Stress distribution pattern in two different no-post systems in endodontically treated maxillary central incisors: A three-dimensional finite element analysis.

Aim: This study aimed to evaluate the stress distribution in an endodontically treated tooth restored with two different reinforcing fibers followed by direct composite restoration using a finite element analysis (FEA). Settings and Design: FEA. Subjects and Methods: Two three-dimensional models of endodontically treated maxillary central incisors were restored with two reinforcing fibers: the polyethylene fibers (PFs) and the short fiber-reinforced composite (SFRC), respectively. The restoration was carried out without any intraradicular preparation using direct composite restoration. The models were generated using SolidWorks. The elastic modulus and Poisson's ratio for various structures and materials were installed into the simulation software, Abaqus. A FEA was then conducted. Each model received a mixed-mode loading of 150 N as distributed pressure to the specified region, and stress distribution was evaluated using the von Mises criteria. Results: Both the reinforcing materials, PF and SRFC, showed maximum concentration of stresses in the cervical third of the tooth. The calculated values of the von Mises stresses for the PF and the SFRC models were 1.7 Mpa and 1.9 Mpa, respectively. Moreover, the stresses generated were of low intensity and were uniformly distributed, suggesting that by using this technique, stresses may be very well tolerated by the remaining tooth structure without any fracture. Conclusion: This no-posttechnique, using the two reinforcing fibers, showed minimal stress concentration in the cervical region of the tooth. Thus, using this ultraconservative approach that aims to preserve and reinforce the pericervical dentin and restore the remaining tooth structure with direct composite restoration could be a promising treatment option for the rehabilitation of badly mutilated teeth.

Maternal Experiences during Pregnancy, Delivery, and Breastfeeding Practices: A Community-based Analytical Cross-sectional Study.

Background: Evidence on variation in the information provided to mothers during antenatal and postnatal periods, its influence on breastfeeding awareness, and practice in urban and rural settings of India is scarce. The aim of the study was to assess the variation in mothers experience during pregnancy, delivery, and maternity period across settings and its influence on breastfeeding practices in the first six months of infants' life. Methods: A community-based analytical cross-sectional study was carried out in urban and rural settings of Coimbatore, Tamil Nadu, among 800 mothers who had delivered between one year and six months before the date of the survey using simple random sampling. Results: The proportion of mothers with less than four antenatal visits were significantly higher in urban areas (urban vs rural, 11.4% vs 6.2%). The mean scores for positive experiences during pregnancy (MD -0.99, 95% CI -1.31 to -0.69), experiences during birth and maternity period (MD -0.59, 95% CI -0.83 to -0.35) were significantly lower in the urban areas compared to rural areas. The prevalence of exclusive breastfeeding was 75.8% and 85.0% in urban and rural areas, respectively. Mothers not satisfied with experiences during delivery and maternity period (OR 1.69, 95% CI 1.18 to 2.42) and from urban areas (OR 1.81, 95% CI 1.27 to 2.59) were at significantly increased risk of nonexclusive breastfeeding. Conclusion: The present study showed that mothers from urban areas were not provided with appropriate, adequate, and timely information by the healthcare providers. It is the need of the hour to train and motivate healthcare providers regarding maternal awareness of antenatal, intranatal, and postnatal care practices including breastfeeding and infant care.

Prevalence and factors associated with cyberbullying among adolescents (15-19 years) in Gurugram District - A community based cross-sectional study.

Background: Digitalization in the form of increased Internet use through screen media has also shown its ramification like cyberbullying. They are aggressive acts with the intention or motivation to harm another person through technology. The aim is to study the prevalence of cyberbullying and its association with mental illness in the adolescent age group (15-19 years). Methods: This community-based cross-sectional study was rolled out among adolescents aged 15-19 years. A total of 387 were given a semistructured interviewer-administered questionnaire consisting of general details, cyberbullying victimization, and offending questions, PHQ-9 and GAD-7. Results: The mean (SD) age was 16.8 (1.3) years. More than half (53.2%) were males, and nearly three-fourths (74.4%) were school-going. Around 28.2% reported being cyberbullied at least once in their lifetime. About 7.0% of adolescents were cyberbullied more than once, and 0.8% more than five times in the past 30 days. The most common ways were posting a mean or hurtful picture (31.9%) and the concerned person's comments (24.2%) online. Multivariable logistic regression analysis found that adolescents attending colleges (AOR 1.9, 95% CI 1.1 to 3.4), using tobacco (AOR 2.5, 95% CI 1.4 to 4.5), and depressed (of any severity, AOR 2.0, 95% CI 1.1 to 4.3) were at significantly increased risk of being cyberbullied (P < 0.05). Conclusion: The prevalence of cyberbullying among adolescents aged 15-19 is notable, with significant associations found between cyberbullying and attending college, tobacco use, and depression. Understanding the correlates of cyberbullying can inform targeted interventions to support mental health and well-being among adolescents.

Comparison between dexmedetomidine and lidocaine for attenuation of cough response during tracheal extubation: A systematic review and meta-analysis.

Background and Aims: Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients. Methods: A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias. Results: In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group. Conclusion: This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.

Technologies that empower women for better access to healthcare in India - A scoping review.

Women from low- and middle-income countries face challenges in accessing and utilising quality healthcare. Technologies can aid in overcoming these challenges and the present scoping review is aimed at summarising the range of technologies used by women and assessing their role in enabling Indian women to learn about and access healthcare services. We conducted a comprehensive search from the date of inception of database till 2022 in PubMed and Google Scholar. Data was extracted from 43 studies and were thematically analysed. The range of technologies used by Indian women included integrated voice response system, short message services, audio-visual aids, telephone calls and mobile applications operated by health workers. Majority of the studies were community-based (79.1%), from five states (60.5%), done in rural settings (58.1%) and with interventional design (48.8%). Maternal and child health has been the major focus of studies, with lesser representation in domains of non-communicable and communicable diseases. The review also summarised barriers related to using technology - from health system and participant perspective. Technology-based interventions are enabling women to improve awareness about and accessibility to healthcare in India. Imparting digital literacy and scaling up technology use are potential solutions to scale-up healthcare access among women in India.

Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study.

OBJECTIVES: The primary objectives were to determine the proportion of modern menstrual method (MMM) users among college going women in Coimbatore district, Tamil Nadu; and to estimate the unmet needs associated with use of MMMs in comparison with other menstrual hygiene methods (MHMs). We also assessed the factors that determine MMM use among college going women. METHODS: This was a descriptive cross-sectional study conducted among college going women in Coimbatore district, Tamil Nadu, India between October 2022 and January 2023 using a purpose predesigned, pretested, semi-structured proforma that included validated Menstrual Practice Needs Scale (MPNS-36). RESULTS: Only 1.4% of the study participants used MMMs - menstrual cups (1.3%) and tampons (0.1%). Sanitary pads were the most common MHM of choice (96.3%); of which majority (98.6%) used disposable pads and more than half (50.4%) used non-biodegradable pads. Importantly, one in six (16.5%) were not aware of nature of sanitary pads (biodegradable or nonbiodegradable) used. The unmet needs associated with MMMs (menstrual cups and tampons) were significantly lower than that for other MHMs (including sanitary pads), in particular, the unmet material and home environment needs, unmet material reliability concerns, unmet reuse needs and unmet reuse insecurity. However, we found no significant difference between MMMs, sanitary pads and other MHMs in terms of unmet transport, college environment, change and disposal insecurity needs. The significant predictors of use of MMMs were age (more than 21 years of age), residence (urban), type of stay (off campus including home), socioeconomic status (upper), fathers' and mothers' education (high school and above), and presence of personal income. Discussions with friends (or peers) both before and after menarche regarding menstruation resulted in higher adoption of modern menstrual methods. CONCLUSION: MMMs provided comparative advantage with lesser unmet needs for material reliability and reuse insecurity concerns, particularly in home environment. However, none of the MHMs fulfilled the user expectations for transport and disposal insecurity concerns, particularly outdoors.

Chemical technology principles for selective bioconjugation of proteins and antibodies.

Proteins are multifunctional large organic compounds that constitute an essential component of a living system. Hence, control over their bioconjugation impacts science at the chemistry-biology-medicine interface. A chemical toolbox for their precision engineering can boost healthcare and open a gateway for directed or precision therapeutics. Such a chemical toolbox remained elusive for a long time due to the complexity presented by the large pool of functional groups. The precise single-site modification of a protein requires a method to address a combination of selectivity attributes. This review focuses on guiding principles that can segregate them to simplify the task for a chemical method. Such a disintegration systematically employs a multi-step chemical transformation to deconvolute the selectivity challenges. It constitutes a disintegrate (DIN) theory that offers additional control parameters for tuning precision in protein bioconjugation. This review outlines the selectivity hurdles faced by chemical methods. It elaborates on the developments in the perspective of DIN theory to demonstrate simultaneous regulation of reactivity, chemoselectivity, site-selectivity, modularity, residue specificity, and protein specificity. It discusses the progress of such methods to construct protein and antibody conjugates for biologics, including antibody-fluorophore and antibody-drug conjugates (AFCs and ADCs). It also briefs how this knowledge can assist in developing small molecule-based covalent inhibitors. In the process, it highlights an opportunity for hypothesis-driven routes to accelerate discoveries of selective methods and establish new targetome in the precision engineering of proteins and antibodies.

Functioning of a Nutritional Rehabilitation Center against acceptable levels of care.

Background: Establishment of Nutritional Rehabilitation Centers (NRCs) is an initiative under National Rural Health Mission to provide institutional care for children with severe acute malnutrition (SAM). The aim of the study was to assess the effectiveness of nutritional interventional measures in improving the nutritional status of children admitted to an NRC. Methods: A retrospective health facility-based descriptive study was conducted in the NRC, Rural Health Training Center, All India Institute of Medical Sciences, Raipur. Results: A total of 765 children were enrolled in the NRC between March 2015 and November 2019, and majority (87.97%) were admitted as per weight for height/length (<-3SD) criteria. The total number of SAM children with complications were 428 (55.94%). Of the 724 total discharges, 498 (68.78%) were cured, 197 (27.2%) were nonresponders and 28 (3.87%) were defaulters. Conclusion: The findings suggest factors affecting nutritional rehabilitation that are complex and require a more integrated management in the health system and community. Regular review, supportive supervision and identification of nutrient-dense food from locally available low-cost ingredients is the need of the hour.

Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review.

Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children.

Depression among older adults in an urban slum of Raipur city - a community based cross-sectional study.

BACKGROUND: Older adults are at risk of chronic, silent depressive changes and the vulnerability of older adults in urban slums of India is rarely exposed. The objective of this study was to estimate the prevalence of depression among the older adults in the urban slums of India and to study the factors associated with it. METHODS: This was a community based analytical cross-sectional study conducted in Urban Field Practice Area of a tertiary care teaching hospital in Chhattisgarh, India among older adults more than or equal to 60 years of age selected using two stage, simple random sampling. The data was collected in a sample of 400 older adults by face-to-face interview using self-designed, semi-structured and pretested proforma that included validated Hindi version of Geriatric Depression Scale (GDS-15) and analyzed using SPSS v23. RESULTS: The prevalence of depression among older adults was 51.5% in the present study; with 27%, 12.8% and 11.8% having mild, moderate and severe depression respectively. Number of family members, living status of spouse, emotional attachment to family members, conflict in family, loneliness, social isolation, marginal friendship ties, functional status, physical exercise, active complains and diastolic BP were independent predictors of depression in older adults. CONCLUSION: Early identification of depression in older adults using GDS-15 and incorporation of social isolation and functionality assessment routinely by healthcare providers for all older adults attending the outpatient departments is the need of the hour. A holistic approach to care of older adults is vital as healthcare providers seek to understand the impact of multiple, complex, interconnected factors on overall health and well-being of older adults.

The Biogenetic Synthesis of Metallic Nanoparticles and the Role They Play in Anti-inflammatory Drug Treatment.

BACKGROUND: Nanoscience and nanotechnology have resulted in the continuous development of new nanomaterials with remarkable properties that make them appealing for pharmaceutical applications. The biocompatibility of metallic nanoparticles is of increasing interest for research scientists currently working towards developing novel nano-based medicines, industrial chemicals, and antigens. There is also a particular interest in using them to counter mutations that up-regulate inflammation enhancers to produce a range of inflammation-related pathologies. AIM: The following review discusses the anti-inflammatory mechanisms of metallic bioconjugated (silver, gold, zinc oxide, titanium dioxide, and selenium) nanoparticles. The current study focuses on nanoparticle manufacturing technologies and the inflammatory response. METHODOLOGY: A thorough search was conducted in several databases, including Scopus, Embase, Cochrane, and PubMed. The search terms used included: Alzheimer's disease, mechanism of action, neuroinflammation, the reaction of Mast cells to stress and neuroinflammation. The study included all publications published in English. RESULTS: Green-synthesised nanoparticles can suppress the NF-B and cyclooxygenase-2 pathways, preventing the production of proinflammatory cytokines and ROS scavenging mechanisms. Metallic nanoparticles with anti-inflammatory properties, such as stability and specific targeting, have been briefly discussed. CONCLUSION: The current research focuses on metallic nanoparticles employed as anti-inflammatory medication molecules, although nanoparticles have applications in various areas (medicine, chemical engineering, and agriculture). Nanoparticles have a large surface-to-volume ratio, which can help them to penetrate cell membranes, and because of their solid ligand-binding capabilities, nanoparticles have been used in the medical treatment of inflammatory pathologies.

EGFR Expression in Gallbladder Carcinoma in North Indian Population.

OBJECTIVE: Gallbladder carcinoma is the most frequent biliary tract carcinoma with over all very poor prognosis. Epidermal growth factor receptor (EGFR) is known to be involved in carcinogenesis and overexpressed in various malignancies including head and neck, breast, lung and colon carcinomas. This study was done to explore the expression of EGFR in gallbladder carcinoma cases in the north Indian population so that it may be used as a therapeutic target in these patients. MATERIALS AND METHODS: 59 cases of gallbladder carcinoma diagnosed by histopathological examination were included in study. Expression of EGFR was seen by immunohistochemistry method on histopathology slides. RESULTS: Out of 59 gallbladder carcinoma cases 46 (78%) were female and 13 (22%) were male with female to male ratio of 3.54:1. Mean age was 51.71±11.32 years. On histopathological examination 51 (86.4%) cases were conventional adenocarcinoma, 2 (3.4%) adenosquamous carcinoma, 2 (3.4%) mucinous adenocarcinoma, 2 (3.4%) papillary adenocarcinoma, 1 (1.7%) signet ring cell carcinoma and 1 (1.7%) squamous cell carcinoma histological subtypes. EGFR expression was present in 31 (52.5%) of gallbladder carcinoma cases and strong EGFR expression was significantly associated with poor differentiation of tumour. CONCLUSION: In our study EGFR was positive in the majority of gallbladder carcinoma cases. There was inverse correlation between differentiation of tumor and EGFR expression. Strong EGFR expression was significantly higher in poorly differentiated tumors compared to well differentiated tumors suggesting its role in prognosis. This also suggest that EGFR might have a role in tumor progression and aggressiveness. Therefore, EGFR have potential to be used as therapeutic target in significant number of patients. More larger sample studies are required to confirm our findings. EGFR may be further studied as therapeutic target in clinical trials in the Indian population to improve morbidity and mortality of gallbladder carcinoma patients. KEY WORDS: EGFR Expression, Gallbladder Carcinoma, Immunohistochemistry, Targeted Therapy.

Spousal Violence among Reproductive Age Group Women - A Community-Based Cross-Sectional Study.

Background: Spousal or intimate partner violence is the most common form of domestic violence and is a preventable cause of morbidity and mortality in women. The aim of this study was to estimate the prevalence of spousal violence, various types of spousal violence, and the factors associated with it among reproductive age group women. Materials and Methods: This was an analytical cross-sectional study conducted in the Urban Health Training Center area of a tertiary care teaching hospital in Nagpur, India, among married women between 15 and 49 years of age who were selected using systematic random sampling. The data was collected from a sample of 373 women by face-to-face interview and analyzed using Statistical Package for the Social Sciences (SPSS) v21. Results: The prevalence of spousal violence among reproductive age group (15-49 years) women was found to be 59.7%, with emotional violence (54.1%) being the most common, followed by physical (51.2%) and sexual (43.4%) violence in that order. Regular alcohol consumption of husband had the highest odds of spousal violence among women (odds ratio [OR] 12.51, 95% confidence interval [CI] 6.51-24.03). Other factors associated with spousal violence among reproductive age group women were early age at marriage, literacy and employment of women and husband, lack of emotional support from the family members, and dowry-related problems in the family. Conclusion: A multifaceted approach including legal measures, empowerment of women, and sociocultural factors involving families, institutions, governmental, nongovernmental, and civil society organizations is the need of the hour.

Combination-type periprosthetic tibial fracture: Felix type (II+IV)A.

Tibial periprosthetic fractures are rare but present a complicated problem for orthopaedic surgeons. Literature in relation to combination-type periprosthetic fractures is extremely scarce, and there is limited guidance available on its treatment. We report the case of a woman in her 60s, whose radiographs revealed a periprosthetic fracture of the tibia, which was a Felix type (II+IV)A fracture. The tibial tuberosity fragment was fixed with a cannulated cancellous screw. The fracture adjacent to the stem was managed conservatively as the prosthesis was stable. Follow-up radiographs revealed both fractures to have healed completely by 12 weeks. The patient returned to preinjury functional levels by 4 months. Our demonstrated treatment of a Felix type II+IV periprosthetic fracture could be a viable treatment option for such fractures.

Disintegrate (DIN) Theory Enabling Precision Engineering of Proteins.

The chemical toolbox for the selective modification of proteins has witnessed immense interest in the past few years. The rapid growth of biologics and the need for precision therapeutics have fuelled this growth further. However, the broad spectrum of selectivity parameters creates a roadblock to the field's growth. Additionally, bond formation and dissociation are significantly redefined during the translation from small molecules to proteins. Understanding these principles and developing theories to deconvolute the multidimensional attributes could accelerate the area. This outlook presents a disintegrate (DIN) theory for systematically disintegrating the selectivity challenges through reversible chemical reactions. An irreversible step concludes the reaction sequence to render an integrated solution for precise protein bioconjugation. In this perspective, we highlight the key advancements, unsolved challenges, and potential opportunities.

Biosorption of methylene blue dye using a novel chitosan pectinase blend.

Biosorption is a key phenomenon that has been used to remove the aquatic pollutants like dyes and heavy metals present in industrial effluents. The current study aims at the development of a chitosan-pectinase blend (CPB) to separate the methylene blue (MB) dye from its synthetic solution. Pectinase, an enzyme isolated from a consortium of Bacillus species, is imbibed in the blend. The electron micrographs revealed the rough surface of the adsorbent, and its amorphous nature was evident from broader peaks in diffraction patterns. The FTIR analyses indicated the perfect blend formation through the presence and shifts in the characteristic peaks. Maximum adsorption was exhibited at pH 7.0, 30 °C, 30 min of contact time and an adsorbent dosage of 2.5 g/L. On comparison, the pseudo-second-order model was found to be the suitable fit with the highest R2 value closer to 1. Different isotherm models were experimentally fitted and the maximum adsorption capacity was obtained at 16.81 mg/g and the Temkin isotherm suits the best. The polymer blend showed an agreeable extent of desorption of MB dye which was evident from the desorption studies and, thereby, the biosorbent could be reused for removing the dye to the maximum extent.

Sepsis screening tools for predicting infection triggers and outcomes in diabetic ketoacidosis.

Background: An early prediction of infection is challenging in diabetic ketoacidosis (DKA). Methods: This prospective cohort study aimed to assess effectiveness of various sepsis screening tools in predicting infections and prognosis in DKA. Results: Among 141 cases, infection (44.0%) was the commonest precipitating factor. A Sequential Organ Failure Assessment score ≥4 showed high specificity (82.28%) and high positive likelihood ratio (2.64) but limited sensitivity (46.77%). Conversely, Systemic Inflammatory Response Syndrome ≥2 exhibited good sensitivity (95.16%) but a high false-positive rate (84.28%). National Early Warning Score ≥7 and Quick Sequential Organ Failure Assessment ≥2 had low sensitivity and specificity. These sepsis tools also demonstrated low prognostic accuracy for mortality. Conclusion: Sepsis screening tools have limited predictive accuracy for infections and mortality in DKA.

Various clinical tools, including the Sequential Organ Failure Assessment score, Quick Sequential Organ Failure Assessment score, Systemic Inflammatory Response Syndrome criteria and the National Early Warning Score, are used to identify serious infections. This study examined the effectiveness of these tools in patients with diabetic ketoacidosis (DKA), a serious diabetes complication. The study involved 141 patients from north India, and nearly half of them had infections such as pneumonia and urinary tract infections. The researchers found that these tools were not highly effective in identifying infections or predicting deaths among DKA patients at the time of hospital admission. The study suggests that doctors need better ways to diagnose infections in DKA, including more thorough clinical evaluations and advanced tests.

Short-axis versus long-axis approach for ultrasound-guided vascular access: An updated systematic review and meta-analysis of randomised controlled trials.

Background and Aims: There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen which approach is better. Therefore, we performed the present updated systematic review and meta-analysis to assess the effectiveness and safety of US-guided vascular cannulation between the SA and LA techniques. Methods: We performed a comprehensive electronic database search in PubMed, Embase, Cochrane Library and Web of Science for the relevant studies from inception to June 2022. Randomised controlled trials comparing the SA approach and the LA approach for US-guided vascular access were incorporated in this updated meta-analysis. The first-attempt success rate was the primary outcome. The secondary outcomes were the overall success rate, cannulation time, number of attempts and the incidence of complications. The statistical analysis was conducted using RevMan software (version 5.4; the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). The Cochrane risk of bias tool was used to evaluate each study's potential risk for bias. Results: In total, 16 studies consisting of 1885 participants were incorporated in this updated meta-analysis. No statistically significant difference was found between the SA and LA vascular access techniques for first-pass success rate (risk ratio = 1.07, 95% confidence interval: 0.94-1.22). The overall cannulation success rate, complication rate, average cannulation time and average number of attempts were not significantly different between the SA and LA groups. Conclusion: This updated meta-analysis demonstrated that the SA and LA approaches of US-guided vessel cannulation are similar regarding first-pass success, overall cannulation success rate, total complication rate, cannulation time and the number of attempts.

An in vitro comparison of incisal preparation design on load-to-failure of ceramic veneers.

Introduction: This in vitro study aimed to compare the load-to-failure values of two different ceramic veneers (IPS e.max Press [Ivoclar Vivadent] and Vintage lithium disilicate [LD] press [Shofu]) with incisal preparation designs under standardized conditions. Materials and Methods: Twenty-two intact extracted maxillary incisors were selected and divided randomly into two groups (n = 11). The veneer tooth preparation was standardized in both groups where a butt joint incisal preparation was done along with chamfer margin. Group 1 included veneers made from IPS e.max Press (Ivoclar Vivadent) and Group 2 included veneers fabricated from Vintage LD Press (Shofu). Veneers were luted to their respective abutment teeth using standardized bonding protocols and resin cement for both groups. Later, every specimen was loaded to failure utilizing a universal testing machine, and the outcomes were noted in Newtons (N). Results: The mean load-to-failure value obtained for Group 1 (IPS e.max Press) was 1386.46 N while that obtained for Group 2 was 1777.07 N. Statistically significant difference was found in this intergroup comparison (P = 0.006). Conclusion: The load-to-failure value of Vintage LD Press veneers (Shofu) was greater than that of IPS e.max Press veneers (Ivoclar Vivadent).