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A bstract In forensic identification, lack of eccentric characteristics of intact dentitions hinders correct ante-mortem/post-mortem (AM/PM) matching. It remains unclear which morphological dental parameters hold strong potential as identifiers. This study aimed to establish a method to quantify and rank the identifying potential of one (or a combination of) continuous morphological parameter(s), and to provide a proof of concept. First, a statistic was defined that quantifies the identifying potential: the mean potential set (MPS). The MPS is derived from inter-observer agreement data and it indicates the percentage of subjects in the AM reference dataset who at least need to be considered to detect the correct PM subject. This was calculated in a univariate and a multivariate setting. Second, the method was validated on maxillary first molar crowns of 82 3D-digitally scanned cast models. Standardized measurements were registered using 3D modeling software (3-Matic Medical 12.0, Materialise N.V., Leuven, Belgium): tooth depth, angles between cusps, distances between cusps, distances between the cusps, and the mesial pit. A random sample of 40 first molars was measured by a second examiner. Quantifying and ranking the parameters allowed selecting those with the strongest identifying potential. This was found for the tooth depth (1 measurement, MPS = 17.1%, ICC = 0.879) in the univariate setting, and the angles between cusps (4 measurements, MPS = 3.9%) in the multivariate setting. As expected, the multivariate approach held significantly stronger identifying potential, but more measurements were needed (i.e., more time-consuming). Our method allows quantifying and ranking the potential of dental morphological parameters as identifiers using a clear-cut statistic.

This study aimed to determine whether patients with persistent erectile dysfunction (ED), minimum 12 months after radical prostatectomy (RP), experienced a better recovery of erectile function (EF) with pelvic floor muscle training (PFMT) compared with patients without this intervention. Second, we aimed to investigate the effect of PFMT on climacturia. All patients, who underwent RP, with persistent ED of minimum 1 year post operation were eligible. The treatment group started PFMT immediately at 12 months post operation and the control group started at 15 months after RP. All patients received PFMT during 3 months. The sample size needed to detect with 80% power a 6 points-difference regarding the EF-domain of the International Index of Erectile Function (IIEF), was at least 12 subjects per group. Patients were evaluated using the IIEF and questioned regarding climacturia. Differences between groups at 15 months were evaluated with Mann–Whitney U -test and Fisher’s exact test. As a result, the treatment group had a significantly better EF than the control group at 15 months after surgery ( P =0.025). Other subdomains of the IIEF remained constant for both groups. The effect of PFMT was maintained during follow-up. At 15 months, a significantly higher percentage of patients in the treatment group showed an improvement regarding climacturia ( P =0.004).

Background Late-onset Pompe disease (LOPD) is a rare, hereditary, progressive disorder that is usually characterized by limb-girdle muscle weakness and/or respiratory insufficiency. LOPD is caused by mutations in the acid alpha-glucosidase ( GAA ) gene and treated with enzyme replacement therapy (ERT). Methods We studied the clinical, brain imaging, and genetic features of the Belgian cohort of late-onset Pompe disease patients ( N  = 52), and explored the sensitivity of different outcome measures, during a longitudinal period of 7 years (2010–2017), including the activity limitations ActivLim score, 6 min walking distance (6MWD), 10 m walk test (10MWT), MRC sum score, and forced vital capacity (FVC) sitting/supine. Results In Belgium, we calculated an LOPD prevalence of 3.9 per million. Mean age at onset of 52 LOPD patients was 28.9 years (SD: 15.8 y), ranging from 7 months to 68 years. Seventy-five percent ( N  = 39) of the patients initially presented with limb-girdle weakness, whereas in 13% ( N  = 7) respiratory symptoms were the only initial symptom. Non-invasive ventilation (NIV) was started in 37% ( N  = 19), at a mean age of 49.5 years (SD: 11.9 y), with a mean duration of 15 years (SD: 10.2 y) after symptom onset. Brain imaging revealed abnormalities in 25% ( N  = 8) of the patients, with the presence of small cerebral aneurysm(s) in two patients and a vertebrobasilar dolichoectasia in another two. Mean diagnostic delay was 12.9 years. All patients were compound heterozygotes with the most prevalent mutation being c.-32-13 T > G in 96%. We identified two novel mutations in GAA : c.1610_1611delA and c.186dup11. For the 6MWD, MRC sum score, FVC sitting and FVC supine, we measured a significant decrease over time ( p  = 0.0002, p  = 0.0001, p  = 0.0077, p  = 0.0151), which was not revealed with the ActivLim score and 10MWT ( p  > 0.05). Conclusions Awareness on LOPD should even be further increased because of the long diagnostic delay. The 6MWD, but not the ActivLim score, is a sensitive outcome measure to follow up LOPD patients.

Automatic craniomaxillofacial (CMF) three dimensional (3D) dense phenotyping promises quantification of the complete CMF shape compared to the limiting use of sparse landmarks in classical phenotyping. This study assesses the accuracy and reliability of this new approach on the human mandible. Classic and automatic phenotyping techniques were applied on 30 unaltered and 20 operated human mandibles. Seven observers indicated 26 anatomical landmarks on each mandible three times. All mandibles were subjected to three rounds of automatic phenotyping using Meshmonk. The toolbox performed non-rigid surface registration of a template mandibular mesh consisting of 17,415 quasi landmarks on each target mandible and the quasi landmarks corresponding to the 26 anatomical locations of interest were identified. Repeated-measures reliability was assessed using root mean square (RMS) distances of repeated landmark indications to their centroid. Automatic phenotyping showed very low RMS distances confirming excellent repeated-measures reliability. The average Euclidean distance between manual and corresponding automatic landmarks was 1.40 mm for the unaltered and 1.76 mm for the operated sample. Centroid sizes from the automatic and manual shape configurations were highly similar with intraclass correlation coefficients (ICC) of > 0.99. Reproducibility coefficients for centroid size were < 2 mm, accounting for < 1% of the total variability of the centroid size of the mandibles in this sample. ICC’s for the multivariate set of 325 interlandmark distances were all > 0.90 indicating again high similarity between shapes quantified by classic or automatic phenotyping. Combined, these findings established high accuracy and repeated-measures reliability of the automatic approach. 3D dense CMF phenotyping of the human mandible using the Meshmonk toolbox introduces a novel improvement in quantifying CMF shape.

Purpose This study investigated the evolution of Low Anterior Resection Syndrome (LARS) over 2 years following Total Mesorectal Excision (TME) for rectal cancer. Methods In this prospective cohort study, patients were recruited from three Belgian hospitals between January 2017 and January 2021. The primary outcome was the evolution of LARS, assessed with the LARS score at 1, 6, 12, and 24 months postoperatively or after stoma closure. The proportion of patients in each LARS category (no, minor, major) was analyzed, and transitions over time were examined using Bowker’s test of symmetry. The secondary outcome was health-related quality of life, measured using the Short Form-12 (SF-12) at the same time points. Results Of 180 patients who underwent TME for rectal cancer, 87 (48.3%) completed the LARS score at all time points. At 1 month postoperatively, 66 patients (75.9%) had major LARS, decreasing to 51 patients (58.6%) at 6 months ( p  = 0.028). No significant changes were observed thereafter ( p  = 0.43 and p  = 0.45 for 6 to 12 months and 12–24 months, respectively). Among the 51 patients with major LARS at 6 months, 10 patients (20%) improved by 12 and 24 months. Between 1 month and later time points, approximately 60% remained in the same category, 30% improved, and 10% deteriorated. Mean SF-12 physical and mental scores were similar across LARS categories at all time points. Conclusion The majority of spontaneous improvement in LARS occurred within the first 6 months postoperatively, with little improvement thereafter. These findings highlight the need for early proactive management rather than expectant follow-up.

The majority of age estimation models based on third molar development are constructed on samples from populations with described and outlined origin. Due to unlike research protocols these studies can rarely be compared for the evaluation of possible geographical or ethnical influences on third molar development. The aim of this study is to evaluate country specific third molar development on standardized collected and analyzed data. On panoramic radiographs selected from subjects out of 9 country specific populations (Belgium, China, Japan, Korea, Poland, Thailand, Turkey, Saudi-Arabia and South-India) the four third molar scores were registered, according to a modified Gleiser and Hunt methodology. To obtain for each subject a (factor) score which represents the degree of third molar development, a generalized linear mixed model for multivariate ordinal data was fitted on the repeated third molar scores. Differences between countries are analyzed using gender-specific regression models for these factor scores with age and country as predictors. Comparisons between countries revealed differences in speed and onset of development. However, although reaching statistical significance, differences in actual value were small and not constant over the considered age range. In all countries, at all ages, males were ahead in third molar development compared to females.

Background Concerns have been raised regarding outcome after laparoscopic resection of hepatic neoplasms. This prospective study compared morbidity and adequacy of surgical margins in laparoscopic (LLR) versus open liver resection (OLR). Methods Outcome in 359 consecutive patients [male/female ratio 187/172; median age 60 years (range 18–84 years)] who underwent partial hepatectomy was analysed. Cirrhosis was present in 32 patients and preoperative chemotherapy was administered in 141 patients. Comparative analyses were performed using propensity scores for all and for matched patients ( n  = 76 per group). Results Complications occurred in 68/250 (27.2%) patients after OLR and in 6/109 (5.5%) after LLR [odds ratio (OR) 0.16; 95% confidence interval (CI) 0.07–0.37; p  < 0.0001]. Median intraoperative blood loss was 500 ml (range 10–7,000 ml) in OLR and 100 ml (range 5–4,000 ml) in LLR ( p  < 0.0001). Postoperative hospital stay was 8 days (range 0–155 days) after OLR and 6 days (range 0–41 days) after LLR ( p  < 0.0001). In patients treated for liver malignancy, the surgical resection margin was positive on histopathological examination in 5/237 after OLR and in 1/77 after LLR. The magnitude of the resection margin was 7.5 mm (range 0–45 mm) in OLR and 10.0 mm (range 0–30 mm) in LLR ( p  = 0.087). Conclusions LLR for hepatic neoplasms seems to be noninferior to OLR regarding adequacy of surgical margins, and superior to OLR regarding short-term postoperative outcome.

To evaluate patient satisfaction and patient reported anaesthesia related outcome parameters after outpatient surgery. A three-year (2013–2016) observational study. A surgical day care centre embedded in a tertiary care, university hospital. Adult Dutch-speaking patients who underwent surgery under general or regional anaesthesia on an outpatient basis (n=5424). A questionnaire was developed to evaluate patients' satisfaction with care during their hospitalisation in the surgical day centre, as well as to assess their reports of anaesthesia related outcomes. Various aspects of care were measured, including care by nurses, care by doctors, organisational and safety items. Variation in satisfaction and surgery and anaesthesia related outcomes as a function of different categories (gender, age, education, type of anaesthesia, discipline and era) were also investigated. Confirmatory factor analysis showed an excellent fit to the hypothesized factors of the survey. Satisfaction scores were very high for different aspects of care, resulting in 98% of patients being (very) satisfied (59.1% very satisfied, 38.9% satisfied). Male (p=0.0003), higher educated (p<0.0001) and older patients (p<0.0001) were more likely to be very satisfied. Postoperative nausea and vomiting (PONV) were frequent (nausea: 13.9%, vomiting: 3.3%), and more present in female than in male patients (p<0.0001). Pain scores at the PACU differed among disciplines (p<0.0001) were higher in female patients compared to male patients (3.41% versus 2.54%, p<0.0001) and after general anaesthesia compared to regional anaesthesia (3.25% versus 0.39%, p<0.0001) and decreased with higher age (p=0.0001) and education level (p=0.0033). Whereas satisfaction with all aspects of care is generally high, the results regarding pain and PONV should inspire quality improvement initiatives. The questionnaire developed in this study can be a vehicle to assess and improve the quality of care in surgical day care centres. •A questionnaire was developed to evaluate patient satisfaction and anesthesia related outcomes in ambulatory care.•High patient satisfaction scores in our day care centre were consistently obtained over a 3-year period.•Reducing PONV incidence and pain scores continuous to be a priority amid ambulatory care.

Dental age estimation methods based on the radiologically detected third molar developmental stages are implemented in forensic age assessments to discriminate between juveniles and adults considering the judgment of young unaccompanied asylum seekers. Accurate and unbiased age estimates combined with appropriate quantified uncertainties are the required properties for accurate forensic reporting. In this study, a subset of 910 individuals uniformly distributed in age between 16 and 22 years was selected from an existing dataset collected by Gunst et al. containing 2,513 panoramic radiographs with known third molar developmental stages of Belgian Caucasian men and women. This subset was randomly split in a training set to develop a classical regression analysis and a Bayesian model for the multivariate distribution of the third molar developmental stages conditional on age and in a test set to assess the performance of both models. The aim of this study was to verify if the Bayesian approach differentiates the age of maturity more precisely and removes the bias, which disadvantages the systematically overestimated young individuals. The Bayesian model offers the discrimination of subjects being older than 18 years more appropriate and produces more meaningful prediction intervals but does not strongly outperform the classical approaches.

Aims To investigate the efficacy and safety of a single intracameral bevacizumab injection to improve the outcome of trabeculectomy. Methods A 12-month, prospective, randomised, double-masked, placebo-controlled trial. Patients with medically uncontrolled open-angle glaucoma scheduled for a primary trabeculectomy were recruited and randomised to receive 50 µL of either bevacizumab (1.25 mg) or placebo (balanced salt solution) peroperatively. Absolute success was defined as intraocular pressure (IOP) ≤18 mm Hg and >5 mm Hg with at least 30% reduction from baseline and no loss of light perception. Success through the use of additional medical and/or surgical IOP-lowering treatments was defined as qualified success. Results 138 patients completed a 12-month follow-up, 69 of whom were in the bevacizumab treated group. IOP at 1 year postoperatively was significantly lower than baseline (placebo: 25.6±9.9 mm Hg vs 11.5±3.9 mm Hg, p<0.01; bevacizumab: 24.8±8.1 mm Hg vs 11.9±3.8 mm Hg, p<0.01), with no difference between treatment groups (p=0.69). However, absolute success was higher in the bevacizumab group (71% vs 51%, p=0.02), with the need for IOP-lowering interventions (needlings) being lower in this group (12% vs 33%, p=0.003). Complication rates were low and comparable between groups. Conclusions Peroperative administration of intracameral bevacizumab significantly reduces the need for additional interventions during the follow-up of patients undergoing trabeculectomy.