The Efficacy and Safety of Endoscopic Balloon Dilatation in the Treatment of Functional Post-Sleeve-Gastrectomy Stenosis.

Background and Objectives: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric twisting without the anatomical constriction of the gastric lumen. During endoscopic examination, the staple line is deviated with a clockwise rotation, and the stenosis requires additional endoscopic manipulations for its transposition. Upper gastrointestinal series show the gastric twist with an upstream dilatation of the gastric tube in some patients. Data on its management have remained scarce. The objective was to assess the efficacy and safety of endoscopic balloon dilatation in the management of functional post-sleeve gastrectomy stenosis. Patients and Methods: Twenty-two patients with functional post-primary-sleeve-gastrectomy stenosis who had an endoscopic balloon dilatation between 2017 and 2023 were included in this retrospective study. Patients with alternative treatment plans and those undergoing endoscopic dilatation for other forms of gastric stenosis were excluded. The clinical outcomes were used to evaluate the efficacy and safety of balloon dilatation in the management of functional gastric stenosis. Results: A total of 45 dilatations were performed with a 30 mm balloon in 22 patients (100%), a 35 mm balloon in 18 patients (81.82%), and a 40 mm balloon in 5 patients (22.73%). The patients' clinical responses after the first balloon dilatation were a complete clinical response (4 patients, 18.18%), a partial clinical response (12 patients, 54.55%), and a non-response (6 patients, 27.27%). Nineteen patients (86.36%) had achieved clinical success at six months. Three patients (13.64%) who remained symptomatic even after achieving the maximal balloon dilation of 40 mm were considered failure of endoscopic dilatation, and they were referred for surgical intervention. No significant adverse events were found during or following the balloon dilatation. Conclusions: Endoscopic balloon dilatation is an effective and safe minimally invasive procedure in the management of functional post-sleeve-gastrectomy stenosis.

The influence of Zircos-E® etchant, silica coating, and alumina air-particle abrasion on the debonding resistance of endocrowns with three different preparation designs.

OBJECTIVES: The study aimed to evaluate the debonding resistance of three different endocrown designs on molar teeth, using three different zirconia surface pretreatments. MATERIAL AND METHOD: Ninety human mandibular first molars were divided into three main groups: endocrowns without ferrule, with 1 mm ferrule, and with 2 mm ferrule. The subgroups were defined by their surface pretreatment method used (n = 15): 50 µm alumina air-particle abrasion, silica coating using 30 µm Cojet™ particles, and Zircos-E® etching. The endocrowns were fabricated using multilayer zirconia ceramic, cemented with self-adhesive resin cement, and subjected to 5000 thermocycles (5-55°C) before debonding. The data obtained were analyzed using a two-way ANOVA. RESULTS: All test specimens survived the thermocyclic aging. The results indicated that both the preparation design and the surface treatment had a significant impact on the resistance to debonding of the endocrowns (p < .001). The 2 mm ferrule followed by the 1 mm ferrule designs exhibited the highest debonding resistance, both were superior to the endocrown without ferrule. Zircos-E® etching and silica coating yielded comparable debonding resistance, which were significantly higher than alumina air-particle abrasion. All endocrowns demonstrated a favorable failure mode. CONCLUSIONS: All designs and surface treatments showed high debonding resistance for a single restoration. However, ferrule designs with Zircos-E® etching or silica coating may represent better clinical options compared to the nonferrule design or alumina airborne-particle abrasion. Nonetheless, further research, including fatigue testing and evaluations with different luting agents is recommended.

Clinical survival and complication rate of ceramic veneers bonded to different substrates: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Evidence on the long-term clinical assessment and longevity of ceramic veneers bonded to different substrates is limited. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the effect of various substrates, including enamel, dentin, or an existing composite resin restoration, on the clinical survival and complication rates of ceramic veneers. MATERIAL AND METHODS: The PubMed, Scopus, and the Cochrane Library electronic databases were searched, and related journals were hand searched without time or language restrictions to identify clinical trials that compared the survival rate and clinical complication rates when bonding ceramic veneers to different tooth substrates. The success rate of the included participants was estimated by the number of veneers that did not require a clinical intervention, and the survival rate by all veneers that did not fail absolutely. The risk difference (RD) with 95% confidence intervals (CIs) for dichotomous outcomes was used to quantify the intervention effect. RESULTS: Of 973 screened articles, 6 clinical studies were included. The survival and success rates varied depending on the bonding substrate. Enamel-bonded veneers had almost perfect rates of survival (99% with a range of 98% to 100%) and success (99% with a range of 98% to 100%). Veneers bonded to composite resin or surfaces with minimal dentin exposure had slightly lower survival rates (94% with a range of 91% to 97% and 95% with a range of 91% to 100%, respectively) and success rates (70% with a range of 60% to 80% and 95% with a range of 90% to 99%). Severe dentin exposure significantly decreased both survival rates (91% with a range of 84% to 98%) and success rates (74% with a range of 64% to 85%). The combined findings suggested that ceramic veneers bonded to enamel had fewer clinical complications (RD: -0.04; 95% CI: -0.09 to 0.02) and lower failure rates (RD: -0.13; 95% CI: -0.32 to 0.07) compared with those bonded to exposed dentin. Additionally, veneers attached to teeth with minimal dentin exposure were significantly less likely to require clinical interventions (RD: -0.16; 95% CI: -0.31 to -0.01) and had a reduced incidence of failure (RD: -0.08; 95% CI: -0.17 to 0.01) compared with those with severe dentin exposure. CONCLUSIONS: Ceramic veneers bonded to enamel showed higher survival and success rates with lower clinical incidences of complications and failure than those bonded to dentin or teeth with existing composite resin restorations.

Neutrophil percentage-to-albumin ratio is a new diagnostic marker for spontaneous bacterial peritonitis: a prospective multicenter study.

BACKGROUND: The neutrophil percentage-to-albumin ratio (NPAR) is a novel measure of systemic inflammation and infection. Low albumin levels increase the risk of infection, while high neutrophil counts indicate the presence of infection. Spontaneous bacterial peritonitis (SBP) is a serious infection in cirrhotic ascites, and the potential of NPAR in diagnosing SBP is not yet established. OBJECTIVE: The objective of this study is to determine the diagnostic value of NPAR in identifying SBP. PATIENTS: This prospective multicenter study included 465 patients diagnosed with cirrhotic ascites and SBP according to international guidelines. Demographic, clinical, and laboratory data were collected. The sensitivity and specificity of NPAR values for diagnosing SBP were assessed using the receiver operating characteristic curve. RESULTS: For SBP diagnosis in the total cohort, NPAR of > 17 had a sensitivity of 85.71%, specificity of 66.67%, and 95% CI (42.1-99.6). In culture-positive SBP, the NPAR at a cut-off > 5.2 had a sensitivity of 85.71%, specificity of 83.33%, and 95% CI (0.709 to 0.979), while in culture-negative SBP, the NPAR at a cut-off > 2.1 had a sensitivity of 92.86%, specificity of 33.33% and CI (0.367 to 0.764). The multivariate analysis revealed that albumin (OR = 2.78, [1.11;3.98], INR (OR = 0.198, [0.066;0.596], creatinine (OR = 0.292, [0.1; 0.81], CRP (OR = 3.18, [1.239;4.52] total leukocytic count (TLC) (OR = 1.97, [1.878; 2.07], platelets (OR = 2.09, [0.99; 2.31] and neutrophil (OR = 3.43, [1.04;3.89] were significantly associated with higher prediction rates for culture positive SBP. CONCLUSIONS: NPAR could be a new, affordable, noninvasive test for diagnosing SBP.

The Influence of Ferrule Design and Pulpal Extensions on the Accuracy of Fit and the Fracture Resistance of Zirconia-Reinforced Lithium Silicate Endocrowns.

The study aimed to assess the marginal, axial, and internal adaptation, as well as the fracture resistance of zirconia-reinforced lithium silicate (ZLS) endocrowns with varying pulpal inlay extensions and marginal geometry. Sixty extracted maxillary first molar teeth were divided into six groups (n = 10) according to pulpal inlay extension and marginal configuration. The first three groups (J2, J3, and J4) utilized prepared teeth for endocrowns without ferrule design and 2 mm, 3 mm, and 4 mm pulpal extensions, respectively. The second three groups (F2, F3, and F4) utilized prepared teeth with 1 mm shoulder margins and 2 mm, 3 mm, and 4 mm pulpal extensions. The endocrowns were fabricated from ZLS blocks using CAD/CAM milling technology. After cementation, the specimens underwent thermal aging for 5000 cycles and were evaluated for marginal adaptation. Using a universal testing machine, the fracture resistance was tested under quasistatic loading (1 mm/min). Two-way ANOVA and the Tukey's post hoc test were employed for data analysis (p ≤ 0.05). The results of this study revealed that endocrowns without ferrule exhibited superior fracture strength than a 1 mm ferrule design p < 0.05, irrespective of the inlay depth. All designs with and without ferrule and all inlay depths showed clinically acceptable marginal and internal fit. The conventional endocrown design without ferrule and 2 mm inlay depth showed the lowest surface gap. The pulpal surface showed the highest discrepancy among all groups compared to the other surfaces. Endocrowns without ferrule are more conservative and have higher fracture strength than 1 mm ferrule designs; extending the inlay depth showed a significant increase in fracture resistance of the 1 mm ferrule design, but not for the conventional design without ferrule and 2 mm inlay depth. All groups exhibited a high auspicious fracture strength value for molar endocrown restorations.

Effect of ceramic materials and tooth preparation design on computer-aided design and computer-aided manufacturing endocrown adaptation and retentive strength: An in vitro study.

OBJECTIVES: To evaluate how various tooth preparation designs impact the adaptation-both at the margins and internally-and the retentive strength of computer-aided design and computer-aided manufacturing (CAD/CAM) produced endocrowns. MATERIALS AND METHODS: 60 extracted human mandibular first molars were endodontically treated and assigned into three groups (n = 20) according to the tooth preparation design: Group N: butt joint design, Group F and F1 received 1- and 2-mm circumferential ferrule preparation, respectively. Endocrowns were milled using either lithium disilicate glass-ceramic (IPS emax ceramic) or monolithic zirconia. The internal and marginal adaptation of the endocrowns were evaluated using the replica technique. After cementation, the endocrowns of all test groups were dislodged axially at 0.5 mm/min using a universal testing machine. A 2-way ANOVA and the independent samples t-test (α = .05) were performed to statistically analyze the data. RESULTS: The effect of changing the design of the tooth preparation (butt joint, ferrule) on the marginal and internal gap was shown to be statistically significant (p < .05); the lower gap values were recorded at the axial followed by cervical, marginal, and pulpal floor walls in both ceramic groups regardless of the teeth preparation design. The ANOVA test revealed similar average removal forces and stresses for the two types of tested ceramic materials. CONCLUSION: IPS emax ceramic adapted better than monolithic zirconia ceramic, regardless of the preparation design. Ferrule preparation design is more retentive than butt joint preparation, regardless of the type of ceramic material used.

The post-operative tonsillectomy (POPT) study: A multi-centre prospective paediatric cohort study.

OBJECTIVES: Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary. DESIGN: Prospective observational cohort study. SETTING: Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed. PARTICIPANTS: Children (≥4 years, ≤16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology. MAIN OUTCOME MEASURES: Frequency and severity of post-operative bleeding. Intensity and pattern of post-operative pain. RESULTS: In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008). CONCLUSION: A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery.

Polymeric Denture Base Materials: A Review.

An ideal denture base must have good physical and mechanical properties, biocompatibility, and esthetic properties. Various polymeric materials have been used to construct denture bases. Polymethyl methacrylate (PMMA) is the most used biomaterial for dentures fabrication due to its favorable properties, which include ease of processing and pigmenting, sufficient mechanical properties, economy, and low toxicity. This article aimed to comprehensively review the current knowledge about denture base materials (DBMs) types, properties, modifications, applications, and construction methods. We searched for articles about denture base materials in PubMed, Scopus, and Embase. Journals covering topics including dental materials, prosthodontics, and restorative dentistry were also combed through. Denture base material variations, types, qualities, applications, and fabrication research published in English were considered. Although PMMA has several benefits and gained popularity as a denture base material, it has certain limitations and cannot be classified as an ideal biomaterial for fabricating dental prostheses. Accordingly, several studies have been performed to enhance the physical and mechanical properties of PMMA by chemical modifications and mechanical reinforcement using fibers, nanofillers, and hybrid materials. This review aimed to update the current knowledge about DBMs' types, properties, applications, and recent developments. There is a need for specific research to improve their biological properties due to patient and dental staff adverse reactions to possibly harmful substances produced during their manufacturing and use.

Early protective effect of a ("pan") coronavirus vaccine (PanCoVac) in Roborovski dwarf hamsters after single-low dose intranasal administration.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted the danger posed by human coronaviruses. Rapid emergence of immunoevasive variants and waning antiviral immunity decrease the effect of the currently available vaccines, which aim at induction of neutralizing antibodies. In contrast, T cells are marginally affected by antigen evolution although they represent the major mediators of virus control and vaccine protection against virus-induced disease. Materials and methods: We generated a multi-epitope vaccine (PanCoVac) that encodes the conserved T cell epitopes from all structural proteins of coronaviruses. PanCoVac contains elements that facilitate efficient processing and presentation of PanCoVac-encoded T cell epitopes and can be uploaded to any available vaccine platform. For proof of principle, we cloned PanCoVac into a non-integrating lentivirus vector (NILV-PanCoVac). We chose Roborovski dwarf hamsters for a first step in evaluating PanCoVac in vivo. Unlike mice, they are naturally susceptible to SARS-CoV-2 infection. Moreover, Roborovski dwarf hamsters develop COVID-19-like disease after infection with SARS-CoV-2 enabling us to look at pathology and clinical symptoms. Results: Using HLA-A*0201-restricted reporter T cells and U251 cells expressing a tagged version of PanCoVac, we confirmed in vitro that PanCoVac is processed and presented by HLA-A*0201. As mucosal immunity in the respiratory tract is crucial for protection against respiratory viruses such as SARS-CoV-2, we tested the protective effect of single-low dose of NILV-PanCoVac administered via the intranasal (i.n.) route in the Roborovski dwarf hamster model of COVID-19. After infection with ancestral SARS-CoV-2, animals immunized with a single-low dose of NILV-PanCoVac i.n. did not show symptoms and had significantly decreased viral loads in the lung tissue. This protective effect was observed in the early phase (2 days post infection) after challenge and was not dependent on neutralizing antibodies. Conclusion: PanCoVac, a multi-epitope vaccine covering conserved T cell epitopes from all structural proteins of coronaviruses, might protect from severe disease caused by SARS-CoV-2 variants and future pathogenic coronaviruses. The use of (HLA-) humanized animal models will allow for further efficacy studies of PanCoVac-based vaccines in vivo.

Sleep Patterns of Pilots: An Objective Assessment.

Objectives Circadian dysregulation (jetlag), sleep loss (extended wakefulness), sleep deprivation (acute or chronic), fatigue (exhaustion), preexisting medical and mental conditions, and medication use can all affect the cognitive and behavioral performance of commercial aircraft pilots. This study evaluated the sleep habits of pilots and copilots flying short-haul flights in the Gulf region. Methods This cross-sectional study examined Airbus A320 pilots and copilots for one of Saudi Arabia's commercial airlines. Data such as age, sex, body mass index (BMI), employment position, work experience, flight hours, and rest time were collected. Each participant completed the Epworth Sleepiness Scale (ESS) for daytime sleepiness, the Pittsburgh Sleep Quality Index (PSQI), and the Fatigue Severity Index (FSI). Actigraphy equipment was used to perform objective sleep evaluations. Results Twenty-four participants were included. Actigraphy showed that 66.7% had an irregular sleep pattern and that 41.7% had poor sleep efficiency. We found that 12.5% had daytime sleepiness, 33% had poor sleep quality, and 29.2% had fatigue. We found a significant negative correlation between years of experience and time in bed; however, there was no significant difference in sleep time or sleep efficiency between pilots with different levels of experience. Conclusions We found that pilots and copilots are at risk of irregular sleep patterns, poor sleep efficiency, poor sleep quality, daytime sleepiness, and fatigue. This study emphasizes the need to instigate measures to minimize these risks.

A risk score to predict 30-day hospital readmission rate in cirrhotic patients with spontaneous bacterial peritonitis.

BACKGROUND AND AIM: There is lack of 30-day hospital readmission prediction score in patients with liver cirrhosis and SBP. The aim of this study is to recognize factors capable of predicting 30-day readmission and to develop a readmission risk score in patients with SBP. METHODS: This study prospectively examined the 30-day hospital readmission for patients previously discharged with a diagnosis of SBP. Based on index hospitalization variables, a multivariable logistic regression model was implemented to recognize predictors of patient hospital readmission within 30 days. Consequently, Mousa readmission risk score was established to predict 30-day hospital readmission. RESULTS: Of 475 patients hospitalized with SBP, 400 patients were included in this study. The 30-day readmission rate was 26.5%, with 16.03% of patients readmitted with SBP. Age ≥ 60, MELD > 15, serum bilirubin > 1.5 mg/dL, creatinine > 1.2 mg/dL, INR > 1.4, albumin < 2.5 g/dL, platelets count ≤ 74 (103/dL) were found to be independent predictors of 30-day readmission. Incorporating these predictors, Mousa readmission score was established to predict 30-day patient readmissions. ROC curve analysis demonstrated that at a cutoff value ≥ 4, Mousa score had optimum discriminative power for predicting the readmission in SBP with sensitivity 90.6% and specificity 92.9%. However, at cutoff value ≥ 6 the sensitivity and specificity were 77.4% and 99.7%, respectively, while a cutoff value ≥ 2 had sensitivity of 99.1% and specificity of 31.6%. CONCLUSIONS: The 30-day readmission rate of SBP was 25.6%. With the suggested simple risk assessment Mousa score, patients at high risk for early readmission can be easily identified so as to possibly prevent poorer outcomes.

A Novel Electrochemical Differentiation between Exosomal-RNA of Breast Cancer MCF7 and MCF7/ADR-Resistant Cells.

Cancer is considered one of the most burdensome diseases affecting lives and, hence, the economy. Breast cancer is one of the most common types of cancer. Patients with breast cancer are divided into two groups: one group responds to the chemotherapy, and the other group resists the chemotherapy. Unfortunately, the group which resists the chemotherapy is still suffering the pain associated with the severe side effects of the chemotherapy. Therefore, there is a critical need for a method to differentiate between both groups before the administration of the chemotherapy. Exosomes, the recently discovered nano-vesicles, are often used as cancer diagnostic biomarkers as their unique composition allows them to represent their parental cells, which makes them promising indicators for tumor prognosis. Exosomes contain proteins, lipids, and RNA that exist in most body fluids and are expelled by multiple cell types, including cancer cells. Furthermore, exosomal RNA has been significantly used as a promising biomarker for tumor prognosis. Herein, we have developed an electrochemical system that could successfully differentiate between MCF7 and MCF7/ADR depending on the exosomal RNA. The high sensitivity of the proposed electrochemical assay opens the door for further investigation that will address the other type of cancer cells.

Resolved hepatitis B infection in patients receiving immunosuppressive therapy: Monitor versus prophylaxis against viral reactivation.

Risk of hepatitis B virus reactivation (HBVr) in patients with resolved HBV infection receiving immunosuppressive therapy has been a growing concern, particularly in the era of biological and targeted therapies. HBV monitoring versus antiviral prophylaxis against HBVr in those patients remains controversial. The aim of the study was to determine the incidence of HBVr and HBV-related hepatitis in resolved HBV patients who received immunosuppressive therapy with or without antiviral prophylaxis. This retrospective study included 64 patients with resolved HBV infection who received different regimens of immunosuppressive medications, with moderate risk of HBVr, for variable underlying diseases. Patients who had chronic HBV infection or other viral infections were excluded. Patients who received B-cell depleting therapies were ruled out. They were divided into 2 groups: group 1 included 31 patients who received immunosuppressive therapy without antiviral prophylaxis, and group 2 included 33 patients who received antiviral prophylaxis (entecavir) within 2 weeks of commencing the immunosuppressive therapy. HBVr, HBV-related hepatitis, and HBV-unrelated hepatitis were assessed along a 1-year duration. The overall HBVr incidence was 1.56% (1/64). This patient who had HBVr was seen in group 1. There were no significant differences between the 2 groups regarding the incidence of HBVr, HBV-related hepatitis, HBV-unrelated hepatitis, and immunosuppressive therapy interruption along a 1-year duration. Based on this retrospective study, close monitoring was equal to antiviral prophylaxis regarding the outcome of resolved HBV patients who received moderate risk immunosuppressive therapy. HBV treatment should commence once HBVr is confirmed.

Personal caution about some cancer-related lifestyle habits in Northern Saudi Arabia.

OBJECTIVE: The present study aimed at assessing community familiarity with cancer-related lifestyle habits in Northern Saudi Arabia. SUBJECTS AND METHODS: This descriptive cross-sectional study involved a community-based sample of 442 civilians living in Hail, Northern Saudi Arabia. Data were collected during the period between October and November 2020. Data were randomly collected from different public gathering places regardless of age or sex. RESULTS: Higher nescience percentages were associated with physical inactivity followed by obesity and fast food, representing 328/390 (84%), 311/390 (80%), and 263/390 (67%), respectively. CONCLUSIONS: Northern Saudi Arabia has a high negative attitude toward cancer risk factors, necessitating the implementation of community-based health education and cancer awareness programs. Level of education and age have no significant role in the level of cancer awareness.

Epstein-Barr virus, interleukin-10 and multiple sclerosis: A ménage à trois.

Multiple Sclerosis (MS) is an autoimmune disease that is characterized by inflammation and demyelination of nerve cells. There is strong evidence that Epstein-Barr virus (EBV), a human herpesvirus infecting B cells, greatly increases the risk of subsequent MS. Intriguingly, EBV not only induces human interleukin-10 but also encodes a homologue of this molecule, which is a key anti-inflammatory cytokine of the immune system. Although EBV-encoded IL-10 (ebvIL-10) has a high amino acid identity with its cellular counterpart (cIL-10), it shows more restricted and partially weaker functionality. We propose that both EBV-induced cIL-10 and ebvIL-10 act in a temporally and functionally coordinated manner helping the pathogen to establish latency in B cells and, at the same time, to balance the function of antiviral T cells. As a result, the EBV load persisting in the immune system is kept at a constant but individually different level (set point). During this immunological tug of war between virus and host, however, MS can be induced as collateral damage if the set point is too high. Here, we discuss a possible role of ebvIL-10 and EBV-induced cIL-10 in EBV-driven pathogenesis of MS.

Determining the Site of Upper Airway Narrowing in Snorers Using a Noninvasive Technique.

Background In this study, we aimed to determine the site of obstruction if surgical treatment is considered. Flexible nasopharyngoscopy is an invasive procedure currently used for the assessment of snoring and the level of obstruction. Here, we examine the role of Somnoscreen™ plus, a noninvasive cardiorespiratory polysomnographic device, in identifying the site of obstruction in patients presenting with snoring. Methodology This cross-sectional study was conducted in the Sleep Research Center at King Abdulaziz University Hospital. Polysomnography was conducted using Somnoscreen™ plus. All participants underwent flexible nasopharyngoscopy after polysomnography. Results Nasopharyngoscopy revealed that the most common site of obstruction was the nose and the soft palate (35.4%), followed by the soft palate alone (25%). Somnoscreen revealed that the site of obstruction was the nose and the soft palate in 18 (37.5%) patients and the nose alone in 16 (33.3%) patients. However, distal obstructions were not detected using Somnoscreen. The concordance of nasopharyngoscopy and Somnoscreen was 52.9%. However, it showed a discrepancy in identifying distal obstructions, which Somnoscreen™ plus failed to detect. Conclusions Somnoscreen appears to be sensitive for identifying proximal airway obstructions. The audio signal recordings can potentially be used as a tool to detect the site of airway obstruction in snoring; however, further studies are needed.

MicroCT evaluation for CAD/CAM occlusal veneer fit using two materials and three cement space settings.

This study was aimed to evaluate the fit of occlusal veneer restoration for two CAD/CAM materials with different cement space settings, using microCT scans. Sixty resin dies were made and divided into two groups (n=30) according to the materials, (I): Hybrid all-ceramic, and (II): zirconia-reinforced lithium silicate glass-ceramic. Each group was subdivided into three subgroups (n=10) according to the cement space parameters (30, 40, and 50 µm). Occlusal veneers for the six subgroups were milled. A circle with 20 different sections was placed at the center of every scanned specimen to measure four different locations (Occlusal, Axial, Marginal, and Absolute marginal discrepancy). Data were analyzed using two-way ANOVA at a 0.05 level of significance. There was no statistically significant effect of material type on the mean values of internal and marginal gaps for the three cement space parameters (P>0.05). There were no statistically significant differences in the occlusal and axial gap between the cement space parameters, furthermore, there were statistically significant differences in marginal gap distances and absolute marginal discrepancies (P>0.05). Hybrid all-ceramic showed smaller marginal and internal discrepancies than zirconia-reinforced lithium silicate glass-ceramic without statistically significant differences, and, for both materials, 50 µm cement space significantly improved the marginal fit and absolute marginal discrepancy.

MicroCT evaluation for CAD/CAM occlusal veneer fit using two materials and three cement space settings

Abstract This study was aimed to evaluate the fit of occlusal veneer restoration for two CAD/CAM materials with different cement space settings, using microCT scans. Sixty resin dies were made and divided into two groups (n=30) according to the materials, (I): Hybrid all-ceramic, and (II): zirconia-reinforced lithium silicate glass-ceramic. Each group was subdivided into three subgroups (n=10) according to the cement space parameters (30, 40, and 50 µm). Occlusal veneers for the six subgroups were milled. A circle with 20 different sections was placed at the center of every scanned specimen to measure four different locations (Occlusal, Axial, Marginal, and Absolute marginal discrepancy). Data were analyzed using two-way ANOVA at a 0.05 level of significance. There was no statistically significant effect of material type on the mean values of internal and marginal gaps for the three cement space parameters (P>0.05). There were no statistically significant differences in the occlusal and axial gap between the cement space parameters, furthermore, there were statistically significant differences in marginal gap distances and absolute marginal discrepancies (P>0.05). Hybrid all-ceramic showed smaller marginal and internal discrepancies than zirconia-reinforced lithium silicate glass-ceramic without statistically significant differences, and, for both materials, 50 µm cement space significantly improved the marginal fit and absolute marginal discrepancy.

Resumo Este estudo teve como objetivo avaliar o ajuste da restauração de facetas oclusais para dois materiais CAD/CAM com diferentes configurações de espaço de cimento, usando microCT. Foram feitos sessenta moldes de resina e divididos em dois grupos (n=30) de acordo com os materiais, (I): cerâmica pura híbrida, e (II): cerâmica de vidro de silicato de lítio reforçada com zircónia. Cada grupo foi subdividido em três subgrupos (n=10), de acordo com os parâmetros do espaço de cimento (30, 40, e 50 µm). As facetas oclusais para os seis subgrupos foram fresadas. Um círculo com 20 secções diferentes foi colocado no centro de cada amostra digitalizada para medir quatro locais diferentes (Oclusal, Axial, Marginal, e discrepância marginal absoluta). Os dados foram analisados utilizando ANOVA bidireccional a um nível de significância de 0,05. Não houve efeito estatisticamente significativo do tipo de material nos valores médios das aberturas internas e marginais para os três parâmetros do espaço de cimento (P>0,05). Não houve diferenças estatisticamente significativas no intervalo oclusal e axial entre os parâmetros do espaço de cimento, além disso, houve diferenças estatisticamente significativas nas distâncias do intervalo marginal e discrepâncias marginais absolutas (P>0,05). A cerâmica pura híbrida mostrou discrepâncias marginais e internas menores do que a cerâmica de vidro de silicato de lítio reforçada com zircónia sem diferenças estatisticamente significativas, e, para ambos os materiais, 50 µm de espaço de cimento melhoraram significativamente o ajuste marginal e a discrepância marginal absoluta.

Two is not always better than one: ST-segment elevation myocardial infarction and acute pulmonary embolism in COVID-19.

Coronavirus disease 2019 (COVID-19) has become a significant global health burden with potential consequences on the cardiovascular system. We describe a case of a healthy male with no prior cardiovascular risk factors who developed ST-segment elevation myocardial infarction and pulmonary embolism following a diagnosis of severe COVID-19 pneumonitis. The patient made a significant recovery following coronary thromboaspiration and anticoagulation therapy. Multiple mechanisms including an indirect hyperinflammatory immune response and/or direct endothelial damage may explain the prothrombotic state related to COVID-19. The cytokine storm leads to endothelial dysfunction and subsequent thromboembolism. Awareness of the lethal cardio-pulmonary sequalae of COVID-19 is important as surges continue across the world owing to new variants.