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Study Objectives Mandibular advancement devices (MAD) constitute a feasible option for management of mild-to-moderate obstructive sleep apnea (OSA) and in severe cases, when indicated. As a chronic condition, the management of OSA with MAD requires long-term patient adherence to treatment. The aim of the study was to investigate adherence to MAD therapy during a 36-month observation period in relation to changes in self-reported symptoms and objective response to therapy. Methods Retrospective chart review of patients referred to the Orofacial Pain Clinic (University of Kentucky) between 2016 and 2021 for management of OSA with MAD was performed. Based on a posttreatment sleep study with MAD in situ, participants were subdivided into optimal response (> 50% reduction of baseline apnea-hypopnea index) and suboptimal response (< 50% reduction of baseline apnea-hypopnea index) groups. Outcomes included self-reported adherence to MAD use, self-reported OSA symptoms including snoring, apneic episodes, tiredness upon awakening, fatigue, and sleep quality (on a 100-mm numerical rating scale), and daytime sleepiness (0–24 on the Epworth Sleepiness Scale). Intragroup and intergroup differences at different time points over a 36-month observation period were assessed with one-way and repeated-measures analysis of variance. Results Of 54 participants included (46.3% female, age 64.4 ± 10.71 years), 30 (55.6%) achieved optimal response and 24 (44.4%) achieved suboptimal response . At baseline, participants with optimal response differed from those with suboptimal response in apnea-hypopnea index ( P = .007), snoring ( P = .026), and sleep quality ( P = .042). Although fluctuating in both groups, no difference was found over time in adherence (7 nights/wk, 7 h/night) and in OSA symptoms (all P > .05). Conclusions Adherence to MAD was maintained over 36 months regardless of fluctuation in self-reported OSA symptoms and effectiveness of MAD therapy.

Due to the individual-level clinical variation in dosing requirements in commercially available drugs, attaining the objective of clinical individualization and precise drug administration continues to pose a global challenge. Currently, the optimal approach for preparing personalized and precise medications within the clinical setting is unknown. This study aimed to explore the effectiveness, safety and satisfaction of three-dimensional (3D) printing technology as a novel subdivision method in providing precise warfarin sodium (WFS) subdivided tablets for patients after prosthetic valve replacement (PVR). The optimal formulation, preparation process, parameters, and the relationship between dose and the printing volume were investigated, and the quality of the six specifications of WFS 3D-printed subdivided and pharmacist-split tablets was studied. A retrospective cohort study evaluated the effectiveness, safety, and satisfaction of patients taking WFS 3D-printed subdivided or pharmacist-split tablets. The hardness, weight variation, drug content, and content uniformity of the six specifications of WFS pharmacist-split tablets did not comply with the European Pharmacopoeia, United States Pharmacopoeia, and Chinese Pharmacopoeia. In contrast, all doses of 3D-printed subdivided tablets met the requirements. The 3D-printed subdivided group showed a significantly higher target international normalized ratio (INR) compliance rate (P<0.05) and lower over-anticoagulation rate (P<0.05) than the pharmacist-split group. Also, 66.67% of patients preferred taking 3D-printed subdivided tablets. 3D printing technology is superior to the traditional subdivision method, as it can improve the effectiveness and safety of patients receiving WFS anticoagulation after PVR.

Objective Inferior pole patellar fractures (IPPFs) pose a significant challenge due to their complex fracture patterns and high risk of complications associated with current treatment methods. This study aims to (1) characterize the fracture patterns of IPPFs using fracture mapping and (2) compare the biomechanical stability and clinical outcomes of treatment with anchor suture with patellar cerclage versus Kirschner‐wire tension band combined with patellar cerclage. Methods (1) A retrospective analysis was conducted on 61 patients with IPPF. For each case, fracture reduction was manually simulated, with fracture lines and fragments overlaid onto a complete patella template to identify fracture patterns. (2) Finite‐element models were used to analyze the mechanical properties of anchor suture and titanium cable cerclage treatment and Kirschner‐wire tension band combined with patellar cerclage in treating IPPFs. Additionally, a retrospective analysis of clinical data was performed on 57 patients with IPPF (AO/OTA 34 A1) treated at our institution between January 1, 2023, and December 25, 2023. Of these, 18 patients underwent anchor suture and titanium cable cerclage (Group A), and 39 underwent Kirschner‐wire tension band combined with patellar cerclage (Group B). We compared operative time, final knee range of motion, incidence of secondary surgery, postoperative complications, and functional recovery between the two groups based on medical records and follow‐up results. Results (1) IPPFs were predominantly comminuted, with fracture lines on the anterior view concentrated laterally and near the superior surface of the inferior pole. Fracture lines became more sparse as they approached the distal patella. The posterior view was similar to the anterior, with the majority of fractures near the superior surface of the inferior pole. (2) Finite‐element analysis revealed no significant differences between the two groups in terms of displacement and stress. Operative time was similar between the groups (p > 0.05), as were final knee range of motion (p > 0.05) and postoperative Bostman scores (p > 0.05). Group A had no postoperative complications or readmissions, while Group B had two cases of hardware irritation and one case of knee joint infection. Conclusion The fracture lines of IPPF are varied, often comminuted, and correlate with the mechanism of injury. Biomechanical and clinical outcomes suggest that anchor suture with patellar cerclage is a viable option for stabilizing IPPF. Trial Registration: ClinicalTrials.gov identifier: NCT06736639 This study characterizes the fracture patterns of inferior pole patellar fractures (IPPFs) and compares the clinical outcomes of anchor suture with titanium cable cerclage versus Kirschner‐wire tension band. Finite‐element analysis and clinical results indicate that anchor suture with cerclage provides stable fixation and is associated with fewer postoperative complications.

ObjectiveThis study analysed utilisation of statins for new statin users and assessed market dynamics of statins in South Korea.DesignThis study is a retrospective cohort study.SettingThe yearly claims data for statins were retrieved from the National Health Insurance Service-National Sample Cohort.Main outcome measureWe are interested in new statin users during 2003–2015 in Korea. Information on prescribed statins, including intensity of statins and entry of new and follow-on statins in the market, and healthcare institutions that prescribed the statins were also collected. In time series analysis, we estimated the effect of introduction of generics in the market, specifically for newly prescribed statin users.ResultsThis 13-year longitudinal study of a sample cohort provided by the National Health Insurance Service found that the incidence of new statin user increase from 838.1/100 000 persons in 2003 to 1626.9/100 000 persons in 2015. Most new users were initiated on a monotherapy that was prescribed at primary healthcare institutions. However, the statin market for new users were quite dynamic in Korea. First, the most commonly prescribed statin changed several times during the study period. Second, the use of moderate-intensity statins increased from 57% in 2003 to 92% in 2015. In line with this result, we could not observe substantial differences in prescription of statins in groups having selected diseases history. Lastly, we found market invasion or switch of statins among new statin users, specifically at primary healthcare institutions.ConclusionSimilar to other countries, the incidence of new statin users has been increased in Korea. However, the statin market in Korea is quite dynamic compared with other countries. Interestingly, discounted price of originals after the introduction of generics immediately expand markets or substitute the market particularly in primary healthcare institutions in Korea.

Objective This study aimed to analyze the characteristics of patients who fail high-flow nasal cannula(HFNC) therapy for acute hypoxemic respiratory failure(AHRF) and to identify predictors of treatment failure. Methods This single-center, retrospective, observational study analyzed clinical data from 388 patients with AHRF. Patients were divided into two groups: the HFNC success group (HFNC-S, n  = 256) and the HFNC failure group (HFNC-F, n  = 132). The primary endpoint was the need for escalation of respiratory support to tracheal intubation in the enrolled patients. The demographic data, laboratory tests, blood gas analysis data, CT severity scores, and disease severity scores were analysed to determine the difference between patients who were successful and those who failed HFNC treatment. Univariate and multivariate logistic regression models were used to assess potential predictors of failure of HFNC for patients with acute hypoxaemic respiratory failure. Results The mean age of patients enrolled was 67.97 ± 14.40 years. The HFNC-F group had significantly higher PSI(Pneumonia Severity Index) score, CURB(Confusion, Urea, Respiratory Rate, Blood Pressure, and Age)-65 score, CPIS(Clinical Pulmonary Infection Score) score, CT score and SOFA(Sequential Organ Failure Assessment) scores compared to the HFNC-S group. Within 12 h of the initiation of treatment, the HFNC-F group exhibited significantly lower oxygen saturation index (PaO2/FiO2) and significantly higher respiratory rate. Additionally, the HFNC-F group exhibited significantly higher levels of C-reactive protein (CRP), platelet count (PLT), D-dimer, interleukin-10 (IL-10), total bilirubin (TB) and creatinine (CB), but lower albumin levels. Multivariate analysis identified CT score, SOFA score, interleukin-1β (IL-1β), and albumin as independent predictors of HFNC failure. Conclusion HFNC is effective for treating AHRF. CT score, SOFA score, IL-1β, and albumin are independent predictors of HFNC failure.

[This corrects the article DOI: 10.3389/fcimb.2022.948602.].[This corrects the article DOI: 10.3389/fcimb.2022.948602.].

Immature permanent teeth pose therapeutic challenges due to immature root development; primary approaches include apexification, vital pulpotomy and revascularization, with few systematic imaging studies on their efficacy. This study systematically compares the radiographic outcomes of apexification, vital pulpotomy, and pulp revascularization in managing immature permanent teeth, assessing root development and periapical healing to inform clinical decision-making. This retrospective cohort analysis employed propensity score matching (PSM) to evaluate treatments for immature permanent teeth. Patients treated between January 2022 and December 2024 were categorized into three groups: apexification (n = 51), vital pulpotomy (n = 50), and revascularization (n = 51) after 1:1 nearest-neighbor matching. Primary outcomes were resolution of clinical signs and symptoms and periapical lesion healing; secondary outcomes were root development (increase in root length and canal wall thickness) and apical closure. Outcomes were assessed radiographically using pre- and postoperative periapical radiographs and cone-beam computed tomography (CBCT) at 6- and 12-month follow-ups. After PSM, baseline characteristics were balanced ( > 0.05). At the 12-month follow-up, the revascularization group demonstrated significantly greater increases in both root length (1.8 ± 0.4 mm) and canal wall thickness (0.35 ± 0.05 mm) compared to the other interventions ( < 0.05). While apical closure rates were comparable between revascularization (88.2%) and vital pulpotomy (82.0%), both significantly outperformed apexification (56.9%, < 0.01). Similarly, treatment success rates were higher in revascularization (88.5%) and vital pulpotomy (92.0%) than in apexification (76.5%, < 0.05). Revascularization achieved superior periapical lesion healing (95.0%) versus both apexification (76.9%) and vital pulpotomy (72.0%) ( < 0.05). Complication rates showed no significant intergroup differences ( > 0.05). Revascularization demonstrated superior efficacy in promoting root maturation, followed by vital pulpotomy and apexification. It is recommended to choose a personalized treatment plan according to the condition of the affected teeth.

Cervical spine injury (CSI) accounts for significant mortality in the intensive care unit (ICU), whereas sepsis remains one of the major causes of death in patients with CSI. However, there is no effective method to diagnose sepsis timely. The aim of this study is to investigate the effect of metagenomic next-generation sequencing (mNGS) on the pathogen features and the prognostic prediction of CSI patients with sepsis. A total of 27 blood samples from 17 included patients were tested by mNGS. Data of mNGS were compared with the conventional culture method. The Kaplan–Meier plots were used to visualize survival curves. A Cox proportional hazards model was used to identify independent prognostic factors for survival. Results showed that mNGS detected a wide spectrum of pathogens in CSI patients with sepsis, including 129 bacterial species, 8 viral species, and 51 fungal species. mNGS indicated 85.2% positive results, while the conventional culture method only showed 11.1% positive results in the blood samples. Further analyses revealed that mNGS had no prognostic effect on the septic CSI patients in ICU, whereas positive results of blood culture were closely correlated with an increased hazard ratio (HR) (HR 77.7067, 95%CI 2.860–2641.4595, p = 0.0155). Our results suggested that the mNGS application may provide evidence for clinicians to use antibiotics when a CSI case is diagnosed with sepsis.

The purpose of this study was to compare the viral shedding time in patients infected with the Omicron variant during Paxlovid therapy and conventional therapy and to analyze the effects of Paxlovid on patients infected with COVID-19. In this study, the demographic and clinical characteristics and laboratory data of 3159 patients infected with the SARS-CoV-2 Omicron variant treated at Jilin Province People's Hospital were collected and analyzed. A total of 362 patients received Paxlovid therapy, and 2797 patients received conventional therapy. After propensity score matching (PSM), 1086 patients were obtained. The difference in platelet (PLT) count between the two groups was statistically significant but within the normal range ( < 0.05). CT value revealed that the nucleic acid test results became negative more quickly in the Paxlovid therapy group. Analysis of the Paxlovid therapy group showed that IgG and IgM levels were increased after Paxlovid therapy administration. The CT value of the Paxlovid therapy group became negative more quickly. This finding suggests that Paxlovid treatment after early diagnosis of the Omicron variant may achieve good therapeutic efficacy.

Aim: This study aimed to analyze corneal transplantation trends and voluntary donor characteristics at the Chongqing Eye Bank in China. Methods: We retrospectively reviewed and analyzed data from January 1, 1999, to December 31, 2018, covering 5,397 preregistered voluntary donors, 1,955 actual donors, 3,910 donated tissues, and 2,374 corneal transplantations. Results: The 5,397 preregistered donors included 13 ethnic groups, with an overall mean age of 39.6 years (SD 21.5) and 3,010 were women (55.8%). The most prevalent education level was college and above (2,546, 47.2%), and the most common ethnic group was Han (5,335, 98.85%). Of the 1,955 actual donors, the male-to-female ratio was 3.3, and the mean age was 57.1 (SD 23.0 years). Based on population size in 2018, Jiangbei county was the most active in donation willingness, with ~60 × 10 −6 per capita, and the Yuzhong county was the most active in cornea donations, with ~451 × 0 −6 per capita. Of the 3,910 donated corneas, 2,540 (65.0%) were clinically used. Of those not used, 978 (71.4%) were rejected for poor corneal quality. The 2,374 (93.5%) corneal transplantation procedures were done at the Department of Ophthalmology of the First Affiliated Hospital of Chongqing Medical University and the rest ( n = 166, 6.5%) were performed in other centers. Of those 2,374 corneal transplantations, there were 1,671 penetrating keratoplasty (70.39%), 700 anterior lamellar keratoplasty (29.49%), and three corneal endothelial transplantations in our center (0.13%). The number of annual corneal transplantations increased by nearly 10 times, from 35 cases in 1999 to 327 cases in 2018. Among them, cases of penetrating keratoplasty and anterior lamellar keratoplasty increased from 27, and eight cases in 1999 to 230 and 94 cases in 2018, respectively. Infectious keratitis (37.0%) was the leading indication for keratoplasty, followed by corneal scar (19.8%). Over the study period, corneal scars dropped from the first (41.1% in 1999–2003) to the second indication (20.5% in 2014–2018), while infectious keratitis advanced to take the lead, ranging from 12.2% in 1999–2003 to 26.3% in 2014–2018. Conclusion: Our study reports corneal donation and transplantation trends in Chongqing over 20 years, showing that infectious keratitis is a leading indication for keratoplasty and that penetrating keratoplasty and anterior lamellar keratoplasty show upward trends. The analysis further suggests that a potential preregistered cornea donor is a female Han, with a higher education level.