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Digital denture design requires anatomic information, an accurate maxillomandibular relationship, and parameters to guide tooth arrangement. Capturing all these data by intraoral scanning makes their immediate digitization, integration, and transfer to the computer-aided design workflow possible, which can be started without an additional procedure. The presented technique describes the digital workflow to automatically align intraoral scans of completely or partially edentulous maxillary and mandibular arches according to the maxillomandibular relationships registered in digitally designed occlusion rims adapted on the patient. [ABSTRACT FROM AUTHOR]

Using intraoral scans for removable dentures has been questioned because of a suggested lack of accuracy. However, data regarding the accuracy of digital intraoral complete-arch scans are sparse, present some methodological issues, and mostly come from in vitro studies on dentate casts, which are very different from edentulous arches. The purpose of this clinical study was to evaluate 3D differences between intraoral scans (IOS) and conventional impressions of edentulous arches by means of digital analysis. Ten maxillary and 10 mandibular edentulous arches were investigated. For each of them, IOS was performed, and a custom tray was digitally designed based on these scans. Trays were built by using a 3D printer and used to make a conventional impression with a polysulfide impression material. The conventional impression was scanned immediately by using the same intraoral scanner and by the same dentist. Standard tessellation language (STL) files of IOS and the scans of the corresponding conventional impressions (CIS) were superimposed with a 2-phase best-fit alignment in a reverse engineering software program. The corresponding full-scan, 3D mean distance was measured. This procedure was repeated after trimming the IOS and CIS to eliminate peripheral areas not present in both files, as well as nonmatching areas caused by practical aspects related to obtaining the IOS (mobile tissue stretching) and the conventional impressions (mobile tissue compression and folding at the margin of impression), which could have impaired alignment and, consequently, measurement accuracy. The mean distance between the full and trimmed IOS and CIS was statistically investigated, and subgroup analysis was performed for the maxillary and mandibular arches. The statistical significance of the differences between the 2 impression methods was also investigated. The full-scan mean distance between the IOS and CIS (−0.19 ±0.18 mm) was significantly different from that of the trimmed scan mean distance (−0.02 ±0.05 mm), with no significant differences for maxillary and mandibular arches. The differences between the IOS and CIS were statistically significant for full scans; they were not significant for trimmed scans, except for the maxillary subgroup. The mean distance between the IOS and CIS may be significantly different if they are not properly superimposed. The mean distance (−0.02 ±0.05 mm) between the IOS and CIS falls within the range of mucosa resilience. Thus, 3D differences between the IOS and CIS can be attributed to the different physics behind the 2 impression methods and not to defects in accuracy of one method compared with the other. The size of the measured difference between the 2 impression methods was not statistically significant and was not clinically significant for removable denture fabrication. [ABSTRACT FROM AUTHOR]

Limited evidence is available for the marginal fit of multiunit fixed dental prostheses (MFDPs) fabricated with digital technologies compared with those fabricated with conventional techniques. The purpose of this systematic review and meta-analysis was to answer the following question: Does digital workflow for the fabrication of tooth-supported or implant-supported MFDPs provide better marginal fit than the conventional workflow? PubMed, SCOPUS, EBSCO, and Web of Science databases were searched for controlled in vitro studies addressing direct comparison of the fit of MFDPs produced with digital or conventional workflows and excluding studies addressing interim restorations, MFDPs on mixed abutments (teeth and implants), or studies in which reproduction of the basic master cast was performed in 1 group. Vertical and horizontal marginal fit were the primary outcomes; meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with subgroup analysis for tooth- or implant-supported MFDPs. Four studies published between 2011 and 2015 met the inclusion criteria and were included in the review. They investigated 3-unit partial fixed dental prostheses, exhibited a high degree of heterogeneity, and reported data only regarding vertical marginal fit. MFDPs fabricated with digital techniques presented a nominally higher vertical marginal discrepancy than those fabricated with the conventional technique, but the mean difference (MD) (19.8 μm, 95% confidence interval [CI]: −12.1; 51.7) has no statistical significance. The same is also applicable to subgroup analysis for a tooth-supported (MD=45.8 μm, 95% CI: −45.4; 137.0) or implant-supported (MD=14.7 μm, 95% CI: −38.6; 68.1) MFDP. Digital technologies offer a reliable alternative to conventional techniques for the fabrication of tooth- or implant-supported 3-unit fixed partial dentures; additional studies with up-to-date technologies and for prostheses with more than 3 units are recommended to provide stronger evidence. [ABSTRACT FROM AUTHOR]

Abstract Objective Islets from the same pancreas show remarkable variability in glucose sensitivity. While mitochondrial respiration is essential for glucose-stimulated insulin secretion, little is known regarding heterogeneity in mitochondrial function at the individual islet level. This is due in part to a lack of high-throughput and non-invasive methods for detecting single islet function. Methods We have developed a novel non-invasive, high-throughput methodology capable of assessing mitochondrial respiration in large-sized individual islets using the XF96 analyzer (Agilent Technologies). Results By increasing measurement sensitivity, we have reduced the minimal size of mouse and human islets needed to assess mitochondrial respiration to single large islets of >35,000 μm2 area (∼210 μm diameter). In addition, we have measured heterogeneous glucose-stimulated mitochondrial respiration among individual human and mouse islets from the same pancreas, allowing population analyses of islet mitochondrial function for the first time. Conclusions We have developed a novel methodology capable of analyzing mitochondrial function in large-sized individual islets. By highlighting islet functional heterogeneity, we hope this methodology can significantly advance islet research. Highlights • Islets from the same pancreas show remarkable variability in glucose sensitivity. • Little is known about heterogeneity in mitochondrial respiration in individual islets. • We developed a novel high-throughput method to measure individual islet function. • Individual islets within a population show heterogeneous glucose-stimulated respiration. • Our method may advance islet research by enabling populational metabolic profiling. [ABSTRACT FROM AUTHOR]

Aims Sinonasal symptoms cause significant productivity losses in patients with chronic rhinosinusitis (CRS). Patient-perceived CRS symptom control is a longitudinal measure of CRS symptomatology and is directly associated with general health-related quality of life (QOL) in patients with CRS. The aim of this study was to better understand the relationship between symptom control and productivity loss in CRS. Materials and methods Prospective cross-sectional cohort study of 200 patients with CRS. Patients categorized their CRS symptom control as “Not at all”, “A little”, “Somewhat”, “Very”, and “Completely”. Lost productivity was assessed by determining the number of work and/or school days missed in the last 3 months due to CRS symptoms. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22). Associations were sought between lost productivity and patient-perceived CRS symptom control. Objective To determine the association between patient-perceived longitudinal symptom control and productivity in patients with CRS. Results A total of 200 participants (48% male, 52% female), with a mean age of 52 years (Standard Deviation [SD]: 16) were enrolled. The mean SNOT-22 score of participants was 33.5 (SD: 22.4). Participants missed a mean of 3 days (SD: 10) of work or school due to CRS. CRS symptom control classified as “not at all” was associated with 11 days of lost productivity due to CRS on univariate analysis (β = 11.16, 95% CI: 5.39–16.94, P < 0.001) and 8 days of lost productivity on multivariate analysis (β = 8.02, 95% CI: 1.92–14.13, P = 0.011). None of the other categories of patient-reported CRS symptom control were associated with lost productivity due to CRS. Conclusions Patient-perceived control of CRS symptoms, an important metric previously shown to be significantly associated with QOL in CRS patients, is independently associated with lost productivity. These results motivate longitudinal studies to determine if improvement of CRS symptom control may reduce losses in productivity. [ABSTRACT FROM AUTHOR]

Summary: Objective: Temporomandibular disorders (TMD) is a term reflecting chronic, painful, craniofacial conditions usually of unclear etiology with impaired jaw function. The effect of osteopathic manual therapy (OMT) in patients with TMD is largely unknown, and its use in such patients is controversial. Nevertheless, empiric evidence suggests that OMT might be effective in alleviating symptoms. A randomized controlled clinical trial of efficacy was performed to test this hypothesis. Methods: We performed a randomized, controlled trial that involved adult patients who had TMD. Patients were randomly divided into two groups: an OMT group (25 patients, 12 males and 13 females, age 40.6±11.03) and a conventional conservative therapy (CCT) group (25 patients, 10 males and 15 females, age 38.4±15.33). At the first visit (T0), at the end of treatment (after six months, T1) and two months after the end of treatment (T2), all patients were subjected to clinical evaluation. Assessments were performed by subjective pain intensity (visual analogue pain scale, VAS), clinical evaluation (Temporomandibular index) and measurements of the range of maximal mouth opening and lateral movement of the head around its axis. Results: Patients in both groups improved during the six months. The OMT group required significantly less medication (non-steroidal medication and muscle relaxants) (P <0.001). Conclusions: The two therapeutic modalities had similar clinical results in patients with TMD, even if the use of medication was greater in CCT group. Our findings suggest that OMT is a valid option for the treatment of TMD. [Copyright &y& Elsevier]

Abstract: Background: Coeliac disease is still under-diagnosed as a consequence of poor physician awareness of the clinical spectrum of the disease. We evaluated the feasibility and the cost-effectiveness of a case-finding approach for early identification of cases, carried out by primary care practitioners. Methods: We developed a case-finding strategy based on testing for anti-tissue transglutaminase IgA antibodies in subjects showing predefined signs and symptoms or belonging to at-risk groups. Results: Sixty-nine primary care doctors and 60 primary care paediatricians agreed to participate. One thousand forty-one adults and 447 children were selected for anti-tissue transglutaminase testing during the year of the study (2001). Thirty-one (2.08%, 19 adults and 12 children) were ultimately diagnosed as coeliac patients. While no cases of coeliac disease had been diagnosed by the participating doctors in the previous year, 29 subjects were diagnosed as coeliacs in the year after the completion of the study (2002). The prevalence of confirmed coeliac disease in the population under study increased from 1:1506 to 1:1073 in adults and from 1:827 to 1:687 in children from year 2000 to 2001. When cases diagnosed in 2002 are included, the prevalence is 1:832 and 1:602, respectively. We calculated a cost of 923.25 euros for each new case diagnosed. Conclusions: Case-finding is a feasible and successful strategy for detecting undiagnosed coeliac patients and has the important added value of increasing the awareness of the disease among primary care physicians; it represents a cost-effective alternative to population screening for reducing the burden of undiagnosed coeliac disease. [Copyright &y& Elsevier]

Background: This study was aimed at evaluating the determinants of postoperative dialysis-requiring acute renal failure and at identifying eventual correlations between the different etiologic mechanisms and postoperative prognosis. Methods: We evaluated the preoperative and intraoperative features of the 69 out of 6,542 consecutive cardiac surgery patients who developed postoperative dialysis-requiring acute renal failure at our Institution during a 10-year period. Results: Age, valvular and aortic surgery, hypertension, extracardiac vasculopathy, timing of surgery, cardiopulmonary bypass time, and preoperative creatinine level greater than 2.0 mg/dL were identified as predictors by multivariate analysis. In a second analysis, patients were divided in two groups according to the preoperative creatinine level: group A (preoperative creatinine 2.0 mg/dL or less; 38 cases) and group B (preoperative creatinine 2.1 mg/dL or more; 31 cases). The two groups significantly differed in preoperative and intraoperative characteristics and in postoperative outcome: group A patients were younger, had a lower incidence of cardiac and vascular risk factors and comorbidities, were mainly operated on urgent or emergent basis for valvular or aortic pathologies, had longer cardiopulmonary bypass and cross-clamp time, and worse in-hospital outcome but higher midterm survival. Group B patients were older, had a higher prevalence of comorbidities, required more often in-hospital or after-discharge dialysis, had lower in-hospital mortality, but reduced midterm survival. Conclusions: Postoperative dialysis-requiring acute renal failure can be the result of two different pathophysiological pathways: complicated perioperative course due to urgent-emergent surgery or main intraoperative technical complications in patients with preoperative normal renal function and uncomplicated perioperative course associated with reduced preoperative kidney function. The two patient groups significantly differ in baseline preoperative features, as well as in in-hospital and in midterm outcome. [Copyright &y& Elsevier]

Summary Long-chain fatty acid (LCFA) oxidation has been shown to play an important role in interleukin-4 (IL-4)-mediated macrophage polarization (M(IL-4)). However, many of these conclusions are based on the inhibition of carnitine palmitoyltransferase-1 with high concentrations of etomoxir that far exceed what is required to inhibit enzyme activity (EC 90 < 3 μM). We employ genetic and pharmacologic models to demonstrate that LCFA oxidation is largely dispensable for IL-4-driven polarization. Unexpectedly, high concentrations of etomoxir retained the ability to disrupt M(IL-4) polarization in the absence of Cpt1a or Cpt2 expression. Although excess etomoxir inhibits the adenine nucleotide translocase, oxidative phosphorylation is surprisingly dispensable for M(IL-4). Instead, the block in polarization was traced to depletion of intracellular free coenzyme A (CoA), likely resulting from conversion of the pro-drug etomoxir into active etomoxiryl CoA. These studies help explain the effect(s) of excess etomoxir on immune cells and reveal an unappreciated role for CoA metabolism in macrophage polarization. [ABSTRACT FROM AUTHOR]

Objective Postoperative atrial fibrillation is a major cause of morbidity and mortality for stroke after cardiac surgery. Both systemic inflammation and oxidative stress play a role in the initiation of postoperative atrial fibrillation after cardiac surgery. The possible association between long-term intake of antioxidant-rich foods and postoperative atrial fibrillation incidence was examined in patients undergoing cardiac surgery. Methods A total of 217 consecutive patients (74% were men; median age, 68.4 years) undergoing cardiac surgery, mainly coronary artery bypass grafting and valve replacement or repair, were recruited from January 2010 to September 2012. Total antioxidant capacity was measured in foods by the Trolox equivalent antioxidant capacity assay. The European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary total antioxidant capacity assessment. The association among tertiles of dietary total antioxidant capacity and postoperative atrial fibrillation incidence was assessed using multivariable logistic analysis. Results The overall incidence of total arrhythmias and postoperative atrial fibrillation was 42.4% and 38.2%, respectively. In multivariable analysis, after adjustment for age, gender, use of hypoglycemic drugs, physical activity, education, previous diagnosis of atrial fibrillation, and total energy intake, patients in the highest tertile of dietary total antioxidant capacity had a lower risk of postoperative atrial fibrillation than patients in the 2 lowest tertiles (odds ratio, 0.46; 95% confidence interval, 0.22-0.95; P = .048). A restricted cubic spline transformation confirmed the nonlinear relationship between total antioxidant capacity (in continuous scale) and postoperative atrial fibrillation ( P = .023). When considering only coronary artery bypass grafting, valve replacement/repair, and combined surgeries, the protective effect on postoperative atrial fibrillation of a diet rich in antioxidants was confirmed. Conclusions Long-term consumption of antioxidant-rich foods is associated with a reduced incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Introduction: Ocular convergence defects have been confirmed in adults with temporomandibular joint (TMJ) dysfunction, but few studies of the relationship of the oculomotor apparatus to TMJ disc displacement have been reported. The purpose of this study was to examine the impact of disc displacement on the oculomotor capacity of the eyes in adults. Methods: Fifty symptomatic patients with bilateral TMJ disc displacement (13 men, 37 women; mean age, 28.84 ± 8.22 years; range, 18-40 years) were compared with the same number of asymptomatic volunteers with normal disc position (14 men, 36 women; mean age, 29.96 ± 5.04 years; range, 18-37 years). All subjects underwent standardized clinical examinations, bilateral TMJ magnetic resonance imaging, and sensorial and motor orthoptic tests by an orthoptist. Results: Subjects with TMJ disc displacement had alterations in binocular function, including reductions in convergence (P <0.023) and positive fusional vergence (break point [P <0.046] and recovery point [P <0.045]) compared with those with normal disc positions. Conclusions: Significant alternations in binocular function were seen in patients with TMJ disc displacement compared with healthy control subjects. [Copyright &y& Elsevier]