Comparison of Various Commonly Used Luting Cements on the Success of Composite Inlays Assessed by the Levels of the Microleakage-An In vitro Study.

Introduction: Indirect composite restoration is one of the commonly followed procedures in the posterior teeth. The success of this is dependent on many factors, one being the luting cement. Hence, the current study explores the microleakage of the two luting cements at 2 different times. Materials and Methods: Eighty extracted human teeth were taken, and class II cavities were made that were to receive the composite inlays. They were grouped as supragingival and subgingival, which for further divided as were further subdivided to be observed for marginal leakage at cervical and occlusal margins, at the end of a day and 1 month. Each group had ten specimens. The luting cements that were evaluated were Variolink N and RelyX Unicem. After the composite inlay restoration was done for all the specimens, the sections were put on slides, and a stereomicroscope was used to measure the amount of dye penetration. Leakage was evaluated and compared using Mann-Whitney U test. Results: At the end of 1 day, there was no significant alteration in the microleakage in the occlusal or cervical regions for either region supragingivally or subgingivally between the two luting cements. Significant difference between the two cements at the cervical borders at the end of a month was seen for both the margins. When compared supragingivally and subgingivally at the end of 1 day or at the end of 1 month, there was not a significant difference for any of the cements. Conclusion: Within the constraints of the current investigation, it can be said that there was similar microleakage for both Variolink N and RelyX Unicem at the conclusion of a day's storage time. After a 1-month storage period, RelyX Unicem showed more cervical microleakage than Variolink N.

Scrub typhus in pregnancy: A report of two cases.

Scrub typhus shows a high prevalence in South-East Asia. In pregnant females, it can cause both maternal and fetal adverse outcomes. We report a case series of two women with scrub typhus and their varied outcomes. A 25-year-old primigravida treated for scrub typhus at 23 weeks' gestation presented at 34 weeks with stage three fetal growth restriction (FGR). Caesarean delivery was performed. The neonate had biliary atresia. A 24-year-old primigravida at 31 weeks' gestation was referred from a local hospital due to scrub typhus induced multi-organ dysfunction. She had FGR stage 1 with oligohydramnios. Emergency caesarean delivery was performed in view of acute fetal bradycardia. There is an emerging need for research to reassess what is already known about scrub typhus in pregnancy and to develop techniques for its treatment inorder to achieve a positive maternal and neonatal outcome in these cases.

Replicator-mutator dynamics of the rock-paper-scissors game: Learning through mistakes.

We generalize the Bush-Mosteller learning, the Roth-Erev learning, and the social learning to include mistakes, such that the nonlinear replicator-mutator equation with either additive or multiplicative mutation is generated in an asymptotic limit. Subsequently, we exhaustively investigate the ubiquitous rock-paper-scissors game for some analytically tractable motifs of mutation pattern for which the replicator-mutator flow is seen to exhibit rich dynamics that include limit cycles and chaotic orbits. The main result of this paper is that in both symmetric and asymmetric game interactions, mistakes can sometimes help the players learn; in fact, mistakes can even control chaos to lead to rational Nash-equilibrium outcomes. Furthermore, we report a hitherto-unknown Hamiltonian structure of the replicator-mutator equation.

Seeking Safety for women in incarceration: a systematic review.

PURPOSE: Seeking Safety is an evidence-based treatment for individuals with comorbid posttraumatic stress disorder and substance use disorder. This treatment shows promise to address the unique, unmet needs of women in prison. The current systematic literature review aims to highlight several critical gaps in research on Seeking Safety in forensic settings that need to be filled before Seeking Safety can be implemented in a widespread manner. METHODS: PsycINFO, PubMed and Google scholar databases were used to identify studies that were published in English, included women in forensic settings, and incorporated Seeking Safety treatment. A total of seven studies met review criteria. The quality of studies was assessed with the mixed methods appraisal tool. RESULTS: High risk of contamination, inclusion of small, predominantly White samples, high attrition rates, need for dose-response testing, and lack of follow-up data currently limit the ability to assess the efficacy of Seeking Safety in forensic settings. In addition, there is a lack of research on Seeking Safety's ability to reduce symptoms of substance use disorder for incarcerated women and further cultural adaptation may be needed. CONCLUSION: Seeking Safety has the potential to address the underlying causes of incarceration for justice-involved women, but additional research addressing these identified gaps is needed to facilitate more widespread implementation.

Assessment of Various Reciprocating System in the Extrusion of Debris from Curved Root Canals: An Original Study.

Introduction: The endodontic preparation depends largely on the file systems that are used in the canal preparations. The amount of the intracanal debris that is extruded from the apex may be influenced by the file systems. Hence, the present in vitro study evaluated the amount the debris that is extruded for the two file systems at different working lengths. Methods: Forty human mesiobuccal canals of the first molars were collected that were extracted for various causes. They were equally divided to four groups of Reciproc (full length), Reciproc (short by 1 mm), WaveOne Gold (full length), and WaveOne Gold (short by 1 mm). Routine crown-down technique was followed for the canal preparation with the intermittent irrigation. The extruded debris was weighed and compared for the significance. Results: The amount of the debris that was extruded weighed similarly in all the four groups with no significant variations. The Reciproc extruded lesser material than the WaveOne Gold. Conclusions: The file systems seem not to affect the debris extrusion irrespective of the files' physical properties. Further studies in a clinical setup are warranted.

The burden of paraovarian cysts - a case series and review of the literature.

Introduction: A paraovarian cyst (POC) is a cyst in the broad ligament or mesosalpinx. Paraovarian cysts have an estimated prevalence of 5-20% amongst the adnexal masses. Despite the high prevalence and availability of advanced imaging modalities, an accurate pre-operative diagnosis of POC is still made in less than 50% of patients. Case reports: Two females with suspected ovarian torsion underwent laparotomy and had POCs. A 42-year-old hysterectomized female underwent surgery for a suspected POC which turned out to be a mesenteric cyst. Two females underwent laparotomy for suspected mesenteric cysts which turned out to be POCs. A nulliparous female with infertility conceived spontaneously after cystectomy of POC. Results: Optimal management of an adnexal mass depends on the knowledge of the origin and the exact nature of the mass. No clear-cut guidelines exist for the management of POCs despite their high prevalence. There is a need for further research on this topic to formulate clear-cut guidelines for their management. Conclusions: Radiologists and gynaecologists need to keep them in mind as differentials for patients with adnexal masses to ensure a correct pre-operative diagnosis in order to achieve an optimal outcome for these females. Gynaecologists need to be aware of the cases which can be managed conservatively and those that need surgery, along with the extent of the surgery required, taking care to protect the ovary at all costs, particularly in benign cases.

Luteoma of Pregnancy Presenting as Ruptured Ectopic Pregnancy: A Case Report.

Luteoma of pregnancy is a rare, benign neoplasm arising from the ovary, which occurs due to pregnancy-induced hormones.This rare ovarian lesion was first described by Sternberg and Barclay in 1966. Our case is unusual as the ovarian mass was misdiagnosed as ruptured ectopic pregnancy. Only three such cases have been previously reported in the literature. A 28-year-old multigravida with three months of amenorrhea presented with vaginal bleeding, abdominal pain, and gradually increasing vertigo for six days with increased intensity in the last four hours. On examination, she was conscious and oriented, clinically moderate pallor was present, her pulse rate was 112 beats per minute (bpm), and her blood pressure (BP) was 98/68 mm Hg. On abdominal examination, there was no palpable abdominal mass, but left iliac fossa guarding and tenderness were present. On per-vaginal examination, the uterus was eight weeks in size, the right fornix was free, the left fornix was full and tender, and cervical motion tenderness was present. Her urine pregnancy test was positive. Transvaginal sonography was performed in the emergency setting, which showed a bulky uterus with thickened endometrium and a non-visualized right ovary, and the left ovary was seen adjacent to a hyperechoic collection in the pouch of Douglas of size 3.5×3.5×1.8 cm, likely organized hematoma; there was free fluid in the pouch of Douglas, and left forniceal tenderness was also present. In view of the clinical evidence of tachycardia and hypotension, an exploratory laparotomy was performed for suspected ruptured ectopic pregnancy, and the ovarian mass was excised. The histopathological examination (HPE) of the ovarian mass showed findings suggestive of luteoma of pregnancy. There is an extreme paucity of literature on luteoma of pregnancy. That, along with the rarity of the lesion, results in it often not being kept in mind as a differential diagnosis on clinical or radiological examination, thereby leading to more aggressive management. Obstetricians and gynecologists need to be aware of this condition so that it is kept as a differential diagnosis in patients presenting with adnexal masses. A vigilant outlook will help in preventing unnecessary radical surgery during pregnancy, thereby preserving the ovary and reducing morbidity in these young females.

Adverse Perinatal Outcomes of True Knot of the Umbilical Cord: A Case Series and Review of Literature.

A true knot of the umbilical cord (TKUC) is an actual knot formed in pregnancy. It is seen in approximately 0.3%-1.2% of all pregnancies. True knots are of significance as they can cause a wide spectrum of adverse perinatal outcomes like small for gestational age (SGA) fetus, low appearance, pulse, grimace, activity, and respiration (Apgar) score at birth, fetal hypoxia, and even fetal demise. Here, we report a case series of three patients with TKUC and the varied adverse perinatal outcomes associated with them. A low-risk primigravida at term gestation had a suspicious non-stress test (NST). Repeat NST after maternal resuscitation became pathological. Emergency cesarean delivery was performed in view of pathological NST persisting despite intrauterine resuscitation. A healthy male baby weighing 2920 g was delivered, and the umbilical cord had a true knot. A multigravida at 33 + 3 weeks of gestation was referred with fetal growth restriction (FGR). Color Doppler examination showed absent end-diastolic flow (AEDF) in the umbilical artery (UA). Cesarean delivery was performed in view of FGR stage two with AEDF in the UA at 34 weeks of gestation as per the Barcelona criteria. A male baby weighing 1505 g was delivered. The umbilical cord had a true tight knot. The baby had an Apgar score of 7 at one minute after birth but was shifted to the neonatal intensive care unit (NICU) in view of low birth weight and prematurity. The baby slowly gained weight and was discharged from NICU after 15 days in stable condition. A multigravida at 32 weeks of gestation was referred with intrauterine fetal demise. Ultrasonography confirmed the presence of a single intrauterine dead fetus corresponding to 30 + 4 weeks of gestation with an estimated fetal weight (EFW) of 1633 g, amniotic fluid index (AFI) equal to nine, and presence of Spalding's sign. Induction of labor was done, and she expelled a dead macerated male fetus weighing 1825 g. The infantogram was normal. A true umbilical cord knot was found. The umbilical cord is the source of fetal blood supply; therefore, any cord abnormality can have a significant impact on the fetal outcome. There are various factors that can predispose to TKUC, such as polyhydramnios, increased cord length, monoamniotic twins, male baby, grand multiparity, small fetus, and amniocentesis. TKUC can lead to various adverse outcomes in pregnancy and labor like SGA fetus, low Apgar score at birth, fetal hypoxia, and fetal demise. TKUC increases the risk of fetal demise by as much as four times. With the development of advanced techniques such as three-dimensional/four-dimensional color Doppler ultrasounds, TKUC can be diagnosed antenatally in the form of a four-leaf-clover, a "hanging-noose sign," or by an unusual multicolor pattern in the cord. The prenatal detection rate of TKUC is only 12%. It mostly remains undetected unless visualized incidentally. Although TKUC is not rare and can have serious outcomes, the importance of its antenatal diagnosis has not been determined. It should be suspected in patients with risk factors, and emphasis should be placed on its antenatal diagnosis on ultrasonography to avoid obstetric disasters in otherwise low-risk females. Though there is no specific management of these cases, a good clinical outcome can be achieved if TKUC is diagnosed antenatally and monitored closely until fetal maturity is attained.

IUCD as bladder stone.

Intrauterine Contraceptive Devices (IUCDs) are commonly used in low to middle-income countries. IUCD migration into the adjacent organs, especially bladder, is exceptionally rare, though important to exclude. A 55-year-old para three post-menopausal female with history of recurrent urinary tract infections presented with lower urinary tract symptoms. Urine examination was indicative of Eschericia coli infection. Pelvic radiograph revealed an intravesical calculus having a T-shaped extension. Cystoscopy confirmed a bladder stone encasing an encrusted IUCD. Cystolithotripsy was performed, fragmenting the calculus which was then removed along with the IUCD in toto. IUCDs require regular evaluation to confirm their correct position. Gynecologists must properly counsel the patient so that the incidence of forgotten IUCDs can be minimized. Urologists need to be aware of these cases so that gynecological history is kept in mind while evaluating females with urinary symptoms. Serious complications such as intravesical migration are extremely rare but possible.

Ultrafast electron dynamics at water covered alkali adatoms adsorbed on Cu(111).

Here we report on the ultrafast electron dynamics of the alkalis Na, K, and Cs coadsorbed with D2O on Cu(111) surfaces, which we investigated with femtosecond time-resolved two-photon photoemission. The well known transient electronic binding energy stabilization in bare adsorbed alkalis is enhanced by the presence of water which acts as a solvent and increases the transient energy gain. We observe for all adsorbed alkalis a transient binding energy stabilization of 100-300 meV. The stabilization rates range from 1 to 2 eV ps(-1). Here the heavier alkali exhibits a slower stabilization which we explain by their weaker static alkali-water interaction observed in thermal desorption spectroscopy. The population dynamics at low water coverage is described by a single exponential. With increasing water coverage the behavior becomes non-exponential suggesting an additional excited state due to electron solvation.

Effect of laser preparation on bond strength of a self-adhesive flowable resin.

The aim of this in vitro study was to evaluate the effect of laser treatment on shear bond strength of a self-adhesive flowable resin composite to human dentin. Eighty extracted sound human molar teeth were used for the study. The teeth were sectioned mesiodistally and embedded in acrylic blocks. The dentin surfaces were ground wet with 600-grit silicon carbide (SiC) paper. They were randomly divided into two preparation groups: laser (Er:YAG laser, with 12 Hz, 350 mJ energy) and control (SiC). Each group was then divided into two subgroups according to the flowable resin composite type (n = 20). A self-adhesive flowable (Vertise Flow) and a conventional flowable resin (Premise Flow) were used. Flowable resin composites were applied according to the manufacturer's recommendations using the Ultradent shear bond Teflon mold system. The bonded specimens were stored in water at 37 °C for 24 h. Shear bond strength was tested at 1 mm/min. The data were logarithmically transformed and analyzed using two-way analysis of variance and Student-Newman-Keul's test at a significance level of 0.05. The self-adhesive flowable resin showed significantly higher bond strength values to laser-prepared surfaces than to SiC-prepared surfaces (p < 0.001). The conventional flowable resin did not show such differences (p = 0.224). While there was a significant difference between the two flowable resin composites in SiC-prepared surfaces (p < 0.001), no significant difference was detected in laser-prepared surfaces (p = 0.053). The bond strength of a self-adhesive flowable resin composite differs according to the type of dentin surface preparation. Laser treatment increased the dentin bonding values of the self-adhesive flowable resin.