Diagnostics

Background/Objectives: Quantifying cerebrovascular reactivity (CVR) is essential for stroke risk assessment in patients with Moyamoya Angiopathy (MMA). Breath-hold functional MRI (bh-fMRI) is an easily implementable method to assess CVR. Determining the optimal time period of the BOLD signal for analyzing the best bh-fMRI data quality remains an open question. Methods: A retrospective analysis of 46 bh-fMRI data sets of MMA patients was conducted. The percentage BOLD signal changes were evaluated at different time periods (time point of the maximum cerebellar signal peak (TP_{cereb. max}) ± 0 s, TP_{cereb. max} ± 1 s, TP_{cereb. max} ± 2 s, TP_{cereb. max} ± 3 s, TP_{cereb. max} ± 4 s, TP_{cereb. max} ± 5 s). The agreement between the bh-fMRI maps and [¹⁵O]water PET maps was independently and consensually rated on a 4-point Likert scale (1 = poor, 2 = moderate, 3 = good, 4 = excellent) and compared with the Friedman test. The inter-rater agreement was calculated separately for each time period using quadratic weighted Cohen’s kappa κ_w. Results: The selected time period had a significant impact on the agreement between bh-fMRI and [¹⁵O]water PET (χ²(5) = 79.448, p < 0.001, W = 0.345). Short time periods of TP_cereb.max ± 0 s or TP_cereb.max ±1 s demonstrated the highest level of concordance between bh-fMRI and [¹⁵O]water PET (median = 3.5 for TP_cereb.max ± 0 s; median = 3 for TP_cereb.max ± 1 s, modus = 4 in both cases). The agreement between bh-fMRI and [¹⁵O]water PET was significantly higher when evaluating time periods of TP_cereb.max ± 0 s than when evaluating all time periods ≥ TP_{cereb. max} ± 2 s. The inter-rater agreement was almost perfect for all time periods except one (TP_{cereb. max} ± 1 s). Conclusions: Short time periods should be selected when evaluating CVR with bh-fMRI, as this study suggests a high level of validity in comparison to [¹⁵O]water PET.

Background/Objectives: The COVID-19 pandemic has brought about significant clinical challenges in regard to digestive systems, as well as causing complications such as pancreatitis and biliary infections. Whether diabetes mellitus (DM) contributes to both an increased risk for these complications and mortality amongst COVID-19 patients remains to be investigated. This study aimed to illuminate any possible outcomes, including pancreatitis, cholangitis, cholecystitis and all-cause mortality, among COVID-19 patients with and without pre-existing type 2 diabetes mellitus (T2DM), using real-world data taken from a multinational electronic health record database. Methods: A retrospective cohort study based upon data taken from the database of the TriNetX Global Collaborative Network was conducted. We included patients from the database who had been diagnosed with COVID-19 from January 2020 to December 2023. Enrolled subjects were divided into two cohorts: COVID-19 patients with pre-existing T2DM who had had at least two medical visits, and those without T2DM. Propensity score matching was performed using 68 baseline variables. Outcomes were evaluated within 90 days following COVID-19 diagnosis, with patients with prior relevant diagnoses being excluded. Risk analyses, Kaplan–Meier survival estimates, and hazard ratios were calculated as the outcomes. Results: The incidence of acute pancreatitis was significantly higher in the DM+ group when compared to the DM– group (Hazard ratio (HR) = 1.307; 95% confidence interval (CI) 1.048–1.630, p = 0.017) and mortality (HR = 1.141; 95% CI 1.102–1.181, p < 0.05) by Kaplan–Meier analysis. Risk of cholecystitis (HR = 1.264; 95% CI 1.042–1.533, p = 0.017) was borderline increased, and cholangitis was not significant (HR 0.847, 95% CI 0.583–1.230) Conclusions: In COVID-19 patients, pre-existing T2DM is independently associated with increased risks of acute pancreatitis and mortality.

Background: Zygomatic implants (ZIs) were initially pioneered by Brånemark to rehabilitate patients suffering from destructive diseases through original surgical technique (OST). Subsequently, other techniques were proposed, such as the zygomatic anatomy-guided approach (ZAGA). This umbrella review was conceived to quantify and critically characterize the spectrum of complications associated with different techniques of ZI placement. Methods: Systematic reviews, encompassing both those with and without meta-analysis, focusing on the complications associate with ZIs and published only in the English language were systematically sought. A systematic literature search was performed through MEDLINE/Pubmed, Scopus, BioMed Central, and the Cochrane Library, and the PROSPERO register. Results: A total of 11 articles were included. The latter documented the spectrum of complications associated with ZIs, ranging from minor morbidities such as sinusitis, hematoma, and soft tissue complications up to severe adverse events such as orbital penetration and diplopia. Conclusions: The use of described ZI OST and ZAGA in cases of severe maxillary resorption is associated with a high implant survival rate and a low incidence of surgical complications. However, complications, the most common of which were sinusitis and peri-implant soft tissue infection, may be underestimated due to the heterogeneity of the studies included.