Influence of Preparation Design and Restorative Material on Fatigue and Fracture Strength of Restored Maxillary Premolars

Statement of Problem: Extensive carious lesions and/or large preexisting restorations possibly contribute to crack formation, ultimately resulting in a fracture that may lead to the loss of a tooth cusp. Hence, preparation design strategy in conjunction with the restorative material selected could be influential in the occurrence of a cuspal fracture. Purpose: The purpose of this in vitro study was to evaluate the fatigue behavior and fracture strength of maxillary premolars restored with direct composite and indirect ceramic inlays and overlays, with different preparation depths in the presence or absence of cuspal coverage, and analyze their failure types. Methods and Materials: Sound maxillary premolars (N=90; n=10) were divided into nine groups: group C: control; group DCI3: direct composite inlay 3 mm; group DCI5: direct composite inlay 5 mm; group ICI3: indirect ceramic inlay 3 mm; group ICI5: indirect ceramic inlay 5 mm; group DCO3: direct composite overlay 3 mm; group DCO5: direct composite overlay 5 mm; group ICO3: indirect ceramic overlay 3 mm; group ICO5: indirect ceramic overlay 5 mm. In indirect ceramic, lithium disilicate restoration groups, immediate dentin sealing was applied. After restoration, all specimens were tested in fatigue (1,200,000 cycles, 50 N, 1.7 Hz). Samples were critically appraised, and the specimens without failure were subjected to a load to failure test. Failure types were classified and the data analyzed. Results: Zero failures were observed in the fatigue testing. The following mean load to failure strengths (N) were recorded: group ICO5: 858 N; group DCI3: 829 N; group ICO3: 816 N; group C: 804 N; group ICI3: 681 N; group DCO5: 635 N; group DCI5: 528 N; group DCO3: 507 N; group ICI5: 482 N. Zero interaction was found between design-depth-material (p=0.468). However, significant interactions were found for the design-depth (p=0.012) and design-material (p=0.006). Within restorations at preparation depth of 3 mm, direct composite overlays obtained a significantly lower fracture strength in comparison to indirect ceramic onlays (p=0.013) and direct composite inlays (p=0.028). In restorations at depth 5 mm, significantly higher fracture load values were observed in indirect ceramic overlays compared with the inlays (p=0.018). Indirect ceramic overlays on 3 mm were significantly stronger than the deep inlays in ceramic (p=0.002) and tended to be stronger than the deep direct composite inlays. Severe, nonreparable fractures were observed with preparation depth of 5 mm within ceramic groups. Conclusions: The preparation depth significantly affected the fracture strength of tooth when restored with either composite or ceramic materials. Upon deep cavity preparations, cuspal coverage proved to be beneficial when a glass ceramic was used as the restorative material. Upon shallow cavity preparations, a minimally invasive approach regarding preparation design used in conjunction with a direct composite material was favorable

“Deficiency in ELF4, X-Linked”:a Monogenic Disease Entity Resembling Behçet’s Syndrome and Inflammatory Bowel Disease

Defining monogenic drivers of autoinflammatory syndromes elucidates mechanisms of disease in patients with these inborn errors of immunity and can facilitate targeted therapeutic interventions. Here, we describe a cohort of patients with a Behçet’s- and inflammatory bowel disease (IBD)-like disorder termed “deficiency in ELF4, X-linked” (DEX) affecting males with loss-of-function variants in the ELF4 transcription factor gene located on the X chromosome. An international cohort of fourteen DEX patients was assessed to identify unifying clinical manifestations and diagnostic criteria as well as collate findings informing therapeutic responses. DEX patients exhibit a heterogeneous clinical phenotype including weight loss, oral and gastrointestinal aphthous ulcers, fevers, skin inflammation, gastrointestinal symptoms, arthritis, arthralgia, and myalgia, with findings of increased inflammatory markers, anemia, neutrophilic leukocytosis, thrombocytosis, intermittently low natural killer and class-switched memory B cells, and increased inflammatory cytokines in the serum. Patients have been predominantly treated with anti-inflammatory agents, with the majority of DEX patients treated with biologics targeting TNFα.</p

“Deficiency in ELF4, X-Linked”:a Monogenic Disease Entity Resembling Behçet’s Syndrome and Inflammatory Bowel Disease

Defining monogenic drivers of autoinflammatory syndromes elucidates mechanisms of disease in patients with these inborn errors of immunity and can facilitate targeted therapeutic interventions. Here, we describe a cohort of patients with a Behçet’s- and inflammatory bowel disease (IBD)-like disorder termed “deficiency in ELF4, X-linked” (DEX) affecting males with loss-of-function variants in the ELF4 transcription factor gene located on the X chromosome. An international cohort of fourteen DEX patients was assessed to identify unifying clinical manifestations and diagnostic criteria as well as collate findings informing therapeutic responses. DEX patients exhibit a heterogeneous clinical phenotype including weight loss, oral and gastrointestinal aphthous ulcers, fevers, skin inflammation, gastrointestinal symptoms, arthritis, arthralgia, and myalgia, with findings of increased inflammatory markers, anemia, neutrophilic leukocytosis, thrombocytosis, intermittently low natural killer and class-switched memory B cells, and increased inflammatory cytokines in the serum. Patients have been predominantly treated with anti-inflammatory agents, with the majority of DEX patients treated with biologics targeting TNFα.</p

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London