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PMC11276326_p3
|
PMC11276326
|
sec[0]/p[3]
|
1. Introduction
| 3.263672 |
biomedical
|
Study
|
[
0.9990234375,
0.00048279762268066406,
0.0006246566772460938
] |
[
0.99853515625,
0.0013790130615234375,
0.00016736984252929688,
0.00012242794036865234
] |
A recent study of patients with BC evaluated in a private hospital in the Federal District of Brazil showed that 2.7% were p.R337H carriers (6/224); however, while approximately 80% of Brazilian have access to health care only in the public service, the study cohort mostly comprised patients with health insurance . Considering the lack of germline testing for patients using the public health system in the Federal District, the frequency of p. R337H in an underserved population remains of interest.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276326_p4
|
PMC11276326
|
sec[0]/p[4]
|
1. Introduction
| 3.896484 |
biomedical
|
Study
|
[
0.99853515625,
0.0012063980102539062,
0.0002384185791015625
] |
[
0.9990234375,
0.0005707740783691406,
0.0001741647720336914,
0.0001844167709350586
] |
This exploratory study aimed to describe the frequency of TP53 p.R337H as well as the clinical and pathological characteristics of patients diagnosed with BC treated in the Brazilian Public Health System (SUS) in the Federal District of Brazil who were stratified as high risk for hereditary breast cancer (HBC).
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p5
|
PMC11276326
|
sec[1]/sec[0]/p[0]
|
2.1. Study Design
| 4.113281 |
biomedical
|
Study
|
[
0.998046875,
0.001834869384765625,
0.0002582073211669922
] |
[
0.9990234375,
0.0004146099090576172,
0.00022590160369873047,
0.00018477439880371094
] |
This observational cross-sectional study was conducted at a public institution in the Federal District. We recruited patients with a history of invasive BC of any stage and any clinical subtype, who were undergoing treatment or in follow-up and presented at least one of the National Comprehensive Cancer Network (NCCN) criteria for HBC, considering version 1.2020 ( Supplementary Materials, Table S1 ). These patients were offered to participate in the study and consented to undergo testing for the TP53 p.R337H variant specified in the study protocol. Patients who chose to perform a multigene panel testing at commercial laboratories at their own expense were also included in the study. Additionally, all these patients underwent genetic counseling. First-degree family members with positive TP53 p.R337H index cases were offered genetic counseling and family variant testing. Patients with missing clinicopathological BC data or those who did not undergo germline testing were excluded.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276326_p6
|
PMC11276326
|
sec[1]/sec[0]/p[1]
|
2.1. Study Design
| 2.496094 |
biomedical
|
Study
|
[
0.99560546875,
0.0022525787353515625,
0.001934051513671875
] |
[
0.9658203125,
0.03167724609375,
0.0007405281066894531,
0.0015401840209960938
] |
Blood samples were collected for those patients who were going to test only the TP53 p.R337H variant.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p7
|
PMC11276326
|
sec[1]/sec[0]/p[2]
|
2.1. Study Design
| 3.882813 |
biomedical
|
Study
|
[
0.99853515625,
0.0010423660278320312,
0.00027942657470703125
] |
[
0.9990234375,
0.0006108283996582031,
0.0001513957977294922,
0.00013148784637451172
] |
The primary outcome was to describe the detection rate of the TP53 p.R337H in these patients. We also aimed to describe the percentage of patients who met the revised Chompret criteria ( Supplementary Materials, Table S2 ) and identify family members carrying the TP53 p.R337H variant based on the index case.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p8
|
PMC11276326
|
sec[1]/sec[0]/p[3]
|
2.1. Study Design
| 1.03418 |
biomedical
|
Other
|
[
0.89013671875,
0.00316619873046875,
0.10687255859375
] |
[
0.049407958984375,
0.94775390625,
0.0013704299926757812,
0.0012531280517578125
] |
This study was approved by the Research Ethics Committee of Sírio-Libanês Hospital and the Brazilian Research Ethics Committee . All the participants provided informed consent.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276326_p9
|
PMC11276326
|
sec[1]/sec[1]/p[0]
|
2.2. Genotyping for TP53 p.R337H
| 4.09375 |
biomedical
|
Study
|
[
0.99951171875,
0.0003218650817871094,
0.0001627206802368164
] |
[
0.998046875,
0.0014486312866210938,
0.0002532005310058594,
0.00012218952178955078
] |
DNA was extracted from peripheral blood samples using a Wizard ® Genomic DNA Purification Kit (Promega, Madison, WI, USA). Genotyping for TP53 p.R337H was performed using a Custom TaqMan ® SNP Genotyping Assay, performing allelic discrimination (Applied Biosystems, Thermo Fisher Scientific, Pleasanton, CA, USA).This assay is specific to detecting the TP53 p.R337H variant, and the presence of other variants in TP53 or in other genes could not be evaluated for those patients who performed only this genetic test.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276326_p10
|
PMC11276326
|
sec[1]/sec[1]/p[1]
|
2.2. Genotyping for TP53 p.R337H
| 4.117188 |
biomedical
|
Study
|
[
0.99951171875,
0.00040912628173828125,
0.0001811981201171875
] |
[
0.99462890625,
0.00478363037109375,
0.00039005279541015625,
0.00018322467803955078
] |
Allelic discrimination analysis was performed in a 7300 (Applied Biosystems) real-time PCR equipment using a Custom TaqMan™ SNP Genotyping Assay (Thermo Fisher). Fwd Primer: CCTCCTCTGTTGCTGCAGATC, Rev Primer: CCTCATTCAGCTCTCGGAAC, Probe 1-GGTGAGCGCTTCGAG (WT_VIC/MGB-NFQ), Probe 2-CGTGAGCACTTCGAG (Mut_R337H_ FAM/MGB-NFQ). Reactions were prepared for a total volume of 12 uL, using 1× TaqMan genotyping master mix, 1× TaqMan Primers + Probes mix and 50 ng of DNA. After the Pre-read step, amplification was performed by 60 °C for 1 min, 95 °C for 10 min and 50 cycles of 95 °C for 15 s/60 °C for 90 s, followed by 60 °C for 1 min. Post-read analysis was defined using control samples.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276326_p11
|
PMC11276326
|
sec[1]/sec[2]/p[0]
|
2.3. Sociodemographic and Clinical Variables
| 2.146484 |
biomedical
|
Study
|
[
0.990234375,
0.008270263671875,
0.0016536712646484375
] |
[
0.986328125,
0.0107574462890625,
0.001117706298828125,
0.0016775131225585938
] |
During the genetic counseling consultation, sociodemographic data were collected: self-declared race and birthplace. Clinical and pathological data were retrospectively reviewed using the electronic medical records of all study participants.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276326_p12
|
PMC11276326
|
sec[1]/sec[3]/p[0]
|
2.4. Statistical Analysis
| 3.001953 |
biomedical
|
Study
|
[
0.9990234375,
0.00041294097900390625,
0.0005345344543457031
] |
[
0.88427734375,
0.1129150390625,
0.001964569091796875,
0.0006647109985351562
] |
Values are expressed as medians and percentiles for non-normally distributed continuous variables and as means and standard deviations for normally distributed continuous variables. Categorical data are presented as absolute values and percentages and were tested using Fisher’s exact test, where applicable. Analyses were performed using JASP version 0.14.1.0 software.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276326_p13
|
PMC11276326
|
sec[1]/sec[4]/p[0]
|
2.5. Sample Calculation
| 3.78125 |
biomedical
|
Study
|
[
0.99853515625,
0.0007328987121582031,
0.0007696151733398438
] |
[
0.99658203125,
0.0030689239501953125,
0.00010585784912109375,
0.0001024007797241211
] |
An estimated 730 new cases of BC are estimated for 2020 in the Federal District (INCA). Of these cases, 70% will be treated in the public service; therefore, the estimated N is 511 patients to be screened per year diagnosed with breast cancer in public hospitals in the DF. With the majority being followed up at IHB-DF, we expect at least 300 patients (60%) with breast cancer per year at this hospital. For the primary objective, the detection rate of PV p.R337H, for a population of 300 women with breast cancer treated in public hospitals in the Federal District from January 2021 to January 2022, considering an average prevalence of 4.8% for PV R337H of TP53 obtained from previous studies , for a sampling error of 2% and a confidence interval of 95%, it was estimated that 178 patients would be needed to compose the sample.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p14
|
PMC11276326
|
sec[2]/sec[0]/p[0]
|
3.1. Clinical and Pathological Characteristics of the Population
| 3.46875 |
biomedical
|
Study
|
[
0.99609375,
0.0035858154296875,
0.0003914833068847656
] |
[
0.9990234375,
0.0006289482116699219,
0.0002543926239013672,
0.0002696514129638672
] |
A total of 245 women with BC were screened for this study. Of these, 180 patients met the study criteria. The median age at BC diagnosis was 43.5 years (range: 18–78 years). Among the participants, 75 (42%) were brown. The median interval between BC diagnosis and genetic counseling was one year, ranging from 0.1 to 12 years. The demographic, clinical, and pathological characteristics of the patients are summarized in Table 1 .
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p15
|
PMC11276326
|
sec[2]/sec[0]/p[1]
|
3.1. Clinical and Pathological Characteristics of the Population
| 4.085938 |
biomedical
|
Study
|
[
0.9931640625,
0.006809234619140625,
0.0002262592315673828
] |
[
0.9970703125,
0.00130462646484375,
0.0006875991821289062,
0.0008344650268554688
] |
Regarding invasive BC features, most were invasive ductal carcinomas (93%), whereas the remainder were invasive lobular carcinomas (6%) and other types (1%). Most tumors (50%, n = 90) were estrogen receptor-positive (ER+)/HER2-negative, 45 (25%) were HER2-positive, and 45 (25%) were triple-negative. A total of 21 women (9.5%) had bilateral breast tumors, including both synchronous and metachronous cases. In terms of initial breast cancer staging, 94 patients (52%) were at stage III or IV at the time of BC diagnosis. At the time of genetic counseling, 31 patients (17%) had metastatic disease.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276326_p16
|
PMC11276326
|
sec[2]/sec[0]/p[2]
|
3.1. Clinical and Pathological Characteristics of the Population
| 1.664063 |
biomedical
|
Other
|
[
0.95703125,
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0.037078857421875
] |
[
0.4775390625,
0.517578125,
0.002017974853515625,
0.0030517578125
] |
Most patients were native to the Midwest (47%) or Northeastern (35%) regions of Brazil. Furthermore, 5% of patients hailed from the North, 1% from the South, and 11% from the Southeast .
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276326_p17
|
PMC11276326
|
sec[2]/sec[1]/p[0]
|
3.2. Revised Chompret Criteria for Li-Fraumeni Syndrome
| 4.054688 |
biomedical
|
Study
|
[
0.99755859375,
0.002162933349609375,
0.00020694732666015625
] |
[
0.998046875,
0.001117706298828125,
0.00023424625396728516,
0.00036144256591796875
] |
Forty patients (40/180; 22%) met the revised Chompret criteria for LFS. Among these 40 patients, 40% (n = 16) met the criteria for BC diagnosis before 31 years of age, and 60% (n = 24) met the criteria for BC diagnosis at or before 45 years of age, along with a positive family history of sarcoma, brain cancer, or adrenocortical carcinoma. Among those patients who were found to harbor the p.R337H variant, 5% (2/40) met the revised Chompret criteria for LFS.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p18
|
PMC11276326
|
sec[2]/sec[2]/p[0]
|
3.3. TP53 p.R337H Detection Rate
| 3.914063 |
biomedical
|
Study
|
[
0.99462890625,
0.005168914794921875,
0.0002655982971191406
] |
[
0.99609375,
0.00240325927734375,
0.00027441978454589844,
0.0010175704956054688
] |
Among the 180 included patients, 100 underwent allelic discrimination testing and 80 underwent germline multigene panel testing. We identified two patients (1.1%) with the p.R337H variant, one through variant testing and the other through a multigene panel. Both patients met the NCCN HBC criteria, as they were diagnosed with BC at or before 45 years of age.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p19
|
PMC11276326
|
sec[2]/sec[2]/p[1]
|
3.3. TP53 p.R337H Detection Rate
| 3.84375 |
biomedical
|
Clinical case
|
[
0.744140625,
0.25439453125,
0.0015201568603515625
] |
[
0.09954833984375,
0.0278778076171875,
0.0036773681640625,
0.86865234375
] |
One patient met the revised Chompret criteria for LFS because of a BC diagnosis at 28 years of age; that is, she met the criteria of juvenile breast cancer (<31 years). She was submitted to two molecular tests (a multigene out-of-pocket test and the specific one for p.R337H offered by the study). This patient was born in the Federal District, with a family from the Midwest region, presented with stage IIIA invasive ductal carcinoma, histological grade 2, ER+/HER2-negative, and Ki67 > 14%. The patient underwent neoadjuvant chemotherapy, followed by bilateral mastectomy and adjuvant hormone therapy. Familial cascade testing revealed variant segregation through the maternal side of the family.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p20
|
PMC11276326
|
sec[2]/sec[2]/p[2]
|
3.3. TP53 p.R337H Detection Rate
| 1.602539 |
clinical
|
Clinical case
|
[
0.369384765625,
0.609375,
0.02154541015625
] |
[
0.010650634765625,
0.1004638671875,
0.0030612945556640625,
0.8857421875
] |
Another patient was diagnosed with BC at 43 years of age and had a family history of cancer. This history included a nephew diagnosed with brain cancer at four years of age, as well as seven close relatives diagnosed with BC: four sisters, one niece, one paternal cousin, and one paternal aunt.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p21
|
PMC11276326
|
sec[2]/sec[2]/p[3]
|
3.3. TP53 p.R337H Detection Rate
| 1.677734 |
clinical
|
Clinical case
|
[
0.171142578125,
0.81396484375,
0.01497650146484375
] |
[
0.0030193328857421875,
0.0202789306640625,
0.00197601318359375,
0.974609375
] |
The patient was born in the Federal District, but her family was from the Southeast region. She was diagnosed with de novo stage IV, ER+/HER2-negative invasive ductal carcinoma (grade 2).
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276326_p22
|
PMC11276326
|
sec[2]/sec[2]/p[4]
|
3.3. TP53 p.R337H Detection Rate
| 2.748047 |
biomedical
|
Study
|
[
0.98974609375,
0.00864410400390625,
0.0016794204711914062
] |
[
0.80859375,
0.14697265625,
0.002826690673828125,
0.041656494140625
] |
Genetic counseling and family variant testing were extended to 31 relatives, revealing that 19 individuals were carriers of the p.R337H variant.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p23
|
PMC11276326
|
sec[2]/sec[3]/p[0]
|
3.4. Patients Who Underwent Germline Genetic Panel Testing
| 4.101563 |
biomedical
|
Study
|
[
0.9990234375,
0.0007181167602539062,
0.00020205974578857422
] |
[
0.9990234375,
0.00040602684020996094,
0.00020813941955566406,
0.00012433528900146484
] |
Among 80 patients who underwent out-of-pocket multigene panel testing, 17 (21.2%) carried pathogenic variants (PV) in cancer susceptibility genes, including 12 (15%) patients with BRCA1/BRCA2 PV, two (2.5%) with TP53 PV, one with p.R337H and one with non-R337H TP53 PV (p.W146X), along with 3 (3.7%) in genes not associated with HBC ( Table S3 in the Supplementary Materials ).
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p24
|
PMC11276326
|
sec[2]/sec[3]/p[1]
|
3.4. Patients Who Underwent Germline Genetic Panel Testing
| 2.712891 |
biomedical
|
Study
|
[
0.966796875,
0.031951904296875,
0.0012187957763671875
] |
[
0.97509765625,
0.02032470703125,
0.0010662078857421875,
0.003307342529296875
] |
Regarding the timing of genetic testing, 37 (46%) patients underwent genetic testing before the surgical planning, whereas 43 (54%) underwent testing only during follow-up or at the time of disease recurrence.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p25
|
PMC11276326
|
sec[3]/p[0]
|
4. Discussion
| 3.738281 |
biomedical
|
Study
|
[
0.99951171875,
0.0003466606140136719,
0.00030875205993652344
] |
[
0.99853515625,
0.0009350776672363281,
0.00023806095123291016,
0.00011968612670898438
] |
Our results suggest a lower prevalence of TP53 p.R337H among women with BC in the Brazilian Midwest public health system compared to other Brazilian studies. Nonetheless, a significant number of family members harboring this variant were identified through cascade genetic testing, reinforcing the potential impact of genetic testing as a preventive approach.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276326_p26
|
PMC11276326
|
sec[3]/p[1]
|
4. Discussion
| 4.023438 |
biomedical
|
Study
|
[
0.99951171875,
0.0002453327178955078,
0.00023412704467773438
] |
[
0.99951171875,
0.0002186298370361328,
0.00023412704467773438,
0.0000565648078918457
] |
We found 1.1% TP53 p.R337H carriers among the studied population, characterized by public health users, with a median age at BC diagnosis of 43.5 years. The population was enriched with individuals from the Midwest and Northeast regions of the country. This finding is in concordance with studies from the Northeast that reported lower frequencies of TP53 p.R337H carriers, ranging from 0% to 0.6% . In contrast, Giacomazzi et al. found 12% TP53 p.R337H carriers among Southern women diagnosed with BC at or before 45 years of age .
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276326_p27
|
PMC11276326
|
sec[3]/p[2]
|
4. Discussion
| 4.058594 |
biomedical
|
Study
|
[
0.99951171875,
0.0002579689025878906,
0.0003418922424316406
] |
[
0.99951171875,
0.0002111196517944336,
0.00015497207641601562,
0.00005143880844116211
] |
Although haplotype studies and Brazilian colonization history have indicated a common Portuguese ancestor as an explanation for the higher concentration of TP53 p.R337H carriers in the Southeastern region of the country , the largest Brazilian BC genotyping study, which included 1663 BC patients unselected by age at BC onset or family history of cancer, mostly from the South/Southeast of Brazil (70%), had a detection rate of p.R337H carriers of 1.6% . These data suggest that regional colonization differences and population selection criteria affect the TP53 p.R337H detection rate, as one can see in Table 2 .
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276326_p28
|
PMC11276326
|
sec[3]/p[3]
|
4. Discussion
| 3.876953 |
biomedical
|
Study
|
[
0.9990234375,
0.0006651878356933594,
0.00029587745666503906
] |
[
0.9990234375,
0.0004916191101074219,
0.00034928321838378906,
0.00008809566497802734
] |
It is also important to point out other clinical characteristics of the cohort. Similar to the AMAZONA study , in which 80.8% of the patients received treatment through the public health system, we observed that a substantial proportion of the patients were diagnosed with locally advanced or metastatic breast cancer (52% in stages III or IV). Several Brazilian studies have indicated an association between the socioeconomic status of women and their ability to undergo recommended preventive exams, such as Pap smears and mammography . Therefore, a lack of resources in a given population is associated with delayed cancer diagnosis at more advanced stages.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276326_p29
|
PMC11276326
|
sec[3]/p[4]
|
4. Discussion
| 3.951172 |
biomedical
|
Study
|
[
0.9990234375,
0.0005421638488769531,
0.0002579689025878906
] |
[
0.85546875,
0.01317596435546875,
0.130859375,
0.0005841255187988281
] |
The primary clinical utility of germline genetic testing for hereditary cancer lies in identifying individuals at a higher risk of developing cancer, thereby providing an opportunity for effective cancer screening and implementing risk reduction strategies. However, owing to the limited resources and constraints of the Brazilian public health system, patients often face restrictions accessing most screening examinations and may be required to cover the costs themselves. The Toronto protocol, a follow-up protocol for LFS carriers, has been shown to improve early cancer detection and survival rates . According to Frankenthal et al., the Toronto protocol is cost-effective for LFS carriers in Brazil . Annual whole-body MRI, a component of the protocol, detects neoplasms in 9% of asymptomatic patients. Unfortunately, a lack of specific public information renders the complete protocol unavailable to users of the Brazilian public health system.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276326_p30
|
PMC11276326
|
sec[3]/p[5]
|
4. Discussion
| 3.927734 |
biomedical
|
Study
|
[
0.9990234375,
0.0005311965942382812,
0.00039887428283691406
] |
[
0.99951171875,
0.0002684593200683594,
0.00014138221740722656,
0.00006449222564697266
] |
This study had some limitations. First, only patients alive at the time of enrollment were included in this study, which may represent a survivorship bias. Second, the cohort consisted mostly of patients from two public hospitals in the Federal District, which serve 80% of the population who need oncologic care and do not have health insurance in the region; this fact can represent a socioeconomic bias. Other economic barriers may have influenced patient recruitment, since there was no financial support for enrollment or transportation expenses. In addition, one hundred patients were only tested for the specific TP53 p.R337H; among these, we may have missed carriers of other TP53 non-p.R337H carriers and carriers of PV in other breast cancer susceptibility genes.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276326_p31
|
PMC11276326
|
sec[4]/p[0]
|
5. Conclusions
| 2.808594 |
biomedical
|
Study
|
[
0.998046875,
0.0006518363952636719,
0.0012340545654296875
] |
[
0.93310546875,
0.06488037109375,
0.0013227462768554688,
0.0008745193481445312
] |
The detection rate of the TP53 p.R337H variant was lower than that reported in other Brazilian studies in Southeastern Brazil. Despite this, our findings draw attention to the LFS carriers overlooked by the Brazilian public healthcare system. The implementation of hereditary cancer screening through genetic testing and preventive interventions is urgently required for this underserved population.
|
[
"Tatiana Strava Corrêa",
"Paula Fontes Asprino",
"Eduarda Sabá Cordeiro de Oliveira",
"Ana Carolina Rathsam Leite",
"Luiza Weis",
"Maria Isabel Achatz",
"Claudiner Pereira de Oliveira",
"Renata Lazari Sandoval",
"Romualdo Barroso-Sousa"
] |
https://doi.org/10.3390/genes15070928
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p0
|
PMC11276338
|
sec[0]/p[0]
|
1. Introduction
| 3.988281 |
biomedical
|
Other
|
[
0.99267578125,
0.006439208984375,
0.0009102821350097656
] |
[
0.129638671875,
0.6435546875,
0.22265625,
0.004001617431640625
] |
Cleft lip and/or palate (CL/P) are a highly prevalent congenital anomaly affecting neonates and necessitate specialised, multidisciplinary, and meticulous care from an early age . The orthodontic management of neonates with CL/P begins soon after birth with Naso Alveolar Moulding (NAM), with the accuracy of oral impressions serving as a fundamental aspect in treatment planning and intervention . The World Health Organisation recommends study models to be recorded at various stages; soon after birth, before the lip’s surgical repair, and at 5, 10, 18, and 20 years of age . Hence, in neonates, an oral impression is one of the first procedures undertaken as a diagnostic aid for constructing oral appliances, mainly for pre-operative orthopaedic preparation.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p1
|
PMC11276338
|
sec[0]/p[1]
|
1. Introduction
| 3.943359 |
biomedical
|
Study
|
[
0.998046875,
0.001781463623046875,
0.0004134178161621094
] |
[
0.77587890625,
0.1365966796875,
0.08612060546875,
0.0015153884887695312
] |
Conventional impression (CI) techniques using alginate or rubber-based materials have proven challenging in neonates due to the anatomical complexities and potential risks associated with airway obstruction during impression procedures . Due to the constricted airway of infants, CI procedures may result in a reduction in oxygen saturation levels, and it is recommended that a reduction of more than 5 percent should receive an additional oxygen supply . Consequently, the impression procedure for neonates with CL/P is mostly carried out within a hospital environment due to the elevated risk of respiratory complications, as the procedure can also potentially obstruct the airway or elicit a gag reflex, necessitating immediate medical intervention . Moreover, the plaster models from CI have the added disadvantage of being brittle, cumbersome, and heavy, which makes their storage, transfer, and retrieval difficult. Additionally, plaster models are susceptible to dimensional changes .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276338_p2
|
PMC11276338
|
sec[0]/p[2]
|
1. Introduction
| 3.947266 |
biomedical
|
Other
|
[
0.99462890625,
0.00438690185546875,
0.0008740425109863281
] |
[
0.07080078125,
0.83642578125,
0.08978271484375,
0.00316619873046875
] |
Recently, the production of a digital impression (DI), facilitated by an intraoral scanner (IOS), has been introduced to be used at various stages of cleft care . DI is a diagnostic tool that enables clinicians to accurately record the maxillary arch dimensions and the size of the alveolar cleft in children with CL/P. This capability is critical during the early phases of treatment planning as it allows for a thorough examination of the oral anatomy and cleft morphology . Another application of DI in cleft care is fabricating the appliances used in pre-surgical orthopaedics, such as NAM appliances . DI creates a digital workflow for fabricating appliances that prepare the newborn for cleft lip repair surgery. Furthermore, it is instrumental in evaluating the outcome of various treatments in patients with CL/P .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p3
|
PMC11276338
|
sec[0]/p[3]
|
1. Introduction
| 3.886719 |
biomedical
|
Review
|
[
0.99853515625,
0.0008196830749511719,
0.0004456043243408203
] |
[
0.390625,
0.0151214599609375,
0.59326171875,
0.0008349418640136719
] |
In the pursuit of improving the precision, efficiency, and safety of obtaining oral impressions in neonates with CL/P, DI technology has emerged as a promising alternative . Incorporating intraoral scanners (IOSs) for DI in CL/P patients overcomes issues associated with traditional procedures. It provides benefits, including instant modifications, decreased discomfort, and the possibility of more efficient operations . While the clinical implications of DI in the clinical care of neonates with CL/P have been explored, a comprehensive understanding of the accuracy of these DIs in neonates with CL/P is limited . Moreover, neonates, especially those with CL/P, present a unique challenge due to their small oral cavities, limited cooperation, and potential difficulty in maintaining proper positioning during the scanning process.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p4
|
PMC11276338
|
sec[0]/p[4]
|
1. Introduction
| 4.089844 |
biomedical
|
Study
|
[
0.9970703125,
0.0025806427001953125,
0.0003204345703125
] |
[
0.998046875,
0.0013179779052734375,
0.0004513263702392578,
0.00025916099548339844
] |
This study aimed to assess the accuracy of DIs in neonates with CL/P compared to conventional alginate and putty impressions using a laboratory-based investigation. This study evaluated the accuracy of DIs in this population to determine whether this technology is viable and the potential of streamlining the treatment process and improving patient outcomes. The null hypothesis postulated that there are no significant differences between digital and conventional impressions in neonates with cleft lip and/or cleft palate (CL/P), irrespective of the cleft’s severity (cleft size) and cleft types (Unilateral/Bilateral/Midline Defect).
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276338_p5
|
PMC11276338
|
sec[1]/p[0]
|
2. Materials and Methods
| 0.928711 |
biomedical
|
Other
|
[
0.58642578125,
0.004730224609375,
0.408935546875
] |
[
0.00890350341796875,
0.98974609375,
0.0005173683166503906,
0.0006785392761230469
] |
Ethical approvals for this laboratory-based study were obtained from the Queensland Children’s Hospital Human Research Ethics Committee and from the ethical committee at Griffith University, Queensland, Australia [HREC/23/QCHQ/97036; 3 May 2023].
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p6
|
PMC11276338
|
sec[1]/p[1]
|
2. Materials and Methods
| 3.753906 |
biomedical
|
Study
|
[
0.9931640625,
0.006069183349609375,
0.0006055831909179688
] |
[
0.99658203125,
0.00258636474609375,
0.0002543926239013672,
0.0004715919494628906
] |
The inclusion criteria included neonates with cleft lip and/or cleft palate (CL/P), of both genders, with unilateral, bilateral, or midline defects of varying severity. Neonates who required impressions for either NAM or feeding plates were included in this study. The patient models selected consisted of those with a bilateral complete cleft lip and palate, unilateral complete cleft lip and palate, cleft palate only, unilateral cleft of the alveolar ridge only, and unilateral cleft lip only. These patients attended Queensland Children’s Hospital for the management of their cleft defect.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276338_p7
|
PMC11276338
|
sec[1]/sec[0]/p[0]
|
2.1. Cleft Lip and Palate Models
| 4.132813 |
biomedical
|
Study
|
[
0.99853515625,
0.0008196830749511719,
0.00046515464782714844
] |
[
0.9990234375,
0.0005741119384765625,
0.00025153160095214844,
0.00010585784912109375
] |
Soft acrylic models were prepared in the Queensland Children’s Hospital (Children’s Oral Health Service and Child Specialist Services, Metro North Hospital and Health Service) for educational and demonstration purposes . These models were duplicated from the original models using a soft acrylic material (Vertex Dental by 3D Systems, Soesterberg, The Netherlands) for the palatal, alveolar pad, and lip areas to mimic the flexibility and softness of the oral tissues. The base of the models was made of hard acrylic (Vertex Rapid, Vertex Dental by 3D Systems, Soesterberg, The Netherlands). Three cylindrical-shaped hard acrylic areas were incorporated into the soft acrylic model’s hard base as a superimposition reference. The purpose of these cylindrical areas was to create a reference point that would not be affected by the impression procedures due to its position outside the area of interest and its hard consistency. Before impression procedures, a cross was delineated in each cylindrical reference to facilitate the selection of multiple reference points for enhanced digital image superimposition. The models included in this study represented a range of cleft conditions: a bilateral complete cleft lip and palate (n = 4), unilateral complete cleft lip and palate (n = 4), unilateral incomplete cleft lip and palate (n = 2), cleft palate only (n = 2), and cleft lip only (n = 2).
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p8
|
PMC11276338
|
sec[1]/sec[1]/sec[0]/p[0]
|
2.2.1. Conventional Impressions
| 4.097656 |
biomedical
|
Study
|
[
0.9970703125,
0.0021190643310546875,
0.0006537437438964844
] |
[
0.931640625,
0.06597900390625,
0.0011796951293945312,
0.0011930465698242188
] |
To ensure optimal pressure for documenting the intricate details of the oral structures within the alveolar cleft, a customised acrylic tray was designed to enclose the models, including the hard spheres, completely. Alginate impressions (Blueprint XCreme: Dust free Alginates—DENTSPLY Sirona, Charlotte, NC, USA) of the models were obtained using a customised impression tray. The rubber-based impression was obtained using heavy body impression material (Henry Schein V-Posil Mix Putty Fast Set Kit, VOCO-, Cuxhaven, Germany) in a customised impression tray. Inadequate impressions were repeated. Plaster models were generated by filling alginate and rubber-based impressions with dental stone (FUJI ROCK EP Pastel Yellow Die Stone, Gc corporation, Tokyo, Japan) as soon as the impressions were taken.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276338_p9
|
PMC11276338
|
sec[1]/sec[1]/sec[1]/p[0]
|
2.2.2. Digital Impressions
| 4.1875 |
biomedical
|
Study
|
[
0.99755859375,
0.00202178955078125,
0.0003407001495361328
] |
[
0.994140625,
0.00469970703125,
0.0007982254028320312,
0.00042724609375
] |
Each soft acrylic model was scanned using a 3Shape TRIOS 4 intraoral scanner (3Shape Dental Systems, Copenhagen, Denmark), which has a smaller scanner head compared to most of the other intraoral scanners on the market, making it more compact, with dimensions of 4.9 × 4.0 × 27.8 cm. Utilising the same IOS, plaster models derived from CIs were scanned and stored as Stereolithographic (STL) images. The scanner head was calibrated daily prior to use to ensure accuracy and reliability. A standardised scanning protocol was meticulously developed to ensure consistency and thoroughness in scanning models with discontinuous arches due to cleft conditions. Firstly, the scan began at one tuberosity area, starting from the greater segment in unilateral cleft cases, setting a starting point for a systematic approach. Then, it extended into the hard acrylic, capturing superimposition spheres to facilitate the precise alignment and merging of scans. Then, it moved to the opposite tuberosity area, ensuring both posterior ends of the arch were comprehensively documented. The process then continued to the palatal surface of the alveolar cleft and then to the anterior part of the alveolar arch. The next step involved scanning the palatal surface of the alveolar arch on the opposite side, providing a detailed view of the upper dental arch’s interior. Finally, the scanning concluded with a focus on the deep part of the cleft, moving from the anterior to the posterior, to ensure a detailed documentation of the cleft’s depth and morphology. A number of inadequately scanned model regions were revisited until the investigator was satisfied with the quality of the scan.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276338_p10
|
PMC11276338
|
sec[1]/sec[2]/p[0]
|
2.3. Model Comparison Procedure
| 4.015625 |
biomedical
|
Study
|
[
0.9990234375,
0.0004973411560058594,
0.0005698204040527344
] |
[
0.99951171875,
0.0002148151397705078,
0.00019478797912597656,
0.00005602836608886719
] |
This study focused exclusively on assessing trueness while evaluating the accuracy of DIs, as it measures the closeness of a scan’s average dimensions to the true dimensions of an object, providing a direct reflection of the scanner’s ability to replicate the precise morphology of dental structures. The soft acrylic models and the plaster models generated from both alginate and putty impressions were scanned to generate STL files and a comparison was made between the three models
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p11
|
PMC11276338
|
sec[1]/sec[2]/p[1]
|
2.3. Model Comparison Procedure
| 4.046875 |
biomedical
|
Study
|
[
0.99853515625,
0.0009431838989257812,
0.0006208419799804688
] |
[
0.99951171875,
0.0004115104675292969,
0.0001531839370727539,
0.00006890296936035156
] |
Random numbers were assigned to the 3D models of the soft acrylic and plaster models derived from alginate and putty impressions to mitigate potential bias during the data collection process. Using Materialise 3 Matic software Version 16.0 (Materialise, Technologielaan, Leuven, Belgium), three STL images from each group were aligned with N point registration by placing multiple points in the cross mark of the reference sphere. Subsequently, the images were superimposed. Intra-arch measurements and surface discrepancies were compared to analyse the differences among the groups .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p12
|
PMC11276338
|
sec[1]/sec[2]/sec[0]/p[0]
|
2.3.1. Intra-Arch Measurements
| 4.066406 |
biomedical
|
Study
|
[
0.9990234375,
0.00047278404235839844,
0.0002601146697998047
] |
[
0.99951171875,
0.000232696533203125,
0.00022470951080322266,
0.00007224082946777344
] |
Ten anatomical reference points were identified and marked on the superimposed models of a scan . The linear distance, in millimetres, and angular deviations between the reference points were measured from each scan using Materialise 3-Matic software (Materialise, Technologielaan, Leuven, Belgium) . Marking the reference points on the aligned models ensured that the reference points were marked in these exact locations in all images, and it enabled the accurate recording of the linear and angular measurements in all three scanned images ( Table 1 ). Each measurement was repeated three times, and average data values were used to avoid subjective errors. No reliability tests were performed for these measurements. The decision to rely on average values from three repeated measurements was intended to reduce the variability and potential subjective errors inherent in individual measurements.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276338_p13
|
PMC11276338
|
sec[1]/sec[2]/sec[1]/p[0]
|
2.3.2. Surface Discrepancy
| 3.804688 |
biomedical
|
Study
|
[
0.99853515625,
0.00044798851013183594,
0.0011262893676757812
] |
[
0.99951171875,
0.0004742145538330078,
0.00015223026275634766,
0.00005894899368286133
] |
The digital scans were exported into Materialise 3-Matic software Version 16.0 (Materialise, Technologielaan, Leuven, Belgium). Scanned images (n = 3) were superimposed in each of the fourteen groups (IOS vs. alginate, IOS vs. putty, and alginate vs. putty), and the surface discrepancy between the three models was analysed. The median values and minimum and maximum discrepancy ranges were documented from histogram data .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276338_p14
|
PMC11276338
|
sec[1]/sec[3]/p[0]
|
2.4. Statistical Analysis
| 4.136719 |
biomedical
|
Study
|
[
0.99853515625,
0.0011005401611328125,
0.00025582313537597656
] |
[
0.99853515625,
0.00102996826171875,
0.0003056526184082031,
0.00012129545211791992
] |
A sample size calculation was performed using G*Power software (v3.1.9.2). The calculation assumed a large effect size (d = 0.6), an alpha level of 0.05, and a study power of 80%. The minimum difference considered significant was 0.5 mm. The minimum sample size required was 30 models, with 10 models in each group. Only seven soft acrylic models were available, which were created from the models of seven neonates; to create an adequate sample size, each model was used twice, resulting in a sample size of fourteen models per group. Despite using only seven silicone models, impressions were taken twice to increase the sample size and power of the study. The inherent variability in impression-taking, such as differences in the amount of pressure applied or minor deviations in technique, can indeed result in different outcomes even when the same model is used. Also, the ability to use models multiple times and still obtain reliable data reflects real-world conditions, where clinicians and laboratory staff often work with varying levels of precision and repeatability. The linear and angular measurements were repeated after one month to determine intra-examiner reliability.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p15
|
PMC11276338
|
sec[1]/sec[3]/p[1]
|
2.4. Statistical Analysis
| 3.613281 |
biomedical
|
Study
|
[
0.9990234375,
0.0002703666687011719,
0.0005130767822265625
] |
[
0.99853515625,
0.0012035369873046875,
0.0002384185791015625,
0.00007218122482299805
] |
An ANOVA test was applied to compare the mean linear and angular measurements between the three groups. The intra-correlation coefficient was calculated to analyse the intra-examiner variability in linear and angular measurements. Data analysis was conducted using IBM SPSS version 29.0. The level of significance was set at a p value of <0.05.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p16
|
PMC11276338
|
sec[2]/sec[0]/p[0]
|
3.1. Intra-Arch Measurements
| 2.507813 |
biomedical
|
Study
|
[
0.9970703125,
0.0014905929565429688,
0.001255035400390625
] |
[
0.98486328125,
0.01390838623046875,
0.0008854866027832031,
0.0005435943603515625
] |
A descriptive statistics overview of many variables’ properties across various parameters is available in Table 2 . The variability observed in different dimensions is in line with what is expected in a population with cleft lip and palate, as this naturally includes a range of anatomical variations in size and severity.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p17
|
PMC11276338
|
sec[2]/sec[0]/p[1]
|
3.1. Intra-Arch Measurements
| 4.054688 |
biomedical
|
Study
|
[
0.9990234375,
0.0002911090850830078,
0.0005602836608886719
] |
[
0.99951171875,
0.00020742416381835938,
0.00017392635345458984,
0.00004279613494873047
] |
An ANOVA test was performed to evaluate the variance distribution between and within groups for each tested variable ( Table 3 ). There was no significant difference ( p > 0.05) between groups in the PP1-A1, PP2-A2, A1-A2, C1-C2, T1-T2, W1-W2, and P-T1-T2 measurements. The between-groups variance was relatively low, indicating similar measurements across the groups, suggesting no significant differences between groups.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p18
|
PMC11276338
|
sec[2]/sec[0]/p[2]
|
3.1. Intra-Arch Measurements
| 2.847656 |
biomedical
|
Study
|
[
0.98486328125,
0.0006899833679199219,
0.01421356201171875
] |
[
0.99462890625,
0.004810333251953125,
0.00029397010803222656,
0.00011307001113891602
] |
For each of the 14 groups of digital models, a line graph represents six linear and one angular measurement for the alginate (Alg), IOS, and putty models . Most groups have a significant degree of similarity in their measurements since the coloured lines that depict each group’s putty, IOS, and alginate are almost precisely parallel. P/P1-A1 had the maximum measurement variation. Still, the degree of deviation was not statistically significant.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276338_p19
|
PMC11276338
|
sec[2]/sec[1]/p[0]
|
3.2. Surface Discrepancy
| 4.167969 |
biomedical
|
Study
|
[
0.998046875,
0.0003991127014160156,
0.0016546249389648438
] |
[
0.99951171875,
0.00018334388732910156,
0.00023865699768066406,
0.000037610530853271484
] |
Histograms showed a trend towards negative minimum values for alginate compared to IOS, while positive values for putty suggest that the IOS typically has lower minimum values than putty. This indicates a difference in statistical measurements in the minimum value between the two comparisons . This study showed a notable difference in the distribution of maximum values between alginate and IOS. Conversely, the maximum values of the putty impression were distributed more uniformly across the dataset compared to those of the alginate and IOS . However, the first quartile values are primarily negative for alginate and positive for putty, suggesting that alginate typically has lower Q1 values . The distribution is balanced above and below zero, indicating that the highest values of these materials may not follow a similar trend. The median-value histograms show that alginate and putty have similar medians, with higher median values than IOS . Their third quartile (Q3) values are greater than the IOS’s . Alginate has a lower mean value than the IOS but higher than putty . Standard deviation histograms show that it has higher variability than IOS but lower variability than putty . RMS histograms show that alginate has a similar RMS to putty and a generally greater RMS than IOS .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p20
|
PMC11276338
|
sec[2]/sec[1]/p[1]
|
3.2. Surface Discrepancy
| 1.964844 |
biomedical
|
Study
|
[
0.9873046875,
0.0015859603881835938,
0.01119232177734375
] |
[
0.80029296875,
0.1944580078125,
0.003765106201171875,
0.0015363693237304688
] |
Similar observations are made in the box plot of the measurements, showing the mean in the three-comparison group .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276338_p21
|
PMC11276338
|
sec[2]/sec[1]/p[2]
|
3.2. Surface Discrepancy
| 3.212891 |
biomedical
|
Study
|
[
0.994140625,
0.00036215782165527344,
0.005336761474609375
] |
[
0.99609375,
0.0034027099609375,
0.00025272369384765625,
0.00008481740951538086
] |
The data show a moderate distribution of alginate vs. IOS values, with a median of −0.2 and an interquartile range of −0.3 to +0.1. The outliers below indicate lower alginate values. The data are moderately distributed within this range. Putty vs. IOS has a median value of 0, with noticeable disparities. Alginate vs. putty has less fluctuation, with a narrow IQR and outliers. Most data points lie within a larger range but within 1.5 times the IQR.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276338_p22
|
PMC11276338
|
sec[2]/sec[1]/p[3]
|
3.2. Surface Discrepancy
| 4.078125 |
biomedical
|
Study
|
[
0.99853515625,
0.0003197193145751953,
0.0012111663818359375
] |
[
0.99951171875,
0.00021779537200927734,
0.00015413761138916016,
0.00003451108932495117
] |
The ANOVA table indicates no statistically significant differences in the median and mean values among the groups ( Table 4 ). There are notable variations in the minimum and maximum values across the comparison groups, with p -values of 0.000 and 0.026, respectively. The F-statistics are relatively low, and the corresponding p -values exceed the conventional significance threshold of 0.05 for variables such as Q1, median, Q3, mean, and RMS. This suggests that there is uniformity in these characteristics and no noticeable variations in averages among the groups for these variables.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p23
|
PMC11276338
|
sec[2]/sec[1]/p[4]
|
3.2. Surface Discrepancy
| 4.105469 |
biomedical
|
Study
|
[
0.99853515625,
0.0005230903625488281,
0.0009160041809082031
] |
[
0.99951171875,
0.00027251243591308594,
0.0002053976058959961,
0.00004589557647705078
] |
Intra-examiner reliability was assessed using Intra Class Coefficient (ICC) estimates and their 95% confidence intervals, which were calculated using IBM SPSS version 29.0 (SPSS Inc., Chicago, IL, USA) based on a mean-rating ( k = 2), absolute-agreement, and a two-way random model ( Table 5 ). The examiner demonstrated that intra-examiner reliability was high across all three tools (IOS, Alg, putty) at baseline and the one-month follow-up assessments. The measurements made by the examiner are highly consistent, with ICC values close to 1 and statistically significant p -values, indicating excellent reliability in the measurements over time.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p24
|
PMC11276338
|
sec[3]/p[0]
|
4. Discussion
| 4.105469 |
biomedical
|
Study
|
[
0.9990234375,
0.0006680488586425781,
0.0001819133758544922
] |
[
0.9990234375,
0.0003497600555419922,
0.00044918060302734375,
0.00011652708053588867
] |
This study evaluated the trueness of DIs in neonates with CL/P. Trueness and precision are two key components of accuracy in DIs . Trueness refers to the closeness of the average measurement to the true or reference value, essentially assessing how accurately the DI reflects the actual anatomical structure. On the other hand, precision measures the consistency and repeatability of measurements, indicating the degree of variation between repeated measurements of the same object. The primary focus of this study was to evaluate the accuracy of DIs in terms of their ability to reproduce the true anatomical features of the oral cavity. In such cases, assessing trueness alone allows researchers to specifically examine how closely the digital models match the actual patient anatomy, providing valuable insights into the overall performance of IOSs, as trueness is often considered the primary indicator of accuracy in DIs, particularly from a clinical perspective.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p25
|
PMC11276338
|
sec[3]/p[1]
|
4. Discussion
| 4.082031 |
biomedical
|
Study
|
[
0.9990234375,
0.000652313232421875,
0.00020766258239746094
] |
[
0.99951171875,
0.0001939535140991211,
0.00042057037353515625,
0.00010383129119873047
] |
The results of this study supported the null hypothesis as there were no significant variations between the superimposed models created from the digital impressions and CIs in neonates with cleft lip and palate. This outcome was evident regardless of the cleft severity (cleft size) and cleft types (unilateral/bilateral). The compared means of the three groups (alginate, IOS, and putty) had no significant differences in either type of measurements; the intra-arch measurements or surface discrepancies. Due to the different sizes and severity of cleft lip and palate in the models used in the study, there was some fluctuation in the measurements. For all measured variables, the analysis of variance (ANOVA) showed no statical differences among the compared groups. Furthermore, the intra-examiner reliability of the measurements was high, indicating excellent consistency and reliability over time.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276338_p26
|
PMC11276338
|
sec[3]/p[2]
|
4. Discussion
| 4.082031 |
biomedical
|
Study
|
[
0.998046875,
0.000392913818359375,
0.0015096664428710938
] |
[
0.99951171875,
0.00014400482177734375,
0.00018227100372314453,
0.00003522634506225586
] |
Descriptive statistics of the intra-arch measurements provide an overview of many variables’ properties across various parameters. PP1_A1 has a mean score of 8.71 and a standard deviation of 0.49, which suggests that there is not much variation in the sample around the mean. On the other hand, variables with higher standard deviations (5.77 and 7.62, respectively), such as A1_A2 and PP2_A2, indicate that their values are more variable. Significant variations exist in the range of values for each variable, with PP2_A2 exhibiting a broad range from 5.37 to 23.30. Additionally, compared to other variables, the means of C1_C2 and T1_T2 are bigger (29.60 and 32.43, respectively), suggesting that their distributions have a higher central tendency. However, this variation in each measurement is insignificant, as the 14 models included in this study consist of cleft lip and palates of varying sizes and severity.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999992 |
PMC11276338_p27
|
PMC11276338
|
sec[3]/p[3]
|
4. Discussion
| 4.117188 |
biomedical
|
Study
|
[
0.9970703125,
0.0002987384796142578,
0.00254058837890625
] |
[
0.99951171875,
0.00018298625946044922,
0.00020694732666015625,
0.000030934810638427734
] |
The analysis of variance (ANOVA) findings shed light on how each variable’s group means differ. The F-statistic values vary from 0.004 to 0.13 for all variables (PP1_A1, PP2_A2, A1_A2, C1_C2, T1_T2, W1_W2, and P_T1_T2). Their corresponding p -values consistently surpass the traditional significance threshold of 0.05. This suggests no discernible variation between the group means for any given variable. In particular, the p -values for variables such as PP1_A1, A1_A2, C1_C2, T1_T2, W1_W2, and P_T1_T2 are all more than 0.05, indicating that there is no significant difference in the group means. All things considered, these ANOVA findings suggest that there are no statistically significant differences in the means of the groups each variable defines. Moreover, the p -value for every variable, aside from PP1_A1 ( p = 0.555), is closer to 1, meaning there is no difference in any of these measurements between the three groups.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276338_p28
|
PMC11276338
|
sec[3]/p[4]
|
4. Discussion
| 4.113281 |
biomedical
|
Study
|
[
0.998046875,
0.0015306472778320312,
0.00019228458404541016
] |
[
0.99609375,
0.0008668899536132812,
0.002605438232421875,
0.00036072731018066406
] |
This laboratory-based study aimed to assess the accuracy of DIs compared to CIs in neonates with CL/P. In patients with cleft lip and palate, an oral impression is the first procedure that has been undertaken and has typically been carried out in neonates until adulthood, as the rehabilitation of CL/P is a long-term process . DIs have become increasingly popular in all areas of dentistry due to their numerous advantages over traditional impression techniques, such as increased patient comfort, reduced chairside time, and improved accuracy . IOSs are rapidly becoming a favoured tool in paediatric dentistry, especially for improving patient comfort and experience during dental impressions. Recent studies have illuminated the advantages of DI methods over traditional alginate impressions, particularly for children and adolescents . Additionally, IOSs demonstrate comparable accuracy to conventional impression methods in capturing the dental arch morphology in children despite potential challenges such as interference and the inability to produce exact replicas of the dentition . However, when it comes to patients with CL/P, the accuracy of DIs becomes even more critical due to the complex anatomical variations and unique challenges presented by this population .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p29
|
PMC11276338
|
sec[3]/p[5]
|
4. Discussion
| 3.921875 |
biomedical
|
Study
|
[
0.99951171875,
0.00046825408935546875,
0.00021314620971679688
] |
[
0.92822265625,
0.01059722900390625,
0.0609130859375,
0.0004458427429199219
] |
There has been some growing research on the viability of using IOSs in neonates and infants with CL/P to explore the potential application of these technologies in various stages of CL/P treatment . However, very few studies have rigorously assessed the accuracy of IOSs in neonates with CL/P, a critical factor for effective treatment planning and outcome evaluations in this group. If the DI is accurate and efficient, replacing CIs with digital ones may remarkably reduce the risks and discomfort associated with the procedure. Therefore, validating the accuracy of IOSs in neonates with cleft lip and palate patients is a prerequisite for their use in clinical care.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276338_p30
|
PMC11276338
|
sec[3]/p[6]
|
4. Discussion
| 4.09375 |
biomedical
|
Study
|
[
0.9990234375,
0.00057220458984375,
0.00022685527801513672
] |
[
0.99853515625,
0.00023293495178222656,
0.0010862350463867188,
0.00010645389556884766
] |
The results of our study substantially contribute to the body of knowledge about the accuracy of DIs compared to CIs produced by putty and alginate in neonates with CL/P. Our findings align with those of Patel , El Naghy , and Okazaki in highlighting consistent intra-arch measurement characteristics, statistically insignificant differences across variables, and high intra-examiner reliability and offering valuable insights for the use of digital impression in neonates with CL/P . Patel and El Naghy utilised superimposition exclusively and Okazaki focused on intra-arch measurements, whereas our study adopted a comprehensive approach, integrating both intra-arch measurements and surface discrepancy analyses, offering a broader overview of the accuracy of DIs compared to CIs. Our study’s findings align with research that compared the accuracy of IOSs with alginate and putty materials in edentulous arches, emphasising the accuracy of IOSs in capturing detailed impressions across a variety of dental landscapes, including the challenging scenario of edentulous arches .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p31
|
PMC11276338
|
sec[3]/p[7]
|
4. Discussion
| 4.167969 |
biomedical
|
Study
|
[
0.9990234375,
0.0006470680236816406,
0.00037598609924316406
] |
[
0.99951171875,
0.0001722574234008789,
0.0004432201385498047,
0.0000768899917602539
] |
The line diagrams of the intra-arch measurement variations between the IOS, alginate, and putty impressions presented in our study demonstrate the lack of a consistent pattern in how these distances change, emphasising the differences in material behaviour and dimensional stability when capturing dental impressions. The difference in the measurements was not statistically significant, with the most variation in the PP/P1-A1 measurement. This variation could likely be attributed to the soft, movable anterior segment distortion resulting from the pressure applied by the impression materials. In groups exhibiting greater variation, alginate sometimes showed larger fluctuations, while putty demonstrated more variability in other instances. Despite the observed inconsistencies in linear distance variations between the alginate and putty impressions, the analysis of surface deviations reveals that the variability between putty impressions and intraoral scanning (IOS) is significantly less, indicating a closer agreement in the accuracy of these two methods, as depicted in the box plot. The reduced variability between putty impressions (Polyvinyl siloxane- PVS) and IOSs compared to alginate impressions can be explained by considering the material’s qualities and the effects of syneresis and imbibition on dimensional stability. Todd et al., on the dimensional variations in extended-pour alginate impression materials due to syneresis and imbibition, reveal that alginate tends to undergo dimensional changes over time . The reduced variability between putty impressions and the IOS compared to alginate is due to the specific material qualities and environmental resilience of PVS and digital impressions. Furthermore, the alginate and putty impressions were poured immediately after being made to create the plaster models to minimise dimensional alterations.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p32
|
PMC11276338
|
sec[3]/p[8]
|
4. Discussion
| 4.144531 |
biomedical
|
Study
|
[
0.9990234375,
0.0004916191101074219,
0.00043702125549316406
] |
[
0.998046875,
0.0001798868179321289,
0.00170135498046875,
0.00007796287536621094
] |
The surface discrepancy analysis revealed patterns in the minimum, maximum, median, and standard deviation values between the three groups (alginate, IOS, and putty). Overall, there were no significant differences in the surface discrepancies among the groups. The box plots further illustrated the homogeneity in the differences between the groups. However, the analysis did show statistically significant differences in the minimum and maximum values of the alginate among the groups compared, but not in its median or standard deviation values. While extreme discrepancies may vary, the general accuracy across methods remains consistent. The difference observed in the minimum and maximum values for alginate impressions can be attributed to material-specific behaviours under pressure, as explained by Patel et al. . They noted that the maximum deviation was observed in the freely movable premaxilla, suggesting that the deformation could be due to the pressure exerted by the alginate impression material during the impression-taking process. This could be explained by the thinner consistency of the alginate impression material in comparison to the putty impression material, which allows excessive flow of the material around the freely movable premaxilla even with minimal pressure exerted during the impression-taking process. No constant deviations were observed in specific areas in this investigation, highlighting the intricate interaction of elements that affect impression accuracy. Currently, no studies compare the accuracy of alginate and putty in cleft lip and palate (CL/P) patients and how it varies with material properties.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276338_p33
|
PMC11276338
|
sec[3]/p[9]
|
4. Discussion
| 4.109375 |
biomedical
|
Study
|
[
0.9990234375,
0.0005559921264648438,
0.00026869773864746094
] |
[
0.9990234375,
0.0006651878356933594,
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0.00008916854858398438
] |
In the present study, we utilised the Trios 4 scanner, leveraging the advanced capabilities of the Trios 3Shape intraoral digital impression system, which is based on the principles of ultrafast optical sectioning and confocal microscopy. This system employs range finding to accurately define surface manifolds, maintaining a constant spatial relationship between the scanner and the object . Its notable scanning speed of up to 3000 images per second significantly reduces errors due to patient movement, enabling the rapid creation of precise digital 3D models of teeth and arch forms. Scanners with high-speed imaging capabilities and advanced optical technologies, such as confocal microscopy, would be better suited for working with neonates, as they can quickly capture detailed images, reducing chairside time. This is especially important for neonates with CL/P, who may experience discomfort or have difficulty remaining still for long periods.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276338_p34
|
PMC11276338
|
sec[3]/p[10]
|
4. Discussion
| 4.144531 |
biomedical
|
Study
|
[
0.9990234375,
0.0009002685546875,
0.00022494792938232422
] |
[
0.9931640625,
0.002368927001953125,
0.004253387451171875,
0.00027251243591308594
] |
The scanning strategy we used, considering the suggestion by Weise et al., focused on a comprehensive approach to create the continuity of the scanned areas . It involved starting with the least deformed area to establish a reliable baseline for the scan, progressively moving towards more complex regions. Having soft acrylic models with a rigid base significantly facilitated this scanning strategy by providing a stable foundation that ensured a consistent scan quality, even across the complex and varied topographies characteristic of cleft lip and palate (CL/P) conditions. The rigid base served as a reliable anchor point, allowing for the accurate initiation and stabilisation of the scanning process. With the Trios 4 scanner, we deviated from the ideal strategy specific to this particular device. This strategy ensures that the scanner accurately registers the intricate details of the cleft area by building upon an initial, more stable digital framework. Intra-oral scanning in neonates with cleft lip and palate (CL/P) requires experimenting with various scanning strategies to achieve optimal results. Due to their delicate oral anatomy and difficulty maintaining stillness, flexibility in scanning techniques is crucial to accommodate cleft morphology and severity variations. By systematically testing different strategies, the best scanning strategies can be identified that bring out the optimal balance between accuracy, efficiency, and patient comfort, ultimately enhancing the quality of care and treatment outcomes for neonates with CL/P.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276338_p35
|
PMC11276338
|
sec[3]/p[11]
|
4. Discussion
| 3.945313 |
biomedical
|
Study
|
[
0.9990234375,
0.0007944107055664062,
0.0003209114074707031
] |
[
0.8251953125,
0.00556182861328125,
0.16845703125,
0.0006814002990722656
] |
The choice of scanning tip size could influence the accuracy and efficacy of DI, particularly in neonates with cleft lip and palate (CL/P). Larger scanning tips may struggle to navigate the narrow and complex spaces in neonates with CL/P, potentially leading to incomplete or inaccurate DIs, especially in deep cleft areas with limited access. Moreover, a few studies have reported the inability of an IOS to capture the deepest part of the alveolar cleft. Case reports and studies explaining the digital workflow for NAM in neonates with CL/P advocates for small scanning tips. Compact and easy-to-manoeuvre devices are preferable in a neonatal setting, where space is often limited and the patient’s comfort is a priority. Previous studies in adult edentulous dentition show that a smaller scanning tip could compromise the accuracy of the DI . Hence, more studies are recommended in this area to determine how a smaller scanning tip could benefit neonates with CL/P and its impact on the accuracy of DIs.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276338_p36
|
PMC11276338
|
sec[3]/p[12]
|
4. Discussion
| 4.273438 |
biomedical
|
Study
|
[
0.9990234375,
0.0008826255798339844,
0.0002646446228027344
] |
[
0.9970703125,
0.0003325939178466797,
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0.00019550323486328125
] |
Our findings must be evaluated in consideration of specific limitations. The findings of this study are limited by its in vitro nature, which may not accurately represent the clinical validity of the impressions acquired. In a case study, Patel et al. found that the premaxillary region of a BCLP is where the difference between a conventional and digital impression occurs. This discrepancy may result from pressure exerted on the freely moving premaxilla during the use of a CI, which might cause deformation. The absence of these typical clinical conditions might have resulted in an idealised experimental environment, potentially leading to more controlled and consistent intra-arch measurements and surface analyses than would be encountered in real-world clinical settings. To compensate for the lack of these clinical settings, we used soft acrylic models intended to resemble the softness of oral tissue. This decision was made to simulate the impression procedures accurately, as soft tissue displacement can occur due to the pressure applied during these procedures. This is particularly critical in cases of bilateral cleft lip and palate (BCLP), where the premaxilla is mobile and the anterior segment can be displaced as the impression material pushes through the cleft defect. Regarding the digital impressions, it is indeed correct that the softness or hardness of the material does not affect the scanning process or results from the IOS. The scanner captures surface data effectively regardless of the material’s properties. However, using soft acrylic models allowed us to better simulate the clinical conditions under which traditional impression materials are used. This ensures that our comparisons between traditional and digital methods are as realistic and clinically relevant as possible. By using these soft acrylic models, we aimed to bridge the gap between experimental conditions and real-world clinical scenarios, enhancing the validity of our findings regarding the accuracy of digital impressions in reproducing true anatomical features. This approach provides a comprehensive understanding of how both traditional and digital impression techniques perform under conditions that closely mimic the clinical scenario. A systematic review reporting the clinician-centred outcomes related to DIs in infants with CL/P reported that clinicians faced some challenges while recording the oral structures in this population, such as frequent head movement, increased salivation, with a preference for a smaller scan tip due to the limited mouth opening which could affect the quality of DIs . Also, the quality of the scanned images can be affected by the scanner’s optical characteristics and the presence of blood and saliva . However, in vitro investigations can aid clinical scenarios by offering a controlled setting and minimising confounding variables . Our study, though conducted in vitro, aligns with accuracy assessments of IOSs in various dental fields, including orthodontics, as supported by systematic reviews such as Aragón et al. and Floriani et al. .
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276338_p37
|
PMC11276338
|
sec[3]/p[13]
|
4. Discussion
| 2.416016 |
biomedical
|
Study
|
[
0.99267578125,
0.001201629638671875,
0.00597381591796875
] |
[
0.84912109375,
0.148681640625,
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0.0009284019470214844
] |
The current study has the limitation of being designed as a lab study with a limited number of cleft severity variations, particularly with the objective of accuracy from the aspect of trueness. Additional lab studies are necessary to explore the optimal scan strategies to achieve the best digital impression outcomes in cleft lip and palate infants. It is crucial to validate the accuracy of digital impressions through clinical studies to confirm the current findings. These aspects are under research by the ADD Tec+ research group at Metro North Health and Queensland Children’s Hospital in Brisbane, Australia.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276338_p38
|
PMC11276338
|
sec[4]/p[0]
|
5. Conclusions
| 4.066406 |
biomedical
|
Study
|
[
0.99853515625,
0.0013799667358398438,
0.00019693374633789062
] |
[
0.99755859375,
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] |
In conclusion, our study demonstrates that DI exhibits comparable accuracy to CI techniques in neonates with cleft lip and palate (CL/P). Through a systematic evaluation of trueness, we have shown that DIs reliably capture the intricate anatomical details of the oral cavity in this vulnerable patient population. These findings suggest that DI holds promise as a viable alternative to CI methods for neonates with CL/P, offering the potential for improved efficiency, patient comfort, and treatment outcomes. While further research is needed to fully explore the clinical implications of DI and the factors that could affect it, our study provides valuable evidence supporting its feasibility and accuracy in managing CLP in neonates.
|
[
"Jyotsna Unnikrishnan",
"Mahmoud Bakr",
"Robert Love",
"Ghassan Idris"
] |
https://doi.org/10.3390/children11070827
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p0
|
PMC11276350
|
sec[0]/p[0]
|
1. Introduction
| 2.375 |
biomedical
|
Other
|
[
0.99609375,
0.002536773681640625,
0.0014886856079101562
] |
[
0.032623291015625,
0.95703125,
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0.00437164306640625
] |
For most children and young people (CYP), a COVID-19 infection causes a mild respiratory illness with low rates of hospital admission and a low risk of mortality . However, in April 2020, a novel inflammatory condition in CYP was identified, termed Paediatric Multisystem Inflammatory Syndrome (PIMS-TS).
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p1
|
PMC11276350
|
sec[0]/p[1]
|
1. Introduction
| 3.966797 |
biomedical
|
Study
|
[
0.99658203125,
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] |
[
0.68798828125,
0.1201171875,
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0.00359344482421875
] |
The first case definition was released by the UK Royal College of Paediatrics and Child Health (RCPCH) in May 2020, defining PIM-TS as a “persistent fever, inflammation and evidence of single or multi-organ dysfunction in a child, with exclusion of any other microbial cause with or without PCR evidence of SARS-CoV-2”. It is a rare condition, with estimates suggesting that it occurs in less than 0.5% of children who have (or who had) COVID-19 . Despite this, in the first wave of the pandemic, affected children required hospitalisation and most of them required Paediatric Intensive Care (PICU) . The data suggests that young people from different social and ethnic backgrounds were differentially affected, with children in global majority groups, living in more deprived areas and in key worker families being over-represented .
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p2
|
PMC11276350
|
sec[0]/p[2]
|
1. Introduction
| 1.679688 |
biomedical
|
Other
|
[
0.98974609375,
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0.007297515869140625
] |
[
0.2496337890625,
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] |
There has been research into the clinical features, causes, treatment and management of CYP with a PIMS-TS diagnosis . However, to date, little has been published on the psychological effects of PIMS-TS for CYP and their families.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p3
|
PMC11276350
|
sec[0]/p[3]
|
1. Introduction
| 1.847656 |
clinical
|
Other
|
[
0.391845703125,
0.58349609375,
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] |
[
0.055633544921875,
0.90869140625,
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0.032012939453125
] |
London-based tertiary children’s hospitals include a paediatric psychologist in their PIMS-TS MDT as part of routine care , initially as inpatient support and later following discharge. Clinical observations have identified a number of common themes amongst young people affected. These included feelings of isolation, uncertainty about the trajectory and recovery from illness and shame and stigma associated with the condition
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p4
|
PMC11276350
|
sec[0]/p[4]
|
1. Introduction
| 4.046875 |
biomedical
|
Study
|
[
0.998046875,
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] |
[
0.79052734375,
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] |
The limited research conducted to date has highlighted psychological distress and trauma symptoms following discharge from hospital, at 6–8 weeks and at 6 months . This evolving picture regarding the psychological needs of CYP with PIMS-TS is not surprising given all children in the early waves of the pandemic experienced an intensive care admission . PTSD diagnosis and symptomology has been shown to be significantly more common in children who have been admitted to an intensive care unit compared to general wards . Research has also shown that the psychological sequalae is still present 1 year following admission and risk factors for ongoing distress have been found to be associated with illness severity, clinical scores at 3 months post-admission and parental anxiety . There is emerging evidence highlighting the needs of the parent(s) of children admitted to PICU with research identifying that a significant minority (between 21% and 32% of parents meeting cut off on screening) of parents experience post-traumatic stress symptoms following the PICU admission of their child and that children’s trauma symptoms are positively correlated with those of their parents . The research findings suggest that parents experiencing post-traumatic stress disorder is “related to parents’ perceptions of the threat to their child’s life and to acute stress reactions to the PICU” .
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p5
|
PMC11276350
|
sec[0]/p[5]
|
1. Introduction
| 3.974609 |
biomedical
|
Study
|
[
0.99658203125,
0.0021381378173828125,
0.0012540817260742188
] |
[
0.99951171875,
0.00042057037353515625,
0.00018012523651123047,
0.00010406970977783203
] |
The importance of psychological monitoring for parents and CYP following PICU admission is widely acknowledged . There is also a recognition that trauma in the form of PTSD or PTSS (post-traumatic stress symptoms) can follow devastating diagnoses, such as childhood cancer . It has also been recognised that there are considerable psychological sequalae that are the result of physical health diagnoses in CYP and their families. The main purpose of this current study is to provide an insight into the psychological needs of CYP with this novel syndrome and their parents after discharge from hospital. It was hypothesised that as all had a PICU admission, a significant number of the CYP would report PTSD symptoms and emotional distress. Some of the results of this study have been reported previously in the form of an abstract/presentation . It is important to note that screening was carried out during a period of heighted global anxiety in the context of national lockdown during the COVID-19 pandemic. At this point, little was known or documented about the possible long-term impact of the pandemic on CYP’s mental health more generally.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p6
|
PMC11276350
|
sec[0]/p[6]
|
1. Introduction
| 1.828125 |
biomedical
|
Other
|
[
0.92529296875,
0.00439453125,
0.07037353515625
] |
[
0.0221710205078125,
0.974609375,
0.0026092529296875,
0.0006194114685058594
] |
The current research has implications for health care resources and the care provided. It is hoped that a better understanding of the psychological needs of this population will inform psychological care and improve the outcomes of children with a significant health condition and their parents/care givers .
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276350_p7
|
PMC11276350
|
sec[1]/sec[0]/p[0]
|
2.1. Participants
| 3.306641 |
biomedical
|
Study
|
[
0.9931640625,
0.00551605224609375,
0.0011138916015625
] |
[
0.99853515625,
0.0008707046508789062,
0.0002613067626953125,
0.0003311634063720703
] |
This was a retrospective cohort study of psychological screening and referral to psychological services for patients with PIMS-TS and their families. This study includes all patients aged 18 years or younger meeting diagnostic criteria for PIMS-TS who were admitted a paediatric tertiary hospital in London, UK, between April 2020 and May 2021.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p8
|
PMC11276350
|
sec[1]/sec[1]/p[0]
|
2.2. Procedure
| 1.369141 |
biomedical
|
Other
|
[
0.76904296875,
0.04608154296875,
0.18505859375
] |
[
0.1448974609375,
0.8486328125,
0.001964569091796875,
0.004550933837890625
] |
A full ethics review under the terms of the Government Arrangements of Research Ethics Committees in the UK was not required as the data analysis was retrospective, and no additional data was collected beyond that collected for standard medical care. A service evaluation was registered with the NHS Trust Audit Committee . Demographics and medical data were obtained from the CYP’s medical record.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p9
|
PMC11276350
|
sec[1]/sec[1]/p[1]
|
2.2. Procedure
| 3.519531 |
clinical
|
Study
|
[
0.2410888671875,
0.7548828125,
0.00379180908203125
] |
[
0.80126953125,
0.1282958984375,
0.00409698486328125,
0.06646728515625
] |
The 121 CYP included in this study would have typically become unwell at home before presenting to their local hospital without having had any prior knowledge of PIMS-TS before being transferred to a specialist centre with a Paediatric Intensive Care Unit (PICU). This admission will have taken place between April 2020 and May 2021 during a period of national COVID-19 pandemic restrictions. The patient pathway is illustrated in Figure 1 below. The typical PICU stay was 2–4 days before being moved to a paediatric ward for on-going care, typically for a further 5–7 days (admission average 9.34 days and ranged from 2 to 28 days). During their hospital admission, both CYP and their parent/carer would have had access to the paediatric psychology service through a referral from their nursing or medical team. After discharge home, the CYP would be invited to follow-up outpatient PIMS-TS Multi-Disciplinary Team (MDT) review appointments at 2 weeks, 6 weeks, 6 months and 1 year post-discharge. Paediatric psychology was an integrated part of the PIMS-TS MDT and all parents/carers would have been made aware that they could access separate psychological appointments at any point during their CYP’s care.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p10
|
PMC11276350
|
sec[1]/sec[1]/p[2]
|
2.2. Procedure
| 2.246094 |
biomedical
|
Study
|
[
0.6826171875,
0.293701171875,
0.023834228515625
] |
[
0.7666015625,
0.224365234375,
0.0016965866088867188,
0.007549285888671875
] |
All families were given a brief psychological wellbeing screening as part of their 6-week outpatient PIMS-TS MDT review appointment. All parents and CYP consented at the point of being given the measures. Screening measures included those for post-traumatic stress symptoms and emotional distress for the CYP (aged 8 years and over). In addition, one parent or carer (referred to as parent throughout the text for clarity) for CYP of all ages was asked to complete a post-traumatic stress screening measure. Further psychological follow-up support was offered to all CYP and/or parents who scored above the screening cut off, and/or who identified any psychological distress during the psychology review.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p11
|
PMC11276350
|
sec[1]/sec[1]/p[3]
|
2.2. Procedure
| 2.025391 |
biomedical
|
Study
|
[
0.64501953125,
0.344970703125,
0.00989532470703125
] |
[
0.810546875,
0.14111328125,
0.00890350341796875,
0.03924560546875
] |
A retrospective case note review of all psychology inpatient and outpatient referrals for PIMS-TS for CYP and parents was completed to provide a summary of psychological support offered to these families, and the number of subsequent follow-up psychology appointments was calculated. This included any documented reason or identified need related to the psychological support.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p12
|
PMC11276350
|
sec[1]/sec[2]/p[0]
|
2.3. Measures
| 4.117188 |
biomedical
|
Study
|
[
0.998046875,
0.0015039443969726562,
0.0004031658172607422
] |
[
0.99609375,
0.0009632110595703125,
0.002605438232421875,
0.00013506412506103516
] |
The screening questionnaires used during the psychology review were selected based on brevity, as well as their validity for use with a paediatric population that had been admitted to PICU after sudden onset of symptoms. The purpose of the measures was to identify any persisting psychological distress after the CYP returned home and was no longer acutely unwell. The screening measures administered are detailed below: Children’s Revised Impact of Events Scale (CRIES-13): Children’s post-traumatic stress symptoms were measured using the 13-item version of the CRIES. This is a self-report measure for use with children aged 8 years and above, with established reliability and validity (α = 0.80) . A total score of 30 means that 75–83% of children with a PTSD diagnosis have been correctly identified Paediatric Index of Emotional Distress (PI-ED): Emotional distress, including anxiety and depression symptoms, was measured using the PI-ED screening measure . This is a 14-item self-report measure for children aged 8 to 18 years, with established reliability and validity in paediatric population (α = 0.86) . A total score of 20 or above indicates a CYP experiencing clinically significant levels of distress . Impact of Events Scale-Revised (IES-R): Post-traumatic stress symptoms were screened for in parents using the IES-R. This is a self-report measure used for adults aged 18 years and above, with established reliability and validity (α = 0.96) . A cut-off score of 24 or more was used as an indication of ‘clinical concern’ for post-traumatic stress symptoms .
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p13
|
PMC11276350
|
sec[1]/sec[3]/p[0]
|
2.4. Data Analysis
| 2.101563 |
biomedical
|
Study
|
[
0.98779296875,
0.0089874267578125,
0.0032444000244140625
] |
[
0.9892578125,
0.00908660888671875,
0.0006575584411621094,
0.0010318756103515625
] |
Descriptive statistics were used to describe the patient demographic and admission information, psychological screening scores and number of psychology sessions attended following a PIMS-TS hospital admission.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p14
|
PMC11276350
|
sec[1]/sec[3]/p[1]
|
2.4. Data Analysis
| 2.822266 |
biomedical
|
Study
|
[
0.99365234375,
0.000560760498046875,
0.005550384521484375
] |
[
0.994140625,
0.00524139404296875,
0.00038909912109375,
0.00013744831085205078
] |
Non-parametric statistics were used to analyse the data. This was due to not all variables being normally distributed. A chi-square test of independence was used to identify any relationship between parents’ and children’s post-traumatic stress scores, between CYP trauma and emotional distress screening scores, and between ethnicity grouping and referral to psychology. Analyses were performed using the SPSS version 24 software (SPSS, Inc., Chicago, IL, USA).
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p15
|
PMC11276350
|
sec[2]/sec[0]/p[0]
|
3.1. Demographics
| 2.660156 |
biomedical
|
Study
|
[
0.8935546875,
0.0968017578125,
0.00951385498046875
] |
[
0.982421875,
0.0142364501953125,
0.0005216598510742188,
0.00266265869140625
] |
A total of 121 CYP were admitted to the hospital to receive acute care for PIMS-TS between April 2020 and May 2021. The average age was 9.3 (median 9, interquartile range 5). Of the CYP, 70 were recorded as male and 51 as female. Figure 2 below shows the breakdown of the CYP population by ethnicity recorded in patient records. The majority of those admitted were identified in patient records as being from Black African, Afro-Caribbean, Asian or other UK minority ethnic backgrounds (N82, 67.8%), which will be classified as Global Majority Ethnicity Backgrounds from here on. We identified 21 (17.4%) of the CYP as being from White or European ethnic backgrounds and for 18 CYP the ethnicity was documented as ‘Other’ or was not recorded (14.9%). All CYP lived in the city of London or surrounding North London regions.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p16
|
PMC11276350
|
sec[2]/sec[1]/p[0]
|
3.2. Hospital Journey
| 1.868164 |
clinical
|
Other
|
[
0.1112060546875,
0.880859375,
0.00807952880859375
] |
[
0.352783203125,
0.4990234375,
0.00814056396484375,
0.1397705078125
] |
The hospital admission ranged from 2 to 28 days, with a median of 9.3 days. This included both the intensive care and the subsequent ward admission. The outpatient PIMS-TS MDT reviews took place at 2 weeks, 6 weeks, 6 months and 12 months post-discharge, as described by . A psychological review and completion of screening measures took place at the 6-week outpatient appointment.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p17
|
PMC11276350
|
sec[2]/sec[2]/p[0]
|
3.3. Psychological Screening
| 2.832031 |
biomedical
|
Study
|
[
0.9677734375,
0.027099609375,
0.005126953125
] |
[
0.9970703125,
0.002040863037109375,
0.00036597251892089844,
0.0005927085876464844
] |
A retrospective descriptive analysis of the psychology review screening measures was completed to provide a summary of the CYP’s (aged 8–17 years) and their parent’s psychological needs at 6–8 weeks post-discharge. Most of the screenings took place at a 6-week PIMS-TS MDT review appointment, with an average length post-admission of 7 weeks (SD 2.8, range 2–20 days).
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p18
|
PMC11276350
|
sec[2]/sec[2]/p[1]
|
3.3. Psychological Screening
| 2.050781 |
biomedical
|
Study
|
[
0.97216796875,
0.0052642822265625,
0.0225677490234375
] |
[
0.98876953125,
0.01082611083984375,
0.0002319812774658203,
0.0003025531768798828
] |
Of the 121 CYP, 86 were aged 8 years or older, and eligible to complete CRIES-13 and PI-ED screening measures. A total of 60 CYP (70%) completed the CRIES-13 and the PI-ED, and a total of 79 (65%) of 121 parents of CYP also completed the IES-R screening questionnaire.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p19
|
PMC11276350
|
sec[2]/sec[2]/p[2]
|
3.3. Psychological Screening
| 2.265625 |
biomedical
|
Study
|
[
0.974609375,
0.011138916015625,
0.01403045654296875
] |
[
0.9921875,
0.00702667236328125,
0.00029540061950683594,
0.00033283233642578125
] |
In total, 40.5% of the parents and 23.3% of the CYP met the cut-off value on the traumatic stress screening (IES-R and CRIES-13) and 11.6% of CYP met the cut-off value on the measure of emotional distress (PI-ED) ( Table 1 ). Those who did not complete the measures either did not consent to screening or were not available to meet the psychologist during their MDT review.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p20
|
PMC11276350
|
sec[2]/sec[2]/p[3]
|
3.3. Psychological Screening
| 3.794922 |
biomedical
|
Study
|
[
0.99560546875,
0.00043129920959472656,
0.004116058349609375
] |
[
0.99951171875,
0.0003600120544433594,
0.0001735687255859375,
0.000035762786865234375
] |
A chi-square test of independence was performed to examine the relationship between the CYP meeting CRIES-13 cut-off and the parent meeting IES-R cut-off. The relationship between these CYP and parent trauma screenings was significant, χ 2 (1, N = 50) = 12.346, p = 0.0001, suggesting that a relationship exists between child and parent post-traumatic stress risk.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p21
|
PMC11276350
|
sec[2]/sec[2]/p[4]
|
3.3. Psychological Screening
| 3.970703 |
biomedical
|
Study
|
[
0.99755859375,
0.00042724609375,
0.0018415451049804688
] |
[
0.99951171875,
0.0002123117446899414,
0.00014793872833251953,
0.0000330805778503418
] |
The number of CYP meeting the cut-off for emotional distress on the PI-ED was lower (11.6%) than those reaching the cut-off for PTSD on the CRIES-13 (23.3%). The relationship between the CYP screening measure cut-offs was assessed using a chi-square test of independence to examine the relationship between CYP aged 8 years and older meeting CRIES-13 trauma cut-off and meeting the PIED emotional distress cut-off. The relationship between these variables was not significant, χ 2 (1, N = 59) = 4.058, p = 0.044, suggesting these screening measures identify different aspects of psychological distress, which supports the potential value of using both measures for screening this population of CYP.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p22
|
PMC11276350
|
sec[2]/sec[3]/p[0]
|
3.4. Referrals to Psychology
| 2.765625 |
biomedical
|
Study
|
[
0.88427734375,
0.10479736328125,
0.01113128662109375
] |
[
0.9921875,
0.004680633544921875,
0.0011844635009765625,
0.0017652511596679688
] |
A retrospective case notes review of psychology inpatient and outpatient referrals and subsequent number of psychology sessions recorded in medical records was completed. This showed that a total of 64 (53%) of the 121 CYP included in this study were referred for psychological support either during admission or post-discharge with an average of 5.10 (SD 4.53) psychology sessions (telephone/video/in-person) and a range of 1–20 sessions.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p23
|
PMC11276350
|
sec[2]/sec[3]/p[1]
|
3.4. Referrals to Psychology
| 1.731445 |
biomedical
|
Study
|
[
0.5712890625,
0.032012939453125,
0.396728515625
] |
[
0.83935546875,
0.1566162109375,
0.0020751953125,
0.0021038055419921875
] |
Of the 64 CYP referred to psychology, 58 had complete documentation regarding the reason for referral and psychology support offered, which is summarised below in Table 2 and Table 3 . Six of the CYP’s records were excluded due to incomplete or inconsistent documentation.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p24
|
PMC11276350
|
sec[2]/sec[3]/p[2]
|
3.4. Referrals to Psychology
| 2.136719 |
biomedical
|
Study
|
[
0.97216796875,
0.0178680419921875,
0.00982666015625
] |
[
0.9814453125,
0.016571044921875,
0.0008492469787597656,
0.0010728836059570312
] |
The most frequent reasons for referral to psychology were emotional distress, anxiety and making sense of hospital experience ( Table 2 ). Trauma was mentioned in only 7% of referrals, despite the screening showing 40.5% of parents and 23.30% of the CYP met cut-off for clinical indication of PTSD ( Table 1 ).
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276350_p25
|
PMC11276350
|
sec[2]/sec[3]/p[3]
|
3.4. Referrals to Psychology
| 1.803711 |
biomedical
|
Study
|
[
0.80859375,
0.05438232421875,
0.136962890625
] |
[
0.8896484375,
0.1031494140625,
0.004940032958984375,
0.002315521240234375
] |
Of the 58 reviewed referrals, the majority (89.6%) included a request for the CYP to access psychology support, and only 8.6% of referrals were a request for parent/carer support only ( Table 3 ).
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p26
|
PMC11276350
|
sec[2]/sec[3]/p[4]
|
3.4. Referrals to Psychology
| 2.111328 |
biomedical
|
Study
|
[
0.8720703125,
0.0941162109375,
0.03375244140625
] |
[
0.921875,
0.06939697265625,
0.006134033203125,
0.002696990966796875
] |
Of the 58 referrals reviewed, 31% were categorised as assessment, liaison or consultation only (1–2 sessions), 43.1% as brief interventions (2–6 psychology sessions) and 25.8% as extended psychology intervention (7–20 sessions) ( Table 4 ).
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p27
|
PMC11276350
|
sec[2]/sec[3]/p[5]
|
3.4. Referrals to Psychology
| 1.947266 |
biomedical
|
Study
|
[
0.93115234375,
0.0053558349609375,
0.06365966796875
] |
[
0.640625,
0.18994140625,
0.1666259765625,
0.0027141571044921875
] |
Due to the variability in the format and recording practices of psychology sessions, a systematic qualitative review of the themes that emerged in the psychology sessions was not possible. However, it was noted that the psychology interventions offered were often in relation to the themes of anxiety and emotional distress in the context of managing the uncertainty and fear for the future with a new and unknown diagnosis within a pandemic context, and to a lesser extent the potential for isolation, stigma and shame and not feeling able to share or talk about their PIMS-TS experience with friends and family.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p28
|
PMC11276350
|
sec[2]/sec[3]/p[6]
|
3.4. Referrals to Psychology
| 1.580078 |
other
|
Study
|
[
0.12371826171875,
0.001583099365234375,
0.87451171875
] |
[
0.75048828125,
0.247314453125,
0.0012941360473632812,
0.0008978843688964844
] |
The likelihood of a CYP being referred to psychology was broken down by ethnicity grouping, as illustrated in Figure 3 below. This shows a lower percentage of psychology referrals made for CYP identified as having White British and White Other ethnic (33%) backgrounds compared to the other ethnicity groupings (Asian, 70.6%; Black African and Afro-Caribbean 42.1%; other ethnic minority groups 56.3%).
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p29
|
PMC11276350
|
sec[2]/sec[3]/p[7]
|
3.4. Referrals to Psychology
| 2.626953 |
biomedical
|
Study
|
[
0.8798828125,
0.0021152496337890625,
0.11785888671875
] |
[
0.9970703125,
0.0025577545166015625,
0.000186920166015625,
0.00008004903793334961
] |
A chi-square test of independence was performed to examine the relationship between ethnicity grouping (Global Majority Ethnicity Backgrounds or White UK and Other) and referral to psychology. The relationship between ethnicity and whether a CYP/family were referred to psychology was significant, χ 2 (1, N = 109) = 10.288, p = 0.001. Those CYP identified as being from Global Majority Ethnicity Backgrounds were more likely to be referred to psychology than those classified as being from White ethnic backgrounds.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276350_p30
|
PMC11276350
|
sec[3]/p[0]
|
4. Discussion
| 4.039063 |
biomedical
|
Study
|
[
0.99853515625,
0.0011625289916992188,
0.00037670135498046875
] |
[
0.99951171875,
0.00020492076873779297,
0.0003173351287841797,
0.00011861324310302734
] |
This study shows that approximately 23.3% of CYP presenting to a tertiary paediatric hospital during the early stages of the COVID-19 pandemic with a novel disease called PIMS-TS were at risk of developing a traumatic stress response and 11.6% were at risk of experiencing emotional disturbance. A total of 40.5% of the parents screened also scored above the clinical cut-off value for a trauma response. All CYP had an admission to a PICU. The psychological impact found in this current study is in line with research looking at the emotional sequelae of CYP following PICU admissions , and of those with other paediatric conditions ). The data also showed positive significant correlations between the trauma scores of a CYP and their parent. Again, this finding is well documented in the paediatric literature .
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276350_p31
|
PMC11276350
|
sec[3]/p[1]
|
4. Discussion
| 2.246094 |
biomedical
|
Other
|
[
0.9326171875,
0.04681396484375,
0.0206756591796875
] |
[
0.157958984375,
0.81689453125,
0.019683837890625,
0.005710601806640625
] |
Important clinical themes for CYP that have emerged from this current data include increased feelings of uncertainty about the illness and the illness trajectory as well as feelings of isolation, fear for future and potential shame and stigma.
|
[
"Anita Freeman",
"Emily Golding",
"Jennifer Gardner",
"Zoe Berger"
] |
https://doi.org/10.3390/children11070858
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
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