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Background: Supraglottic airway devices perform more poorly and have lower oropharyngeal leak pressure in edentulous patients than in patients with teeth. The Ambu Aura Gain is a newer second generation supraglottic airway device., Objective: This randomized clinical trial assessed the oropharyngeal leak pressure in edentulous patients using the Ambu Aura Gain with a gastric tube for insertion guidance and without insertion guidance., Material and Methods: Patients with ASA (American Society of Anesthesiology) physical status I-III were recruited. Primary outcome was oropharyngeal leak pressure after insertion. Secondary outcome parameters were oropharyngeal leak pressure 15 min and 30 min after insertion, insertion time, insertion attempts and glottis view through flexible fiberscope., Results: In this study 72 patients aged between 51 and 90 years (mean 73 years) were randomly allocated to the "with guidance" (n = 36) or the "without guidance" group (n = 36). Mean (SD) oropharyngeal leak pressure in "with guidance" and "without guidance" group was 24 cm H 2 O and 24 cm H 2 O (ns), respectively. A difference was found in mean insertion time with guidance versus without guidance group 52 s (45 s) vs. 26 s (15 s) (p < 0.001). No difference was found in any of the other secondary outcome parameters., Conclusion: A guided insertion technique does not improve oropharyngeal leak pressure of the Ambu AuraGain™ in edentulous patients. As the only difference is an increase in insertion time this technique is of no benefit for this population., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Antepartum stillbirth, i.e., intrauterine fetal death (IUFD) above 24 weeks of gestation, occurs with a prevalence of 2.4-3.1 per 1000 live births in Central Europe. In order to ensure highest standards of treatment and identify causative and associated (risk) factors for fetal death, evidence-based guidelines on clinical practice in such events are recommended. Owing to a lack of a national guideline on maternal care and investigations following stillbirth, we, hereby, sought to assess the use of institutional guidelines and clinical practice after IUFD in Austrian maternity units., Methods: A national survey with a paper-based 12-item questionnaire covering demographic variables, local facilities and practice, obstetrical care and routine post-mortem work-up following IUFD was performed among all Austrian secondary and tertiary referral hospitals with maternity units (n = 75) between January and July 2019. Statistical tests were conducted using Chi 2 and Fisher's Exact test, respectively. Univariate logistic regression analyses were performed to calculate odds ratio (OR) with a 95% confidence interval (CI)., Results: 46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) have implemented an institutional guideline. The three most common investigations always conducted following stillbirth are placental histology (20.9%), fetal autopsy (13.1%) and maternal antibody screen (11.5%). Availability of an institutional guideline was not significantly associated with type of hospital, on-site pathology department, or institutional annual live and stillbirth rates. Post-mortem consultations only in cases of abnormal investigations following stillbirth were associated with lower odds for presence of such guideline [OR 0.133 (95% CI 0.018-0.978); p = 0.047]. 26 (56.5%) departments consider a national guideline necessary., Conclusions: Less than half of the surveyed maternity units have implemented an institutional guideline on maternal care and investigations following antepartum stillbirth, independent of annual live and stillbirth rate or type of referral centre., (© 2021. The Author(s).)

Objectives: To evaluate the precision of aligner (Invisalign®) treatment with the current material (SmartTrack®) in achieving expansion or contraction of the maxilla and occlusal contacts as simulated in the proprietary planning software (ClinCheck®, CC)., Materials and Methods: Thirty patients thus treated were retrospectively evaluated. Four maxillary models were analyzed per patient: a pretreatment model, a scan-based CC model, a posttreatment clinical model, and a CC model reflecting the treatment outcome as initially simulated. Thirteen transverse parameters were measured on each model separately by two investigators. Occlusal contacts were also analyzed., Results: The measuring method was validated by both investigators arriving at similar results for the effectiveness by which the simulated treatment goals had been clinically achieved. Significant differences (p < 0.05; Wilcoxon signed-rank test) were observed for transfer precision from the casts to the planning software and between the simulated and clinical outcomes. Intense occlusal contacts in the simulations materialized less common (≈ 2%) than ideal contacts (≈ 60%) in the clinical outcomes., Conclusions: The effectiveness of achieving the simulated transverse goals was 45% and was generally not found to be better with SmartTrack® than with the previously used Ex30® material. Out of 100 simulated occlusal contacts, 40 will never materialize, and achieving around 60 will adequately ensure a clinically favorable contact pattern., Clinical Relevance: With the caveat that any overcorrection will to some extent reduce the precision, it seems perfectly possible to make deliberate use of overcorrection in current aligner therapies for transverse maxillary expansion or contraction., (© 2021. The Author(s).)

Introduction: Classification and management of osteoporotic pelvic ring injuries (OPRI) continue to pose a considerable challenge to orthopaedic traumatologists. The currently used fragility fractures of the pelvis (FFP) classification of OPRI has recently been shown to have significant weaknesses. The aim of this study therefore was to propose a new, simple, yet comprehensive alphanumeric classification (ANC) of OPRI and to assess its intra- and interobserver reliability. Furthermore, its potential advantages over the FFP classification are discussed., Materials and Methods: One hundred consecutive CT scans from patients with OPRI were evaluated by three orthopaedic traumatologists with varying levels of experience and one musculoskeletal radiologist. Intra- and interobserver reliability of the proposed classification system was assessed using weighted kappa (κ) statistics and percentage agreement. In addition, the Fleiss' kappa statistic was computed to assess interobserver agreement among all four raters., Results: Overall intraobserver reliability of the proposed ANC was substantial [κ ranging from 0.71 to 0.80; percentage agreement: 70% (range, 67-76%)]. Overall interobserver reliability between pairs of raters was substantial as well [κ ranging from 0.61 to 0.68; percentage agreement: 58% (range, 53-61%)]. For ANC types, groups and subgroups, intra- and interobserver reliability were substantial to almost perfect. Interobserver agreement among all four raters was moderate to substantial, with Fleiss' kappa values of 0.48, 0.69, 0.71 and 0.52 for ANC overall, types, groups and subgroups, respectively., Conclusion: The proposed ANC of OPRI demonstrated overall reliability comparable to that of the FFP classification. The ANC, however, is simple, more comprehensive, and consistently relates to injury severity.

Objectives: Driving ability largely depends on the total brake response time (TBRT) corresponding to the time a subject needs to react to a stimulus and apply a well-defined force on the brake pedal. As yet, the English literature completely lacks clinical studies evaluating the TBRT following oral surgery., Materials and Methods: In this case-control study, a driving simulator was used to evaluate the TBRT in patients scheduled for oral surgery in local anesthesia. Measurements were taken shortly before (t1) and after (t2) surgery as well as 7-10 days later (t3) when sutures were removed. Results were compared to data of a group of healthy volunteers., Results: Seventy-three patients (37 women, 36 men) underwent evaluation at t1, t2, and t3. In 13 patients who did not return for removal of sutures, only measurements at t1 and t2 could be performed. The median TBRT was 583 milliseconds (ms), 634 ms, and 520 ms at t1, t2, and t3, respectively. Statistical analysis revealed significant differences between readings at t1 versus t2 (t = - 4.944, p < 0.001), t1 versus t3 (t = 7.454, p < 0.001), and t2 versus t3 (t = 11.971, p < 0.001). There was no significant difference between TBRT at t3 in study subjects compared to normal reference values of 67 healthy volunteers. TBRT was significantly increased immediately after oral surgery (t2) compared to measurements 7-10 days postoperatively (t3). Since readings at t3 did not differ from TBRT values in the comparison group, they were considered normal., Conclusions: Due to significantly elevated total brake response time, driving ability is assumed to be considerably affected following oral surgery, and patients should be advised to abstain from driving immediately after such operations., Clinical Relevance: Our study results put into question patients' driving ability following dentoalveolar procedures which should be considered regarding informed consent and could potentially have consequences on health issues (road traffic accidents) as well as legal and financial matters (court charges, insurance claims).

Background: Recent studies have shown that during cardiopulmonary resuscitation (CPR) head-up position (HUP) as compared to standard supine position (SUP) decreases intracranial pressure (ICP) and increases cerebral perfusion pressure (CPP). The impact of this manoeuvre on brain oxygenation and metabolism is not clear. We therefore investigated HUP as compared to SUP during basic life support (BLS) CPR for their effect on brain oxygenation and metabolism., Methods: Twenty pigs were anaesthetized and instrumented. After 8 min of cardiac arrest (CA) pigs were randomized to either HUP or SUP and resuscitated mechanically for 20 min. Mean arterial pressure (MAP), ICP, CPP, cerebral regional oxygen saturation (rSO 2 ) and brain tissue oxygen tension (P bt O 2 ) were measured at baseline, after CA and every 5 min during CPR. Cerebral venous oxygen saturation (S cv O 2 ) was measured at baseline, after CA and after 20 min of CPR. Cerebral microdialysis parameters, e.g. lactate/pyruvate ratio (L/P ratio) were taken at baseline and the end of the experiment., Results: ICP was significantly lower in HUP compared to SUP animals after 5 min (18.0 ± 4.5 vs. 24.1 ± 5.2 mmHg; p = 0.033) and 20 min (12.0 ± 3.4 vs. 17.8 ± 4.3 mmHg; p = 0.023) of CPR. Accordingly, CPP was significantly higher in the HUP group after 5 min (11.2 ± 9.5 vs. 1.0 ± 9.2 mmHg; p = 0.045) and 20 min (3.4 ± 6.4 vs. -3.8 ± 2.8 mmHg; p = 0.023) of CPR. However, no difference was found in rSO 2 , P bt O 2 , S cv O 2 and L/P ratio between groups after 20 min of CPR., Conclusion: In this animal model of BLS CPR, HUP as compared to SUP did not improve cerebral oxygenation or metabolism., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Elective cryopreservation of cultured embryos has become a treatment option for women at risk for ovarian hyperstimulation syndrome (OHSS). The aim of our study was to investigate the outcome of elective cryopreservation and consecutive frozen-thawed embryo transfer (FET) in a large IVF clinic in Austria. A total of 6104 controlled ovarian hyperstimulation cycles (COH) were performed on 2998 patients including 200 patients (6.7%) who were undergoing elective cryopreservation and FET due to high risk of OHSS. We estimated the cumulative live birth rate using the Kaplan-Meier method and evaluated independent predictors for successful live births with a Cox model. A total of 270 frozen-thawed embryo transfers were performed on 200 patients with up to 4 transfers per patient. The first embryo transfer showed a live birth rate of 42.0%, the second transfer showed a cumulative rate of 58.5%. After a total of 4 FETs from the same COH cycle, a cumulative live birth rate of 61.0% per COH cycle could be achieved. Four cases of OHSS occurred amongst these patients (2.0%), all of them of moderate severity. Multivariate analysis identified maternal age, the use of assisted hatching and the number of embryos transferred at the blastocyst stage as independent predictors for cumulative live birth. Our study clearly suggests that elective FET is safe and shows excellent cumulative live birth rates. This concept can, therefore, be used to avoid the severe adverse events caused by COH and the inefficient use of cultured embryos., (Copyright © 2017 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn. Published by Elsevier B.V. All rights reserved.)

Nonoptimal liver grafts, and among them organs from anti-HBc+ donors, are increasingly used for liver transplantation. In this retrospective study including 1065 adult liver transplantations performed between 1977 and 2012, we analyzed long-term patient and graft survival and occurrence of HBV infection. A total of 52 (5.1%) patients received an anti-HBc+ graft. The 10-year graft and patient survival of these recipients were 50.9% and 59.0% compared to 72.0% and 76.5% (P = 0.001; P = 0.004) of patients receiving anti-HBc- grafts, respectively. Cox regression model showed that high urgency allocation (P = 0.003), recipient age (P = 0.027), anti-HCV+ recipients (P = 0.005), and anti-HBc+ organs (P = 0.048) are associated with decreased graft survival. Thirteen of 52 (25.0%) patients receiving anti-HBc+ grafts developed post-transplant HBV infection within a mean of 2.8 years. In this study, antiviral prophylaxis did not have significant impact on HBV infection, but long-term survival (P = 0.008). Development of post-transplant HBV infection did not affect adjusted 10-year graft survival (100% vs. 100%; P = 1). Anti-HBc+ liver grafts can be transplanted with reasonable but inferior long-term patient and graft survival. The inferior graft survival is not, however, related with post-transplant HBV infection as long as early diagnosis and treatment take place., (© 2015 Steunstichting ESOT.)