The Effect of Bevel on Fracture Resistance of GIC Restorations in Primary Molars: In Vitro Study Rôle du Biseau dans la Résistance à la Fracture des Restaurations aux Ciments Verres-Ionomères des Molaires Temporaires : Étude In Vitro

Background: Glass ionomer cements (GICs) are commonly used for restorations in primary molars due to their adhesive, hydrophilic, and bioactive properties. However, their low mechanical resistance may limit their use in proximal cavities. Recent advancements in GICs, such as the high viscosity GIC EQUIA Forte®, have improved their mechanical properties. The effect of a Cavo superficial bevel on the mechanical strength of GIC restorations has been previously studied. Objectives: To investigate the effect of a Cavo superficial bevel on fracture resistance and the type of fracture (adhesive, cohesive, or catastrophic) in EQUIA Forte® GIC restorations in primary molars. Methods: 56 standardized proximal cavities were created on 51 temporary molars. The cavities were randomly divided into two groups: group I without a Cavo superficial bevel (n=28) and group II with a 45° Cavo superficial bevel (n=28). The cavities were restored with EQUIA Forte®. The samples were subjected to thermocycling and artificial aging, then, an axial speed loading of 1 mm/min was applied until fracture. Fracture toughness was recorded, and the type of fracture was observed under an optical microscope. A Mann-Whitney U test was used to compare the average fracture resistance between the groups. All tests were two-tailed and the level of significance was set at 5%. Results: The average fracture resistance for group I was (237.57 ± 139.97 N) and for group II was (294.89 ± 171.07 N). There was no statistically significant difference in fracture resistance between the two groups (p\u3e0.05). Mixed fractures were observed in all samples, with adhesive fractures only present in group I and cohesive fractures only present in group II. Conclusion: The Cavo superficial bevel does not significantly affect the fracture resistance of GIC restorations in primary molars. However, the bevel design may prevent adhesive and catastrophic fractures. Contexte : Les ciments verres-Ionomères (CVI) sont couramment utilisés pour les restaurations des molaires temporaires grâce à leurs propriétés adhésives, hydrophiles et bioactives. Cependant, leur faible résistance mécanique limite leur utilisation dans les cavités proximales. Avec les récents progrès de cette classe de matériaux, un CVI à haute viscosité a été introduit : EQUIA Forte®, visant à améliorer leurs propriétés mécaniques. Le rôle du biseau cavo-superficiel sur la résistance mécanique des restaurations au CVI a déjà été étudié. Objectifs : Tester le rôle du biseau dans l’amélioration de la résistance à la fracture et d’étudier la nature du trait de fracture adhésif, cohésif, ou catastrophique des restaurations aux CVI EQUIA Forte® des molaires temporaires. Méthodes : 56 cavités proximales standardisées ont été réalisées sur 51 molaires temporaires. Ces cavités ont été divisées aléatoirement en deux groupes : groupe I sans biseau cavo-superficiel (n=28) et groupe II avec biseau cavo-superficiel de 45° (n=28). Les cavités ont été restaurées par EQUIA Forte®. Les échantillons ont été soumis à un thermocyclage et à un vieillissement artificiel, puis une vitesse axiale de chargement de 1 mm/min a été appliquée jusqu\u27à la fracture. La résistance à la fracture a été enregistrée et le type de fracture a été observé au microscope optique. Le test de Mann-Whitney U a été utilisé pour comparer la résistance moyenne à la fracture entre les groupes. Tous les tests étaient bilatéraux et le niveau de signification a été fixé à 5 %. Résultats : La résistance moyenne à la fracture pour le groupe I était de (237,57 ± 139,97 N) et pour le groupe II était de (294,89 ± 171,07 N). Il n\u27y avait pas de différence statistiquement significative en termes de résistance à la fracture entre les deux groupes (p \u3e 0,05). Cependant, des fractures mixtes ont été observées dans tous les échantillons, les fractures adhésives étant uniquement présentes dans le groupe I et les fractures cohésives présentes uniquement dans le groupe II. Conclusion : Le biseau cavo-superficiel n\u27influence pas de manière significative la résistance à la fracture des restaurations CVI des molaires temporaires. Cependant, il s’est avéré que la conception du biseau empêche les fractures adhésives et catastrophiques d’avoir lieu. Mots clés : Biseau, CVI, Classe II, Molaires Temporaires, Restauration, Type de fractur

Validity of chronic obstructive pulmonary disease diagnoses in a large administrative database,”

H ealth authorities (often the payers of health care) create and maintain administrative databases by compiling claims data sets. Claims data include the patient diagnosis that motivated the provision of services and the charges paid for the services provided. Typically, the database includes patient demographics and patient-level data about their use of health care resources. Administrators and health care researchers can access the information in these databases to ascertain resource use, even if it involved several providers and health care centres (1-3). When one payer reimburses all health care provisions, these databases afford the opportunity to conduct large populationbased observational studies with minimal referral bias, nonresponse and drop-outs. Similar to other investigators, we were interested in exploiting such a database for a series of studies that could answer health services questions (eg, utilization or quality of care) and clinical questions related to chronic obstructive pulmonary disease (COPD). Before doing so, we considered the underlying validity of the diagnoses included in the database. The objective of the present study was, therefore, to determine the extent to which the principal diagnoses of COPD made in hospitalized patients and recorded in a large administrative database were valid, ie, corroborated by clinical history (including smoking status) and pulmonary function tests

Gender role orientation is associated with health-related quality of life differently among African-American, Hispanic, and White youth

PurposeThis study examined the association between gender role orientation (GRO) and health-related quality of life (HRQOL) in youth, and how this relationship may differ between males and females as well as among African-American, White, and Hispanic individuals. GRO has been reported to influence serious health outcomes including cancer, heart disease, mental illness, and mortality rates. However, few studies have examined the link between GRO and health outcomes for children, even though gender identity is formed in childhood.MethodsData were examined from 4824 participants in the Healthy Passages™ project, a population-based survey of fifth-grade children in three US metropolitan areas. Children reported their own HRQOL using the PedsQL and degree of female, male, and androgynous GRO using the Children's Sex Role Inventory.ResultsBased on structural equations analysis, male GRO was positively associated with HRQOL for all racial/ethnic groups, regardless of sex, whereas female GRO was associated with better HRQOL for Hispanic and White females and poorer HRQOL for Hispanic males. Androgynous GRO was associated with better HRQOL among Hispanic and White females, but not males nor African-Americans of either sex.ConclusionsRacial/ethnic differences emerged for female and androgynous, but not male, GROs. Hispanic males are the only group for which GRO (female) was associated with poorer HRQOL. Future research should find ways to help youth overcome negative effects on health from gender beliefs and behavior patterns with sensitivity to racial/ethnic membership

Potential Curative Effects of Aqueous Extracts of Cissus quadrangularis (Vitaceae) and Jatropha gossypiifolia (Euphorbiaceae) on Acetaminophen-Induced Liver Injury in Mice

ABSTRACT: Background: Acetaminophen-induced liver injury remains a significant public health problem because available treatments are limited due to their adverse effects. Medicinal plants, which are an important source of bioactive molecules, could be an alternative treatment for liver disease. Objective: This study was designed to investigate the curative effect of aqueous extracts of Cissus quadrangularis (Vitaceae) and Jatropha gossypiifolia (Euphorbiaceae) on acetaminophen-induced liver injury in mice. Methods: Mice were divided into groups and treated with distilled water, silymarin (50 mg/kg), a reference hepatoprotective agent, and aqueous extracts of C quadrangularis and J gossypiifolia (50 and 100 mg/kg, PO, respectively). These substances were given as a single daily dose 4 hours after acetaminophen administration (300 mg/kg, PO) for 2 days. Mice were humanely put to death 24 hours after the last dose and serum alanine aminotransferase and aspartate aminotransferase activities, total bilirubin and protein levels, reduced glutathione, superoxide dismutase, malondialdehyde, catalase, and nitrite tissue levels were assessed. Histology of the livers of the mice was performed by hematoxylin and eosin staining. Results: Acetaminophen administration induced a significant (P < 0.05) mean (SEM) body weight loss (–14.45% [5.92%]), a significant elevation of alanine aminotransferase activity (15.08%), total protein and bilirubin levels (25.80%), and a significant (P < 0.05) increase in liver superoxide dismutase (67.71%), catalase (63.00%), glutathione (40.29%), malondialdehyde (30.67%), and nitrite levels compared with the control group. In curative treatment, C quadrangularis and J gossypiifolia (50 and 100 mg/kg) significantly (P < 0.05) reduced mean (SEM) body weight loss (16.67% [7.16%] and 1.25% [0.51%], respectively), serum alanine aminotransferase activity (17.62% and 11.14%, respectively), bilirubin level (29.62% and 49.14%, respectively) compared with acetaminophen group, and J gossypiifolia normalized serum total protein level. Both extracts significantly (P < 0.05) reduced the levels of glutathione and malondialdehyde and normalized that of nitrite, superoxide dismutase, and catalase compared with the acetaminophen group. Hepatocyte necrosis and inflammatory cell infiltration were remarkably reduced by the plant extracts. Conclusions: The results obtained are evidence in favor of the development of a formulation based on the extracts of these plants against liver diseases

Does Spinal Surgery in Elderly Patients (Over 80 Years-Old) Lead to More Early Post-Operative Complications Than Lower Limb Prosthetic Surgery?

Purpose: Patients and surgeons may be reluctant on spinal surgery over 80 years old, fearing medical complications despite the possible improvement on quality of life. However, fewer reservations for lower limb prosthetic surgery (LLPS) seem to be arisen in this population. Is spinal surgery after 80 years-old responsible of more complications than lower limb surgery? Methods: The consecutive files of 164 patients over 80 years that had spinal surgery or LLPS were analyzed. The data collected pre-operatively were demographic, clinical and post-operatively the number and types of medical complications and length of stay. Results: The mean number of medical complications was 1.11 ± 0.6 [0–6] for spinal surgery and 1.09 ± 1.0 [0–3] for LLPS, ( p  = 0,87). The length of stay in orthopedic unit was comparable between the two groups: 10.7 ± 4.9 days [2–36] for SS and 10.7 ± 3.0 days [5–11] for LLPS ( p  = 0,96). Conclusion: The global rate of peri-operative complications and the length of hospital stay were similar between spinal surgery and lower limb prosthetic surgery. These results may be explained by the rising cooperation between geriatric specialist and surgeons and the development of mini-invasive surgical technics, diminishing the early post-operative complication rates

Progress on impoverishing health spending in 122 countries: a retrospective observational study

Background: The goal of universal health coverage (UHC) requires that families who get needed health care do not suffer financial hardship as a result. This can be measured by instances of impoverishment, when a household's consumption including out-of-pocket spending on health is more than the poverty line but its consumption, excluding out-of-pocket spending, is less than the poverty line. This links UHC directly to the policy goal of reducing poverty. Methods: We measure the incidence and depth of impoverishment as the difference in the poverty head count and poverty gap with and without out-of-pocket spending included in household total consumption. We use three poverty lines: the US$1·90 per day and$3·10 per day international poverty lines and a relative poverty line of 50% of median consumption per capita. We estimate impoverishment in 122 countries using 516 surveys between 1984 and 2015. We estimate the global incidence of impoverishment due to out-of-pocket payments by aggregating up from each country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We do not derive global estimates to measure the depth of impoverishment but focus on the median depth for the 122 countries in our sample, accounting for 90% of the world's population. Findings: We find impoverishment due to out-of-pocket spending even in countries where the entire population is officially covered by a health insurance scheme or by national or subnational health services. Incidence is negatively correlated with the share of total health spending channelled through social security funds and other government agencies. Across countries, the population-weighted median annual rate of change of impoverishment is negative at the $1·90 per day poverty line but positive at the$3·10 per day and relative poverty lines. We estimate that at the $1·90 per day poverty line, the worldwide incidence of impoverishment decreased between 2000 and 2010, from 131 million people (2·1$1·90 per day poverty line and ¢3·74 per capita at the $3·10 per day poverty line. In all countries, out-of-pocket spending can be both catastrophic and impoverishing at all income levels, but this partly depends on the choice of the poverty line. Interpretation: Out-of-pocket spending on health can add to the poverty head count and the depth of poverty by diverting household spending from non-health budget items. The scale of such impoverishment varies between countries and depends on the poverty line but might in some low-income countries account for as much as four percentage points of the poverty head count. Increasing the share of total health expenditure that is prepaid, especially through taxes and mandatory contributions, can help reduce impoverishment. Funding: Rockefeller Foundation, Ministry of Health of Japan, and UK Department for International Development

Subtalar Joint Arthritis After Total Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: It has been shown that total ankle replacement (TAR) is effective in reducing pain and maintaining function in posttraumatic ankle osteoarthritis (OA). Compared to ankle fusion, TAR restores hindfoot kinematics more physiological. However, the assumption that the maintenance of ankle motion has a protective effect on the subtalar joint is still a matter of debate. Only a scarce number of long-term studies exist to support this statement.The purpose of this study was (1) to evaluate to which extent the integrity of the subtalar joint can be preserved by treating patients with a TAR, (2) to determine the rate of subtalar fusion following TAR, and (3) to determine whether the need of subsequent subtalar fusion was predictable at time of TAR. Methods: A consecutive series of 1140 primary TAR (508 female, 632 male, median age 63.5 years), performed between May 2000 and December 2015, were prospectively documented. The indication for TAR was posttraumatic OA in 78%, primary and systemic OA in 10% each, and other secondary OA in 3% of the cases. 199 subtalar joints were either fused before (n=73) or during TAR surgery (n=126), leaving 941 subtalar joints available for analysis. Radiographs before implantation and at latest follow-up were classified using the Kellgren and Lawrence Grading Score (KLS). In case of a subtalar fusion, the radiograph prior to the fusion was classified. Results: After a median radiographic follow-up of 6.1 years, the KLS remained unchanged in 66% of all cases. While it was increased by one stage in 30%, it was increased by two stages in 3%; whereas, signs of OA decreased by one stage in 1%. Cases with an increase of two stages on the KLS had a longer follow-up compared to cases without increase (p=0.047).37 cases (3.9%) underwent a subtalar joint fusion, of which the indication was progressive OA in 19 cases (51%), instability in 10 cases (27%) and others in 8 cases (22%). Subtalar joints that required a fusion after TAR did not show higher preoperative KLS than the group which did not need a subtalar joint fusion. Conclusion: Apparently, TAR protects the subtalar joint from secondary degeneration, as found in 67% with no increase in KLS. Although 33% showed an increase in the KLS, only 2% required a subtalar fusion due to progressive OA. Overall, the rate of subtalar joint fusion after TAR was low and comparable to the rates reported in the literature. Subtalar joints requiring fusion after TAR did not show higher preoperative rates of OA. Therefore, the KLS classification of subtalar OA on conventional radiographs provides only limited information about the need for postoperative subtalar fusion, and thus need to be interpreted with caution