Search Results (43)

Background: In metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation, osimertinib is the cornerstone treatment able to prolong overall survival (OS). Evidence around osimertinib being effective in leptomeningeal metastasis (LM) is scarce. Methods: We conducted a retrospective cohort study of patients with metastatic NSCLC-EGFR mutation treated with osimertinib at Sunnybrook Hospital. Results: We identified a total of 56 patients. Of these, 45 (79.4%) were never smokers, 53 (94.6%) had adenocarcinoma histology, and 26 (46.42%) had either the EGFR exon 21-L858R mutation or exon 19 deletion. The estimated median OS was 51 months (43.5–58.5). All eight patients with LM died during the study period. From the time of NSCLC diagnosis, the OS of patients without LM was 53 months (95% CI 47.2–58.7), and with LM was 21 months (95% CI 3.0–39), p = 0.001. However, the median OS from LM diagnosis was 2 months (95% CI, 1.0–26). Conclusions: In our population of patients with metastatic NSCLC-EGFR mutation who received osimertinib, there was a significant reduction in life expectancy in the group with LM. Patients who had advanced stage at diagnosis and were more likely to develop LM exhibited poorer survival compared to those who had early-stage cancer at diagnosis and developed metastases later on. Full article

Background: Catheter insertion is the most commonly used method for treating intracerebral hemorrhage (ICH). Simultaneous hematoma aspiration allows for faster decompression than catheter insertion alone. Methods: Between March 2020 and Apri1 2024, 49 patients (25 men and 24 women) with ICH underwent ICH catheter insertion. Thirty-two patients (Group A) underwent intraoperative aspiration simultaneously with ICH catheter insertion. The other seventeen patients underwent catheter insertion alone (Group B). Four patients in Group A (12.5%) and two patients in Group B (11.8%) died within one month after surgery. Consequently, a total of 43 patients were included in the final analysis (Group A-1 vs. Group B-1). The Glasgow coma scale (GCS) score and muscle strength of the four extremities in both groups were compared 2 weeks later (first period) and on the date of discharge (second period). Patients in Group A-1 were discharged 5 days earlier than those in Group B-1. (average 49 ± 20 vs. 54 ± 31 days). Results: In Group A, the preoperative ICH volume was 66.2 ± 28.8 mL, and the median aspiration volume was 30 ± 19.6 mL. The preoperative ICH volume was 55.9 ± 22.2 mL in group B. Intraoperative ICH aspiration (Group A-1) significantly improved motor scores during the second period (p = 0.001). It also showed the trend toward improved GCS scores during the first period (p = 0.095) and the second period (p = 0.069). Conclusions: Compared to ICH catheter insertion alone, additional intraoperative ICH aspiration resulted in greater motor improvement at 7 weeks postoperatively (p = 0.004). It also showed a trend toward greater improvement in the GCS scores (p = 0.12). Full article

Background: Exposure to pesticides has been associated with an increased risk of developing childhood leukemia. However, the impact of pesticides on childhood leukemia survival has not been examined. We investigated the associations between residential pesticide use during key developmental periods and 5-year survival in children treated for acute lymphoblastic leukemia (ALL). Methods: Residential use of insecticides, herbicides, rodenticides, and flea control products from preconception up to 12 months prior to diagnosis and sociodemographic characteristics were collected via parental interview among 837 children diagnosed with ALL between 1995 and 2008 in California, USA. Data on clinical features were abstracted from medical records. Vital status was obtained through linkage to the National Death Index (NDI) up to 2020. Cox proportional hazards regression models were used to estimate hazard ratios (HRs), adjusting for sociodemographic factors and clinical risk group. Results: A total of 108 children with ALL (~13%) died within 5 years of diagnosis. Exposure to any pesticides pre- and/or postnatally was slightly higher among deceased compared to alive children (95.4% vs. 91.5%; p = 0.23), while use of rodenticides was significantly higher in children who died (25.0%) vs. those who survived (15.5%; p = 0.02). In fully adjusted models, exposure to rodenticides was associated with an increased risk of mortality (HR 1.70; 95% confidence interval (CI) 1.08–2.64; p = 0.02), especially when the child was exposed during pregnancy (HR 1.90; 95% CI 1.15–3.16; p = 0.01) and possibly 12 months before diagnosis (HR 1.60; 95% CI 0.98–2.61; p = 0.06). Increased hazards of death were also observed with other types of pesticides during pregnancy, but those associations were not statistically significant. Conclusions: This study is the first to report reduced survival among children with ALL previously exposed to rodenticides, particularly during pregnancy, underscoring the need to further evaluate mechanisms by which environmental exposures during key developmental stages may later impact cancer outcomes. Full article

Background: This study aimed to investigate the clinical and prognostic significance of preoperative maximum standardized uptake value (SUVmax) and GLUT-1 expression in patients with advanced gastric cancer (AGC). Methods: Medical records of patients who were diagnosed with AGC between 2018 and 2020 at Zhongshan Hospital of Fudan University (Shanghai, China) were retrospectively analyzed. Finally, 182 patients were enrolled, and for each patient, SUVmax was calculated for the primary lesion on PET/CT prior to curative surgery. A total of 165 clinical tissue specimens were collected for immunohistochemical analysis of GLUT-1 expression. Results: A total of 182 patients were divided into two groups based on their SUVmax values. The low SUVmax group comprised 92 patients. Patients with low SUVmax tended to be younger and included a higher proportion of women, with their primary tumors typically smaller or in earlier TNM stages. The median follow-up time was 52 months. The 1-, 3-, and 5-year progression-free survival (PFS) rates were 90.7%, 71.4%, and 67.0%, respectively. Among them, 33 patients experienced recurrence and metastasis, and 40 ultimately died. Log-rank analysis revealed that the low SUVmax group exhibited superior progression-free survival (PFS) and overall survival (OS). Multivariate analysis indicated that, for AGC without preoperative treatment, later stage (stage III) was independently correlated with a higher risk of recurrence (HR = 3.049; 95%CI = 1.076–8.639; p = 0.036), while the low SUVmax group exhibited a reduced risk of recurrence and mortality compared with the high SUVmax group (HR = 0.565; 95%CI = 0.326–0.979; p = 0.042). Conclusions: The clinicopathological characteristics of patients with AGC with different SUVmax values appeared significantly different. Tumor stage and SUVmax were found as independent factors affecting postoperative recurrence and death of patients with AGC. Full article

Purpose: To prospectively investigate dynamic ¹³N-ammonia PET-CT for evaluating early treatment response and predicting prognosis in advanced hepatocellular carcinoma (HCC) patients who have undergone antiangiogenic therapy. Methods: Dynamic ¹³N-ammonia PET-CT was performed in 23 advanced HCC patients before antiangiogenic therapy (baseline) and in 18/23 patients after 8-10 weeks of treatment (post-therapy). At kinetic PET-CT analysis, mean, maximum, and peak values of K₁ (mL/cm³/min) and k₂ (min⁻¹) were estimated in HCC lesions and non-neoplastic liver using cardiologic ¹³N-ammonia PET-CT in 15 patients without any liver diseases as normal controls. Outcome endpoints were treatment response after 8–10 weeks assessed by contrast-enhanced CT, progression-free survival (PFS), and overall survival (OS). Results: At both baseline and post-therapy PET-CT, all kinetic PET parameters were significantly higher (p < 0.05) in HCC lesions than in non-neoplastic and healthy liver of HCC patients and controls. According to mRECIST criteria, 13/18 patients (72.2%) were responders (1 CR, 1 PR, and 11 SD), and 5/18 patients (27.8%) were non-responders (PD), with no significant differences in baseline and post-therapy PET parameters between the two groups. At follow-up (median: 14.2 months), 15/18 patients (83.3%) experienced radiological progression, and 14/18 (77.8%) died (7/14 within 12 months from treatment). The nine earlier-progression patients (within 6 months from treatment) showed significantly lower baseline K_1mean in HCC lesions than all nine patients with later or no-progression (p = 0.03). Patients still alive 12 months after treatment (n = 11) showed significantly lower post-therapy K_1mean (p = 0.05), K_1max (p = 0.05), and K_1peak (p = 0.03) in non-neoplastic liver than patients with shorter OS (n = 7). Conclusions: In advanced HCC patients treated with antiangiogenic agents, kinetic parameters from baseline and post-therapy ¹³N-ammonia PET-CT may predict early disease progression and survival. PET-CT seems not able to discriminate responders and non-responders after 8-10 weeks of treatment, suggesting the need for future and larger studies after a longer treatment period. Full article

Toxoplasma gondii (T. gondii), a globally distributed obligatory intracellular opportunistic parasite that has infected one third of the world population, has different transmission routes including via organ transplantation. The liver has emerged as a frequent transplanted organ in which the transmission of T. gondii can occur between seropositive donors and seronegative recipients. Allied with immunosuppressive therapy, the presence of latent infection in recipients elevates the risk of severe toxoplasmosis. The goal of this study was to evaluate the demographic, clinical, epidemiological, and anti-T. gondii antibody profiles in liver transplant recipients. All demographic, clinical, epidemiological, and serological data were obtained from the electronic medical records of liver transplant recipients from the Liver Transplantation Service of the Hospital de Base in São José do Rio Preto, Brazil, from 2008 to 2018. Data from 48 eligible recipients (females: n = 17; males: n = 31) were evaluated. The recipients were grouped according to their T. gondii serological profiles (G1: IgM−/IgG−; G2: IgM−/IgG+; G3: IgM+/IgG+; G4: IgM+/IgG−). The overall mean age was 55.3 (±15.3) years; the age difference between women (42.7 ± 17 years) and men (62.2 ± 10.9 years) was statistically significant (p-value > 0.0001). The percentages of the serological profiles were 20 (n = 41.7%), 26 (n = 54.1%), and 2 (n = 4.2%) for G1, G2, and G3, respectively. No recipient had a serological profile for G4. Hepatosplenomegaly (47.9%), fever (35.4%), encephalopathy (20.8%), and headache (16.7%) were commonly observed symptoms. No statistically significant differences were observed between the serological group and clinical data (p-value = 0.953). The percentages of coinfection by T. gondii with hepatitis A, B, and C were 47.9%, 20.8%, and 12.5%, respectively. About 41.7% of the recipients later died. The data demonstrate that infection by T. gondii is common in liver transplant recipients, and it is not associated with the analyzed demographic, clinical, and epidemiological data. Full article

A series of triphenylene (TP) compounds—denoted 3,6-THTP-DiCnOH—bearing four hexyloxy ancillary chains and two variable-length alkoxy chains terminally functionalized with hydroxyl groups have been synthesized and characterized. The shorter homologs revealed mesogenic characteristics, giving rise to thermotropic mesophases in which π-stacked columns of H-bound dimers self-organize yielding superstructures. Molecular-scale models are proposed to account for their structural features. The three studied compounds yielded supramolecular gels in methanol; their ability to gelify higher alcohols was found to be enhanced by the presence of water. The intermediate homolog also gelled n-hexane. Compared to their isomeric 2,7-THTP-DiCnOH analogs, the 3,6-derivatives showed a higher tendency to give rise to LC phases (wider thermal ranges) and a lower organogelling ability (variety of gelled solvents, lower gels stabilities). The overall results are analyzed in terms of different kinds of competing H-bonds: intramolecular, face-to-face dimeric, lateral polymeric, and solvent–TP interactions. Full article

Background and Objectives: Muscle loss is a known complication of ICU admission. The aim of the study was to investigate the effect of neuromuscular functional magnetic stimulation (FMS) on quadriceps muscle thickness in critically ill patients. Materials and Methods: Among ICU patients one quadriceps was randomized to FMS (Tesla Stym, Iskra Medical, Ljubljana, Slovenia) stimulation and the other to control care. Quadriceps thickness was measured by ultrasound (US) in transversal and longitudinal planes at enrolment, Days 3–5, and Days 9–12. The trial stopped early following an interim analysis comparing muscle thickness differences between groups using repeated measures ANOVA. Results: Of 18 patients randomized, 2 died before completing the trial. The final analysis reported included 16 patients (female 38%, age 68 ± 10 years, SOFA 10.8 ± 2.7). Three mild skin thermal injuries were noted initially, which were later avoided with proper positioning of FMS probe. Primary outcome comparison showed that quadriceps thickness in transversal and longitudinal planes decreased in the non-stimulated legs and, but it did not change in FMS legs (−4.1 mm (95%CI: −9.4 to −0.6) vs. −0.7 mm (95%CI: −4.1 to −0.7) (p = 0.03) and −4.4 mm (95%CI: −8.9 to −1.1) vs. −1.5 mm (95%CI: −2.6 to −2.2) (p = 0.02), respectively) (ANOVA difference between groups p = 0.036 and 0.01, respectively). Conclusions: In the critically ill, neuromuscular FMS is feasible and safe with precautions applied to avoid possible skin thermal injury. FMS decreases the loss of quadriceps muscle thickness. Full article

A diet with low content of fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) is established treatment for irritable bowel syndrome (IBS), with well-documented efficiency. A starch- and sucrose-reduced diet (SSRD) has shown similar promising effects. The primary aim of this randomized, non-inferiority study was to test SSRD against low FODMAP and compare the responder rates (RR = ∆Total IBS-SSS ≥ −50) to a 4-week dietary intervention of either diet. Secondary aims were to estimate responders of ≥100 score and 50% reduction; effects on extraintestinal symptoms; saturation; sugar craving; anthropometric parameters; and blood pressure. 155 IBS patients were randomized to SSRD (n = 77) or low FODMAP (n = 78) for 4 weeks, with a follow-up 5 months later without food restrictions. The questionnaires Rome IV, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS) were completed at baseline and after 2 and 4 weeks and 6 months. Weight, height, waist circumference, and blood pressures were measured. Comparisons were made within the groups and between changes in the two groups. There were no differences between groups at baseline. The responder rate of SSRD was non-inferior compared with low FODMAPs at week 2 (79.2% vs. 73.1%; p = 0.661;95% confidence interval (CI) = −20–7.2) and week 4 (79.2% vs. 78.2%; p = 1.000;95%CI = −14–12). Responder rate was still high when defined stricter. All gastrointestinal and extraintestinal symptoms were equally improved (p < 0.001 in most variables). SSRD rendered greater reductions in weight (p = 0.006), body mass index (BMI) (p = 0.005), and sugar craving (p = 0.05), whereas waist circumference and blood pressure were equally decreased. Weight and BMI were regained at follow-up. In the SSRD group, responders at 6 months still had lowered weight (−0.7 (−2.5–0.1) vs. 0.2 (−0.7–2.2) kg; p = 0.005) and BMI (−0.25 (−0.85–0.03) vs. 0.07 (−0.35–0.77) kg/m²; p = 0.009) compared with baseline in contrast to non-responders. Those who had tested both diets preferred SSRD (p = 0.032). In conclusion, a 4-week SSRD intervention was non-inferior to low FODMAP regarding responder rates of gastrointestinal IBS symptoms. Furthermore, strong reductions of extraintestinal symptoms were found in both groups, whereas reductions in weight, BMI, and sugar craving were most pronounced following SSRD. Full article

To manage the number of critical COVID-19 patients, Umberto I Teaching Hospital in Rome established a temporary ICU on March 1, 2021. This study investigated the incidence and risk factors of healthcare-associated infections (HAIs) among these patients during various COVID-19 waves. Patients were grouped by admission date according to the dominant SARS-CoV-2 variant prevalent at the time (Alpha, Delta, Omicron BA.1, Omicron BA.2, Omicron BA.5, and Omicron XBB). First-HAI and mortality rates were calculated per 1000 patient-days. Predictors of first-HAI occurrence were investigated using a multivariable Fine–Gray regression model considering death as a competing event. Among 355 admitted patients, 27.3% experienced at least one HAI, and 49.6% died. Patient characteristics varied over time, with older and more complex cases in the later phases, while HAI and mortality rates were higher in the first year. Pathogens responsible for HAIs varied over time, with first Acinetobacter baumannii and then Klebsiella pneumoniae being progressively predominant. Multivariable analysis confirmed that, compared to Alpha, admission during the Omicron BA.1, BA.2, BA.5, and XBB periods was associated with lower hazards of HAI. Despite worsening COVID-19 patient conditions, late-phase HAI rates decreased, likely due to evolving pathogen characteristics, improved immunity, but also better clinical management, and adherence to infection prevention practices. Enhanced HAI prevention in emergency situations is crucial. Full article

Grapevine trunk diseases are a threat to table- and grape-wine cultivation worldwide. Phaeomoniella chlamydospora (Pch) is a vascular fungus recognized as one of the most important pathogens associated with grapevine trunk diseases. The relationships between xylem vessel features and Pch susceptibility of 10 table- and 17 wine-grape genotypes, as well as 3 rootstocks, were investigated by image analysis of 50 µm cross-sections and artificial Pch inoculation on one-year-old vine cuttings. Vessels were grouped in the diameter classes 1–30, 31–60, 61–90, 91–120, and >120 µm. Among the table-grape varieties, ‘Sable’, ‘Timco’, and ‘Red Globe’ showed higher densities of large vessels (>120 μm) than ‘Italia’, ‘Sugar Crisp’, and ‘Sugraone’. Among the wine-grape varieties, ‘Minutolo’, ‘Montepulciano’, ‘Primitivo’ CDTa19, and ‘Verdeca’ showed higher densities of large vessels than ‘Aglianico’, ‘Nero di Troia’, ‘Sangiovese’, and ‘Susumaniello’. In the rootstocks, the vessel diameters were 50.8, 54.0, and 60.9 μm for ‘34 E.M.’, ‘140 Ruggieri’, and ‘1103 Paulsen’, in that order. For table-grape varieties, Pch was re-isolated from 13.3% for ‘Sugar Crisp’ and ‘Sugraone’ cuttings up to 93.3% for ‘Timco’. For wine-grape varieties, Pch re-isolation ranged from 51.1% (‘Bombino nero’, ‘Negroamaro’ D15, and ‘Sangiovese’) to 81.1% (‘Montepulciano’), while for the rootstocks, the values were from 33 to 51%. A principal component analysis (PCA) revealed a positive correlation between the frequencies of large vessels and Pch re-isolation. In addition, in wine grapes and rootstocks, higher Pch re-isolation frequencies in the lateral parts of cuttings were correlated (r = 0.79) to a higher frequency of large vessels. The results highlight relationships between grapevine xylem vessel sizes and susceptibility to P. chlamydospora that are worthy of further research. Full article

Purpose: Osteosarcoma may arise as a secondary cancer following leukemias or lymphomas. We intended to increase the knowledge about such rare events. Patients and methods: We searched the Cooperative Osteosarcoma Study Group’s database for individuals who developed their osteosarcoma following a previous hematological malignancy. The presentation and treatment of both malignancies was investigated, and additional neoplasms were noted. Outcomes after osteosarcoma were analyzed and potential prognostic factors were searched for. Results: A total of 33 eligible patients were identified (male: 23, female: 10; median age: 12.9 years at diagnosis of hematological cancer; 20 lymphomas, 13 leukemias). A cancer predisposition syndrome was evident in one patient only. The hematological cancers had been treated by radiotherapy in 28 (1 unknown) and chemotherapy in 26 cases, including bone-marrow transplantation in 9. The secondary bone sarcomas (high-grade central 27, periosteal 2, extra-osseous 2, undifferentiated pleomorphic sarcoma of bone 2) arose after a median lag-time of 9.4 years, when patients were a median of 19.1 years old. Tumors were considered radiation-related in 26 cases (1 unknown). Osteosarcoma-sites were in the extremities (19), trunk (12), or head and neck (2). Metastases at diagnosis affected eight patients. Information on osteosarcoma therapy was available for 31 cases. All of these received chemotherapy. Local therapy involved surgery in 27 patients, with a good response reported for 9/18 eligible patients. Local radiotherapy was given to three patients. The median follow-up was 3.9 (0.3–12.0) years after bone tumor diagnosis. During this period, 21 patients had developed events as defined, and 15 had died, resulting in 5-year event-free and overall survival rates of 40% (standard error: 9%) and 56% (10%), respectively. There were multiple instances of additional neoplasms. Several factors were found to be of prognostic value (p < 0.05) for event-free (osteosarcoma site in the extremities) or overall (achievement of a surgical osteosarcoma-remission, receiving chemotherapy for the hematologic malignancy) survival. Conclusions: We were able to prove radiation therapy for hematological malignancies to be the predominant risk factor for later osteosarcomas. A resulting overrepresentation of axial and a tendency towards additional neoplasms affects prognosis. Still, selected patients may become long-term survivors with appropriate therapies, which is an argument against therapeutic negligence. Full article

Juvenile idiopathic arthritis is a heterogeneous group of diseases characterized by arthritis with poorly known causes, including monogenic disorders and multifactorial etiology. 22q11.2 proximal deletion syndrome is a multisystemic disease with over 180 manifestations already described. In this report, the authors describe a patient presenting with a short stature, neurodevelopmental delay, and dysmorphisms, who had an episode of polyarticular arthritis at the age of three years and eight months, resulting in severe joint limitations, and was later diagnosed with 22q11.2 deletion syndrome. Investigation through Whole Genome Sequencing revealed that he had no pathogenic or likely-pathogenic variants in both alleles of the MIF gene or in genes associated with monogenic arthritis (LACC1, LPIN2, MAFB, NFIL3, NOD2, PRG4, PRF1, STX11, TNFAIP3, TRHR, UNC13DI). However, the patient presented 41 risk polymorphisms for juvenile idiopathic arthritis. Thus, in the present case, arthritis seems coincidental to 22q11.2 deletion syndrome, probably caused by a multifactorial etiology. The association of the MIF gene in individuals previously described with juvenile idiopathic arthritis and 22q11.2 deletion seems unlikely since it is located in the distal and less-frequently deleted region of 22q11.2 deletion syndrome. Full article

Neonatal brain injury (NBI) is a critical condition for preterm neonates with potential long-term adverse neurodevelopmental outcomes. This prospective longitudinal case–control study aimed at investigating the levels and prognostic value of serum neuron-specific enolase (NSE) during the first 3 days of life in preterm neonates (<34 weeks) that later developed brain injury in the form of either periventricular leukomalacia (PVL) or intraventricular hemorrhage (IVH) during their hospitalization. Participants were recruited from one neonatal intensive care unit, and on the basis of birth weight and gestational age, we matched each case (n = 29) with a neonate who had a normal head ultrasound scan (n = 29). We report that serum NSE levels during the first three days of life do not differ significantly between control and preterm neonates with NBI. Nevertheless, subgroup analysis revealed that neonates with IVH had significantly higher concentrations of serum NSE in comparison to controls and neonates with PVL on the third day of life (p = 0.014 and p = 0.033, respectively). The same pattern on the levels of NSE on the third day of life was also observed between (a) neonates with IVH and all other neonates (PVL and control; p = 0.003), (b) neonates with II–IV degree IVH and all other neonates (p = 0.003), and (c) between control and the five (n = 5) neonates that died from the case group (p = 0.023). We conclude that NSE could be an effective and useful biomarker on the third day of life for the identification of preterm neonates at high risk of developing severe forms of IVH. Full article

Obtaining accurate models and well-fitting prostheses during the fabrication of complete implant-supported prostheses has been a significant challenge. Conventional impression methods involve multiple clinical and laboratory steps that can lead to distortions, potentially resulting in inaccurate prostheses. In contrast, digital impressions may eliminate some of these steps, leading to better-fitting prostheses. Therefore, it is important to compare conventional and digital impressions for producing implant-supported prostheses. This study aimed to compare the quality of digital intraoral and conventional impressions by measuring the vertical misfit of implant-supported complete bars obtained using both types of techniques. Five digital impressions using an intraoral scanner and five impressions using elastomer were made in a four-implant master model. The plaster models produced with conventional impressions were scanned in a laboratory scanner to obtain virtual models. Screw-retained bars (n = five) were designed on the models and milled in zirconia. The bars fabricated using digital (DI) and conventional (CI) impressions were screwed to the master model, initially with one screw (DI1 and CI1) and later with four screws (DI4 and CI4), and were analyzed under a SEM to measure the misfit. ANOVA was used to compare the results (p < 0.05). There were no statistically significant differences in the misfit between the bars fabricated using digital and conventional impressions when screwed with one (DI1 = 94.45 µm vs. CI1 = 101.90 µm: F = 0.096; p = 0.761) or four screws (DI4 = 59.43 µm vs. CI4 = 75.62 µm: F = 2.655; p = 0.139). Further, there were no differences when the bars were compared within the same group screwed with one or four screws (DI1 = 94.45 µm vs. DI4 = 59.43 µm: F = 2.926; p = 0.123; CI1 = 101.90 µm vs. CI4 = 75.62 µm: F = 0.013; p = 0.907). It was concluded that both impression techniques produced bars with a satisfactory fit, regardless of whether they were screwed with one or four screws. Full article