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Repair offers significant time—cost savings and durability by reusing existing parts efficiently. Prior to implementation of repaired parts, it is crucial to clarify mechanical properties and deformation mechanisms to ensure proper performance. In this study, a repair deposition was performed on the groove of wrought stainless steel 316L using the same material powder. The repaired sample exhibited an excellent combination of ductility and strength (T.EL: 58%, YS: 407 MPa, UTS: 673 MPa) compared to the wrought counterpart. With heterogeneity in microstructure, the hetero-deformation-induced strengthening of the repaired sample resulted in a synergy of strength-ductility combinations.

Direct energy deposition (DED) has gained attention in the field of metal repair because of its ability to integrate additively deposited material with preexisting components. Having the beneficial aspects of depositing right material, DED is evaluated the best option for repair deposition. Machining grooves in damaged components is the common first to repair, which is necessary to remove cracked or damaged material and provide suitable geometry for deposition. Preprocessing as grooving is commonly applied to prevent the propagation cracks or tears. However, challenges such as dimensional error and crack induced by residual stress emerge owning to complex interactions between the DED parameters and groove geometry during repair deposition. This study investigates effective deposition strategies for repairing 316L stainless steel grooves with wall-angles of 90° and 135° by exploring the relationship between the repair integrity and parameters such as groove angles, laser energy input, and powder supply, all with reference to the underlying mechanism of metallurgical bonding in angled areas. Based thereon, a modified effective repair strategy is proposed, using enhanced dual laser power to address bonding issues in the angled areas. Samples repaired using this method exhibit a defect-free groove–deposit interface and a continuous columnar-grained microstructure with abrupt changes in grain size between the repaired area and groove. This microstructural heterogeneity results in an exceptional combination of strength and ductility when compared to the base material and samples repaired using a single laser strategy. The findings of this study provide insights into the optimization of DED strategies for achieving robust metallurgical bonding within grooves, thereby advancing technological maturity in the field of metal repair.

High-strength materials are essential for applications in the structural industry. However, their limited formability restricts broader industrial use. This study proposes a novel methodology to achieve an excellent combination of formability and strength. Surface heterostructuring through laser treatment induces local austenitization on the as-rolled martensitic stainless steel. The resultant bendability was significantly improved, enabling its bending to ∼180° folding while maintaining high tensile strength. Consequently, the present surface heterostructuring suggests achieving the superior combination of strength and formability by tailoring the microstructure specifically to forming. This surface heterostructuring will explore the empty area of the formability-strength relationship.

Heterostructured materials offer great promise as next-generation structural materials, providing excellent combinations of strength and elongation. However, the need for additional equipment for heterostructuring poses challenges for scalability. In this study, we propose a strategy to fabricate heterostructured materials using conventional cold-rolling, eliminating the need for additional pre- or post-treatments. This newly developed method refines only surface grains with shear stress induced by cold-rolling performed at a slight thickness reduction. The cold-rolled samples exhibited improved strengths at the expense of ductility compared to the as-received homogeneous sample, primarily attributed to the heterogeneous strengthening effect and the increased pre-existing dislocation densities. Depending on the cold-rolling process conditions, yield strength increased from 85.6 MPa to 138.6 MPa, and the corresponding elongation loss was 5.5% and 14.8%, respectively. The increase in yield strength of the cold-rolled samples at the same uniform elongation as the as-received sample, calculated using a trend line, was about 51.5 MPa. This proposed strategy has the potential to advance the industrialization of heterostructured materials by enabling large-scale fabrication using conventional processing equipment.

A heterostructuring strategy is an effective approach for abiding problems referred to as the strength-ductility trade-off. However, tailoring the heterostructure is an arduous problem. This work synthesized hierarchically heterogeneity by combining the eutectic high-entropy alloy (EHEA) and medium-entropy alloy powders through novel powder metallurgy-based severe plastic deformation (P-SPD). EHEA forms nano-scaled heterogeneity composed of FCC and B2, and the mixture of powder types forms micro-scale heterogeneity with hard and soft domains. This hierarchically heterogeneous microstructure leads to strong hetero-deformation-induced strengthening, achieving a yield strength of ∼1.5 GPa. The present P-SPD represents the feasibility of heterostructuring, aiding the development of HEAs.

The configurational design of heterostructures has received considerable attention to achieve a superior combination of strength and ductility. Although heterostructuring for enhanced tensile properties has been widely analyzed, studies on the effect of heterogeneity on sheet formability are still insufficient. Sheet metal formability is one of the most crucial factors for determining hetero-materials’ industrial utilization. To broaden the industrial applicability of heterostructured layered materials, investigating the effects of heterogeneity in the layered structure on formability is necessary. This study investigated the stretch formability of aluminum-steel-aluminum clad sheets using the Erichsen cupping test. The three-layered clad sheets showed additional hardening with a slight increase in ductility owing to hetero-deformation-induced hardening because the strain-hardening exponent has a linear relationship with stretchability or necking resistance. After necking, damage evolution owing to severe internal stress concentration led to delamination at the interface. Interestingly, delamination serves as a block to full cracking through the thickness during forming. This study contributes to the industrial applicability of heterogeneous structuring by elucidating the characteristics of heterogeneity and formability.

The advantages of heterostructured materials as structural materials include superior mechanical properties and the ability to tailor the strength-ductility combination via microstructure customization. To maximize heterostructure effects, this study combined direct energy deposition and ultrasonic nanocrystalline surface modification processes to create a CoCrFeMnNi equiatomic high-entropy alloy with multi-layered microstructures. The fabricated CoCrFeMnNi high-entropy alloy has a novel microstructure composed of multiple layers of repetitive microstructures with heterogeneity and demonstrates a remarkable synergetic strengthening effect in comparison to conventional heterogeneous materials. The outstanding mechanical properties derived from various hard and soft layer interfaces, as well as the effects of each layer and interface, were quantitatively analyzed using grain-scale digital image correlation technology. By combining the direct energy deposition and ultrasonic nanocrystalline surface modification processes, this study presents a method for fabricating a new class of heterostructured materials with multi-layered microstructure that exhibit deformation heterogeneity and grain size heterogeneity. The multi-layered microstructure with multiple heterogeneous boundaries breaks the conventional wisdom regarding heterostructured materials having only one or two heterogeneous interfaces.

Macroscopic and microscopic mechanical properties, and damage behaviors of materials should be evaluated through multi-scale investigations to allow for practical industrial applications and promote user safety. Clad metal, a type of heterostructured material, is one of the most promising advanced materials for commercialization. However, heterostructured materials (e.g., clad metals, multi-phase metals, and composite metals) are limited by the possible deterioration of their mechanical properties caused by the strain partitioning at the interface of dissimilar phases when heavily deformed. Therefore, quantitative analysis of multi-scale damage development is necessary for the beneficial future utilization of clad metals as well as structural materials that are currently used in the industry. In this study, the mechanical properties and damage behaviors of Al1050/low-carbon steel/Al1050 clad sheet at multiple scales were quantitatively analyzed using macro-scale digital image correlation (DIC) and micro-scale DIC techniques. The multi-scale investigation results will contribute to the improvement of the reliability of clad materials by quantitatively identifying their mechanical properties and damage behaviors on various scales, which will be beneficial for industrial applications.

Background: Treatment adherence is a vital aspect in the management of chronic diseases like leprosy; however, most studies on treatment adherence focus on patients. This study aims to examine the perceptions of healthcare providers on factors that can promote or prevent patients from adhering to treatment. Methods: We conducted three focus group discussions (FGDs) with healthcare providers who have at least one year experience in managing leprosy in three large leprosy case-holding hospitals in Metro Manila, Philippines. We audio-recorded, transcribed, translated the FGD proceedings, and analyzed the transcripts thematically to identify patient-intrinsic and patient-extrinsic enablers and barriers to treatment adherence of leprosy patients. Results: Patient-intrinsic motivators to complete treatment include innate desire to be cured, fear of infecting family and friends, fear of disability, good knowledge about the disease, need for medical clearance to be considered fit to work, and experiencing leprosy reactions. Patient-extrinsic motivators to complete treatment include free treatment, immediate and sufficient counselling, flexibility in treatment, follow-up and motivation of healthcare workers, and presence of Hansen’s Club and support groups. Patient-intrinsic barriers to good treatment adherence include distance between residence and hospital, financial and opportunity costs, adverse drug reactions, misconceptions about being cured, disabilities and presence of leprosy reactions, stubbornness and/or laziness, and undergoing clinical depression. Patient-extrinsic barriers to good treatment adherence include poor availability of MDT, transfer to other leprosy treatment facilities without informing current facility, and stigma. Conclusion: Healthcare providers perceive that patient-intrinsic and patient-extrinsic factors influence the treatment adherence of leprosy patients through different mechanisms. We highlight the role of healthcare provider attitudes, stigma, and support groups in promoting treatment adherence.

Purpose: The purpose of this study was to assess the preferences of pediatric dentists in Canada and the United States about clinical decision-making related to the placement of direct restorative materials. Methods: A cross-sectional web-based survey was used to collect the preference of all active pediatric members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth in healthy, developmentally delayed (DD), and medically compromised (MC) children. Bivariate and multivariate analyses were performed to determine the association between the predictor variables and all materials at two-tailed P<0.05. Results: A response rate of 193 percent (N equals 762) was achieved. For DD patients, stainless steel crowns were the most preferred material for primary teeth, and a similar frequency of amalgam and composite were preferred for permanent teeth. Amalgam usage was increasingly preferred in the DD population versus healthy and MC patients. Conclusions: Composite resin was the most preferred restoration for Class I, II, and V restorations in primary and permanent teeth in healthy and medically compromised individuals. In DD individuals, stainless steel crowns and amalgam were preferred more frequently. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess usage, indications, and contraindications for rubber dam isolation (RDI) by pediatric dentists in Canada and the United States. Methods: A cross-sectional, web-based, self-administered survey was utilized to collect the opinions of all active pediatric dentist members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth (N equals 4,648; 19.3 percent response rate). The main survey also included a domain on the RDI utilization and its perceived indications and contraindications. Bivariate and multivariate analyses for RDI usage and its predictor were performed at two-tailed P<0.05. Results: A response rate of 19.3 percent was obtained. Most participants (72.5 percent) reported using RDI "all the time." The material with the lowest usage of RDI was composite (82 percent) in the primary dentition and stainless steel crown (80.7 percent) in the permanent dentition. The three top-noted reasons for not using RDI included decreased trauma to the patient (66.2 percent), being able to prevent soft tissue from interfering without using RDI (55.9 percent), and decreased time for appointments (45.6 percent). Conclusion: Rubber dam isolation was valued by the majority of pediatric dentists when restoring primary and permanent dentition for all materials. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess Canadian and American pediatric dentists' preferred level of participation in clinical decision-making. Methods: A web-based survey was used to collect the opinions of all active Royal College of Dentists of Canada members and American Academy of Pediatric Dentistry members on the use of direct restorative materials in posterior teeth (N equals 4,648; 19.3 percent response rote). The main survey also included a domain to elicit participants! preferred role in clinical decision-making, ranging from an active role (the dentist takes the primary role in decision-making while considering patients/caregivers opinions) to a passive role (the dentist prefers to have the patient guide the decision-making). Bivariate and multivariate analyses for the preferred role and its predictor were performed (two-tailed P<0.05). Results: Fifty-eight percent of participants preferred an active role. The passive role was chosen three times more by those who worked in a hospital-based setting (odds ratio [OR] equals 3.15, 95 percent confidence interval [Cl] equals 1.13 to 8.79) or a university-based setting versus a combined setting (OR equals 3.61, 95 percent Cl equals 1.11 to 11.77). Conclusion: The majority of participants preferred an active role in decision-making, a role that may not be consistent with a patient-centered practice that emphasizes patient autonomy in decision- making. [ABSTRACT FROM AUTHOR]

Background: Poor treatment adherence among leprosy patients contribute to relapse, development of antimicrobial resistance, and the eventual plateauing of the prevalence and incidence of leprosy not just in the Philippines, but also worldwide. For this reason, we aimed to identify the patterns and determinants affecting treatment completion and default among multibacillary leprosy patients. Methods: We conducted a retrospective cohort study involving three large hospitals in Metro Manila, Philippines. Patients who started the World Health Organization - Multiple Drug Therapy for multibacillary leprosy between January 1, 2007 and December 31, 2013 were included in the study. Selected socio-demographic and clinical data were abstracted from the patient treatment records. Survival analysis and proportional hazards regression were used to analyze the data. Results: Records of 1,034 patients with a total follow-up time of 12,287 person-months were included in the analysis. Most patients were male, younger than 45 years old, had an initial bacterial index between 1 and 4, and were residents of Metro Manila. Less than 20% had their treatment duration extended to more than 12 months. Treatment adherence of the patients was poor with less than 60% completing treatment. Most patients complete their treatment within 12 months, but treatment duration may be extended for up to three years. Patients who default from treatment usually do so a few months after initiating it. After adjusting for other variables, hospital, initial bacterial index, and non-extended treatment duration were associated with treatment completion. These factors, in addition to age, were also found to be associated with treatment default. Conclusion: This study provides quantitative evidence that there might be marked variations in how doctors in particular hospitals manage their patients, and these findings underscore the need to revisit and re-evaluate clinical practice guidelines to improve treatment outcomes and adherence.

Buddhist tantric practitioners embrace the liminal status of the human body to manifest divine identity. In piercing to the pith of human embodiment, the tantric practitioner reconfigures the shape and contours of his/her reality. This article investigates the evolution of one particular technique for piercing to the pith of the body on Tibetan soil, a ritual practice known as body mandala [lus dkyil Skt. deha-maṇḍala]. In particular, it uncovers a significant shift of emphasis in the application of the Guhyasamāja body mandala practice initiated by champions of the emerging Gandenpa [Dga’ ldan pa] or Gelukpa [Dge lugs pa] tradition of Tibetan Buddhism, Tsongkhapa (1357–1419) and Mkhas grub rje (1385–1438). This article reveals some of the radical implications of ritual exegesis, ranging from the socioreligious aspects of securing prestige for a tradition to the ultimate soteriological goals of modifying the boundaries between life and death and ordinary and enlightened embodiment.

Introduction: The aim of this 11-year retrospective multicentric study is to evaluate the policy of 14 maxillofacial surgery divisions in terms of titanium plate removal from paediatric patients who had undergone open reduction and internal fixation (ORIF) to treat maxillofacial fractures., Material and Methods: Patients ≤ 16 years undergoing surgical treatment for fractures of middle and lower third of the face between January 2011 and December 2022, with a minimum follow-up of 6 months, were included. Age (group A: ≤ 6 years, B: 7-12 years, C: 13-16 years), sex, fracture location and type, surgical approach, number, and location of positioned and removed plates, timing and indications for removal were recorded., Results: 191/383 (50 %) patients (median age, 10 years; M:F ratio 2.1:1) underwent removal of 319/708 (45 %) plates. Maxillary dentoalveolar process (91 %), angle/ramus (63 %) and mandibular body (61 %) had a significantly higher removal rate than other fracture sites (p < 0.001). A significant decreasing trend in removal with increasing age was observed, from 83 % in Group A to 24 % in Group C (p < 0.001). On the total of positioned plates, 11 % were removed for symptomatic reasons (5 % infections, 6 % discomfort/pain) and 34 % for other reasons (28 % scheduled removal)., Discussion: This multicentric study showed that plate removal was not performed routinely in the paediatric population. The incidence and causes of symptomatic plates removal were consistent with the literature, while the plate removal rate from asymptomatic patients was lower. A correlation was found between increasing age and a reduction in the frequency of plate removal procedures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background : Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective : This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods : A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results : 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment-stand-alone maxillomandibular fixation (MMF)-in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments ( p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions : Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry.

Introduction: Trapdoor fractures of the orbital floor occur almost exclusively in the paediatric population. Despite being widely discussed in the literature, their management remains controversial. The objective of this retrospective study was to analyse the surgical experiences on paediatric trapdoor fractures in the maxillofacial centres participating in the WORMAT project., Materials and Methods: 14 centres collected data for patients aged ≤16 years operated between January 2011 and December 2022. The demographic, cause and type of fracture, timing from injury to surgery, surgical approach, type of floor repair and outcomes were recorded. Diplopia, surgical wound infection, hardware loosening and dysesthesia in the infraorbital nerve area were recorded at follow-up., Results: 43 patients were included: 25 children (0-12 y) and 18 adolescents (13-16 y) (mean age, 11.1 years). Surgical treatment was performed within 24 h in 51 % of the patients, within 24-72 h in 33 %, and beyond 72 h in the remaining. The orbital floor was repaired with a resorbable implant/membrane in 63 % of the patients, open reduction without an implant in 30 %, a titanium mesh implant in 3 adolescent patients. At follow-up (mean 16.3 months), 14 patients had residual diplopia in the upper fields, only two of these resolved within 6 months., Discussion: A tendency toward an increased incidence of postoperative diplopia with longer intervals between trauma and surgery was observed. This study showed different choices regarding the material placed on the floor, with a preference for open reduction without implants in children, compared to the use of resorbable implants or membranes in adolescents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

In view of the increasing age of cardiac surgery patients, questions arise about the expected postoperative quality of life and the hoped-for prolonged life expectancy. Little is known so far about how these, respectively, are weighted by the patients concerned. This study aims to obtain information on the patients' preferences. Between 2015 and 2017, data were analyzed from 1349 consecutive patients undergoing cardiac surgery at seven heart centers in Germany. Baseline data regarding the patient's situation as well as a questionnaire regarding quality of life versus lifespan were taken preoperatively. Patients were divided by age into four groups: below 60, 60-70, 70-80, and above 80 years. As a result, when asked to decide between quality of life and length of life, about 60% of the male patients opted for quality of life, independent of their age. On the other hand, female patients' preference for quality of life increased significantly with age, from 51% in the group below sixty to 76% in the group above eighty years. This finding suggests that female patients adapt their preferences with age, whereas male patients do not. This should impact further the treatment decisions of elderly patients in cardiac surgery within a shared decision-making process.

Design: A single-centre retrospective case-control study from 2012-2020 comparing the prevalence of apical periodontitis (AP) in patients with autoimmune disorders (AD) against a control group of those without. The different medication groups commonly used for treatment of AD were included for comparison., Case/control Selection: This study utilised patients' electronic records. These were anonymous. Patient sociodemographic variables were collected and compared. Two cases were removed from selection as they were being treated with dual biologic therapy., Data Analysis: Both the control group and AP group contained 89 patients. Various additional variables were considered, such as DMFT and a logistical regression analysis was used to correlate between AD and AP., Results: For the autoimmune disease conditions within this study, the authors found a higher prevalence of apical periodontitis than in the control group, 89.9% versus 74.2%, respectively (p = 0.015). Furthermore, those taking conventional disease-modifying drugs such as methotrexate had a lower prevalence than those on biologics. These results were of statistical significance., Conclusions: Individuals with autoimmune disorders may have increased prevalence of apical periodontitis irrespective of their treatment with biologics or not. A DMFT score can be used to predict the occurrence of AP., (© 2023. The Author(s), under exclusive licence to British Dental Association.)

A preload challenge (PC) is a clinical maneuver that, first, increases the cardiac filling (i.e., preload) and, second, calculates the change in cardiac output. Fundamentally, a PC is a bedside approach for testing the Frank-Starling-Sarnoff (i.e., "cardiac function") curve. Normally, this curve has a steep slope such that a small change in the cardiac preload generates a large change in the stroke volume (SV) or cardiac output. However, in various disease states, the slope of this relationship flattens such that increasing the volume into the heart leads to little rise in the SV. In this pathological scenario, additional cardiac preload (e.g., intravenous fluid) is unlikely to be physiologically effective and could lead to harm if organ congestion evolves. Therefore, inferring both the cardiac preload and output is clinically useful as it may guide intravenous (IV) fluid resuscitation. Accordingly, the goal of this protocol is to describe a method for contemporaneously tracking the surrogates of cardiac preload and output using a novel, wireless, wearable ultrasound during a well-validated preload challenge.

Background/aim: The World Oral Maxillofacial Trauma (WORMAT) project was performed to analyze the causes and characteristics of maxillofacial fractures managed in 14 maxillofacial surgery divisions over a 1-year period., Methods: The following data were collected: age, sex, cause and mechanism of maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score (FISS), associated injury, day of trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software., Results: Between 30 September 2019 and 4 October 2020, 2,387 patients (1,825 males and 562 females [ratio 3.2:1], 47.6% aged 20-39 years [mean age 37.2 years, median 33.0 years]) were hospitalised. The main cause of maxillofacial fracture was road traffic accidents (RTA), which were statistically associated with male adults as like as assault, sport, and work (p<0,05). Half of the fractures involved the middle third of the face, statistically associated with fall and assault (p<0.05). Trauma in multiple locations was significantly associated with longer hospital stay (p<0.05). The mean length of hospitalization was 3.9 days (95% Confidence Interval 3.7-4.2)., Conclusions: This prospective, multicenter epidemiological study confirmed that young adult males were the ones most commonly affected by maxillofacial fracture. RTAs and assaults are statistically associated with the adult population, while falls are associated with females and older population., (Copyright © 2022. Published by Elsevier Masson SAS.)

Abstract: The purpose of this prospective multicenter study was to analyze the epidemiology, patterns, and management of maxillofacial fractures due to road traffic accidents (RTAs) worldwide.Between Monday September 30, 2019 and Sunday October 4, 2020,1066 patients with RTAs related fractures were admitted to 14 maxillofacial surgery departments. The following data were analyzed: age, gender, mechanism of injury, alcohol or drug abuse at the time of trauma, maxillofacial fracture site, facial injury severity scale (FISS) score, associated injuries, day and month of trauma, time of treatment, type of treatment and length of hospital stay. Data were analyzed using bivaried and multivaried statistical analysis.Eight hundred seventy patients were male, and 196 were female. The most common mechanism of injury was motorcycle accidents (48%). More than half of the patients had fractures of the middle third of the maxillofacial skeleton. In total, 59% of the study sample underwent open reduction internal fixation. The median facial injury severity scale (3 points) and the medial hospital stay (3 days) were significantly lower in patients with seatbelts and helmet (P  < 0.001).This first prospective, multicenter epidemiological study shows that motorcycle accidents are the leading cause of RTAs related fractures, mostly in young males. Particularly in Australia and Europe, the incidence of RTAs was significantly lower. Moreover, this study found that the severity of maxillofacial lesions was significantly higher in patients without safety devices, with consequent longer hospital stay demonstrating the efficacy of road safety policies in preventing maxillofacial injury., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Background/aims: The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world., Methods: The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non-parametric and association tests, as well as linear regression., Results: Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2-7.2). Statistical analysis showed that women were more involved in fall-related trauma compared with males (p < .001). It was also shown that road traffic accidents cause more fractures in the lower third (p < .001) and in the middle third-lower third complex compared with upper third (p < .001)., Conclusions: Maxillofacial fractures in the elderly were more frequent in European and Australian centres and affected men slightly more than women. Falls were the leading cause of fractures, especially among women. The middle third of the face was most often affected, and conservative treatment was the most common choice for the management of such patients., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background/aims: Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1-year period., Methods: The following data were collected: age (preschool [0-6 years], school age [7-12 years], and adolescent [13-18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software., Results: Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0-18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001)., Conclusion: The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0-6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood., (© 2022 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Data sources The review carried out electronic searches using several online databases through November 2018, namely PubMed, Virtual Health Library, Cochrane Library and Scopus. Terms searched for on these databases included third molar, flap and variations thereof. A grey literature search was also conducted.Study selection In total, 2,455 articles were identified,1,449 being duplicates. Additionally, 1,006 articles remained for assessment which, with clear exclusion criteria listed, was reduced to 20. From the 20 incorporated into the review, 18 articles were utilised for meta-analysis. Three of the researchers were involved in assessing the articles after research management software was used to remove the aforementioned duplicates. A Cohen's kappa index was calculated to confirm inter-rater consistency using 10% of the articles.Data extraction and synthesis Data extraction followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance.Results From their systematic review and meta-analyses, the authors found that flap design had no effect on common post-operative complications including pain, trismus, dehiscence, or osteitis. The triangular flap did, however, have greater post-operative ecchymosis but reduced periodontal probing depth on day seven when compared to the envelope flap in mandibular third molar surgeries.Conclusions Third molar surgery is carried out across all facets of dentistry, including general and specialised. Further studies must be carried out that look specifically at these variables utilising randomised controlled trials so a consensus can be achieved across the profession of which flap is of superior design., (© 2021. British Dental Association.)

This study represents one of the few exploring the effectiveness of an integrated HIV nurse navigation program on engagement and virologic outcomes. A navigator provided individualized care management (eg, pillbox renewals), intensive outreach, and collaboration with existing support systems (eg, families, community programs). Clinical data from the Veterans Affairs (VA) Medical Center site of a longitudinal, observational study of HIV in the District of Columbia (DC) cohort were used for comparison (N = 706). Navigation patients (n = 84) were less likely to have permanent housing, and more likely to be disabled, have detectable viral load, comorbid depressive, and substance use disorders. Navigation patients showed improvements in clinic visits (doubled), rate of medication renewal (40.91% to 80.61%), CD4 count and CD4%, and viral rates of Veterans with <200 copies/mL increased from 47.6% to 69.0% after one year. Integration of nurse navigation into a HIV primary care setting shows promise in improving engagement and virologic suppression in a high-risk population.

Phosphagen kinases (PKs) are well-studied enzymes involved in energy homeostasis in a wide range of animal, protozoan, and even some bacterial species. Recent genome efforts have allowed comparative work on the PKs to extend beyond the biochemistry of individual proteins to the comparative cellular physiology and examining of the role of all PK family members in an organism. The sequencing of the Caenorhabditis elegans genome and availability of sophisticated genetic tools within that system affords the opportunity to conduct a detailed physiological analysis of the PKs from a well known invertebrate for comparison with the extensive work conducted on vertebrate systems. As a first step in this effort we have carried out a detailed molecular genetic and biochemical characterization of the PKs in C. elegans. Our results reveal that C. elegans has five PK genes encoding arginine kinases that range in catalytic efficiency (kcat/KM(Arg)) from (3.1±0.6)×10(4) to (9±4)×10(5) M(-1) s(-1). This range is generally within the range seen for arginine kinases from a variety of species. Our molecular genetic and phylogenetic analysis reveals that the gene family has undergone extensive intron loss and gain within the suborder Rhabditina. In addition, within C. elegans we find evidence of gene duplication and loss. The analysis described here for the C. elegans AKs represents one of the most complete biochemical and molecular genetic analysis of a PK family within a genetically tractable invertebrate system and opens up the possibility of conducting detailed physiological comparisons with vertebrate systems using the sophisticated tools available with this model invertebrate system., (Copyright © 2015 Elsevier Inc. All rights reserved.)