Publications by authors named "William Johnston"

254 Publications

Growth and tolerance of healthy, term infants fed lower protein extensively hydrolyzed or amino acid-based formula: double-blind, randomized, controlled trial.

BMC Pediatr 2021 Jul 21;21(1):323. Epub 2021 Jul 21.

Medical Affairs and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Evansville, IN, 47721, USA.

Background: Optimal protein level in hypoallergenic infant formulas is an area of ongoing investigation. The aim was to evaluate growth of healthy term infants who received extensively hydrolyzed (EH) or amino acid (AA)-based formulas with reduced protein.

Methods: In this prospective, multi-center, double-blind, controlled, parallel group study, infants were randomized to receive a marketed EH casein infant formula at 2.8 g protein/100 kcal (Control) or one of two investigational formulas: EH casein formula at 2.4 g protein/100 kcal (EHF) or AA-based formula at 2.4 g total protein equivalents/100 kcal (AAF). Control and EHF each had 2 × 10 CFU Lactobacillus rhamnosus GG/100 kcal. Anthropometrics were measured and recall of formula intake, tolerance, and stool characteristics was collected at 14, 30, 60, 90, 120 days of age. Primary outcome was weight growth rate (g/day) between 14 and 120 days of age (analyzed by ANOVA). Medically confirmed adverse events were recorded throughout the study.

Results: No group differences in weight or length growth rate from 14 to 120 days were detected. With the exception of significant differences at several study time points for males, no group differences were detected in mean head circumference growth rates. However, mean achieved weight, length, and head circumference demonstrated normal growth throughout the study period. No group differences in achieved weight or length (males and females) and head circumference (females) were detected and means were within the WHO growth 25th and 75th percentiles from 14 to 120 days of age. With the exception of Day 90, there were no statistically significant group differences in achieved head circumference for males; means remained between the WHO 50th and 75th percentiles for growth at Days 14, 30, and 60 and continued along the 75th percentile through Day 120. No differences in study discontinuation due to formula were detected. The number of participants for whom at least one adverse event was reported was similar among groups.

Conclusions: This study demonstrated hypoallergenic infant formulas at 2.4 g protein/100 kcal were safe, well-tolerated, and associated with appropriate growth in healthy term infants from 14 to 120 days of age.

Trial Registration: ClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT01354366 . Registered 13 May 2011.
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http://dx.doi.org/10.1186/s12887-021-02617-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293492PMC
July 2021

Development of a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis.

Pilot Feasibility Stud 2021 Jun 16;7(1):127. Epub 2021 Jun 16.

School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.

Background: Patients with end-stage kidney disease who receive haemodialysis experience a protracted treatment regimen that can result in an increased risk of depression and anxiety. Arts-based interventions could address this unique issue; however, no arts-based interventions have been developed for delivery within a haemodialysis unit and evaluation within a randomised controlled trials (RCTs).

Aim: To develop a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis.

Methods: The development process utilised the Arts in Health framework (Fancourt, 2017). The framework was addressed through the establishment of an interdisciplinary advisory group, collaboration and consultation with stakeholders, a scoping and realist review, shadowing of artists-in-residence, personal arts practice and logic modelling.

Results: The intervention involved six 1-h long, one-to-one facilitated sessions focused on creative writing and visual art. Patients could choose between art form and self-select a subject matter. The sessions had a primary focus on skill development and were delivered using principles derived from the psychological theory of flow.

Conclusion: The Arts in Health framework provided an appropriate and pragmatic approach to intervention development. Complex arts-based interventions can be developed for the purpose of evaluation within a trial framework. This intervention was designed to strike a balance between standardised components, and a person-centred approach necessary to address existential boredom.
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http://dx.doi.org/10.1186/s40814-021-00868-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207758PMC
June 2021

Screw stability of CAD-CAM titanium and zirconia abutments on different implants: An in vitro study.

Clin Implant Dent Relat Res 2021 Jun 2;23(3):373-379. Epub 2021 May 2.

Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA.

Background: Limited information is available regarding the removal torque values (RTVs) of screws of different abutment materials when used with different implants.

Purpose: To evaluate the effect of implant type and abutment material (zirconia; Zir and titanium; Ti) on the RTVs of abutment screws after cyclic loading.

Materials And Methods: Internal conical connection implants (CC, OsseoSpeed TX) and modified internal conical connection implants (MCC, OsseoSpeed EV) (n = 10) were clamped in resin dies. Zir and Ti (N = 20) custom abutments were tightened to implants (20 Ncm for CC and 25 Ncm for MCC) as specified by their manufacturers. The abutments were cyclically loaded by using a sequentially increased loading protocol; 2-million cycles under 100 N, 3-million cycles under 200 N, and 2-million cycles under 300 N loads with 2 Hz. After 7 million cycles, RTVs (Ncm) were measured by using a torque gauge. The data were analyzed with ANOVA by using the restricted maximum likelihood estimation method. Tukey-Kramer adjustment was used for any significant interaction of implant-abutment pairs (α = 0.05).

Results: Two CC implants, 1 with Ti and 1 with Zir abutment, fractured during cyclic loading (under 300 N loads within the 6th and 7th million cycles) and discarded for statistical analysis. Only implant type had a significant effect on RTVs (p <0.001). Screws of Ti abutments on MCC implants had significantly higher RTVs than the screws of Ti (p = 0.003) and Zir (p = 0.005) abutments on CC implants.

Conclusions: Implant type affected the RTVs, however, the RTVs were higher than the initial torque values for all groups. Screws of Ti abutments on implant, which required greater initial torque values had higher RTVs than the screws of Ti and Zir abutments on the implant that required smaller initial torque values. RTVs were similar for Zir and Ti abutment screws within each implant type.
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http://dx.doi.org/10.1111/cid.13001DOI Listing
June 2021

Effect of crown height on the screw joint stability of zirconia screw-retained crowns.

J Prosthet Dent 2021 Apr 8. Epub 2021 Apr 8.

Professor, Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio.

Statement Of Problem: Medium- to long-term data for the performance of zirconia crowns with titanium (Ti) bases are sparse, particularly when the crown height space and occlusal loads are high.

Purpose: The purpose of this in vitro study was to assess the effect of the height of zirconia screw-retained implant crowns with a Ti base on the screw joint stability after cyclic loading. A secondary aim was to investigate the survival of zirconia crowns of different heights after cyclic loading.

Material And Methods: Twenty-one internal connection implants were secured between fiberglass-reinforced epoxy resin sleeves. Mandibular first molar monolithic zirconia crowns with 3 different heights (6 mm, 10 mm, and 14 mm) were milled and bonded to the Ti bases (n=7). The screws were tightened to 30 Ncm, and a 30-degree 120-N cyclic load was applied to the crowns at 2 Hz for 5 million cycles. After 5 million cycles, the crowns were evaluated for stability, and the same protocol was repeated for 275-N and 435-N loads for 5 million cycles each. After loading, the detorque values were recorded. Failure was characterized based on whether the crown, screw, and/or implant fracture was observed. The detorque values were analyzed by using a 1-way-ANOVA with the restricted maximum likelihood estimation. The percentage of torque loss was calculated. The LIFETEST procedure was used to analyze the survival probability of the groups (α=.05).

Results: The effect of crown height on the detorque values of screws was not found to be statistically significant (P>.05). The mean detorque value for 6-mm crowns was 23.5 Ncm, 24.4 Ncm for 10-mm crowns, and 22.1 Ncm for 14-mm crowns. A significant effect of crown height was found on the survival (P=.006), and the time-to-failure survival of 14-mm crowns was significantly lower than the survival of 6 mm and 10 mm crowns (P=.020), where no failures were observed. Four 14-mm crowns failed between the 1 and 2 million cycles after the loads were increased to 435 N. The failure modes were the same for all the crowns, implants, and screws fractured.

Conclusions: When the tested internal connection implant was used, the crown height did not affect the detorque values, and 14-mm crowns performed similarly to the shorter crowns in terms of torque loss after cyclic loading. However, survival of the 14-mm crown-implant complex was lower, resulting in screw and implant fractures.
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http://dx.doi.org/10.1016/j.prosdent.2021.02.027DOI Listing
April 2021

Electrochemical impedance spectroscopy study of corrosion characteristics of palladium-silver dental alloys.

J Biomed Mater Res B Appl Biomater 2021 Apr 4. Epub 2021 Apr 4.

Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio, USA.

Electrochemical impedance spectroscopy (EIS) has been used to obtain insight into corrosion processes for three Pd-Ag alloys, and compare their behavior with an Au-Pd alloy. Five specimens of each alloy received clinically-appropriate simulated porcelain-firing heat treatment. EIS testing was performed at ambient temperature, using 0.09% NaCl, 0.9% NaCl and Fusayama solutions. EIS data are presented as Bode plots. At the open-circuit potential (OCP), the data fit a modified Randles equivalent electrical circuit with a constant phase element (CPE), and the charge-transfer resistance (R ) and the two CPE parameters (CPE-T and CPE-P) were determined. The area-normalized capacitance of the double layer (C ) was also calculated. The EIS data at two relevant elevated potentials in the passive range were also found to fit well a modified Randles equivalent circuit with different values for the charge transfer resistance and CPE parameters. At the OCP no significant effect on R was found for the alloys and electrolytes, and both alloy and electrolyte significantly affected CPE-P. In vitro corrosion was controlled by charge transfer and charge accumulation processes, and the behavior differed at the elevated potentials compared to the OCP. Significant effects were found for alloy, electrolyte, and alloy/electrolyte interaction on C at the OCP. The EIS parameters at elevated potentials indicate that the Pd-Ag alloys should have satisfactory clinical corrosion resistance. The EIS analyses yielded information about in vitro corrosion of these alloys that cannot be obtained from potentiodynamic polarization testing.
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http://dx.doi.org/10.1002/jbm.b.34837DOI Listing
April 2021

The association between habitual posture and intensity-related physical activity with sympathetic neurohemodynamic transduction in young males.

Clin Auton Res 2021 04 30;31(2):339-341. Epub 2021 Mar 30.

Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada.

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http://dx.doi.org/10.1007/s10286-021-00802-9DOI Listing
April 2021

Concussion History and Balance Performance in Adolescent Rugby Union Players.

Am J Sports Med 2021 04 17;49(5):1348-1354. Epub 2021 Mar 17.

Royal Victoria Hospital, Belfast, UK.

Background: Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players.

Hypothesis: Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes (, , and ).

Results: Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- ( = .47) and dual-task ( = .67) conditions.

Conclusion: Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.
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http://dx.doi.org/10.1177/0363546521998709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020306PMC
April 2021

Effect of Crown Height on the Screw Stability of Titanium Screw-Retained Crowns.

J Prosthodont 2021 Jul 27;30(6):515-519. Epub 2021 Mar 27.

Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, OH, USA.

Purpose: The aim of this in vitro study was to evaluate the effect of crown height on the screw stability of screw-retained titanium implant crowns subjected to cyclic loading conditions.

Materials And Methods: Twenty-one implants with internal hex connections were placed in epoxy resin holders. Mandibular first molar screw-retained titanium implant crowns with UCLA type, crown-abutment connections were CAD/CAM fabricated. Seven crowns of 3 different heights (6 mm, 10 mm, and 14 mm) were made. The crowns were seated onto the implants and screws were tightened to 30 Ncm. The implants were clamped into holders and stepwise cyclic loads were applied to the occlusal surface at 30-degree angles to the long axes of the crowns. The detorque values were measured after each 5 million cycles. Before increasing the applied load, the crowns were secured with new screws and tightened to 30 Ncm. Failure times, survival estimates and detorque values were then analyzed. (alpha = 0.05).

Results: Crown height did not significantly affect detorque values. However, five 14-mm crowns failed with varying fractures during the 475 N loading condition. Overall, a significantly lower survival for 14 mm crowns was found compared to 6 mm and 10 mm crowns (p = 0.004).

Conclusions: Crown heights of one-piece screw-retained titanium implant crowns did not significantly affect detorque values. Screw fracture, however, was greater for crown height of 14 mm than those of 6 mm and 10 mm.
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http://dx.doi.org/10.1111/jopr.13352DOI Listing
July 2021

Effect of cyclic loading on reverse torque values of angled screw channel systems.

J Prosthet Dent 2021 Feb 19. Epub 2021 Feb 19.

Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio; Associate Professor, Department of Reconstructive Dentistry and Gerodontology, University of Bern, School of Dental Medicine, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive, and Pediatric Dentistry, University of Bern, School of Dental Medicine, Bern, Switzerland.

Statement Of Problem: The angled screw channel concept has become popular. However, research is lacking as to how reverse torque values of nonaxially tightened implant crowns compare with axially tightened cement-retained crowns restored on angle-correcting abutments when subjected to long-term cyclic loading.

Purpose: The purpose of this in vitro study was to evaluate the ability of different 25-degree angled screw channel hexalobular systems to apply the target torque value on their screws, the effect of cyclic loading on their reverse torque values, and their survival compared with crowns cemented on conventional 0-degree screw channel abutments.

Material And Methods: A total of 28 implants were divided into 4 groups. Twenty-one angled screw channel crowns were fabricated at a 25-degree angle correction by using angled titanium (Ti) bases by 3 manufacturers DY (Dynamic Tibase), DE (AngleBase), and ASC (Angulated Screw Channel) (n=7). The fourth group, UB (Universal Base, Control), had cement-retained crowns with 25-degree custom-milled, angled zirconia abutments that were cemented onto their respective Ti bases (n=7). All implants were embedded in epoxy resin blocks and tightened to manufacturer recommended values: 35 Ncm for ASC, UB, and DE and 25 Ncm for DY. Initial torque values (ITV1) were recorded. After 24 hours, the reverse torque values (24hr-RTV1) were recorded. A new set of screws was then used for each group, and the initial torque values (ITV2) were recorded. Specimens were loaded at 2 Hz for 5 million cycles under a 200-N load, and reverse torque values (RTV2) were recorded. ANOVA (α=.05) was used to compare differences in the means of deviation of initial torque values and means of reverse torque values followed by a Tukey-Kramer post hoc analysis (α=.05). Preload efficiency was calculated for each system (RTV2/ITV2), and a survival analysis was performed by using the Lifetest procedure.

Results: A significant difference in the means of deviation of initial torque values of the groups with 25-degree torque application (DY, DE, and ASC) was found when compared with UB at 0 degrees. ASC and DE had lower initial torque values than UB (P<.001 and P=.003 for ASC ITV1 and ITV2, P<.001 and P=.006 for DE ITV1 and ITV2). A significant difference was found in mean reverse torque values both for after 24 hours and after cyclic loading among all groups (P<.001). A significant difference was found between mean reverse torque values before and after cyclic loading for each group (P<.001). Preload efficiency was 43.8% for DY, 46.8% for DE, 54.2% for ASC, and 48.5% for UB. No significant difference was found in the time-to-failure survival among groups (P>.05).

Conclusions: The hexalobular system of DY delivered comparable initial torque values to its target value at 25 degrees, similar to how UB (control group) delivered at 0 degrees. ASC and DE scored lower initial torque values than their target value compared with UB. The DY abutment, which had a lower manufacturer recommended torque value, had lower reverse torque values compared with those of other groups. Time-to-failure survival of all groups was similar. Fractures at the zirconia to titanium base connection were seen with ASC crowns.
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http://dx.doi.org/10.1016/j.prosdent.2020.12.020DOI Listing
February 2021

ICP-MS measurements of elemental release from two palladium alloys into a corrosion testing medium for different solution volumes and agitation conditions.

J Prosthet Dent 2021 Feb 14. Epub 2021 Feb 14.

Professor Emeritus, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio.

Statement Of Problem: The in vivo release of Pd from palladium alloys into the oral environment and sensitivity reactions by patients has been of concern. However, little information is available about the variation in elemental release from different palladium alloys.

Purpose: The purpose of this in vitro study was to compare the elemental release into a corrosion-testing medium from a high-palladium alloy (Freedom Plus, 78Pd-8Cu-5Ga-6In-2Au) and a Pd-Ag alloy (Super Star, 60Pd-28Ag-6In-5Sn) under different conditions.

Material And Methods: Alloys were cast into Ø12×1-mm-thick disks, subjected to simulated porcelain-firing heat treatment, polished, and ultrasonically cleaned in ethanol. Three specimens of each alloy were immersed for 700 hours in a solution for in vitro corrosion testing (ISO Standard 10271) that was maintained at 37 °C. Two solution volumes (125 mL and 250 mL) were used, and the solutions were subjected to either no agitation or agitation. Elemental compositions of the solutions were analyzed by using inductively coupled plasma-mass spectroscopy (ICP-MS). Concentrations of released elements from each alloy for the 2 solution volumes and agitation conditions were compared by using the restricted maximum likelihood estimation method with a 4-way repeated-measures ANOVA, the Satterwhite degrees of freedom method, a lognormal response distribution, and the covariance structure of compound symmetry.

Results: For the 4 combinations of solution volume and agitation conditions, the mean amount of palladium released was 3 orders of magnitude less for the Pd-Ag alloy (0.009 to 0.017 μg/cm of alloy surface) compared with the Pd-Cu-Ga alloy (17.9 to 28.7 μg/cm). Larger mean amounts of Sn, Ga, Ag, and In (0.29 to 0.39, 0.57 to 0.83, 0.71 to 1.08, and 0.91 to 1.25 μg/cm, respectively) compared with Pd were released from the Pd-Ag alloy. Smaller amounts of Cu, Ga, and In (4.8 to 9.9, 5.9 to 12.8, and 4.2 to 9.5 μg/cm, respectively) compared with Pd were released from the Pd-Cu-Ga alloy. The Ru released was much lower for the Pd-Ag alloy (0.002 μg/cm) than the Pd-Cu-Ga alloy (0.032 to 0.053 μg/cm). Statistically significant differences (P<.001) in elemental release were found for the factors of alloy and element and the alloy×element interaction. Significant differences were found for the solution volume (P=.022), solution volume×element interaction (P=.022), and alloy×solution volume×element interaction (P=.004). No significant effect was found for agitation condition.

Conclusions: The relative amounts of released elements from each alloy were not proportional to the relative amounts in the composition. The amounts of Pd and Ga released from the Pd-Cu-Ga alloy were consistent with the breakdown of a PdGa microstructural phase and perhaps some dissolution of the palladium solid solution matrix. Precipitates, rather than the palladium solid solution matrix, appeared to undergo greater dissolution in the Pd-Ag alloy. The Pd-Ag alloy should have lower risk of adverse biological reactions than the Pd-Cu-Ga alloy.
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http://dx.doi.org/10.1016/j.prosdent.2020.12.038DOI Listing
February 2021

Surface roughness of high-performance polymers used for fixed implant-supported prostheses.

J Prosthet Dent 2021 Feb 11. Epub 2021 Feb 11.

Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio. Electronic address:

Statement Of Problem: High-performance polymers have been recommended by their manufacturers as a framework material for implant-supported fixed prostheses. However, little is known about the surface roughness of high-performance polymers in different compositions and whether they require layering with a composite resin or acrylic resin on the tissue surface.

Purpose: The purpose of this in vitro study was to evaluate the surface roughness of different computer-aided design and computer-aided manufacture (CAD-CAM) high-performance polymers and the effect of polishing on their surface roughness.

Material And Methods: Seventy high-performance polymer specimens (n=10) for 4 different polyetheretherketone (PEEK) brands (BRE, CP, ZZ, J), 1 polyetherketoneketone (PEKK) (PK), and 2 different fiber-reinforced composite resin (FRC) materials (T, TR) were milled from 7×8×30-mm CAD-CAM blocks. The surface roughness (Ra) of each specimen was measured on the same surfaces after milling (baseline) and after polishing by using a contact profilometer. Two-way repeated measures ANOVA (MIXED procedure) and the Bonferroni corrected t test (α=.05) were used to analyze the surface roughness data.

Results: No significant differences were found among high-performance polymers when the baseline surface roughness measurements of the materials were compared (P>.05). All materials (BRE, PK, CP, T, TR, ZZ), except for a PEEK material (J) (P<.05), had no significant differences in their surface roughness before and after polishing. After polishing, the surface roughness of the J PEEK material was higher than that of CP, PK, T, and ZZ (P<.05).

Conclusions: The surface roughness of high-performance polymers in different compositions after milling was similar. Polishing increased the surface roughness of only one PEEK (J) material. All surface roughness values were above the clinical acceptability threshold of 0.2 μm.
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http://dx.doi.org/10.1016/j.prosdent.2020.11.029DOI Listing
February 2021

The Subgingival Plaque Microbiome, Systemic Antibodies Against Bacteria and Citrullinated Proteins Following Periodontal Therapy.

Pathogens 2021 Feb 10;10(2). Epub 2021 Feb 10.

Oral Sciences, College of Medical, Veterinary and Life Sciences, Dental School, University of Glasgow, Glasgow G12 8QQ, UK.

Periodontitis (PD) shows an association with rheumatoid arthritis (RA) and systemic inflammation. Periodontal pathogens, namely and , are proposed to be capable of inducing citrullination of peptides in the gingiva, inducing the formation of anti-citrullinated protein antibodies (ACPAs) within susceptible hosts. Here, we sought to investigate whether periodontal treatment influenced systemic inflammation and antibody titres to , , and ACPA in 42 systemically health patients with periodontal disease. Subgingival plaque and serum samples were collected from study participants before (baseline) and 90 days after treatment to analyse the abundance of specific bacteria and evaluate anti-bacterial antibodies, C-reactive protein (CRP), tumour necrosis factor α (TNF-α), interleukin 6 (IL-6) and ACPA in serum. Following treatment, all patients showed reduced periodontal inflammation. Despite observing a weak positive correlation between CRP and IL-6 with periodontal inflammation at baseline, we observed no significant reductions in any indicators of systemic inflammation 90 days after treatment. In contrast, anti- IgG significantly reduced post-treatment ( < 0.001, Wilcoxon signed rank test), although no changes were observed for other antibody titres. Patients who had detectable in subgingival plaques had significantly higher anti- IgG and ACPA titres, suggesting a potential association between colonisation and systemic antibody titres.
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http://dx.doi.org/10.3390/pathogens10020193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916579PMC
February 2021

Rehearsal's effect on recall and comprehension of orthodontic informed consent.

Am J Orthod Dentofacial Orthop 2021 Apr 8;159(4):e331-e341. Epub 2021 Feb 8.

Cincinnati Insurance Company, Cincinnati, Ohio.

Introduction: Proper informed consent allows patients to take an active role in their own treatment decisions, and enhanced compliance might improve treatment outcomes. The objective of this research was to determine if handwritten rehearsal of core and custom consent items would increase short-term recall and comprehension.

Methods: A total of 90 patient-parent pairs were randomly assigned to 2 groups. After case presentation, each subject was provided 10 minutes to read a modified informed consent document. Group A received visual printouts containing the 4 core elements (root resorption, decalcification, pain, and relapse/retention) likely to be encountered by all patients and up to 4 custom elements (eg, impacted teeth, orthognathic surgery, or other case-specific treatment issues). Subjects identified and wrote what the image depicted and how it could affect treatment. Group B viewed a slideshow presentation on all 18 consent elements arranged from general to specific. All participants were interviewed, and each provided their sociodemographic data, as well as completed literacy, health literacy, and state anxiety questionnaires. The groups were compared for recall and comprehension through an analysis of covariance.

Results: The rehearsal intervention significantly improved recall and comprehension of the core elements (P = 0.001). Rehearsal also improved custom recall and comprehension, but not significantly. Group B performed significantly better on treatment questions (P = 0.001). Overall, as anxiety increased, correct responses decreased.

Conclusions: The rehearsal group improved recall and comprehension of the core and custom elements of informed consent and proved a more efficient method than an audiovisual presentation to provide informed consent. It also improved meeting legal obligations.
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http://dx.doi.org/10.1016/j.ajodo.2020.09.026DOI Listing
April 2021

Evaluation of Patient- and Surgeon-Specific Variations in Patient-Reported Urinary Outcomes 3 Months After Radical Prostatectomy From a Statewide Improvement Collaborative.

JAMA Surg 2021 Mar 10;156(3):e206359. Epub 2021 Mar 10.

Department of Urology, Henry Ford Health System, Detroit, Michigan.

Importance: Understanding variation in patient-reported outcomes following radical prostatectomy may inform efforts to reduce morbidity after this procedure.

Objective: To describe patient-reported urinary outcomes following radical prostatectomy in the diverse practice settings of a statewide quality improvement program and to explore whether surgeon-specific variations in observed outcomes persist after accounting for patient-level factors.

Design, Setting, And Participants: This prospective population-based cohort study included 4582 men in the Michigan Urological Surgery Improvement Collaborative who underwent radical prostatectomy as primary management of localized prostate cancer between April 2014 and July 2018 and who agreed to complete validated questionnaires prior to surgery and at 3, 6, and 12 months after surgery. Data were analyzed from 2019 to June 2019.

Exposures: Radical prostatectomy.

Main Outcomes And Measures: Patient- and surgeon-level analyses of patient-reported urinary function 3 months after radical prostatectomy. Outcomes were measured using validated questionnaires with results standardized using previously published methods. Urinary function survey scores are reported on a scale from 0 to 100 with good function established as a score of 74 or higher.

Results: For the 4582 men undergoing radical prostatectomy within the Michigan Urological Surgery Improvement Collaborative who agreed to complete surveys, mean (SD) age was 63.3 (7.1) years. Survey response rates varied: 3791 of 4582 (83%) responded at baseline, 3282 of 4137 (79%) at 3 months, 2975 of 3770 (79%) at 6 months, and 2213 of 2882 (77%) at 12 months. Mean (SD) urinary function scores were 88.5 (14.3) at baseline, 53.6 (27.5) at 3 months, 68.0 (25.1) at 6 months, and 73.7 (23.0) at 12 months. Regression analysis demonstrated that older age, lower baseline urinary function score, body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher, clinical stage T2 or higher, and lack of bilateral nerve-sparing surgery were associated with a lower probability of reporting good urinary function 3 months after surgery. When evaluating patients with good baseline function, the rate at which individual surgeons' patients reported good urinary function 3 months after surgery varied broadly (0% to 54.5%; P < .001). Patients receiving surgery from top-performing surgeons were more likely to report good 3-month function. This finding persisted after accounting for patient risk factors.

Conclusions And Relevance: In this study, patient- and surgeon-level urinary outcomes following prostatectomy varied substantially. Documenting surgeon-specific variations after accounting for patient factors may facilitate identification of surgical factors associated with superior outcomes.
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http://dx.doi.org/10.1001/jamasurg.2020.6359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948058PMC
March 2021

"It's Not as Simple as Just Looking at One Chart": A Qualitative Study Exploring Clinician's Opinions on Various Visualisation Strategies to Represent Longitudinal Actigraphy Data.

Digit Biomark 2020 26;4(Suppl 1):87-99. Epub 2020 Nov 26.

Insight Centre of Data Analytics, University College, Dublin, Ireland.

Background: Data derived from wearable activity trackers may provide important clinical insights into disease progression and response to intervention, but only if clinicians can interpret it in a meaningful manner. Longitudinal activity data can be visually presented in multiple ways, but research has failed to explore how clinicians interact with and interpret these visualisations. In response, this study developed a variety of visualisations to understand whether alternative data presentation strategies can provide clinicians with meaningful insights into patient's physical activity patterns.

Objective: To explore clinicians' opinions on different visualisations of actigraphy data.

Methods: Four visualisations (stacked bar chart, clustered bar chart, linear heatmap and radial heatmap) were created using Matplotlib and Seaborn Python libraries. A focus group was conducted with 14 clinicians across 2 hospitals. Focus groups were audio-recorded, transcribed and analysed using inductive thematic analysis.

Results: Three major themes were identified: (1) the importance of context, (2) interpreting the visualisations and (3) applying visualisations to clinical practice. Although clinicians saw the potential value in the visualisations, they expressed a need for further contextual information to gain clinical benefits from them. Allied health professionals preferred more granular, temporal information compared to doctors. Specifically, physiotherapists favoured heatmaps, whereas the remaining members of the team favoured stacked bar charts. Overall, heatmaps were considered more difficult to interpret.

Conclusion: The current lack of contextual data provided by wearables hampers their use in clinical practice. Clinicians favour data presented in a familiar format and yet desire multi-faceted filtering. Future research should implement user-centred design processes to identify ways in which all clinical needs can be met, potentially using an interactive system that caters for multiple levels of granularity. Irrespective of how data is displayed, unless clinicians can apply it in a manner that best supports their role, the potential of this data cannot be fully realised.
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http://dx.doi.org/10.1159/000512044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768127PMC
November 2020

Displacement and performance of abutments in narrow-diameter implants with different internal connections.

J Prosthet Dent 2021 Jan 4. Epub 2021 Jan 4.

Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio. Electronic address:

Statement Of Problem: Displacement of abutments into conical connection implants during screw tightening may also occur during functional loading, creating unsettling forces that may cause loss of preload. A recent conical-hexagon connection with double friction fit (conical-hexagon connection) could prevent this axial displacement.

Purpose: The purpose of this in vitro study was to measure the 3D axial displacement of abutments with a conical-hexagon connection or conical connection in narrow-diameter implants. Removal torque values (RTVs), preload efficiency, and survival after cyclic loading were also compared.

Material And Methods: Narrow-diameter implants with a conical connection (Osseospeed EV, 3.0×13 mm-AST) and narrow-diameter implants with a conical-hexagon connection (Eztetic, 3.1×13 mm) were embedded in resin rods (G10) (n=6). Six titanium abutments per system were used, and their spatial relationship to the implant platforms after hand tightening was determined by using 3D digital image correlation. The abutments were tightened to the manufacturers' specified values, and the abutments' relative position was recorded again. The displacement of the abutment after tightening was calculated. The implants were subjected to cyclic loading (5×10 cycles at 2 Hz) under 200-N loads at a 30-degree angle. After cyclic loading, the RTVs of screws were measured and compared with those specified by the manufacturers to calculate preload efficiency. ANOVA was used to compare the differences in displacements after tightening and to compare differences in RTVs after cyclic loading across the groups (α=.05).

Results: The mean displacement in the U direction (X-axis) for the AST was -0.7 μm and -4.7 μm for ZIM, with no statistical difference (P=.73). The mean displacement in the V direction (Y-axis) for AST was -37.0 μm, and -150.0 μm for ZIM, with significant statistical difference (P<.001). The mean displacement in the W direction (Z-axis) for AST was -0.9 μm, and -23.0 μm for ZIM, with no statistical difference (P=.35). The survival of groups was similar (P=.058). During cyclic loading, 3 AST specimens fractured. After cyclic loading, mean RTV for AST was -8.77 Ncm, and -14.24 Ncm for ZIM, and these values were significantly different (P=.04). Preload efficiency was 28.1% for AST and 41.5% for ZIM.

Conclusions: Greater abutment displacements were observed with the conical-hexagon connection, which required a higher torque, as specified by its manufacturer. The abutments displaced more in the V-axis in both implants. Only the conical connection implant (Ti Grade 4, commercially pure) had failures during cyclic loading, but the survival of the implants was similar. After cyclic loading, the abutment screws in both systems lost some of their torque value. The abutment screws of the conical-hexagon connection implant maintained preload more efficiently during cyclic loading than those of the conical connection implant.
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http://dx.doi.org/10.1016/j.prosdent.2020.11.008DOI Listing
January 2021

Recommendations for determining the validity of consumer wearable heart rate devices: expert statement and checklist of the INTERLIVE Network.

Br J Sports Med 2021 Jul 4;55(14):767-779. Epub 2021 Jan 4.

Institute of Cardiovascular Research and Sports Medicine, Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany

Assessing vital signs such as heart rate (HR) by wearable devices in a lifestyle-related environment provides widespread opportunities for public health related research and applications. Commonly, consumer wearable devices assessing HR are based on photoplethysmography (PPG), where HR is determined by absorption and reflection of emitted light by the blood. However, methodological differences and shortcomings in the validation process hamper the comparability of the validity of various wearable devices assessing HR. Towards Intelligent Health and Well-Being: Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables assessing HR by PPG. The recommendations were developed through the following multi-stage process: (1) a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, (2) an unstructured review of the wider literature pertaining to factors that may introduce bias during the validation of these devices and (3) evidence-informed expert opinions of the INTERLIVE Network. A total of 44 articles were deemed eligible and retrieved through our systematic literature review. Based on these studies, a wider literature review and our evidence-informed expert opinions, we propose a validation framework with standardised recommendations using six domains: considerations for the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. As such, this paper presents recommendations to standardise the validity testing and reporting of PPG-based HR wearables used by consumers. Moreover, checklists are provided to guide the validation protocol development and reporting. This will ensure that manufacturers, consumers, healthcare providers and researchers use wearables safely and to its full potential.
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http://dx.doi.org/10.1136/bjsports-2020-103148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273688PMC
July 2021

Recommendations for determining the validity of consumer wearable and smartphone step count: expert statement and checklist of the INTERLIVE network.

Br J Sports Med 2021 Jul 24;55(14):780-793. Epub 2020 Dec 24.

Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal

Consumer wearable and smartphone devices provide an accessible means to objectively measure physical activity (PA) through step counts. With the increasing proliferation of this technology, consumers, practitioners and researchers are interested in leveraging these devices as a means to track and facilitate PA behavioural change. However, while the acceptance of these devices is increasing, the validity of many consumer devices have not been rigorously and transparently evaluated. The Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives to develop best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice consumer wearable and smartphone step counter validation protocol. A two-step process was used to aggregate data and form a scientific foundation for the development of an optimal and feasible validation protocol: (1) a systematic literature review and (2) additional searches of the wider literature pertaining to factors that may introduce bias during the validation of these devices. The systematic literature review process identified 2897 potential articles, with 85 articles deemed eligible for the final dataset. From the synthesised data, we identified a set of six key domains to be considered during design and reporting of validation studies: target population, criterion measure, index measure, validation conditions, data processing and statistical analysis. Based on these six domains, a set of key variables of interest were identified and a 'basic' and 'advanced' multistage protocol for the validation of consumer wearable and smartphone step counters was developed. The INTERLIVE consortium recommends that the proposed protocol is used when considering the validation of any consumer wearable or smartphone step counter. Checklists have been provided to guide validation protocol development and reporting. The network also provide guidance for future research activities, highlighting the imminent need for the development of feasible alternative 'gold-standard' criterion measures for free-living validation. Adherence to these validation and reporting standards will help ensure methodological and reporting consistency, facilitating comparison between consumer devices. Ultimately, this will ensure that as these devices are integrated into standard medical care, consumers, practitioners, industry and researchers can use this technology safely and to its full potential.
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http://dx.doi.org/10.1136/bjsports-2020-103147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273687PMC
July 2021

A mixed-methods feasibility study of an arts-based intervention for patients receiving maintenance haemodialysis.

BMC Nephrol 2020 11 19;21(1):497. Epub 2020 Nov 19.

School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.

Background: Haemodialysis can negatively impact quality of life and mental health. Arts-based interventions used successfully in other settings to improve health and well-being, could help address the impact of haemodialysis. This study aimed to evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) of an arts-based intervention for patients receiving haemodialysis.

Methods: A parallel convergent mixed-methods design was used, including a pilot cluster RCT and qualitative process evaluation. Phase 1 evaluated recruitment and retention rates through a pilot cluster RCT at a single haemodialysis unit in Northern Ireland. Participants included patients who received haemodialysis for ESKD, were over the age of 18 and had the capacity to consent. These participants were randomised to the intervention or control group according to their haemodialysis shift. The intervention involved six one-hour, one-to-one facilitated arts sessions during haemodialysis. Phase 2 explored intervention and trial acceptability through a qualitative process evaluation using semi-structured interviews based on the RE-AIM framework. Participants included 13 patients who participated in phase 1 of the study, including 9 participants from the experimental group and four participants from the control group, and nine healthcare professionals who were present on the unit during implementation.

Results: Out of 122 outpatient haemodialysis patients, 94 were assessed as eligible for participation. Twenty-four participants were randomised, meaning 80% of the target sample size was recruited and the attrition rate at 3 months was 12.5% (n = 3). Participants viewed the arts as more accessible and enjoyable than anticipated following implementation. All participants who started the intervention (n = 11) completed the full six sessions. Qualitative benefits of the intervention suggest improvements in mental well-being. Patient choice and facilitation were important factors for successful implementation.

Conclusion: An arts-based intervention for patients receiving haemodialysis is acceptable for both patients and healthcare professionals, and a definitive trial is feasible. The intervention may help improve mental-wellbeing in patients receiving haemodialysis, but this requires further investigation in a definitive trial.

Trial Registration: The trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496 .
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http://dx.doi.org/10.1186/s12882-020-02162-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678271PMC
November 2020

Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized controlled trial.

Bone Joint J 2020 Nov;102-B(11):1511-1518

Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK.

Aims: The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery.

Methods: An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups.

Results: The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001).

Conclusion: Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: 2020;102-B(11):1511-1518.
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http://dx.doi.org/10.1302/0301-620X.102B11.BJJ-2020-1166.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954184PMC
November 2020

In vitro evaluation of the accuracy and precision of intraoral and extraoral complete-arch scans.

J Prosthet Dent 2020 Oct 15. Epub 2020 Oct 15.

Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Shahed University, Tehran, Iran. Electronic address:

Statement Of Problem: The accuracy of intraoral and extraoral scanners for different models of edentulousness is unclear.

Purpose: The purpose of this in vitro evaluation was to determine the accuracy (trueness and precision) of complete-arch scans made by 3 intraoral and 1 extraoral scanners compared with an industrial 3D scanner.

Material And Methods: Digital scans were made of a reference cast with 3 intraoral scanners (CEREC Omnicam; Dentsply Sirona, TRIOS 3; 3shape A/S; Carestream CS 3600; Carestream Dental) and an extraoral scanner (Deluxe scanner; Open Technologies). A dental maxilla model was used for tooth preparation for ceramic restorations with a shoulder finishing line. Maxillary right central and lateral incisors and third molar and maxillary left second premolar and first and third molar teeth were removed. One operator scanned the reference cast 10 times with each scanner. All the recorded standard tessellation language (STL) files were imported into an inspection software program and individually overlaid on the STL file for the reference model made by the 3D scanner. The measured distance between the distal point of the maxillary left second molar tooth and the mesial point of the maxillary left first premolar was defined as distance 1; distance 2 was defined as the distance between the mesial point of the maxillary second molar tooth and the distal point of the maxillary right first premolar tooth. The Levene test for homoscedasticity of variances was used to evaluate precision, and a 2-way repeated-measures ANOVA and Bonferroni-corrected Student t tests were used to evaluate trueness (α=.05).

Results: A statistically significant difference was found between the Carestream scanner and the other scanners when scanning both mucosa and teeth. The Carestream scanner had the lowest accuracy and highest magnitude mean deviation of all the scanners.

Conclusions: Obtaining an accurate partial-arch impression is still challenging for some intraoral scanners. The Carestream scanner's trueness was outside the acceptable range. However, other scanners tested here appeared to be suitable alternatives to conventional impression techniques.
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http://dx.doi.org/10.1016/j.prosdent.2020.08.017DOI Listing
October 2020

Aerobic fitness and sympathetic responses to spontaneous muscle sympathetic nerve activity in young males.

Clin Auton Res 2021 04 9;31(2):253-261. Epub 2020 Oct 9.

Autonomic Cardiovascular Control and Exercise Laboratory, Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada.

Purpose: Lower aerobic fitness increases the risk of developing hypertension. Muscle sympathetic nerve activity (MSNA) is important for the beat-by-beat regulation of blood pressure. Whether the cardiovascular consequences of lower aerobic fitness are due to augmented transduction of MSNA into vascular responses is unclear. We tested the hypothesis that aerobic fitness is inversely related to peak increases in total peripheral resistance (TPR) and mean arterial pressure (MAP) in response to spontaneous MSNA bursts in young males.

Methods: Relative peak oxygen consumption (VOpeak, indirect calorimetry) was assessed in 18 young males (23 ± 3 years; 41 ± 8 ml/kg/min). MSNA (microneurography), cardiac intervals (electrocardiogram) and arterial pressure (finger photoplethysmography) were recorded continuously during supine rest. Stroke volume and cardiac output (CO) were estimated via the ModelFlow method. TPR was calculated as MAP/CO. Changes in TPR and MAP were tracked for 12 cardiac cycles following heartbeats associated with or without spontaneous bursts of MSNA.

Results: Overall, aerobic fitness was inversely correlated to the peak ΔTPR (0.8 ± 0.7 mmHg/l/min; R = - 0.61, P = 0.007) and ΔMAP (2.3 ± 0.8 mmHg; R = - 0.69, P < 0.001), but not with the peak ΔCO (0.2 ± 0.1 l/min; P = 0.50), MSNA burst frequency (14 ± 5 bursts/min; P = 0.43) or MSNA relative burst amplitude (65 ± 12%; P = 0.13). Heartbeats without an associated burst of MSNA did not increase TPR, MAP or CO.

Conclusion: Although unrelated to traditional MSNA characteristics, aerobic fitness was inversely associated with spontaneous sympathetic neurovascular transduction in young males. This may be a potential mechanism by which aerobic fitness modulates the regulation of arterial blood pressure through the sympathetic nervous system.
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http://dx.doi.org/10.1007/s10286-020-00734-wDOI Listing
April 2021

Quantifying Y Balance Test performance with multiple and single inertial sensors.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:4243-4247

A growing body of evidence has highlighted that inertial sensor data can increase the sensitivity and clinical utility of the Y Balance Test, a commonly used clinical dynamic balance assessment. While early work has demonstrated the value of a single lumbar worn inertial sensor in quantifying dynamic balance control, no research has investigated if alternative (shank) or combined (lumbar and shank) sensor mounting locations may improve the assessments discriminant capabilities. Determining the optimal sensor set-up is crucial to ensuring minimal cost and maximal utility for clinical users The aim of this cross-sectional study was to investigate if single or multiple inertial sensors, mounted on the lumbar spine and/or shank could differentiate young (18-40 years [n = 41]) and middle-aged (40-65 years [n = 42]) adults, based on dynamic balance performance. Random-forest classification highlighted that a single lumbar sensor could classify age-related differences in performance with an accuracy of 79% (sensitivity = 81%; specificity = 78%). The amalgamation of shank and lumbar data did not significantly improve the classification performance (accuracy = 73-77%; sensitivity = 71-76%; specificity = 73-78%). Jerk magnitude root-mean-square consistently demonstrated predictor importance across the three reach directions: posteromedial (rank 1), anterior (rank 3) and posterolateral (rank 6).
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http://dx.doi.org/10.1109/EMBC44109.2020.9176416DOI Listing
July 2020

Analysis of color differences in stained contemporary esthetic dental materials.

J Prosthet Dent 2020 Sep 18. Epub 2020 Sep 18.

Professor, Department of Prosthetic Dentistry, College of Dentistry, Çukurova University, Balcalı, Adana, Turkey; Professor, Department of Biotechnology, Institute of Natural and Applied Sciences, Çukurova University, Balcalı, Adana, Turkey; Professor, Department Head, Department of Advanced Materials and Nanotechnology, Institute of Natural and Applied Sciences, Çukurova University, Balcalı, Adana, Turkey.

Statement Of Problem: Although contemporary analytical methods are available for application to data which exhibit a lack of equality of variances or a lack of normality in the error distribution, little guidance is provided for selecting the methods of data handling and analysis which best fit color difference data for stained esthetic materials.

Purpose: The purposes of this in vitro study were to apply information criteria of analysis of variance (ANOVA) methods of differing error distributions and covariance structures when analyzing color differences to determine the degree of alienation among 3 Commission Internationale de l'Eclairage (CIE) color difference formulae to assess the linearity of relationships among these formulae and to independently assess differences among various computer-aided design and computer-aided manufacture (CAD-CAM) materials in any color change after common forms of staining over time.

Material And Methods: Hybrid ceramic, resin nanoceramic, feldspathic-ceramic, and lithium-disilicate ceramic specimens (N=128) were subjected to staining from water, tea, coffee, and red wine over 1, 7, and 30 days, with color differences calculated from baseline. Akaike information criteria (AIC) and Bayesian information criteria (BIC) values were determined for Gaussian and lognormal error distributions at covariance structures of standard variance components and compound-symmetry. The analysis of variance used to analyze any significant effects on these color differences was the one with the lowest AIC and BIC values. Then, for each solution, day, and CIE color difference formula, any significant difference in the color differences between all pairs of materials was found by Bonferroni-corrected Student t tests. Those statistically significant pairwise comparisons where the larger of the color differences met or exceeded the acceptability threshold were labeled as statistically and visually noteworthy.

Results: For this color difference data set, the lognormal error distribution and the covariance structure of compound symmetry provided the best AIC and BIC. Because the interaction between material, solution, and day was statistically significant (P<.0001), pairwise comparisons were made between all pairs of materials for each level of solution and day studied. Noteworthy differences were identified, where hybrid ceramic and resin nanoceramic each had color changes after staining in coffee and red wine that were greater than each of feldspathic-ceramic and lithium-disilicate ceramic.

Conclusions: AIC and BIC values evaluate distinctively the Gaussian and lognormal error distributions when analyzing highly varying color differences. Although there is a high linear correlation between the 3 color difference formulae studied, each formula is unique, and each represents a different assessment of the perceived color difference. CAD-CAM materials, staining liquids, and time points affected the notable color changes.
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http://dx.doi.org/10.1016/j.prosdent.2020.08.006DOI Listing
September 2020

Optical properties of bisacryl-, composite-, ceramic- resin restorative materials: An aging simulation study.

J Esthet Restor Dent 2020 Sep 8. Epub 2020 Sep 8.

The Ohio State University College of Dentistry, Columbus, Ohio, USA.

Objective: Compare optical properties of a bisacryl-, composite-, and ceramic-resin restorative materials pre and post artificial aging.

Methods: Bisacryl-resin (LuxaCrown [LC], DMG), resin-composite (Filtek Supreme Ultra, [Filtek SU] 3M ESPE), and ceramic-resin (Enamic, VITA Zahnfabrik) specimens were prepared. The L*, C* , and h values were measured pre and post artificial aging to determine color stability (CIEDE2000) and changes in contrast ratio (CR), transmittance block, and relative translucency parameter. The datasets were analyzed using 2-way ANOVA followed by pairwise comparisons.

Results: Color difference data showed a significant interaction between materials and treatments [F(6:60) = 375.04, P < .0001] with Enamic being most color stable material and coffee having most effect on color stability. CR data showed a significant interaction between materials and treatments [F(6:60) = 4.12, P = .0016]. LC showing most change in CR values with coffee treatment. Change in transmittance blocked by Filtek SU and LC was greater for coffee treatment than that by each of the other treatments (P < .0001). Filtek SU and LC, coffee produced a greater decrease in relative translucency than that each of the other treatments (P < .0001).

Conclusions: Resin-based materials demonstrate optical properties that encourage their use for direct/indirect restorative options. Color stability and translucency of these materials are proportionally related.

Clinical Significance: Understanding the optical properties of resin-based materials provides help in material selection and provides insight into clinical performance and esthetic longevity. The optical stability of certain bisacryl-resin is better than what was previously determined for these restorative materials.
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http://dx.doi.org/10.1111/jerd.12653DOI Listing
September 2020

Color and translucency stability of contemporary resin-based restorative materials.

J Esthet Restor Dent 2020 Aug 14. Epub 2020 Aug 14.

The Ohio State University College of Dentistry, Columbus, Ohio, USA.

Objective: To determine color and translucency stability of present-day resin-based restorative materials.

Materials And Methods: Disk-shaped (1.0 × 10 mm) resin composites (Filtek Universal, 3M ESPE; Spectra ST, Dentsply Sirona; Gradia Direct X, GC America; Estilite Quick, Tokuyama; Harmonize, Kerr; ACTIVA Bioactive-Restorative, Pulpdent) were prepared and divided into four staining groups (n = 5); coffee (55°C), grape juice (5°C), deionized water (25°C) and thermocycling (20 000 cycles, 5°C to 55°C with a 30-second dwell time). Spectrophotometer measurements were taken at baseline and 14 days for each group and the color stability (CIEDE2000) and changes in the translucency parameter (RTP ) and luminous transmittance of each composite were determined. A 2-way analysis of variance (ANOVA) using maximum likelihood estimations was used for analysis for these changes, with subsequent pairwise comparisons using Bonferroni-corrected Student's t tests and an experiment-wise α = 0.05.

Results: A significant interaction (P < .0001) between material and treatment was found for each change in the esthetic property tested over 14 days. Multiple significant differences between materials for each treatment and between treatments for each material were identified.

Conclusions: The severity of color change and translucency of resin-based materials are dependent on their type, mostly affected by the coffee staining medium. Nano-filled resin composite is most resistant to color change and with stable translucency after artificial aging.

Clinical Relevance: Nano-filled resin composite may be the most esthetically durable resin- based restorative material. Micro-hybrid resin composite and resin-modified glass ionomer restorative material are susceptible to color change and losing their translucency. Hot coffee solution may shorten the esthetic lifespan of a resin-based material.
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http://dx.doi.org/10.1111/jerd.12640DOI Listing
August 2020

Effects of orthognathic surgery on quality of life compared with nonsurgical controls in an American population.

Am J Orthod Dentofacial Orthop 2020 Oct 31;158(4):555-563. Epub 2020 Jul 31.

Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, Ohio. Electronic address:

Introduction: To determine the psychosocial effects of a facial skeletal mal-relationship with its subsequent surgical correction in a group of patients treated using surgical orthodontics compared with a matched group of nontreated controls.

Methods: This study was approved by The Ohio State University Institutional Review Board. Subjects were patients presenting with facial skeletal mal-relationships whose proposed treatment plans included orthognathic surgery. This study used valid and reliable questionnaires: Orthognathic Quality of Life Questionnaire (OQLQ), Beck Depression Inventory II (Children's Depression Inventory - 2), Satisfaction with Life Scale, and State Trait Anxiety Inventory (State Trait Anxiety Inventory for Children), administered at 3 different stages of treatment (time 1 = initial pretreatment, time 2 = before oral surgery, and time 3 = at completion of treatment). Matched controls recruited at each time point completed the same questionnaires.

Results: A total of 267 subjects were recruited to participate in this study. There were no significant differences between treatment and control groups in age, sex, education level, or employment status at any of the 3 time points. The randomization test was used to compare values for all outcome variables between groups at the 3 stages of treatment. For the pretreatment period, T, there were significant differences between patients and controls in domains 1 (P = 0.0126), 2 (P = 0.0000), and 3 (P = 0.0000) of the OQLQ (social aspects, facial esthetics, and oral function, respectively) as well as total OQLQ (P = 0.0000). For the presurgery period, T, there were significant differences between patients and controls in domains 2 (P = 0.0136) and 3 (P = 0.0001) of the OQLQ (facial esthetics and oral function) as well as total OQLQ (P = 0.0291). Finally, for the posttreatment period, T there was a significant difference between patients and controls only in domain 3 (P = 0.0196) of the OQLQ (oral function).

Conclusions: The psychosocial profile of patients with a facial skeletal mal-relationship does not differ from the general population in depression, anxiety, and overall satisfaction with life. However, these patients do report a reduced quality of life based on condition-specific measures in social aspects, facial esthetics, and oral function. Concerns about oral function remain even up to 2 years after treatment is completed.
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http://dx.doi.org/10.1016/j.ajodo.2019.09.020DOI Listing
October 2020

The systemic inflammatory response following hand instrumentation versus ultrasonic instrumentation-A randomized controlled trial.

J Clin Periodontol 2020 09 27;47(9):1087-1097. Epub 2020 Jul 27.

Oral Sciences, Glasgow Dental Hospital and School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

Objective: This study sought to investigate whether the immediate systemic inflammatory response following full-mouth debridement differs following use of hand compared with ultrasonic instruments.

Methods: Thirty-nine periodontitis patients were randomized to treatment with full-mouth debridement using either hand or ultrasonic instrumentation completed within 24 hr. Serum and periodontal clinical parameters were collected at baseline, day 1, day 7 and day 90 post-treatment. Differences in systemic inflammatory markers were assessed using general linear models at each timepoint, corrected for age, gender, smoking status, body mass index and baseline levels of each marker.

Results: Across all patients, serum C-reactive protein increased at day 1, with no differences between hand and ultrasonic groups (p(adjusted) = .22). There was no difference between groups in interleukin-6 (p(adjusted) = .29) or tumour necrosis factor α (p(adjusted) = .53) at day 1. Inflammatory markers returned to baseline levels by day 7. Treatment resulted in equal and marked improvements in clinical parameters in both groups; however, total treatment time was on average shorter for ultrasonic instruments (p(adjusted) = .002).

Conclusions: Ultrasonic instrumentation resulted in shorter treatment time with comparable clinical outcomes. Levels of serum C-reactive protein at day 1 were similar following debridement with hand or ultrasonic instruments.
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http://dx.doi.org/10.1111/jcpe.13342DOI Listing
September 2020

Concussion Recovery Evaluation Using the Inertial Sensor Instrumented Y Balance Test.

J Neurotrauma 2020 12 8;37(23):2549-2557. Epub 2020 Jul 8.

Insight Center for Data Analytics, Physiotherapy and Sports Science, University College Dublin, Ireland.

The current sports concussion assessment paradigm lacks reliability, has learning effects, and is not sufficiently challenging for athletes. As a result, subtle deficits in sensorimotor function may be unidentified, increasing the risk of future injury. This study examined if the inertial-sensor instrumented Y Balance test could capture concussion-induced alterations in dynamic movement control. A cohort of 226 elite Rugby Union, American football, and ice hockey athletes were evaluated using the inertial-sensor instrumented Y balance test. Dynamic balance performance was quantified using normalized reach distance, jerk magnitude root-mean-squared (Jerk Mag RMS), and gyroscope magnitude sample entropy (Gyro Mag SEn). Concussed athletes who consented to follow-up were evaluated 24 to 48 h post-injury, and at the point of return to full contact training (RTP). Seventeen athletes sustained a concussion and consented to both the 24- to 48-h and RTP follow-up testing. Twenty uninjured control athletes were re-tested 6 months following initial screening. Concussed athletes had reductions in normalized reach distance (Cohens D = 0.66-1.16) and Jerk Mag (Cohens D = 0.57-1.14) 24 to 48 h post-injury, which returned to pre-injury levels by the point of RTP. There was no significant difference in performance between the baseline and 6-month follow-up in the 20 uninjured athletes (Cohens D = 0.06-0.51). There was a statistically significant linear association between Jerk Mag RMS 24 to 48 h post-injury and the natural log of RTP duration (R = 0.27 to 0.33). These results indicate that concussed athletes possessed alterations in dynamic movement control 24 to 48 h post-concussion, which typically returns to pre-injury levels by the point of RTP. Further, evaluation of dynamic movement control 24 to 48 h post-injury may aid in the evaluation of recovery prognosis.
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http://dx.doi.org/10.1089/neu.2020.7040DOI Listing
December 2020

Athletes with a concussion history in the last two years have impairments in dynamic balance performance.

Scand J Med Sci Sports 2020 Aug 11;30(8):1497-1505. Epub 2020 May 11.

Insight Centre for Data Analytics, University College Dublin, Belfield, Ireland.

The purpose of this study was to determine if National Collegiate Athletics Association Division 1 American Football and Ice Hockey athletes with a history of concussion have impaired dynamic balance control when compared to healthy control athletes. This cross-sectional observational study recruited 146 athletes; 90 control athletes and 56 athletes with a history of concussion. Athletes were tested during a pre-season evaluation using the inertial-sensor instrumented Y Balance Test. Independent variables were normalized reach distance, gyroscope magnitude sample entropy, and jerk magnitude root mean square. Kruskal-Wallis H test and Dunn-Bonferroni analysis demonstrated that individuals with a concussion history within the last 2 years have statistically significantly lower jerk magnitude root mean square in the posteromedial (Z = 23.22, P = .015) and posterolateral (Z = 24.64, P = .010) reach directions, when compared to the control group. There was no significant difference between those who sustained a concussion longer than two years ago and the control group for the posteromedial (Z = -1.25; P = .889) and posterolateral (Z = 6.44; P = .469) directions. These findings show that athletes with a concussion history within the last two years possess dynamic balance deficits, when compared to healthy control athletes. Conversely, athletes whose injury occurred greater than 2 years ago possessed comparable performance to the healthy controls. This suggests that sensorimotor control deficits may persist beyond clinical recovery, for up to 2 years. Therefore, clinicians should integrate balance training interventions into the return-to-play process to accelerate sensorimotor recovery and mitigate the risk of future injury.
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http://dx.doi.org/10.1111/sms.13691DOI Listing
August 2020
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