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BackgroundPublic health faces a significant challenge in reducing rural–urban disparities in diabetes. Since dietary control is part of the medical regimen for diabetes management, how diabetic patients perceive the impact of oral health on their quality of life is critical. The present study aimed to compare the Oral Health-related Quality of Life (OHRQoL) between rural and urban diabetic patients.MethodsThe study design was cross-sectional. The study sample included 831 self-reported diabetic patients, extracted from the first wave of the new-cohort Taiwan Longitudinal Study on Aging survey (NC_TLSA) that comprised a nationally representative sample of community-dwelling adults aged 50 and above in Taiwan. The composite score generated from the Oral Health Impact Profile-7 (OHIP-7), which has seven questions, was used to construct two OHRQoL measures, the severity of perceived poor OHRQoL and the prevalence of poor OHRQoL. These two OHRQoL measures were treated as dichotomous variables. Multivariate logistic regression models were applied for analysis.ResultsRural diabetic patients had a higher likelihood of experiencing the severity of perceived poor OHRQoL than those in urban areas (OR = 2.40, 95% CI: 1.30–4.40). Although rural diabetic patients also had a higher prevalence of poor OHRQoL than urban diabetic patients, the difference was not significant (OR = 1.47, 95% CI: 0.95–2.28). Social determinants, such as education, are essential factors attributed to both OHRQoL measures.ConclusionOverall, rural diabetes community-dwelling patients had a poorer OHRQoL than those in urban areas. Given a bidirectional relationship between oral health and diabetes, improving oral health in rural areas may be a critical avenue to improve the quality of diabetes care in rural areas.

The purpose of this study was to investigate the corrosion behavior of four different dental casting alloys in artificial saliva solutions with varying pH values. Microstructures were observed using scanning electron microscopy. The corrosion behavior of the experimental alloys in artificial saliva was examined using potentiodynamic polarization measurements. The high noble alloy (Au-8.5Pt-2.6Pd-1.4In) exhibited better corrosion resistance with lower anodic current densities in the pH range of 3–5. The anodic current density of the noble alloy (Au-24.9Pd-19.0Ag-5.5In) decreased as the pH decreased. The noble (Pd-37.7Ag-8.5Sn) and base metal (Ni-25Cr-11.5Mo-1.4Si) alloys exhibited lower corrosion resistance with a relatively high current density at pH 3. Compared with noble alloys, base metal alloys exhibited good corrosion resistance in this study. This makes them a promising material for dental castings considering the complex pH changes in the oral environment.

Supplemental material, sj-docx-1-cjk-10.1177_20543581231181032 for COVID-19 Vaccine Effectiveness Among Patients With Maintenance Dialysis; Observations From Population Level Cohort Studies in 2 Large Canadian Provinces by Mohammad Atiquzzaman, Yuyan Zheng, Lee Er, Ognjenka Djurdjev, Joel Singer, Mel Krajden, Shabnam Balamchi, Doneal Thomas, Michelle Hladunewich, Matthew J Oliver and Adeera Levin in Canadian Journal of Kidney Health and Disease

Supplemental Material, sj-docx-1-ptd-10.1177_08968608221149546 for Evaluation and outcomes of a 5-year assisted peritoneal dialysis program by Shannon N Wong, Linda Turnbull, Sushila Saunders, Lee Er, Micheli U Bevilacqua, Adeera Levin and Rajinder S Singh in Peritoneal Dialysis International

Objective Endothelial progenitor cells (EPCs) contribute to the recovery of neurological function after ischemic stroke. Indirect revascularization has exhibited promising effects in the treatment of cerebral ischemia related to moyamoya disease and intracranial atherosclerotic disease. The role of EPCs in augmenting the revascularization effect is not clear. In this study, we investigated the therapeutic effects of indirect revascularization combined with EPC transplantation in rats with chronic cerebral ischemia. Methods Chronic cerebral ischemia was induced by bilateral internal carotid artery ligation (BICAL) in rats, and indirect revascularization by encephalo-myo-synangiosis (EMS) was performed 1 week later. During the EMS procedure, intramuscular injection of EPCs and the addition of stromal cell-derived factor 1 (SDF-1), and AMD3100, an SDF-1 inhibitor, were undertaken, respectively, to investigate their effects on indirect revascularization. Two weeks later, the cortical microcirculation, neuronal damage, and functional outcome were evaluated according to the microvasculature density and partial pressure of brain tissue oxygen (PbtO2), regional blood flow, expression of phosphorylated Tau (pTau), TUNEL staining and the rotarod performance test, respectively. Results The cortical microcirculation, according to PbtO2 and regional blood flow, was impaired 3 weeks after BICAL. These impairments were improved by the EMS procedure. The regional blood flow was further increased by the addition of SDF-1 and decreased by the addition of AMD3100. Intramuscular injection of EPCs further increased the regional blood flow as compared with the EMS group. The rotarod test results showed that the functional outcome was best in the EMS combined with EPC injection group. Western blot analysis showed that the EMS combined with EPC treatment group had significantly decreased expressions of phosphorylated Tau and phosphorylated glycogen synthase kinase 3 beta (Y216 of GSK-3β). pTau and TUNEL-positive cells were markedly increased at 3 weeks after BICAL induction. Furthermore, the groups treated with EMS combined with SDF-1 or EPCs exhibited marked decreases in the pTau expression and TUNEL-positive cells, whereas AMD3100 treatment increased TUNEL-positive cells. Conclusion The results of this study suggested that indirect revascularization ameliorated the cerebral ischemic changes. EPCs played a key role in augmenting the effect of indirect revascularization in the treatment of chronic cerebral ischemia.

Aneurysmal subarachnoid hemorrhage (SAH) can cause severe neurological deficits and high mortality. Early brain edema following SAH contributes to the initiation of microcirculation impairment and may further lead to delayed ischemic neurologic deficit (DIND). This study aimed to investigate whether dental pulp stem cell conditioned medium (DPSC-CM) ameliorates SAH-induced microcirculation impairment and the underlying mechanisms. SAH was induced via intrathecal injection of fresh autologous blood in Wistar male adult rat. DPSC-CM or DPSC-CM + insulin growth factor-1 (IGF-1) antibody was randomly administered by intrathecal route 5 min after SAH induction. To evaluate the underlying mechanisms of DPSC-CM in the treatment of SAH, primary rat astrocyte and microglia co-cultures were challenged with hemolysate or SAH-patient CSF in the presence or absence of DPSC-CM. The results showed that in vivo, DPSC-CM treatment decreased the brain water content, improved microcirculation impairment and enhanced functional recovery at 24 h post-SAH. DPSC-CM treatment also alleviated the expressions of water channel protein aquaporin-4 (AQP4) and pro-inflammatory cytokines, and enhanced the expressions of anti-inflammatory factors in the cortical region. However, all the beneficial effects of DPSC-CM were abrogated after treatment with IGF-1 neutralizing antibody. The in vitro results further showed that DPSC-CM treatment reduced hemolysate/SAH-patient CSF-induced astrocyte swelling and promoted M2 microglia polarization, partially through IGF-1/AKT signaling. The data suggested that DPSC-CM significantly reduced brain edema and rescued microcirculation impairment with concomitant anti-inflammatory benefits after SAH, and may potentially be developed into a novel therapeutic strategy for SAH.

The use of a continuous lumbar drain (LD) for the treatment of aneurysmal subarachnoid hemorrhage (aSAH), and malondialdehyde (MDA), a marker of oxidative stress, is correlated with clinical outcome. This study aimed to investigate the relationship between LD placement and MDA level after aSAH.Patients with modified Fisher's grade III and IV aSAH who underwent early aneurysm obliteration were enrolled. Cerebrospinal fluid (CSF) was obtained on day 7 after aSAH in non-LD group. In LD group, the LD was inserted on day 3 after aSAH for continuous CSF drainage. The levels of intrathecal hemoglobin, total bilirubin, ferritin, and MDA were measured.There were 41 patients in non-LD group (age: 58.7 ± 13.7 years; female: 61.0%) and 48 patients in LD group (age: 58.3 ± 10.4 years; female: 79.2%). There were more favorable outcomes (Glasgow Outcome Scale ≥4) at 3 months after aSAH in LD group (p = 0.0042). The intrathecal hemoglobin, total bilirubin, ferritin, and MDA levels at day 7 after aSAH were all significantly lower in LD group. An older age (60 years) (p = 0.0293), higher MDA level in the CSF (p = 0.0208), and delayed ischemic neurological deficit (p = 0.0451) were independent factors associated with unfavorable outcomes. LD placement was associated with a decreased intrathecal MDA level on day 7 after aSAH (p 0.001).The intrathecal MDA level at day 7 after aSAH can be an effective outcome indicator in modified Fisher's grade III/IV aSAH. Continuous CSF drainage via a LD can decrease the intrathecal MDA level and improve the functional outcome.

Multidrug resistance (MDR) is a multifactorial issue in cancer treatment. Drug efflux transporters, particularly P-glycoprotein (P-gp), are major contributors to such resistance. In the present study, we evaluated the P-gp-inhibiting and MDR-reversing effects of two compounds, namely rhein, an anthraquinone, and diacerein, the acetylated prodrug of rhein. ABCB1/Flp-In-293 was used as a model for investigating the related molecular mechanisms, and the multi-drug-resistant cancer cell line KB/VIN was used as a platform for evaluating the reversal of MDR0. The results indicated that at a concentration of 2.5 μM, both diacerein and rhein significantly inhibited P-gp efflux function. They also downregulated P-gp expression by interacting with the signal transducer and activator of transcription 3. Further investigation of the inhibitory mechanism of these compounds revealed that both stimulated P-gp ATPase activity dose dependently and engaged in the noncompetitive inhibition of rhodamine 123 efflux. Furthermore, rhein was revealed to be a potent reverser of MDR in cancer, and the combination of 30 μM rhein and 1000 nM vincristine exerted a strong synergistic effect, achieving a high combination index (CI) of 0.092. Diacerein demonstrated potential applications as a selective cytotoxic agent against multi-drug-resistant cancer cells at a concentration of 18.92 μM and as a mild MDR reverser at doses of 10 μM. In conclusion, diacerein and rhein are potential candidates for P-gp inhibition and MDR reversal in cancer cells.

Servo presses achieve high formability by using different punch motion curves, thereby increasing their applicability in conventional processing fields. In this study, the punch motion curves of servo presses were optimized, and the effects of punch motion curves on the springback of U-shaped sheet metal were explored. Subsequently, the optimal punch motion curve was determined, and the springback effect after processing was investigated. Different punch motion curves were proposed and simulated for comparison with the results of conventional methods, and the equivalent stress values obtained using different motion curves and mold angles were analyzed. DEFORM software was used to conduct simulations to determine the differences between processing methods. In addition, the spring-go, springback, load–stroke characteristics, and stress and strain distributions of U-shaped sheet metal were investigated. The conventional motion curve resulted in springback, stress, strain, and required processing force higher than those achieved by the curves proposed in this study. The smaller the movement difference in the motion curve of the servo press was, the lower the springback, stress, and strain were. These results indicate that the punch motion curves obtained for different types of processing can serve as a reference for selecting appropriate parameter values for servo presses.

Background Multidrug resistance (MDR) in cancer is one of the main obstacles in treatment with chemotherapy. Drug efflux through P-glycoprotein is the major mechanism involved in MDR. A potential strategy to provide the best possible clinical outcomes is to develop P-glycoprotein (P-gp) inhibitors from natural products. Purpose The present study investigated the effects of the natural sesquiterpene lactone tenulin and its derivative isotenulin on human P-gp; the mechanisms of kinetic interactions were also explored. Methods The human P-gp (ABCB1/Flp-In™-293) stable expression cells were established by using the Flp-In™ system. The effects of tenulin and isotenulin on cell viability were evaluated by SRB assays in established cell lines, sensitive cancer cell line (HeLaS3), and resistant cancer cell line (KB-vin). The transporter inhibition ability was evaluated by calcein-AM uptake assays. The P-gp inhibition kinetics of tenulin and isotenulin were evaluated by rhodamine123 and doxorubicin efflux assays. The ATPase activity was evaluated with the Pgp-Glo™ Assay System. Results Tenulin and isotenulin significantly inhibited the P-gp efflux function by stimulating P-gp ATPase activity. Tenulin and isotenulin interacted with the effluxes of rhodamine 123 and doxorubicin through a competitive and noncompetitive mechanism, respectively. The combinations of tenulin and isotenulin with chemotherapeutic drugs significantly resensitized MDR cancer cells. Conclusion These results suggested that tenulin and isotenulin are potential candidates to be developed for synergistic treatment of MDR cancers.

Staple composition can influence target binding and bioactivity of peptides. We present strategies to modulate E/Z ratios and access saturated analogues., All-hydrocarbon, i, i+7 stapled peptide inhibitors of the p53-Mdm2 interaction have emerged as promising new leads for cancer therapy. Typical chemical synthesis via olefin metathesis results in the formation of both E- and Z-isomers, an observation that is rarely disclosed but may be of importance in targeting PPI. In this study, we evaluated the effect of staple geometry on the biological activity of five p53-reactivating peptides. We also present strategies for the modulation of the E/Z ratio and attainment of the hydrogenated adduct through repurposing of the metathesis catalyst.

Macrocyclic peptides open new opportunities to target intracellular protein-protein interactions (PPIs) that are often considered nondruggable by traditional small molecules. However, engineering sufficient membrane permeability into these molecules is a central challenge for identifying clinical candidates. Currently, there is a lack of high-throughput assays to assess peptide permeability, which limits our capacity to engineer this property into macrocyclic peptides for advancement through drug discovery pipelines. Accordingly, we developed a high throughput and target-agnostic cell permeability assay that measures the relative cumulative cytosolic exposure of a peptide in a concentration-dependent manner. The assay was named NanoClick as it combines in-cell Click chemistry with an intracellular NanoBRET signal. We validated the approach using known cell penetrating peptides and further demonstrated a correlation to cellular activity using a p53/MDM2 model system. With minimal change to the peptide sequence, NanoClick enables the ability to measure uptake of molecules that enter the cell via different mechanisms such as endocytosis, membrane translocation, or passive permeability. Overall, the NanoClick assay can serve as a screening tool to uncover predictive design rules to guide structure-activity-permeability relationships in the optimization of functionally active molecules.

OBJECTIVE. Nosocomial transmission of coronavirus disease (COVID-19) to frontline health care workers is well known, and health care workers may inadvertently become vectors for onward transmission. Ultrasound (US) service providers are at significant risk because scanning usually requires prolonged close patient contact. The bulky US equipment may also facilitate fomite transmission of disease. With increasing use of point-of-care and portable diagnostic US services, the risk is substantial. CONCLUSION. Our experience and protocols may help service providers with their own effective response against COVID-19.

Active hybrid aerodynamic and aerostatic bearing system has gradually become more valued in recent years for its application in the precision machine field, especially for precision instruments and mechanisms that require high rotational speed, high precision, and high rigidity support. In this system, air lubricated bearing is mainly used for support. Although the carrying capacity is not as high as oil film bearings, air lubricated bearings can provide a work environment where the rotor (spindle) will not experience axial deformation at high rotational speed and low heat generation. In practice, spindle system dynamic problems include critical speed, spindle imbalance, and improper bearing design, which can cause the spindle system to produce aperiodic motion, instability, and even chaotic motion under certain parameters and conditions during its operation. If severe, these irregular motions may cause machine damage or delay production. In order to understand what type of work situation can produce aperiodic phenomenon, and to prevent irregular vibration and reduce instantaneous air hammer effect, the finite difference method and mixed method are used to explore the related characteristics for spindle system. Meanwhile, relevant theories including bifurcation diagram, Poincare map, spectrum response phenomenon, and maximum Lyapunov exponents are applied to analyze rotor non-linear dynamic behavior. In addition, we verified the non-linear motion parameter conditions to prevent spindle system from falling into the instable status during design. The objective is to lower the probability of chaotic phenomenon in the system and reduce damage caused by irregular vibrations in the system. The result of this study can serve as a reference when designing precision spindle systems or mechanisms.

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

No study has investigated the effect of learning curves on the accuracy of dental implant navigation systems. This study evaluated the accuracy of the dental implant navigation system and established the learning curve according to operation site and operating time. Each dental model was used for drilling 3 missing tooth positions, and a patient tracking module was created. The same dentist performed the drilling test for 5 sets of dental models. CT back scanning was performed on the dental models. Customized implants based on the drilled holes were inserted. The relative error between the preoperative planning and actual implant was calculated. Using the dental navigation system could help dentists position implants more accurately. Increasing the frequency with which a dentist used the navigation system resulted in shorter operations. Longitudinal and angular deviation were significantly (P

Cancer multi-drug resistance (MDR) caused by P-glycoprotein (P-gp) efflux is a critical unresolved clinical concern. The present study analyzed the effect of cinnamophilin on P-gp inhibition and MDR reversion. The effect of cinnamophilin on P-gp was investigated through drug efflux assay, ATPase assay, MDR1 shift assay, and molecular docking. The cancer MDR-reversing ability and mechanisms were analyzed through cytotoxicity and combination index (CI), cell cycle, and apoptosis experiments. P-gp efflux function was significantly inhibited by cinnamophilin without influencing the drug’s expression or conformation. Cinnamophilin uncompetitively inhibited the efflux of doxorubicin and rhodamine 123 and exhibited a distinct binding behavior compared with verapamil, the P-gp standard inhibitor. The half maximal inhibitory concentration of cinnamophilin for doxorubicin and rhodamine 123 efflux was 12.47 and 11.59 μM, respectively. In regard to P-gp energy consumption, verapamil-stimulated ATPase activity was further enhanced by cinnamophilin at concentrations of 0.1, 1, 10, and 20 μM. In terms of MDR reversion, cinnamophilin demonstrated synergistic cytotoxic effects when combined with docetaxel, vincristine, or paclitaxel. The CI was

Periodontal disease is a chronic inflammatory disease that is commonly treated with surgical and nonsurgical techniques. However, both approaches have limitations. Low-level laser therapy (LLLT) has been widely applied in reducing inflammatory reactions, and research indicates that LLLT induces an anti-inflammatory effect that may enhance periodontal disease therapy. The purpose of this study was to investigate the anti-inflammatory effect of LLLT on human periodontal ligament cells (hPDLCs) in an inflammatory environment and aimed to determine the possible mechanism of action. Cells were cultured and treated with or without lipopolysaccharide (LPS) from Porphryromonas gingivalis or Escherichia coli, followed by irradiation with a gallium-aluminum-arsenide (GaAlAs) laser (660 nm) at an energy density of 8 J/cm2. Quantitative real-time polymerase chain reactions were used to assess the expression of pro-inflammatory genes, including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8. The dual-luciferase reporter assay was used to examine nuclear factor-κB (NF-κB) transcriptional activity. An enzyme-linked immunosorbent assay was used to monitor the concentration of intracellular cyclic adenosine monophosphate (cAMP). Both LPS treatments significantly induced the mRNA expression of pro-inflammatory cytokines. However, LLLT inhibited the LPS-induced pro-inflammatory cytokine expression and elevated intracellular levels of cAMP. The LLLT inhibitory effect may function by downregulating NF-κB transcriptional activity and by increasing the intracellular levels of cAMP. LLLT might inhibit LPS-induced inflammation in hPDLCs through cAMP/NF-κB regulation. These results should be further studied to improve periodontal therapy.

Color Doppler imaging (CDI) can be used to noninvasively create images of human blood vessels and quantitatively evaluate blood flow in real-time. The purpose of this study was to assess the effects of acupuncture on the blood flow of the peripheral, mesenteric, and retrobulbar arteries by CDI. Statistical significance was defined as P values less than 0.05. Blood flow in the radial and brachial arteries was significantly lower during needle stimulation on LR3 than before in healthy volunteers, but was significantly higher after needle stimulation than before. LR3 stimulation also resulted in a significant decrease in the vascular resistance of the short posterior ciliary artery and no significant change of blood flow through the superior mesenteric artery (SMA) during acupuncture. In contrast, ST36 stimulation resulted in a significant increase in blood flow through the SMA and no significant change in the vascular resistance of the retrobulbar arteries. Additionally, acupuncture at previously determined acupoints in patients with open-angle glaucoma led to a significant reduction in the vascular resistance of the central retinal artery and short posterior ciliary artery. Our results suggest that acupuncture can affect blood flow of the peripheral, mesenteric, and retrobulbar arteries, and CDI can be useful to evaluate hemodynamic changes by acupuncture.

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

To investigate the milling properties of different yttria-tetragonal zirconia polycrystalline (Y-TZP) block materials by applying a dental computer numerical control (CNC) milling center. Low temperature sintering zirconia block denoted by KMUZ (experimental) with two commercial zirconia blocks for T block made in Taiwan and a G block made in Germany were compared for the milling properties. Seventy-two specimens were milled using the same CNC milling center, and properties were evaluated by measuring the weight loss (g), milling time (s), margin integrity (%) and broken diameter (μm). The crystalline phases contents were identified by X-ray diffraction and the microstructures of the sintering specimens were observed by scanning electron microscopy and transmission electron microscopy. The mean milling time of G and KMUZ were significantly shorter than T (P

Aims/Introduction To elucidate whether axonal changes arise in the prediabetic state and to find a biomarker for early detection of neurophysiological changes. Materials and Methods We enrolled asymptomatic diabetes patients, as well as prediabetic and normoglycemic individuals to test sensory nerve excitability, and we analyzed those findings and their correlation with clinical profiles. Results In nerve excitability tests, superexcitability in the recovery cycle showed increasing changes in the normoglycemic, prediabetes and diabetes cohorts (−19.09 ± 4.56% in normoglycemia, −22.39 ± 3.16% in prediabetes and −23.71 ± 5.15% in diabetes, P = 0.002). Relatively prolonged distal sensory latency was observed in the median nerve (3.12 ± 0.29 ms in normoglycemia, 3.23 ± 0.38 ms in prediabetes and 3.45 ± 0.43 ms in diabetes, P = 0.019). Superexcitability was positively correlated with fasting plasma glucose (r = 0.291, P = 0.009) and glycated hemoglobin (r = 0.331, P = 0.003) in all participants. Conclusions Sensory superexcitability and latencies are the most sensitive parameters for detecting preclinical physiological dysfunction in prediabetes. In addition, changes in favor of superexcitability were positively correlated with glycated hemoglobin for all participants. These results suggest that early axonal changes start in the prediabetic stage, and that the monitoring strategy for polyneuropathy should start as early as prediabetes., We explored early changes of axonal function in prediabetes using axonal excitability test. The changes progressed from normoglycemia, prediabetes and early diabetes. Superexcitability is the most sensitive parameter for sensory axonal dysfunction. Fasting sugar and glycated hemoglobin were correlated with superexcitability in all participants.

Increasing prevalence of mobile technology and declining mobility often lead to poor posture and increased healthcare costs, all of which require better ergonomic interventions. Musculoskeletal disorders are often caused by progressive compromised posture and diminished physical recovery. They are commonly seen in the workplace which not only negatively impact productivity and increase absentees but incur significant health costs. The purpose of this review is to evaluate the existing research regarding the effectiveness of ergonomic interventions designed to improve musculoskeletal wellness in the workplace, and present newly wellness technology for potential ergonomic improvement. Twenty-one studies sourced from Google Scholar and PubMed were reviewed. The programs evaluated in these studies include sit-stand desks; intermittent standing bouts; ergonomic interventions or education; exercise programs; and posture wear. The results were mostly positive in preventing and alleviating musculoskeletal symptoms but failed to decrease health care costs. More research and innovations should be focus on more cost-effective interventions to improve posture in the workplace, especially on workplace posture correcting cost effective solutions.

Recently, golf has become a very popular sport, and most golfers focus on improving their skills and learning process. However, many researchers have studied and found that the hardness and vibration frequency of golf club, and the weight and angle of club head can result in unstable swing distance and accuracy. The golfers modify their swings attitude to adapt to the equipments, or even change the club set, and sometimes these situations cause sports injuries to golfers. Therefore, this study discusses how to design an optimal club set for individual golfers by customization and decreases the cases of sports injuries. The Taguchi method is applied to analyze and design the optimum club for shaft hardness, club head weight, spine and grip weight. The improved club is tested, and the result shows that the driving distance is increased by more than 10%, so that the maximum efficiency of hitting is increased. This study provides important reference for design of golf clubs.

The aim of this study was to compare the accuracy of implant placement by using the conventional freehand method, the surgical guide alone, the dental navigation system alone, and the dental navigation system with a surgical guide. The participants were aged 20 years or older and were requiring dental implant surgery according to an assessment made by a dentist between July 2014 and December 2017. A total of 128 dental implants were inserted, 32 dental implants in each group, and participants with similar or identical age (i.e., 20&ndash, 50 years or 50 years or above) and missing tooth locations were paired for comparison. Accuracy was measured by overlaying the real position in the postoperative Cone Beam Computerized Tomography (CBCT) on the virtual presurgical placement of the implant in a CBCT image. Using the dental navigation system with a surgical guide could help dentists to position implants more accurately. Total, longitudinal, and angular error deviation were significantly different (p &lt, 0.0001). The same level of accuracy could be obtained for the different jaws and tooth positions. The one-way analysis of variance (ANOVA) showed that the total, longitudinal, and angular errors differed significantly (p &lt, 0.0001). A comparison of the four dental implant surgical methods indicated that the combination of a dental implant navigation system and a surgical guide kit achieved the highest accuracy in terms of the different tooth positions and jaws.

Pulmonary embolism (PE) is associated with mortality. There are many clinical prediction tools to predict early mortality in acute PE but little consensus on which is best. Our study aims to validate existing prediction tools and derive a predictive model that can be applied to all patients with acute PE in both inpatient and outpatient settings. This is a retrospective cohort study of patients with acute PE. For each patient, the Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), European Society of Cardiology (ESC), and Angriman scores were calculated. Scores were assessed by the area under the receive-operating curve (AUC) for 30-day, all-cause mortality. To develop a new prognostic model, elastic logistic regression was used on the derivation cohort to estimate β-coefficients of 8 different variables; these were normalized to weigh them. A total of 321 patients (mean age 60±17 years) were included. Overall 30-day mortality was 10.3%. None of the scores performed well; the AUCs for the PESI, sPESI, ESC, and Angriman scores were 0.67 (95% confidence interval [CI], 0.57-0.77), 0.58 (0.48-0.69), 0.65 (0.55-0.75), and 0.67 (0.57-0.76), respectively. Our new prediction model outperformed PESI, with an AUC of 0.82 (95% CI, 0.76-0.88). At a cutoff score of 100, 195 (60.1%) patients were classified as low risk. Thirty-day mortality was 2.1% (95% CI, 0.8%-5.2%) and 23.0% (16.5%-31.1%) for low- and high-risk groups, respectively ( P < .001). In conclusion, we have developed a new model that outperforms existing prediction tools in all comers with PE. However, further validation on external cohorts is required before application.

The influence of aneurysmal subarachnoid hemorrhage (SAH) on brain microcirculation has not yet been systematically investigated. We established an animal model to examine (1) the brain surface microcirculation (2) the influences of cerebrospinal fluid (CSF) from aneurysmal SAH on the brain surface microcirculation. A rat SAH model was induced by injection of autologous arterial blood into the cisterna magnum, and the brain surface microcirculation was evaluated by a capillary videoscope with craniotomy at the fronto-parietal region. CSF from SAH rats and SAH patients was applied on the brain surface of naïve rats to assess the resulting microcirculatory changes. In the SAH rats, diffuse constriction of cortical arterioles within 24 hours of SAH was observed. Similar patterns of microcirculation impairment were induced on normal rat brain surfaces via application of CSF from SAH rats and SAH patients. Furthermore, the proportion of subjects with arteriolar vasoconstriction was significantly higher in the group of SAH patients with delayed ischemic neurological deficits (DIND) than in those without DIND (p

Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH.Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed.There were 28 patients (mean age, 55.4 y; males, 46.6%), including 18 (64.3%) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95% confidence interval: 3.8-270.8; P = 0.0015).By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.

Ultrasound has been commonly used to guide clinical procedures in Western medicine, such as peripheral nerve blocks, biopsies, and fluid aspiration. Ultrasound is a useful tool because it is non-invasive, allows real-time visualisation of body images, and poses no risk to the human body, as it uses sound waves that are generally safe. In addition to guiding clinical procedures, ultrasound has been used to train medical students to perform clinical examinations.1 From a review of the literature, only one study has explored the use of ultrasound for acupuncture, and this focused on detecting soft-tissue displacement from movement of the needle.2 No study has explored the use of ultrasound in demonstrating the relationship between an acupuncture needle and the surrounding anatomical structures real-time in vivo. The aim of our study was to evaluate its feasibility and to discuss the implications for education and research. This study was conducted on a human cadaveric hand. Ultrasound scans were conducted using a Siemens Acuson P300 ultrasound system with a …

OBJECTIVEDirect brain compression and secondary injury due to increased intracranial pressure are believed to be the pathognomic causes of a grave outcome in acute subdural hemorrhage (aSDH). However, ischemic damage from aSDH has received limited attention. The authors hypothesized that cerebral microcirculation is altered after aSDH. Direct visualization of microcirculation was conducted in a novel rat model.METHODSA craniectomy was performed on each of the 18 experimental adult Wistar rats, followed by superfusion of autologous arterial blood onto the cortical surface. Changes in microcirculation were recorded by capillary videoscopy. Blood flow and the partial pressure of oxygen in the brain tissue (PbtO2) were measured at various depths from the cortex. The brain was then sectioned for pathological examination. The effects of aspirin pretreatment were also examined.RESULTSInstantaneous vasospasm of small cortical arteries after aSDH was observed; thrombosis also developed 120 minutes after aSDH. Reductions in blood flow and PbtO2 were found at depths of 2–4 mm. Blood-brain barrier disruption and thrombi formation were confirmed using immunohistochemical staining, while aspirin pretreatment reduced thrombosis and the impairment of microcirculation.CONCLUSIONSMicrocirculation impairment was demonstrated in this aSDH model. Aspirin pretreatment prevented the diffuse thrombosis of cortical and subcortical vessels after aSDH.

Thermal behavior and phase transformation of ZrO 2 –10%SiO 2 precursor powder prepared by a co-precipitation route without adding stability agent has been studied using different thermal analysis/thermogravimetry (DTA/TG), X-ray diffraction (XRD), transmission electron microscopy (TEM), selected area electron diffraction (SAED), nano beam electron diffraction (NBED), high-resolution TEM (HRTEM) and energy-dispersive X-ray spectrometer (EDS). The TG results show that four weight loss regions were from 298 to 443 K, 443 to 743 K, 743 to 793 K and 793 to 1400 K. The DTA result shows that the ZrO 2 freeze-dried precursor powders crystallization at 1014 K. The activation energy of 993.7 kJ/mol was obtained for tetragonal ZrO 2 crystallization using a non-isothermal process. The XRD result shows that only a single phase of tetragonal ZrO 2 appears when the freeze-dried precursor powders after calcination between 1173 and 1373 K for 2 h. Moreover, when calcined at 1473 K for 2 h, the phase transformation from tetragonal ZrO 2 fully converted to monoclinic ZrO 2 occurred.

Object Experimental studies have demonstrated the crucial role of posthemorrhagic erythrocyte catabolism in the pathogenesis of subarachnoid hemorrhage (SAH). The authors of this study aimed to investigate the prognostic value of a series of CSF biomarkers linked to heme metabolism in SAH patients. Methods Patients with Fisher Grade III aneurysmal SAH undergoing early aneurysm obliteration were enrolled. The levels of heme oxygenase–1 (HO-1), oxyhemoglobin, ferritin, and bilirubin in intrathecal CSF were measured on the 7th day posthemorrhage. The associations of functional outcome with clinical and CSF parameters were analyzed. Results The study included 41 patients (mean age 59 ± 14 years; 16 male, 25 female), 17 (41.5%) of whom had an unfavorable outcome (Glasgow Outcome Scale score ≤ 3) 3 months after SAH. In terms of the clinical data, age > 60 years, admission World Federation of Neurosurgical Societies Grade ≥ III, and the presence of acute hydrocephalus were independent factors associated with an unfavorable outcome. After adjusting for clinical parameters, a higher level of HO-1 appeared to be the most significant CSF parameter related to an unfavorable outcome among all tested CSF molecules (OR 0.934, 95% CI 0.883–0.989, p = 0.018). Further analysis using a generalized additive model identified a cutoff HO-1 value of 81.2 μM, with higher values predicting unfavorable outcome (82.4% accuracy). Conclusions The authors propose that the level of intrathecal CSF HO-1 at Day 7 post-SAH can be an effective outcome indicator in patients with Fisher Grade III aneurysmal SAH.

Background/purpose We studied the correlation between clinical covariates and blood loss under hypotensive anesthesia, in patients undergoing a bilateral vertical ramus osteotomy (BVRO). Materials and methods BVROs were performed on 37 patients with mandibular prognathism. The preoperative and postoperative values of blood constituents were examined and analyzed. Correlations among blood loss, sex, age, operative time, and reduced values of blood constituents were statistically assessed. Results The average operative time was 255.5 ± 42.56 minutes, and blood loss was 105.9 ± 66.83 mL. No patient required a blood transfusion in this study. There were no significant correlations between blood loss and related factors (sex, operative time, and reductions in blood constituents). Comparing sexes, blood loss and reductions in blood constituents exhibited non-significant differences. However, male patients had significantly larger values for presurgical and postsurgical blood constituents than female patients. Conclusion In our study, blood loss was acceptable in patients who underwent a BVRO, and thus, no preoperative autologous blood donation was necessary.

Background/purpose: Improper assessment of the maxillary buccal vestibular space can contribute to the fabrication of maxillary dentures with inadequate buccal flange extensions. The purpose of this study was to determine whether a significant difference existed between the anatomic dimensions of the buccal vestibules and the corresponding buccal flanges of maxillary complete dentures in an edentulous population. Materials and methods: The anterior, middle, and posterior depth and width of the maxillary buccal vestibules in 100 randomly selected subjects were measured with a periodontal probe. Corresponding measurements of the buccal flanges of the subjects' existing dentures were recorded. The differences between buccal vestibule widths and depths and denture flange widths and lengths were statistically compared according to site. Results: The difference in the mean depth between the vestibules and the flanges in the posterior area (6.4 mm and 10.3 mm, respectively) was approximately 38% (P

The phase transformation and crystalline growth of 4 mol% yttria partially stabilized zirconia (4Y-PSZ) precursor powders have been investigated using the coprecipitation route, using zirconium oxide chloride octahydrate (ZrOCl2·8H2O) and yttrium nitrate (Y(NO3)3·6H2O) as the initial materials. Differential thermal analysis (DTA), X-ray diffraction (XRD), transmission electron microscopy (TEM), selected area electron diffraction (SAED), nano beam electron diffraction (NBED), and high resolution TEM (HRTEM) were utilized to characterize the behavior of phase transformation and crystalline growth of the 4Y-PSZ precursor powders after calcined. Tetragonal ZrO2 crystallization occurred at about 718.2 K. The activation energy of tetragonal ZrO2 crystallization was 227.0 ± 17.4 kJ/mol, obtained by a non-isothermal method. The growth morphology parameter (n) and growth mechanism index were close to 2.0, showing that tetragonal ZrO2 had a plate-like morphology. The crystalline size of tetragonal ZrO2 increased from 7.9 to 27.6 nm when the calcination temperature was increased from 973 to 1,273 K. The activation energies of tetragonal ZrO2 growth were 14.97 ± 0.33 and 84.46 ± 6.65 kJ/mol when precursor powders after calcined from 723–973 and 973–1,273 K, respectively.

The growth kinetics of tetragonal and monoclinic ZrO2 crystallites in 3 mol% yttria partially stabilized ZrO2 (3Y-PSZ) precursor powder has been investigated using X-ray diffraction (XRD), Brunauer–Emmett–Teller (BET) specific surface area analysis, transmission electron microscopy (TEM) and high resolution TEM (HRTEM). After calcination of the 3Y-PSZ precursor powder between 773 and 1073 K for 2 h, the crystalline structures were composed of tetragonal and monoclinic ZrO2 as the primary and secondary phases, respectively. When the 3Y-PSZ precursor powder was calcined at 773 K for 2 h, the BET specific surface area was 97.13 m2/g, which is equivalent to a particle size of 10.30 nm. The crystallite sizes determined via XRD and BET agreed well, indicating that the powder was virtually non-agglomerated. The growth kinetics of tetragonal and monoclinic ZrO2 crystallite isothermal growth in the 3Y-PSZ precursor powder are described.

The integrity of the cemented fixation interface is responsible for the long-term longevity of artificial hip prostheses. Metallic stems with roughened surfaces are considered to provide stronger adhesion with cement. However, clinical studies have reported that roughened stems show a lower survival rate than polished stems. These studies clearly reveal that the causes of artificial stem loosening are very complicated and multifaceted. Therefore, this study was conducted to investigate the mechanical effect of stem surface finish in cemented hip replacement. To accomplish this, a series of cement&ndash, metal specimens were tested configurations to assess the mechanical characteristics of the cement&ndash, metal interface specimens. A finite elemental model of cemented femoral prostheses was then created, in which the cement&ndash, stem interface was assumed to be in different bonding states according to the experimentally measured interface properties. The failure probabilities of the cement mantle and cemented interface under physiological loadings were evaluated. Experimental results indicate that the polished metal produced higher interfacial tensile and lower shearing strengths than the roughened metal. The polished stems were predicted to induce a lower failure probability of cement mantle and higher integrity of the cement&ndash, stem interface when compared to the roughened stem. Overall, current results provide significant evidence to support the clinical outcomes of cemented hip prostheses with different stem surface finishes.

Background/purpose This study evaluated the fracture resistance of different metal substructure designs for implant-supported porcelain-fused-to-metal (PFM) crowns. Materials and methods Eighteen PFM crowns were fabricated using different metal substructure designs and were conventionally cemented on an implant abutment analog. The crowns were divided according to the metal substructure design for manufacturing the metal framework into three groups of six specimens each: Group A had a minimum required thickness; Group B had a conventional design; and Group C had a wrinkled design. After applying a load of 200 N at a frequency of 2 Hz with 300,000 cycles of dynamic loading, all specimens were tested for fracture resistance using compression loading on the buccal functional cusp. Results Among these three groups, Groups A and B, respectively, had the minimum and maximum fracture resistance strengths. Respective data for Groups A, B, and C were 111.13 ± 27.15 kg, 236.13 ± 39.21 kg, and 188.63 ± 12.10 kg. Statistically significant differences were observed among the three groups (P Conclusion These results confirm that the conventional design had the best fracture resistance, and an excessively thick porcelain layer can cause crown fracture. However, there was no obvious proof that the wrinkled design had better fracture resistance than the conventional design. Therefore, the theory that PFM can provide better support requires further corroboration.

The effect of sintering process parameters on the properties of 3 mol% yttria partially stability zirconia (3Y-PSZ) ceramics has been investigated. The relative density of the sintered pellet rapidly increases from 70.5 to 93.6 % with rose temperature from 1473 to 1573 K. In addition, the relative density only slightly increases from 94.9 to 96.6 %, when rose sintered temperature from 1573 to 1773 K. This result shows that no significant influence on the densification behavior when sintering at 1573 to 1773 K for 2 h. The Vickers hardness and toughness also increase with the sintered temperature.

Two mol% yttria-partially stabilized zirconia (2Y-PSZ) precursor powders were obtained through a co-precipitation process using ZrOCl 2 .8H 2 O and Y(NO 3 ) 3 .6H 2 O as starting materials. Phase transformation and crystallite growth behavior have been investigated using X-ray diffraction (XRD), transmission electron microscopy (TEM) and selected area electron diffraction (SAED). XRD results show that the crystal structure to be composed of coexisting tetragonal ZrO 2 (t-ZrO 2 ) and monoclinic ZrO 2 (m-ZrO 2 ) when the 2Y-PSZ freeze dried precursor powders was calcined at 773–1273 K for 2 h. The fraction of m-ZrO 2 content is lower than 3.0 % when the calcination temperature is lower than 1073 K, whereas m-ZrO 2 content rapidly increases to 8.7 % with the increase of calcination temperature to 1273 K. The crystallite size of t-ZrO 2 increases from 12.3 to 30.2 nm when calcination temperature increased from 773 to 1273 K. In addition, the activation energy of t-ZrO 2 and m-ZrO 2 crytallite growth in 2Y-PSZ freeze dried precursor powders are 29.2 and 21.8 kJ/mol, respectively.

Objective: to understand the effectiveness of the health and fitness evaluation among the staff members in Asia University. Method: Evaluating and analyzing 95 staff members by using descriptive statistic (17 male, 58 female). The average age of male was 37.73, and 31.59 years old for the female. The evaluation included physical health norm and physical fitness level. The result showed that the average male BMI was over the standard, with blood pressure a little higher than normal. The female BMI and blood pressure were showed as normal. The waistline of both male and female were normal. In the physical fitness area, the male aerobic fitness level was normal, muscular strength was very good and flexibility was normal. The aerobic fitness level of female was normal, muscular strength was good and flexibility was poor. In conclusion, both male and female staff members were doing well in terms of their physical fitness. The male staff members especially need to control their weight in the BMI area. The female staff members should use stretching exercises to improve their flexibility. By doing the health and fitness evaluation helped us to understand the participation in physical activities of the staff members. Their physical fitness level indicated as a reference for their personal physical and health status. Practicing health and physical evaluation has a positive meaning and qualitative reasons. In promoting physical fitness activities and gets the staff members to involve in physical activities in daily basis also develop it as a lifetime habit. Not only to improve the staff members’ health and fitness level effectively, but also the quality of their life.

Aim: Research is a key component of evidence-based medical imaging. Good knowledge and attitude towards research is important in implementing the paradigm shift from the traditional model of practice to evidence-based practice. The aim of this study was to ascertain the attitude, level of awareness and knowledge of radiographers about research. Potential barriers might also be identified so that programmes and schemes could be developed to raise the profile of research in clinical practice. Methods: A 20-item scale self-completion questionnaire was designed and distributed to radiographers in the Department of Diagnostic Radiology, SGH. The questionnaire consisted of questions pertaining to years of working experience, specialization of practice, role/involvement in any research, training needs and identification of potential barriers to research. Results: The final response rate was 67% (N ¼ 114). Although the involvement in research is 39% (N ¼ 44), the radiographers strongly believed that it is essential for them to participate in research to develop themselves and the profession, as well as to improve the quality of care delivered to patients. The main identified perceived barriers to research included lack of time, resources and heavy clinical workload. Sixty-four percent (N ¼ 73) of participants indicated that provision of courses would improve their research skills, such as research methodology, biostatistics, literature critique, and a lack of these could be some of the reasons for low research involvement among radiographers. Conclusions: The data suggest that positive attitudes, institutional support and provision of research related courses are needed to increase radiographers’ involvement in research.

Objective To determine whether perfusion computed tomography (CT) is useful for identifying patients with poor-grade subarachnoid hemorrhage (SAH) with reversible etiologies and whether early obliteration in patients with poor-grade aneurysmal SAH leads to favorable outcomes. Methods Patients with new-onset aneurysmal SAH in World Federation of Neurological Surgeons (WFNS) grade IV or V neurologic condition who had perfusion CT performed at admission were eligible for the study. The study retrospectively enrolled 38 patients seen between January 2007 and July 2009. The decision to perform an early obliteration was made by the family after a discussion with the neurosurgeons, neurointensivists, and interventional radiologists. The functional outcomes were correlated with the Glasgow Outcome Scale (GOS) at 6 months, and quantitative perfusion CT data were collected. Results This study included 10 (26%) grade IV and 28 (74%) grade V patients. Favorable outcomes occurred in 19 (50%) patients, and 11 (29%) patients died. After a multivariate logistic regression analysis of the parameters, older age (odds ratio 1.104, P = 0.0317), bilateral prolonged mean transient time (MTT) at the thalami (odds ratio 4.155, P = 0.0362), and early obliteration (odds ratio 0.098, P = 0.003) were predictive of poor outcome. Conclusions Early bilateral prolonged MTT at the thalami and old age are associated with a poor outcome. Early obliteration benefits a significant portion of SAH patients.

Ischemia is an important etiology of painful neuropathies. We generated a mouse system of ischemic neuropathy by ligation-reperfusion of the femoral artery to mimic neuropathic pain and nerve injury patterns observed clinically. Mice exhibited spontaneous neuropathic pain behaviors, which were most obvious after ischemia for 5 h. Mechanical and cold allodynia developed by post-operative day (POD) 7 and persisted through the experimental period up to POD 56. Neuropathic pain behaviors were alleviated with intraperitoneal gabapentin (50 and 100 mg/kg) in a dose-dependent manner. Large-fiber deficit assessed with nerve conduction studies was demonstrated by reduced amplitudes of the compound muscle action potential (CMAP) on POD 7 (48.4% of the control side, p < 0.001). Small-fiber impairment was demonstrated by decreased epidermal nerve density (END) on POD 7 (29.1% of the control side, p < 0.001). Reductions in CMAP amplitudes and ENDs persisted through POD 56. Our system replicated the clinical manifestations of ischemic neuropathy: (1) neuropathic pain with cold and mechanical allodynia and (2) nerve injury to both large and small fibers with pathologic and physiologic evidence. This system produced by a simple procedure provides an opportunity to investigate mechanisms and further treatments of ischemic neuropathy on genetically engineered mice.

Background/purpose The objective of this study was to assess the relationship between the essential functional qualities of complete dentures and participants' oral health-related well-being among an elderly edentulous population. Materials and methods Four hundred elderly participants from Taiwan, aged ≥ 65 years, with diverse levels of formal education, received intraoral examinations in accordance with the 10 criteria embedded in the Functional Assessment of Dentures (FAD) and personal interviews in accordance with the Oral Health Impact Profile (OHIP)-14. The mean OHIP-14 scores were compared among categories using a t test or ANOVA. A multiple-regression analysis was used to identify significant FAD criteria related to specific OHIP-14 domains, while adjusting for gender, age, and educational level. Results Maxillary stability and retention, denture articulation, and occlusion demonstrated significant relationships with the mean OHIP-14 scores and individual mean OHIP-14 domain scores. Maxillary denture stability and denture articulation were the two most significant denture-related variables. Conclusion A stable and retentive maxillary denture with adequate articulation provided the optimal environment for oral function with the highest level of patient oral health-related well-being in this elderly population.