completion of the procedure. We recorded the duration of the procedure—as well as complications such as bleeding, hypotension, and intractable vomiting; the sleep duration in a 24 h period was also documented. Results A total of 38 patients completed the trial, and we observed no differences in the baseline characteristics or pre-procedural measurements between the two groups. Compared with the patients in group C, patients in group F exhibited significantly lower exercising VAS scores at 6 and 12 h after the procedure, faster heart rates at 6 and 24 h after the procedure, a longer procedural duration, and a longer sleep duration. There were no differences in the frequencies of complications between the two groups. The percentages of patients who took oral analgesics and the numbers of medications consumed were also not different between the two groups. Conclusions The supra-inguinal FICB provided effective analgesia and improved exercise tolerance compared with the classical approach. Trial registration The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100045644, registration date: 2021 April 20).

Vojta Approach Affects Neck Stability and Static Balance in Sitting Position of Children With Hypotonia

Purpose: In this study, the effect of the Vojta approach on neck stability and static balance in children with hypotonia was studied.Methods: Seventeen children with hypotonia were randomly divided into the Vojta approach group (n=9) and the general physical therapy group (n=8). Each group was applied intervention for 30 minutes per session, 3 times a week, for a total of 4 weeks. Ultrasonography was used to measure deep neck flexor muscle thickness, craniovertebral angle (CVA) to measure neck alignment along the spine segment, and Balancia software program to measure static balance.Results: In the Vojta approach group, the deep neck flexor muscle thickness was significantly increased (P<0.05), and the CVA was significantly improved (P<0.05). In addition, path area among static balance was significantly improved (P<0.05).Conclusions: The Vojta approach can be suggested as an effective intervention method for improving neck stability and static balance in children with hypotonia.

Comparison of clinical efficacy of suprapatellar and infrapatellar intramedullary nailing in treating tibial shaft fractures

Objectives: To compare clinical efficacies of suprapatellar and infrapatellar intramedullary nailing approaches in treating tibial shaft fractures. Methods: Patients (n=110) admitted with tibial shaft fractures in our hospital from January 2017 to June 2020, who underwent procedures with internal fixation intramedullary nails, were retrospectively divided into suprapatellar and infrapatellar approach groups (n=55 each) based on the surgical method used for fracture repair. The clinical and functional outcomes of the knee were assessed six months after the surgery Results: Six months after the operation, the pooled value for excellent and good efficacy rates in the suprapatellar approach group, as indicated by Hospital for Special Surgery (HSS) Knee scoring system, was 90.91%, which was significantly higher than that in the infrapatellar approach group (76.36%). The degree of pain (visual analogue scale (VAS) score) of the patients in the suprapatellar approach group was over 2-fold lower than in the infrapatellar approach group (P < 0.001).The Lysholm knee score, range of motion (ROM), SF-36p, and SF-36M scores in the suprapatellar approach group were significantly higher than those in the infrapatellar approach group (P < 0.001). Conclusion: Suprapatellar approach had significantly higher clinical efficiency than infrapatellar approach, and can significantly reduce the degree of pain, promote the recovery of patients with knee joint involvement, improve the physical and psychological well-being, reduce the number of cases of postoperative delayed healing. doi: https://doi.org/10.12669/pjms.37.7.4766 How to cite this:Zhu Z, Wang Z, Zhou P, Wang X, Guan J. Comparison of clinical efficacy of suprapatellar and infrapatellar intramedullary nailing in treating tibial shaft fractures. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4766 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Subjective identification and ablation of drivers in persistent atrial fibrillation

Background Ablation of drivers in persistent atrial fibrillation (AF) has shown controversial results. Purpose To test the efficacy of a tailored approach for persistent AF ablation which includes pulmonary vein isolation (PVI) plus “subjective” identification and ablation of drivers. Methods From May 2017 to December 2019, selected patients with persistent AF and ongoing AF at the beginning of the ablation procedure were included. Conventional high-density mapping catheters (PentaRay NAV, IntellaMap Orion or Advisor HD Grid) were used. Drivers were subjectively identified as: a) fractionated continuous (or quasi-continuous) electrograms on 1–2 adjacent bipoles, without dedicated software (Figure 1A, dashed line; PR = PentaRay NAV); and b) sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles (Figure 1B, arrows; in panels A and B: paper speed 200 mm/s; ORB = 24-pole ORBITER Woven catheter, blue bipoles around tricuspid annulus and green bipoles into the coronary sinus). Ablation included PVI + focal or linear ablation targeting sites with drivers. Ablation success was defined as conversion to sinus rhythm or atrial flutter during ablation. Follow-up included visits with 24h Holter ECG at 3–6–12 months. Survival free from atrial arrhythmias lasting &gt;30 seconds was compared between patients ablated with this tailored approach, and all consecutive patients with persistent AF treated with a PVI-only strategy during the same period. Results 158 Patients received ablation: 35 with the tailored approach (61,7±10,2 years; 29% females) and 123 with only PVI (62,5±9,6 years; 25% females; 89% cryoablation). Basal characteristics were similar (Table 1). In the tailored-approach group, 14 patients (40%) presented 28 detectable sites with continuous fractionated electrograms, 26 on the left atrium and 2 on the right atrium, which was only mapped if ablation of drivers in the left atrium was not successful; 12 (43%) were located within the pulmonary vein antra. 27 patients (77%) showed 103 sites with spatiotemporal dispersion (4 [3–5] per patient). Ablation success was achieved in 17 patients (48%; conversion to sinus rhythm, n=7; conversion to atrial flutter, n=10) in the tailored-approach group and 1 patient (0,8%, sinus rhythm) in the PVI-only group. Excluding a 3-month blanking period, the tailored approach, compared to only PVI, improved one-year freedom from atrial arrhythmias (71% Vs 51%, p=0,05) and mean survival free from atrial arrhythmias (26±3 months; 95% CI 21–32 months Vs 18±2 months; 95% CI 15–22 months) (Figure 1C), at the cost of a longer median procedural time (246 [212–277] vs 108 [81–143] min, p&lt;0,001) and fluoroscopy time (51 [36–76] vs 33 [21–45] min, p&lt;0,001). Conclusion Subjective identification and ablation of drivers, added to PVI, improved freedom from atrial arrhythmias. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Basal characteristics Figure 1

Comparison of different approaches to combined spinal epidural anesthesia (CSEA) under the guidance of ultrasound in cesarean delivery of obese patients: a randomized controlled trial

Background Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. However, it is difficult to perform in obese parturients because of positioning challenges. The aim of this study was to compare the effect of different approaches to CSEA under the guidance of ultrasound. Methods One hundred obese patients (BMI ≥ 30 kg/m2) who underwent elective cesarean section were randomly enrolled. Patients were assigned to a median approach group and a paramedian approach group randomly. Clinical characteristics were compared between groups. First-attempt success rate, the median positioning time and total operation time, ultrasonic predicted anesthesia puncture depth, actual puncture depth, anesthesia adverse reactions, complications after anesthesia, and patients’ satisfaction with the epidural puncture were recorded. Results The first-attempt success rate was significantly different between the two groups [92% (46/50) vs. 76% (38/50), P = 0.029]. The median positioning time and total operation time in the paramedian approach group were higher than those in the median approach group (227.7 s vs. 201.6 s, P = 0.037; 251.3 s vs. 247.4 s, P = 0.145). The incidence of postanesthesia complications in the paramedian approach group was significantly lower than that in the median approach group (2% vs. 12%, P = 0.026), and patient satisfaction was higher in the paramedian approach group than in the median approach group (P = 0.032). Conclusion The ultrasound-guided paramedian approach for CSEA is time-consuming, but it can effectively improve the success rate of the first puncture, reduce the incidence of anesthesia-related adverse reactions, and improve patient satisfaction. Trial registration: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024722) on July 24, 2019

Use of Propensity Score Matching to Compare Short Outcomes from Transoral and External Surgical Approaches in Patients with Deep-Lobe Parotid Pleomorphic Adenomas

To compare the outcomes of patients who had deep-lobe parotid gland pleomorphic adenomas (PAs) that extended into the parapharyngeal space after surgical treatment, using a transoral approach or an external approach. One hundred and twelve eligible patients, with deep-lobe parotid gland PAs, were enrolled in this retrospective study. The surgical outcomes were compared for patients who received a transoral approach and an external approach, using 1:1 propensity score matching (PSM). The outcome measures were recurrence rate, facial nerve deficit, Frey’s syndrome, and hospitalization time. The median follow-up time was 4.8 years. After PSM, the transoral approach and external approach groups had no statistically significant difference in recurrence (10.3% vs. 3.4%; p = 0.201). The transoral approach group had no facial nerve deficit, but 5 of 29 patients (17.2%) in the external approach group had transient facial nerve paralysis (p = 0.052). The external approach group had a longer hospitalization time than the transoral approach group (5 vs. 4 days, p = 0.0017). The use of a transoral surgical approach to treat patients with deep-lobe parotid gland PAs led to low recurrence, shorter hospitalization times, and good functional and cosmetic outcomes.