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Does the Use of Injectable Platelet-Rich Fibrin Following Arthrocentesis for Disc Displacement Without Reduction Alleviate Pain? 关节穿刺术治疗无还原性椎间盘突出后注射富血小板纤维蛋白能减轻疼痛吗?
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.09.002
Tahsin Tepecik DDS, Mehmet Zahit Baş DDS

Background

The role of adjunctive injection agents at the end of temporomandibular joint (TMJ) arthrocentesis remains controversial.

Purpose

This study aims to compare pain reduction in patients with disc displacement without reduction treated with arthrocentesis alone (AO), arthrocentesis with injectable platelet-rich fibrin (iPRF), and arthrocentesis with hyaluronic acid (HA).

Study Design, Setting, and Sample

A single-center, retrospective cohort study was conducted at the affiliated hospital of Health Sciences University, Hamidiye Faculty of Dentistry. Inclusion criteria were female subjects aged 18-65, who underwent TMJ unilateral arthrocentesis, and diagnosed with disc displacement without reduction. Exclusion criteria were prior use of occlusal splints, accompanying diagnosis of myalgia and bilateral arthralgia which both of the joints exceeds or equal to 50 mm visual analogue scale for pain (pVAS) value.

Predictor Variable

The primary predictor variable was the adjunctive injection agent: iPRF, HA, or no injection (AO as control).

Main Outcome Variables

Primary and secondary outcomes were measured preoperatively (T0), and at 1 month (T1) and 6 months (T2) postoperatively. The primary outcome was pain (pVAS) at T2. Secondary outcomes were pVAS at T1 and maximum interincisal opening at T1 and T2.

Covariates

Demographics, preoperative and perioperative data were collected.

Analyses

Descriptive, bivariate, and multivariate analyses were conducted. The P value was set at ≤.05.

Results

A total of 88 subjects completed the study. The mean age of the subjects in the AO (n = 30), HA (n = 29) and iPRF (n = 29) groups was 36.8 (±10.2), 34.8 (±8.9) and 37.6 (±11.6) respectively (P > .05). The mean pVAS scores at T0 for the AO, HA and iPRF groups were 63.2 (±8.7), 66.7 (±9.6) and 66.2 (±9.6) respectively (P > .05). The mean pVAS scores at T1 were 36.5 (±10.8), 29.0(±11.5) and 35.9 (±9.8) respectively (P < .05). The mean pVAS scores at T2 were 34.8 (±16.3), 24.7 (±12.7) and 25.3 (±13.4) respectively (P < .05). There were no differences in maximum interincisal opening between the groups at any timepoint (P > .05).

Conclusion and Relevance

iPRF and HA injections are associated with greater pain relief compared to AO. No significant difference was observed between iPRF and HA, suggesting that the choice between them can be based on cost-effectiveness.
背景:目的:本研究旨在比较单纯关节腔穿刺术(AO)、关节腔穿刺术联合可注射富血小板纤维蛋白(IPRF)和关节腔穿刺术联合透明质酸(HA)治疗椎间盘移位患者疼痛减轻情况:在哈米迪耶健康科学大学牙科学院附属医院进行了一项单中心、回顾性队列研究。纳入标准为年龄在18-65岁之间、接受过颞下颌关节单侧关节切除术并被诊断为椎间盘移位且未缩小的女性受试者。排除标准为曾使用过咬合夹板、伴有肌痛诊断以及双侧关节痛(两个关节的疼痛视觉模拟量表(pVAS)值均超过或等于 50 毫米):主要预测变量是辅助注射剂:IPRF、HA 或不注射(AO 作为对照):主要结果和次要结果在术前(T0)、术后 1 个月(T1)和 6 个月(T2)进行测量。主要结果是 T2 时的疼痛(pVAS)。次要结果是 T1 时的 pVAS 以及 T1 和 T2 时的最大椎间隙开度:收集人口统计学、术前和围术期数据:分析:进行描述性、双变量和多变量分析。P值设定为≤.05:共有 88 名受试者完成了研究。AO 组(n = 30)、HA 组(n = 29)和 iPRF 组(n = 29)受试者的平均年龄分别为 36.8(±10.2)岁、34.8(±8.9)岁和 37.6(±11.6)岁(P > .05)。AO、HA 和 iPRF 组在 T0 时的平均 pVAS 分数分别为 63.2(±8.7)、66.7(±9.6)和 66.2(±9.6)(P > .05)。T1时的平均pVAS评分分别为36.5(±10.8)、29.0(±11.5)和35.9(±9.8)(P .05)。在 iPRF 和 HA 之间未观察到明显差异,这表明可根据成本效益在两者之间做出选择。
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引用次数: 0
Is Insurance Payor Associated With Hospital Admission of Emergency Department Adult Patients With Odontogenic Infections? 保险支付方是否与急诊科成人牙源性感染患者入院有关?
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.08.062
Lang Liang BS , Tim T. Wang DMD, MD, MPH , Cameron C. Lee DMD, MD , Zachary S. Peacock DMD, MD

Background

Patients who present to the emergency department (ED) with severe odontogenic infections are often hospitalized for surgical drainage and medical management. However, inpatient management of these patients can be financially burdensome. While medical indications for hospital admission are well established, it remains unclear if patient insurance status is associated with admission.

Purpose

The purpose of this study was to determine the nationally representative estimates of the incidence of hospital admission for patients with odontogenic infections and the association with insurance payor.

Study Design, Setting, Sample

This retrospective cohort study used the 2018 Nationwide Emergency Department Sample. Patients with odontogenic infections (based on International Classification of Diseases, 10th Revision codes) were included. Patients aged <18 years or who had missing data were excluded.

Predictor Variable

The primary predictor variable was primary payor (private insurance, Medicare, Medicaid, self-pay, and other).

Main Outcome Variable

The primary outcome variable was hospital admission (yes/no).

Covariates

Covariates included sociodemographic, medical, infection, and hospital variables.

Analyses

Descriptive, bivariate, and multivariable logistic regression analyses were used to determine national estimates and predictors of admission. Odds ratios and 99% confidence intervals were computed. Discharge weights were accounted for in all analyses to provide nationally representative estimates.

Results

This study included 31,221 weighted ED encounters, of which 10,451 (33.5%) were admitted. In the study cohort, 7,687 (24.6%) had private insurance, 5,046 (16.2%) had Medicare, 10,070 (32.3%) had Medicaid, 7,436 (23.8%) were self-pay, and 982 (3.1%) had other. Bivariate analysis suggested that payor status was significantly associated with hospital admission (P < .01). The multivariable analysis showed that self-pay patients had significantly lower odds of hospital admission compared to those with private insurance (odds ratio, 0.54; 99% confidence interval, 0.42-0.70). Other independent predictors of hospital admission included infection in more than 1 location based on International Classification of Diseases, 10th Revision code, higher Charlson comorbidity index, and alcohol/substance use disorders.

Conclusion and Relevance

Approximately one-third of patients presenting to the ED with odontogenic infections were admitted. Patients with no insurance were less likely to be admitted compared to those with private insurance. This finding may reflect multiple possibilities, including hospital financial incentives.
背景:急诊科(ED)收治的严重牙源性感染患者通常需要住院进行手术引流和药物治疗。然而,这些患者的住院治疗可能会造成经济负担。目的:本研究旨在确定具有全国代表性的牙源性感染患者入院治疗的发生率估计数以及与保险支付方的关联:这项回顾性队列研究使用了 2018 年全国急诊科样本。研究纳入了牙源性感染患者(基于国际疾病分类第十版代码)。患者年龄 预测变量:主要预测变量是主要付款人(私人保险、医疗保险、医疗补助、自费和其他):主要结果变量为入院(是/否):协变量:包括社会人口学变量、医疗变量、感染变量和医院变量:描述性分析、双变量分析和多变量逻辑回归分析用于确定入院的全国估计值和预测因素。计算出了比率和 99% 的置信区间。所有分析均考虑了出院加权数,以提供具有全国代表性的估计值:这项研究包括 31,221 次加权急诊室就诊,其中 10,451 人(33.5%)入院。研究队列中有 7,687 人(24.6%)购买了私人保险,5,046 人(16.2%)购买了医疗保险,10,070 人(32.3%)购买了医疗补助,7,436 人(23.8%)自费,982 人(3.1%)购买了其他保险。双变量分析表明,支付者身份与入院有显著相关性(P 结论和相关性):在急诊室就诊的牙源性感染患者中,约有三分之一被收治入院。与有私人保险的患者相比,没有保险的患者入院的可能性较低。这一发现可能反映了多种可能性,包括医院的经济激励机制。
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引用次数: 0
REPLY: The Risk of Medication-Related Osteonecrosis of the Jaw in Children: Guidance for Antiresorptive Use in Pediatric Patients 答复:儿童颌骨药物相关性骨坏死的风险:儿科患者抗骨吸收应用指南
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.08.061
Sasha Lasky BS, Tayla Moshal BS, Pasha Shakoori MD, DDS, Idean Roohani BS, Marah Jolibois MS, Simon Youn MD, DDS, Eloise Stanton MD, Mark M. Urata MD, DDS, Jeffrey A. Hammoudeh MD, DDS
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引用次数: 0
Is Dental Specialty Referral Associated With Earlier Presentation of Oral Cavity Squamous Cell Carcinoma? 牙科专科转诊是否与口腔鳞状细胞癌的早期表现有关?
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.08.004
Kevin C. Lee MD, DDS , Jae Gardella BA , Robert Balsiger DO , Anurag K. Singh MD , Wesley L. Hicks Jr. MD, DDS , Michael R. Markiewicz MD, DDS, MPH , Ayham Al Afif MD, MSc

Background

Oral cavity squamous cell carcinoma (OSCC) may mimic other more common odontogenic processes such as infection, trauma, and benign pathology. Delays in diagnosis and treatment are known to result in poorer survival outcomes.

Purpose

The study purpose was to measure the association between referral type and OSCC stage at time of presentation.

Study Design, Setting, Sample

This was a retrospective cohort study composed of newly diagnosed OSCC patients treated with surgical resection from 2014 to 2023 at Roswell Park Comprehensive Cancer Center. Patients who presented with self-referrals or had surgical treatment outside of Roswell Park Comprehensive Cancer Center were excluded.

Predictor Variable

The primary predictor was referral source (dental vs medical specialty).

Main Outcome Variable

The primary outcome was pathological T stage (pT stage). The secondary outcome was overall survival (OS).

Covariates

Covariates included demographic data and cancer-related variables (symptomatology, subsite, and risk factors).

Analyses

A multivariate logistical regression model for pT stage was constructed using all significant covariates as well as preoperative patient and tumor characteristics. For OS, Kaplan-Meier survival curves were constructed and compared with the log-rank test. A P < .05 was considered statistically significant.

Results

A total of 215 subjects were included in the study sample. The majority were referred by a dental provider (n = 132, 62.3%). Dental referrals presented with significantly earlier T stage disease (RRpT3/T4 0.65, P < .01) and had lower rates of cervical nodal positivity (RRpN1-N3 0.62, P = .01). Dental referral independently increased the odds of early pT stage presentation (odds ratio 5.10, P < .01) after controlling for age, sex, oral pain symptoms, social history (smoking and drinking), head neck cancer history, and tumor subsite. Dental referrals had significantly improved OS (P = .03) and were also associated with lower rates of oral pain symptoms (RRoral pain 0.80, P = .02), lymphovascular invasion (RRLVI 0.50; P = .04), and perineural invasion (RRPNI 0.63, P = .04).

Conclusions and Relevance

Among subjects with similar risk factors, those referred from dental providers were found to have earlier stage disease. Unfortunately, over half of dental referrals still presented with pain symptoms and more than a third presented with locally advanced disease. Dental providers appear to be positioned to detect earlier OSCC; however, there is room for improvement.
背景:口腔鳞状细胞癌(OSCC)可能会模仿其他更常见的牙源性过程,如感染、创伤和良性病变。研究目的:本研究旨在测量转诊类型与发病时 OSCC 分期之间的关系:这是一项回顾性队列研究,研究对象是2014年至2023年在罗斯威尔帕克综合癌症中心接受手术切除治疗的新诊断OSCC患者。不包括自行转诊或在罗斯威尔帕克综合癌症中心以外接受手术治疗的患者:主要预测因素是转诊来源(牙科与内科):主要结果是病理 T 分期(pT 分期)。次要结果为总生存期(OS):协变量包括人口统计学数据和癌症相关变量(症状、分期和风险因素):分析:利用所有重要的协变量以及术前患者和肿瘤特征,构建了pT分期的多变量统计回归模型。对于 OS,构建了 Kaplan-Meier 生存曲线,并用对数秩检验进行比较。A P 结果:共有 215 名受试者被纳入研究样本。大多数患者是由牙科医生转诊的(n = 132,62.3%)。牙科转诊者的 T 期疾病明显提前(RRpT3/T4 0.65,P pN1-N3 0.62,P = 0.01)。牙科转诊会独立增加早期pT期的出现几率(几率比5.10,P口腔疼痛0.80,P = .02)、淋巴管侵犯(RRLVI 0.50; P = .04)和神经周围侵犯(RRPNI 0.63,P = .04):在具有相似风险因素的受试者中,由牙科医疗机构转诊的受试者的病程较早。不幸的是,超过一半的牙科转诊者仍伴有疼痛症状,超过三分之一的人患有局部晚期疾病。牙科医疗机构似乎有能力更早地发现 OSCC,但仍有改进的余地。
{"title":"Is Dental Specialty Referral Associated With Earlier Presentation of Oral Cavity Squamous Cell Carcinoma?","authors":"Kevin C. Lee MD, DDS ,&nbsp;Jae Gardella BA ,&nbsp;Robert Balsiger DO ,&nbsp;Anurag K. Singh MD ,&nbsp;Wesley L. Hicks Jr. MD, DDS ,&nbsp;Michael R. Markiewicz MD, DDS, MPH ,&nbsp;Ayham Al Afif MD, MSc","doi":"10.1016/j.joms.2024.08.004","DOIUrl":"10.1016/j.joms.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Oral cavity squamous cell carcinoma (OSCC) may mimic other more common odontogenic processes such as infection, trauma, and benign pathology. Delays in diagnosis and treatment are known to result in poorer survival outcomes.</div></div><div><h3>Purpose</h3><div>The study purpose was to measure the association between referral type and OSCC stage at time of presentation.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This was a retrospective cohort study composed of newly diagnosed OSCC patients treated with surgical resection from 2014 to 2023 at Roswell Park Comprehensive Cancer Center. Patients who presented with self-referrals or had surgical treatment outside of Roswell Park Comprehensive Cancer Center were excluded.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor was referral source (dental vs medical specialty).</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome was pathological T stage (pT stage). The secondary outcome was overall survival (OS).</div></div><div><h3>Covariates</h3><div>Covariates included demographic data and cancer-related variables (symptomatology, subsite, and risk factors).</div></div><div><h3>Analyses</h3><div>A multivariate logistical regression model for pT stage was constructed using all significant covariates as well as preoperative patient and tumor characteristics. For OS, Kaplan-Meier survival curves were constructed and compared with the log-rank test. A <em>P</em> &lt; .05 was considered statistically significant.</div></div><div><h3>Results</h3><div>A total of 215 subjects were included in the study sample. The majority were referred by a dental provider (n = 132, 62.3%). Dental referrals presented with significantly earlier T stage disease (RR<sub>pT3/T4</sub> 0.65, <em>P</em> &lt; .01) and had lower rates of cervical nodal positivity (RR<sub>pN1-N3</sub> 0.62, <em>P</em> = .01). Dental referral independently increased the odds of early pT stage presentation (odds ratio 5.10, <em>P</em> &lt; .01) after controlling for age, sex, oral pain symptoms, social history (smoking and drinking), head neck cancer history, and tumor subsite. Dental referrals had significantly improved OS (<em>P</em> = .03) and were also associated with lower rates of oral pain symptoms (RR<sub>oral pain</sub> 0.80, <em>P</em> = .02), lymphovascular invasion (RR<sub>LVI</sub> 0.50; <em>P</em> = .04), and perineural invasion (RR<sub>PNI</sub> 0.63, <em>P</em> = .04).</div></div><div><h3>Conclusions and Relevance</h3><div>Among subjects with similar risk factors, those referred from dental providers were found to have earlier stage disease. Unfortunately, over half of dental referrals still presented with pain symptoms and more than a third presented with locally advanced disease. Dental providers appear to be positioned to detect earlier OSCC; however, there is room for improvement.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1610-1619"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Cross-Sectional Study Examining Andrews' Analysis in Caucasian and African American Subjects 对高加索人和非洲人进行安德鲁斯分析的横断面研究。
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.08.059
Andrew A. Bertot DMD, MD , Chad W. Dammling DDS, MD , Nada M. Souccar DMD , Patrick J. Louis DDS, MD , Guihua Zhai PhD , Brian E. Kinard DMD, MD

Background

Andrews' analysis is a commonly utilized instrument to aid in esthetic positioning of the anteroposterior position of the maxillomandibular complex; however, there is limited data regarding use in non-Caucasian subjects.

Purpose

The purpose of this study was to document laypersons preferences of anteroposterior position of the maxillomandibular complex in relation to Andrews' lateral profile analysis in African American (AA) and Caucasian subjects.

Study Design, Setting, Sample

A cross-sectional study was implemented to evaluate the esthetics of AA and Caucasian subjects. Photographs were taken and simulated with anteroposterior maxillomandibular complex positioning in varying relationships to Andrews' goal anterior line limit. A survey was then designed to select the preferred simulation of the facial profile of each subject.

Independent Variable

The independent variable was the race of the study subjects.

Main Outcome Variable

The main outcome was the layperson's preferred lateral facial profile for each subject.

Covariates

The covariates included age, race, sex, education level, income, of the laypersons.

Analyses

A proportion test was used to decide which profile was preferred. Logistic regression analyses were conducted to assess the association between the preference and respondent demographics. P < .05 was considered significant.

Results

A total of 264 surveys were distributed, and 250 complete surveys were utilized (response rate = 95%). Respondents were majority male (51.2%), aged 35-44 (37.2%), college-educated (57.2%), earning between $20,000 and $50,000 annually (44%), and identified as Caucasian (77.2%). For the female subjects, the respondents preferred +4 and + 6 mm anterior to goal anterior line limit with 54.2% for the Caucasian and 65.9% for the AA subjects (difference = 11.7%; 95% CI:2.7 to 20.7%; P = .008). For the males, 47.4% of the respondents chose 0 mm and +2 mm for the AA subject, while only 24.9% preferred +2 mm for the Caucasian male (difference = 22.5%; 95% CI: 13.8 to 31.1%; P < .0001). Respondent demographics were not found to influence selection.

Conclusion and Relevance

The preferred facial profile as judged by laypersons differs between Caucasian and AA subjects when defined through Andrews' analysis.
背景:目的:本研究旨在记录非裔美国人(AA)和高加索受试者对上颌颌面复合体前胸位置与Andrews侧面轮廓分析的相关性的偏好:一项横断面研究旨在评估非裔美国人和白种人的美学效果。拍摄照片并模拟上颌下颌复合体的前胸定位与安德鲁斯目标前线极限的不同关系。然后设计了一项调查,以选择每个受试者喜欢的面部轮廓模拟:自变量:研究对象的种族为自变量:主要结果变量:主要结果是每个受试者的非专业人士首选的面部侧面轮廓:协变量:包括非专业人士的年龄、种族、性别、教育水平、收入等:分析:采用比例检验来确定哪种侧脸轮廓更受青睐。进行逻辑回归分析,以评估偏好与受访者人口统计学特征之间的关联。P 结果:共发放了 264 份调查问卷,其中 250 份完整(回复率 = 95%)。受访者以男性居多(51.2%),年龄在 35-44 岁之间(37.2%),受过大学教育(57.2%),年收入在 2 万至 5 万美元之间(44%),白种人占 77.2%。在女性受试者中,高加索人和 AA 受试者分别有 54.2% 和 65.9% 的受试者偏好目标前线限值前 +4 和 +6 mm(差异 = 11.7%;95% CI:2.7 至 20.7%;P = .008)。就男性而言,47.4% 的受访者选择 0 毫米和 +2 毫米的 AA 受试者,而只有 24.9% 的受访者选择 +2 毫米的高加索男性(差异 = 22.5%;95% CI:13.8 至 31.1%;P 结论和相关性:通过安德鲁斯分析法确定的非专业人士对高加索人和 AA 受试者面部轮廓的偏好存在差异。
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引用次数: 0
AAOMS Author Disclosure forms 作者披露表
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/S0278-2391(24)00872-3
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引用次数: 0
Editorial Board Page 编委会页面
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/S0278-2391(24)00870-X
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引用次数: 0
Comparing Treatment Effectiveness and Patient-Reported Outcome Measures of Four Treatment Options for Obstructive Sleep Apnea 比较四种阻塞性睡眠呼吸暂停治疗方案的治疗效果和患者报告的结果指标。
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.07.015
Robert J. Diecidue DMD, MD, PhD, MBA, MPH , Marianna D. LaNoue PhD, MS , Erika L. Manning PhD, MD, MPH , Colin T. Huntley MD , Joseph D. Harrington

Background

Continuous positive airway pressure (CPAP), mandibular advancement device (MAD), upper airway stimulation (UAS), and maxillomandibular advancement (MMA) are techniques to reduce apnea hypopnea index (AHI) in obstructive sleep apnea (OSA) patients. Current literature does not include a direct comparison of the 4 methods.

Purpose

The purpose of this study is to measure and compare the efficacy of 4 common OSA treatments: CPAP, MAD, UAS, MMA.

Study Design, Setting, Sample

This retrospective cohort study examines data from 119 patients treated at Thomas Jefferson University Hospital in Philadelphia receiving CPAP, MAD, UAS, or MMA between January 2018 and December 2020. Patients were excluded for significant medical comorbidities, body mass index ≥45, cognitive limitations, central/mixed apnea history, or pregnancy.

Predictor Variables

The primary predictor variable was type of OSA intervention: CPAP, MAD, UAS, MMA. Treatments were assigned by treating physicians per their presenting OSA severity.

Main Outcome Variables

The primary outcome variable was efficacy defined as the therapeutic response to treatment measured using mean disease alleviation, a calculated variable (percentage) which employs post-treatment AHI adjusted by compliance (a measure of a patient's device use). Secondary therapeutic measures included remaining AHI and patient-reported outcome measures: Epworth Sleepiness Scale, Sleep Apnea Quality of Life Index, Patient-reported Apnea Questionnaire.

Covariates

Demographic covariates included age, sex, height, weight, socioeconomic status, level of education, neck size, race, and body mass index. Clinical covariates included pretreatment AHI, AHI change, O2 nadir, adjusted compliance, and compliance.

Analyses

Multivariate statistics were computed with alpha level of 0.05, including a regression with the primary outcome variables, treatment variables, and potential covariates.

Results

The sample included 119 subjects (mean age = 56.12, standard deviation [SD] = 5.81) with males at n = 72 (60%). MMA demonstrated greatest mean disease alleviation (M = 36.08, SD = 28.56), compared to UAS (M = 22.88, SD = 3.16), MAD (M = 6.80, SD = 8.13), and CPAP (M = 5.00, SD = 14.80), analysis of variance: P < .001.

Conclusion and Relevance

Both surgical treatments displayed significantly greater effectiveness than CPAP and MAD, suggesting that offering surgical alternatives sooner, particularly to those with severe OSA, may be logical in formulating more effective treatment guidelines.
背景:持续气道正压(CPAP)、下颌前移器(MAD)、上气道刺激(UAS)和上颌下颌前移器(MMA)是降低阻塞性睡眠呼吸暂停(OSA)患者呼吸暂停低通气指数(AHI)的技术。目的:本研究旨在测量和比较 4 种常见 OSA 治疗方法的疗效:研究设计、环境和样本:这项回顾性队列研究审查了费城托马斯杰斐逊大学医院在 2018 年 1 月至 2020 年 12 月期间接受 CPAP、MAD、UAS 或 MMA 治疗的 119 名患者的数据。排除了有重大医疗合并症、体重指数≥45、认知能力受限、中枢性/混合性呼吸暂停病史或怀孕的患者:主要预测变量为 OSA 干预类型:CPAP、MAD、UAS、MMA。治疗由主治医生根据患者的 OSA 严重程度进行分配:主要结果变量为疗效,即使用疾病缓解平均值衡量的治疗反应,这是一个计算变量(百分比),采用治疗后 AHI,并根据依从性(患者使用设备的衡量标准)进行调整。次要治疗指标包括剩余 AHI 和患者报告结果指标:埃普沃思嗜睡量表、睡眠呼吸暂停生活质量指数、患者报告的呼吸暂停问卷:人口统计学协变量包括年龄、性别、身高、体重、社会经济地位、教育程度、颈部大小、种族和体重指数。临床协变量包括治疗前 AHI、AHI 变化、O2 最低值、调整后依从性和依从性:多变量统计计算的α水平为0.05,包括与主要结果变量、治疗变量和潜在协变量的回归:样本包括 119 名受试者(平均年龄 = 56.12 岁,标准差 [SD] = 5.81),其中男性 72 名(占 60%)。与 UAS(M = 22.88,SD = 3.16)、MAD(M = 6.80,SD = 8.13)和 CPAP(M = 5.00,SD = 14.80)相比,MMA 的平均疾病缓解程度最大(M = 36.08,SD = 28.56),方差分析:P 结论和相关性:两种手术治疗方法的有效性均明显高于 CPAP 和 MAD,这表明尽早提供手术替代方案,尤其是对严重 OSA 患者,可能符合制定更有效治疗指南的逻辑。
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引用次数: 0
Both Type I Bovine Collagen Conduits and Porcine Small Intestine Submucosa Conduits Result in Functional Sensory Recovery Following Peripheral Nerve Microsurgery: A Systematic Review and Meta-Analysis I 型牛胶原导管和猪小肠粘膜下导管都能在周围神经显微手术后实现功能性感觉恢复:系统回顾与元分析》。
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.08.010
Tyler Jacobs DDS, MD , Disha Patil , Vincent B. Ziccardi DDS, MD

Purpose

The study purpose was to measure and compare the time to functional sensory recovery (FSR) and incidence of FSR by 6 and 12 months between type I bovine collagen conduits versus porcine small intestine submucosa (SIS) conduits with primary neurorrhaphy for peripheral nerve injury repair.

Methods

A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were conducted. The predictor variable was the type of conduit—either bovine collagen or porcine SIS. The primary outcome variable was the number of months between surgery and the patient achieving FSR. The secondary outcome variable was the proportion of patients who achieved FSR that did so by 6 and 12 months. A log-rank test was performed to evaluate the statistical significance of the differences observed in the overall time-to-FSR data and by 6 and 12 months.

Results

We screened 67 publications of which 8 were included. The sample sizes were 137 and 96 patients for the bovine collagen and porcine SIS groups, respectively. The median time to FSR for the bovine collagen conduit group was 9 months (interquartile range: 6); the median time to FSR for the porcine SIS conduit group 6 months (interquartile range: 3 months) (P = .50). Of the patients who achieved FSR, 42% of patients with bovine collagen conduits and 64% of patients with porcine SIS conduits did so within 6 months (P < .01). Of the patients who achieved FSR, 94% of patients with bovine collagen conduits and 82% of patients with porcine SIS conduits did so within 12 months (P < .01).

Conclusion

Although a significant difference was found in the incidence of FSR at 6 and 12 months, no significant difference was found in overall time to FSR, supporting the use of either conduit for peripheral nerve repair.
目的:该研究旨在测量和比较 I 型牛胶原导管与猪小肠粘膜下(SIS)导管在用于周围神经损伤修复时,6 个月和 12 个月的功能感觉恢复(FSR)时间和 FSR 发生率:根据《系统综述和元分析首选报告项目》指南进行了系统综述和元分析。预测变量为导管类型--牛胶原或猪 SIS。主要结果变量是手术与患者达到 FSR 之间的月数。次要结果变量是在 6 个月和 12 个月前达到 FSR 的患者比例。我们采用对数秩检验来评估在总体FSR时间数据以及6个月和12个月时观察到的差异的统计学意义:我们筛选了 67 篇文献,其中 8 篇被收录。牛胶原组和猪 SIS 组的样本量分别为 137 例和 96 例患者。牛胶原导管组的 FSR 中位时间为 9 个月(四分位间范围:6 个月);猪 SIS 导管组的 FSR 中位时间为 6 个月(四分位间范围:3 个月)(P = .50)。在实现 FSR 的患者中,42% 的牛胶原导管患者和 64% 的猪 SIS 导管患者在 6 个月内实现了 FSR(P=.50):虽然在 6 个月和 12 个月时 FSR 的发生率有明显差异,但在 FSR 的总体时间上没有发现明显差异,这支持使用其中任何一种导管进行周围神经修复。
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引用次数: 0
RE: The Risk of Medication-Related Osteonecrosis of the Jaw in Children: Guidance for Antiresorptive Use in Pediatric Patients 儿童颌骨药物相关性骨坏死的风险:儿科患者抗骨吸收应用指南
IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-12-01 DOI: 10.1016/j.joms.2024.08.060
Timothy W. Neal DDS, MD, Brian R. Carr DMD, MD, Thomas Schlieve DDS, MD
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引用次数: 0
期刊
Journal of Oral and Maxillofacial Surgery
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