Post-Retained Single Crowns versus Fixed Dental Prostheses: A 7-Year Prospective Clinical Study

Biomechanical integrity of endodontically treated teeth (ETT) is often compromised. Degree of hard tissue loss and type of final prosthetic restoration should be carefully considered when making a treatment plan. The objective of this prospective clinical trial was to assess the influence of the type of prosthetic restoration as well as the degree of hard tissue loss on 7-y clinical performance of ETT restored with fiber posts. Two groups (n = 60) were defined depending on the type of prosthetic restoration needed: 1) single unit porcelain-fused-to-metal (PFM) crowns (SCs) and 2) 3- to 4-unit PFM fixed dental prostheses (FDPs), with 1 healthy and 1 endodontically treated and fiber post-restored abutment. Within each group, samples were divided into 2 subgroups (n = 30) according to the amount of residual coronal tissues after abutment buildup and final preparation: A) >50% of coronal residual structure or B) equal to or <50% of coronal residual structure. The clinical outcome was assessed based on clinical and intraoral radiographic examinations at the recalls after 6, 12, 24, 36, 48, and 84 mo. Data were analyzed by Kaplan-Meier log-rank test and Cox regression analysis (P < 0.05). The overall 7-y survival rate of ETT restored with fiber post and either SCs or FDPs was 69.2%. The highest 84-mo survival rate was recorded in group 1A (90%), whereas teeth in group 2B exhibited the lowest performance (56.7% survival rate). The log-rank test detected statistically significant differences in survival rates among the groups (P = 0.048). Cox regression analysis revealed that the amount of residual coronal structure (P = 0.041; hazard ratio [HR], 2.026; 95% confidence interval [CI] for HR, 1.031–3.982) and the interaction between the type of prosthetic restoration and the amount of residual coronal structure (P = 0.024; HR, 1.372; 95% CI for HR, 1.042–1.806) were statistically significant factors for survival (ClinicalTrials.gov NCT01532947)

Adults with spontaneous aerobic Gram-negative bacillary meningitis admitted to the intensive care unit

ABSTRACTThe characteristics of spontaneous aerobic Gram-negative bacillary meningitis (AGNBM) were determined in 40 adults requiring admission to an intensive care unit (ICU) during a 16-year period in ten French ICUs. Eight infections were hospital-acquired and most patients had predisposing factors, mainly chronic alcoholism and an immunocompromised status. Three immunosuppressed patients had disseminated strongyloidiasis. Gram's stain, cerebrospinal fluid and blood cultures were positive for 85%, 98% and 80% of cases, respectively. Escherichia coli (57%) and Klebsiella pneumoniae (17%) were the most frequent pathogens. In-ICU mortality was 38%. Spontaneous AGNBM is a rare complication of bacteraemia in adults. The severity of predisposing underlying diseases might explain the poor prognosis despite appropriate antimicrobial therapy

The PROMIZING trial enrollment algorithm for early identification of patients ready for unassisted breathing

Background: Liberating patients from mechanical ventilation (MV) requires a systematic approach. In the context of a clinical trial, we developed a simple algorithm to identify patients who tolerate assisted ventilation but still require ongoing MV to be randomized. We report on the use of this algorithm to screen potential trial participants for enrollment and subsequent randomization in the Proportional Assist Ventilation for Minimizing the Duration of MV (PROMIZING) study. Methods: The algorithm included five steps: enrollment criteria, pressure support ventilation (PSV) tolerance trial, weaning criteria, continuous positive airway pressure (CPAP) tolerance trial (0 cmHO during 2 min) and spontaneous breathing trial (SBT): on fraction of inspired oxygen (FO) 40% for 30-120 min. Patients who failed the weaning criteria, CPAP Zero trial, or SBT were randomized. We describe the characteristics of patients who were initially enrolled, but passed all steps in the algorithm and consequently were not randomized. Results: Among the 374 enrolled patients, 93 (25%) patients passed all five steps. At time of enrollment, most patients were on PSV (87%) with a mean (± standard deviation) FO of 34 (± 6) %, PSV of 8.7 (± 2.9) cmHO, and positive end-expiratory pressure of 6.1 (± 1.6) cmHO. Minute ventilation was 9.0 (± 3.1) L/min with a respiratory rate of 17.4 (± 4.4) breaths/min. Patients were liberated from MV with a median [interquartile range] delay between initial screening and extubation of 5 [1-49] hours. Only 7 (8%) patients required reintubation. Conclusion: The trial algorithm permitted identification of 93 (25%) patients who were ready to extubate, while their clinicians predicted a duration of ventilation higher than 24 h

Instability of the steady states of some Ginzburg–Landau-like equations with real coefficients

The instability of the steady states with nonconstant amplitude is analysed for a nonlocal Ginzburg–Landau equation with real coefficients and quasiperiodic boundary conditions. The results are obtained in terms of easily recognized, qualitative properties of the steady states. Some of the results are new, even for the standard (local) Ginzburg–Landau equation with real coefficients. A related Ginzburg–Landau equation coupled to a mean field is also considered that appears in the analyses of counter-propagating waves in extended systems, nonoscillatory instabilities with a conservation law, and viscous Faraday waves in large aspect ratio containers

Control of Rayleigh-Taylor instability by vertical vibration in large aspect ratio containers

We consider a horizontal heavy fluid layer supported by a light, immiscible one in a wide (as compared to depth) container, which is vertically vibrated intending to counterbalance the Rayleigh-Taylor instability of the flat, rigid-body vibrating state. In the simplest case when the density and viscosity of the lighter fluid are small compared to their counterparts in the heavier fluid, we apply a long wave, weakly nonlinear analysis that yields a generalized Cahn-Hilliard equation for the evolution of the fluid interface. This equation shows that the stabilizing effect of vibration is like that of surface tension, and is used to analyze the linear stability of the flat state, the local bifurcation at the instability threshold and some global existence and stability properties concerning the steady states without dry spots. The analysis is extended to two cases of practical interest. Namely, (a) the viscosity of one of the fluids is much smaller than that of the other one, and (b) the densities and viscosities of both fluids are quite close to each other

Analysis of vibration impact on stability of dewetting thin liquid film

Dynamics of a thin dewetting liquid film on a vertically oscillating substrate is considered. We assume moderate vibration frequency and large (compared to the mean film thickness) vibration amplitude. Using the lubrication approximation and the averaging method, we formulate the coupled sets of equations governing the pulsatile and the averaged fluid flows in the film, and then derive the nonlinear amplitude equation for the averaged film thickness. We show that there exists a window in the frequency-amplitude domain where the parametric and shear-flow instabilities of the pulsatile flow do not emerge. As a consequence, in this window the averaged description is reasonable and the amplitude equation holds. The linear and nonlinear analyses of the amplitude equation and the numerical computations show that such vibration stabilizes the film against dewetting and rupture.Comment: 19 pages, 11 figure

The Acceptability of Internet-Based Treatment and Characteristics of an Adult Sample with Obsessive Compulsive Disorder: An Internet Survey

Background: Obsessive-compulsive disorder (OCD) is a disabling anxiety disorder, but most individuals delay seeking treatment. Internet-based cognitive behavioural therapy (iCBT) is an innovative service delivery method that may help to improve access to care, but the acceptability to consumers of such programs has not yet been established. Methodology: People with symptoms of OCD were invited to complete an online survey enquiring about demographic characteristics, symptom severity, and acceptability of Internet-based treatment. Demographic and symptom severity data were compared with people with OCD identified in a national epidemiological survey and with a sample of patients with OCD from a specialist outpatient anxiety clinic. Participants: 129 volunteers to an online Internet survey, 135 patients at a specialist anxiety disorders outpatient clinic, and 297 cases identified in a national epidemiological survey. Main Measures: Demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale, the 12-item World Health Organisation Disability Assessment Schedule - Second Edition and the Yale Brown Obsessive Compulsive Scale - Self Report Version. Principal Findings: The Internet sample was similar demographically but reported more severe symptoms than the comparison groups, although had similar severity of symptoms of OCD compared with other clinical samples reported in the literature. Participants reported Internet-based treatment for OCD would be highly acceptable. Conclusions: Internet-based treatment may reduce barriers to accessing treatment to people with OCD. Individuals in this study were similar demographically to other samples and had similar severity of symptoms as those identified in other clinical samples, suggesting that Internet-based treatment using techniques employed in face-to-face treatment may be effective in this group. Internet-based treatments for OCD need to be developed and evaluated