Research Spotlight

Aminoshariae, A., Azarpazhooh, A., Diogenes, A.R., Fouad, A.F., Glickman, G.N., Kishen, A., Letra, A.M., Levin, L., Roda, R.S., Setzer, F.C., Tay, F.R. and Hargreaves, K.M. (2021). “Insights into the June 2021 Issue of the JOE.” J Endod 47(6): 849-851.

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Welcome to the June 2021 issue of the Journal of Endodontics (JOE). Here we share some of our favorite articles that are published in this issue of the journal. We hope you look forward to reading these and other articles in JOE. [Epub ahead of print].

Revilla-León, M., Piedra-Cascón, W., Methani, M.M., Barmak, B.A. and Att, W. (2021). “Influence of the base design on the accuracy of additive manufac tured casts measured using a coordinate measuring machine.” J Prosthodont Res.

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PURPOSE: To measure the accuracy of the additively manufactured casts with 3 base designs: solid, honeycomb-structure, and hollowed bases. METHODS: A virtual cast was used to create different base designs: solid (S Group), honeycomb-structure (HC group), and hollowed (H group). Three standard tessellation language files were used to fabricate the specimens using a material jetting printer (J720 Dental; Stratasys) and a resin (VeroDent MED670; Stratasys) (n=15). A coordinate measuring machine was selected to measure the linear and 3D discrepancies between the virtual cast and each specimen. Shapiro-Wilk test revealed that all the data was not normally distributed (P<.05). Kruskal Wallis and Mann Whitney U tests were used (α=.05). RESULTS: The S group obtained a median ±interquartile range 3D discrepancy of 53.00 ±73.25 µm, the HC group of 58.00 ±67.25 µm, and the H group of 34.00 ±45.00 µm. Significant differences were found in the x- (P<.001), y- (P<.001), and z-axes (P<.001), and 3D discrepancies among the groups (P<.001). Significant differences were found between the S and H groups (P=.002) and HC and H groups (P<.001) on the x-axis; S and H groups (P<.001) and HC and H groups (P<.001) on the y-axis; S and H groups (P<.001) and HC and H groups (P<.001) on the z-axis; and S and H groups (P<.001) and HC and H groups (P<.001) on the 3D discrepancy. CONCLUSIONS: The base designs influenced on the accuracy of the casts but all the specimens obtained a clinically acceptable manufacturing range. The H group obtained the highest accuracy.

Gómez-Polo, M., Piedra-Cascón, W., Methani, M.M., Quesada-Olmo, N., Farjas-Abadia, M. and Revilla-León, M. (2021). “Influence of rescanning mesh holes and stitching procedures on the complete-arch scanning accuracy of an intraoral scanner: An in vitro study.” J Dent 110: 103690.

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PURPOSE: To measure the impact of different scanning patches on the accuracy (trueness and precision) of an intraoral scanner (IOS). MATERIAL AND METHODS: A typodont was digitized using an industrial optical scanner (GOM Atos Q 3D 12 M) to obtain a reference mesh. The typodont was scanned using an IOS (TRIOS 3). Three groups were generated based on the rescan areas created: no mesh holes (G0 group), 3 mesh holes distributed on the digital scan (G1 group), and 3 mesh holes located on the left quadrant of the digital scan (G2 group). In the G0 group, a digital scan was completed following the manufacturer’s scanning protocol. In the G1 group, a digital scan was obtained following the same protocol as G0 group. Three 12-mm diameter holes were created in the occlusal surfaces of the left second first molar, incisal edges of the central incisors, and right first molar of the digital scan using the IOS software. In the G2 group, a digital scan was obtained following the same protocol as G0 group. Three 12-mm diameter holes in the digital scan were created in the occlusal surface of the left first molar and left second and first premolars using the IOS software program. The discrepancy between the control and the experimental digital scans was measured using the root mean square calculation. The Kolmogorov-Smirnov test demonstrated that data were normally distributed. One-way ANOVA followed by post hoc multiple comparison Bonferroni test were used to analyze the data (α = .05). RESULTS: Trueness values ranged from 15 to 26 μm and the precision ranged from 21 to 150 μm. Significant differences in trueness mean values were found among the groups tested (F(2, 42) = 6.622, P = .003); the Bonferroni test indicated significant mean differences between the G0 and G2 groups (mean difference=0.11, SE=0.003, and P = .002). For precision evaluation, significant precision differences were found between the groups tested (F(2, 39)=9.479, P < .001); the Bonferroni test revealed significant precision differences between G0 and G2 groups (mean difference=-0.12, SE=0.030, and P = .001). CONCLUSIONS: Rescanning mesh holes and stitching procedures decreased the trueness and precision of the IOS tested; furthermore, the number and dimensions of mesh holes rescanned represented an important factor that influenced the scanning accuracy of IOS tested. CLINICAL SIGNIFICANCE: It is a fundamental procedure obtaining intraoral digital scans without leaving mesh holes, so the rescanning techniques are minimized and, therefore, the scanning accuracy of the intraoral scanner tested is maximized.

Hernandez-Montfort, J., Sinha, S.S., Thayer, K.L., Whitehead, E.H., Pahuja, M., Garan, A.R., Mahr, C., Haywood, J.L., Harwani, N.M., Schaeffer, A., Wencker, D., Kanwar, M., Vorovich, E., Abraham, J., Burkhoff, D. and Kapur, N.K. (2021). “Clinical Outcomes Associated With Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock.” Circ Heart Fail 14(5): e007924.

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BACKGROUND: Cardiogenic shock occurring in the setting of advanced heart failure (HF-CS) is increasingly common. However, recent studies have focused almost exclusively on acute myocardial infarction-related CS. We sought to define clinical, hemodynamic, metabolic, and treatment parameters associated with clinical outcomes among patients with HF-CS, using data from the Cardiogenic Shock Working Group registry. METHODS: Patients with HF-CS were identified from the multicenter Cardiogenic Shock Working Group registry and divided into 3 outcome categories assessed at hospital discharge: mortality, heart replacement therapy (HRT: durable ventricular assist device or orthotopic heart transplant), or native heart survival. Clinical characteristics, hemodynamic, laboratory parameters, drug therapies, acute mechanical circulatory support device (AMCS) utilization, and Society of Cardiovascular Angiography and Intervention stages were compared across the 3 outcome cohorts. RESULTS: Of the 712 patients with HF-CS identified, 180 (25.3%) died during their index admission, 277 (38.9%) underwent HRT (durable ventricular assist device or orthotopic heart transplant), and 255 (35.8%) experienced native heart survival without HRT. Patients who died had the highest right atrial pressure and heart rate and the lowest mean arterial pressure of the 3 outcome groups (P<0.01 for all). Biventricular and isolated left ventricular congestion were common among patients who died or underwent HRT, respectively. Lactate, blood urea nitrogen, serum creatinine, and aspartate aminotransferase were highest in patients with HF-CS experiencing in-hospital death. Intraaortic balloon pump was the most commonly used AMCS device in the overall cohort and among patients receiving HRT. Patients receiving >1 AMCS device had the highest in-hospital mortality rate irrespective of the number of vasoactive drugs used. Mortality increased with deteriorating Society of Cardiovascular Angiography and Intervention stages (stage B: 0%, stage C: 10.7%, stage D: 29.4%, stage E: 54.5%, 1-way ANOVA=<0.001). CONCLUSIONS: Patients with HF-CS experiencing in-hospital mortality had a high prevalence of biventricular congestion and markers of end-organ hypoperfusion. Substantial heterogeneity exists with use of AMCS in HF-CS with intraaortic balloon pump being the most common device used and high rates of in-hospital mortality after exposure to >1 AMCS device.

Ward, M.A., Hasan, S.S., Sanchez, C.E., Whitfield, E.P., Ogola, G.O. and Leeds, S.G. (2021). “Complications Following Robotic Hiatal Hernia Repair Are Higher Compared to Laparoscopy.” J Gastrointest Surg.

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BACKGROUND: The use of robotic platforms in surgery is becoming increasingly common in both practice and residency training. In this study, we compared the perioperative outcomes between robotic platforms and traditional laparoscopy in paraesophageal hernia repair. METHODS: A retrospective population-based analysis was performed using the National Inpatient Sample for the period of 2010-2015. Adult patients (≥18 years old) who underwent laparoscopic or robotic paraesophageal hernia repairs were included. Weighted multivariable random intercept linear and logistic regression models were used to assess the effects of robotic surgery on patient outcomes. RESULTS: A total of 168,329 patients were included in the study. The overall adjusted rate of complications was significantly higher in patients who underwent robotic paraesophageal hernia (PEH) repair compared to laparoscopic PEH OR (95% CI) = 1.17 (1.07, 1.27). Specifically, respiratory failure OR (95% CI) = 1.68 (1.37, 2.05) and esophageal perforation OR (95% CI) = 2.19 (1.42, 3.93) were higher in robotic PEH patients. A subset analysis was performed looking at high-volume centers (>20 operations per year), and, although the risk of complications was lower in the high volume centers compared to intermediate volume centers, complication rates were still significantly higher in the robotic surgery group compared to laparoscopic. Overall charges per surgery were significantly higher in the robotic group. CONCLUSION: Robotic PEH repair is associated with significantly more complications compared to laparoscopic paraesophageal hernia repair even in high-volume centers.