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Objectives This study aimed to determine whether distally angulating an implant is a successful strategy to avoid the maxillary sinus and the need for bone augmentation, while increasing the anterior-posterior (A-P) implant distribution in the edentulous maxilla. Materials and methods In 115 patients with edentulous maxillae, virtual implant planning was performed utilizing cone-beam computer tomographs. Axial (8 mm length) and tilted (12 mm length) dental implants with 30-degree and 45-degree angulation were virtually positioned to avoid entering the maxillary sinus, while maximizing A-P distribution. Measurements were made between the tilted and axial implants to assess the change in A-P distribution of implants at the implant and abutment levels. Results Forty-seven sites (20.4%) were not able to have either treatment modality with insufficient bone for implant placement. Axial implants were placed more distally than 45-degree and 30-degree tilted implants in 24% and 42% of sites, respectively. The average change in A-P spread measured at the implant level, for 30- and 45-degree tilted implants was -0.25 mm (95% CI -0.76, 0.26) and 1.9 mm (95% CI 1.4, 2.3), respectively. When measured from the center of each multi-unit abutment the average increase in A-P distances for tilted implants appears larger in the 30-degree and 45-degree groups by 0.97 mm and 1.74 mm, respectively compared to measurements at the implant level. Conclusions Angulating 12 mm implants provides a limited increase in A-P distribution of implants in edentulous rehabilitation in most situations. In certain patients, the use of 8mm axial implants may provide a greater A-P spread.

Purpose of review Treatment of Peyronie's disease with collagenase Clostridium histolyticum (CCh) has gained world-wide adoption following the phase III clinical trials IMPRESS I and II. However, the optimal treatment parameters remain largely unknown. Many groups have made modifications to CCh treatment in Peyronie's disease in recent years. This review aims to discuss the variations in CCh treatment reported and associated outcomes. Recent findings Variations in CCh treatment protocols include administering higher CCh doses (0.9 mg) less frequently (q1month), use of home penile modeling, use of angulating penile traction devices, and vacuum therapy devices. Authors have reported different injection techniques to include three-point fans and tunneling techniques. Patient selection has expanded to include and evaluate responses among men with some extent of plaque calcification, and ventral curves. Summary Since publication of the IMPRESS trials, several variations of CCh treatment have been reported with similar treatment responses to the original trials. However, future studies are required with prospective, randomized comparative designs to identify the optimal treatment strategies for men with Peyronie's disease.

An operator often finds it hard to assess the ideal timing to start angulating the driver while placing infrazygomatic crest screws. Thus, we have designed a simple system to guide the operator to know exactly when the angulation of the driver should be started for the ideal placement of the IZC screw. The components of the system include the calculation of the amount of tissue that needs to be pierced perpendicularly and the fabrication of an indicator device over the implant driver with a stainless steel wire. Hence, using this system, the proper timing for angulation can be obtained, thus improving the accuracy of placement.

Aims: To evaluate the strategic role of social and environmental reporting in Ethiopian large tax payer companies based on the resource-based view of the firm. Study Design: The study employed explanatory research design. Place and Duration of Study: Large tax payer companies for the year 2018, Ethiopia. Methodology: The study used annual audited financial reports of 262 companies and structured questionnaire which were distributed to three individuals per each sampled company. Interaction effect model was developed for which ordinary least square (OLS) regression with robust standard errors on a cross-sectional analysis were used to test the hypotheses. Results: The regression result showed that social & environmental reporting and the interaction effect of social & environmental reporting with companies’ environmental sensitivity had significant positive impact on reputability of companies. Conclusion: The study concluded that through social and environmental reporting, companies can develop valuable resource which in turn increase their reputability. Hence, environmental sensitive companies have more operational negative effect to society and environment, they are considered as dangerous by the society. Heretofore, these companies can strategically shift this perception to companies’ advantage through social and environmental reporting. Originality/Value: In the availability of limited studies which explore social and environmental reporting practice within developing country perspective, this study shed some light about the Ethiopian companies reporting practice. Furthermore, the results of this study were an indication for companies’ managers to strategically use social and environmental reporting, which in turn increase their reputability and prevent them from being perceived as dangerous by the society.

Background A cadaveric feasibility study was carried out. Osteotomies to correct fixed sagittal imbalance are usually performed at L3/ L4. Objective To investigate the feasibility of S1 pedicle subtraction osteotomy to correct spinal deformity and spinopelvic parameters, achieving better results with more limited exposure. The data obtained will allow a fixation construct specific for this osteotomy to be designed. Methods S1 pedicle subtraction osteotomy was performed on 12 cadaveric specimens. Baseline and postprocedural computed tomography and biomechanical studies were performed. Data were analyzed with a fixation system SolidWorks model, and the redesigned fixation construct was described and analyzed with an ANSYS model. Results S1 pedicle subtraction osteotomy is technically feasible. The fixation can be achieved with L4, L5, and iliac screws connected with bars. The system can be reinforced with a polyetheretherketone cage placed anteriorly in the S1 body osteotomy site, a cross-connecting bar, a double iliac screw, or an anterior interbody cage placed at the L5-S1 disc. The fixation strength is improved by angulating the iliac rod channel 10°, adding a semi-sphere to the locking screw contact surface and 2 fins to its saddle. The redesigned construct showed suitable stress and deformation levels, achieving the expected biomechanical requirements. Discussion Compared with surgery on higher levels, S1 pedicle subtraction osteotomy allows greater correction with shorter fixation, because the osteotomy is performed at a more caudal level, modifying the spinopelvic parameters. Conclusions S1 pedicle subtraction osteotomy is technically feasible. Finite element analysis results indicate that it has appropriate biomechanical properties.

Artificial anal sphincter (AAS) is an in situ implanted device that acts as a treatment for fecal incontinence regardless of etiology by augmenting the incompetent sphincteric structures. However, AAS is impeded from becoming a valid therapy by its high rate of ischemic complication and malfunction. This article presents an original puborectalis-like artificial anal sphincter (PAAS) that features a low risk of ischemia necrosis and rectal perception remodeling. The device retains continence by reproducing the action, including the pulling and angulating the rectum, of the puborectalis muscle, which forms the anorectal angle and reduces the required clamping pressure. Three rectal pressure sensors were embedded to maintain the pressure exerted on the rectal wall in a safe range and to monitor the distention of the rectum. A series of in vitro studies were conducted with a porcine rectum, and this PAAS prototype manifested the ability of maintaining continence with a clamping pressure considerably lower than that required by other AAS devices. The pressure sensors exhibit good linearity, and the function of rectal perception remodeling has also revealed high reliability with a success rate of 93.3%.

PURPOSE To investigate the fracture resistance and performance of zirconia when employed for the fabrication of implant abutments with different angulations, simulating anterior maxillary oral rehabilitation. MATERIALS AND METHODS Forty-five monolithic zirconia custom abutments of internal conical implant connection were CAD/CAM designed and fabricated. The specimens were divided into three groups (n = 15/group) according to implant-to-abutment angulation. The angulations used were; 0°, 15°, and 25°. The abutments were loaded until failure at 135° using the Universal Testing Machine (Instron, Canton, MA). Collected data were statistically analyzed using one-way ANOVA and post hoc Tukey test. RESULTS Mean (±standard deviation) load at fracture of the zirconia abutments for the three groups were 962.37 ± 93.81 N (Gr15) > 718.25 ± 93.71 N (Gr25) > 534.05 ±133.77 N (Gr0). Statistically significant difference (p < 0.0001) was found between all groups; Gr0 vs. Gr15, Gr0 vs. Gr25, Gr15 vs. Gr25. CONCLUSIONS Contrary to expectations, the non-angulated monolithic zirconia abutments presented the lowest fracture resistance values. Angulating the abutments 15 or 25 degrees, following the palatal resorption pattern of the premaxilla, significantly increased the in vitro fracture resistance.

Objective We report our experience with surgery in 50 patients with C2 neurinomas. The anatomic subtleties of these discrete forms of tumors and their surgical implications are analyzed. Methods During the period 2006–2016, we operated on 50 patients with 55 C2 neurinomas. Type A tumors were located within the spinal canal, type B tumors were located in the lateral gutter, and type C tumors had a paraspinal extension. By working within the dural confines of the tumor and appropriately angulating the microscope, the entire tumor bulk extending into 1 or all 3 compartments was resected. Follow-up duration ranged from 3 months to 10 years (mean 68 months). Results This series included 36 male and 14 female patients. Age range of patients was 14–70 years (mean age 36 years). Progressive symptoms of myelopathy were present in 41 patients. There were 16 type A + B tumors, 27 type B tumors, 10 type B + C tumors, and 2 type A + B + C tumors. All patients experienced symptom improvement after surgery and were able to resume their normal lifestyle. Conclusions C2 neurinomas arise in the region of the C2 ganglion, and despite the fact that some achieve a large size, they remain confined within the dura. Radical tumor resection can be achieved by working within the layers of the dural cover. Bone removal and opening of spinal dura for tumor exposure and resection can be avoided.

Management of open lower limb fractures with soft tissue defects can be a technically challenging orthopaedic problem. Limited availability of orthoplastic services means that alternatives to the fix and flap concept are required in order to prevent infected non-unions from developing. The proposed ‘bayonet apposition’ allows the surgeon to temporarily shorten the limb without angulating the limb or creating a bone defect and removing viable bone. The viable bone edges are overlapped in a bayonet-like manner in order to appose the wound and skin edges. The limb length is restored by gradually distracting the bone segments once the soft tissues have healed. This is facilitated with a hexapod fixator for stabilization of the fracture and distraction. Prerequisites for utilizing this method are circumferential soft tissue damage to the lower limb with viable distal tissue. The bayonet method allows primary closure of a wound and rapid restoration of the native length of the limb.

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is an effective, safe, and cost-effective diagnostic bronchoscopy technique for the work-up of mediastinal lymphadenopathy. Concern has been raised, however, about the high cost of convex-probe EBUS bronchoscope repairs. The damage is usually due to breakage of the insertion tube (the flexible part that is advanced into the airways), moisture invasion and damages to the working channel, image guide bundle, or umbilical cord. Understanding the root cause of EBUS scope damage is important for its prevention. We describe 2 unusual cases of EBUS scope damage. In the first case, the distal black rubber covering of the EBUS scope insertion tube was damaged due to friction with the edge of an endotracheal tube and in the second case, the EBUS scope insertion tube was angulating laterally instead of vertically during the flexion maneuver, probably due to scope manipulation while wedged tightly in a segmental bronchus.

Objective To describe the initial experience of a group of emergency department (ED) physicians, utilizing a Glidescope videolaryngoscope (GVL) for orotracheal intubations in the ED. Methodology A 6-month, single center, prospective observational study from 19 Feb 2007 to 18 Aug 2007 was conducted on all orotracheal intubations, which involved utilization of the original GVL in different emergency airway management scenarios. Results Overall success of GVL intubation was 15 out of 21 (71.4%) cases. The GVL was able to provide at least Cormack-Lehane grade I or II laryngoscopy views in all cases. All the operators highlighted difficulty in angulating and maneuvering the endotracheal tube for insertion through the glottis as the primary difficulty encountered. Conclusion We found the GVL to be an effective device in our ED's emergency airway control repertoire. Its role in the anticipated difficult airway in the ED will need further studies.

Introduction The aim of this study was to compare treatment outcomes in university vs private practice settings with Class I patients using the American Board of Orthodontics Objective Grading System. Methods A parent sample of 580 Class I patients treated with and without extractions of 4 first premolars was subjected to discriminant analysis to identify a borderline spectrum of 66 patients regarding the extraction modality. Of these patients, 34 were treated in private orthodontic practices, and 32 were treated in a university graduate orthodontic clinic. The treatment outcomes were evaluated using the 8 variables of the American Board of Orthodontics Objective Grading System. Results The total scores ranged from 10 to 47 (mean, 25.44; SD, 9.8) for the university group and from 14 to 45 (mean, 25.94; SD, 7.7) for the private practice group. The university group achieved better scores for the variables of buccolingual inclination (mean difference, 2.28; 95% confidence interval [CI], 0.59, 3.98; P = 0.01) and marginal ridges (mean difference, 1.32; 95% CI, 0.28, 2.36; P = 0.01), and the private practice group achieved a better score for the variable of root angulation (mean difference, −0.65; 95% CI, −1.26, −0.03; P = 0.04). However, no statistically intergroup differences were found between the total American Board of Orthodontics Objective Grading System scores (mean difference, −0.5; 95% CI, −3.82, 4.82; P = 0.82). Conclusions Patients can receive similar quality of orthodontic treatment in a private practice and a university clinic. The orthodontists in the private practices were more successful in angulating the roots properly, whereas the orthodontic residents accomplished better torque control of the posterior segments and better marginal ridges.

The Proximal Femoral Nail® (PFN) has an extra hip pin in the head–neck fragment, to prevent rotation of the fracture fragments. However, this hip pin brought along two unexpected complications: medial migration and cutout. In order to reduce the risk of migration and cutout, the hip pin should bear no or minimal load. For this reason, a modified PFN (mPFN) prototype was developed, with an oval instead of a round hole in the nail through which the hip pin passes. Under load–bearing conditions the hip pin could angulate, thereby reducing its load, but maintaining its antirotational function. A multicenter observational study was initiated, to investigate the handling of the mPFN, the stability and strength of the construct, the incidence and type of implant–related complications, and whether the angulating hip pin concept functioned in clinical practice. In six European teaching hospitals 250 patients with unstable trochanteric fractures were included and treated with the mPFN prototype. Handling was found to be equal to the use of the regular PFN. No breakage of the nail at the side of the oval hole was documented. The cutout risk was practically, but not completely, eliminated, if reduction of the fracture and position of fixation were adequate. Medial migration was no longer documented. The angulation concept with the oval hole in the intramedullary nail of the mPFN worked in clinical practice, and helped further reducing the risk of specific implant–related complications.

Background A novel prosthetic anal sphincter (PAS) has been developed that aims to occlude by flattening and angulating the bowel, reproducing the action of the puborectalis muscle. The safety of the PAS has been confirmed in biomechanical, in vitro and long-term animal survival studies. The Medical Devices Agency approved implantation in 12 patients. Methods The PAS was placed in the pelvis around the anorectal junction via a transabdominal approach in 12 patients with severe faecal incontinence. The device was activated 6 weeks after surgery. Fibreoptic examination of the mucosa below the device was undertaken at various intervals during review. Results At a median follow-up of 59 (range 30–72) months nine of the 12 patients had a functioning PAS. There were no device-related infective complications after the initial operation but one patient developed pseudomembranous colitis and had the device removed. The PAS was effective in restoring continence in ten of 11 patients. Median (range) Cleveland Clinic continence scores improved from 16 (7–20) before to 3 (0–7) after surgery. In two patients the PAS was eventually removed owing to infection after revisional surgery. There was no clinical or histological evidence of gastrointestinal mucosal ischaemia. Conclusion The PAS was effective in restoring continence. There was no device-related infection after the initial operation, no device erosion and no clinical or histological evidence of gastrointestinal ischaemia.

An artificial anal sphincter was designed to reproduce the normal physiology of the ano-rectum by flattening and angulating the bowel without causing crenation. It was shown in the laboratory that by eliminating crenation, occlusion pressure was evenly distributed without localized high pressure points under the device. Further, the design facilitates the creation of angulation of the bowel in a relatively large area of distribution of the occlusion pressure, allowing the device to be set at lower operating occlusion pressures than that required for circular designs yet still achieve continence. Each of the components of the device was studied separately and the whole system was assessed in an acute and survival animal model.

Minute lesions of the esophagus were biopsied using a transparent hood designed by the authors to fit on the tip of a forward viewing endoscope. The quality of the bite biopsies performed using the hood and their accuracy, as well as technical difficulty, were investigated. Minute lesions of less than 5 mm in diameter located at 1, 2 or 3 o'clock were chosen for investigation since these are usually difficult areas from which to obtain a biopsy. Twenty subjects were biopsied using the hood and 20 were biopsied without it, in the conventional way, over the 15 month period from November 1993 to January 1995. A comparison of first biopsy success rates, with and without the hood, was made. The rate of success was very high (19/20; 95%) when the hood was used, but low (11/20; 55%) when the hood was not used (p

Little is known about the forces transmitted to the tip of the endoscope or about forces exerted by manipulating accessories in the biopsy channel of a flexible endoscope. Every endoscopist is concerned about the possibility of perforation of viscera while manoeuvring the endoscope. Perforation is an occasional complication of endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy [1-11]. Pushing the endoscope, angulating the tip of the endoscope, rotatory movements (torque) of the endoscope, pushing accessories through the channel of duodenoscope, flexing the tip of the cannula or sphincterotome by movements of the bridge, and bowing the sphincterotome are some commonly performed manoeuvres to cannulate the sphincter of Oddi and perform sphincterotomy. The aim of this study was to measure the forces exerted on the duodenum and sphincter of Oddi during endoscopic sphincterotomy and to evaluate the force required to actually perforate the stomach and duodenum in bench experiments.

The echo pattern of the aortic root is elicited by locating the typical echo of the mitral valve and then angulating the transducer medially and sometimes cephalically. The characteristic echo pattern of the aortic root consists of paired undulating signals three to five cm apart. These signals move

There has been much recent progress in reducing radiation hazards and in increasing the quality of roentgenograms. New techniques associated with this progress have created problems directly related to angulating the x-ray machine. A device which solves some of the problems concerned with angulation and centering of the x-ray beam has been described in this article.

It appears that man assumed the erect form by angulating the lumbosacral area at the sacrum. The pelvis was not altered with this change and it therefore bears the same horizontal relationship to the limbs attached thereto as does the pelvis of a quadruped to its hind limbs. This concept of the relationship between the pelvic and abdominal cavities may suggest some alterations in our established gynecological and obstetrical procedures.

The inferior epigastric vein is a good access site when central venous nutrition cannot be delivered through the usual routes. The babies can remain mobile without angulating the catheter and, by tunneling above the diaper line, contamination can be avoided.

A pericardial incision is described that allows internal mammary artery grafts to reach their destination without angulating around a cut edge of pericardium and leaves a pericardial flap for covering bypass grafts anterior to the heart.