The use of extraoral implants for distal-extension removable dentures: a clinical evaluation up to 8 years

PURPOSE: This retrospective study reports the clinical outcome following placement of extraoral implants in severely resorbed posterior ridges to support distal-extension removable dentures. MATERIAL AND METHODS: Consecutively treated patients with partially or completely edentulous ridges, with available bone height in the posterior region of 6 mm or less, were included in the study. Implants originally intended for extraoral use (Straumann) were placed in second molar regions and allowed to heal for 4 to 6 months before abutment connection. At recall appointments, the peri-implant hard and soft tissues were evaluated. Complications with implant components, as well as mechanical and structural failures of the prostheses, were recorded. Two-year survival rates were calculated and life table analyses undertaken. RESULTS: Twenty-nine patients (19 women and 10 men; average age 61.2 years, range, 44 to 75 years) were included in the study. Forty-seven extraoral implants in 26 patients were placed in the second molar site of the mandible. Two extraoral implants in 2 patients failed during the osseointegration phase, yielding an 8-year cumulative success rate of 91.8%. The mean distance from the extraoral implants to the most distal tooth/implant was 28.1 mm (range, 16.7 to 39.2 mm). Twenty-three extraoral implants were restored with magnets, 18 with ball anchors, and 4 with conical cylinders. Replacement of abutments and retention elements was necessary in 2 patients. Four abutments in 2 patients were disconnected from the restorations. CONCLUSIONS: Within the limits of the employed research design, extraoral implants may be used successfully to provide support for distal-extension removable dentures in severely resorbed posterior alveolar ridges.

Strong Down-Valley Low-Level Jets over the Atacama Desert: Observational Characterization

The near-surface wind and temperature regime at three points in the Atacama Desert of northern Chile is described using two-year multi-level measurements from 80-m towers located in an altitude range between 2100 and 2700 m ASL. The data reveal the frequent development of strong nocturnal drainage flows at all sites. Down-valley nose-shaped wind speed profiles are observed with maximum values occurring at heights between 20 m and 60 m AGL. The flow intensity shows considerable inter-daily variability and a seasonal modulation of maximum speeds, which in the cold season can attain hourly average values larger than 20 m s−1. Turbulent mixing appears significant over the full tower layer, affecting the curvature of the nighttime temperature profile and possibly explaining the observed increase of surface temperatures in the down-valley direction. Nocturnal valley winds and temperatures are weakly controlled by upper-air conditions observed at the nearest aerological station. Estimates of terms in the momentum budget for the development and the quasi-stationary phases of the down-valley flows suggest that the pressure gradient force due to the near-surface cooling along the sloping valley axes plays an important role in these drainage flows. A scale for the jet nose height of equilibrium turbulent down-slope jets is proposed, based on surface friction velocity and surface inversion intensity. At one of the sites this scale explains about 70% of the case-to-case observed variance of jet nose heights. Further modeling and observational work is needed, however, in order to better define the dynamics, extent and turbulence structure of this flow system, which has significant wind-energy, climatic and environmental implications.

Jackson County Heifer Development Project Summary

The heifer development project was a five year project conducted on the site of the former Jackson County Farm north of Andrew, Iowa, for four years and on an area producer’s farm for the fifth year. Heifers arrived around December 1 each year and the average number of heifers each year was 43 with a low of 37 and high of 47. After a 30+ day warm-up period the heifers were put on a 112-day test from early January to late April. They were fed a shelled corn and legume-grass hay ration consisting of between 13% and 14% crude protein and a range of .44 to .58 megacal/pound of NEg over the five years. During the 112-day test heifers gained 1.86, 1.78, 1.5, 1.63 and 2.2 pounds per day, respectively, for years 1992 through 1996. The actual average breeding weight was less than the target weight in three years by 5, 12 and 22 pounds and exceeded the target weight in two year by 17 and 28 pounds. Estrus synchronization used a combination of MGA feeding and Lutalyse injection. Heifers were heat detected and bred 12 hours later for a three-day period. On the fourth day, all heifers not bred were mass inseminated. Heifers then ran with the cleanup bull for 58 days. The average synchronization response rate during the project was 79%. The overall pregnancy rates based on September pregnancy averaged 92%. The five year average total cost per head for heifer development was $286.18 or about $.85 per day. Feed and pasture costs averaged 61% of the total costs.

Effect of Parenteral Vitamin E and/or A on Reproductive Performance of Ewes Mated on Pasture or in Drylot

Forty-four Hampshire (H) and 41 Suffolk (S) ewes were allotted within breed to one of four treatment groups (VitA, VitE, VitAE, and Control) to evaluate the effect of supplemental vitamin E and A on reproductive performance of ewes mated on pasture or in drylot. Beginning two weeks before the mating period, ewes received 0 or 300 IU of vitamin E every 14 days and 0 or 250,000 IU of vitamin A every 28 days. Hampshire ewes remained on pasture during the mating period, whereas S ewes were moved to drylot. Treatment did not affect ovulation rate (OR), embryonic loss (EL), fetal loss (FL) or litter size (LS) of H ewes. Embryonic loss was higher (P<.05) in the H yearlings and two-year olds than in older ewes. Litter size was lower (P<.01) for H yearlings compared with other age groups. Suffolk ewes in the VitE group exhibited a lower (P<.01) OR than S ewes in other treatment groups, but no effect of treatment was observed for EL, FL, or LS. Although S yearling ewes did not differ from ewes of other age groups for OR and EL, they did produce fewer (P<.05) lambs. Analysis of serum samples revealed that H yearling ewes exhibited lower (P<.05) serum a-tocopherol levels than older H ewes. In addition, H ewes had a higher (P<.05) serum a-tocopherol level than S ewes at the beginning of study when they were managed as one group. Even though age and breed influenced certain reproductive parameters, results of this study indicate little effect of supplemental vitamin E and A on the overall reproductive efficiency of ewes mated on pasture or in drylot.

Called versus Calculated Yield Grades

An evaluation of carcass data collected over a two year period from southwest Iowa steer tests and 4-H carcass shows was conducted to compare USDA yield grades called by the Federal grader to yield grades calculated by actual carcass measurements. A regression equation was developed to predict called yield grade from carcass measurements. A comparison of the generated equation with the USDA equation used in calculating yield grades suggest that USDA graders accurately predict preliminary yield grades based on fat thickness, but may not have adequate time at line speeds to fully account for adjustments in ribeye size relative to carcass weight.

Clinical outcomes after zotarolimus and everolimus drug eluting stent implantation in coronary artery bifurcation lesions: insights from the RESOLUTE All Comers Trial

OBJECTIVE We investigated clinical outcomes after treatment of coronary bifurcation lesions with second generation drug eluting stents (DES). DESIGN Post hoc analysis of a randomised, multicentre, non-inferiority trial. SETTING Multicentre study. PATIENTS All comers study with minimal exclusion criteria. INTERVENTIONS Patients were treated with either zotarolimus or everolimus eluting stents. The patient population was divided according to treatment of bifurcation or non-bifurcation lesions and clinical outcomes were compared between groups. MAIN OUTCOMES MEASURES Clinical outcomes within 2-year follow-up. RESULTS A total of 2265 patients were included in the present analysis. Two-year follow-up data were available in 2223 patients: 1838 patients in the non-bifurcation group and 385 patients in the bifurcation group. At 2-year follow-up the bifurcation and the non-bifurcation lesion groups showed no significant differences in terms of cardiac death (2.3 vs 2.1, p=0.273), target lesion failure (9.7% vs 13.8%, p=0.255), major adverse cardiac events (11.5% vs 15.1%, p=0.305), target lesion revascularisation (4.7% vs 6.0%, p=0.569), and definite or probable stent thrombosis (1.6% vs 1.8%, p=0.419). CONCLUSIONS The use of second generation DES for the treatment of coronary bifurcation lesions was associated with similar long term mortality and clinical outcomes compared with non-bifurcation lesions.

Long-term outcomes of patients receiving zotarolimus-eluting stents in ST elevation myocardial infarction, non-ST elevation acute coronary syndrome, and stable angina: data from the Resolute program

BACKGROUND Outcome data are limited in patients with ST-segment elevation acute myocardial infarction (STEMI) or other acute coronary syndromes (ACSs) who receive a drug-eluting stent (DES). Data suggest that first generation DES is associated with an increased risk of stent thrombosis when used in STEMI. Whether this observation persists with newer generation DES is unknown. The study objective was to analyze the two-year safety and effectiveness of Resolute™ zotarolimus-eluting stents (R-ZESs) implanted for STEMI, ACS without ST segment elevation (non-STEACS), and stable angina (SA). METHODS Data from the Resolute program (Resolute All Comers and Resolute International) were pooled and patients with R-ZES implantation were categorized by indication: STEMI (n=335), non-STEACS (n=1416), and SA (n=1260). RESULTS Mean age was 59.8±11.3 years (STEMI), 63.8±11.6 (non-STEACS), and 64.9±10.1 (SA). Fewer STEMI patients had diabetes (19.1% vs. 28.5% vs. 29.2%; P<0.001), prior MI (11.3% vs. 27.2% vs. 29.4%; P<0.001), or previous revascularization (11.3% vs. 27.9% vs. 37.6%; P<0.001). Two-year definite/probable stent thrombosis occurred in 2.4% (STEMI), 1.2% (non-STEACS) and 1.1% (SA) of patients with late/very late stent thrombosis (days 31-720) rates of 0.6% (STEMI and non-STEACS) and 0.4% (SA) (P=NS). The two-year mortality rate was 2.1% (STEMI), 4.8% (non-STEACS) and 3.7% (SA) (P=NS). Death or target vessel re-infarction occurred in 3.9% (STEMI), 8.7% (non-STEACS) and 7.3% (SA) (P=0.012). CONCLUSION R-ZES in STEMI and in other clinical presentations is effective and safe. Long term outcomes are favorable with an extremely rare incidence of late and very late stent thrombosis following R-ZES implantation across indications.

Atlantoaxial epidural abscess secondary to grass awn migration in a dog.

A two-year-old female Lucerne Hound was presented with a one-week history of signs of progressive neck pain, inappetence, apathy, and an elevated rectal temperature. Findings of magnetic resonance imaging (MRI) were consistent with a foreign body abscess in the epidural space at the level of the first and second cervical vertebrae. A left-sided dorso-lateral atlantoaxial approach was performed, revealing an epidural abscess containing a grass awn. The clinical signs resolved within three days of surgery and the dog made a full recovery. This case report shows that grass awns can migrate to the atlantoaxial region in dogs and MRI findings lead to a suspicion of caudo-cranial migration within the spinal canal.

Television viewing, C-reactive protein, and depressive symptoms in older adults

There is emerging evidence for a link between sedentary behavior and mental health, although the mechanisms remain unknown. We tested if an underlying inflammatory process explains the association between sedentary behavior and depressive symptoms. We conducted a two year follow-up of 4964 (aged 64.5 ± 8.9 years) men and women from the English Longitudinal Study of Ageing, a cohort of community dwelling older adults. Self-reported TV viewing time was assessed at baseline as a marker of leisure time sedentary behavior. The eight-item Centre of Epidemiological Studies Depression (CES-D) scale was administered to measure depressive symptoms at follow-up. At baseline, TV time was associated with C-reactive protein (CRP), adjusted geometric mean CRP values were 2.94 mg/L (<2 h/d TV); 3.04 mg/L (2–4 h/d TV); 3.29 mg/L (4–6 h/d TV); 3.23 mg/L (>6 h/d TV). We observed both a direct association of TV time on CES-D score at follow-up (B = 0.08, 95% CI, 0.05, 0.10) and indirect effects (B = 0.07, 95% CI, 0.05, 0.08). The indirect effects were largely explained through lack of physical activity, smoking, and alcohol, but not by CRP or body mass index.

In-situ X-ray micro-diffraction studies of heterogeneous interfaces between cementitious materials and geological formations

In the present study the challenge of analyzing complex micro X-ray diffraction (microXRD) patterns from cement–clay interfaces has been addressed. In order to extract the maximum information concerning both the spatial distribution and the crystal structure type associated with each of the many diffracting grains in heterogeneous, polycrystalline samples, an approach has been developed in which microXRD was applied to thin sections which were rotated in the X-ray beam. The data analysis, performed on microXRD patterns collected from a filled vein of a cement–clay interface from the natural analogue in Maqarin (Jordan), and a sample from a two-year-old altered interface between cement and argillaceous rock, demonstrate the potential of this method.

An examination of the rate of high school completion experienced by handicapped and nonhandicapped students in the state of Texas

This research examines the graduation rate experienced by students receiving public education services in the state of Texas. Special attention is paid to that subgroup of Texas students who meet Texas Education Agency criteria for handicapped status. The study is guided by two research questions: What are the high school completion rates experienced by handicapped and nonhandicapped students attending Texas public schools? and What are the predictors of graduation for handicapped and nonhandicapped students?^ In addition, the following hypotheses are explored. Hypothesis 1: Handicapped students attending a Texas public school will experience a lower rate of high school completion than their nonhandicapped counterparts. Hypothesis 2: Handicapped and nonhandicapped students attending school in a Texas public school with a budget above the median budget for Texas public schools will experience a higher rate of high school completion than similar students in Texas public schools with a budget below the median budget. Hypothesis 3: Handicapped and nonhandicapped students attending school in large Texas urban areas will experience a lower rate of high school completion than similar students in Texas public schools in rural areas. Hypothesis 4: Handicapped and nonhandicapped students attending a Texas public school in a county which rates above the state median for food stamps and AFDC recipients will experience a lower rate of high school completion than students living in counties below the median.^ The study will employ extant data from the records of the Texas Education Agency for the 1988-1989 and the 1989-1990 school years, from the Texas Department of Health for the years of 1989 and 1990, and from the 1980 Census.^ The study reveals that nonhandicapped students are graduating with a two year average rate of.906, while handicapped students following an Individualized Educational Program (IEP) achieve a two year average rate of.532, and handicapped students following the regular academic program present a two year average graduation rate of only.371. The presence of other handicapped students, and the school district's average expense per student are found to contribute significantly to the completion rates of handicapped students. Size groupings are used to elucidate the various impacts of these variables on different school districts and different student groups.^ Conclusions and implications are offered regarding the need to reach national consensus on the definition and computation of high school completion for both handicapped and nonhandicapped students, and the need for improved statewide tracking of handicapped completion rates. ^

The response of four winter wheat (Triticum aestivum L.) varieties to field water deficit: leaf anti-oxidative protection and proteolytic activity

Introduction: Drought is one of the most significant factors that limit plant productivity. Oxidative stress is a secondary event in many unfavorable environmental conditions. Intracellular proteases have a role in the metabolism reorganisation and nutrient remobilization under stress. In order to under stand the relative significance of oxidative stress and proteolysis in the yield reduction under drought, four varieties of Triticum aestivum L. with different field drought resistance were examined. Methods: A two-year field experiment was conducted. Analyses were performed on the upper most leaf of control plants and plants under water deficitat the stages most critical for yield reduction under drought (from jointing till milk ripeness). Leaf water deficit and electrolyte leakage, malondyaldehyde level, activities and isoenzymes of superoxide dismutase, catalase and peroxidase, leaf protein content and proteolytic activity were studied. Yield components were analyzed. Results: A general trend of increasing the membrane in stability and accumulation of lipid hydroperoxides was observed with some differences among varieties, especially under drought. The anti-oxidative enzyme activities were progressively enhanced, as well as the azocaseinolytic activities. The leaf protein content decreased under drought at the last phase. Differences among varieties were observed in the parameters under study. They were compared to yield components` reduction under water deprivation.

Long-Term Comparison of Everolimus-Eluting and Biolimus-Eluting Stents in All-Comer Patients

AIMS: Second-generation everolimus-eluting stents (EES) are safer and more efficient than first-generation paclitaxel-eluting stents (PES). Third-generation biolimus-eluting stents (BES) have been found to be non-inferior to PES. To date, there is no available comparative study between EES and BES. We aimed to investigate the safety and efficacy of BES with biodegradable polymer compared to EES with durable polymer at a follow-up of two years in an unselected population of consecutively enrolled patients. METHODS AND RESULTS: A group of 814 consecutive patients undergoing percutaneous coronary intervention (PCI) was enrolled between 2007 and 2010, of which 527 were treated with EES and 287 with BES implantation. Clinical outcome was compared in 200 pairs using propensity score matching. The primary endpoint was a composite of death, myocardial infarction (MI) and target vessel revascularisation (TVR) at two-year follow-up. Median follow-up was 22 months. The primary outcome occurred in 11.5% of EES and 10.5% of BES patients (HR 1.11, 95% CI: 0.61-2.00, p=0.74). At two years, there was no significant difference with regard to death (HR 0.49, 95% CI: 0.18-1.34, p=0.17), cardiac death (HR 0.14, 95% CI: 0.02-1.14, p=0.66) or MI (HR 6.10, 95% CI: 0.73-50.9, p=0.10). Stent thrombosis (ST) incidence was evenly distributed between EES (n=2) and BES (n=2) (p-value=1.0). CONCLUSIONS: This first clinical study failed to demonstrate any significant difference regarding safety or efficacy between these two types and generations of drug-eluting stents (DES).

Performance of the resolute zotarolimus-eluting stent in small vessels.

BACKGROUND Drug eluting stents for the treatment of small vessel coronary artery disease have traditionally yielded inferior clinical outcomes compared to the use of DES in large vessels. The benefit of the second-generation Resolute zotarolimus-eluting stent (R-ZES) in small vessels was examined. METHODS Two-year clinical outcomes from five combined R-ZES studies were compared between patients with small (reference vessel diameter [RVD] ≤2.5 mm; n = 1,956) and large (RVD >2.5 mm; n = 3174) vessels. RESULTS Despite a higher incidence of comorbidities in the small vessel group, there was no significant difference in target lesion failure (TLF) (10.1% vs. 8.7%; P = 0.54) at 2 years. When the subgroup of patients with diabetes was examined (n = 1,553) there was no significant difference in 2-year TLF in small compared to large vessels (11.2% vs. 11.1%; P = 0.17). Similarly, within the small vessel cohort, no significant difference was seen regarding TLF at 2 years between people with and without diabetes (11.2% vs 9.6%; P = 0.28). CONCLUSION When used for the treatment of small vessels, the R-ZES appears to provide acceptable clinical results at 2 years when compared to its performance in large vessels.

German Total Ankle Replacement Register of the German Foot and Ankle Society (D. A. F.) - presentation of design and reliability of the data as well as first results

INTRODUCTION Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. MATERIAL AND METHODS The D. A. F.'s total ankle replacement register is a nation-wide, voluntary registry. After giving written informed consent, the patients can be added to the database by participating providers. Data are collected during hospital stay for surgical treatment, during routine follow-up inspections and in the context of revision surgery. The information can be submitted in paper-based or online formats. The survey instruments are available as minimum data sets or scientific questionnaires which include patient-reported outcome measures (PROMs). The pseudonymous clinical data are collected and evaluated at the Institute for Evaluative Research in Medicine, University of Bern/Switzerland (IEFM). The patient-related data remain on the register's module server in North Rhine-Westphalia, Germany. The registry's methodology as well as the results of the revisions and patient satisfaction for 115 patients with a two year follow-up period are presented. Statistical analyses are performed with SAS™ (Version 9.4, SAS Institute, Inc., Cary, NC, USA). RESULTS About 2½ years after the register was launched there are 621 datasets on primary implantations, 1,427 on follow-ups and 121 records on re-operation available. 49 % of the patients received their implants due to post-traumatic osteoarthritis, 27 % because of a primary osteoarthritis and 15 % of patients suffered from a rheumatic disease. More than 90 % of the primary interventions proceeded without complications. Subsequent interventions were recorded for 84 patients, which corresponds to a rate of 13.5 % with respect to the primary implantations. It should be noted that these secondary procedures also include two-stage procedures not due to a complication. "True revisions" are interventions with exchange of components due to mechanical complications and/or infection and were present in 7.6 % of patients. 415 of the patients commented on their satisfaction with the operative result during the last follow-up: 89.9 % of patients evaluate their outcome as excellent or good, 9.4 % as moderate and only 0.7 % (3 patients) as poor. In these three cases a component loosening or symptomatic USG osteoarthritis was present. Two-year follow-up data using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale (AOFAS-AHS) are already available for 115 patients. The median AOFAS-AHS score increased from 33 points preoperatively to more than 80 points three to six months postoperatively. This increase remained nearly constant over the entire two-year follow-up period. CONCLUSION Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.