KÖPRÜ SÖKÜM TEKNİKLERİNİN İMPLANT DESTEKLİ SABİT PROTEZLER VE ÇEVRE KEMİK ÜZERİNDEKİ STRES DAĞILIMINA ETKİSİ: SONLU ELEMAN ANALİZİ

Background & Aims: Implant retained restorations may be retrieved due to many reasons. However, implant retained restorations have many components which may be damaged during removal. The aim of this study is to observe stress concentrations in the surrounding bone, the implant and its components, during retrieval of a three-unit implant-supported fixed partial denture using two different removal techniques. Materials and Methods: One three-dimensional digital model of an implant-supported three-unit restoration was constructed. The implants’ dimensions were 3.7 mm x 10mm. A pull out force of 40 N was applied on a single support and on the connectors with a loop device. The stress values were calculated within the dental implant, abutment, abutment screw and surrounding bone. Results: The highest stress concentration was observed at the collar of the abutment during load on a single support (16.246 MPa). The stress concentrations at the cortical bone were lower than the stress concentration at implants, while the maximum stress concentration in bone structure was 1.175 MPa. The loop device technique was enabled to share the load through both implants and reduce the stress concentration levels (9.941 MPa). Conclusion: The pull-out force, did not show a great effect in bone structure. However, implant components were under higher stress and abutment screw was the weakest part of the system. During a crown removal, more attention is needed in order not to damage implant components rather than the bone.Amaç: İmplant destekli restorasyonlar çeşitli nedenlerle çıkarılabilir. Ancak implant destekli restorasyonların söküm sırasında zarar görebilecek birçok parçası mevcuttur. Bu çalışmanın amacı, iki farklı çıkarma tekniğini kullanarak, üç üyeli implant destekli bir restorasyonun çkarılması sırasında; çevre kemik, implant ve bileşenlerindeki stres yoğunluklarını gözlemlemektir. Gereç ve Yöntem: Üç üyeli implant destekli bir restorasyonun üç boyutlu dijital modeli oluşturuldu. İmplantların boyutları 3.7 mm x 10 mm idi. 40 N’lık bir çekme kuvveti tek bir destek üzerinden ve konnektörlerden geçen bir tel ile uygulandı. Dental implant, abutment, abutment vidası ve çevre kemik içindeki stres değerleri hesaplandı. Bulgular: Tek bir destek üzerine uygulanan yük sırasında en yüksek gerilme konsantrasyonu abutment boynunda görülmüştür (16.246 MPa). Kemik yapısındaki maksimum stres konsantrasyonu 1.175 MPa iken, kortikal kemikteki stres konsantrasyonları, implantlardaki stres konsantrasyonundan daha düşük olarak gözlendi. Abutment vidalarındaki stres konsantrasyon seviyeleri benzer ancak lokalizasyonları farklıdır. Tel ile her iki konnektör üzerinden kuvvet uygulanması, yükün her iki implant tarafından paylaşlmasına ve stres konsantrasyon seviyelerinin (9.941 MPa) azalmasına olanak sağlamaktadır. Sonuç: Kron çıkarılması sırasında uygulanan çekme kuvveti, kemik yapısında büyük bir etki göstermemektedir. Bununla birlikte, implant bileşenleri daha yüksek gerilme konsantrasyonlarına maruz kalmıştır ve abutment vidası sistemin en zayıf bileşeni olmuştur. Bir kron sökümü sırasında, kemik yerine implant bileşenlerine zarar vermemek için daha fazla dikkat gerekir

New horizons in bank mergers: A quantum spherical fuzzy decision-making framework for analyzing Islamic and conventional bank mergers and enhancing resilience

This study explores the implications of merging two fundamentally different types of banks: Islamic and conventional banks. The research aims to provide insight into the unique opportunities and challenges presented by such a merger and to offer strategic guidance for future mergers. A balanced scorecard-based strategic analysis using a Quantum Spherical Fuzzy Decision-Making Approach was used to develop short- and long-term strategic plans for the merged bank. The balanced scorecard included 12 key performance indicators (KPIs) in 4 groups, and the methodology incorporated several questions to guide the analysis. The results of the study offer valuable insights into the potential opportunities and challenges of merging these two types of banks, as well as strategic recommendations for stakeholders at all levels. The study serves as a useful guideline for future mergers between similar or different types of banks. Overall, the findings suggest that a well-planned merger strategy is essential for avoiding challenges and maximizing the benefits of merging Islamic and conventional banks. By integrating the strengths of both types of banks, a merged entity could create a competitive advantage and potentially improve financial performance. However, this requires careful consideration of cultural differences, regulatory challenges, and other factors that could impact on the success of the merger

Serving SDGs via bank mergers: A neuro quantum fuzzy approach for qatari banks

Determining the right merger strategy for banks is an important step. In this way, risks can be managed more effectively, and long-term financial performance can be achieved. However, there are many different factors that affect this process. It is not optimal for banks to consider all factors due to budget constraints. In this context, it is important to determine the most important ones among these criteria. Accordingly, the purpose of this study is to evaluate alternative merger strategies for banks. For this purpose, 12 different Sustainable Development Goals (SDGs)-based criteria are selected. Multi stepwise weight assessment ratio analysis (M-SWARA) methodology is used to compute the weights of these items. The main contribution of this study is that the implications of the merger process on SDGs can be examined. Furthermore, a new methodology (M-SWARA) is proposed in this study that has an increasing impact on the methodological originality. The findings indicate that increasing profitability has the greatest weight (0.095). Similarly, market share is found as the second most critical factor (0.092) for merger decisions in the banking industry. A profitable bank can attract more investors and with the help of this situation it can be much easier to raise capital and access funding from capital markets. These issues can be used to finance projects that align with SDGs, such as renewable energy, affordable housing, or clean water initiatives. In addition to this situation, profitability can also have a positive impact on innovation and technological advancement. With sufficient resources, a bank can invest in research and development, technological infrastructure, and innovative products and services. Owing to these investments, sustainable development can be promoted

Diagnostic stewardship in infectious diseases:a continuum of antimicrobial stewardship in the fight against antimicrobial resistance

Antimicrobial resistance (AMR) has been exacerbated by the inappropriate use of diagnostics, leading to excessive prescription of antimicrobials, and is an imminent threat to global health. Diagnostic stewardship (DS) is an auxiliary to antimicrobial stewardship (AMS) and comprises ordering the right tests, for the right patient, at the right time. It also promotes the judicious use of rapid and novel molecular diagnostic tools to enable the initiation of proper antibiotic therapy, while avoiding excessive use of broad-spectrum antibiotics. Proper interpretation of test results is crucial to avoid overdiagnosis and excessive healthcare costs. Although many rapid diagnostic tools have been developed with a high diagnostic yield, they are often limited by accessibility, cost, and lack of knowledge regarding their use. Careful consideration of clinical signs and symptoms with knowledge of the local epidemiology are essential for DS. This enables appropriate interpretation of microbiological results. Multidisciplinary teams that include well trained professionals should cooperate to promote DS. Challenges and barriers to the implementation of DS are mostly caused by scarcity of resources and lack of trained personnel and, most importantly, lack of knowledge. The lack of resources is often due to absence of awareness of the impact that good medical microbiology diagnostic facilities and expertise can have on the proper use of antibiotics.</p

Potential cost-effectiveness of RSV vaccination of infants and pregnant women in Turkey: An illustration based on Bursa data

Background: Worldwide, respiratory syncytial virus (RSV) is considered to be the most important viral cause of respiratory morbidity and mortality among infants and young children. Although no active vaccine is available on the market yet, there are several active vaccine development programs in various stages. To assess whether one of these vaccines might be a future asset for national immunization programs, modeling the costs and benefits of various vaccination strategies is needed. Objectives: To evaluate the potential cost-effectiveness of RSV vaccination of infants and/or pregnant women in Turkey. Methods: A multicohort static Markov model with cycles of one month was used to compare the costeffectiveness of vaccinated cohorts versus nonvaccinated cohorts. The 2014 Turkish birth cohort was divided by twelve to construct twelve monthly birth cohorts of equal size (111,459 new-borns). Model input was based on clinical data from a multicenter prospective study from Bursa, Turkey, combined with figures from the (inter) national literature and publicly available data from the Turkish Statistical Institute (TUIK). Incremental costeffectiveness ratios (ICERs) were expressed in Turkish Lira (TL) per qualityadjusted life year (QALY) gained. Results Vaccinating infants at 2 and 4 months of age would prevent 145,802 GP visits, 8,201 hospitalizations and 48 deaths during the first year of life, corresponding to a total gain of 1650 QALYs. The discounted ICER was estimated at 51,969 TL (26,220 US $in 2013) per QALY gained. Vaccinating both pregnant women and infants would prevent more cases, but was less attractive from a pure economic point of view with a discounted ICER of 61,653 TL (31,106 US$ in 2013) per QALY. Vaccinating only during pregnancy would result in fewer cases prevented than infant vaccination and a less favorable ICER. Conclusion: RSV vaccination of infants and/or pregnant women has the potential to be costeffective in Turkey. Although using relatively conservative assumptions, all evaluated strategies remained slightly below the threshold of 3 times the GDP per capita

Intrabiliary rupture of liver hydatid cyst: a case report and review of the literature

Herein, we report a 66 year old woman who was diagnosed to have intrabiliary rupture of liver hydatid cyst with demonstrative computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography findings, with a review of the literature

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID‑19 (Bari‑SolidAct): a randomised, double‑blind, placebo‑controlled phase 3 trial

Background Baricitinib has shown efcacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifcally on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/ critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modifed intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute diference and 95% CI −0.1% [−8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (−3.2% [−9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a signifcant interac‑ tion between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated partici‑ pants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to con‑ clude on a potential survival beneft of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these fnd‑ ings warrant further investigation in other trials and real-world studies

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.[Background] Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants.[Methods] Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures.[Results] Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities.[Conclusion] This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu (2022-500385-99-00).EU-SolidAct is part of the European pandemic preparedness network EU RESPONSE, funded by the EU Horizon 2020 Research and Innovation programme, under grant number 101015736. EU-SolidAct has also received funding from CAPNET (France) and Klinbeforsk (Norway).Peer reviewe