Outcome of secondary root canal treatment: a systematic review of the literature.

UNLABELLED: AIMS (I): To investigate the effects of study characteristics on the reported success rates of secondary root canal treatment (2 degrees RCT or root canal retreatment); and (ii) to investigate the effects of clinical factors on the success of 2 degrees RCT. METHODOLOGY: Longitudinal human clinical studies investigating outcome of 2 degrees RCT which were published upto the end of 2006 were identified electronically (MEDLINE and Cochrane database 1966-2006 Dec, week 4). Four journals (Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Endodontics Radiology), bibliographies of all relevant papers and review articles were hand-searched. Two reviewers (Y-LN, KG) independently assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were: (i) Clinical studies on 2 degrees RCT; (ii) Stratified analyses available for 2 degrees RCT where 1 degrees RCT data included; (iii) Sample size given and larger than 10; (iv) At least 6-month post-operative review; (v) Success based on clinical and/or radiographic criteria (strict = absence of apical radiolucency; loose = reduction in size of radiolucency); and (vi) Overall success rate given or could be calculated from the raw data. Three strands of evidence or analyses were used to triangulate a consensus view. The reported findings from individual studies, including those excluded for quantitative analysis, were utilized for the intuitive synthesis which constituted the first strand of evidence. Secondly, the pooled weighted success rates by each study characteristic and potential prognostic factor were estimated using the random effect model. Thirdly, the effects of study characteristics and prognostic factors (expressed as odds ratios) on success rates were estimated using fixed and random effects meta-analysis with DerSimonean and Laird's methods. Meta-regression models were used to explore potential sources of statistical heterogeneity. Study characteristics considered in the meta-regression analyses were: decade of publication, study-specific criteria for success (radiographic, combined radiographic & clinical), unit of outcome measure (tooth, root), duration after treatment when assessing success ('at least 4 years' or '<4 years'), geographic location of the study (North American, Scandinavian, other countries), and qualification of the operator (undergraduate students, postgraduate students, general dental practitioners, specialist or mixed group). RESULTS: Of the 40 papers identified, 17 studies published between 1961 and 2005 were included; none were published in 2006. The majority of studies were retrospective (n = 12) and only five prospective. The pooled weighted success rate of 2 degrees RCT judged by complete healing was 76.7% (95% CI 73.6%, 89.6%) and by incomplete healing, 77.2% (95% CI 61.1%, 88.1%). The success rates by 'decade of publication' and 'geographic location of study' were not significantly different at the 5% level. Eighteen clinical factors had been investigated in various combinations in previous studies. The most frequently and thoroughly investigated were 'periapical status' (n = 13), 'size of lesion' (n = 7), and 'apical extent of RF' (n = 5) which were found to be significant prognostic factors. The effect of different aspects of primary treatment history and re-treatment procedures has been poorly tested. CONCLUSIONS: The pooled estimated success rate of secondary root canal treatment was 77%. The presence of pre-operative periapical lesion, apical extent of root filling and quality of coronal restoration proved significant prognostic factors with concurrence between all three strands of evidence whilst the effects of 1 degrees RCT history and 2 degrees RCT protocol have been poorly investigated

A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health.

AIM: To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. METHODOLOGY: This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. RESULTS: proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). CONCLUSIONS: Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments

Bethe Ansatz for a Quantum Supercoset Sigma Model

We study an integrable conformal OSp(2m + 2|2m) supercoset model as an analog to the AdS_5 X S^5 superstring world-sheet theory. Using the known S-matrix for this system, we obtain integral equations for states of large particle density in an SU(2) sector, which are exact in the sigma model coupling constant. As a check, we derive as a limit the general classical Bethe equation of Kazakov, Marshakov, Minahan, and Zarembo. There are two distinct quantum expansions around the well-studied classical limit, the lambda^{-1/2} effects and the 1/J effects. Our approach captures the first type, but not the second.Comment: 30 pages, 1 figure, v2: references adde

Composition of Jupiter irregular satellites sheds light on their origin

Irregular satellites of Jupiter with their highly eccentric, inclined and distant orbits suggest that their capture took place just before the giant planet migration. We aim to improve our understanding of the surface composition of irregular satellites of Jupiter to gain insight into a narrow time window when our Solar System was forming. We observed three Jovian irregular satellites, Himalia, Elara, and Carme, using a medium-resolution 0.8-5.5 micro m spectrograph on the National Aeronautics and Space Administration (NASA) Infrared Telescope Facility (IRTF). Using a linear spectral unmixing model we have constrained the major mineral phases on the surface of these three bodies. Our results confirm that the surface of Himalia, Elara, and Carme are dominated by opaque materials such as those seen in carbonaceous chondrite meteorites. Our spectral modeling of NIR spectra of Himalia and Elara confirm that their surface composition is the same and magnetite is the dominant mineral. A comparison of the spectral shape of Himalia with the two large main C-type asteroids, Themis (D 176 km) and Europa (D 352 km), suggests surface composition similar to Europa. The NIR spectrum of Carme exhibits blue slope up to 1.5 microm and is spectrally distinct from those of Himalia and Elara. Our model suggests that it is compositionally similar to amorphous carbon. Himalia and Elara are compositionally similar but differ significantly from Carme. These results support the hypotheses that the Jupiter irregular satellites are captured bodies that were subject to further breakup events and clustered as families based on their similar physical and surface compositions

Efficacy of a crosslinked hyaluronic acid-based hydrogel as a tear film supplement: a masked controlled study.

This is the final publish manuscript distributed under a Creative Commons Attribution License 2.0 UK, which can also be found on the publisher's website at: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0099766Keratoconjunctivitis sicca (KCS), or dry eye, is a significant medical problem in both humans and dogs. Treating KCS often requires the daily application of more than one type of eye drop in order to both stimulate tear prodcution and provide a tear supplement to increase hydration and lubrication. A previous study demonstrated the potential for a crosslinked hyaluronic acid-based hydrogel (xCMHA-S) to reduce the clinical signs associated with KCS in dogs while using a reduced dosing regimen of only twice-daily administration. The present study extended those results by comparing the use of the xCMHA-S to a standard HA-containing tear supplement in a masked, randomized clinical study in dogs with a clinical diagnosis of KCS. The xCMHA-S was found to significantly improve ocular surface health (conjunctival hyperaemia, ocular irritation, and ocular discharge) to a greater degree than the alternative tear supplement (P = 0.0003). Further, owners reported the xCMHA-S treatment as being more highly effective than the alternative tear supplement (P = 0.0024). These results further demonstrate the efficacy of the xCMHA-S in reducing the clinical signs associated with KCS, thereby improving patient health and owner happiness

Soft Shell Clam Mya arenaria

Large populations of soft shell clams persist only in relatively shallow, sandy, mesohaline portions of the Chesapeake Bay. These areas are mostly in Maryland, but also occur in the Rappahannock River, Virginia. In some other portions of the Bay, especially polyhaline portions, low populations of soft shell clams persist subtidally. Restricted populations persist intertidally. Soft shell clams grow rapidly in the Chesapeake Bay, reaching commercial size in two years or less. They reproduce twice per year, in spring and fall, but probably only fall spawnings are important in maintaining population levels. Major recruitment events do not occur in most years, despite heavy annual sets. Soft shell clams are important food for many predators. Major predators on juveniles include blue crabs, mud crabs, flatworms, mummichogs, and spot. Major predators on adults include blue crabs, eels, and cownose rays. Some other species that may depend heavily on soft shell clams include ducks, geese, swans, muskrats, and raccoons. Diseases may play an important role in regulating adult populations of soft shell clams; hydrocarbon pollution is linked to increased frequency of disease. Oil pollution does the most widespread and persistent damage to soft shell clams through toxicity, aside from its role in inducing disease. Heavy metals, pesticides, and similar pollutants can be extremely toxic, but the harmful effects to clams do not last if the pollution abates. The main concern with the latter toxicants is bioaccumulation by soft shell clams, with the potential for passing toxic contaminants on to predators or to humans. Siltation caused by storm events, dredging operations, or erosion, can smother clam populations. Eutrophication, enhanced by nutrient inputs from sewage or agriculture, is not known to have affected soft shell clam populations.https://scholarworks.wm.edu/vimsbooks/1019/thumbnail.jp

Experimental study of wing leading-edge devices for improved maneuver performance of a supercritical maneuvering fighter configuration

Wind tunnel tests were conducted to examine the use of wing leading-edge devices for improved subsonic and transonic maneuver performance. These devices were tested on a fighter configuration which utilized supercritical-wing technology. The configuration had a leading-edge sweep of 45 deg and an aspect ratio of 3.28. The tests were conducted at Mach numbers of 0.60 and 0.85 with angles of attack from -0.5 deg to 22 deg. At both Mach numbers, sharp leading-edge flaps produced vortices which greatly altered the flow pattern on the wing and resulted in substantial reductions in drag at high lift. Underwing or pylon-type vortex generators also reduced drag at high lift. The vortex generators worked better at a Mach number of 0.60. The vortex generators gave the best overall results with zero toe-in angle and when mounted on either the outboard part of the wing or at both an outboard location and halfway out the semispan. Both the flaps and the vortex generators had a minor effect on the pitching moment. Fluorescent minitufts were found to be useful for flow visualization at transonic maneuver conditions

Prognostic factors in seminomas with special respect to HCG: Results of a prospective multicenter study

Objective: In a prospective multicenter trial, it was our intention to elucidate clinical prognostic factors of seminomas with special reference to the importance of human chorionic gonadotropin (HCG) elevations in histologically pure seminomas. Methods: Together with 96 participating urological departments in Germany, Austria, and Switzerland, we recruited 803 seminoma patients between 1986 and 1991. Out of 726 evaluable cases, 378 had elevated, while 348 had normal HCG values in the cubital vein. Histology was reviewed by two reference pathologists. HCG levels were determined in local laboratories and in a study laboratory. Standard therapy was defined as radiotherapy in stages I (30 Gy) and IIA/B (36 Gy) to the paraaortal and the ispilateral (stage I) and bilateral (stage IIA/B) iliac lymph nodes; higher stages received polychemotherapy and surgery in case of residual tumor masses. Statistics included chi-square tests, linear Cox regression, and log-rank test. Results: The HCG elevation is associated with a larger tumor mass (primary tumor and/or metastases). HCG-positive and HCG-negative seminomas had no different prognostic outcome after standard therapy. The overall relapse rate of 6% and the survival rate of 98% after 36 months (median) indicate an excellent prognosis. The calculation of the relative risk of developing a relapse discovered only stage of the disease and elevation of the lactate dehydrogenase concentration and its prolonged marker decay as independent prognostic factors for seminomas. A more detailed analysis of the prognostic significance of the stage revealed that the high relapse rate in stage IIB seminomas after radiotherapy (24%) is responsible for this result. Conclusions: We conclude that HCG-positive seminomas do not represent a special entity. Provided standard therapy is applied, HCG has no influence on the prognosis. Patients with stage IIB disease should be treated with chemotherapy because of the demonstrated higher relapse rate outside the retroperitoneum. Copyright (C) 1999 S. Karger AG. Basel

Type II Seesaw Dominance in Non-supersymmetric and Split Susy SO(10) and Proton Life Time

Recently type II seesaw dominance in a supersymmetric SO(10) framework has been found useful in explaining large solar and atmospheric mixing angles as well as larger values of $theta_{13}$ while unifying quark and lepton masses. An important question in these models is whether there exists consistency between coupling unification and type II seesaw dominance. Scenarios where this consistency can be demonstrated have been given in a SUSY framework. In this paper we give examples where type II dominance occurs in SO(10) models without supersymmetry but with additional TeV scale particles and also in models with split-supersummetry. Grand unification is realized in a two-step process via breaking of SO(10) to SU(5) and then to a TeV scale standard model supplemented by extra fields and an SU(5) Higgs multiplet ${15}_H$ at a scale about $10^{12}$ GeV to give type-II seesaw. The predictions for proton lifetime in these models are in the range $\tau_p^0 = 2\times 10^{35}$ yrs. to $\tau_p^0 = 6\times 10^{35}$ yrs.. A number of recent numerical fits to GUT-scale fermion masses can be accommodated within this model.Comment: 7 pages LaTeX, 3 figures, related areas: hep-ex, hep-th, astro-ph; Reference added, typo corrected, version to appear in Physical Review

Exact Black Hole and Cosmological Solutions in a Two-Dimensional Dilaton-Spectator Theory of Gravity

Exact black hole and cosmological solutions are obtained for a special two-dimensional dilaton-spectator ($\phi-\psi$) theory of gravity. We show how in this context any desired spacetime behaviour can be determined by an appropriate choice of a dilaton potential function $V(\phi)$ and a ``coupling function'' $l(\phi)$ in the action. We illustrate several black hole solutions as examples. In particular, asymptotically flat double- and multiple- horizon black hole solutions are obtained. One solution bears an interesting resemblance to the $2D$ string-theoretic black hole and contains the same thermodynamic properties; another resembles the $4D$ Reissner-Nordstrom solution. We find two characteristic features of all the black hole solutions. First the coupling constants in $l(\phi)$ must be set equal to constants of integration (typically the mass). Second, the spectator field $\psi$ and its derivative $\psi^{'}$ both diverge at any event horizon. A test particle with ``spectator charge" ({\it i.e.} one coupled either to $\psi$ or $\psi^{'}$), will therefore encounter an infinite tidal force at the horizon or an ``infinite potential barrier'' located outside the horizon respectively. We also compute the Hawking temperature and entropy for our solutions. In $2D$ $FRW$ cosmology, two non-singular solutions which resemble two exact solutions in $4D$ string-motivated cosmology are obtained. In addition, we construct a singular model which describes the $4D$ standard non-inflationary big bang cosmology ($big-bang\rightarrow radiation\rightarrow dust$). Motivated by the similaritiesbetween $2D$ and $4D$ gravitational field equations in $FRW$ cosmology, we briefly discuss a special $4D$ dilaton-spectator action constructed from the bosonic part of the low energy heterotic string action andComment: 34 pgs. Plain Tex, revised version contains some clarifying comments concerning the relationship between the constants of integration and the coupling constants