Resin Nano-Ceramic Material Surface Roughness, Color Stability, and Bacterial Adhesion Evaluation After Different Scaling Methods / Rugosidade superficial, estabilidade de cor e adesão bacteriana de resina nano-cerâmica após diferentes métodos de raspagem

Objective: TThe study evaluated in vitro the changes in roughness, color stability, and bacterial count of a CAD/CAM Resin Nano-Ceramic material surface treated by various scaling procedures. Material and Methods: 70 disks (5mm diameter, 0.5 mm thickness) of Resin Nano-Ceramic (Lava ™Ultimate, 3M, ESPE) material were cemented in standardized cavities prepared in bovine teeth. A custom-made scaling apparatus of a double pan balance was used for different scaling methods, simulating standard clinical conditions. The specimens were assigned to three main groups: no scaling(C), ultrasonic scaling (U), and manual scaling (M). Each group was then divided into three subgroups according to scaling tip material; stainless steel tip (St), plastic tip (P), and titanium tip (Ti). The surface texture was analyzed quantitatively and qualitatively with a tactile profilometer and atomic force microscopy. A spectrophotometer was used for color measurement. Streptococcus mutans were counted in a colony counter. All the data were tabulated and statistically analyzed. Results: Two-way ANOVA was used to study the effect while One-way ANOVA was performed to compare between study groups. The significance level was set at p ≤ 0.05. The ultrasonic titanium tip(UTi) revealed the significant highest mean value of alterations (p < 0.001). The integrity of the material surface was altered in the form of deep scratches on the ultrasonically scaled surfaces and numerous smaller scratches on the hand-scaled surfaces. Conclusion: The plastic instrument would appear to be the instrument of choice during a routine maintenance procedure for Resin Nano-Ceramic materials (AU).

Objetivo: Este estudo avaliou in vitro as alterações na rugosidade, estabilidade de cor e quantidade de bactérias da superfície de uma resina nano-cerâmica produzida em CAD/CAM tratada por diferentes procedimentos de raspagem. Material e Métodos: 70 discos (5 mm diâmetro, 0,5 espessura) de resina nano-cerâmica (Lava ™Ultimate, 3M, ESPE) foram cimentadas em cavidades padronizadas preparadas em dentes bovinos. Um aparato customizado de raspagem com pratos duplos de balança foram usados para os diferentes métodos de raspagem, simulando uma condição clínica padronizada. Os espécimes foram distribuídos em três principais grupos: Sem raspagem (C), raspagem ultrassônica (U) e raspagem manual (M). Cada grupo foi dividido em três subgrupos de acordo com a ponta do material de raspagem; ponta de aço inoxidável (St), ponta plástica (P), ponta de titânio (Ti). A textura da superfície foi analisada qualitativamente e quantitativamente por um perfilômetro tátil e microscopia de força atômica. Um espectrofotometro foi usado para a mensuração da cor. Estreptococos mutans foram contados em um contador de colônias. Todos os dados foram tabulados e analisados estatisticamente. Resultados: Anova dois fatores foi utilizado para estudar os efeitos, enquanto ANOVA um fator foi utilizado para comparar os grupos experimentais. O nível de significância foi estabelecido em p≤ 0,05. A ponta de ultrassom de titânio (UTi) revelou o valor significante mais alto de alterações (p < 0,001). A integridade da superfície d matérias foi alterada na forma ranhuras profundas, nas superfícies raspada por ultrassom e numerosas ranhuras menores nas superfícies raspadas à mão. Conclusão: O instrumento plástico poderia apresentar-se como um instrumento de escolha durante o pocedimento de manutenção routineira para materiais de resina nano-ceramica. (AU)

Fracture Resistance of Anterior CAD/CAM Nanoceramic Resin Endocrowns with Different Preparation Designs / Resistência à Fratura de Endocrowns de Resina Nanocerâmica CAD / CAM Anterior Com Diferentes Projetos de Preparação

Objective: The aim of the study was to evaluate the effect of extension of endocrown in pulp space and the effect of ferrule on the fracture resistance of anterior endocrowns made of nano-ceramic resin blocks. Material and Methods: Twenty-eight freshly extracted human upper central incisor teeth were prepared to receive CAD/CAM nanoceramic resin endocrowns with four different designs. The specimens were divided into two groups (n = 14) according to the extension of the endocrown inside root canal (A:short and B:long), then each group was further subdivided into another two subgroups (n = 7) according to the presence or absence of ferrule effect (1:ferrule and 2: no ferrule). Endocrowns were then fabricated using CEREC in lab and nanoceramic resin blocks (DENTSPLY Sirona, Germany) and LAVA ultimate (3M ESPE, Germany) blocks size 14L. Results: Two-way ANOVA showed that the ferrule (p > 0.0001) had statistically significant effect on the fracture resistance. However, the extension of the endocrown into the canal had no statistical significant effect on the fracture resistance (p = 0.837). The interactions between the independent variables (extension into the canal and ferrule) had statistically significant effect on the fracture resistance (p = 0.029). Load to fracture for group 1A was 439.53 N, 1B was 306.46 N, 2A was 516.29 N and 2B was 242.04 N. Conclusions: Fracture resistance was not improved by the long or short extensions of the endocrowns in the pulp space, however, the ferrule effect shows significant improvement of the fracture resistance of the nanoceramic resin endocrowns. (AU)

Objetivo: O objetivo deste estudo foi avaliar o efeito da extensão da coroa endocrown na câmara pulpar e o efeito férula na resistência à fratura de coroas endocrowns anteriores confeccionadas através de blocos de resina nanocerâmica. Material e Métodos: Vinte e oito dentes incisivos centrais superiores humanos recém-extraídos foram preparados para receber endocrowns de resina nanocerâmica CAD / CAM com quatro diferentes tipos de preparos. Os espécimes foram divididos em dois grupos (n = 14) de acordo com a extensão da endocrown dentro do canal radicular (A: curto e B: longo), então cada grupo foi subdividido em outros dois subgrupos (n = 7) de acordo com presença ou ausência do efeito férula (1: com férula e 2: sem férula). As endocrowns foram usinadas através do CEREC In Lab e blocos de resina nanocerâmica (DENTSPLY Sirona, Alemanha) e blocos de LAVA ultimate (3M ESPE, Alemanha) tamanho 14L. Resultados: ANOVA dois fatores demostrou que a férula (P> 0,0001) teve efeito estatisticamente significativo na resistência à fratura. No entanto, a extensão do endocrown no canal não teve efeito estatisticamente significativo na resistência à fratura (P = 0,837). As interações entre as variáveis independentes (extensão no canal e férula) tiveram efeito estatisticamente significativo na resistência à fratura (P = 0,029). A carga para fratura do grupo 1A foi de 439,53 N, 1B foi de 306,46 N, 2A foi de 516,29 N e 2B foi de 242,04 N. Conclusões: A resistência à fratura não foi melhorada pelas extensões longas ou curtas das endocrowns na câmara pulpar, no entanto, o efeito férula mostrou uma melhora significativa na resistência à fratura das coroas endocrowns de resina nanocerâmica (AU)

An in vitro evaluation of surface roughness, color stability and bacterial accumulation of lithium disilicate ceramic after prophylactic periodontal treatment / Avaliação in vitro da rugosidade superficial, estabilidade de cor e acúmulo bacteriano em cerâmica de dissilicato de lítio após tratamento de profilaxia periodontal

Objective: To evaluate the effect of scaling procedures using different ultrasonic tips on the surface roughness, color stability and bacterial accumulation of lithium disilicate ceramic. Material and Methods: Scaling procedure was carried out using ultrasonic scaler (Satalec, Acteon, North America) with stainless-steel tip (US), titanium tip (UT) and plastic tip (UP), on disc shaped lithium disilicate samples cemented into a cavity prepared onto the labial surface of freshly extracted bovine teeth (10 samples per group). The samples were stored in coffee solution in an incubator at 37°C for 12 days, which is equivalent to 1 year of coffee consumption. The surface roughness was measured before and after the scaling procedure using a profilometer and atomic force microscopy. The color parameters were measured before and after scaling and staining procedures using VITA Easyshade Advance 4.0 according to the CIE L*a*b* color order system. The samples were then incubated with Streptococcus mutans (S. mutans) suspension. After incubation, the plates with 30 to 300 typical colonies of S. mutans were counted in a colony counter and mean values of colony forming units were obtained (CFU/mL). Results:The titanium scaling tip showed a statistically significant higher mean values of change in surface roughness ΔRa and bacterial count than the plastic scaling tip. Color changes (ΔE) were not a statistically significant among the groups. The results showed a statistically significant positive (direct) correlation between surface roughness and color change (p = 0.012) and also between surface roughness and bacterial count (p = 0.00). Conclusion: Within the limitations of this study, titanium scaling instruments cause irreversible surface alterations of lithium disilcate ceramics which was in direct correlation to the color changes and bacterial accumulation; therefore, dentists should proceed with caution when scaling lithium disilicate surfaces. The findings of the current study may indicate the need for instruments or equipment that can remove plaque and calculus without causing surface damage (AU)

Introdução: Avaliar o efeito de procedimentos de raspagem com diferentes pontas de ultrassom na rugosidade superficial, estabilidade de cor e acúmulo bacteriano em cerâmica de dissilicato de lítio. Material e Métodos: O procedimento de raspagem foi realizado usando um aparelho de ultrassom (Satalec, Acteon, América do Norte) com ponta de aço inoxidável (US), ponta de titânio (UT) e ponta de plástico (UP), em amostras de dissilicato de lítio em forma de disco cimentadas em uma cavidade preparada na superfície vestibular de dentes bovinos recém-extraídos (10 amostras por grupo). As amostras foram armazenadas em solução de café em incubadora a 37 ° C por 12 dias, o que equivale a 1 ano de consumo de café. A rugosidade da superfície foi medida antes e após o procedimento de raspagem usando um perfilômetro e um microscópio de força atômica. Os parâmetros de cor foram medidos antes e depois dos procedimentos de raspagem e armazenagem no café usando VITA Easyshade Advance 4.0 de acordo com o sistema de ordem de cores CIE L*a*b*. As amostras foram incubadas com suspensão de Streptococcus mutans (S. mutans). Após a incubação, as placas com 30 a 300 colônias típicas de S. mutans foram contadas em contador de colônias e obtidos os valores médios das unidades formadoras de colônias (UFC / mL). Resultados: A ponta de titânio mostrou valores estatisticamente maiores de mudança na rugosidade da superfície ΔRa e contagem de bactérias do que a ponta de raspagem de plástico. A mudança de cor (ΔE) não foi estatisticamente significativa entre os grupos. Os resultados mostraram uma correlação positiva (direta) estatisticamente significativa entre rugosidade superficial e alteração de cor (p = 0,012) e também entre rugosidade superficial e contagem bacteriana (p = 0,00). Conclusão: Dentro das limitações deste estudo, os instrumentos de raspagem de titânio causam alterações irreversíveis na superfície das cerâmicas de dissilicato de lítio que estão em correlação direta com as mudanças de cor e o acúmulo de bactérias. Portanto, os dentistas devem proceder com cautela ao realizar raspagem em superfícies de dissilicato de lítio. Os resultados deste estudo podem indicar a necessidade de instrumentos ou equipamentos que possam remover a placa e cálculo sem causar danos à superfície. (AU)

The effect of different surface treatments on color and translucency of bilayered translucent nano-crystalline zirconia before and after accelerated aging / O efeito de diferentes tratamentos de superfície na cor e translucidez da zircônia de dupla camada nano-cristalina translúcida antes e depois do envelhecimento

Objective: Despite the higher translucency of nanocrystalline Y-TZP than the conventional Y-TZP, it couldn't be used in the anterior region of the mouth in its fully anatomical form without veneering for better esthetics. This study evaluated the color change (ΔE) and translucency parameter (TP) of the bilayered nano-crystalline zirconia restorations after different treatments of the zirconia surface before and after accelerated aging. Material and Methods: Forty samples of inCoris TZI were cut in the form of discs 15 mm (diameter) and 1mm (thickness) so that after sintering each disc dimensions' would be 12 mm (diameter) and 0.8 mm (thickness). All discs were colored by dipping in aqueous zirconia coloring solution of shade A2, then divided into four groups according to the type of surface treatment received before sintering; being tribochemical silica coating, zirconia powder deposition, glass grading, and a control untreated group. After sintering, all discs were veneered with a layer of porcelain 0.7 mm (thickness) and 12 mm (diameter). (ΔE) and TP were measured using VITA Easyshade Compact spectrophotometer before and after accelerated autoclave aging. Results: Different surface treatments applied had significant effect (P<0.05) over ΔE and TP. Glass graded group showed the highest ΔE value and the least TP value among both un-aged and aged sub-groups. Conclusion: Different surface treatments applied affected the color and translucency negatively where the control untreated group showed the highest TP and the least color deviation from the A2 color parameters. On the other hand, accelerated autoclave aging had no effect over translucency or color. (AU)

Objetivo: Apesar da maior translucidez da Y-TZP nanocristalina em relação à Y-TZP convencional, ela não pode ser usada na região anterior da boca em sua forma totalmente anatômica, sem o recobrimento cerâmico para uma melhor estética. Este estudo avaliou a mudança de cor (ΔE)eoparâmetrodetranslucidez(PT)das restauraçõesde zircônia nano-cristalina em duas camadas após diferentes tratamentos de superfície, antes e após o envelhecimento. Material e Métodos: Quarenta amostras de inCoris TZI foram cortadas na forma de discos de 15 mm (diâmetro) e 1 mm (espessura) para que, após sinterização, cada diâmetro dos discos fosse de 12 mm (diâmetro) e 0,8 mm (espessura). Todos os discos foram corados por imersão em solução aquosa de zircônia corante da sombra A2, divididos em quatro grupos de acordo com o tipo de tratamento de superfície recebido antes da sinterização; sendo revestimento de sílica químico-química, deposição de pó de zircônia, jateamento de vidro e um grupo de controle sem tratamento. Após a sinterização, todos os discos foram revestidos com uma camada de porcelana de 0,7 mm (espessura) e 12 mm (diâmetro). ΔE e TP foram medidos usando o espectrofotômetro VITA Easyshade Compact antes e depois do envelhecimento em autoclave. Resultados: Diferentes tratamentos de superfície aplicados tiveram efeito significativo (P <0,05) sobre ΔE o e maior TP. valor O grupo com de ∆E e o menor jateamento de vidro valor de TP apresentou entre os subgrupos não envelhecidos e envelhecidos. Conclusão: Diferentes tratamentos de superfície aplicados afetaram negativamente a cor e a translucidez, onde o grupo controle sem tratamento apresentou o maior TP e o menor desvio de cor dos parâmetros de coloração A2. Por outro lado, o envelhecimento acelerado da autoclave não teve efeito sobre a translucidez ou a cor. (AU)

Predictors of hepatitis C virus recurrence after living donor liver transplantation: Mansoura experience

Background and Study Aims: Hepatitis C virus [HCV]-related cirrhosis is the leading cause of liver transplantation[LT]. All patients who undergo LT with detectable serum HCV-RNA experience graftreinfection, which is the most frequent cause of graft loss and death in these patients. We estimated the rate of HCV recurrence and evaluated the current therapeutic regimens

Patients and Methods: The records of consecutive 325 living donor LT [LDLT] surgeries performed between May 2004 and August 2014 were retrospectively analysed; 207 of them were followed-up throughout the study. Clinical, laboratory, radiological and histopathological examinations were performed thoroughly. Patients received treatment in the form of either pegylated interferon [PEG-IFN] or sofosbuvir, both in combination with ribavirin

Results: In total, 90.3% of recipients who were transplanted because of HCV-related end-stage liver disease experienced recurrence due to the virus. The donor age was older in the HCV recurrent group versus the non-recurrence group [28.7 +/- 7.1 versus 22.6 +/- 2.6 years: p

Conclusions: Older donor age and prolonged warm ischaemia time are independent predictors of HCV recurrence after LDLT, and early treatment with the direct-acting sofosbuvir is helpful in resolving the problem of post-LT HCV recurrence

Relation between severity of bronchial asthma and body composition parameters in obese asthmatic children

Background: Obesity and asthma in children are both increasing concomitantly with serious effects on health and quality of life. Obesity worsens the severity of asthma symptoms. Both, asthma and obesity have serious health consequences and significant financial costs. Assessment of body composition is important in understanding the relationship between obesity and asthma

Aim: This study was designed to evaluate body composition parameters in both obese and non-obeseasthmatic children and their effect on severity of asthma symptoms

Methods: A cross-sectional case-control study included 90 children divided into 3 equal groups including both males and females with an age range of [7-12] years; 30 non-obese asthmatics, 30 obese asthmatics from children attending allergy clinic at Abu-El Rish Pediatric Hospital, and 30 healthy controls. Complete history, clinical examination, anthropometric measurements; including: height, weight and body mass index, and body composition parameters including: fat mass, fat free mass, fat %, total body water, impedance and basal metabolic rate were taken

Results: Prevalence of both asthma and obesity was more among males with a male to female ratio-2: 1. Non-obese asthmatics were classified into 76.7% mild and 23.3% moderate cases. The obese asthmatics were classified into 30% mild, 60% moderate and 10% severe cases. The obese asthmatic group showed highly statistically significant differences compared to the non-obese asthmatic group: P< 0.005 regarding: weight, BMI, FM, FFM, IMP, TBW, BMR and in Fat% P< 0.05. The obese asthmatic group showed statistically significant differences compared to the control regarding weight, BMI, FM, FFM, IMP, TBW, BMR with [P< 0.005] and in the Fat% with [P<0.05]

Conclusion: Obesity aggravates the severity of asthma and body composition plays an important role as well

the bispectral index a sensitive monitor for survival after living donor liver transplantation?

Bispectral index [BIS] monitoring has been established as a standard monitoring method for the assessment of the depth of anesthesia during living donor liver transplantation [LDLT]. We tested the sensitivity and specificity of BIS readings during LDLT in predicting the postoperative 3-month survival. After receiving ethical approval, 42 patients who had undergone LDLT under sevoflurane-fentanyl-rocuronium anesthesia were studied. Correlations between BIS readings and extubation time, postoperative liver function tests, intensive care unit stay, and 3-month mortality were tested. Receiver operating characteristic curves were generated to determine the sensitivity and specificity of the BIS readings during different phases of surgery in predicting the survival outcome. The extubation time, liver function tests, coagulation factors V and VII, and intensive care unit stay were not statistically correlated with the BIS values. Receiver operating characteristic curve analyses showed reasonable sensitivity and specificity of mean BIS values during hepatic resection and neohepatic periods for predicting the 3-month mortality, with an unweighted accuracy of 76 and 73%, respectively. The nonsurvivors had significantly higher mean BIS values during the neohepatic phase [P<0.05]. The researchers concluded that the BIS monitoring during hepatic resection and neohepatic phases seems to be a suitable noninvasive monitoring tool with reasonable sensitivity and specificity for predicting the 3-month mortality after LDLT under sevoflurane-fentanyl anesthesia

Pelvic floor dyssynergia: Efficacy of biofeedback training

Paradoxical contraction of the pelvic floor during attempts to defaecate is described as pelvic floor dyssynergia [anismus]. It is a behavioural disorder [no associated morphological or neurological abnormalities]; consequently, biofeedback training has been recommended as a behavioural therapy for such a disorder. The aim of the present study was to evaluate long-term satisfaction of patients diagnosed with pelvic floor dyssynergia after biofeedback. Sixty patients [35 females and 25 males] with a mean age of 30 +/- 12 years and a 4 year duration of constipation were included. Forty-five patients had normal colonic transit and 15 patients had slow colonic transit. History, physical examination and barium enema were done to exclude constipation secondary to organic causes. Colonic and pelvic floor functions [colon-transit time, anorectal manometry, EMG and defaecography] were performed before and after biofeedback treatments. Patients were treated on a weekly basis with an average of [6 +/- 2] sessions. At the end of sessions, 55 out of 60 patients [91.6%] reported a subjectively overall improvement. Symptoms of dyschezia were reported less frequently after biofeedback. Age and gender were not predictive factors of outcome. No symptoms at initial assessment were predictive for patient's satisfaction but the only factor of predictive value was the diagnosis of anismus and the motivated patient who wanted to continue the sessions. Biofeedback remains a morbidity free, low-cost and effective outpatient therapy for well-motivated patients complaining of functional constipation and diagnosed as pelvic floor dyssynergia

Outcome of pouch surgery for ulcerative colitis: Single center experience

The purpose of the present study is to present the experience of our center in surgical management of ulcerative colitis [UC], stressing on evaluating the outcome of pouch surgery. Fifty eight patients underwent surgery for UC between 1996 and 2007 at Mansoura Gastroenterology Center. A retrospective analysis has been done of all patients with UC undergoing surgery which includes details of the patient's history, indication of surgery, type of operation, postoperative morbidity, and functional outcome. The main indication for operation was failed medical treatment [n=42, 72.4%]. Pouch surgery was performed in 25/58 patients [43.1%]. The majority of patients, 23/25 [92%] had J-shaped pouch. Twenty patients [80%] had a defunctioning ileostomy. There was one postoperative death after pouch surgery. Early complications after pouch surgery included pelvic sepsis [n=4], small bowel obstruction [n=2], pouch hemorrhage [n=1], wound sepsis [n=3]. The most common long-term complication after pouch surgery [n=14] was anastomotic stricture [n=9, 42.6%]. Five patients [35.7%] presented with pouchitis. Median daytime stool frequency was 5.1. Three patients [21.4%] presented with fecal incontinence. Pouch surgery is a major one that attains many complications. However, the long term results and patient's satisfaction are reasonable

Impact of lntra-operative transfusion protocol on post-operative coagulation parameters in living-related liver transplantation recipients: a chronological profile

Background: Living related liver transplantation is an established line of treatment for end stage liver disease. Massive transfusion is a frequent practice in this procedure. A variety of coagulation abnormalities may complicate the post-operative period

Patients and methods: The study was conducted in Mansoura University between May 2004 and July 2006. 21 patients were included in the study. Time of normalization [TON] of 7 coagulation parameters [prothrombin concentration, international normalization ratio, activated partial thromboplastin time, platelet count, factor V, VII and fibrinogen concentration] to predefined normalization cutoff limits were recorded. Mean of normalization times of 6 of these parameters [excluding platelets] was calculated as overall normalization time [ONT]. These times were then compared between two pairs of groups based on either total intraoperative blood transfusion [average transfusion AT Vs massive transfusion MT groups or intraoperative colloid/blood infusion ratio [Low colloid/blood LCB Vs high colloid/blood HCB] groups. Correlation analysis was performed to test association between intra-operative replacement protocol and post-operative coagulation profile

Results: Patients with higher pre-operative MELD score had more intra-operative blood components transfusion [absolute and compared to colloids]. Apart from ONT 5, which was significantly longer in the MT and LCB groups compared to AT and H08 groups, no significant differences were observed between each pair of groups. Significant linear correlation existed between ONT and total blood components transfusion volume

Conclusion: The recorded TON of coagulation system components favours the start of prophylactic anti-coagulants after the 3rd post-operative day in absence of clinically significant bleeding. The pre-operative and intra-operative conditions are not appropriate alone to anticipate the time by which the coagulation system will be normalized making thrombosis a risk