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Background: Errors of horizontal condylar inclinations and Bennett angles had largely affected the articulation of teeth and the pathways of cusps. The aim of this study was to estimate and compare between the horizontal condylar (protrusive) angles and Bennett angles of full mouth rehabilitation patients using two different articulator systems. Materials and Methods: Protrusive angles and Bennett angles of 50 adult males and females Iraqi TMD-free full mouth rehabilitation patients were estimated by using two different articulator systems. Arbitrary hinge axis location followed by protrusive angles and Bennett angles, estimation was done by a semiadjustable articulator system. A fully adjustable articulator system was utilized to locate the terminal hinge axis using a kinematic face bow followed by protrusive angles location by the aid of two square shaped transparent hard plastic protractors attached close to the condylar stylus of the articulator followed by Bennett angles calculation according to the Hanau formula. All results were subjected to statistical analyses. Results: The two articulator systems scored protrusive angles for male patients greater than female patients which were non-significant for the fully adjustable articulator but they were significant for the semiadjustable articulator. Non-significance existed between females of the fully adjustable articulator and males of the semiadjustable articulator while high significance was located between males of the fully adjustable articulator and females of the semiadjustable articulator. Concerning Bennett angles, the highest mean value belonged to the male group of the fully adjustable articulator, while the lowest scored by the female group of the semiadjustable articulator. Highly significant differences were located between the Bennett angle mean values of the groups. Conclusion: Using both articulators, the total mean values of the males were greater than the females regarding both horizontal condylar angles and Bennett angles with the total means scored by the fully adjustable articulator being larger than those of the semi-adjustable type. Using both articulators, the males' right and left condyles exhibited greater Bennett angles than their female equivalents. The precision estimation of the horizontal condylar angles and Bennett angles provided by the condylar axis protractors of the fully adjustable articulator render such type of articulators most suitable for treating full mouth rehabilitation cases. Keywords: Horizontal codylar angles, Bennett angles, two articulator systems.

The present investigation was aimed to determine serum xanthine oxidase profile in stressed Marwari breed of sheep belonging to arid tracts in Rajasthan, India. Extreme hot and cold ambiences were considered as stress conditions to the animals. Blood samples were collected to obtain sera during moderate, extreme hot and cold ambiences. The mean value of serum xanthine oxidase during moderate ambience was 93.33±1.11 mU L-1.The mean value of serum xanthine oxidase was significantly (p≤0.05)higher during hot and significantly (p≤0.05) lower during cold ambiences as compared to moderate mean value serving as control. The sex and age effects were significant (p≤0.05) in all ambiences. The mean values were significantly (p≤0.05) higher in males than females. In each ambience the age effect showed a significant (p≤0.05) increase in the mean values being highest in the animals of 2.5-4.5 years of age. The effects of extreme ambiences were observed on the male and female animals of all age groups as revealed by various interactions studied viz. ambience X age; ambience X sex and age X sex (p≤0.01). Further sex effect was present in the animals of each age group. It can be concluded that serum xanthine oxidase can be used as an effective marker to assess oxidative stress in these animals. Mean values obtained from large number of animals during moderate ambience will help in providing physiological reference values for future research and clinical interpretations.

ABSTRACT Background: One of the major problems of all ceramic restorations is their probable fracture against the occlusal forces. The objective of this in vitro study was to evaluate the effect of two gingival finishing lines (90°shoulder and deep chamfer) on the fracture resistance of full contour CAD/CAM and heat press all-ceramic crowns. Materials and Methods: Thirty two maxillary first premolars were prepared to receive full contour CAD/CAM (zolid) and heat press (Cergo Kiss) ceramic crowns using a special paralleling device (Parallel-A-Prep). The teeth were divided into four groups according to the type of finishing line prepared. Each crown was cemented to its corresponding tooth using self-etch, self-adhesive dual cure resin cement. Following storage for 1 week in distilled water at room temperature, teeth were subjected to thermal cycling. Fracture resistance was determined using a universal testing machine, and the samples were investigated microscopically from the point of view of the origin of the failure. Statistical analysis was carried out using the one-way ANOVA and Student’s t-tests. Results: The mean values of fracture resistance for CAD/CAM group showed 1367.250+178.967 N for 90°shoulder margins and 1109.250+252.455 N for the deep chamfer margins. ANOVA test results revealed high significance between and within the groups. The mean values of fracture resistance for heat press group were 548.562+272.471 N for 90°shoulder margins and 247.912+96.995 N for the deep chamfer margins expressing statistical significance. Conclusions: The results of this study pointed to a relationship between the design of the cervical finishing line and the fracture strength of the full CAD/CAM crowns and the full heat press ceramic crowns. Both 90° shoulder and deep chamfer finishing lines are suitable for zolid crowns while the 90° shoulder is more suitable for the Cergo Kiss crowns than the deep chamfer preparation. Key words: Full contour, All-ceramic crowns, CAD/CAM, Heat press, Fracture strength.

Background: Controversy exists concerning the presence and amount of the Bennett mandibular immediate side shift among patients and whether it is necessary to accommodate for it in adjustable articulators. The aim of this study was to register and calculate the amount of any immediate side shift (ISS) present in patients requiring full mouth rehabilitation. Materials and methods: 3- dimensional condylar movements of 50 Iraqi TMD-free patients were recorded using a stereographic fully adjustable articulator system during protrusion, left and right eccentric mandibular movements. Protrusive angles of each patient were verified to figure out the suitable fossa analog for each case. The thickness of each right and left premade fossa analog selected was measured with a vernier caliper and was tightly secured in the articulator fossa compartment. Functionally-generated path recordings were performed using custom-made intraoral clutches. Bennett ISSs, verified by the stereographic system in the molded fossae, were measured using the vernier caliper. The final right and left ISSs were estimated by subtracting the thickness of the blank fossa analog from that of the molded one. The final ISSs were recorded and statistically compared. Results: Stereographic recordings of eccentric mandibular movements revealed ISSs within all patients involved in this study. The ISSs varied among the patients and bilaterally within them. Their average values ranged between 0.80 mm for females and 1.68 mm for males, showing significant statistical differences between them but with no relevancy to age advancement. Mean values of ISSs of males' and females' mandibular left joints were more than those recorded by their right joints. Conclusion: Verifying the mandibular ISS in the molded fossae is an essential step to efficiently rehabilitate full mouth cases; thus it would be helpful to use a fully adjustable articulator system to restore complicated cases since very minor intraoral occlusal adjustments might be required for the finished restorations prior to the final cementation.

Background: The accuracy of fitness of any dental casting is imperative for the success of any prosthodontic treatment. From the time that dental casting was first introduced, efforts have been made to produce more accurate and better fitted castings with minimal marginal discrepancy. The aim of this in vitro study was to evaluate the effects of three different investing and burnout techniques on the vertical marginal discrepancies ofceramometalcopings invested with two types of phosphate- bonded investments. Materials and methods: Sixty wax patterns were fabricated on a standardized prepared brass die representing an upper central incisor by the aid of a custom-made split mold. Three different investing and burnout techniques were applied for an Iraqi investment and a commercial type; Group I:Ring investing with conventional burnout technique (RC);Group II: Ringless investing with conventional burnout technique (RLC);Group III: Ring investing with accelerated burnout technique (RA).Twenty wax patterns of each group were divided into two subgroups according to the type of investment material used (10 for each subgroup) represented as (B) for the BellaStar XL and (W) for the WYMvest investments. Complete castings were finished and seated on the metal die. The accuracy of fit of each coping was determined by measuring the vertical marginal discrepancies between the finish line on the metal die and the margins of each coping at four specific reference points on the labial, mesial, palatal, and distal aspects of the die by the aid of a light microscope supplied with a digital camera.The arithmetic mean of each three records was computed and regarded as the amount of the marginal discrepancy of each coping and was used as a unit for the statistical analysis. Results: Mean marginal accuracy for W(RLC)was found to be the least (13.839+4.5724 um) while the highest mean value related to B(RLC) (29.033+2.102 um). In general, ANOVA test showed significant results among the mean values of the Binvestment subgroups while LSD test showed non-significance between the (RA) and both the (RC) and (RLC) subgroups. On the other hand, significance was present between the (RLC) and (RA)of the Winvestment subgroups while non-significance was located between the (RC) and both the (RLC) and (RA) subgroups. Comparing similar subgroups of the two tested investments, the Student's t-test showed non-significance between the (RC) subgroups while high significance was located between the (RLC) and (RA) subgroups respectively.Concerning the vertical marginal discrepancy of the copings, applying the (RC) technique for both investments caused non-statistical significance between the labial, mesial, palatal, and distal aspects.The (RLC) technique caused high significance between the four aspects, while the (RA) technique caused non-significance between the labial aspect only and the others. Conclusion: The Iraqi investment generally produced less vertical marginal discrepancies (using the three different investing and burn-out techniques) than the commercial investment.In order to achieve a better marginal fit, it seems that ceramometalcopings invested with the commercial investment tested are better be cast using the conventional ring investing and burnout technique.

Background In the era of highly effective direct-acting antivirals (DAAs) for treatment of patients with chronic hepatitis C virus (HCV) infection, ribavirin (RBV) is still considered beneficial in certain patients. Aim To assess the association between RBV steady-state plasma levels and sustained virological response (SVR). Methods Consecutive HCV-infected patients treated with DAAs plus RBV from four Dutch academic medical centres were enrolled. RBV steady-state plasma levels were prospectively measured at treatment week 8 using validated assays. Logistic regression analyses were performed to assess the influence of RBV steady-state plasma level on SVR, and RBV therapeutic range was explored using area under the ROC curve analyses. Results A total of 183 patients were included, of whom 85% had one or more difficult-to-cure characteristics (ie treatment experienced, HCV genotype 3, cirrhosis). The majority was treated with a sofosbuvir-based regimen and 163 (89%) patients achieved SVR. Median RBV dose was 12.9 (interquartile range 11.2-14.7) mg/kg/d, and median RBV steady-state plasma level was 2.66 (1.95-3.60) mg/L. In multivariable analyses, higher RBV steady-state plasma level (adjusted odds ratio 1.79 [95% CI 1.09-2.93]) was an independent predictor of SVR. With regard to the optimal RBV therapeutic range, 2.28 mg/L was the optimal lower cut-off for achieving SVR and 3.61 mg/L was the upper cut-off for preventing significant anaemia (Haemoglobin < 10 g/dL). Conclusion In this cohort of mainly difficult-to-cure patients treated with DAAs plus RBV, higher RBV steady-state plasma level was an independent predictor of SVR. [ABSTRACT FROM AUTHOR]

Rebound insomnia, worsened sleep when discontinuing use of a hypnotic, is reported in some short-term studies. No study has prospectively assessed, using patient reports or nocturnal polysomnography (NPSG), the likelihood of rebound insomnia with chronic hypnotic use. The objectives of this study was to assess in primary insomniacs the likelihood of experiencing rebound insomnia and a withdrawal syndrome on repeated placebo substitutions over 12 months of nightly zolpidem use. A group of 33 primary insomniacs, without psychiatric disorders or drug and alcohol abuse, 32–65 years old, 15 men and 18 women, were randomized to take zolpidem 10 mg (n = 17) or placebo (n = 16) nightly for 12 months. In probes during months 1, 4, and 12, placebo was substituted for 7 consecutive nights in both the zolpidem and placebo groups. NPSGs were collected and Tyrer Bezodiazepine Withdrawal Symptom Questionnaires were completed on the first two discontinuation nights. Rebound insomnia was not observed on the first two and the seventh discontinuation nights and its likelihood did not increase over the 12 months of nightly zolpidem use. Some individuals did show rebound insomnia, approximately 30–40% of participants, but the percentage of ‘rebounders’ did not differ between the placebo and zolpidem groups and did not increase across 12 months. No clinically significant withdrawal symptoms on the Tyrer were observed on the discontinuation nights over the 12 months of nightly use. Chronic nightly hypnotic use at therapeutic doses by primary insomniacs does not lead to rebound insomnia or withdrawal symptoms. [ABSTRACT FROM AUTHOR]

Background and Aims: Since the introduction of SARS-CoV-2 vaccines, several cases of vaccine-induced immune thrombocytopenia and thrombosis (VITT) have been described, especially cerebral vein thrombosis. We aimed to retrospectively collect all new cases of acute onset first or recurrent splanchnic vein thrombosis (SVT) following a recent SARS-CoV-2 vaccination within the Vascular Liver Disease Group network., Approach and Results: New cases of SVT were identified from April 2021 to April 2022; follow-up was completed on December 31, 2022. Criteria to define VITT were derived from previous studies. Data from a pre-COVID cohort of patients with SVT (N=436) were used for comparison of clinical presentation, etiology, and outcome. Twenty-nine patients were identified with SVT occurring with a median of 11 days (range 2-76) after the first (48%), second (41%), or third (10%) vaccination (ChAdOx1 nCov-19 (n=12) or BNT162b2 (n=14), other (n=3) Only 2 patients(7%) fulfilled criteria for definite VITT. Twenty (69%) had SVT at multiple sites, including 4 (14%) with concomitant extra-abdominal thrombosis. Only 28% had an underlying prothrombotic condition, compared to 52% in the pre-COVID SVT cohort ( p =0.01). Five patients (17%) underwent bowel resection for mesenteric ischemia, compared with 3% in pre-COVID SVT ( p <0.001). Two patients died shortly after diagnosis (7%)., Conclusions: Although definite VITT was rare, in 72% of cases, no other cause for SVT could be identified following SARS-CoV-2 vaccination. These cases were different from patients with nonvaccine-related SVT, with lower incidence of prothrombotic conditions, higher rates of bowel ischemia, and poorer outcome. Although SVT after SARS-CoV-2 vaccination is rare in absolute terms, these data remain relevant considering ongoing revaccination programs., (Copyright © 2024 American Association for the Study of Liver Diseases.)

Background and Aims: Biopsy-proven severe graft steatosis is associated with adverse outcomes after liver transplantation. The concomitant presence of metabolic risk factors might further increase this risk. We studied the association between graft steatosis and metabolic risk factors in the donor, with recipient outcomes after liver transplantation., Methods: We analyzed data from all consecutive first adult full-graft donation after brain death (DBD) liver transplantations performed in the Eurotransplant region between 2010 and 2020. The presence of graft steatosis and metabolic risk factors was assessed through a review of donor (imaging) reports, and associations with recipient retransplantation-free survival were studied through survival analyses., Results: Of 12 174 transplantations, graft steatosis was detected in 2689 (22.1%), and donor diabetes mellitus (DM), hypertension, and dyslipidemia were present in 1245 (10.2%), 5056 (41.5%), and 524 (4.3%). In multivariable Cox regression analysis, graft steatosis (adjusted HR [aHR] 1.197, p < 0.001) and donor DM (aHR 1.157, p = 0.004) were independently associated with impaired retransplantation-free survival. Graft steatosis and donor DM conferred an additive risk of retransplantation or death (DM alone, aHR: 1.156 [p = 0.0185]; steatosis alone, aHR: 1.200 [p < 0.001]; both steatosis and DM, aHR: 1.381 [p < 0.001]). Findings were consistent in sensitivity analyses focusing on retransplantation-free survival within 7 days., Conclusions: Graft steatosis and donor diabetes mellitus additively increase the risk of retransplantation or death in adult DBD liver transplantation. Future studies should focus on methods to assess and improve the quality of these high-risk grafts. Until such time, caution should be exercised when considering these grafts for transplantation., (© 2024 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.)