Causal Effect of Chronic Pain on Mortality through Opioid prescriptions: Application of the Front-Door Formula

alexandrossfakianakis shared this article with you from Inoreader Causal Effect of Chronic Pain on Mortality through Opioid prescriptions: Application of the Front-Door Formula Via Epidemiology - Published Ahead-of-Print Background: Chronic pain is the leading cause of disability worldwide and is strongly associated with the epidemic of opioid overdosing events. However, the causal links between chronic pain, opioid prescriptions, and mortality remain unclear. Methods: This study included 13,884 US adults aged ≥20 years who provided data on chronic pain in the National Health and Nutrition Examination Survey 1999-2004 with linkage to mortality databases through 2015. We employed the generalized form of the front-door formula within the structural causal model framework to investigate the causal effect of chronic pain on all-cause mortality mediated by opioid prescriptions. Results: We identified a total of 718 participants at 3 years of follow-up and 1260 participants at 5 years as having died from all causes. Opioid prescriptions increased the risk of all-cause mortality with an estimated odds ratio [OR] (95% confidence interval) = 1.5 (1.1-1.9) at 3 years and 1.3 (1.1-1.6) at 5 years. The front-door formula revealed that chronic pain increased the risk of all-cause mortality through opioid prescriptions; OR = 1.06 (1.01-1.11) at 3 years and 1.03 (1.01-1.06) at 5 years. Our bias analysis showed that our findings based on the front-door formula were likely robust to plausible sources of bias from uncontrolled exposure–mediator or mediator–outcome confounding. Conclusions: Chronic pain increased the risk of all-cause mortality through opioid prescriptions. Our findings highlight the importance of careful guideline-based chronic pain management to prevent death from possibly inappropriate opioid prescriptions driven by chronic pain. Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of cervical and ocular vestibular-evoked myogenic potential responses between tone burst versus chirp stimulation

paythelady.61 shared this article with you from Inoreader Comparison of cervical and ocular vestibular-evoked myogenic potential responses between tone burst versus chirp stimulation Via Latest Results for European Archives of Oto-Rhino-Laryngology Abstract Purpose To compare the effectiveness of chirp and tone burst stimuli in oVEMP and cVEMP testing for healthy adults Methods This study was conducted in 56 healthy volunteers (112 ears). Ocular and cervical VEMP (oVEMP, cVEMP) tests were performed for each participant using tone burst and chirp stimuli. VEMP response rates, latency of each peak (p1–n1, n1–p1), peak to peak amplitude (p1–n1 amplitude and n1–p1 amplitude), and rectified amplitudes were measured and compared between these two different stimuli. Results VEMP response rates with chirp stimuli are higher than the tone burst stimuli for both cVEMP and oVEMP tests (The difference was statistically significant for oVEMP, p = 0.001). Chirp stimuli have higher p1n1 amplitude and rectified amplitude and shorter p1and n1 latency then tone burst stimuli for cVEMP (p = 0.015, p = 0.007, p < 0.001, p < 0.001, respectively). Chirp stimuli also have higher n1p1 amplitude and shorter n1and p1 latency then tone burst stimuli for oVEMP (p = 0.006, p < 0.001, p < 0.001, respectively). Conclusion The present findings show that the chirp stimulus triggers earlier VEMP responses with higher amplitudes than the tone burst stimulus during cVEMP and oVEMP testing. VEMP response rate with chirp stimulus is also higher than the tone burst. Therefore chirp stimulus can be used in VEMP testing as effectively as, if not more than, tone burst stimulus in clinical practice. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endolymphatic sac tumor: single-institution series of seven cases with updated review of literature

paythelady.61 shared this article with you from Inoreader Endolymphatic sac tumor: single-institution series of seven cases with updated review of literature Via Latest Results for European Archives of Oto-Rhino-Laryngology Abstract Background Endolymphatic sac tumour (ELST) is a rare low-grade locally aggressive neoplasm arising from the endolymphatic duct or sac. It presents mostly with vestibulo-cochlear symptoms either sporadically or as part of von Hippel–Lindau (VHL) syndrome. Micro-neurosurgical excision remains the cornerstone of therapy with the role of radiotherapy (RT) being controversial. This is a clinico-pathological analysis of consecutive ELST patients presenting to a single-institution in India. Methods Neuropathology database of a tertiary-care comprehensive cancer centre was searched electronically to identify consecutive patients with histopathological diagnosis of ELST registered at the institute over last one decade. Data regarding demographic profile, clinical presentation, histopathological features, treatment details and outcomes were retrieved from electronic medical records for this retrospective analysis. Results Electronic search identified seven unique patients with biopsy-proven ELST registered at the institute between 2009 and 2020. Median age of the study cohort was 39 years (range 24–65 years) with strong male predilection (5:2 ratio) and left-sided preponderance (71%). Most common presenting symptoms were hearing loss (86%) and earache (71%) on affected side followed by headache (43%). All patients underwent maximal safe resection at initial diagnosis and were followed-up closely with periodic surveillance imaging. Two patients underwent salvage RT using high-precision conformal techniques at recurrence/progression. Conclusion ELST is a rare low-grade locally aggressive neoplasm that arises generally as part of VHL syndrome or sometimes sporadically. Gross total resection provides the best chance of cure with RT being reserved for unresectable disease, large residue, medical inoperability, or as salvage therapy for recurrent/progressive tumor. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

High-quality imaging of endolymphatic hydrops acquired in 7 minutes using sensitive hT2W–3D–FLAIR reconstructed with magnitude and zero-filled interpolation

paythelady.61 shared this article with you from Inoreader High-quality imaging of endolymphatic hydrops acquired in 7 minutes using sensitive hT2W–3D–FLAIR reconstructed with magnitude and zero-filled interpolation Via Latest Results for European Archives of Oto-Rhino-Laryngology Abstract Background It is still challenging to detect endolymphatic hydrops (EH) in patients with Meniere's disease (MD) using MRI. The aim of the present study was to optimize a sensitive technique generating strong contrast enhancement from minimum gadolinium–diethylenetriamine pentaacetic acid (Gd–DTPA) while reliably detecting EH in the inner ear, including the apex. Materials and methods All imaging was performed using a 3.0 T MR system 24 h after intratympanic injection of low-dose Gd–DTPA. Heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed with magnitude and zero-filled interpolation (hT2W–FLAIR–ZFI) was optimized and validated in phantom studies and compared with medium inversion time inversion recovery imaging with magnitude reconstruction (MIIRMR). The following parameters were used in hT2W–FLAIR–ZFI: repetition time 14,000 ms, echo time 663 ms, inversion time 2900 ms, flip angle 120°, echo train length 271, and field of view 166 × 196 mm2. Results MRI obtained using hT2W–FLAIR–MZFI yielded high-quality images with sharper and smoother borders between the endolymph and perilymph and a higher signal intensity ratio and more homogenous perilymph enhancement than those generated with MIIRMR (p < 0.01). There were predominantly grade II EHs in the cochleae and grade III EHs in the vestibule in definite MD. EH was detected in the apex of 11/16 ipsilateral ears, 3/16 contralateral ears in unilateral definite MD and 3/6 ears in bilateral MD. Conclusions The novel hT2W–FLAIR–MZFI technique is sensitive and demonstrates strong and homogenous enhancement by minimum Gd–DTPA in the inner ear, including the apex, and yields high-quality images with sharp borders between the endolymph and perilymph. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of PET-CT, CT and MRI scan in initial staging and management of head and neck cancers

paythelady.61 shared this article with you from Inoreader Comparison of PET-CT, CT and MRI scan in initial staging and management of head and neck cancers Via Latest Results for European Archives of Oto-Rhino-Laryngology Abstract Background To evaluate the utility of positron-emission tomography (FDG PET) in initial staging and management of head and neck cancers. Methods This is a retrospective study of 99 treatment naïve head and neck cancer patients treated between January 2017 and December 2020 at a tertiary teaching centre. Change in initial staging and management was noted based on PET scan compared to cross-sectional imaging (CT and MRI). Results There were 73 (73.7%) males and 26 (26.2%) females with male-to-female ratio of 2.8:1.Overall, change in management was seen in 36/99 (36.4%) patients due to PET scan. With regards to initial staging, T, N and M stage was changed in 14/99 (14.1%), 19/99 (19.1%) and 3/99 (3%) patients, respectively. These changes were significantly higher in patients with unknown primary (63.3%, p value −0.001) and N3 (41%, p −0.045) nodal disease. Conclusion PET-CT plays an important role in appropriate initial staging and subsequent treatment planning of head and neck cancers. Advances in knowledge Initial staging PETCT changes management in 36.4% cases. Accuracy of various different imaging modalities have been compared. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skeletal maturation in different anteroposterior and vertical skeletal growth patterns in female subjects

paythelady.61 shared this article with you from Inoreader Skeletal maturation in different anteroposterior and vertical skeletal growth patterns in female subjects Via Latest Results for Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Abstract Purpose The aim of the present work was to study the sequence of skeletal maturation in the various anteroposterior and vertical skeletal growth patterns and to detect whether differences existed between them. Methods Cephalograms of 861 growing and adolescent female patients were traced to categorize the subjects into 9 skeletal patterns. Each subject was assigned a skeletal maturational stage. Analysis of variance (ANOVA) followed by Bonferroni test were used to detect differences in the onset of the three growth stages (prepubertal, pubertal and postpubertal) between the 9 groups. The same statistical methods were used to detect differences between the mean ages at the three growth stages within each group. Results No statistically significant differences were found between the mean ages of pubertal and postpubertal growth stages between the 9 skeletal patterns. However, class III growers had a significantly earlier onset of prepubertal growth (10.25 ± 1.56 years) when compared to that of class II high angle cases (11.11 ± 1.67 years; P < 0.01). Also, significant differences were found between the mean ages at the three growth stages within the groups. Conclusion A map was created defining the sequence of skeletal maturation for each skeletal growth pattern. This map defines clinically relevant differences in the starting time points and the optimum intervals of growth modification for each skeletal growth pattern. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Between a Rock and a Hard Place: Anticoagulating an Adolescent with Post-Tonsillectomy Massive PE: A Case Report

paythelady.61 shared this article with you from Inoreader Between a Rock and a Hard Place: Anticoagulating an Adolescent with Post-Tonsillectomy Massive PE: A Case Report Via SAGE Publications Inc: Annals of Otology, Rhinology & Laryngology: Table of Contents Annals of Otology, Rhinology &Laryngology, Ahead of Print. Objectives:To report a case of a morbidly obese 17-year-old boy who presented 4 days post-tonsillectomy with acute deep venous thromboses and a massive pulmonary embolism. To describe a protocol and decision-making tree for providing anticoagulation in the immediate post-tonsillectomy period.Methods:A chart review and review of the literature.Results:The patient ultimately did well and had no bleeding from the tonsil beds or further thromboembolic complications. A review of the literature revealed no available data regarding the safety of anticoagulation in the immediate post-tonsillectomy period.Conclusions:We propose that if anticoagulation is needed within 14 days of tonsillectomy, submaximal anticoagulation with a reversible and titratable anticoagulant may be optimal. A multidisciplinary team approach is needed for these complex cases. Future reporting and investigation of anticoagulation post-tonsillec tomy is needed. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quantitative proteomics in medication‐related osteonecrosis of the jaw: a proof‐of‐concept study

paythelady.61 shared this article with you from Inoreader Quantitative proteomics in medication‐related osteonecrosis of the jaw: a proof‐of‐concept study Via Oral Diseases ABSTRACT Objective Medication-related osteonecrosis of the jaw (MRONJ) is a paradoxical effect associated with bone modifying agents (BMAs) and other drugs. Currently no valuable diagnostic or prognosis biomarkers exist. This goal of this research was to study MRONJ related salivary proteome. Materials and Methods This case-control aimed to study salivary proteome in MRONJ versus control groups i) formed from BMAs consumers and ii) healthy individuals to unravel biomarkers. 38 samples of unstimulated whole saliva (18 MRONJ patients, 10 BMA consumers, and 10 healthy controls) were collected. Proteomic analysis by SWATH-MS coupled to bioinformatics analysis was executed. Results 586 proteins were identified, 175 proteins showed significant differences among MRONJ versus controls. SWATH-MS revealed differentially expressed proteins among three groups, which have never isolated. These proteins had distinct roles including cell envelope organization, positive regulation of vesicle fusion, positive regulation of receptor binding, or regulation of low-density lipoprotein particle clearance. Integrative analysis prioritised 3 proteins (MMP9, AACT and HBD). Under receiver operating characteristic analysis, this panel discriminated MRONJ with a sensitivity of 90% and a specificity of 78.9%. Conclusion These findings may inform of a novel biomarker panel for MRONJ prediction or diagnosis. Nonetheless, further research is needed to validate this panel. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of folate supplementation on recurrence and metabolic status of cervical intraepithelial neoplasia grade 2/3 in overweight and obese women: a randomized double-blind placebo-controlled trial

paythelady.61 shared this article with you from Inoreader Effects of folate supplementation on recurrence and metabolic status of cervical intraepithelial neoplasia grade 2/3 in overweight and obese women: a randomized double-blind placebo-controlled trial Via European Journal of Clinical Nutrition - Issue - nature.com science feeds European Journal of Clinical Nutrition, Published online: 05 April 2022; doi:10.1038/s41430-021-01022-0 Effects of folate supplementation on recurrence and metabolic status of cervical intraepithelial neoplasia grade 2/3 in overweight and obese women: a randomized double-blind placebo-controlled trial View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of Responses to DCN vs. VCN Stimulation in a Mouse Model of the Auditory Brainstem Implant (ABI)

paythelady.61 shared this article with you from Inoreader Comparison of Responses to DCN vs. VCN Stimulation in a Mouse Model of the Auditory Brainstem Implant (ABI) Via Latest Results for Journal of the Association for Research in Otolaryngology Abstract The auditory brainstem implant (ABI) is an auditory neuroprosthesis that provides hearing to deaf patients by electrically stimulating the cochlear nucleus (CN) of the brainstem. Whether such stimulation activates one or the other of the CN's two major subdivisions is not known. Here, we demonstrate clear response differences from the stimulation of the dorsal (D) vs. ventral (V) subdivisions of the CN in a mouse model of the ABI with a surface-stimulating electrode array. For the DCN, low levels of stimulation evoked multiunit responses in the inferior colliculus (IC) that were unimodally distributed with early latencies (avg. peak latency of 3.3 ms). However, high levels of stimulation evoked a bimodal distribution with the addition of a late latency response peak (avg. peak latency of 7.1 ms). For the VCN, in contrast, electrical stimulation elicited multiunit responses that were usually unimodal and had a latency similar to the DCN's late respon se. Local field potentials (LFP) from the IC showed components that correlated with early and late multiunit responses. Surgical cuts to sever the output of the DCN, the dorsal acoustic stria (DAS), gave insight into the origin of these early and late responses. Cuts eliminated early responses but had little-to-no effect on late responses. The early responses thus originate from cells that project through the DAS, such as DCN's pyramidal and giant cells. Late responses likely arise from the spread of stimulation from a DCN-placed electrode array to the VCN and could originate in bushy and/or stellate cells. In human ABI users, the spread of stimulation in the CN may result in abnormal response patterns that could hinder performance. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Occlusal schemes for complete dentures

paythelady.61 shared this article with you from Inoreader Message: APR 4 2022Profile photo of Derek Richards Posted by Derek Richards shutterstock_13679275 Occlusal schemes for complete dentures may influence clinical performance and patient satisfaction. Patient characteristics such as alveolar ridge shape and height also influence choice of scheme. There are several schemes to choose from including bilateral balanced, lingualised, canine guidance, group function, and monoplane. A number of studies and reviews have been conducted but a consensus on an ideal occlusal scheme if lacking. The aim of this overview was to assess the methodological quality and summarize the scientific evidence from secondary studies about the influence of occlusal schemes on the clinical performance of and patient satisfaction with complete dentures. Methods A protocol for the review was registered with PROSPERO. Searches were carried out in the Cochrane Library, PubMed, Embase, LILACS, Scopus, the Web of Science, PROSPERO, Google Scholar and Open Science Framework databases. Systematic reviews that included randomized or non-randomized clinical trials evaluating conventional complete dentures with different occlusion schemes on clinical performance and patient satisfaction were considered. Two reviewers independently selected studies and extracted data with disagreements being resolved by a third reviewers. The AMSTAR 2 tool was used to assess the quality of the reviews. The effect of each occlusal scheme in comparison with others was summarized and classified as positive, neutral, negative, or inconclusive based on the conclusions of the systematic review concerning clinical performance and patient satisfaction outcomes. Results 10 systematic reviews were included. All 10 reviews included randomised controlled trials (RCTs) 5 also included prospective studies, 2 included other systematic reviews, 2 included clinical studies involving partial dentures or implants. No meta-analyses were presented in any of the 10 reviews. Confidence in the reviews was rated as critically low for 7 reviews, low for 2 reviews and moderate for one review using the AMSTAR 2 tool. Summary suggested that occlusal schemes may influence objective and subjective clinical performance and patients' satisfaction. Conclusions The authors concluded: – .occlusal schemes might interfere with the clinical performance of and patient satisfaction with complete dentures. Lingualized, bilateral balanced, and canine guidance are preferred compared with monoplane occlusion, but lingualized occlusion tends to show better results in some reviews. However, the results should be carefully considered because of the low quality of the systematic reviews included. Occlusal schemes for complete dentures Via The Dental Elf This overview of reviews of the influence of occlusal schemes on the clinical performance of and patient satisfaction with complete dentures included 10 systematic reviews. While the findings suggest that occlusal schemes might interfere with the clinical performance the results should be carefully considered because of the low quality of the systematic reviews included. The post Occlusal schemes for complete dentures appeared first on National Elf Service. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.