Search

Idiopathic pulmonary fibrosis (IPF) is an area of high unmet clinical need and high research activity in the pharmaceutical and biotech industries. The two approved therapies, nintedanib and pirfenidone, have issues with efficacy and tolerability. Despite a considerable number of development programs reaching late-stage Phase 2b or 3 clinical trials, no drug other than nintedanib and pirfenidone has successfully demonstrated a benefit for patients. An analysis of these failures, and consideration of the trajectories of some of the current development projects, may offer novel paradigms for choosing modes-of-action and for the development of successful drugs., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Upper respiratory tract infections (URTI) are common and a common cause of sick-leave for healthcare workers, and furthermore pose a threat especially for patients susceptible to other diseases. Sufficient use of respiratory protective equipment (RPE) may protect both the workers and the patients. The COVID-19 pandemic provided a unique opportunity to study the association between use of RPE and URTI in a real-life setting. The aim of this study was to examine if failure of RPE or non-compliance with RPE guidelines increases the risk of non-COVID-19 URTI symptoms among healthcare workers., Methods: In a longitudinal cohort study, we collected self-reported data daily on work tasks, use of RPE, and URTI symptoms among healthcare workers with patient contact in 2 Danish Regions in 2 time periods during the COVID-19 pandemic. The association between failure of RPE or non-compliance with RPE guidelines and URTI symptoms was analyzed separately by generalized linear models. Persons tested positive for severe acute respiratory syndrome coronavirus 2 were censored from the analyses. The 2 waves of data collection were analyzed separately, as there were differences in recommendations of RPE during the 2 waves., Results: We found that for healthcare workers performing work tasks with a risk of transmission of viruses or bacteria, failure of RPE was associated with an increased risk of URTI symptoms, RR: 1.65[0.53-5.14] in wave 1 and RR: 1.30[0.56-3.03] in wave 2. Also non-compliance with RPE guidelines was associated with an increased risk of URTI symptoms compared to the use of RPE in wave 1, RR: 1.28[0.87-1.87] and wave 2, RR: 1.39[1.01-1.91]. Stratifying on high- versus low-risk tasks showed that the risk related to failure and non-compliance was primarily associated with high-risk tasks, although not statistically significant., Discussion: The study was conducted during the COVID-19 pandemic and thus may be affected by other preventive measures in society. However, this gave the opportunity to study the use of RPE in a real-life setting, also in departments that did not previously use RPE. The circumstances in the 2 time periods of data collection differed and were analyzed separately and thus the sample size was limited and affected the precision of the estimates., Conclusion: Failures of RPE and non-compliance with RPE guidelines may increase the risk of URTI, compared to those who reported use of RPE as recommended. The implications of these findings are that the use of RPE to prevent URTI could be considered, especially while performing high-risk tasks where other prevention strategies are not achievable., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Objectives: To examine the impact of bisphosphonates (BPs) on dental implant treatment and alveolar bone in post-menopausal ladies., Materials and Methods: Twenty post-menopausal ladies who had at least one dental implant within the previous 5 years participated in the current study. Ten subjects were categorized into two groups: Group A had BP medication for 1.5 years, and group B received parathyroid hormone (PTH). Both groups' bone thickness and bone mineral density (BMD) were measured., Result: Group A had 5%, and group B had 5% of dental implants failures. BMD of cortical bone was 1468 ± 136 mg/mL and 1008 ± 84 mg/mL in groups A and B, correspondingly. The cortical and cancellous bone densities in both the groups were statically significant. Cortical bone thickness was insignificant in comparison., Conclusion: Both cortical and cancellous bones' bone mineral density decreased in both groups. With continued usage of BPs, the cortical bone thickness increased., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

Study Design: Retrospective study., Objective: Spinal cord stimulation has been mainly used for the management of postsurgical persistent neuropathic. The purpose of the study was to evaluate the rate and causes for reoperation following spinal cord stimulation, and to identify risk factors for reoperation., Methods: A retrospective study was conducted including patients who underwent surgical implantation of spinal cord stimulators within a 10-year period. The medical records of the included patients were reviewed for reoperations, demographics and certain clinical parameters. Demographics and clinical parameters were compared between patients with and without reoperations, and between patients with and without surgical site infections., Results: Overall, 1014 index procedures and 175 reoperations were performed within the study period. At least 1 reoperation was performed in 97 (9.5%) cases. The most common cause for revision was lead migration or lead misplacement (n = 31, 3.0%). In 31 (3.1%) cases the stimulator was removed due to no pain relief. Surgical site infection that required reoperation developed in 30 cases (2.9%). Younger age was associated with a need for reoperation (Odds Ratio [OR]: .97,95% Confidence Interval [CI]:0.95-.99, P = .005), while higher Body Mass index and diabetes were associated with development of infection (OR: 1.05, 95% CI: 1.00-1.11, P = .036 and OR: 2.42, 95% CI: 1.05-5.47, P = .033 respectively)., Conclusions: The results of this study indicate that certain measures could improve the overall reoperation rate after spinal cord stimulation, such as accurate positioning of the spinal cord stimulators and design of smaller generators. Moreover, preoperative optimization of patients could result in lower complication rate, lower reoperations rate, and subsequently better clinical outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Disclosures Dr Saylor reports grants from National Institute of Mental Health; grants from National Multiple Sclerosis Society; grants from Fogarty International Center; grants from American Academy of Neurology; grants from National Institute of Aging; and grants from National Institute of Neurological Disorders and Stroke.

Backgrounds: Long-span dental bridges may cause excessive load on abutment teeth and the periodontal area, which may lead to bridge fractures or periodontal problems. However, some reports have revealed that short- and long-span bridges can provide a similar prognosis. This clinical study aimed to investigate the technical complications associated with fixed dental prostheses (FDPs) of different span lengths., Methods: All patients with previously cemented FDPs were clinically examined during their follow-up visits. Several data related to FDPs were registered, such as design, material type, location, and type of complication. The main clinical factors analyzed were technical complications. Life table survival analyses were performed to calculate the cumulative survival rate of FDPs when technical complications were detected., Results: The study examined 229 patients with a total number of 258 prostheses and an average of 98 months of follow-up. Seventy-four prostheses suffered from technical complications, and the most common complication was ceramic fracture or chipping (n = 66), while loss of retention occurred in 11 prostheses. The long-term evaluation of long-span prostheses revealed a significantly higher technical complication rate compared to short-span prostheses (P = ,003). The cumulative survival rate for short-span FDPs was 91% in year 5, 68% in year 10, and 34% in year 15. For long-span FDPs, the cumulative survival rate was 85% in year 5, 50% in year 10, and 18% in year 15., Conclusion: Long-span prostheses (5 units or more) can be associated with a higher technical complication rate compared to short-span prostheses after long-term evaluation., (© 2023. The Author(s).)

Background: Total ankle arthroplasty is increasingly used as a treatment for end stage ankle arthropathy. The aim of this study was to report the mid-term clinical function and survival results of Ceramic Coated Implant (CCI) ankle replacements and assess the association between the alignment of the CCI total ankle replacements and early functional outcome and complication incidence., Methods: Data of 61 patients, who received 65 CCI implants between 2010 and 2016, were obtained from a prospectively documented database. Mean follow-up time was 85.2 months (range 27-99 months). Clinical function was assessed with AOFAS questionnaire and passive range of motion (ROM). Survival analysis and elaborate radiographic analysis was performed. Furthermore, complications and reoperations were recorded for all patients., Results: Progression in ROM was most seen in the first 10 months from 21.8 degrees of passive range of motion preoperative to 27.6 degrees postoperative (p < 0.001), while the mean AOFAS gradually increased during follow-up postoperative from a mean of 40.9 points preoperative to an average of 82.5 but shows a small decline towards the end of follow-up (p < 0.001). During follow-up we recorded 8 failures (12.3%) resulting in a Kaplan-Meier survival analysis of 87.7% with a median follow-up of 85.2 months., Conclusion: We observed excellent clinical results and survival after TAA with the CCI implant with only a low mid-term complication rate., Level of Evidence: Level III, prospective cohort study., (© 2023. The Author(s).)

Aim: The study aimed to evaluate and compare the shear bond strength (SBS) at the interface of monolithic zirconia with zirconomer (Zr) core build-up, a new type of glass ionomer cement to monolithic zirconia with composite resin core build-up material., Setting and Design: In vitro a comparative study., Materials and Methods: A total of 32 disk-shaped samples of monolithic zirconia and two distinct core build-up materials: Zr (n = 16) and composite resin (n = 16) were used. The two components, monolithic zirconia with Zr core build-up and monolithic zirconia with composite resin core build-up, were bonded using zirconia primer and self-adhesive, dual-cure cement. The samples were subsequently thermocycled, and the SBS was tested at their interfaces. The failure modes were determined using a stereomicroscope. Data were evaluated using the descriptive analysis for mean, standard deviation, confidence interval, and independent t-test for intergroup comparison., Statistical Analysis Used: Descriptive analysis, independent t-test, Chi-square test., Results: The mean SBS (megapascals) of monolithic zirconia to Zr core build-up (0.74) was statistically significant when compared to monolithic zirconia with composite resin core build-up material (7.25) (P ≤ 0.001). Zirconomer core build-up showed 100% adhesive failure; composite resin core build-up had 43.8% cohesive, 31.2% mixed, and 25.0% adhesive failures., Conclusion: When evaluating the two core build-up materials' bindings to monolithic zirconia, Zr and composite resin core build-up showed statistically significant differences. Although Zr has been demonstrated to be the optimal core build-up material; however, additional investigation is required to determine how it bonds to monolithic zirconia more effectively.

Whereas mechanics theories for isotropic materials are almost matured, only linear elastic theories for composites were essentially established. This is because only homogenized or approximated stresses are obtainable for a composite. Its mechanical properties must be estimated on a true stress level. According to Eshelby, the true stresses of the fiber are the same as its homogenized counterparts. The true stress theory for the matrix was systematically established by the author, and is reviewed and summarized in the paper. An Excel table-based program for calculating all of the possible true stress components is provided as a supplement for the reader to download. As most composite failures are caused by matrix failures, the true stress theory plays a predominant role in estimating the composite properties outside a linear elastic range. Some challenging composite failures were resolved upon the matrix true stresses, and are highlighted in the paper.

Purpose: To evaluate the clinical outcome of deantigenated equine bone (DEB) grafts in a series of patients treated with DEB at six months postaugmentation., Materials and Methods: One hundred DEB grafts were inserted in 81 patients between January 2004 and December 2006. Thirty-two DEBs were blocks and 68 were granules (52 sinus lift and 16 guided bone regeneration [GBR] procedures performed). A total of 147 implants were inserted. A Pearson chi-square test was used to detect any statistically significant correlation between the studied variables and early and/or late failures., Results: There were 6 early and 26 late graft failures and another 16 failures after prosthesis placement. The overall failure rate was 25% in the GBR procedures, 31.9% in sinus lift, and 54.3% with blocks, for a total complication rate of 39.5%. A statistically significant relation was detected with respect to graft type and early complications (p = .005), with a worse outcome for DEB blocks compared to granules. After provisional prosthesis restoration, 23 implants were lost, and another 41 failed after definitive prosthesis delivery, for an overall failure rate of 43.5%. The follow-up period was 3 years after surgery., Conclusions: DEB grafting material had a very high rate of complications. Blocks had more than 50% failures, mainly in the immediate postoperative period. Other procedures such as GBR and sinus lift also showed more than 25% infections and resorption, and late failures (i.e., after-implant placement) were also common. Our results show that DEB is less than ideal for crestal bone reconstruction., (© 2013 Wiley Periodicals, Inc.)

Deficiencies in performance in forensic science have led to the need for a statutory regulator with powers over standards and performance, investigation, compliance and enforcement.

Artificial intelligence applications for health care have come a long way. Despite the remarkable progress, there are several examples of unfulfilled promises and outright failures. There is still a struggle to translate successful research into successful real-world applications. Machine learning (ML) products diverge from traditional software products in fundamental ways. Particularly, the main component of an ML solution is not a specific piece of code that is written for a specific purpose; rather, it is a generic piece of code, a model, customized by a training process driven by hyperparameters and a dataset. Datasets are usually large, and models are opaque. Therefore, datasets and models cannot be inspected in the same, direct way as traditional software products. Other methods are needed to detect failures in ML products. This report investigates recent advancements that promote auditing, supported by transparency, as a mechanism to detect potential failures in ML products for health care applications. It reviews practices that apply to the early stages of the ML lifecycle, when datasets and models are created; these stages are unique to ML products. Concretely, this report demonstrates how two recently proposed checklists, datasheets for datasets and model cards, can be adopted to increase the transparency of crucial stages of the ML lifecycle, using ChestX-ray8 and CheXNet as examples. The adoption of checklists to document the strengths, limitations, and applications of datasets and models in a structured format leads to increased transparency, allowing early detection of potential problems and opportunities for improvement. Keywords: Artificial Intelligence, Machine Learning, Lifecycle, Auditing, Transparency, Failures, Datasheets, Datasets, Model Cards Supplemental material is available for this article. © RSNA, 2022., Competing Interests: Disclosures of Conflicts of Interest: C.G. No relevant relationships. O.M. No relevant relationships., (2022 by the Radiological Society of North America, Inc.)

Background: Few studies on outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) have provided insight into the very long-term effects of this procedure., Purpose: To systematically review the outcomes, failure rate, incidence, and predictors of osteoarthritis (OA) for different ACLR techniques at a minimum 20-year follow-up., Study Design: Systematic review; Level of evidence, 4., Methods: A search of the PubMed, SCOPUS, and Cochrane databases was performed on June 2020 for studies of patients who underwent ACLR and had a minimum follow-up of 20 years. We extracted data on patient and surgical characteristics, patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee [IKDC] score, Knee injury and Osteoarthritis Outcome Score [KOOS], and Tegner score), clinical outcomes (IKDC grade, pivot shift, Lachman, and KT-1000 laxity), degree of OA (Kellgren-Lawrence, Ahlbäck, and IKDC OA grading), revisions, and failures. Relative risk (RR) of OA between the operated and contralateral knees was calculated as well as the pooled rate of revisions, failures, and conversion to total knee arthroplasty (TKA)., Results: Included were 16 studies (N = 1771 patients; mean age, 24.8 years; mean follow-up, 22.7 years); 80% of the patients underwent single-bundle bone-patellar tendon-bone (BPTB) reconstruction. The average Lysholm (89.3), IKDC (78.6), and KOOS subscale scores were considered satisfactory. Overall, 33% of patients had "abnormal" or "severely abnormal" objective IKDC grade, 6.7% had KT-1000 laxity difference of ≥5 mm, 9.4% had Lachman ≥2+, and 6.4% had pivot shift ≥2+. Signs of OA were reported in 73.3% of patients, whereas severe OA was reported in 12.8%. The operated knee had a relative OA risk of 2.8 ( P < .001) versus the contralateral knee. Identified risk factors for long-term OA were male sex, older age at surgery, delayed ACLR, meniscal or cartilage injuries, BPTB autograft, lateral plasty, nonideal tunnel placement, residual laxity, higher postoperative activity, and postoperative range of motion deficits. Overall, 7.9% of patients underwent revision, and 13.4% of ACLRs were considered failures. TKA was performed in 1.1% of patients., Conclusion: Most patients had satisfactory subjective outcomes 20 years after ACLR; however, abnormal anteroposterior or rotatory laxity was found in nearly 10% of cases. The presence of radiographic OA was high (RR 2.8 vs uninjured knee), especially in patients with concomitant meniscal or cartilage injuries, older age, and delayed surgery; however, severe OA was present in only 12.8% of cases, and TKA was required in only 1.1%., Competing Interests: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Introduction Rheumatoid arthritis (RA) is one of the most commonly encountered autoimmune diseases. Treatment generally includes disease-modifying anti-rheumatic drugs (DMARDs) and/or biological therapy. However, a significant proportion of the patients do not respond to treatment either as a (primary failure) or lose efficacy over time (secondary failure). Several factors are assumed to influence these conditions. Objectives To estimate the prevalence of failure of biological therapy in patients with RA and its causes. Methods A total of 335 RA patients who were diagnosed at a tertiary center in Jeddah, Saudi Arabia, and had a failure after receiving biological therapy were included in this study. Several variables were considered; patient's socio-demographic data, comorbid conditions, types of biological therapy, the duration of using biological therapy in months, number of biological therapies, allergic reactions, disease activity, and treatment duration. Results Overall the prevalence of failure to biological therapy was 58%; 77% primary failure and 23% secondary failure. Patients with negative rheumatoid factor (RF) (p=0.006), using low-dose steroids, and with a longer disease duration had a significant failure of biological therapy (p=0.023). Conclusion A high percentage of RA patients had a failure of biological therapy. A multicentric trial is recommended to look for additional factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Fatani et al.)

Despite the unprecedented unmet need to discover new antibiotics, only a few molecules have been registered for clinical use. This shortage is primarily based on the scientific failure in the postgenomic era of drug discovery. It appears counterintuitive that knowledge of the bacterial genome was followed by the failure to produce new antibiotics using the paradigm of target-driven drug discovery. Here, I discuss the causes of the failures and also describe how small biotech is mitigating these risks and moving forward using new strategies to identify new antibiotics., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The aim of this retrospective study was to determine the survival rate of single-unit porcelain-fused-to-metal (PFM) and metal crowns placed by dental students at an Australian university undergraduate dental clinic over a five-year period. Complications and the incidences of crown failures were recorded. Clinical records pertaining to single-unit PFM and metal crowns inserted over a five-year period were reviewed, including patient-related, tooth-related, and procedural factors for each crown. Crowns were evaluated as surviving, surviving with complications, or failed. Kaplan-Meier statistical analysis was used to estimate survival rate., This study is based on a sample of 232 (78.4%) PFM crowns and 64 (21.6%) metal crowns inserted between 2014 and 2018. Cumulatively, 224 (75.7%) were surviving, 48 (16.2%) were surviving but previously had complications, and 24 (8.1%) failed. The 5-year cumulative survival rate of all PFM and metal crowns was 83.9% (0.839 ± 0.038, Kaplan-Meier). The average survival time for all crowns was 4.432 ± 0.089 years. Comparatively, PFM crowns had a higher survival rate at 1 year (0.972 ± 0.010) and 2 years (0.919 ± 0.017), compared to metal crowns at 1 year (0.964 ± 0.011) and 2 years (0.894± 0.018). The survival rate of metal crowns remained constant from 2 years to 4 years and thereafter, whereas there was a continued decline in the survival rate of PFM crowns to 83.2% (0.832 ± 0.038) at 4 years and thereafter. Crowns placed on premolars had the highest cumulative survival rate whereas those placed on molars exhibited the lowest survival rate for the duration of the study period. Despite single-unit PFM crowns having a higher 1- and 2-year survival rate compared to metal crowns, metal crowns had a higher survival rate at 4 years and thereafter. Survival rates are comparable to previous studies.

A novel and innovative solution addressing wind turbines' main bearing failure predictions using SCADA data is presented. This methodology enables to cut setup times and has more flexible requirements when compared to the current predictive algorithms. The proposed solution is entirely unsupervised as it does not require the labeling of data through work orders logs. Results of interpretable algorithms, which are tailored to capture specific aspects of main bearing failures, are merged into a combined health status indicator making use of Ensemble Learning principles. Based on multiple specialized indicators, the interpretability of the results is greater compared to black-box solutions that try to address the problem with a single complex algorithm. The proposed methodology has been tested on a dataset covering more than two year of operations from two onshore wind farms, counting a total of 84 turbines. All four main bearing failures are anticipated at least one month of time in advance. Combining individual indicators into a composed one proved effective with regard to all the tracked metrics. Accuracy of 95.1%, precision of 24.5% and F1 score of 38.5% are obtained averaging the values across the two windfarms. The encouraging results, the unsupervised nature and the flexibility and scalability of the proposed solution are appealing, making it particularly attractive for any online monitoring system used on single wind farms as well as entire wind turbine fleets.

Background: Studies have reported relatively high failure rates of isolated meniscal repairs. Platelet-rich plasma (PRP) has been suggested as a way to increase growth factors that enhance healing., Purpose: To compare (1) meniscal repair failures and (2) patient-reported outcomes after isolated arthroscopic meniscal repair augmented with and without PRP., Study Design: Systematic review; Level of evidence, 3., Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Multiple databases were searched for studies that compared outcomes of isolated arthroscopic meniscal repair augmented with PRP versus without PRP in human patients. Failures and patient-reported outcome scores were reported for each study and compared between groups. Study heterogeneity was assessed using I 2 for each outcome measure before meta-analysis. Study methodological quality was analyzed. Continuous variable data were reported as mean and standard deviation from the mean. Categorical variable data were reported as frequency with percentage. All P values were reported with significance set at P < .05., Results: Five articles were analyzed (274 patients [110 with PRP and 164 without PRP]; 65.8% male; mean age, 29.1 ± 4.6 years; mean follow-up, 29.2 ± 22.1 months). The risk of meniscal repair failure ranged from 4.4% to 26.7% for PRP-augmented repairs and 13.3% to 50.0% for repairs without PRP. Meniscal repairs augmented with PRP had significantly lower failure rates than repairs without PRP (odds ratio, 0.32; 95% CI, 0.12-0.90; P = .03). One of the 5 studies reported significantly higher outcomes in the PRP-augmented group versus the no-PRP group for the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) ( P < .05 for all). The remaining 4 studies reported no significant difference between groups with regard to outcomes for the IKDC, Lysholm knee scale, visual analog scale for pain, or Tegner activity level., Conclusion: Although the studies were of mostly of low quality, isolated arthroscopic meniscal repairs augmented with PRP led to significantly lower failure rates (10.8% vs 27.0%; odds ratio, 0.32; P = .03) as compared with repairs without PRP. However, most studies reported no significant differences in patient-reported outcomes., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.R.S. has received research support from Smith & Nephew; consulting fees from Anika Therapeutics, Linvatec, Medacta, and Smith & Nephew; speaking fees from Medacta and Smith & Nephew; and royalties from DJO, Saunders/Mosby–Elsevier, Smith & Nephew, Stryker, and Wolters Kluwer Health–Lippincott Williams & Wilkins. M.R.S. also has stock/stock options in Biomimedica. G.D.A. has received educational support from Arthrex, Evolution Surgical, and Stryker; has received consulting fees from Cytonics, Fidia Pharma, RubiconMD, and Sideline Sports Doc; and has stock/stock options in Cytonics. J.D. has received educational support from Arthrex, consulting fees from DePuy Synthes/Medical Device Business Systems, and hospitality payments from Evolution Surgical and has stock/stock options in Stabilynx. C.C. has received honoraria from Fidia Pharma. S.L.S. has received research support from Arthrex and DJO; educational support from Elite Orthopedics; consulting fees from Arthrex, Ceterix, Conmed Linvatec, Flexion Therapeutics, GLG Consulting, JRF Ortho, Moximed, Olympus, RTI Surgical, and Vericel; nonconsulting fees from Arthrex and Vericel; and honoraria from Vericel. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Purpose: This retrospective cohort study investigated the long-term effectiveness of one type of maxillary and 2 types of mandibular fixed lingual retainers., Materials and Methods: Eighty orthodontic patients in retention for 10-15 years were included. Irregularity index, intercanine width, overjet (OJ) and overbite (OB) were measured on plaster models at 3 occasions: (T1) pre-treatment, (T2) post-treatment and (T3) 10-15 years post-treatment. Analyses assessed the effect of the retainer type and time on mandibular irregularity, intercanine width and retainer failure., Results: In the mandible, the irregularity index increased (0.43 mm) between T2 and T3 for the 0.027" β-titanium (TMA) retainers bonded to canines only while it was stable (-0.02 mm) for the 0.016" x 0.022" braided stainless steel retainers (SS6) bonded to all six anterior teeth. The intercanine width was relatively stable in both groups during the entire observation period. In the maxilla, the irregularity index was stable between T2 and T3 (+0.07 mm). The intercanine width increased (+2.02 mm) during treatment T1-T2 and was stable (-0.02 mm) in the retention phase T2 to T3., Conclusions: In the mandible, SS6 retainers were slightly more effective in maintaining alignment compared to the TMA retainers. In the maxilla, the SS4 retainers without canine extensions were effective in maintaining alignment. All retainers were effective in maintaining the intercanine width.

The efficacy of neocortical synapses to transmit during bursts of action potentials (APs) increases during development but the underlying mechanisms are largely unclear. We investigated synaptic efficacy at synapses between layer 5 pyramidal neurons (L5PNs) during development, using paired recordings, presynaptic two-photon Ca 2+ imaging, and numerical simulations. Our data confirm a developmental increase in paired-pulse ratios (PPRs). Independent of age, Ca 2+ imaging revealed no AP invasion failures and linear summation of presynaptic Ca 2+ transients, making differences in Ca 2+ signaling an unlikely reason for developmental changes in PPR. Cumulative excitatory postsynaptic current (EPSC) amplitudes indicate that neither the size of the readily-releasable pool (RRP) nor replenishment rates were different between age groups, while the time-courses of depression differed significantly. At young synapses, EPSCs depressed rapidly to near steady-state during the first four APs, and synaptic failures (F syn ) increased from 0 to 30%. At mature synapses this drop was significantly slower and strongly biphasic, such that near steady-state depression was reached not before 18 APs with F syn remaining between 0 and 5%. While young synapses reliably transmitted during pairs of APs, albeit with strong depression, mature synapses maintained near 100% transfer efficacy with significantly less depression during high-frequency bursts of APs. Our analysis indicates that at mature synapses a replenishment pool (RepP) is responsible for their high efficacy during bursting activity, while this RepP is functionally immature at young synapses. Hence, our data provide evidence that the functional maturation of a RepP underlies increasing synaptic efficacy during the development of an excitatory cortical synapse., (Copyright © 2020 Bornschein, Brachtendorf and Schmidt.)

Background and Purpose: To gauge the potential effect of mode of content delivery on overall student success in a pharmaceutical sciences course in a doctor of pharmacy program., Educational Activity and Setting: Principles of Drug Action I (PDAI) is a first-year pharmaceutical science course typically taught by multiple faculty, and each utilizes their own approach to deliver course content. Over a seven year period, the course naturally separated into blocks. Block-1 was taught using a traditional lecture-based approach while Block-2 varied between either a lecture-based or a flipped-classroom format. Student success was evaluated by exam at the end of each block., Findings: For the four years in which Block-2 was taught by lecture, the number of exam failures was similar to Block-1. For each of the three years Block-2 was taught via the flipped-classroom format, the number of exam failures was approximately half that of Block-1. While grades for the lecture-based Block-1 trended downward over the seven-year evaluation period, average exam grades overall were similar between Block-1 and Block-2 each year regardless of teaching modality., Summary: Retrospective analysis of this novel blocked approach within PDAI provided a means of internally evaluating the potential effect of teaching format on overall student performance. The results described here support previous studies that indicate that the flipped-classroom approach can reduce course failures. These findings also show that flipped-classroom teaching may have a greater impact on improving learning in lower-performing students., (Copyright © 2019. Published by Elsevier Inc.)

Aim: To assess amoxicillin-clavulanate (AMC) for the oral therapy of diabetic foot infections (DFIs), especially for diabetic foot osteomyelitis (DFO)., Methods: We performed a retrospective cohort analysis among 794 DFI episodes, including 339 DFO cases., Results: The median duration of antibiotic therapy after surgical debridement (including partial amputation) was 30 days (DFO, 30 days). Oral AMC was prescribed for a median of 20 days (interquartile range, 12-30 days). The median ratio of oral AMC among the entire antibiotic treatment was 0.9 (interquartile range, 0.7-1.0). After a median follow-up of 3.3 years, 178 DFIs (22%) overall recurred (DFO, 75; 22%). Overall, oral AMC led to 74% remission compared with 79% with other regimens (χ 2 -test; P = 0.15). In multivariate analyses and stratified subgroup analyses, oral AMC resulted in similar clinical outcomes to other antimicrobial regimens, when used orally from the start, after an initial parenteral therapy, or when prescribed for DFO., Conclusions: Oral AMC is a reasonable option when treating patients with DFIs and DFOs., (© 2019 John Wiley & Sons Ltd.)

Background: The use of a preoperative single dose of antibiotics as routine in conjunction with implant surgery is controversial, in light of the unclear effect on early implant failure rate and risk for development of resistant bacterial strains., Purpose: This randomized clinical trial compared the early implant failure rates in two different patient cohorts: One group receiving a single dose of preoperative antibiotics (AB group) and one group receiving no antibiotics, prior to implant surgery (noAB group)., Materials and Methods: Patients were referred for treatment at four specialist clinics in the county council of West Sweden, Vastra Gotaland and randomly assigned into one of the two groups. A total of 447 patients received 963 implants were included in the study. Of these, 223 patients (535 implants) belonged to the AB-group and 224 patients (428 implants) to the noAB-group. Four commercial implant brands were utilized, albeit one system was only represented with four implants. The outcome was evaluated after 4 months using either a one-stage or two-stage procedure. The surgical procedures were performed by experienced implant surgeons and the surgical protocol for implant placement follows standard. Failure was defined as removal of an implant for any reason. The study outcomes were statistically analyzed to evaluate the differences between the two groups., Results: Twelve implants failed in 11 patients for the AB group, and 32 implants failed in 29 patients for the noAB group. Preoperative antibiotics, AB group, had significantly (P < 0.0011) lower implant failure 2.2% compared to 7.5% in the noAB group analyzed on implant level adjusted for dependence within patients, OR = 0.30, 95% confidence interval (0.14-0.62)., Conclusion: Administration of a single dose of antibiotics in conjunction with implant placement surgery resulted in a statistically significant lower early implant failure rate compared to when no antibiotics were used., (© 2019 Wiley Periodicals, Inc.)

Background: Metal on metal hip resurfacing (MoM-HR) is an alternative to total hip arthroplasty in young and active patients. The purpose was to determine the survivorship of MoM-HR procedures performed in patients aged 45 years and younger assessing patient-reported outcome measures (PROMs) at minimum 5-year follow-up., Methods: All 217 patients equal to or younger than 45 years of age at the time of surgical intervention presenting to our center with MoM-HR between May 2002 and May 2011 were prospectively followed. Baseline demographic data, preoperative and postoperative radiographic measurements, and validated PROMs were obtained (Hip Disability and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles Activity Score). Survivorship was calculated using Kaplan-Meier analysis, and risk factors for failure were identified using multivariate regression analysis., Results: The overall survivorship excluding septic failures was 94.6% and 93.8% at 5 and 10 years, respectively. Aseptic loosening of the acetabular component was the most common mode of failure (11/20 cases). Gender, head size, and acetabular abduction angle had no significant effect on survivorship. Significant improvements in PROMs were seen for Hip Disability and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles Activity Scale (P < .001)., Conclusion: This study indicates that MoM-HR is a suitable option for young individuals, as demonstrated through improved functional scores and low revision rates. The survivorship of HR in the younger than 45 age-group was similar to that of total hip arthroplasty, as well as HR in older patients. Given the proposed benefits of HR, this procedure may be viewed as a viable option in patients aged younger than 45 years., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

A unique feature of battery electric vehicles (BEV) is their regenerative braking system (RBS) to recapture kinetic energy in deceleration maneuvers. If such a system is triggered via gas pedal, most deceleration maneuvers can be executed by just using this pedal. This impacts the driving task as different deceleration strategies can be applied. Previous research has indicated that a RBS failure leading to a sudden reduced deceleration represents an adverse event for BEV drivers. In the present study, we investigated such a failure's impact on the driver's evaluation and behavior. We conducted an experiment on a closed-off test track using a modified BEV that could temporarily switch off the RBS. One half of the 44 participants in the study received information about an upcoming RBS failure whereas the other half did not. While 91% of the drivers receiving prior information noticed the RBS failure, only 48% recognized it in the "uniformed" group. In general, the failure and the perception of its occurrence influenced the driver's evaluation and behavior more than receiving prior information. Nevertheless, under the tested conditions, drivers kept control and were able to compensate for the RBS failure. As the participants drove quite simple maneuvers in our experiment, further studies are needed to validate our findings using more complex driving settings. Given that RBS failures could have severe consequences, appropriate information and warning strategies for drivers are necessary., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background. Since osseointegration depends on bone metabolism, low levels of vitamin D in the blood may negatively affect bone formation around dental implants. To date, only a few studies have investigated the possible connection between serum levels of vitamin D and early dental implant failure (EDIF), i.e. failure that occurs within 4 months after placement, before the connection of the prosthetic abutment. The aim of this study was to investigate whether there is a relationship between low serum levels of vitamin D and EDIF. Methods. Data used for this retrospective study were derived from the records of a private dental clinic. Inclusion criteria were patients who had been treated with dental implants, inserted with a submerged technique from January 2003 to December 2017. EDIF was the outcome of this study. Chi-squared test was used to investigate the effect of patient-related variables (age, gender, smoking habit, history of periodontal disease and serum levels of vitamin D) on EDIF. Results. Originally, 885 patients treated with 1,740 fixtures were enrolled in this study. Overall, 35 EDIFs (3.9%) were reported. No correlation was found between EDIF and the patients' gender (P=0.998), age (P=0.832), smoking habit (P=0.473) or history of periodontal disease (P=0.386). Three EDIFs (11.1%) were reported in 27 patients with serum levels of vitamin D <10 ng/mL, 20 EDIFs (4.4%) in 448 patients with levels between 10 and 30 ng/mL, and 12 EDIFs (2.9%) in 410 patients with levels >30 ng/mL. Although there was a clear trend toward an increased incidence of EDIF with lowering of serum vitamin D levels, no statistically significant difference (P=0.105) was found among these three groups. Conclusion. Within its limitations (retrospective design, low number of patients with severe blood levels of vitamin D enrolled), this study failed to demonstrate a significant relationship between low serum levels of vitamin D and increased risk of EDIF. However, since a dramatic increase in EDIFs with lowering of vitamin D levels in the blood has been reported, further clinical studies with appropriate design (prospective or randomized controlled studies on a larger sample of severely deficient patients) are needed to better investigate this topic.

Lifting the limb sufficiently to clear an obstacle seems like a straightforward task, yet trips are a common cause of falls across all ages. Examination of obstacle contacts in the lab revealed a progressive decrease in foot elevation with repeated exposures, ultimately resulting in failure (Heijnen et al. Exp Brain Res 23:219-231, 2012). The purpose of this study was to determine if the progressive decrease in foot elevation continued when knowledge of obstacle contact was removed. Twenty-one young adults (mean 20.0 ± 1.0 years; 8 males) crossed a 20 cm obstacle in a 12 m walkway for 150 trials. The obstacle was covertly lowered between the lead and trail limb crossing of the obstacle, which eliminated obstacle contact with the trail limb if the limb was too low. The average failure rate was 8%, substantially higher than the 1-2% observed for stationary, visible obstacles. Therefore, tactile information from obstacle contact was instrumental for guiding the trail limb; visual information and joint angle information were insufficient for most participants. Foot elevation change over successive trials varied across participants, and was categorized as (1) asymptotic decrease (N = 11, 52%), with foot elevation converging to obstacle height, (2) linear decrease (N = 7, 33%), and (3) stable (N = 3, 14%). The asymptotic and stable groups appeared to have reasonable knowledge of obstacle height; the linear group did not. The asymptotic behavior is consistent with participants exploring the region above the obstacle through trial-and-error to determine appropriate foot elevation.

"If terms be incorrect, then statements do not accord with facts". (Confucius) "Words form the thread on which we string our experiences". (Aldous Huxley) Semantics is a term coined by Michel Bréal (1832 to 1915) a Jewish German-French linguist referring to the Greek semantikos (= meaning) in his 1897 book, "Essai de sémantique". He was a very gifted man: for example, he was the one who suggested to Pierre de Coubertin to include the marathon in the Olympic Games and who also, with the help of a Francophile American dental practitioner, Thomas William Evans, created the "Doctorat d'Université", finally allowing American students to pursue their doctorate at a French university.

The introduction of biologic disease-modifying anti-rheumatic drugs (bDMARDs) has dramatically changed the management of rheumatoid arthritis (RA). However, in a real-life setting about 30-40% of bDMARD treated patients experience drug discontinuation because of either inefficacy or adverse events. According to international recommendations, to date the best strategy for managing first-line bDMARD failures has not been defined yet and available data (especially on TNF inhibitors [TNFis]) seem to drive toward a personalized approach for the individual patient. Some TNFi partial responders may benefit from optimization of concomitant methotrexate therapy or from switching to a different concomitant sDMARD such as leflunomide. Conversely, apart from infliximab, TNFi dose escalation seems to be poor efficacious and poor cost-effective compared with alternative strategies. Albeit counterintuitive, the use of a second TNFi after the failure of the first-one (cycling strategy) is supported by clear evidences and has become widespread in the 2000s as the result of the limited alternative options till the introduction of bDMARDs with a mechanism of action other than TNF blockade. Nowadays, the use of abatacept, rituximab, tocilizumab, or JAK inhibitors as second-line agent (swapping strategy) is strongly supported by RCTs and real-life experiences. In the absence of head-to-head trials directly comparing these two strategies, meta-analyses of separated RCTs failed to find significant differences in favor of one or another choice. However, results from most observational studies, including well designed prospective pragmatic randomised analyses, demonstrated the superiority of swapping over cycling approach, whereas only few studies reported a comparable effectiveness. In this review, we aimed to critically analyze all the potential therapeutic options for the treatment of first-line bDMARD failures in order to provide a comprehensive overview of available strategies to be applied in clinical practice., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: The objective of this systematic review was to assess the 5-year and 10-year survival of resin-bonded fixed dental prostheses (RBBs) and to describe the incidence of technical and biological complications., Materials and Methods: An electronic MEDLINE search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on RBBs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction were performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson regression models to obtain summary estimates of 5- and 10-year proportions., Results: The search provided 367 titles and 87 abstracts. Full-text analysis was performed for 22 articles resulting in seven studies that met the inclusion criteria. Five articles were found through manual search, and 17 studies were provided from (Pjetursson et al. 2008, Clinical Oral Implants Research, 19, 131), resulting in an overall number of included studies of 29. Meta-analysis of these studies reporting on 2300 RBBs indicated an estimated survival of resin-bonded bridges of 91.4% (95 percent confidence interval [95% CI]: 86.7-94.4%) after 5 years and 82.9% (95% CI: 73.2-89.3%) after 10 years. A significantly higher survival rate was reported for RBBs with zirconia framework compared with RBBs from other materials. RBBs with one retainer had a significantly higher survival rate (P < 0.0001) and a lower de-bonding rate (P = 0.001) compared with RBBs retained by two or more retainers. Moreover, the survival rate was higher for RBBs inserted in the anterior area of the oral cavity compared with posterior RBBs. The most frequent complications were de-bonding (loss of retention), which occurred in 15% (95% CI: 10.9-20.6%) and chipping of the veneering material that was reported for 4.1% (95% CI: 1.8-9.5%) of the RBBs over an observation period of 5 years., Conclusion: Despite the high survival rate of RBBs after 5 and 10 years, technical complications like de-bonding and minor chipping were frequent. RBBs with zirconia framework and RBBs with one retainer tooth showed the highest survival rate., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Ankle joint distraction (AJD) avoids the potential complications associated with ankle fusion or total ankle replacement (TAR) in patients with advanced ankle osteoarthritis (OA). AJD could a tenable option to ankle fusion or TAR., Methods: A review has been performed on the role of AJD in advanced OA of the ankle. The exploration machine was MedLine. The keywords utilized were: joint distraction ankle. Three hundred and eleven articles were found. Of the above-mentioned, only 14 were chosen and analyzed because they were rigorously focused on the issue and the question of this paper., Results: The types of articles published until now have a poor level of evidence (levels III and IV). The overall number of patients managed until now by way of AJD is 249. The published mean follow-up is very variable, from 1 year to 12 years., Conclusion: The rate of good outcomes ranged between 73% and 91%. The percentage of failure (final ankle arthrodesis or TAR) ranged between 6.2% and 44%. A minimum of 5.8 mm of distraction gap must be achieved. Ankle function after AJD deteriorates over time. Putting together ankle movement and distraction will result in an early and maintained profitable influence on outcome.

Background: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are important markers in the evaluation and treatment of painful total knee arthroplasty (TKA). Elevation of both markers usually occurs with infected TKAs while a normal ESR and CRP usually point to aseptic causes for failure. The purpose of this study is to compare (1) rate of revision, (2) infection, and (3) reason for reoperation in a group of patients undergoing revision TKA with a single abnormality in either ESR or CRP in an otherwise negative conventional infection work-up compared to patients with normal preoperative ESR and CRP., Methods: We retrospectively reviewed 791 consecutive revision TKAs performed at our institution between years 2004 and 2011. Following exclusion for infection, periprosthetic fracture, prior revision TKA, positive cultures, incomplete records, and patients with less than 24-month follow-up, a total of 228 aseptic revisions (89 knees with 1 abnormal serologic marker) were available for final analysis. No patients met the current established criteria for infection. All knees underwent revision TKA using antibiotic-impregnated cement. The 2 groups were compared in terms of overall survivorship, infection rate, and rate and causes of subsequent aseptic revision., Results: The average follow-up was 60 months (24-110). There were no significant differences between the 2 groups in terms of age, sex, American Society of Anesthesiologists class, and Charlson comorbidity index. A preoperative abnormality of either ESR or CRP significantly increased the risk for reoperation for all reasons (odds ratio [OR], 3.2; P = .0028), infection (OR, 4.0; P = .034), and revision for aseptic loosening (OR, 3.69; P = .044). There were no differences in reoperations for any other reason. The average time to revision in the study group was 28.3 months compared to 40.0 months in the control group (P = .213)., Conclusion: A single abnormality in either the ESR or CRP increased the likelihood of both infection and reoperation following revision TKA. Conventional methods and criteria for infection detection may not be sufficiently sensitive or specific in these cases. Further work-up with additional modalities may help increase the confidence of aseptic failure before revision TKA., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging (MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable post-operatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions., Competing Interests: Conflict-of-interest statement: There is no conflict of interest associated with the senior author or other coauthors.

Lab appliances are an integral part of orthodontics, from active treatment to retention. The quality and fit of an appliance can affect the treatment result and stability., Aims: This study aims to determine common points of failure in orthodontic appliances, and suggest methods to reduce this rate., Methods: A survey consisting of 23 questions was distributed to active members of the American Association of Orthodontists (AAO) via Survey Monkey., Results: The most common appliance to need an adjustment was the wrap-around retainer, with the Hawley retainer as a close second. The least common appliance needing adjustment was the Essix/clear retainer. Respondents were asked which component of each appliance was most commonly responsible for an ill-fit. For Hawley and wrap-around retainers, clasps were the most common problem at 50%, whereas spring aligners had two components - clasps and labial bows, both at 38%. Ill-fitting Essix/clear retainers had gingival impingement (52%) closely followed by poor posterior seating (43%)., Conclusions: Communication between the orthodontist and lab technician can be improved by establishing a quality assurance protocol for outgoing and incoming cases. The labial bow of Hawley's, wrap-arounds and spring aligners should be clearly demarcated on the casts. Impressions should be free of distortion and casts should be inspected for accuracy. Clear retainers and positioner should be trimmed to avoid gingival impingement. The type of clasp should be selected based on the anatomy of the teeth, and bands should be checked for accuracy of fit.

Background: Multidrug-resistant TB (MDR-TB) is a major public health concern and threat for tuberculosis control efforts worldwide. Globally, 3.6% of new TB cases and 20.2% of previously treated cases, are estimated to have MDR-TB. The prevalence of MDR-TB in India has been estimated to be 1-3% in new TB cases and around 12-14% in previously treated TB cases. There is limited information of the trends of MDRTB among various types of previously treated cases, i.e. relapse, treatment after failure, treatment after default and other cases. This study was conducted to know the trends of MDR-TB among various types of previously treated cases treated as per Revised National TB Control Program (RNTCP) guidelines., Methods: This was a retrospective record review of MDRTB cases diagnosed during 2007-2011 who were previously treated for anti-TB treatment under RNTCP., Results: A total of 249 retreatment tuberculosis patients diagnosed as having MDRTB were included. Majority 84 (34%) of cases were from 25 to 34 years age group, which is productive age group. Among the MDRTB cases, 177 (71%) were male and 72 (29%) were female. The proportion of MDR-TB among different subcategories of retreatment TB cases were relapse 117 (47%), treatment failure 96 (39%), treatment after default 22 (9%) and others 14 (6%)., Conclusion: Study findings highlight high proportion of MDRTB among the relapse and treatment failure cases. Further research is needed to understand high occurrence rates of MDRTB among relapse and failure cases treated under RNTCP and need for early detection of MDR-TB among these high-risk groups., (Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Objective: To assess the 5-year survival of metal-ceramic and all-ceramic tooth-supported fixed dental prostheses (FDPs) and to describe the incidence of biological, technical and esthetic complications., Methods: Medline (PubMed), Embase and Cochrane Central Register of Controlled Trials (CENTRAL) searches (2006-2013) were performed for clinical studies focusing on tooth-supported FDPs with a mean follow-up of at least 3 years. This was complemented by an additional hand search and the inclusion of 10 studies from a previous systematic review [1]. Survival and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions., Results: Forty studies reporting on 1796 metal-ceramic and 1110 all-ceramic FDPs fulfilled the inclusion criteria. Meta-analysis of the included studies indicated an estimated 5-year survival rate of metal-ceramic FDPs of 94.4% (95% CI: 91.2-96.5%). The estimated survival rate of reinforced glass ceramic FDPs was 89.1% (95% CI: 80.4-94.0%), the survival rate of glass-infiltrated alumina FDPs was 86.2% (95% CI: 69.3-94.2%) and the survival rate of densely sintered zirconia FDPs was 90.4% (95% CI: 84.8-94.0%) in 5 years of function. Even though the survival rate of all-ceramic FDPs was lower than for metal-ceramic FDPs, the differences did not reach statistical significance except for the glass-infiltrated alumina FDPs (p=0.05). A significantly higher incidence of caries in abutment teeth was observed for densely sintered zirconia FDPs compared to metal-ceramic FDPs. Significantly more framework fractures were reported for reinforced glass ceramic FDPs (8.0%) and glass-infiltrated alumina FDPs (12.9%) compared to metal-ceramic FDPs (0.6%) and densely sintered zirconia FDPs (1.9%) in 5 years in function. However, the incidence of ceramic fractures and loss of retention was significantly (p=0.018 and 0.028 respectively) higher for densely sintered zirconia FDPs compared to all other types of FDPs., Conclusions: Survival rates of all types of all-ceramic FDPs were lower than those reported for metal-ceramic FDPs. The incidence of framework fractures was significantly higher for reinforced glass ceramic FDPs and infiltrated glass ceramic FDPs, and the incidence for ceramic fractures and loss of retention was significantly higher for densely sintered zirconia FDPs compared to metal-ceramic FDPs., (Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objective: To assess the 5-year survival of metal-ceramic and all-ceramic tooth-supported single crowns (SCs) and to describe the incidence of biological, technical and esthetic complications., Methods: Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL) searches (2006-2013) were performed for clinical studies focusing on tooth-supported fixed dental prostheses (FDPs) with a mean follow-up of at least 3 years. This was complimented by an additional hand search and the inclusion of 34 studies from a previous systematic review [1,2]. Survival and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions., Results: Sixty-seven studies reporting on 4663 metal-ceramic and 9434 all-ceramic SCs fulfilled the inclusion criteria. Seventeen studies reported on metal-ceramic crowns, and 54 studies reported on all-ceramic crowns. Meta-analysis of the included studies indicated an estimated survival rate of metal-ceramic SCs of 94.7% (95% CI: 94.1-96.9%) after 5 years. This was similar to the estimated 5-year survival rate of leucit or lithium-disilicate reinforced glass ceramic SCs (96.6%; 95% CI: 94.9-96.7%), of glass infiltrated alumina SCs (94.6%; 95% CI: 92.7-96%) and densely sintered alumina and zirconia SCs (96%; 95% CI: 93.8-97.5%; 92.1%; 95% CI: 82.8-95.6%). In contrast, the 5-year survival rates of feldspathic/silica-based ceramic crowns were lower (p<0.001). When the outcomes in anterior and posterior regions were compared feldspathic/silica-based ceramic and zirconia crowns exhibited significantly lower survival rates in the posterior region (p<0.0001), the other crown types performed similarly. Densely sintered zirconia SCs were more frequently lost due to veneering ceramic fractures than metal-ceramic SCs (p<0.001), and had significantly more loss of retention (p<0.001). In total higher 5 year rates of framework fracture were reported for the all-ceramic SCs than for metal-ceramic SCs., Conclusions: Survival rates of most types of all-ceramic SCs were similar to those reported for metal-ceramic SCs, both in anterior and posterior regions. Weaker feldspathic/silica-based ceramics should be limited to applications in the anterior region. Zirconia-based SCs should not be considered as primary option due to their high incidence of technical problems., (Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Background: Little knowledge is available on incidence of patients treated for peri-implantitis problems in routine follow-up protocols., Purpose: The aim was to report the incidence, and clinical and radiographic characteristics related to routine follow-up patients who are surgically treated for peri-implantitis problems during 8 years of inclusion., Materials and Methods: Patients with a history of peri-implantitis surgery were identified from patients examined on routine basis at one clinic (Brånemark clinic) between January 2003 and December 2010. Data on included patients were retrospectively retrieved and reported from dental records and radiographs., Results: On an average, 1,294 patients per year (SD 96) were followed up during inclusion period. Altogether, 134 patients had surgery related to peri-implantitis problems, corresponding to an average of 1.2% of followed-up patients per year. No prosthesis was completely lost, but altogether, 37 implants (6% of included implants) were removed in 34 patients (25%) during these surgical interventions. Peri-implantitis surgery was observed more often in the edentulous upper jaw (p < .05), and there was a tendency that surgery increased by time of follow-up. No significant differences were found between patients provided with machined or medium-rough implant surfaces., Conclusions: Incidence of peri-implantitis surgery was on an average 1.2% of followed-up patients per year during an 8 years period of inclusion. As no data were available on patient compliance, it could be assumed that the result may underscore the clinical need. Significantly, more edentulous upper jaws were included compared with other treated jaw situations. Data also indicated that the need for surgery may increase by time of follow-up, but no significant differences were observed between patients provided with machined and medium-rough implant surfaces., (© 2013 Wiley Periodicals, Inc.)

Aim: To assess the failure and bone-to-implant contact rate of dental implants placed on osteoporotic subjects., Methods: Extensive examination strategies were created to classify studies for this systematic review. MEDLINE (via PubMed) and EMBASE database were examined for studies in English up to and including May 2014. The examination presented a combination of the MeSH words described as follow: "osteoporosis" or "osteopenia" or "estrogen deficiency" AND "implant" or "dental implant" or "osseointegration". Assessment of clinical and/or histological peri-implant conditions in osteoporosis subjects treated with titanium dental implants. The examination included a combination of the MeSH terms described as follow: "osteoporosis" or "osteopenia" or "estrogen deficiency" AND "implant" or "dental implant" or "osseointegration"., Results: Of 943 potentially eligible articles, 12 were included in the study. A total of 133 subjects with osteoporosis, 73 subjects diagnosed with osteopenia and 708 healthy subjects were assessed in this systematic review. In these subjects were installed 367, 205, 2981 dental implants in osteoporotic, osteopenic and healthy subjects, respectively. The failure rate of dental implant was 10.9% in osteoporotic subjects, 8.29% in osteopenic and 11.43% in healthy ones. Bone-to-implant contact obtained from retrieved implants ranged between 49.96% to 47.84%, for osteoporosis and non-osteoporotic subjects., Conclusion: Osteoporotic subjects presented higher rates of implant loss, however, there is a lower evidence to strengthen or refute the hypothesis that osteoporosis may have detrimental effects on bone healing. Consequently, final conclusions regarding the effect of osteoporosis in dental implant therapy cannot be made at this time. There are no randomized clinical trial accessible for evaluation and the retrospective nature of the evaluated studies shall be taken in account when interpreting this study.

Objective: Information of implant periapical lesion(IPL) is insufficient by now. The aim of this review is to analyze the possible causes of IPL and to find out the proper treatment protocol., Material and Methods: A systematic literature search was carried out (up to June 2012) using relevant search terms in PUBMED. And a case of IPL with histological evaluation is reported., Results: The IPL is accompanied by the radiolucency around the apex of the implant and usually presents symptoms of red, pain, tenderness, swelling, or fistulous tract. It may occur due to infection, overheating, poor bone quality of the implant site, etc. Debridement is considered as the crucial procedure of the treatment, and the prognosis is normally good when assessed by clinical parameters and radiograph., Conclusion: The causes of IPL seem to be multifactorial. Most of the cases are connected with pre-existing infection. Elimination of the infection is the only consensus of the treatment protocols., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Management of post-treatment apical periodontitis after surgery--assuming the tooth is restorable, periodontally sound, and the patient desires to retain it--includes nonsurgical retreatment and surgical reintervention. This article presents 2 cases of surgical reintervention using a modern surgery technique that utilized an operating microscope, ultrasonic tips, and biocompatible materials. After the reinterventions were performed, adequate periradicular healing was observed in both cases. These cases reinforce the precept that combining knowledge about the biologic aspects of endodontics with surgical endodontic treatment using a modern technique is a predictable treatment option.

The treatment of hallux valgus depends on multiple factors, including clinical examination, patient considerations, clinical findings, radiographic assessment, and surgeon preference. Appropriate procedure selection and proper technique will usually result in good-to-excellent outcomes. Complications following hallux valgus correction include recurrence, transfer metatarsalgia, avascular necrosis, hallux varus, and nonunion and malunion of metatarsal osteotomies. In order to decrease the risks of complication, a precise and meticulous physical examination should be conducted preoperatively. In addition, a surgeon should select appropriate osteotomies to correct complex hallux valgus deformities. As a general principle, the severity of deformity dictates treatment options., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Even in the case of implant loss, replacement of the implant and refabrication of the superstructure are often sufficient, as long as the bone and soft tissue are in good condition. However, if implant loss accompanied by serious bone resorption occurs with a fixed implant superstructure supported by multiple implants, it is very difficult to treat. This clinical report describes the process by which multiple implant-supported fixed metal ceramic restorations were repaired with a metal ceramic resin-bonded fixed partial denture without complete refabrication after removal of one of the implants due to severe bone resorption. The 3-year follow-up indicated excellent serviceability and a well-satisfied patient.

Accidents involving portable ladders are a common cause of serious occupational and non-occupational injuries throughout the industrialized world. Many of these injuries could be prevented with better instruction on the proper usage of portable ladders. Research is reported that focused on both the human factors and engineering aspects of portable extension ladder usage based on common ladder setup procedures. Results of the human factors experiment revealed evidence of unsafe acts that could lead to catastrophic ladder slide-out accidents in real-life situations. Six different ladder setup methods were evaluated for safety and stability based on placement angles: the basic, 75 degree, stand-reach, L sticker, 4:1, and bubble level methods. Ideally, ladder users would set the ladder up at 75.5 degrees to achieve the consensus industry standard safest angle. Setup methods varied in complexity and nature of instruction. The level method produced the most accurate and the least variable results. The engineering analysis determined the coefficient of friction of a variety of clean and contaminated surfaces commonly used with ladders. This analysis determined the total number of slide-out failures that would likely have occurred in the data obtained in each of the ladder setup methods tested in the human factors experiment. Based on test participants' setup angles, the average calculated ladder slide-out failure rate was 8.7 percent for ladders positioned on a surface with the lowest measured coefficient of friction. When broken down by ladder setup method, the 4:1 method had a failure rate of 18.8 percent, the 75 degree method had a failure rate of 15.2 percent, and the basic method had a failure rate of 9.8 percent. The stand-reach and L sticker methods had identical failure rates at 3.3 percent and the level method was best at 1.1 percent. The level method provided the lowest error, least variability, and setup closest to the target angle of 75.5 degrees. Analysis of the overall results revealed the need for additional user training and clearer instructions affixed to ladders. This research is unique in that it combines an analysis and comparison of human factors and engineering in the same study., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: To determine the effect of various systemic antibiotic prophylaxis regimes on patient-reported outcomes and postsurgical complications in patients undergoing conventional implant installation., Material and Methods: Three hundred and twenty-nine healthy adults in need of conventional implant installation were randomly assigned to one of four groups: (i) preoperatively 2 g of amoxycillin 1 h before surgery (positive control, PC), (ii) postoperatively 2 g of amoxycillin immediately following surgery (test 1, T1), (iii) preoperatively 2 g of amoxycillin 1 h before and 500 mg thrice daily on days 2 and 3 after surgery (test 2, T2), (iv) preoperatively 2 g of placebo 1 h before surgery (negative control, NC). Subjects were examined clinically by blinded examiners over 8 weeks after implant installation. In addition, Visual Analogue Scales (VAS) for pain, swelling, bruising and bleeding were obtained over 14 days. ANOVA was performed for the VAS. Chi-square tests were applied for postsurgical complications., Results: All VAS scores were low for all groups and decreased over time (P < 0.001). There were no significant differences for the VAS scores between the various groups at any time point (P > 0.05). There was only a significant difference in flap closure at week 4, where NC had 5% of the subjects not achieving complete wound closure compared to 0% for the three other groups (P = 0.01), with no other significant differences for any postsurgical complications (P > 0.05)., Conclusion: For standard single implant placement, prophylactic systemic antibiotics either before or after, or before and after the surgical procedure do not improve patient-reported outcomes or prevalence of postsurgical complications., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Objective: To compare oral health-related quality of life (OHRQoL) among subjects who received implant-supported crowns (ISC) and 2-unit cantilevered resin-bonded bridges (cRBB) in a bounded single tooth space (BSTS) after at least 5 years and to investigate factors associated with their OHRQoL., Methods: A case-control study among 78 subjects who received ISC or cRBB rehabilitation at a teaching hospital (39 ISCs and 39 cRBBs). OHRQoL was measured using the Oral Health Impact Profile (OHIP-49) and compared between treatment modality. Variations in OHIP scores with respect to "minor complications" (repair of the original "survived" restorations) and "major complications" (replacement of "failed" restorations); and number of complications were determined in bivariate and multivariate analyses (negative binominal regression) controlling for socio-demographic and clinical factors., Results: Oral Health Impact Profile scores were similar among those who received ISC and cRBB (P = 0.53). Among subjects with complicated restorations, those with major complications reported significantly higher OHIP scores (poorer OHRQoL) than those with minor complications (P = 0.02). Subjects who experienced multiple complications had significantly higher OHIP scores (poorer OHRQoL) than those with a single complication (P = 0.04). In regression analyses (which considered OHIP scores of those with complications), the nature of complications (P < 0.01), treatment modality (P = 0.04), and gender (P = 0.02) emerged as significant factors., Conclusion: In the rehabilitation of a BSTS patients, OHRQoL was similar irrespective of treatment modality (ISC or cRBB). Among those who experienced complications their OHRQoL was associated with the nature of complications, treatment modality and gender., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Objective: To compare "survival" and "success" of implant-supported crowns (ISC) and tooth-supported 2-unit cantilevered resin-bonded bridges (cRBB) in the rehabilitation of a bounded single tooth space (BSTS), after an observation period of ≥5 years., Methods: A case-control study among subjects who received ISC or cRBB rehabilitation at a teaching hospital. The (i) survival (retention in mouth) and (ii) success (absence of complications requiring intervention) for the ISCs and cRBBs were compared (overall, supporting structures and that of the prostheses). Rates of survival and success were compared using log-rank statistics. Prevalence of survival and success (categories) were compared by chi-square/Fisher's exact test., Results: Seventy eight subjects participated in this study (39 ISC and 39 cRBB cases). Both had a mean observation time exceeding 100 months, P > 0.05. ISCs and cRBBs had similar survival rates: overall (P = 0.96), supporting structures (P = 0.14) and prostheses (P = 0.44) There was a significant difference in the rate of overall success between ISCs and cRBBs (P = 0.03), specifically with respect to the success rate of the supporting structures (P = 0.03). There was also a significant difference in the prevalence of supporting structures categorized as a "success": ISCs (69.2%) and cRBBs (89.7%), P = 0.03. Biological complications of supporting structures were more common among ISCs (25.6%) compared with cRBBs (7.7%), P = 0.03., Conclusion: Implant-supported crowns and cRBBs in the rehabilitation of a BSTS survive similarly after at least 5 years. However, cRBBs had a higher success rate and were more frequently categorized as successful than ISCs. Notably, there were fewer biological complications of cRBBs supporting structures than ISCs., (© 2012 John Wiley & Sons A/S.)

There are many detailed articles regarding accidents and local complications in dental implantation. Comparison of the data they report is not always easy because different criteria have been followed in the various classifications and there is confusion between the terms accident and complication. The aim of this paper is to propose a classification that considers the timing of the events and makes a distinction between the two terms. Accidents are events that occur during surgery and complications are all the pathological conditions that appear postoperatively. The proper diagnostic procedures and surgical techniques for complications prevention and treatment are also described.