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Recurrent atrial arrhythmias (RAAs) following posterior left atrial isolation (PLAI) for atrial fibrillation are common and are associated with reconnection of the PLA and pulmonary veins. We aimed to show that P-wave duration (PWD) and P-wave area under the curve (PWAUC) changes in patients undergoing PLAI can be measured using signal-averaged electrocardiogram (SAECG), and that reversal of these changes in patients with RAAs can be used to noninvasively detect reconnection. SAECG recordings before and after PLAI in 52 patients were analyzed for changes in PWD and PWAUC and also in 26 of these patients who had a repeat procedure for RAA. PWD and PWAUC reduced significantly in most leads following PLAI (mean 104 ± 11 ms to 93 ± 15 ms [P < 0.001] and 3.53 ± 1.23 microvolt seconds (μVs) to 2.87 ± 1.23 μVs [P = 0.001], respectively). Reconnection was observed in 20 of 26 patients at the repeat procedure. Compared to after the first procedure, reconnected patients had increased PWD and PWAUC (e.g., the increase in V4 was 14.1 ± 20.9 ms [P = 0.01] and 0.98 ± 1.17 μVs [P = 003], respectively) at the repeat procedure, while nonreconnected patients had decreased PWD and PWAUC (in V4, it was decreased by 11.5 ± 7.0 ms [P = 0.05] and 0.97 ± 0.33 μVs [P = 0.001]). A change in lead V4 PWAUC > −0.29 μVs for detecting reconnection had a sensitivity of 94% and specificity of 100% (receiver operator characteristic area under the curve 0.97, P = 0.005). PLAI reduces PWD and PWAUC while reconnection increases them both. SAECG may be able to detect reconnection of the PLA noninvasively. (PACE 2010; 1324-1334) [ABSTRACT FROM AUTHOR]

In several recent clinical trials on cardiac surgery patients, remote ischaemic preconditioning (RIPC) showed a powerful myocardial protective effect. However the effect of RIPC has not been studied in patients undergoing off-pump coronary artery bypass graft surgery. We evaluated whether RIPC could induce myocardial protection in off-pump coronary artery bypass graft surgery patients. Patients undergoing elective off-pump coronary artery bypass graft surgery were randomly allocated to the RIPC (n = 65) or control group (n = 65). After induction of anaesthesia, RIPC was induced by four cycles of five-minute ischaemia and reperfusion on the upper limb using a pneumatic cuff. Anaesthesia was maintained with sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after surgery. There were no statistical differences in troponin I levels between RIPC and control groups (P = 0.172). Although RIPC reduced the total amount of troponin I (area under the curve of troponin increase) by 26%, it did not reach statistical significance (RIPC group 53.2 +/- 72.9 hours x ng/ml vs control group 67.4 +/- 97.7 hours x ng/ml, P = 0.281). In this study, RIPC by upper limb ischaemia reduced the postoperative myocardial enzyme elevation in off-pump coronary artery bypass graft surgery patients, but this did not reach statistical significance. Further study with a larger number of patients may be needed to fully evaluate the clinical effect of RIPC in off-pump coronary artery bypass graft surgery patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyse the impact of sociodemographic factors on dental school candidates' decision to pursue dentistry as their career of choice., Materials and Methods: Candidates shortlisted by three dental schools were invited to participate in a self-administered questionnaire study, featuring a validated instrument containing sociodemographic questions and 16 motivational items grouped into four domains: economic, professional, vocational and personal background reasons. The variations in motivational item scores across sociodemographic factors were assessed using the Mann-Whitney U test (age, sex, ethnicity, having relatives in the dental profession and dentistry as the first choice) and Kruskal-Wallis test (dental school and family income)., Results: A total of 295 dental school candidates participated in the study (Universiti Teknologi MARA: 137; Universiti Kebangsaan Malaysia: 99; MAHSA University: 59). Approximately 95% of participants identified dentistry as their primary career choice, with the vocational motivation of 'I like to help people' being the most prominent motivational factor. Dental school emerged as the critical factor significantly influencing three quarters of the motivational items. Sex, ethnicity and having relatives in the dental profession were the remaining factors significantly associated with variations in certain motivational items. Both dental school and ethnicity significantly affected four motivational domains (economic, professional, vocational and personal background)., Conclusion: This study provides an insightful overview of the sociodemographic factors that impact career decision-making among prospective dental students. The scores for most motivational items varied among shortlisted candidates in three dental schools. The findings hold implications for policy development in dentistry by universities and public policymakers., (© 2024 The Author(s). European Journal of Dental Education published by John Wiley & Sons Ltd.)

Objective: The present study aimed to investigate the impact of utilizing an innovative and comprehensive patient-centered digital clinical decision aid designed to facilitate shared decision-making in missing tooth replacement between dental students and their patients., Methods: A qualitative study using interview approach was conducted in Hong Kong SAR and Malaysia. Thirty dental undergraduate students, each with one patient from the Faculty of Dentistry at The University of Hong Kong (n = 15) and Universiti Teknologi MARA (n = 15), were introduced to a digitally designed decision aid in missing tooth replacement prior to their treatment appointments. Semi-structured interviews were conducted with each student and patient, adhering to the interview protocol. Each interview was audio-recorded, transcribed, and subsequently coded to investigate the perceptions and potential advantages of this decision aid., Results: Thematic analysis identified three key themes from the dental students' perspective: communication, utilization, and satisfaction. From patients' perceptions, four central themes emerged: communication, treatment information, uncertainty, and utilization. Detailed examination of the data highlighted an enhancement in patients' confidence and trust in their dental care providers, as well as a marked increase in both student and patient satisfaction levels upon implementing this novel approach. The average satisfaction rates for students were 83 % for Hong Kong SAR and 82 % for Malaysia., Conclusion: This patient-centered clinical decision aid helped to enhance communication between dental students and patients in both regions, ultimately leading to heightened patient satisfaction levels. Nonetheless, to address the present study's limitations, future studies should consider diversifying participant backgrounds, including patients without prior treatment discussions with students., Clinical Significance: Clinical decision aids are valuable tools in clinical teaching due to their enhancement of communication between clinicians and patients. They promote shared decision-making, leading to more personalized and evidence-driven treatment plans, ultimately improving patient care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Ltd.)

Introduction: Remote monitoring (RM) for cardiac implantable electronic devices is on the rise and has been shown to reduce the burden of in-clinic follow-up visits. We aimed to investigate the long-term clinical outcomes of RM versus no RM., Methods: This was a prospective, single-centre cohort study of consecutive patients with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy-defibrillator (CRT-D) followed up from 2018 to 2023. Patients who received non-ICD devices were excluded. In general, RM was offered to all patients, but uptake depended on patient preference. For data analysis, patients were stratified according to whether RM was used. The primary outcome was all-cause mortality; secondary outcomes were hospitalisation for heart failure and device therapy (shocks and electrical storm)., Results: Of 551 patients, 284 (51.5%) received RM and 267 (49.5%) did not. Baseline demographics were similar between the two arms. All-cause mortality was significantly lower in RM versus non-RM patients (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.33-0.60, P <0.001), as was hospitalisation for heart failure (HR 0.39, 95% CI 0.25-0.59, P <0.001); these remained significant after adjustment for baseline covariates. More patients on RM received appropriate antitachycardia pacing (ATP) (17.6% vs. 10.7%, P = 0.035) and appropriate shocks (24.1% vs. 14.7%, P = 0.017). The incidences of inappropriate ATP, inappropriate shocks and electrical storm were similar. More patients on RM underwent pulse generator change (34.1% vs. 10.1%, P <0.001)., Conclusion: Remote monitoring was associated with significantly lower mortality in both ICDs and CRT-Ds and in primary and secondary indications, as well as fewer heart failure hospitalisations. This supports current guidelines recommending the use of RM in all patients with ICD or CRT-D., (Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.)

Purpose: To compare the maximum occlusal force in endodontically treated teeth and their vital contralateral counterparts and to evaluate the intraoral factors affecting them., Materials and Methods: Thirty adult participants presented with an endodontically treated tooth and its vital contralateral counterpart were recruited, with 15 males and females in each group. Maximum occlusal forces were measured using a wireless sensor network occlusal force recorder, and the mean maximum occlusal force of endodontically treated teeth was compared with that of their vital contralateral counterparts. Multiple-factor ANOVA was used to examine the association between various clinical factors and maximum occlusal force., Results: The mean maximum occlusal force for endodontically treated teeth was significantly higher than their vital counterparts (215.44 ± 74.11N and 202.40 ± 70.67N, respectively) (P < 0.001). Among the clinical factors, the maximum occlusal forces were significantly influenced by the location of teeth (P < 0.01) and the crown root ratio (P = 0.01). Upon further analysis of endodontically treated teeth and control groups, the location of teeth was identified as a sole factor associated with maximum occlusal force, with P < 0.05., Conclusion: The maximum occlusal forces for endodontically treated teeth were statistically significantly higher than those of their corresponding vital contralateral teeth.

Purpose: The purpose of this study was to evaluate the radiotherapy planning feasibility of dose escalation with intensity-modulated proton therapy (IMPT) to hypoxic tumor regions identified on 18F-Fluoromisonidazole (FMISO) positron emission tomography and computed tomography (PET-CT) in NPC., Materials and Methods: Nine patients with stages T3-4N0-3M0 NPC underwent 18F-FMISO PET-CT before and during week 3 of radiotherapy. The hypoxic volume (GTVhypo) is automatically generated by applying a subthresholding algorithm within the gross tumor volume (GTV) with a tumor to muscle standardized uptake value (SUV) ratio of 1.3 on the 18F-FMISO PET-CT scan. Two proton plans were generated for each patient, a standard plan to 70 Gy and dose escalation plan with upfront boost followed by standard 70GyE plan. The stereotactic boost was planned with single-field uniform dose optimization using two fields to deliver 10 GyE in two fractions to GTVhypo. The standard plan was generated with IMPT with robust optimization to deliver 70GyE, 60GyE in 33 fractions using simultaneous integrated boost technique. A plan sum was generated for assessment., Results: Eight of nine patients showed tumor hypoxia on the baseline 18F-FMISO PET-CT scan. The mean hypoxic tumor volume was 3.9 cm 3 (range .9-11.9cm 3 ). The average SUVmax of the hypoxic volume was 2.2 (range 1.44-2.98). All the dose-volume parameters met the planning objectives for target coverage. Dose escalation was not feasible in three of eight patients as the D0.03cc of temporal lobe was greater than 75GyE., Conclusions: The utility of boost to the hypoxic volume before standard course of radiotherapy with IMPT is dosimetrically feasible in selected patients. Clinical trials are warranted to determine the clinical outcomes of this approach., (© 2023 John Wiley & Sons Australia, Ltd.)

Background: Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide., Methods: A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use., Findings: Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines [51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic [40%, (n = 70)], access [37%, (n = 67)], appointment duration [35%, (n = 61)], concerns about side-effects [(21%, n = 37)], and non-adherence [12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports [79%, (n = 143)], more BP measurement data [67%, (n = 120)], a clinical nudge in health records [61%, (n = 109)] and patient-facing including improved patient health literacy [49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%)., Interpretation: Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: A high burden of respiratory pathogens colonizing removable prosthesis surfaces suggests the potential of association between removable prosthesis-wearing and respiratory infections. Therefore, this systematic review and meta-analysis aimed to evaluate the evidence from clinical studies concerning the association between removable prosthesis-wearing and respiratory infections., Methods: Clinical studies that reported respiratory infections associated with adult patients wearing removable prostheses in any centers (hospitals and nursing homes) or communities were included. Literature was searched across five electronic databases (MEDLINE, Cochrane Library, EMBASE, Web of Science, and Scopus) to 28 May 2024. An additional search was performed for unpublished trials and references cited in related studies. The Newcastle-Ottawa Scale was employed for the quality assessment. The certainty assessment was established using GRADE. The results were pooled using a frequentist random-effects meta-analysis and the odds ratios generated., Results: A total of 1143 articles were identified. Thirteen articles had full-text articles screening and an additional two articles were added through reference linkage. Ultimately, six non-randomized clinical studies reporting various types of pneumonia contributed to this review. Overall odds of having pneumonia among prosthesis wearers were 1.43 (95% CI: 0.76 to 2.69) and 1.27 (95% CI: 1.11 to 1.46) using the random- and fixed-effects models, respectively. The heterogeneity in the meta-analysis was substantial. In subgroup analysis according to the study design, the heterogeneity within prospective studies was much reduced, I 2  = 0% (p = 0.355). The certainty of the evidence evaluated using the GRADE approach was low to very low evidence for prosthesis wearers developing pneumonia based on studies., Conclusions: There was no conclusive evidence from the non-randomized clinical studies supporting whether prosthesis-wearing is a risk factor for pneumonia based on outcomes from this review., (© 2024. The Author(s).)

Objective: To compare the efficacy of test (ultrasonic cleaner combined with immersion in denture cleanser solution) and control (immersion in denture cleanser solution followed by conventional brushing) denture cleaning interventions in enhancing denture cleanliness, reducing denture stomatitis, and improving patient satisfaction., Methods: A prospective, single-blind, block-randomised, two-period crossover, superiority-controlled clinical trial was conducted of a 3-month intervention. The study design included a pre-intervention period (2 weeks), intervention period one (3 months), washout period (2 weeks), and intervention period two (3 months). A total of 56 community-dwelling elders were block-randomized into either sequence Test/Control or sequence Control/Test. The intervention, period, and carryover effects for the changes in the cleanliness of extensive partial and complete acrylic dentures, denture stomatitis, and changes in patient satisfaction were estimated using Generalized Estimating Equations models., Results: Percentage plaque area coverage, patient satisfaction, and denture stomatitis were significantly improved for both intervention and control arms after 3 months (P < 0.05). The intervention arm was found to significantly improve denture cleanliness (P < 0.001) and patient satisfaction (P = 0.002) more than the control arm. Denture-wearing habits and denture age were also significantly associated with the changes in denture plaque coverage (P < 0.05). However, the effect of the test intervention on denture stomatitis was not significantly different compared to the control arm (P = 0.284)., Conclusion: This study revealed that the test intervention group was significantly more effective than the control group in improving denture cleanliness and patient satisfaction among community-dwelling elders. This test intervention is recommended for maintaining optimum denture hygiene among older adults., Clinical Significance: Removable dentures can harbor opportunistic pathogens, emphasizing the need for effective denture hygiene intervention using ultrasonic cleaner combined with immersion in denture cleanser solution to eliminate denture biofilm in community-dwelling elders., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Clostridium septicum infections are highly predictive of certain malignancies in human patients. To initiate infections, C. septicum spores must first germinate and regain vegetative growth. Yet, what triggers the germination of C. septicum spores is still unknown. Here, we observe that C. septicum germinates in response to specific bile salts. Putative bile salt recognition genes are identified in C. septicum based on their similarity in sequence and organization to bile salt-responsive csp genes in Clostridioides difficile. Inactivating two of these csp orthologs (cspC-82 and cspC-1718) results in mutant spores that no longer germinate in the presence of their respective cognate bile salts. Additionally, inactivating the putative cspBA or sleC genes in C. septicum abrogates the germination response to all bile salt germinants, suggesting that both act at a convergent point downstream of cspC-82 and cspC-1718. Molecular dynamics simulations show that both CspC-82 and CspC-1718 bear a strong structural congruence with C. difficile's CspC. The existence of functional bile salt germination sensors in C. septicum may be relevant to the association between infection and malignancy., (© 2024. The Author(s).)

Objectives: To evaluate the longevity of cantilevered zirconia-based resin-bonded fixed partial dentures (RBFPDs) in replacing missing posterior teeth, as well as the quality of life and patient satisfaction experienced by those receiving zirconia RBFPDs., Methods: A prospective single-arm uncontrolled clinical trial was conducted to replace one or more missing premolars or molars with a span of 5 to 8 mm using cantilevered zirconia RBFPDs. Thirty-six participants with 40 prostheses were recruited and underwent a 3-year clinical evaluation. The retainer designs included a minimum thickness of 0.8 mm, a minimum of 200° circumferential wraparound with an occlusal bar, and a connector dimension of 3 × 3 mm. Patient-reported outcomes, including patient satisfaction and Oral Health Impact Profile (OHIP), were assessed., Results: The average age of participants was 45.8 years, and 72.5 % were women. The success rate of the posterior zirconia RBFPDs was 76.2 %, with an estimated mean success duration of 46.1 months. The survival rate was 88.1 %, with an estimated mean survival duration of 49.4 months. Participants were highly satisfied with the treatment, achieving an average satisfaction score of 80.8 ± 11.9. Participants' total OHIP scores decreased from 52.3 to 39.6 after 3 years, indicating a significant improvement in oral health-related quality of life (P = 0.009)., Conclusions: After 3 years, a moderately high survival rate and favourable patient-reported outcomes of posterior cantilevered zirconia RBFPDs were achieved. Therefore, it can be recommended as a conservative treatment option to replace missing posterior teeth, provided that retainer design considerations are taken into account., Clinical Significance: Cantilevered zirconia RBFPDs for posterior teeth can serve as a conservative treatment option that is both aesthetically pleasing and biocompatible. It offers a more cost-effective alternative compared to dental implants, which are often prohibitively expensive for the majority of patients. This approach has the potential to greatly improve patient-reported outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The extent to which differences in results from Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial (ROCKET) atrial fibrillation (AF)-the landmark trials for the approval of apixaban and rivaroxaban, respectively, for non-valvular AF-were influenced by differences in their protocols is debated. The potential influence of selection criteria on trial results was assessed by emulating these trials in data from the Global Anticoagulant Registry in the Field (GARFIELD)-AF registry., Methods: Vitamin K antagonist (VKA) and non-vitamin K oral antagonist (NOAC) users from GARFIELD-AF were selected according to eligibility for the original ARISTOTLE or ROCKET AF trials. A propensity score overlap weighted Cox model was used to emulate trial randomisation between treatment groups. Adjusted HRs for stroke or systemic embolism (SE) within 2 years of enrolment were calculated for each NOAC versus VKA., Results: Among patients on apixaban, rivaroxaban and VKA, 2570, 3560 and 8005 were eligible for ARISTOTLE, respectively, and 1612, 2005 and 4368, respectively, for ROCKET AF. When selecting for ARISTOTLE criteria, apixaban users had significantly lower stroke/SE risk versus VKA (HR 0.57; 95% CI 0.34 to 0.94) while no reduction was observed with rivaroxaban (HR 0.98; 95% CI 0.68 to 1.40). When selecting for ROCKET AF criteria, safety and efficacy versus VKA were similar across the NOACs., Conclusion: Apixaban and rivaroxaban showed similar results versus VKA in high-risk patients selected according to ROCKET AF criteria, whereas differences emerged when selecting for the more inclusive ARISTOTLE criteria. Our results highlight the importance of trial selection criteria in interpreting trial results and underline the problems faced in comparing treatments across rather than within clinical trials., Competing Interests: Competing interests: JC reports institutional grants and personal fees from Bayer, Boehringer Ingelheim, Pfizer/BMS and Daiichi Sankyo and personal fees from Portola. KP has consultancies with Johnson & Johnson, Element Science, Artivion and Novartis. AO received a research grant from Pfizer and is Steering Committee Member and National Coordinator of the ENGAGE-AF (TIMI 48) study. BFJ received speaker honoraria from Boehringer, Sanofi, Aspen, Pfizer, Takeda and Astra Zeneca Jitendra Pal Singh Sawhney reports professional/advisory fees outside the submitted work from Pfizer, Astra Zeneca, Novartis, Sanofi, Torrent and Lupin. TWL has received research support from Bayer, Boehringer Ingelheim and Pfizer. HG received honoraria from Bayer Australia, Eli Lilly Australia, Pfizer Australia and BMS Australia Shinya Goto was a recipient of quality personal fees from Jansen and Antos, and Phillips, fees from the American Heart Association as an Associate Editor for Circulation, and Steering Committee fees from Duke University. SH received personal fees from Bayer, BMS, Daiichi Sankyo, Pfizer, Sanofi. KAAF reports grants and personal fees from Bayer/Janssen and Astra Zeneca. PJ has served as a consultant or on an advisory board for Bayer, Boehringer Ingelheim, and Novartis. FV has received grants from Bayer Healthcare, and personal fees from Bayer Healthcare, BMS/Pfizer, Daiichi-Sankyo, and Boehringer-Ingelheim. AKK received personal fees and grants from Bayer AG, Sanofi S.A. and Anthos Therapeutics. JCLH, SV and REH report no conflicts of interest., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Minimally invasive surgery (MIS) for limited resections for pancreatic uncinate lesions is not widely performed but can adequately treat benign or low-grade malignant lesions. The aim of this study was to evaluate the short-term outcomes of MIS-limited pancreatic resections for patients with suspected pancreatic neuroendocrine tumours (PNETs)., Patients and Methods: This was a retrospective study of six consecutive patients who underwent MIS for PNET within a single institution between 2017 and 2022., Results: Six patients underwent limited pancreas-preserving MIS of the uncinate process (uncinectomy or enucleation), of which two were performed through the robotic approach and four through laparoscopic approach. The median operation time was 212.5 (175-338.75) min, and the median blood loss was 50 (50-112.5) ml. The median post-operative hospital length of stay was 5.5 (3.75-11.5) days. Two patients (33.3%) had major post-operative morbidities (Clavien-Dindo ≥Grade 3). There were no open conversions or post-operative mortalities. Five patients had histologically proven Grade 1 neuroendocrine tumours. One was T2 and four were T1., Conclusions: This study suggests that limited MIS resections of pancreatic uncinate PNETs are a feasible procedure with good patient outcomes. It offers a safe alternative to radical surgical resections like pancreatoduodenectomies in selected patients with low-grade malignant or benign tumours., (Copyright © 2024 Copyright: © 2024 Journal of Minimal Access Surgery.)

Removable denture wearers are at an increased risk of developing periodontal diseases due to biofilm deposition and microbial colonization on the denture surface. This study aimed to characterize and compare the metagenomic composition of saliva in denture wearers with different periodontal statuses. Twenty-four community-dwelling elders were recruited and grouped into denture wearers with active periodontitis (APD), non-denture wearers with active periodontitis (APXD), denture wearers with stable periodontal health conditions (SPCD), and non-denture wearers with stable periodontal health conditions (SPCXD). Saliva samples were collected and underwent Type IIB restriction-site-associated DNA for microbiome (2bRAD-M) metagenomic sequencing to characterize the species-resolved microbial composition. Alpha diversity analysis based on the Shannon index revealed no significant difference between groups. Beta diversity analysis using the Jaccard distance matrix was nearly significantly different between denture-wearing and non-denture-wearing groups ( p = 0.075). Some respiratory pathogens, including Streptococcus agalactiae and Streptococcus pneumoniae , were detected as the top 30 species in saliva samples. Additionally, LEfSe analysis revealed a substantial presence of pathogenic bacteria in denture groups. In the cohort of saliva samples collected from community-dwelling elders, a remarkable abundance of certain opportunistic pathogens was detected in the microbial community.

A technique is presented for creating interocclusal space for a resin-bonded fixed partial denture retainer by applying the Dahl concept. A missing mandibular first molar was replaced with a cantilevered resin-bonded fixed partial denture and had been successfully retained at the 9-year clinical review., (Copyright © 2022 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine and compare the opportunistic respiratory pathogenic index (ORPI) and prevalence of respiratory pathogens between clean and unclean removable prostheses., Methods: A cross-sectional study was conducted among 97 removable prosthesis wearers at a teaching dental hospital. Participants' prosthesis hygiene was grouped into clean and unclean. After prosthesis plaque samples were sequenced using the Type IIB Restriction-site Associated DNA Sequencing for Microbiome method, the prevalence was assessed for the presence of respiratory pathogens on each sample. The ORPIs for clean and unclean prostheses were quantified based on the sum of the relative abundance of respiratory pathogenic bacteria in a microbiome using a reference database that contains opportunistic respiratory pathogens and disease-associated information., Results: A total of 30 opportunistic respiratory pathogens were identified on the removable prostheses. Eighty-one (83.5 %) removable prostheses harboured respiratory pathogenic bacteria. Stenotrophomonas maltophilia (34.0 %), Pseudomonas aeruginosa (27.8 %), and Streptococcus agalactiae (27.8 %) were the top three prevalent respiratory pathogens detected in plaque samples. There was a significantly higher prevalence of respiratory pathogens residing on unclean than clean prostheses (P = 0.046). However, the ORPIs in both groups showed no statistically significant difference (P = 0.516)., Conclusions: The ORPIs for both clean and unclean prostheses demonstrated a similar abundance of respiratory pathogens. However, the high prevalence of respiratory pathogens residing on unclean prostheses should not be underestimated. Therefore, maintaining good prosthesis hygiene is still important for overall oral and systemic health, even though the direct link between prosthesis cleanliness and reduced abundance of respiratory pathogens has not been established., Clinical Significance: The association between the prevalence of respiratory pathogens and unclean removable prostheses has been demonstrated and might increase the theoretical risk of respiratory disease development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: This systematic review and meta-analysis aimed to investigate the prevalence of opportunistic respiratory pathogens colonizing removable dental prostheses in older adults without respiratory diseases., Methods: This review was registered with PROSPERO and conducted in accordance with the principles formed by the working group of the Joanna Briggs Institute (JBI) to evaluate systematic reviews of prevalence data. Literature searches were conducted across five electronic databases. Quality assessments were determined according to a revised JBI critical appraisal checklist across nine criteria. Comparison between fixed- and random-effects meta-analyses were performed for sensitivity analysis. Prediction intervals were also presented when three or more studies were included in the meta-analysis., Results: Across the databases, 1091 articles were identified, and 591 articles remained after the removal of duplicates. Twenty "potentially effective" studies were identified. Ultimately eight studies informed this review and meta-analyses were performed for 13 known respiratory pathogens. The meta-analyses identified the top three common respiratory pathogens residing on the removable prostheses were, in descending order: Staphylococcus aureus: 31.81% (95% CI: 13.34%-48.24%); Staphylococcus epidermidis: 14.07% (95% CI: 7.88%-21.48%); Klebsiella pneumoniae: 10.50% (95% CI: 2.55%-22.30%). The heterogeneity scores for nine respiratory pathogen analyses were classified as "unimportant inconsistency", I 2  = 0% (p > 0.1). For sensitivity analysis, there was no difference between the random- and fixed-effects models., Conclusion: The existing evidence demonstrated a high burden of certain opportunistic respiratory pathogens, which may be considered a major potential cause of respiratory infections in older adults wearing removable prostheses., (© 2023 The Authors. Journal of Prosthodontics published by Wiley Periodicals LLC on behalf of American College of Prosthodontists.)

Objective: This study aimed to assess undergraduate dental students' communication skills in relation to patient sociodemographic factors using a three-perspective approach; the student, the patient, and the clinical instructor perspective., Materials and Methods: A cross-sectional study was conducted using validated modified-communication tools; Patient Communication Assessment Instruments (PCAI), Student Communication Assessment Instruments (SCAI), and Clinical Communication Assessment Instruments (CCAI). Moreover, 176 undergraduate clinical year students were recruited in this study whereby each student was assessed by a clinical instructor, a patient, and self-evaluation., Results: The clinical communication skills domains were not significantly influenced by patient sociodemographic factors, including sex, educational background, and the number of visits (p > .05). However, this study revealed a statistically significant difference in the domain of "caring and respectful" of the SCAI between the low- and middle-income groups., Conclusions: Overall, most of the patient sociodemographic factors did not affect clinical communication skills. However, patient income groups played a significant role in one of the communication domains., (© 2024 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Guidelines recommended remote monitoring (RM) in managing patients with Cardiac Implantable Electronic Devices. In recent years, smart device (phone or tablet) monitoring-based RM (SM-RM) was introduced. This study aims to systematically review SM-RM versus bedside monitor RM (BM-RM) using radiofrequency in terms of compliance, connectivity, and episode transmission time., Methods: We conducted a systematic review, searching three international databases from inception until July 2023 for studies comparing SM-RM (intervention group) versus BM-RM (control group)., Results: Two matched studies (21 978 patients) were retrieved (SM-RM arm: 9642 patients, BM-RM arm: 12 336 patients). There is significantly higher compliance among SM-RM patients compared with BM-RM patients in both pacemaker and defibrillator patients. Manyam et al. found that more SM-RM patients than BM-RM patients transmitted at least once (98.1% vs. 94.3%, p  < .001), and Tarakji et al. showed that SM-RM patients have higher success rates of scheduled transmissions than traditional BM-RM methods (SM-RM: 94.6%, pacemaker manual: 56.3%, pacemaker wireless: 77.0%, defibrillator wireless: 87.1%). There were higher enrolment rates, completed scheduled and patient-initiated transmissions, shorter episode transmission time, and higher connectivity among SM-RM patients compared to BM-RM patients. Younger patients (aged <75) had more patient-initiated transmissions, and a higher proportion had ≥10 transmissions compared with older patients (aged ≥75) in both SM-RM and BM-RM groups., Conclusion: SM-RM is a step in the right direction, with good compliance, connectivity, and shorter episode transmission time, empowering patients to be in control of their health. Further research on cost-effectiveness and long-term clinical outcomes can be carried out., Competing Interests: Authors declare no conflict of interests for this article., (© 2024 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Introduction: Clinical outcomes of long-term ventricular septal pacing (VSP) without His-Purkinje capture remain unknown. This study evaluated the differences in clinical outcomes between conduction system pacing (CSP), VSP, and right ventricular pacing (RVP)., Methods: Consecutive patients with bradycardia indicated for pacing from 2016 to 2022 were prospectively followed for the clinical endpoints of heart failure (HF)-hospitalizations and all-cause mortality at 2 years. VSP was defined as septal pacing due to unsuccessful CSP implant or successful CSP followed by loss of His-Purkinje capture within 90 days., Results: Among 1016 patients (age 73.9 ± 11.2 years, 47% female, 48% atrioventricular block), 612 received RVP, 335 received CSP and 69 received VSP. Paced QRS duration was similar between VSP and RVP, but both significantly longer than CSP (p < .05). HF-hospitalizations occurred in 130 (13%) patients (CSP 7% vs. RVP 16% vs. VSP 13%, p = .001), and all-cause mortality in 143 (14%) patients (CSP 7% vs. RVP 19% vs. VSP 9%, p < .001). The association of pacing modality with clinical events was limited to those with ventricular pacing (Vp) > 20% (p interaction  < .05). Adjusting for clinical risk factors among patients with Vp > 20%, VSP (adjusted hazard ratio [AHR]: 4.74, 95% confidence interval [CI]: 1.57-14.36) and RVP (AHR: 3.08, 95% CI: 1.44-6.60) were associated with increased hazard of HF-hospitalizations, and RVP (2.52, 95% CI: 1.19-5.35) with increased mortality, compared to CSP. Clinical endpoints did not differ between VSP and RVP with Vp > 20%, or amongst groups with Vp < 20%., Conclusion: Conduction system capture is associated with improved clinical outcomes. CSP should be preferred over VSP or RVP during pacing for bradycardia., (© 2024 Wiley Periodicals LLC.)

Background: Clinical practice guidelines on limitation of life-sustaining treatments (LST) in the intensive care unit (ICU), in the form of withholding or withdrawal of LST, state that there is no ethical difference between the two. Such statements are not uniformly accepted worldwide, and there are few studies on LST limitation in Asia. This study aimed to evaluate the predictors and outcomes of withholding and withdrawal of LST in Singapore, focusing on the similarities and differences between the two approaches., Methods: This was a multicentre observational study of patients admitted to 21 adult ICUs across 9 public hospitals in Singapore over an average of three months per year from 2014 to 2019. The primary outcome measures were withholding and withdrawal of LST (cardiopulmonary resuscitation, invasive mechanical ventilation, and vasopressors/inotropes). The secondary outcome measure was hospital mortality. Multivariable generalised mixed model analysis was used to identify independent predictors for withdrawal and withholding of LST and if LST limitation predicts hospital mortality., Results: There were 8907 patients and 9723 admissions. Of the former, 80.8% had no limitation of LST, 13.0% had LST withheld, and 6.2% had LST withdrawn. Common independent predictors for withholding and withdrawal were increasing age, absence of chronic kidney dialysis, greater dependence in activities of daily living, cardiopulmonary resuscitation before ICU admission, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and higher level of care in the first 24 h of ICU admission. Additional predictors for withholding included being of Chinese race, the religions of Hinduism and Islam, malignancy, and chronic liver failure. The additional predictor for withdrawal was lower hospital paying class (with greater government subsidy for hospital bills). Hospital mortality in patients without LST limitation, with LST withholding, and with LST withdrawal was 10.6%, 82.1%, and 91.8%, respectively (p < 0.001). Withholding (odds ratio 13.822, 95% confidence interval 9.987-19.132) and withdrawal (odds ratio 38.319, 95% confidence interval 24.351-60.298) were both found to be independent predictors of hospital mortality on multivariable analysis., Conclusions: Differences in the independent predictors of withholding and withdrawal of LST exist. Even after accounting for baseline characteristics, both withholding and withdrawal of LST independently predict hospital mortality. Later mortality in patients who had LST withdrawn compared to withholding suggests that the decision to withdraw may be at the point when medical futility is recognised., (© 2024. The Author(s).)

Background: Patients with migraines, particularly those with auras, may present with stroke. Atrial fibrillation is a known risk factor for stroke. With common pathophysiological factors between migraines and atrial fibrillation, we aimed to clarify the association between migraine and atrial fibrillation in this systematic review and meta-analysis., Methods: A literature search was conducted in EMBASE, PubMed, Scopus and Cochrane electronic bibliographic databases from inception to 5 September 2022 with the following inclusion criteria: (a) cohort or cross-sectional studies; (b) studies that included only patients aged ≥18 years; and (c) studies that examined the association between atrial fibrillation and migraines. Exclusion criteria were case-control studies and the studies that included patients with previous diagnosis of atrial fibrillation or nonmigrainous headache. The Newcastle-Ottawa Scale was used to assess the quality of studies., Results: Six studies were included, demonstrating a pooled prevalence of atrial fibrillation of 1.61% (95% confidence interval [CI] 0.51, 3.29) in migraine with aura and 1.32% (95% CI 0.17, 3.41) in migraine without aura. The overall prevalence of atrial fibrillation in migraine was 1.39% (95% CI 0.24, 3.46)., Conclusion: In this systematic review and meta-analysis, the overall prevalence of atrial fibrillation in patients with migraine was low. Further studies are needed to clarify this relationship., (Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.)

Background: The microbiomes on the surface of unclean removable prostheses are complex and yet largely underexplored using metagenomic sequencing technology., Objectives: To characterize the microbiome of removable prostheses with different levels of cleanliness using Type IIB Restriction-site Associated DNA for Microbiome (2bRAD-M) sequencing and compare the Microbial Index of Pathogenic Bacteria (MIP) between clean and unclean prostheses., Materials and Methods: Ninety-seven removable prostheses were classified into 'clean' and 'unclean' groups. All prosthesis plaque samples underwent 2bRAD metagenomic sequencing to characterize the species-resolved microbial composition. MIPs for clean and unclean prostheses were calculated based on the sum of the relative abundance of pathogenic bacteria in a microbiome using a reference database that contains opportunistic pathogenic bacteria and disease-associated information., Results: Beta diversity analyses based on Jaccard qualitative and Bray-Curtis quantitative distance matrices identified significant differences between the two groups ( p  < 0.05). There was a significant enrichment of many pathogenic bacteria in the unclean prosthesis group. The MIP for unclean prostheses (0.47 ± 0.25) was significantly higher than for clean prostheses (0.37 ± 0.29), p  = 0.029., Conclusions: The microbial community of plaque samples from 'unclean' prostheses demonstrated compositional differences compared with 'clean' prostheses. In addition, the pathogenic microbiome in the 'unclean' versus 'clean' group differed., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: Messenger ribonucleic acid (mRNA) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been associated with myocarditis/pericarditis, especially in young males. We evaluated the risk of myocarditis/pericarditis following mRNA vaccines by brand, age, sex and dose number in Singapore., Methods: Adverse event reports of myocarditis/pericarditis following mRNA vaccines received by the Health Sciences Authority from 30 December 2020 to 25 July 2022 were included, with a data lock on 30 September 2022. Case adjudication was done by an independent panel of cardiologists using the US Centers for Disease Control and Prevention case definition. Reporting rates were compared with expected rates using historical data from 2018 to 2020., Results: Of the 152 adjudicated cases, males comprised 75.0%. The median age was 30 years. Most cases occurred after Dose 2 (49.3%). The median time to onset was 2 days. Reporting rates were highest in males aged 12-17 years for both primary series (11.5 [95% confidence interval [CI] 6.7-18.4] per 100,000 doses, post-Dose 2) and following booster doses (7.1 [95% CI 3.0-13.9] per 100,000 doses). In children aged 5-11 years, myocarditis remained very rare (0.2 per 100,000 doses). The reporting rates for Booster 1 were generally similar or lower than those for Dose 2., Conclusions: The risk of myocarditis/pericarditis with mRNA vaccines was highest in adolescent males following Dose 2, and this was higher than historically observed background rates. Most cases were clinically mild. The risk of myocarditis should be weighed against the benefits of receiving an mRNA vaccine, keeping in mind that SARS-CoV-2 infections carry substantial risks of myocarditis/pericarditis, as well as the evolving landscape of the disease., (Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.)

Introduction: The communication skills of clinicians are very crucial in providing better health outcomes for patients. Therefore, this study aimed to assess undergraduate dental students' communication skills in relation to their demographics and clinical setting using a three-perspective approach; the student, the patient and the clinical instructor perspective., Methods: A cross-sectional study was conducted using validated modified-communication tools; Patient Communication Assessment Instruments (PCAI), Student Communication Assessment Instruments (SCAI) and Clinical Communication Assessment Instruments (CCAI) which included four communication domains. One hundred and seventy-six undergraduate clinical year students were recruited in this study whereby each of them was assessed by a clinical instructor and a randomly selected patient in two settings: Dental Health Education (DHE) and Comprehensive Care (CC) clinic., Results: Comparing the three perspectives, PCAI yielded the highest scores across all domains, followed by SCAI and CCAI (p < .001). SCAI exhibited a better score in Year 5 compared to Year 3 and Year 4 (p = .027). The male students perceived they performed better than females in all domains (p < .05). Patients rated the students higher in the DHE clinic as compared to the CC clinic for the team interaction domain., Conclusion: There was an upward pattern of the communication skills score rated from the clinical instructor perspective to the student and patient perspectives. The use of PCAI, SCAI and CCAI collectively gave a complementary view of students' communication performance in all the domains assessed., (© 2023 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

This study assessed the corrosion resistance, intracutaneous reactivity, acute systemic toxicity, and in situ tissue effect of the implantation of porous NiTi fabricated by metal injection molding in animal models. For the intracutaneous reactivity study, five intracutaneous injections were administered per site with and without the tested extract in polar and nonpolar solutions. The extract was also delivered via intravenous and intraperitoneal routes for acute systemic toxicity. TiAl6 V4 (control) and porous NiTi were implanted in rabbit femora for a period of 13 weeks to evaluate the in situ tissue response. Corrosion was evaluated through open and cyclic polarization in PBS, while biocompatibility was investigated by assessing the general conditions, skin irritation score (edema and erythema), and histopathology. No active dissolution or hysteresis loop was observed in the corrosion study. None of the animals exhibited death, moribundity, impending death, severe pain, self-mutilation, or overgrooming. No edema was observed at injection sites. Only the positive control showed an erythematous reaction at 24, 48, and 72 h observations ( p < 0.001). Porous NiTi showed a low in situ biological response for inflammation, neovascularization, and fibrosis in comparison to the control implant ( p = 0.247, 0.005, and 0.011, respectively). Porous NiTi also demonstrated high pitting corrosion resistance while causing no acute hypersensitivity or acute systemic toxicity. The study concludes that porous NiTi implants were unlikely to cause local sensitization, acute systemic toxicity, or chronic inflammatory reactions in an animal model. Porous NiTi also exhibited osseointegration equivalent to Ti6AI4 V of known biocompatibility.

Objectives: The aim of this systematic review was to evaluate the survival and complication rates of resin composite laminate veneers., Methods: Randomized controlled trials and cohort studies with a minimum 2-year follow-up assessing survival and complication rates of resin composite laminate veneers on permanent dentition from 1998 to May 2022. Literature searches were conducted in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials electronic databases. References cited in the related reviews and included full-text articles were also hand-searched to further identify potentially relevant studies., Results: A total of 827 articles were identified. Twenty-two studies were considered for full-text review after the title and abstract screening stage. After exclusion, 7 studies (3 randomized controlled trials and 4 cohort studies) were included in the systematic review. Three published scales were adopted for the quality and risk of bias assessment. At the survival rate threshold, the overall heterogeneity (I 2 ) for randomized controlled trials was 50.5% (P = .108). The overall pooled survival rate of the randomized controlled trials was 88% (95% CI: 81%-94%), with the mean follow-up time ranging from 24 to 97 months. Surface roughness, color mismatch, and marginal discoloration were the most reported complications., Conclusion: Resin composite laminate veneers demonstrated moderately high survival rates for the entire sample and the direct laminate veneer group demonstrated higher survival rates than the indirect approach. Most of the complications were regarded as clinically acceptable with or without reintervention., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Resin-bonded fixed dental prostheses (RBFDPs) cemented at an increased occlusal vertical dimension (OVD) (the Dahl concept) to create space for a metal retainer remains controversial because of the lack of reported clinical studies. This study analyzed the demographic (age and sex) and clinical factors (location and arch of prosthesis) affecting the patients' perception of RBFDPs cemented at an increased OVD., Material and Methods: Twenty-eight participants treated with cantilevered RBFDP at an increased OVD were prospectively recruited. They were asked to answer a validated patient satisfaction questionnaire based on six parameters during the 12-week review visit., Results: 71.4% of the participants were completely satisfied with the color, shape, and function. Twenty-one (75%) participants reported no complaints about the prostheses. 89.3% will recommend this treatment option to others. There was a significant difference between males and females in avoiding loading on the prostheses (p = 0.015). The level of satisfaction did not differ by age, ethnicity, location, and arch of the prostheses (p > 0.05)., Conclusions: Patient satisfaction toward RBFDP cemented by using the Dahl approach was generally high on all the parameters at the 12-week review visit., (© 2023 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Red dragon fruit (RDF) is well-known for its high nutritional content, especially the red pigment betacyanins that possess high antioxidant activity. Natural fermentation is an ancient yet outstanding technique that relies on the autochthonous microbiota from fruits and vegetables surfaces to preserve and improve the nutritional values and quality of the food product. The present study was to evaluate and identify the indigenous microbial community (bacteria and fungi) that are involved in the natural fermentation of RDF. Results revealed a total of twenty bacterial pure cultures and nine fungal pure cultures were successfully isolated from fermented red dragon fruit drink (FRDFD). For the first time, the PCR amplification of 16S rRNA and ITS regions and sequence analysis suggested nine genera of bacteria and three genera of fungi ( Aureobasidium pullulans , Clavispora opuntiae , and Talaromyces aurantiacus ) present in the FRDFD. Four dominant (≥10 % isolates) bacteria species identified from FRDFD were Klebsiella pneumonia , Brevibacillus parabrevis , Bacillus tequilensis and Bacillus subtilis . The carbohydrate fermentation test showed that all the indigenous microbes identified were able to serve as useful starter culture by fermenting sucrose and glucose, thereby producing acid to lower the pH of FRDFD to around pH 4 for better betacyanins stability. The present study provides a more comprehensive understanding of the indigenous microbial community that serves as the starter culture in the fermentation of RDF. Besides, this study provides a useful guide for future research to be conducted on studying the rare bacterial strains (such as B. tequilensis ) identified from the FRDFD for their potential bioactivities and applications in medical treatment and functional foods industries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: An unmet need exists to reliably predict the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs)., Hypothesis: An externally validated model improves ICH risk stratification., Methods: Independent factors associated with ICH were identified by Cox proportional hazard modeling, using pooled data from the GARFIELD-AF (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation) and ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registries. A predictive model was developed and validated by bootstrap sampling and by independent data from the Danish National Patient Register., Results: In the combined training data set, 284 of 53 878 anticoagulated patients had ICH over a 2-year period (0.31 per 100 person-years; 95% confidence interval [CI]: 0.28-0.35). Independent predictors of ICH included: older age, prior stroke or transient ischemic attack, concomitant antiplatelet (AP) use, and moderate-to-severe chronic kidney disease (CKD). Vitamin K antagonists (VKAs) were associated with a significantly higher risk of ICH compared with non-VKA oral anticoagulants (NOACs) (adjusted hazard ratio: 1.61; 95% CI: 1.25-2.08; p = .0002). The ability of the model to discriminate individuals in the training set with and without ICH was fair (optimism-corrected C-statistic: 0.68; 95% CI: 0.65-0.71) and outperformed three previously published methods. Calibration between predicted and observed ICH probabilities was good in both training and validation data sets., Conclusions: Age, prior ischemic events, concomitant AP therapy, and CKD were important risk factors for ICH in anticoagulated AF patients. Moreover, ICH was more frequent in patients receiving VKA compared to NOAC. The new validated model is a step toward mitigating this potentially lethal complication., (© 2023 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Objectives: To determine the agreement of removable dental prosthesis cleanliness as assessed by a semi-automated planimetric method between images captured by a digital single-lens reflex camera (DSLR) and smartphone., Methods: A total of 97 participants with removable prostheses were recruited for the quantification of the prosthesis plaque area coverage. The colour images of stained prosthesis plaque were obtained using both a DSLR camera and a smartphone. The prosthesis plaque area coverage was analysed in two ways: (i) prosthesis cleanliness index (PCI) and (ii) percentage plaque area coverage (PPC). The PPC (continuous data) was converted to the PCI (categorical data) to provide prevalence ordinal scales and the agreements in PCI ratings were determined using weighted Kappa statistics. Agreement of PPC scores was determined through assessing directional, standardised directional, and absolute differences and correlation analyses., Results: Weighted Kappa values of agreement between PCI categories were excellent (> 0.80) for all comparisons. The mean PPC was 24.79 % as determined by DSLR and 25.37 % as determined by smartphone. There was no statistically significant difference in the means of PPC between the DSLR and smartphone (P = 0.149). The standardised directional difference was 0.15 ('small'). The mean absolute difference was 2.77. The interclass correlation coefficient was 0.98 ('excellent')., Conclusions: This method showed almost perfect agreements and allowed for threshold-based plaque segmentation on the removable prostheses. There was substantial agreement between DSLR and smartphone assessment of prosthesis plaque area coverage as determined by a semi-automated planimetric assessment., Clinical Significance: This semi-automated planimetric assessment method has implications for monitoring removable prosthesis hygiene initiatives by offering a valid, reliable, and quantitative method of assessment with potential use in managed care and community settings., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Statement of Problem: Removable dental prosthesis cleanliness is multifactorial, and key clinical and nonclinical factors associated with prosthesis hygiene should be identified to inform practice, particularly given the dearth of studies relating specifically to prosthetic factors and prosthesis cleanliness., Purpose: The purpose of this cross-sectional clinical study was to evaluate removable dental prosthesis cleanliness among community-dwelling elders by using a semi-automated planimetric assessment and to determine factors associated with removable prosthesis cleanliness., Material and Methods: The cross-sectional study was conducted among community-dwelling elders wearing removable prostheses. Digital images of plaque on removable prostheses were made after staining with a plaque-disclosing agent by using a single-lens reflex camera with a standardized arrangement. The area of plaque coverage was quantified by using a semi-automated planimetric assessment method. Participant profiles were recorded, including sociodemographic and prosthesis-related variables. Variations in removable prosthesis cleanliness were determined in bivariate and regression analyses with the forward Wald test (α=.05)., Results: A total of 97 community-dwelling elders attending a hospital dental clinic were recruited (41 men and 56 women). The mean percentage of prostheses covered with plaque was 24.8%, and 42 (43.3%) were deemed 'unclean' (plaque coverage>25%). Bivariate analyses identified numerous prosthesis-related factors associated with prosthesis cleanliness (P<.05) including prosthesis age, prosthesis material, prosthesis retention and stability, prosthesis fit, and presence of denture stomatitis. Logistic regression analysis indicated that prosthesis fit was the key factor associated with prosthesis cleanliness, accounting for sociodemographic and other prosthesis-related factors (P<.001). Prostheses that were classified as completely ill-fitting were 12 times more likely to be unclean (OR=12.03; 95% CI 3.33-43.41) than those in the well-fitting group., Conclusions: Among a community-dwelling sample of older individuals attending a teaching hospital, approximately half had unclean prostheses as identified by the semi-automated planimetric method. Prosthesis fit was a key factor associated with prosthesis cleanliness. The findings have implications for maintaining removable prosthesis hygiene in the community., (Copyright © 2023. Published by Elsevier Inc.)

Nowadays, the demand for using healthy natural pigments (betacyanins) in the food industry is increasing. The present study aimed to overcome the circumstances that render the betacyanins instability in the red dragon fruit drink using mild approaches. These included optimised fermentation, incorporation of anionic polysaccharide mixture solution [xanthan gum (XG, 0.30-0.40 %, w/v) and carboxymethyl cellulose (CMC, 0.50-0.90 %, w/v)] and also addition of citric acid (CA, 0.05-0.20 %, w/v). The results of this study showed that the hydrocolloid mixture solution of XG and CMC significantly increased the samples' viscosity, pH and °Brix but reduced the a w , while betacyanins concentration had no significant change. The incorporation of CA at increasing concentration only reduced the samples' pH significantly without affecting the viscosity, a w and °Brix. Among all fermented samples, Formulation 3E (0.40 % XG + 0.50 % CMC + 0.20 % CA) had achieved the desired commercial reference viscosity while also successfully minimised betacyanins degradation from 60.18 % to 14.72 %, had the best pH stability and no significant change in viscosity, a w and °Brix values after 4-week storage at 25 °C. The fermented red dragon fruit drink with betacyanins stabilised by Formulation 3E can be produced and served as an independent functional drink product and as a stable, functional ingredient (natural colourant) for the food industry., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)