Treat to target in Crohn’s disease:A practical guide for clinicians

A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE)-II guidelines specify short,intermediate,and long-term treatment goals,documenting specific treatment targets to be achieved at each of these timepoints.Scheduled appraisal of Crohn’s disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified.Consensus treatment targets in Crohn’s disease comprise combination clinical and patient-reported outcome remission,in conjunction with biomarker normalisation and endoscopic healing.Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing,clinicians must consider that this may not always be appropriate,acceptable,or achievable in all patients.This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets.The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques,particularly intestinal ultrasound,holds great promise;as do emerging treatment targets such as transmural healing.Two randomised clinical trials,namely,CALM and STARDUST,have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn’s disease.Findings from these studies reflect that patient subgroups and Crohn’s disease characteristics likely to benefit most from a T2T approach,remain to be clarified.Moreover,outside of clinical trials,data pertaining to the real-world effectiveness of a T2T approach remains scare,highlighting the need for pragmatic real-world studies.Despite the obvious promise of a T2T approach,a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake.This highlights the need to describe strategies,processes,and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice.Hence,this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn’s disease.

Evaluating the Impact of the Universal Test and Treat Strategy on the Survival of Patients in the Northwest Region of Cameroon

Introduction: The main outcome of efficiently implemented universal test and treat (UTT) program is improved survival. UTT implementation has been ongoing in Cameroon since 2016 but evaluation data are scarce. This study aims to assess the survival of antiretroviral therapy (ART) patients initiated under UTT in Northwest region of Cameroon. Methods: This retrospective cohort study included HIV-positive patients initiated in 2016 at 27 purposefully selected sites and followed until 2021. Data was anonymously abstracted from ART registers and patients’ charts. Kaplan-Meier survival estimates and Cox model were used to compare the survival of patients initiated under UTT with those initiated otherwise, using stata version 14.0. Results: In total, 2490 HIV-positive patients (median age 42.7 years, 94.7% adults, and 69.0% female) participated in the study. Of 1389 patients with viral load (VL) test results, 55% were initiated on ART late. The VL suppression rate of patients initiated late and those initiated early were similar. During follow-up, 1020 (40.9%) participants censored. The survival curves of patients initiated early on ART and those initiated late were similar during the first 2.5 years of follow-up but significantly (p Conclusions: This study confirms the expected impact of UTT. Programs only need to close existing implementation gaps along the critical pathways (diagnosis and treatment) of UTT, focusing more on males.

Clinical Study on the Effectiveness of Xian Fang Huo Ming Yin for Treating Cutaneous Infections and Promoting Wound Healing in Patients with Perianal Abscess

Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.

Performance Evaluation of Two Series Vertical Flow Filters for Wastewater Treatment: A Case Study of the Prototype Installed at Gaston Berger University, Saint-Louis, Senegal

This paper evaluates the efficacy of two sequential vertical flow filters (VFF), FV1 and FV2, implanted with Typha, in a pilot-scale wastewater treatment system. FV1 comprises three cells (FV1a, FV1b, and FV1c), while FV2 consists of two cells (FV2a and FV2b), each designed to reduce various physicochemical and microbiological pollutants from wastewater. Quantitative analyses show significant reductions in electrical conductivity (from 1331 to 1061 μS/cm), biochemical oxygen demand (BOD5 from 655.6 to 2.3 mg/L), chemical oxygen demand (COD from 1240 to 82.2 mg/L), total nitrogen (from 188 to 37.3 mg/L), and phosphates (from 70.9 to 14.6 mg/L). Notably, FV2 outperforms FV1, particularly in decreasing dissolved salts and BOD5 to remarkably low levels. Microbiological assessments reveal a substantial reduction in fecal coliforms, from an initial concentration of 7.5 log CFU/100mL to 3.7 log CFU/100mL, and a complete elimination of helminth eggs, achieving a 100% reduction rate in FV2. The study highlights the impact of design parameters, such as filter material, media depth, and plant species selection, on treatment outcomes. The findings suggest that the judicious choice of these components is critical for optimizing pollutant removal. For instance, different filtration materials show varying efficacies, with silex plus river gravel in FV1c achieving superior pollutant reduction rates. In conclusion, VFFs emerge as a promising solution for wastewater treatment, underscoring the importance of design optimization to enhance system efficiency. Continuous monitoring and adaptation of treatment practices are imperative to ensure water quality, allowing for safe environmental discharge or water reuse. The research advocates for ongoing improvements in wastewater treatment technologies, considering the environmental challenges of the current era. The study concludes with a call for further research to maximize the effectiveness of VFFs in water management.

Scientific connotation of “treating different diseases with the same method” from the perspective of metabolic-immune dysregulation in inflammation-mediated carcinogenesis of digestive organs

Inflammation-mediated carcinogenesis develops in the context of chronic inflammation and is a significant cause of cancer within the digestive system.In the chronic inflammation microenvironment,the metabolic activity of tissue cells undergoes extensive changes,which interfere with the normal function of immune cells.Dysregulation of cell metabolism and immune function has been identified as a key factor contributing to inflammation-mediated carcinogenesis within the major digestive organs,such as the stomach,liver,and colorectum.This metabolic-immune imbalance also corresponds to traditional Chinese medicine(TCM)theories of“yin-yang disharmony”and“disharmony between Ying-nutrients and Wei-defense.”The metabolic-immune imbalance has also been regarded as the key factor supporting“treatment of different diseases with the same method”,in which the same approach is adopted in the treatment of different conditions.In the TCM treatment process,it is necessary to first identify TCM patterns and then apply the corresponding TCM to correct the dysregulated metabolic and immune function,thereby blocking the progression from inflammation to malignancy.Our study findings deepen the TCM understanding of metabolic-immune dysregulation and the relationship between metabolic-immune dysregulation,pattern identification,and treatment method.They also provide new insights for the treatment of inflammation-mediated carcinogenesis in major digestive organs and help us further explore the scientific connotation of the TCM strategy of“treating different diseases with the same method”.

Potential risk of soil irrigation with treated wastewater over 40 years:a field experiment under semi-arid conditions in northeastern Tunisia

In Tunisia,water scarcity is only adding pressure on water demand in agriculture.In the context of sustainable development goals,Tunisia has been reusing treated wastewater(TWW)as a renewable and inexpensive source for soil fertigation and groundwater(GW)recharge.However,major risks can be expected when the irrigation water is of poor quality.This study aims for evaluating the potential risk of TWW and GW irrigation on soil parameters.Accordingly,we evaluated the suitability of water quality through the analysis of major and minor cations and anions,metallic trace elements(MTEs),and the sodium hazard by using the sodium adsorption ratio(SAR)and the soluble sodium percentage(SSP).The risk of soil sodicity was further assessed by SAR and the exchangeable sodium percentage(ESP).The degree of soil pollution caused by MTEs accumulation was evaluated using geoaccumulation index(Igeo)and pollution load index(PLI).Soil maps were generated using inverse spline interpolation in ArcGIS software.The results show that both water samples(i.e.,TWW and GW)are suitable for soil irrigation in terms of salinity(electrical conductivity<7000μS/cm)and sodicity(SAR<10.00;SSP<60.00%).However,the contents of PO_(4)^(3-),Cu^(2+),and Cd^(2+)exceed the maximum threshold values set by the national and other standards.Concerning the soil samples,the average levels of SAR and ESP are within the standards(SAR<13.00;ESP<15.00%).On the other hand,PLI results reveal moderate pollution in the plot irrigated with TWW and no to moderate pollution in the plot irrigated with GW.Igeo results indicate that Cu^(2+)is the metallic trace element(MTE)with the highest risk of soil pollution in both plots(Igeo>5.00),followed by Ni^(2+)and Pb^(2+).Nevertheless,Cd^(2+)presents the lowest risk of soil pollution(Igeo<0.00).Statistical data indicates that Ca^(2+),Na+,Ni^(2+),and Pb^(2+)are highly distributed in both plots(coefficient of variation>50.0%).This study shows that the use of imagery tools,such as ArcGIS,can provide important information for evaluating the current status of soil fertility or pollution and for better managing soil irrigation with TWW.

Case Report of a Pseudoaneurysm of Ascending Aorta Treated by Stent

Pseudoaneurysms of the ascending aorta are a rare complication of aortic and cardiac surgery. In this article, we present a clinical case of a 56-year-old patient with a fortuitous diagnosis of a pseudoaneurysm of ascending aorta that was treated by an endovascular stent-graft. We discuss in this article the diagnostic and therapeutic aspect of the case and the place of endovascular treatment for the ascending aorta.

Screen-and-Treat Approach in Secondary Prevention of Cervical Cancer among HIV-Infected Women in Faith Alive Hospital, Jos Nigeria

Background: Cervical cancer is the fourth most common cancer among women globally, the second most common cancer in Nigeria and the most common cause of cancer-related death in Africa. In 2020, World Health Organization in its updated guidelines recommended cervical cancer screening using HPV DNA, HPV mRNA tests and subsequent treatment as appropriate. However, in resource-poor settings, Visual Inspections with Acetic Acid (VIA), Lugol’s Iodine (VILI) and subsequent treatment of precancerous lesions with thermal ablation remain the practical approaches. Objectives: To determine the prevalence of precancerous cervical lesions and associated risk factors among Women Living with HIV (WLHIV). Methods: A retrospective study on sexually active WLHIV aged 16 - 55 years screened for cervical cancer using VIA and VILI within 16 months period in Faith Alive Hospital Jos. Data were analyzed using IBM-SPSS 26. Sociodemographic characteristics of the study participants and the screening results were presented in frequency tables, and logistic regression was performed to determine risk factors of pre-cancerous lesions. Results: 1113 women were screened for cervical cancer using VIA/VILI. 994 (89.3%) were negative, 101 (9.1%) were positive for precancerous lesions, and 18 (1.6%) were suspicious of cervical cancer. The mean age of clients with pre-cancerous lesions was 41.32 ± 9.89 years. A higher positivity yield (69.4%) was found in ages between 36 and ≥55 years while a less positivity yield (30.6%) was found in age’s ≤ 35 years. History of STI had 1.64 fold risk association with precancerous lesions. Conclusion: Our study demonstrated a high prevalence of precancerous cervical lesions among WLHIV;bimodal age distribution for cancer-suspicious lesions and risk associated with STI. Thus, a “screen-and-treat” approach to cervical cancer prevention by VIA and thermal ablation in resource-poor settings should be undertaken until widespread HPV testing to triage clients is feasible.

Situational Analysis of Malaria Control Following the 2021 Distribution of Long Lasting Insecticide-Treated Bed Nets in the Tiko Health District, South West Region, Cameroon

Malaria is still a major public health concern in Cameroon as more than 20 million people are at risk of the disease. Despite the government’s effort to scale up the distribution of long lasting insecticide-treated bed nets (LLINs), full ownership and optimal use is still limited. In 2021, over a million LLINs were made available for distribution in the South West Region. However, the current situation of malaria has not yet been ascertained following the 2021 mass distribution campaign (MDC). Therefore, the aim of this study was to determine LLIN ownership, coverage, usage and the prevalence of malaria following the 2021 MDC in the Tiko Health District (THD), South West Region of Cameroon. A cross-sectional study was carried from May 1 to 27, 2022 in which a multi-stage sampling technique was used to enroll eligible participants. Data were collected from household heads using questionnaires and capillary blood samples collected from consented household members were used to test for malaria. Data were analyzed using SPSS version 25 at 0.05 significance level. From the 150 households surveyed, 96 (64.0%) owned a mosquito net before the recent MDC. There was an overall significant increase (p p = 0.644) in LLINs ownership between areas where door-to-door (79.5%) and fixed “Hit and Run” (75.8%) strategies were used in the distribution of LLINs in THD. The prevalence of malaria was 10.2%. The regular use of LLINs was significantly associated (p = 0.007) with low malaria prevalence. The 2021 MDC had an impact on malaria prevalence in those who properly used them.

Surface Treatment of PET Nonwovens with Atmospheric Plasma

In this study, polyethylene-terephthalate （PET） nonwovens are treated using an atmospheric plasma and the effects of the treatment time, treatment power and discharge distance on the ability of water-penetration into the nonwovens are investigated. The result indicates that the method can improve the wettability of PET nonwovens remarkably, but the aging decay of the sample＇s wettability is found to be notable as a function of the storage time after treatment due to the internal rotation of the single bond of surface macromolecules. As shown by SEM and XPS analysis, the etching and surface reaction are significant, and water-penetration weight is found to increase remarkably with the increasing power. This variation can be attributed to momentum transfer and enhanced higher-energy particle excitation.

Antibiotic Resistant Bacteria from Treated and Untreated Hospital Wastewater at Ayder Referral Hospital, Mekelle, North Ethiopia

The widespread emergence of antibiotic resistance among bacterial pathogens has become one of the most serious challenges in Ethiopia. This study determined the prevalence and drug resistance patterns of bacterial pathogens isolated from treated and untreated wastewater released from Ayder Referral Hospital in Northern Ethiopia. A cross sectional study design was conducted from September-December, 2015 in wastewater released from Ayder referral hospital. A total of 40 composite samples were aseptically collected, transported and processed for enumeration of indicator organisms, bacteriological identification and susceptibility testing following standard procedure. Data obtained were entered and analyzed using SPSS version 20. Mean heterotrophic plate count, total coliform count, fecal coliform count and E. coli count were found to be 1.6 × 106 CFU/mL, 2.2 × 106 CFU/100 mL, 2.0 × 105 CFU/100 mL and 1.1 × 104 CFU/100 mL from treated wastewater respectively. Among the total samples 134 bacterial isolates were detected and [84 (62.7%)] were from untreated wastewater and [50 (37.3%)] were from treated wastewater. The most frequently isolated bacteria from untreated wastewater samples was Klebsiella spp [14 (16.7%)] followed by S. aureus [13 (15.5%)] and P. aeruginosa [12 (14.3%)], similarly in treated wastewater samples Klebsiella spp [10 (20%)], P. aeruginosa [8 (16%)] and S. aureus [8 (16%)] were frequently detected. The overall multi-drug resistance (MDR) in this study was [79/134 (79.1%)]. MDR from untreated wastewater sample was [64/84 (76.2%)] while from treated wastewater sample was [42/50 (84%)] and shows significant difference with (COR: 1.64, 95% CI: 1.15 - 3.29, P: 0.001). It is concluded that treated hospital wastewater contains large numbers of antibiotic resistant bacteria. Therefore, there should be continuous monitoring and evaluation of the effluent quality of the ponds and chlorination of the final effluent should be developed.

Influence of Ammoniacal Copper Quaternary treatments on mechanical properties of blue-stained Lodgepole Pine wood

Three concentrations （2.8%, 2.0%, 1.2%） of Ammoniacal Copper Quaternary （ACQ） was selected to treat Lodgepole pine wood for evaluating ACQ treatment on mechanical properties of blue-stained wood. The bending modules of elasticity （MOE）, modules of rupture （MOR）, toughness and shearing strength parallel to grain on tangential surface, are tested according to the criteria GB1927-1943-91. Non-treated sample were also tested according to the same procedure. The results showed that the three groups specimen impregnated by different concentrations of ACQ solution met the AWPA standard 2003 of America （UC4A 6.4g/cm^3）. There were significant difference of toughness between treated wood and non-treated wood （p=0.01）, but there were no statistically significant differences among three concentrations in terms of toughness, and toughness of treated wood was approximately 20% lower than non-treated. MOR, MOE as well as sheafing strength parallel to grain were found to be not significantly different between treated wood and non-treated one, and there were no statistically significant difference among three concentrations of ACQ too. Toughness, MOR, MOE and sheafing strength parallel to grain increased with decrease of concentration of ACQ, but they were hardly affected by ACQ preservatives.

TCM Treatment of Asthma in Children with Yin Hua Wu Mei Tang——Professor Liu Bichen's Experience in Treating Asthma

Asthma is characterized by paroxysmaldyspnea,rales in the throat,difficulty in breathing,and inability to lie horizontally.It is commonly seenin children with a weak body constitution,and tendsto be intractable,thus being harmful to the

Advanced Treatment of Biologically Treated Chemical Comprehensive Wastewater by Nano-TiO2 Photocatalytic Oxidation

Nano-TiO2 photocatalytic oxidation was used to perform the advanced treatment of biologically treated chemical comprehensive wastewater. The effects of reaction time,nano-TiO2 dosage and initial p H of the wastewater on the removal rate of COD were tested. The GC/MS and EEM techniques were used to qualitatively analyze organic compounds in the wastewater before and after treatment. The result showed that after the biologically treated chemical comprehensive wastewater was treated by nano-TiO2 photocatalytic oxidation under the conditions of reaction time 3 h,nano-TiO2 dosage 8 g/L,and pH 8. 0,the effluent COD was 61. 9 mg/L and its removal rate was 63. 8%. Additionally,the species of organic pollutants reduced from 12 to 6. Meanwhile,the content of humic-like and fulvic-like substances dropped dramatically.

Effect of high temperature heat treatment on pH value of Masson Pine wood

Heat-treated wood has good dimensional stability,corrosion resistance and visual quality,but it is prone to mold,which limits its application.Based on the pH value of heat-treated wood,this study examines the factors affecting the pathogenesis causing heat-treated wood mold.Normally,the pH value of the heat-treated wood is between 4.38 and 5.10,which is suitable for the growth of mold.However,the pH of the heat-treated copper-containing material is between 6.63 and 7.12,which deviates the treated wood from the comfortable growth conditions for the mold,thereby reducing the occurrence of mold.

An Exploratory Analysis of the Market Perspective on Reclaiming Chromated Copper Arsenate (CCA) from Decommissioned Preservative-Treated Wood Utility Poles

In the area of recycling of spent chromated copper arsenate (CCA)-treated wood, most studies to date have focused on methods of removing/extracting the residual preservative from the wood matrix. It is well recognized that exposure of CCA-treated wood to an acid solution can reverse the CCA fixation process thereby converting the CCA elements into their water-soluble form. The economic viability of the process is enhanced because it can be integrated with other technologies and products (e.g., “green” spray foam insulation, etc.). The market for the “green” CCA is the same as for traditional CCA-the wood treating industry, principally utility poles and pilings. A market research study was conducted to determine the suitability of spent CCA-treated wood as a source for recycled, “green” CCA for manufacturing “green” spray-foam insulation. Specifically, we wanted to discern the attitudes and overall perspectives of buyers/sellers (i.e., utilities and wood treating companies) of CCA preservatives and treated wood products, disposal methods and costs for decommissioned CCA-treated wood, and understand perceptions of and willingness-to-pay for “green” CCA preservatives extracted from the technologies used in this research. Results show that 60% of wood preservative treating respondents and 60% of electric utility company respondents are somewhat or greatly interested in using out-of-service utility poles as feedstock for “green insulation” as part of a new potential business venture.

Treated wastewater irrigation effect on soil,crop and environment:Wastewater recycling in the loess area of China

A study was carded out at the Loess Plateau in Dongzhi, China, to test the feasibility of using secondary treatment sewage effluent and to determine whether the water quality would then meet the recommended irrigation norm. Seven crops, including celery, wheat, maize, millet, apples, rapeseed and yellow beans, were tested in the study. Physical and chemical properties of the soil, crop yield and quality and leachate at different soil depths were measured. In most cases, the quality of the crops that made use of treated sewage was not distinctively different from those that did not use treated sewage. However, yields for the former were much higher than they were for the latter. Leachates at different soil depths were analyzed and the results did not show alarming levels of constituents. For a period of approximately 14 months, the treated sewage irrigation had no significant effect on the loess soil and no cases of illness resulting from contact with the treated sewage were reported. With treated sewage irrigation, a slight increase in the organic content of the soil was observed.

Biosorption of copper ions from dilute aqueous solutions on base treated rubber (Hevea brasiliensis) leaves powder: kinetics, isotherm, and biosorption mechanisms

The effciency of sodium hydroxide treated rubber (Hevea brasiliensis) leaves powder (NHBL) for removing copper ions from aqueous solutions has been investigated. The e?ects of physicochemical parameters on biosorption capacities such as stirring speed, pH, biosorbent dose, initial concentrations of copper, and ionic strength were studied. The biosorption capacities of NHBL increased with increase in pH, stirring speed and copper concentration but decreased with increase in biosorbent dose and ionic strength. The isotherm study indicated that NHBL fitted well with Langmuir model compared to Freundlich and Dubinin-Radushkevich models. The maximum biosorption capacity determined from Langmuir isotherm was 14.97 mg/g at 27°C. The kinetic study revealed that pseudo- second order model fitted well the kinetic data, while Boyd kinetic model indicated that film diffusion was the main rate determining step in biosorption process. Based on surface area analysis, NHBL has low surface area and categorized as macroporous. Fourier transform infrared (FT-IR) analyses revealed that hydroxyl, carboxyl, and amino are the main functional groups involved in the binding of copper ions. Complexation was one of the main mechanisms for the removal of copper ions as indicated by FT-IR spectra. Ion exchange was another possible mechanism since the ratio of adsorbed cations (Cu2+ and H+) to the released cations (Na+, Ca2+, and Mg2+) from NHBL was almost unity. Copper ions bound on NHBL were able to be desorbed at > 99% using 0.05 mol/L HCl, 0.01 mol/L HNO3, and 0.01 mol/L EDTA solutions.

Key parameters controlling electrical resistivity and strength of cement treated soils

The improvement of question soils with cement shows great technical, economic and environmental advantages. And interest in introducing electrical resistivity measurement to assess the quality of cement treated soils has increased markedly recently due to its economical, non-destructive, and relatively non-invasive advantages. This work aims to quantify the effect of cement content （aw）, porosity （nt）, and curing time（T） on the electrical resistivity （p） and unconfined compression strength （UCS） of cement treated soil. A series of electrical resistivity tests and UCS tests of cement treated soil specimen after various curing periods were carried out. A modified Archie empirical law was proposed taking into account the effect of cement content and curing period on the electrical resistivity of cement treated soil. The results show that nt/（aw·T） and nt/（aw·T^1/2） ratio are appropriate parameters to assess electrical resistivity and UCS of cement treated soil, respectively. Finally, the relationship between UCS and electrical resistivity was also established.

Effect of restoration technique on resistance to fracture of endodontically treated anterior teeth with flared root canals

This study was designed to compare the impact of post and core systems on resistance to fracture of endodontically treated anterior teeth with flared root canals and to assess their fracture pattern. Sixty central incisors were cut horizontally 2 mm coronal to the cementoenamel junction(CEJ). After root canal therapy, teeth were assigned into 6 groups(n = 10 each) based on a post system and used as follows: Group C, non-flared root received size #1 glass fiber posts(Control); Group AP, flared root restored with anatomical post; Group RC, flared root restored with size #1 fiber post and cemented with thick layer of resin cement; Group CR, flared root restored with size #1 and reinforced with composite resin; Group CM, cast post-core; Group CP, CAD/CAM polymer-infiltrated ceramic post and core.Following post cementation, core build-up and crown insertion, the specimens were thermo-cycled up to 10,000 cycles(5 C/55 C; 30 seconds dwell time, 6 seconds transition time) and then statically loaded at 1 mm/minute crosshead speed using a universal testing machine. One-way ANOVA and Tukey HSD post hoc test(α= 0.05) were used for data analysis. Group C recorded significantly higher resistance to fracture values [(826.9±39.1) N] followed by group CP [(793.8±55.6) N] while group RC yielded the lowest fracture resistance values [(586.7±51.4) N]. The resistance to fracture of wide root canals can be enhanced by using one-piece CAM/CAM post and core as an alternative to the use of either glass fiber post, relined with composite resin increasing the thickness of luting cement or the use of cast post and core system. However, this was an in vitro investigation and further in vivo studies are necessary.