Zirconia dental implants; the relationship between design and clinical outcome: A systematic review.

OBJECTIVE: To evaluate the clinical outcome of different designs of zirconia dental implants. DATA: This systematic review adhered to the PRISMA checklist and followed the PICO framework. The protocol is registered in PROSPERO (CRD42022337228). SOURCES: The search was conducted in March 2023 through four databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) along with a search of references in the related reviews. Three authors reviewed on title, and abstract level and analysed the risk of bias, and all authors reviewed on a full-text level. STUDY SELECTION: Clinical studies excluding case reports for patients treated with different designs of zirconia dental implants were included. From a total of 2728 titles, 71 full-text studies were screened, and 27 studies were included to assess the risk of bias (ROBINS-I tool) and data extraction. After quality assessment, four studies were included, and the remaining 23 excluded studies were narratively described. RESULT: The included prospective studies with moderate risk of bias reported success and survival rates of one-piece implants that ranged between 95 and 98.4 % with no difference between different lengths and diameters. The acid-etched roughened surface showed higher clinical outcomes compared to other surface roughness designs. CONCLUSION: Promising 5-year clinical outcomes were found for one-piece zirconia implants with no difference between different diameters and lengths. Concerning surface roughness, better outcomes were found when using the acid-etched implant surface. However, due to the limited available studies, further high-quality clinical studies comparing zirconia one-piece and two-piece implants with different diameters, lengths, and surface roughness are needed. CLINICAL SIGNIFICANCE: Based on this systematic review, under suitable clinical situations, the one-piece zirconia implants with diameters of 4.0 mm, 4.5 mm, or 5.5 mm and lengths of 8 mm, 10 mm, 12 mm, or 14 mm have similar promising clinical outcomes. Additionally, the acid-etched roughened implant surface may be preferable.

Risk of ankylosis of avulsed teeth immediately replanted or stored under favorable storage conditions before replantation: A long-term clinical study.

BACKGROUND/AIM: There are few long-term clinical follow-up studies on human teeth replanted immediately or after storage in a suitable storage medium prior to replantation. This study aimed to assess the risk of ankylosis in avulsed human teeth replanted immediately or after storage in physiological media for a short time. MATERIAL: Data from 116 patients with 145 replanted avulsed permanent teeth were selected from a comprehensive dental trauma database in Copenhagen University Hospital. The following teeth were selected: Group 1 comprised 36 teeth replanted immediately (dry time <6 min; wet time <6 min). Group 2 comprised 61 teeth replanted after physiologic storage media (saliva and saline) (dry time <6 min; wet time >5 min; wet time ranged from 7 to 170 min, and mean wet time was 59 min). Group 3 (control) included 48 teeth replanted after dry storage (dry time > 60 min). METHOD: Clinical and radiographic registrations were carried out according to a standardized protocol; follow-up ranged from 7 months to 23 years. Ankylosis was diagnosed by percussion test and radiographs and related to the conditions prior to replantation and stage of root development. RESULTS: The overall risk of ankylosis was 17.2% [95% CI: 4.61; 29.79] for immediately replanted teeth, 55.3% [95% CI: 42.54; 68.00] for teeth stored in physiologic media before replantation, and 85.7% [95% CI: 75.70; 95.73] for teeth stored dry more than 1 h. Mature teeth showed a significantly higher risk of ankylosis than immature teeth. CONCLUSION: This clinical long-term study has verified earlier experimental studies showing that immediate reimplantation has the lowest risk of ankylosis. Physiologic storage media are good alternatives that also reduce the risk of ankylosis compared to dry storage, where ankylosis is more likely although not always seen. Mature teeth are significantly more likely to develop ankylosis.

Local resection may be a strong alternative to cesarean hysterectomy in conservative surgical management of placenta percreta: experiences from a tertiary hospital.

OBJECTIVE: To evaluate and describe a surgical approach for uterine preservation and management of postpartum hemorrhage in placenta percreta. METHODS: We analyzed the data of patients who were diagnosed with placenta percreta prenatally and subsequently underwent cesarean section in which local resection technique was used to manage postpartum hemorrhage and uterine preservation at our tertiary care center between 2013 and 2016. The technique includes local resection of placental invasion site and suturing the new uterine edges. RESULTS: The technique of local resection described above was successful in preserving the uterus and stopping the bleeding in 8 of 12 cases. The diagnosis of placenta percreta in all cases was confirmed intraoperatively and postoperatively by histological examinations. Four cases were resorted to hysterectomy. The mean number of transfused erythrocyte suspension was 4.8 ± 2.6. One complication of bladder injury was encountered in which treated conservatively. CONCLUSION: Local resection of percreta site is an effective, safe and fertility preserving approach that can be applied to manage the postpartum hemorrhage and preservation of uterus in patients with placenta percreta.

The effect of uterine straightening by bladder distention before outpatient hysteroscopy: a randomised clinical trial.

OBJECTIVE: To investigate the effect of bladder distention before outpatient hysteroscopy (OH). STUDY DESIGN: Initially, 120 eligible patients were approached, and a total of 102 patients were recruited into the randomised controlled trial. OH was completed successfully in 97 patients. Pain scoring (visual analogue scale) and the ease of cervical entry (Likert scale) were the primary outcome measures. The secondary outcome measures in this study were the duration of the procedure and patient acceptability (Likert scale). RESULT(S): Bladder distention before OH was related to easier cervical entry, a shorter procedural time and low pain scoring in patients who underwent the procedure with a full bladder. CONCLUSION(S): Bladder distention before OH significantly improved the pain score of patients and increases the feasibility of the hysteroscopy procedure.

Assessment of impaired glucose tolerance prevalence with hemoglobin A1c and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study.

STUDY QUESTION: What is the prevalence of abnormalities in glucose metabolism in patients with polycystic ovary syndrome (PCOS) and controls in a Turkish population? SUMMARY ANSWER: The total prevalence of glucose abnormalities in PCOS patients was 16.3% [impaired glucose tolerance (IGT) 14.3%; type 2 diabetes mellitus (T2DM) 2%] and was higher than in healthy subjects (IGT 8.5%; T2DM 0%, respectively). WHAT IS KNOWN ALREADY: One of the most common markers of chronic glycemia is hemoglobin Alc (HbA1c). However, little is known about whether the use of HbA1c results in diagnosis of more cases of glucose intolerance in the PCOS population than the oral glucose tolerance test (OGTT) alone. STUDY DESIGN, SIZE, DURATION: This was a prospective study, including 252 women with PCOS and 117 control women without PCOS. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was carried out in the gynecological outpatient department of Namik Kemal University Hospital, Turkey, between 2010 and 2012. Women with PCOS (n = 252) were diagnosed according to Rotterdam criteria. The control group included 117 women (aged 17-45 years) who were selected randomly. BMI of participants ranged between 15.6 and 47.9 kg/m(2). MAIN RESULTS AND THE ROLE OF CHANCE: Patients with PCOS were comparable to controls in terms of age (24.8 versus 25.9 years, respectively) and had higher BMI (26.1 versus 24.9 kg/m(2), respectively). Of 252 patients with PCOS, 41 had glucose intolerance (IGT 14.3%; T2DM 2%) when compared with 10 of the 117 control patients (IGT 8.5%; T2DM 0%; odds ratios = 2.08; P = 0.045) during the OGTT. When an HbA1c value ≥ 5.6% was used to divide the total population, the prevalence of abnormal glucose metabolism was 7.9% in the patients with PCOS, below the value detected in the control patients (8.5%), which showed that 20 of 41 patients with abnormal glucose tolerance would not have been diagnosed, if the HbA1c alone had been used. When compared with the OGTT results, HbA1c provided 52.4% sensitivity, 74.4% specificity, 67.1% positive and 60.9% negative predictive values with a threshold value of 5.6% in abnormal glucose tolerance. The receiver operating characteristic analysis suggested a threshold value of 5.35% in HbA1c (75.6% sensitivity and 52.6% specificity) for the prediction of abnormal glucose tolerance. LIMITATIONS, REASONS FOR CAUTION: This study did not involve weight-matched healthy subjects, which may cause a difference in prevalence of abnormal glucose metabolism between the groups, and the results are limited to an unselected population of patients who have the full PCOS phenotype. In addition, the incidence of T2DM among the first-degree relatives and 2-h insulin levels could not be reported in full. WIDER IMPLICATIONS OF THE FINDINGS: Further investigation of the efficacy of HbA1c for the prediction of abnormal glucose tolerance should be undertaken in long-term prospective studies and in different geographic populations. At present, the only way to reliably detect abnormal glucose metabolism in Turkish women with PCOS appears to be using the OGTT. STUDY FUNDING/COMPETING INTEREST(S): No financial support. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER: Not applicable.

Does previous abdominal surgery effect the feasibility of total laparoscopic hysterectomy?

OBJECTIVE: The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH). MATERIAL AND METHODS: In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38). RESULTS: THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did. CONCLUSION: We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.

Effects of maternal left lateral position and rest on amniotic fluid index: a prospective clinical study.

OBJECTIVE: To compare the effect of both maternal rest and activity on the amniotic fluid index (AFI). STUDY DESIGN: Power analysis indicated that in order to achieve 20 mm of increase in AFI with 90% of power at one side alpha of 0.01, we needed at least 51 women in each group. The study group was comprised of pregnant women (n = 152) with a normal AFI and a singleton pregnancy at 26-40 weeks' gestation. Their AFI was determined by averaging the 2 repetitive measurements of the 4 amniotic fluid quadrants. The "rest" group (n = 77) was instructed to lie and rest in the left lateral position, and the "mild activity" group (n = 75) was instructed to sit and walk. RESULTS: AFI increased significantly, from 151.25 +/- 37.40 mm to 173.79 +/- 39.76 mm, in the "rest" group (p = 0.00). However, the change from 153.69 +/- 37.94 to 152.34 +/- 36.62 mm was not significant in the "mild activity" group (p = 0.167). CONCLUSION: Maternal rest in the left lateral position increases the AFI.

Correlation between the duration of maternal rest in the left lateral decubitus position and the amniotic fluid volume increase.

OBJECTIVES: The purpose of this study was to show the relationship between amniotic fluid volume changes and the duration of maternal rest in the left lateral decubitus position. METHODS: Pregnant women (n = 34) with an amniotic fluid index between 6 and 24 cm and an uncomplicated singleton pregnancy at 35 to 40 weeks' gestation were included in the study. After the initial amniotic fluid index measurements, the women were instructed to rest in the left lateral position, and the measurements were repeated at 15, 30, 45, 60, 75, and 90 minutes. RESULTS: The amniotic fluid index increased at each sequential interval. Although each amniotic fluid index value was higher than the preceding one, only the 15- and 30-minute values were significantly higher than the preceding measurements (P < .001; P < .01, respectively). At the beginning of maternal rest in the left lateral position, 15 minutes of rest was sufficient to create significant changes (P < .001). However, after 30 minutes of rest, an additional 45 minutes was needed to create a significant amniotic fluid index increase (P < .01). The curve describing the amniotic fluid index increases caused by maternal rest resembled a saturation curve, and the maximum increase in the amniotic fluid volume was projected to be achieved approximately at the end of the second hour of the rest period. CONCLUSIONS: The correlation between the duration of maternal rest and amniotic fluid volume changes is not linear. However, maternal rest in the left lateral decubitus position significantly increases the amniotic fluid volume, particularly in the first 30 minutes (maximum increase in the first 15 minutes).

Effects of modernisation and new population policies on reproductive health in Kars, Turkey.

BACKGROUND: The 1983 Turkish Population Planning Act aimed at improving reproductive health outcomes. We examined the effects of the Act and of modernisation in a small, underdeveloped city and province, Kars. METHODS: Between June 2009 and January 2010, 576 parous women at a hospital in Kars participated in a study of reproductive histories and living standards. Results were compared by decade during which the birth took place of the first child who survived its first year, and urban/rural residence. Correlation and multi-way analyses of variance (ANOVA), χ(2) and t tests were used as appropriate. We also examined women's education and living standards and use of hospital and family planning (FP) facilities. RESULT: From 1970 through 2009 maternal age at first live birth increased by 4.9 years (p < 0.05) from a baseline of 18.9 years. The number of pregnancies fell from a mean of 8.1 per woman in the 1970s to 5.6 in the 1980s (p < 0.05), with strong indications of continued decreases through the 2000-2009 decade. FP sites in Kars province increased in number and services, as did antenatal hospital visits and the proportions of women giving birth in a hospital. Concomitantly, delivery by caesarean section augmented markedly over the decades. Education levels of both urban and rural women rose from two years of schooling in the 1970s to ten years in the last decade. CONCLUSION: Modernisation, including increasing urbanisation, education, and new governmental policies that translated into maternal-child health and FP services were likely the backbone for improved reproductive health and lower fertility rates of women in Kars over the 40 year-period we studied.

First trimester diagnosis of parapagus diprosopus dibrachius dipus twins with cranirachischisis totalis by three-dimensional ultrasound.

Parapagus (laterally fused), diprosopus (two faces), dibrachius (two upper extremities), dipus (two lower extremities) conjoined twinning is extremely rare. The coexistence of anencephaly with a contiguous spinal defect (craniorachischisis totalis) makes the present case one of the rarest of the published cases. In our case, it was difficult to make the final diagnosis by two-dimensional abdominal and vaginal ultrasound. Three-dimensional ultrasound was helpful for final diagnosis and post-abortal examination confirmed the prenatal ultrasound diagnosis. The heart, diaphragm, liver and perineum were all united. Fine dissection of the heart showed four vessels arising from the ventricles and a membranous type ventricular septal defect.

The first case of Horn Kolb Syndrome in Turkey, diagnosed prenatally at the 23(rd) week of a pregnancy: A very rare and unusual case far from the original geography.

BACKGROUND: The aim of this report was to evaluate and announce the first documented appearance of Horn Kolb syndrome in Turkey. CASE REPORT: Acheiropodia (Horn Kolb Syndrome) is the bilateral congenital amputation of the distal parts of the 4 extremities. It is an autosomal recessive developmental disorder. The characteristic features are amputation of the upper and lower extremities with aplasia of the hands and feet. The disorder affects only the extremities without other systemic manifestations. In this report, we present the first known case of Horn Kolb syndrome in Turkey, along with the diagnostic features. CONCLUSIONS: Severe dysmorphic skeletal anomalies should be excluded as soon as the earlier gestational weeks in every pregnancy by visualizing all 4 limbs of the fetus in routine prenatal ultrasound screening.

Effects of the maternal position and rest on the fetal urine production rate: a prospective study conducted by 3-dimensional sonography using the rotational technique (virtual organ computer-aided analysis).

OBJECTIVES: The purpose of this study was to determine the effect of the maternal left lateral decubitus position and rest on the fetal urine production rate. METHODS: Fifty-four pregnant women with a normal amniotic fluid volume who had a singleton pregnancy between 26 and 40 weeks' gestation were included in this prospective study. Exclusion criteria included rupture of membranes, intake of any food or liquid within the previous 4 hours, and maternal or fetal complications. The amniotic fluid index was determined by averaging 2 or 3 repetitive measurements of the 4 amniotic fluid quadrants at the time of fetal urinary bladder volume measurements. The fetal urine production rate was measured using virtual organ computer-aided analysis. The amniotic fluid index and fetal urine production rate before and after the left lateral position rest period were compared by a paired Student t test. The Pearson correlation was used to study the relationships among the maternal age, gestational age, test time, amniotic fluid index, and fetal urine production changes. RESULTS: The mean amniotic fluid indices ± SD before and after the rest period were 151.0 ± 45.0 and 172.5 ± 46.7 mm, respectively, indicating a significant increase in the amniotic fluid index (P < .05). The mean fetal urine production rates before and after the rest period were 73.7 ± 66.8 and 151.8 ± 119.9 mL/h, respectively, indicating a significant increase in fetal urine production (P < .05). CONCLUSIONS: The fetal urine production rate and amniotic fluid index are markedly increased by maternal rest in the left lateral decubitus position.

The effects of microwave emitted by cellular phones on ovarian follicles in rats.

OBJECTIVE: The aim of this study was to investigate whether there were any toxic effects of microwaves of cellular phones on ovaries in rats. METHODS: In this study, 82 female pups of rats, aged 21 days (43 in the study group and 39 in the control group) were used. Pregnant rats in the study group were exposed to mobile phones that were placed beneath the polypropylene cages during the whole period of pregnancy. The cage was free from all kinds of materials, which could affect electromagnetic fields. A mobile phone in a standby position for 11 h and 45 min was turned on to speech position for 15 min every 12 h and the battery was charged continuously. On the 21st day after the delivery, the female rat pups were killed and the right ovaries were removed. The volumes of the ovaries were measured and the number of follicles in every tenth section was counted. RESULTS: The analysis revealed that in the study group, the number of follicles was lower than that in the control group. The decreased number of follicles in pups exposed to mobile phone microwaves suggest that intrauterine exposure has toxic effects on ovaries. CONCLUSION: We suggest that the microwaves of mobile phones might decrease the number of follicles in rats by several known and, no doubt, countless unknown mechanisms.

Morphological quantitative changes in the number of lymphocytes, macrophages and plasma cells in the uterus and lymph nodes of rats exposed to the systemic administration of BCG.

This study was designed to investigate the effect of systemic administration of BCG on the morphological quantitative changes in the number of lymphocytes, macrophages and plasma cells in the uterus and lymph nodes of rats. Thirty female virgin Wistar Albino rats, aging 6 months and weighing between 200-250 g, were assigned to the two experimental groups; BCG treated and controls (n = 15). BCG group received 0.1 ml BCG in tail skin and control group received 0.1 ml saline at the same place. Two weeks after injections, rats in both groups were anesthesized with a high dose of ether and decapitated. Uterus and ileocecal lymph nodes were processed to determine a napthyl acid esterase (ANAE)-positive T lymphocytes and macrophages. The plasma cells were stained with the methyl green-pyronin method. It was found that the numbers of T lymphocytes, macrophages and plasma cells in the uterus and the ileocecal lymph nodes of BCG treated group significantly increased indicating the presence of an immune response to the systemic BCG administration. It was concluded that the systemic administration of BCG increases humoral and cellular immunity in endometrium, myometrium and regional lymph nodes. The immune deficiency system plays an important role in the pathogenesis of endometriosis. Therefore, the endometriosis might be prevented by using periodical administration of BCG. However, further experimental and clinical studies associated with these issue are required.

A case of successful six consecutive deliveries in a 41-year-old woman with Uhl's anomaly.

Uhl's anomaly, or parchment right ventricle is a myocardial disorder of unknown cause that mainly involves the right ventricle. Uhl's anomaly may represent a cause of right heart dilatation, failure, and premature sudden death due to ventricular arrhythmias. Although most of the cases of Uhl's anomaly end fatally in infancy or childhood, a limited number of cases have been reported in advanced ages. Also, in pregnant women, this situation increases the risk to both mother and baby and requires special management. This is the first report of six successful consecutive gestations and vaginal deliveries without special managements in a patient with Uhl's anomaly.