Prosthetic Rehabilitation Following Lateral Resection of the Mandible with a Long Cantilever Implant-Supported Fixed Prosthesis: A 3-Year Clinical Report

This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever

The benefits of parametric design methodology in developing structural solutions for metal furniture

The parametric design methodology is an updated methodology that aims to employ computer design programs (such as Maya and Rhino programs) to find a new and important design pattern that appeared after modernity. It takes care of finding a suitable design for various areas of life, starting with architecture, product design, passing through metal furniture and the smallest details of treatments. Automatically, which saves effort and time, and is unique in its smooth handling of complex blocks and highly complex structural systems in the design of metal furniture to employ these concepts in impressive designs of very complexity adapted to the era, and is characterized by the possibility of obtaining from it a dynamic design as well as sustainable design through the principle of re-employment and the use of materials, making it an almost integrated design. This research aims to clarify the role of the parametric design methodology in upgrading the design of metal furniture. The design thinking of metal furniture has evolved from the traditional approach to the parametric design methodology, and the research found that parametric furniture is now manufactured using algorithmic thinking through certain parameters and variables that are renewable and implementable, where products are made on solid supports with unconventional creative flowing shapes. The parametric design methodology gives each metal furniture design a great level of adaptability to different materials, tools and individual preferences. The parametric design methodology for manufacturing enables manufacturers anywhere to download the design file, and modify the design to suit local materials, available CNC tools, or any specific uses or need

Risk assessment of power system transient instability incorporating renewable energy sources

Transient stability affected by renewable energy sources integration due to reductions of system inertia and uncertainties associated with the expected generation. The ability to manage relation between the available big data and transient stability assessment (TSA) enables fast and accurate monitoring of TSA to prepare the required actions for secure operation. This work aims to build a predictive model using Gaussian process regression for online TSA utilizing selected features. The critical fault clearing time (CCT) is used as TSA index. The selected features map the system dynamics to reduce the burden of data collection and the computation time. The required data were collected offline from power flow calculations at different operating conditions. Therefore, CCT was calculated using electromagnetic transientsimulation at each operating point by applying self-clearance three phase short circuit at prespecified locations. The features selection was implemented using the neighborhood component analysis, the Minimum Redundancy Maximum Relevance algorithm, and K-means clustering algorithm. The vulnerability of selected features tends to result great variation on the best features from the three methods. Hybrid collection of the best common features was used to enhance the TSA by refining the final selected features. The proposed model was investigated over 66-bus system

Antioxidant and cardioprotective activity of Stachys schimperi Vatke against doxorubicin-induced cardiotoxicity

AbstractCardiotoxicity is one of the major side effects of anthracycline antibiotics. Most studies implicated increased oxidative stress as the major determinant of doxorubicin (DOX) cardiotoxicity. The aim of the current investigation was to study the possible cardioprotective effect of Stachys schimperi Vatke (family Lamiaceae) on DOX-induced cardiotoxicity in rats based on biochemical and histopathological parameters. The phenolic profile of the methanol extract was determined qualitatively by HPLC. Isoscutellarein 7-O-[2″-O-(6″′-acetyl)-β-d-allopyranosyl]-β-d-glucopyranoside (compound 1) was isolated and identified from EB fraction as a major constituent for the first time from this Stachys species. The methanolic extract and the combined EtOAc and n-butanol fractions (EB) as well as compound 1 showed prominent free radical scavenging activity when assessed by the DPPH method. The methanolic extract showed moderate protection against DOX-induced alteration in cardiac oxidative stress markers; GSH and MDA, and cardiac serum markers; CK-MB and LDH activities. Additionally, histopathological study denoted mild protection against DOX-induced cardiotoxicity.It was concluded that Stachys schimperi Vatke methanolic extract protected against DOX-induced cardiotoxicity, at least in part, by virtue of its antioxidant activity

Study on the Effect of the addition of Synthesized Nano scale Lead Oxide for Concrete Samples used in Gamma-Ray Shielding

Our goal in this research is to investigate the effect ofconcrete incorporated with nanoparticles of lead oxide inpowder form by different percentages on Gamma-ray shieldingcharacteristics. The lead oxide nanostructure was synthesizedthrough the reaction of citric acid (C6H7O8.H2O) solution andlead acetate (Pb (C2H3O2)) solution as stabilizer and precursor,respectively. In this synthesis, the prepared lead oxidenanostructure was characterized by X-Ray Diffraction (XRD)and Scanning Electron Microscopy (SEM) techniques. Theprepared PbO consists of the crystallites about 50 nm. Theconcrete samples were prepared according to the localstandards of building materials and doped with PbO nanopowders by different percentages, 0%, 5%and 10% (by weight)by replacing cement and keeping constant w/c ratio. Moreover,commercial PbO bulk powder additive was used to check theeffect of particle size on concrete attenuation properties. The γ-rays attenuation coefficients were measured as a function of theadditive percentage of nanoparticles of lead oxides and using γ-ray point source,126Ra with different energies in the range(0.295- 1.73) MeV. The results were compared with that fornormal concrete incorporated with the same percentage of bulklead oxide. It was found that the γ-ray attenuation coefficientfor concrete doped with nanoparticles of PbO was slightlyimproved

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe