Single Tooth Prosthetic Restoration Through Surgical CrownLengthening, Conservative Therapies and CAD-CAM Milled Restoration in Lithium-Disilicate: A Case Report

Cilj: Restaurativno liječenje destruiranog avitalnog gornjeg pretkutnjaka često zahtijeva interdisciplinarni pristup. Na izbor postupaka i materijala obično utječu estetski zahtjevi i žvačno opterećenje. U ovom prikazu opisuje se konzervativno liječenje u skladu s estetskim potrebama i funkcionalnim zahtjevima. Materijali i metode: Opisan je slučaj žene u dobi od 45 godina s vrlo destruiranim gornjim pretkutnjakom. Zub je ranije bio hitno provizorno endodontski liječen. U trenutku posjeta bio bolan i činilo se da se karijesna lezija proteže subgingivno. Odabran je kirurško-konzervativni pristup koji je uključivao produljenje kliničke krune, endodontsko liječenje i protetičku terapiju krunicom od monolitnog litijeva disilikata. Rezultati: Proces rehabilitacije trajao je tri mjeseca, uključujući i vrijeme cijeljenja nakon operacije te postavljanje privremene krunice. Pacijentica je opskrbljena estetski i funkcionalno. Zaključak: Konzervativno liječenje teško oštećenog zuba zahtijeva kritičku procjenu preostalih struktura i pažljiv odabir restaurativnog materijala. Monolitna krunica mogla bi biti idealno rješenje za restauraciju gornjeg pretkutnjaka koji treba ispuniti estetske i funkcijske zahtjeve. Izbor visoko translucentnog materijala koji se lako polira i uz to može obrađivati u ordinaciji, kliničarima pruža dodanu vrijednost.Objective. The restorative treatment of a decayed, non-vital upper premolar often requires an interdisciplinary approach. Esthetics and the entity of the masticatory loads are usually affecting the choice of procedures and materials. A conservative treatment in a case with esthetic needs and functional requirements is investigated in this case report. Materials and methods. A case of a 45- yearold woman with a severely decayed upper premolar is presented. The tooth has been previously treated in an emergency department with a provisional endodontic medication, but a further treatment has been then performed. The tooth was painful at the moment of the visit and the carious lesion appeared to invade the subgingival level. A surgical-conservative approach has been selected involving crown lengthening, endodontic treatment and a prosthetic crown with a monolithic Lithium- Silicate. Results. The rehabilitative process required 3 months, including maturation times after surgery and the placement of the provisional crown. The patient claimed to be both esthetically and functionally satisfied with the restoration. Conclusion. A conservative treatment of a severely involved tooth requires a critical evaluation of the remaining structures and a precise selection of the restorative materials. A monolithic crown could represent an ideal solution for restoring an upper premolar requiring esthetics and solid function, but the choice of a high translucent, easily polishable and possibly even chair-side prosthetic material might be an appreciable added value for clinicians

On-line center of mass and inertia determination of a space debris during a deorbiting mission

The problem of removing debris from LEO or GEO is broadly recognized as one of the most pressing in the near future and passive mitigation obtained by reducing the de-orbiting time after the operational satellite lifetime is demonstrated to be an insufficient remedy. Active debris removal by means of a chaser satellite is therefore being intensively studied. In particular, space manipulators appear to be a promising solution, due to their long operational history in the space environment. According to this approach, the chaser, clamped to the target debris, changes its orbital altitude by applying a pushing thrust, which is an unstable configuration from the attitude control point of view: a misalignment between the force vector and the chaser+target system center of mass (CoM) leads to a torque that must be continuously compensated, which could be an unacceptable cost in terms of attitude control. Unfortunately, this misalignment must be expected, since the target inertia characteristics are only known with a limited degree of confidence. In this framework, the determination of the characteristics of the chaser+target system is studied by means of a Kalman filtering approach, in a simulation environment in which both the multibody dynamics and the orbital dynamics are taken into account. The estimate variables are the components of the inertia tensor and (above all) the coordinates of the system's CoM, while the measurements are limited to the angular velocity coming from the gyro sensors. It is fundamental for the success of the inertia determination to excite the system dynamics, and this could be done by using the robotic connection between chaser and target, which however brings good results only if the mass of the target is not much larger than the mass of the chaser. Alternatively, the chaser could apply small controlled forces to the system, using the resulting attitude dynamic as input for the filter: this paper investigates the accuracy obtained performing different kinds of maneuvers. Interestingly, this algorithm for center of mass determination can be run even during the deorbiting push: the algorithm is included in closed loop with a thrust vector control, continuously analyzing the attitude motion and improving the knowledge of the CoM position (which by the way will vary due to the fuel consumption). In this way the direction of the thrust is corrected and the attitude control is relieved by the heavy task of compensating the thrust misalignment

The Thin Line between Munchausen Syndrome and Munchausen Syndrome by Proxy

Factitious disorders are the intentional production of feigning symptoms or disabilities; either physical or psychological. We report the case of a young girl, victim of M\ufcnchausen by proxy who became a M\ufcnchausen patient

GRAd-COV2, a gorilla adenovirus-based candidate vaccine against COVID-19, is safe and immunogenic in younger and older adults

International audienceSafe and effective vaccines against coronavirus disease 2019 (COVID-19) are essential for ending the ongoing pandemic. Although impressive progress has been made with several COVID-19 vaccines already approved, it is clear that those developed so far cannot meet the global vaccine demand alone. We describe a COVID-19 vaccine based on a replication-defective gorilla adenovirus expressing the stabilized prefusion severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein named GRAd-COV2. We assessed the safety and immunogenicity of a single-dose regimen of this vaccine in healthy younger and older adults to select the appropriate dose for each age group. For this purpose, a phase 1, dose-escalation, open-labeled trial was conducted including 90 healthy participants (45 aged 18 to 55 years old and 45 aged 65 to 85 years old) who received a single intramuscular administration of GRAd-COV2 at three escalating doses. Local and systemic adverse reactions were mostly mild or moderate and of short duration, and no serious adverse events were reported. Four weeks after vaccination, seroconversion to spike protein and receptor binding domain was achieved in 43 of 44 young volunteers and in 45 of 45 older participants. Consistently, neutralizing antibodies were detected in 42 of 44 younger-age and 45 of 45 older-age volunteers. In addition, GRAd-COV2 induced a robust and T helper 1 cell (T H 1)-skewed T cell response against the spike protein in 89 of 90 participants from both age groups. Overall, the safety and immunogenicity data from the phase 1 trial support the further development of this vaccine

Emotional status and fear in patients scheduled for elective surgery during COVID-19 pandemic: a nationwide cross-sectional survey (COVID-SURGERY)

Background Fragmented data exist on the emotional and psychological distress generated by hospital admission during the pandemic in specific populations of patients, and no data exists on patients scheduled for surgery. The aim of this multicentre nationwide prospective cross-sectional survey was to evaluate the impact of pandemic on emotional status and fear of SARS-CoV-2 contagion in a cohort of elective surgical patients in Italy, scheduled for surgery during the COVID-19 pandemic. Results Twenty-nine Italian centres were involved in the study, for a total of 2376 patients surveyed (mean age of 58 years ± 16.61; 49.6% males). The survey consisted of 28 total closed questions, including four study outcome questions. More than half of patients had at least one chronic disease (54%), among which cardiovascular diseases were the commonest (58%). The most frequent type of surgery was abdominal (20%), under general anaesthesia (64%). Almost half of the patients (46%) declared to be frightened of going to the hospital for routine checkups; 55% to be afraid of getting SARS-CoV-2 infection during hospitalization and 62% were feared of being hospitalised without seeing family members. Having an oncological disease and other patient-related, centre-related or perioperative factors were independently associated with an increased risk of fear of SARS-CoV-2 infection during hospitalization and of being hospitalised without seeing family members. A previous infection due to SARS-COV-2 was associated with a reduced risk of worse emotional outcomes and fear of SARS-CoV-2 infection during hospitalization. Patients who showed the most emotionally vulnerable profile (e.g. use of sleep-inducing drugs, higher fear of surgery or anaesthesia) were at higher risk of worse emotional status towards the hospitalization during COVID-19 pandemic. Being operated in hospitals with lower surgical volume and with COVID-19 wards was associated with worse emotional status and fear of contagion. Conclusions Additional fear and worse emotional status may be frequent in patients scheduled for elective surgery during COVID-19 pandemic. More than half of the participants to the survey were worried about not being able to receive family visits. Psychological support may be considered for patients at higher risk of psychological distress to improve perioperative wellbeing during the pandemic