Intrahospital transmission and infection control of Candida auris originating from a severely infected COVID-19 patient transferred abroad.

BACKGROUND: Intrahospital spread of Candida auris, which survives tenaciously in many environments, can cause sustained colonization and infection. A large outbreak of C. auris was experienced in the intensive care units (ICUs) at the study hospital during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: The index patient with severe COVID-19, who was transferred from Vietnam in January 2022, developed C. auris candidaemia 10 days after hospitalization. From mid-June 2022 to January 2023, strengthened infection prevention and control (IPC) measures were implemented in three ICUs: (1) contact precautions and isolation (CPI) for C. auris-positive cases; (2) surveillance cultures including point-prevalence (N=718) for patients or close contacts or ICU-resident healthcare workers (HCWs); (3) intensive environmental disinfection with 10-fold diluted bleach; and (4) 2% chlorhexidine bathing for all ICU patients. Environmental cultures (ECx) on surfaces and shared objects (N=276) were conducted until early September 2022, when all ECx were negative. RESULTS: Among 53 C. auris-positive patients between February 2022 and January 2023, invasive infections resulted in seven cases of candidaemia and one case of pneumonia. C. auris was isolated from reusable tympanic thermometers (TTMs) contaminated with earwax. The isolation rate of C. auris in ECx decreased from 6.8% in June 2022 to 2.0% in August 2022, and was no longer detected in TTMs. Colonization in HCWs was remarkably rare (0.5%). The number of C. auris-positive patients peaked in July (N=10) then decreased gradually. By January 2023, no C. auris were isolated in the ICU. CONCLUSION: Aggressive IPC measures with CPI, ECx and surveillance, decontamination of TTMs, and bathing were effective in successfully controlling this C. auris outbreak.

Association between Fiber Intake and Risk of Incident Chronic Kidney Disease: The UK Biobank Study.

OBJECTIVES: Dietary fiber intake is associated with a lower risk of diabetes, cardiovascular disease, and cancer. However, it is unknown whether dietary fiber has a beneficial effect on preventing the development of chronic kidney disease (CKD). DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Using the UK Biobank prospective cohort, 110,412 participants who completed at least one dietary questionnaire and had an estimated glomerular filtration rate ≥60 mL/min/1.73 m2, urinary albumin-to-creatinine ratio <30 mg/g, and no history of CKD were included. The primary exposure was total dietary fiber density, calculated by dividing the absolute amount of daily total fiber intake by total energy intake (g/1,000 kcal). We separately examined soluble and insoluble fiber densities as additional predictors. The primary outcome was incident CKD based on diagnosis codes. RESULTS: A total of 3,507 (3.2%) participants developed incident CKD during a median follow-up of 9.9 years. In a multivariable cause-specific model, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for incident CKD were 0.85 (0.77-0.94), 0.78 (0.70-0.86), and 0.76 (0.68-0.86), respectively, for the second, third, and highest quartiles of dietary fiber density (reference: lowest quartile). In a continuous model, the aHR for each +∆1.0g/1,000 kcal increase in dietary fiber density was 0.97 (95% CI, 0.95-0.99). This pattern of associations was similar for both soluble and insoluble fiber densities and did not differ across subgroups of sex, age, body mass index, hypertension, diabetes, smoking, and inflammation. CONCLUSION: Increased fiber intake was associated with a lower risk of CKD in this large well-characterized cohort.

Effects of Material Thickness and Pretreatment on the Interfacial Gap of Translucent Zirconia Restorations with Self-adhesive Resin Cement.

PURPOSE: The first objective was to determine if the dual-curing of self-adhesive resin cement (SAC) with reduced light penetrating through zirconia had an effect on interfacial gap of zirconia restorations. The second purpose was to examine whether pretreatment methods for universal adhesive affected interfacial gap. The last aim was to compare the microhardness of SAC polymerized under different zirconia thicknesses. METHODS AND MATERIALS: This study evaluated self-adhesive resin cement (RelyX U200, 3M ESPE) after different pretreatment with universal adhesive (Single Bond Universal, 3M ESPE) under different polymerization conditions. CAD/CAM inlay cavities were prepared on extracted third molars. Translucent zirconia restorations were milled using Katana UTML (Kuraray). The teeth were divided into three groups: Groups I, II, and III in which the restoration thicknesses were 1, 2, and 3 mm. Each Group had three subgroups according to different pretreatment methods. For subgroup-1, no pretreatment was done on the prepared cavity. For subgroup-2, universal adhesive was applied and light-cured before cement placement (precure method). For subgroup-3, universal adhesive was applied; however, light-curing was done after cement placement (cocure method). After thermo-cycling, the interfacial gap at the restoration-tooth interface was investigated using swept-source optical coherence tomography imaging. Finally, microhardness was measured for SAC under different zirconia thicknesses. For statistical analysis, the interfacial gap was analyzed using two-way analysis of variance (ANOVA) to test the effect of cavity depth and pretreatment. In terms of each cavity depth and pretreatment, the interfacial gap was compared using one-way ANOVA and Scheffe's test. One-way ANOVA was also performed for comparison of the Vickers hardness results. RESULTS: Different thicknesses of the restoration resulted in differences in interfacial gaps except between the precure method of Groups I and II (p<0.05). The effect of universal adhesive pretreatment was different depending on the restoration thickness with exceptions in Groups I and III (p<0.05). Vickers hardness number decreased as the low radiant exposure of light was applied (p<0.05). CONCLUSION: Interfacial gap of zirconia restorations can differ depending on the material thickness, pretreatment, and activation mode. Reduced light intensity penetrating through zirconia may lead to higher interfacial gap percentage and lower microhardness of the self-adhesive resin cement. Application of a universal adhesive showed similar or reduced interfacial gaps in the cement space.

Surprisingly good thermoelectric performance of monolayer C3N.

The rapid emergence of graphene has attracted numerous efforts to explore other two-dimensional materials. Here, we combine first-principles calculations and Boltzmann theory to investigate the structural, electronic, and thermoelectric transport properties of monolayer C3N, which exhibits a honeycomb structure very similar to graphene. It is found that the system is both dynamically and thermally stable even at high temperature. Unlike graphene, the monolayer has an indirect band gap of 0.38 eV and much lower lattice thermal conductivity. Moreover, the system exhibits obviously larger electrical conductivity and Seebeck coefficients for the hole carriers. Consequently, theZTvalue ofp-type C3N can reach 1.4 at 1200 K when a constant relaxation time is predicted by the simple deformation potential theory. However, such a largerZTis reduced to 0.6 if we fully consider the electron-phonon coupling. Even so, the thermoelectric performance of monolayer C3N is still significantly enhanced compared with that of graphene, and is surprisingly good for low-dimensional thermoelectric materials consisting of very light elements.

[Effect of occupational stress on depression in gas field workers].

Objective: To explore the occurrence level of depressive symptoms and it's influencing factors among gas field workers. Methods: In October 2018, a cross-sectional study was conducted in 1726 gas field workers from a gas field by using cluster sampling method. Questionaire was used to evaluate the individual factors, depressive symptoms, occupational stress factors and stress regulatory factors. The correlation between depressive symptoms and occupational stress was analyzed. Multivariate logistic regression was used to analyze the influencing factors of depressive symptoms. Results: The depressive symptoms score of gas field workers was 12.00 (7.00, 19.00) point. Correlation analysis revealed that depressive symptoms score was positively related to sleep disorders (r=0.598) , effort (r=0.186) , daily tension (r=0.478) , negative affectivity (r=0.565) , social support (r=0.446) and monotony of work (r=0.484) (P<0.01) . And it was negatively related to reward (r=-0.386) , work stability (r=-0.294) , promotion opportunities (r=-0.258) , positive affectivity (r= -0.310) , self-efficacy (r=-0.312) , contral strategy (r=-0.268) , support strategy (r=-0.209) and job satisfaction (r=-0.398) (P<0.01) . Multivariate logistic regression analysis revealed that sleep disorder, high negative affectivity, low support from colleagues, low support from family, high monotony of work and high daily tension were the risk factors for depressive symptoms of gas field worker (OR=3.423, 95%CI: 2.644-4.397; OR=2.847, 95%CI: 2.200-3.683; OR=1.646, 95%CI: 1.215-2.116; OR=1.496, 95%CI: 1.164-1.923; OR=1.578, 95%CI: 1.227-2.303; OR=1.903, 95%CI: 1.480-2.440; P<0.01) . High work stability, high self-efficacy and high job satisfaction were protective factors for depressive symptoms of gas field workers (OR=0.752, 95%CI: 0.591-0.958; OR=0.590, 95%CI: 0.465-0.749; OR=0.718, 95%CI: 0.516-0.999; P<0.05) . Conclusion: Occupational stress factors have a great influence on the depressive symptoms of gas field workers. Increased work stability, self-efficacy and job satisfaction could reduce the risk of depressive symptoms.

Parametric excitation and mode control using an Oersted field in a NiFe nanowire.

Parametric pumping is a nonlinear wave phenomenon and a promising technique for electronic devices based on spin waves, so-called "magnonics". For parametric excitation, a magnetic nanowire system that has a built-in dc current line to produce an Oersted field is designed, and for spin wave detection, a micro-Brillouin light scattering (µ-BLS) system is used. A spin wave with a frequency of fsw = 5.6 GHz is observed when a pumping microwave with a frequency of fmw = 11.2 GHz is applied. The wave is found to be of the n = 1 width mode (n is the antinode number), and its mode changes to an edge-localized (or possibly n > 1) mode when the Oersted field (or current) varies. Joule heating effects are not observed in the pumping process. Thus, spin wave mode control by the built-in current would be a convenient and useful method to enhance the efficiency and compatibility in applications of spin-based electronics.

Strong interlayer coupling in two-dimensional PbSe with high thermoelectric performance.

It was generally believed that weak van der Waals interactions exist between neighboring layers in the two-dimensional group-IV chalcogenides. Using PbSe as a prototypal example, we find additional strong coupling between the Pb-Pb layers, as evidenced by detailed analysis of the differential charge density plot. The coupling is covalent-like and can be fine-tuned to obviously reduce the phonon thermal conductivity but slightly change the electronic transport of PbSe layer. As a consequence, a maximumZTvalue of 2.5 can be realized at 900 K for thep-type system. Our work also offers an effective and feasible design strategy to enhance the thermoelectric performance of similar layered structures.

[Correlation between social support and occupational stress among gas production workers in the field].

Objective: To investigate the level of social support and its correlation with occupational stress among gas production workers in the field. Methods: In October 2018, the cluster sampling method was used to perform a cross-sectional survey for 1726 gas production workers in the field, and related data of these workers were collected, including age, education level, marital status, level of social support, and related factors for occupational stress. A Spearman's rank correlation analysis was used to investigate the correlation between social support and occupational stress, and the levels of occupational stress-related factors were compared between the groups with different social support scores. Results: The gas production workers in the field had a median (25th percentile, 75th percentile) social support score of 24.00 (19.00, 28.00) , and there was a significant difference in social support score between the workers with different posts or work shifts (P<0.01) . Social support score was positively correlated with effort, daily stress, negative emotion, and job routinization (P<0.05) and was negatively correlated with job satisfaction, reward, working stability, and promotion opportunity (P<0.05) . The group with a high social support score had significantly higher scores of effort, job routinization, sleep disorders, and daily stress than the other two groups (P<0.01) , and the group with a low social support score had significantly higher scores of reward, self-efficacy, positive affection, and job satisfaction than the other two groups (P<0.01) . Conclusion: High-level social support plays an important role in alleviating occupational stress and protecting mental health among gas production workers in the field.

Interfacial Evaluation of CAD/CAM Resin Inlays on the Cavity Floor Using Swept-source Optical Coherence Tomography.

CLINICAL RELEVANCE: When a resin nanoceramic inlay is cemented using self-adhesive cement, a universal dentin adhesive can be applied to the prepared cavity. The application of the adhesive before self-adhesive cement placement provides similar or better interfacial adaptation than without the adhesive. SUMMARY: Purpose: The first objective of this study was to determine whether the luting material used for computer-aided design and computer-aided manufacture resin nanoceramic inlays affected interfacial adaptation. The second objective was to investigate whether application of a universal dentin adhesive before cementation affected interfacial adaptation. The final objective was to compare the inlay-side and dentin-side interfaces in the cement space.Methods and Materials: Seventy-four class I cavities were prepared on extracted human third molars. Cavities were optically scanned, and resin nanoceramic inlays were milled using Lava Ultimate blocks (3M ESPE). For the control groups, the fabricated inlays were cemented using Panavia V5 (Kuraray Noritake) or FujiCem 2 (GC). For the experimental groups, the teeth were randomly divided into groups I and II. Group I contained four subgroups using different luting materials; in all subgroups, the inlays were cemented and dual cured without pretreatment. Group II contained six subgroups in which inlays were cemented and dual cured after application of a universal dentin adhesive. After thermocycling, interfacial adaptation was measured using swept-source optical coherence tomography (SS-OCT) imaging and statistically compared among groups.Results: Interfacial adaptation was different depending on the luting material used (p<0.05). After application of a universal adhesive, some subgroups showed improved interfacial adaptation (p<0.05). In the comparison of inlay-side and dentin-side interfaces, no difference was found in interfacial adaptation (p>0.05).Conclusions: Interfacial adaptation for resin nanoceramic inlays differed with luting material. For some self-adhesive cements, application of a universal adhesive before cementation improved interfacial adaptation.

Surprisingly good thermoelectric performance of a black phosphorus/blue phosphorus van der Waals heterostructure.

Thermoelectric properties of a black phosphorus/blue phosphorus van der Waals heterostructure are investigated by using first-principles calculations and Boltzmann transport theory for both electrons and phonons. It is found that the heterostructure is both energetically and kinetically stable even at higher temperature. Compared with those of the constituent black and blue phosphorus monolayers, the thermoelectric performance of the heterostructure is significantly enhanced due to sharply decreased thermal conductivity caused by the presence of van der Waals interactions, as well as obviously reduced band gaps and multi-valley structures resulting from type-II band alignment. As a consequence, the room temperature ZT value can reach 1.6, which is much higher than those of the components. Furthermore, we obtain ZT over 2.0 in a wide temperature range from 400 to 800 K, and a maximum ZT of ∼3.2 can be realized at 700 K, which is surprisingly good for systems consisting of light elements only.

[Sleep quality and occupational stress relationship analysis of field gas recovery workers].

Objective: To explore the relationship between sleep quality and occupational stress in field gas recovery workers. Methods: In October 2018, cluster sampling method was adopted to conduct cross-sectional survey on 1726 field workers in a gas production oilfield. The individual characteristics, occupational stress factors, stress regulation factors, stress response and sleep quality, social support and coping strategies were evaluated by occupational stress measurement tools and job content questionnaire. Mann Whitney U test and Kruskal Wallis H test were used to compare sleep quality scores between the groups. Spearman rank correlation analysis was used to analyze the correlation between sleep quality and occupational stress, and logistic regression analysis was used to analyze multiple factors. Results: There were significant differences in sleep quality scores among different positions, gender, marital status, age, length of service, smoking and drinking (P<0.05) . There were no significant differences in sleep quality scores between different education levels and work shift groups (P>0.05) . Spearman rank correlation analysis showed that sleep quality score was negatively correlated with job satisfaction, reward, job stability, promotion opportunity, positive emotion, respect, self-esteem, control strategy, support strategy and self-efficacy score (r(s)=-0.361, -0.311, -0.238, -0.261, -0.248, -0.212, -0.139, -0.188, -0.152, -0.226, P<0.01) , and was positively correlated with social support, giving, daily tension, negative emotion, work monotony and depression symptom (r(s)=0.312, 0.279, 0.547, 0.493, 0.429, 0.599, P<0.01) . Compared with the high sleep quality score group, the middle and low sleep quality score groups had lower giving, work monotony, daily tension, depressive symptoms, negative emotions and social support (P<0.01) , while the scores of respect, reward, job satisfaction, positive emotion, self-efficacy, job stability, promotion opportunity, control strategy and support strategy were higher (P<0.01) . Multiple depressive symptoms, high daily tension, high negative emotion and high work monotony were the risk factors for sleep disorders (OR=3.417, 2.659, 2.913, 1.543) . Conclusion: Depressive symptoms, daily tension and negative emotion have great influence on sleep quality of field gas recovery workers.

Risk factors and renal outcomes of low bone mineral density in patients with non-dialysis chronic kidney disease.

Bone disorder is a common complication of chronic kidney disease (CKD). The clinical usefulness of bone mineral density (BMD) in CKD is not well known. Our study shows that low BMD is associated with physical activity and dietary Na/K intake ratio and can predict poor renal outcome in non-dialysis CKD. PURPOSE: Despite evidence of a link between bone mineral disorders and chronic kidney disease (CKD), the clinical implications of bone mineral density (BMD) in CKD are not well established. We investigated risk factors and renal outcomes of low BMD in CKD. METHODS: We analyzed data from the KNOW-CKD. BMD measured by dual-energy x-ray absorptiometry was classified by T score: normal (T score ≥ - 1.0), osteopenia (- 1.0 > T score > - 2.5), and osteoporosis (T score ≤ - 2.5) of the lumbar spine, hip, or femoral neck. Logistic regression analysis to assess risk factors of low BMD (T score < - 1.0) and Cox proportional hazards models to estimate risk of incident end-stage renal disease (ESRD). RESULTS: Low BMD was prevalent (osteopenia 33%; osteoporosis 8%) in 2128 adults with CKD (age 54 ± 12 years; male 61%). Over a median follow-up of 4.3 years, there were 521 cases of incident ESRD. Lower BMD was associated with female sex, older age, low eGFR, low BMI, and lifestyle factors of physical activity (odds ratio (OR) = 0.62, 95% confidence interval (0.49-0.77)) and spot urine Na/K ratio (1.07 (1.00-1.15)). In adjusted Cox models, low BMD was associated with increased incident ESRD (hazard ratio (HR) = 1.14 (0.92-1.41) for osteopenia; 1.43 (1.01-2.04) for osteoporosis, P for trend < 0.05) compared with the reference of normal BMD. The association between low BMD and ESRD was similar according to T score discordance classification. CONCLUSIONS: Low BMD was associated with modifiable lifestyle factors including low physical activity and high dietary Na/K intake ratio. The presence of low BMD is associated with poor renal outcomes in non-dialysis CKD.

High thermoelectric performance of half-Heusler compound BiBaK with intrinsically low lattice thermal conductivity.

Half-Heusler compounds usually exhibit relatively higher lattice thermal conductivity that is undesirable for thermoelectric applications. Here we demonstrate by first-principles calculations and Boltzmann transport theory that the BiBaK system is an exception, which has rather low thermal conductivity as evidenced by very small phonon group velocity and relaxation time. Detailed analysis indicates that the heavy Bi and Ba atoms form a cage-like structure, inside which the light K atom rattles with larger atomic displacement parameters. In combination with its good electronic transport properties, the BiBaK shows a maximum n-type ZT value of 1.9 at 900 K, which outperforms most half-Heusler thermoelectric materials.

Impact of ethanol and ultrasound treatment on mesophilic aerobic bacteria, coliforms, and Salmonella Typhimurium on chicken skin.

The present study evaluated the efficacy of ethanol treatment (0, 30, 50, or 70%) alone or in combination with ultrasound (37 kHz, 380 W) for the reduction of natural indigenous mesophilic aerobic bacteria (MAB), coliforms, and inoculated Salmonella Typhimurium on chicken skin. Bacterial cells with loose, intermediate, or tight attachment to chicken skin were recovered by shaking in an incubator (200 rpm) for 5 min, stomaching for 1 min, or blending for 1 min, respectively. Chicken skins were inoculated with a suspension (7 log CFU/mL) of S. Typhimurium. Ethanol reduced the number of MAB, coliforms, and S. Typhimurium on the chicken skin in a concentration-dependent manner, whereas ultrasound treatment without ethanol was ineffective. A combination of 70% ethanol with ultrasound treatment was the most effective in reducing S. Typhimurium populations with loose, intermediate, and tight attachment (reduction by 2.86 log CFU/g, 2.49 log CFU/g, and 1.63 log CFU/g, respectively). However, chicken skin treated with 50% ethanol alone or with a combination of >50% ethanol and ultrasound showed significant changes in Hunter color values (a* and b*) and texture (shear force) (P > 0.05). On the other hand, a combination of 30% ethanol and ultrasound yielded the best results, leading to a reduction of S. Typhimurium by a >1.0 log CFU/g, but did not alter the color or texture of chicken skin. Thus, a combination of 30% ethanol and ultrasound appears to be the optimum treatment for reduction of microbial contamination in production and distribution of skin-on chicken products, and enhance poultry safety without decreasing food quality.

Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates. METHODS: Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included. RESULTS: Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5%). The most frequent transplantation organ was lung (43.3%), and the most common sample with CPE isolates other than stool was respiratory tract (22.6%). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3% vs 10.0%; P = .03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95% CI, 1.24-8.68; P = .02), lung transplantation (OR, 4.50; 95% CI, 1.19-17.03; P = .03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95% CI, 1.72-22.45; P = .005) were associated with acquisition of CPE. CONCLUSIONS: Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.

Overexpression of miR-3196 suppresses cell proliferation and induces cell apoptosis through targeting ERBB3 in breast cancer.

OBJECTIVE: Breast cancer is one of the most common malignancies worldwide. MicroRNAs (MiRNAs) have been identified to influence cell behaviors through epigenetic post-transcriptional gene regulation. Therefore, the aim of this study was to determine the role of miR-3196 in the proliferation and apoptosis of breast cancer. MATERIALS AND METHODS: Human breast cancer cell lines (MCF-7 and MDA-MB-231) were obtained and cultured. The expression level of miR-3196 in breast cancer tissues was detected using Real Time-Polymerase Chain Reaction (RT-PCR). The effects of miR-3196 on the proliferation and apoptosis of breast cancer cells were analyzed by cell counting kit-8 (CCK-8) assay and TUNEL assay, respectively. In addition, the interaction between miR-3196 expression and erb-b2 receptor tyrosine kinase 3 (ERBB3) expression, as well as the mechanism of miR-3196 regulating ERBB3 in breast cancer, were also addressed by RT-PCR, Western blot, and luciferase reporter gene assay. RESULTS: MiR-3196 was lowly expressed in breast cancer tissues. Overexpression of miR-3196 could repress the proliferation and induce the apoptosis of breast cancer cells via targeting the 3'UTR of ERBB3. CONCLUSIONS: Our findings provide novel insights into the role of miR-3196 in breast cell proliferation and apoptosis. Meanwhile, this study suggests that miR-3196 can serve as a potential biomarker and therapeutic target for breast cancer.

Devising negative pressure within intercuff space reduces microaspiration.

BACKGROUND: Microaspiration past the tracheal tube cuffs causes ventilator-associated pneumonia. The objective of the current study was to evaluate whether creating negative pressure between the tracheal double cuffs could block the fluid passage past the tracheal tube cuffs. METHODS: A new negative pressure system was devised between the double cuffs through a suction hole in the intercuff space. Blue-dyed water was instilled above the cuff at negative suction pressures of - 54, - 68, - 82, - 95, - 109, - 122, and - 136 cmH2O, and the volume leaked was measured in an underlying water trap after 10 min. Leakage tests were also performed during positive pressure ventilation, and using higher-viscosity materials. The actual negative pressures delivered at the hole of double cuffs were obtained by placing microcatheter tip between the intercuff space and the artificial trachea. RESULTS: No leakage occurred past the double cuff at - 136 cmH2O suction pressure at all tracheal tube cuff pressures. The volume leaked decreased significantly as suction pressure increased. When connected to a mechanical ventilator, no leakage was found at - 54 cmH2suction pressure. Volume of the higher-viscosity materials (dynamic viscosity of 63-108 cP and 370-430 cP) leaked was small compared to that of normal saline (0.9-1.1 cP). The pressures measured in the intercuff space corresponded to 3.8-5.9% of those applied. CONCLUSIONS: A new prototype double cuff with negative pressure in the intercuff space completely prevented water leakage. The negative pressure transmitted to the tracheal inner wall was a small percentage of that applied.

Effect of Irradiance and Exposure Duration on Temperature and Degree of Conversion of Dual-Cure Resin Cement for Ceramic Restorations.

This study investigated the effects of irradiance and exposure duration on dual-cured resin cements irradiated through ceramic restorative materials. A single light-curing unit was calibrated to three different irradiances (500, 1000, and 1500 mW/cm2) and irradiated to three different attenuating materials (transparent acryl, lithium disilicate, zirconia) with 1-mm thicknesses for 20 or 60 seconds. The changes in irradiance and temperature were measured with a radiometer (or digital thermometer) under the attenuating materials. The degree of conversion (DC) of dual-cure resin cement after irradiation at different irradiances and exposure durations was measured with Fourier transform near infrared spectroscopy. Two-way analysis of variance revealed that irradiance ( p<0.001) and exposure duration ( p<0.001) significantly affected temperature and DC. All groups showed higher DCs with increased exposure times ( p<0.05), but there were no statistically significant differences between the groups irradiated with 1000 mW/cm2 and 1500 mW/cm2 ( p>0.05). Higher-intensity irradiances yielded higher temperatures ( p<0.05), but exposure time did not affect temperature when materials were irradiated at 500 mW/cm2 ( p>0.05).

Full-step Class II Correction Using a Modified C-palatal Plate for Total Arch Distalization in an Adolescent.

A 13-year-old adolescent male patient had a convex profile, severe overjet, and deep overbite with a skeletal Class II pattern. His maxillary dentition was distalized using a modified C-palatal plate (MCPP), and the treatment outcome was stable. After 37 months of total treatment, a pleasing profile and a favorable Class I occlusion was successfully achieved with 5 mm of distalization in the maxillary dentition. MCPP is a viable treatment option for full-step Class II in adolescents, especially when the patients/parents decline the extraction option.

Incremental and Bulk-fill Techniques With Bulk-fill Resin Composite in Different Cavity Configurations.

PURPOSE:: To compare the microtensile bond strengths of incremental and bulk-fill techniques under different C-factor and compliance conditions. METHODS AND MATERIALS:: Extracted human third molars were divided into three experimental groups. For group I, Class I cavities were prepared. For group II, MOD cavities of the same size were prepared. For group III, the cavities were prepared the same way as group II only with high compliance cavity walls. The cavity wall compliance of the specimens was evaluated. Each of these groups was divided into four subgroups. The teeth were restored using two different materials: TB (Tetric N-Ceram Bulk Fill; Ivoclar Vivadent, Hanau, Germany) and VB (Venus Bulk Fill; Heraeus Kulzer, Armonk, NY, USA), and two methods, either an incremental or bulk-fill technique. Then, the microtensile bond strengths (µ-TBSs) were measured and compared. The polymerization stresses of the composites were calculated using a custom-made device. The results were statistically analyzed using the Kruskal-Wallis test and Weibull analysis. RESULTS:: In group I, the µ-TBS obtained using the incremental technique was significantly higher than that obtained by the bulk-fill technique ( p<0.05). In contrast, no difference of the µ-TBS value was observed between the two techniques in groups II and III. The µ-TBS value of group I was significantly lower than those of groups II and III ( p<0.05). No statistical difference in the µ-TBS was observed when the cavities were filled with either TB or VB ( p>0.05). CONCLUSIONS:: The incremental technique showed higher bond strength than did the bulk-fill technique in high C-factor cavities. However, no difference was found between the two techniques in the low C-factor cavities. The bond strength in the high C-factor cavities was significantly lower than that of the low C-factor cavities.