A Novel Method to Adjust Saphenous Vein Graft Lengths Using 3D Printing Models.

BACKGROUND: The optimal length of saphenous vein grafts can be challenging in surgical coronary revascularization. It is the cornerstone for graft patency. In this study, we tried to demonstrate the value of 3D printing in determining optimal saphenous graft length. METHODS: Sixteen patients who underwent bypass surgery with only vein grafts were examined. Patients' measurements of graft lengths were obtained from postoperative CT images and from both 3D print models manually with plastic tubes and via 3D print digital images of Mimics software during segmentation. Another measurement was done using the Fit Centerline tool in the analysis module of Mimics software after segmentation. These 3 measurements were compared. RESULTS: There was a statistically significant difference between 3 measurement methods for each graft length (P < .001). Measurements of actual grafts were longer than measurements of 3D printed models manually and segmentation images from software were similar (P > .05). CONCLUSION: 3D printing models and their software may be used to determine optimal saphenous graft length and the anastomosis site to decrease operation time. It can be deducted from these results that 3D printing is a promising method for reducing operator dependent variables in adjusting graft size and finding optimal anastomosis sites.

Closure of an acquired aortocoronary venous fistula after coronary artery bypass grafting causing heart failure and stable angina: A case report.

Iatrogenic aortocoronary venous fistula arising from anastomosing an aortocoronary graft to a cardiac vein is a rare a complication following coronary artery bypass grafting. A 75-year-old male patient was admitted with recurrent angina accompanied by congestive heart failure six years after surgery. He was diagnosed with an acquired saphenous vein graft-to- cardiac vein fistula. Based on the estimation of risks versus benefits, the heart team decided to perform percutaneous closure with a vascular occlusion device. Subsequently, complaints and echocardiographic findings of the patient resolved.

Evaluation of 3D printed carotid anatomical models in planning carotid artery stenting.

BACKGROUND: We aimed to investigate the potential role of threedimensional printed anatomical models in pre-procedural planning, practice, and selection of carotid artery stent and embolic protection device size and location. METHODS: A total of 16 patients (10 males, 6 females; mean age 75.6±4.7 years; range, 68 to 81 years) who underwent carotid artery stenting with an embolic protection device between January 2017 and February 2019 were retrospectively analyzed. The sizing was based on intraprocedural angiography findings with the same brand stent using distal protection device. Pre-procedural computed tomography angiography images used for diagnosis were obtained and modeled with three-dimensional printing method. Pre-procedural and threedimensional data regarding the size of stents and protection devices and implantation sites were compared. RESULTS: Measurements obtained from three-dimensional models manually and segmentation images from software were found to be similar and both were smaller than actually used for stent and embolic protection device sizes. The rates of carotid artery stenosis were similar with manual and software methods, but were lower than the quantitative angiographic measurements. Device implantation sites detected by the manual and software methods were different than the actual setting. CONCLUSION: The planning and practicing of procedure with threedimensional models may reduce the operator-dependent variables, shorten the operation time, decrease X-ray exposure, and increase the procedural success.

A Rare Access Site Complication after Transcatheter Aortic Valve Implantation.

In the majority of patients undergoing transcatheter aortic valve implantation, the transfemoral access is the suggested approach due to its less invasive nature and feasibility in patients with suitable vascular anatomy. The complications of the transfemoral access site are generally vascular; however, we herein present a rare case of colon perforation following the transfemoral procedure owing to prior abdominal surgery. A transfemoral aortic valve was inserted on account of severe aortic stenosis and a high probability of surgical mortality. The patient developed acute abdomen following the procedure. Hemicolectomy was performed because of colonic perforation caused by femoral catheterization. The patient was well at 3 months' follow-up.

Cement Thickness of Inlay Restorations Made of Lithium Disilicate, Polymer-Infiltrated Ceramic and Nano-Ceramic CAD/CAM Materials Evaluated Using 3D X-Ray Micro-Computed Tomography.

PURPOSE: To evaluate the marginal and internal cement thicknesses of inlay restorations made of various CAD/CAM materials using 3D X-ray micro-computed tomography (micro-CT) technique. MATERIALS AND METHODS: Caries-free extracted mandibular molars (N = 30) with similar size were randomly assigned to three groups (N = 10 per group). Mesio-occlusal-distal (MOD) cavities were prepared, and inlay restorations were obtained by milling out CAD/CAM materials namely, (a) IPS: monolithic lithium disilicate (control), (b) VE: polymer-infiltrated ceramic, and (c) CS: nano-ceramic using a CAM unit. Marginal and internal cement thicknesses were measured using 3D micro-CT. Data were analyzed using 1-way ANOVA and Tukey's tests (alpha = 0.05). RESULTS: The mean marginal and internal cement thickness were not significant in all inlay materials (p > 0.05). Mean marginal cement thickness (µm) was the lowest for the IPS group (67.54 ± 10.16) followed by VE (84.09 ± 3.94) and CS (95.18 ± 10.58) (p > 0.05). The internal cement thickness (µm) was the lowest in the CS group (54.85 ± 6.94) followed by IPS (60.58 ± 9.22) and VE (77.53 ± 12.13) (p > 0.05). CONCLUSION: Marginal and internal cement thicknesses of MOD inlays made of monolithic lithium disilicate, polymer-infiltrated ceramic, and nano-ceramic CAD/CAM materials were similar and all less than 100 µm, which could be considered clinically acceptable. CLINICAL SIGNIFICANCE: MOD inlays made of different CAD/CAM materials presented similar cement thickness, less than 100 µm.

Statin treatment in dialysis patients after acute myocardial infarction improves overall mortality.

While statins are widely accepted as a keystone for secondary prevention of cardiovascular disease in the general population, statin treatment in chronic renal failure is still debated. Statins have shown no benefit on cardiovascular outcomes in 4D, AURORA, and SHARP trials conducted in patients on dialysis. However, no study has yet compared statin treatment after acute myocardial infarction in end-stage renal disease (ESRD) patients. Statin treatment significantly decreases overall mortality in ESRD patients with acute myocardial infarction compared to the non-statin group. This is more prominent in the cardiac shock patient subgroup. The results are compatible with other studies, supporting a measurable benefit from statins in ESRD patients. There is no clear consensus on statin treatment in dialysis patients. The study by Chung et al. published in this issue of Atherosclerosis was conducted in a large patients' pool, with a long follow-up period [1]. Authors have reported an important result supporting statin treatment in dialysis patients after acute myocardial infarction.

A Cross-Sectional Survey on Reasons for Initial Placement and Replacement of Single Crowns.

This cross-sectional survey investigated the reasons for placement and replacement of single crowns, the type of materials selected for initial placement and evaluated their longevity. Information was collected over 19 months period using a questionnaire focusing on the principal reasons for the placement and replacement of crowns, selected material type and the age of the crowns at the time of replacement. A total of 842 single crowns were evaluated in 476 patients. Of the 842 crowns, 472 (56%) were initial placements and 370 (44%) replacements. The main reason for placement of first single crowns was related to endodontic problems (26.5%). Metal-ceramic was indicated significantly more frequent (88.9%; p⟨0.01) than other materials for the placement and replacement of single crowns. The median age of the replaced crowns was 6 years.

Directly ventricular septal defect closure without using arteriovenous wire loop: Our adult case series using transarterial retrograde approach.

OBJECTIVE: The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure. METHODS: Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18-58), the mean height was 168.75 cm (Range 155-185cm), and the mean body mass index was 23.4 (Range 17.3-28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side. RESULTS: The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach using AV loop. We didn't encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively. CONCLUSION: Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and shortens the procedure time. The only limitation in adult patients is delivery sheath length.

One-year clinical evaluation of different types of bulk-fill composites.

AIM: In the present study, we evaluated the 1-year clinical performance of a conventional posterior composite resin and three bulk-fill composite resins. METHODS: Fifty patients with four class II restorations under occlusion were enrolled in the present study. A total of 200 restorations were placed in the cavity, 50 for each material (Clearfil Photo Posterior, Filtek Bulk-Fill Flowable and Filtek P60, Tetric EvoCeram Bulk-Fill, and SonicFill). One operator placed the restorations in the cavity, and 1 week later the patients were called for baseline examination. Two calibrated examiners evaluated the restorations once every 3 months for 1 year, according to United States Public Health Service criteria. The data were analyzed using SPSS. Non-parametric tests (Kruskal-Wallis, Mann-Whitney U-test, and Friedman) were used for the analysis at a confidence level of 95%. RESULTS: The 1-year recall rate was 86%. All restorations showed minor modifications after 1 year. However, no statistically-significant differences were detected between the materials' performance at baseline and after 1 year for all criteria (P > 0.05). CONCLUSIONS: The bulk-fill composite resin materials showed similar clinical performance when compared with a conventional posterior composite resin. Further evaluations are necessary for the long-term clinical performance of these materials.

OPERATOR DEPENDENCY OF THE RADIATION EXPOSURE IN CARDIAC INTERVENTIONS: FEASIBILITY OF ULTRA LOW DOSE LEVELS.

INTRODUCTION: Mean radiation exposure in invasive cardiology varies greatly between different centres and interventionists. The International Commission on Radiological Protection and the EURATOM Council stipulate that, despite reference values, 'All medical exposure for radiodiagnostic purposes shall be kept as low as reasonably achievable' (ALARA). The purpose of this study is to establish the effects of the routine application of ALARA principles and to determine operator and procedure impact on radiation exposure in interventional cardiology. MATERIALS AND METHODS: A total of 240 consecutive cardiac interventional procedures were analysed. Five operators performed the procedures, two of whom were working in accordance with ALARA principles (Group 1 operators) with the remaining three working in a standard manner (Group 2 operators). Radiation exposure levels of these two groups were compared. RESULTS: Total fluoroscopy time and the number of radiographic runs were similar between groups. However, dose area product and cumulative dose were significantly lower in Group 1 when compared with Group 2. Radiation levels of Group 1 were far below even the reference levels in the literature, thus representing an ultra-low-dose radiation exposure in interventional cardiology. CONCLUSION: By use of simple radiation reducing techniques, ultra-low-dose radiation exposure is feasible in interventional cardiology. Achievability of such levels depends greatly on operator awareness, desire, knowledge and experience of radiation protection.

Analysis of Endodontic Complications Following Fixed Prosthodontic Rehabilitation.

PURPOSE: The aim of this study was to determine endodontic treatment needs and types of endodontic disease following fixed prosthodontic treatment 24 hours after tooth preparation, 1 week after tooth preparation, 1 month after placement, and 6 months after placement. MATERIALS AND METHODS: Study groups consisted of patients who attended a university dental hospital department of prosthodontics for fixed prosthodontic treatment from January 2011 to December 2013. All teeth were clinically and radiographically evaluated according to American Association of Endodontists evaluation criteria before preparation. Metal-ceramic fixed partial dentures were placed for all patients. A total of 1,633 abutment teeth were prepared with 1,100 pontics in 524 patients (214 female and 310 male). Participant age, sex, and tooth number were recorded. Endodontic treatment follow-up was scheduled for 24 hours after tooth preparation, 1 week after preparation, 1 month after placement, and 6 months after placement, and all teeth were evaluated after placement of FPDs according to a modified criteria. RESULTS: 2,733 retainers were placed with 624 FPDs. Of the FPDs, 332 (53%) were placed in the posterior and 196 (31.5%) in the anterior region. The remaining 96 FPDs (15.5%) were placed anteroposterior. The abutment/pontic ratio was 1.44:1. The number of retainers per FPD was 4.37. Of 1,633 abutment teeth, 103 were endodontically treated after placement of FPDs. Most observed endodontic disease was symptomatic irreversible pulpitis. There were statistically significant differences in terms of teeth regions (P < .001). When follow-up times of 24 hours, 1 week, 1 month, and 6 months were evaluated, there was no statistically significant difference among all teeth groups (P > .05). CONCLUSION: A total of 2,733 retainers on 624 FPDs were evaluated over 6 months, and the mean endodontic treatment need ratio was 6.3%.

The effect of different adhesives and setting times on bond strength between Biodentine and composite.

BACKGROUND: The aim of this study was to evaluate the effects of 3 different adhesives with different functional monomers, on the shear bond strength (SBS) of Biodentine®. METHODS: Acrylic blocks (n = 90) were prepared and a 2-mm height x 4-mm diameter hole was opened in each block. Every hole was completely restored with Biodentine®. Before preparation of composite restorations over the Biodentine® (2-mm height x 2-mm diameter), 3 different adhesives (Etch-37 (37%) w/BAC by Bisco & Prime Bond N&T, Clearfil S3 Bond and Adper Prompt L-Pop) were applied. SBS was evaluated using a universal testing machine, and failure mode for each sample was recorded. The results were statistically analyzed using 2-way ANOVA and post hoc Tukey test. RESULTS: When the megapascal values of all groups were compared, although there was no statistically significant difference in the different setting times (p>0.05), statistically significant differences were observed among all adhesive groups (p<0.05). Moreover, the highest SBS values were observed in the Clearfil S3 Bond group. CONCLUSIONS: Clinical performance of Biodentine® may be affected by adhesive procedures and its setting time.

Evaluation of school-based prevention program in Turkey: Results of a 24-month study.

OBJECTIVE: In this paper, cavity experiences of children with different levels of eruption and cavity activities that are enrolled at an elementary school with semi-rural characteristics in Kirikkale Provincial center were monitored for 2 years after a variety of protective applications. MATERIALS AND METHODS: Three hundred and twenty-two children at the age of 7-11 were included in this study. Children were grouped as follows according to their cavity experiences and applications done: Group 1 - control group (with or without cavities) - was given hygiene training only; Group 2 - with medium level cavity activity (2-4 cavities in average) - oral hygiene training + surface restoration applied; Group 3 - children with 2-4 cavities on average - oral hygiene training + professional flour gel applied; Group 4 - children with 2-4 cavities in average - oral hygiene training + flour gel applied with brush; Group 5 - children with extreme cavity activity (children with 5 or more cavities) - oral hygiene training + surface restoration + professional flour gel combination applied. RESULTS: At the end of the 2(nd) year, 277 children were reached. The increase of number of cavities in permanent teeth was determined as 35%, 0%, 1%, 0%, and 7% in groups 1-5, respectively. The difference between groups was found to be significant (Chi-square analysis, Pearson Chi-square = 27.002, P < 0.01). CONCLUSION: These findings have showed that, in Kirikkale Provincial center, some cavity-preventive measures such as surface restoration and gel applications, along with hygiene training, could provide optimum protection for school-age children.

Shear bond strength of bulk-fill and nano-restorative materials to dentin.

OBJECTIVES: Bulk-fill composite materials are being developed for preparation depths of up to 4 mm in an effort to simplify and improve the placement of direct composite posterior restorations. The aim of our study was to compare shear-bond strength of bulk-fill and conventional posterior composite resins. MATERIALS AND METHODS: In this study, 60 caries free extracted human molars were used and sectioned parallel to occlusal surface to expose midcoronal dentin. The specimens were randomly divided into four groups. Total-etch dentine bonding system (Adper Scotchbond 1XT, 3M ESPE) was applied to dentin surface in all the groups to reduce variability in results. Then, dentine surfaces covered by following materials. Group I: SonicFill Bulk-Fill, Group II: Tetric EvoCeram (TBF), Group III: Herculite XRV Ultra, and Group IV: TBF Bulk-Fill, 2 mm × 3 mm cylindrical restorations were prepared by using application apparatus. Shear bond testing was measured by using a universal testing machine. Kruskal-Wallis and Mann-Whitney U-tests were performed to evaluate the data. RESULTS: The highest value was observed in Group III (14.42 ± 4.34) and the lowest value was observed in Group IV (11.16 ± 2.76) and there is a statistically significant difference between these groups (P = 0.046). However, there is no statistically significant difference between the values of other groups. In this study, Group III was showed higher strength values. CONCLUSION: There is a need for future studies about long-term bond strength and clinical success of these adhesive and bulk-fill systems.

Impact of anxiety level on circadian rhythm of blood pressure in hypertensive patients.

INTRODUCTION: Considering the high prevalence rates and growing incidences of hypertension (HT) and anxiety disorders in the modern world, a full understanding of anxiety's relationship to HT is crucial. In this study we aimed to investigate the effects of anxiety level on circadian rhythm of blood pressure (BP) in hypertensive patients. MATERIAL AND METHOD: This cross-sectional study included 160 previously diagnosed essential hypertensive patients (80 female, 80 male, mean age: 55.3±15.1 years). All participants underwent 24 h ambulatory blood pressure monitoring (ABPM) and filled State-Trait Anxiety Inventory (STAI) (trait) Questionnaire. The study population was divided into 2 groups according to their STAI scores; an anxiety group (n=97; STAI ≥45) and a control group (n=63; STAI<44). Clinical characteristics, laboratory findings and ABPM measurements were compared between the groups. RESULTS: There was no significant difference between the groups for ABPM parameters except morning blood pressure surge (MBPS). Anxiety group had a significantly higher MBPS compared to control group (14.4±17.0 vs 9.1±11.9 mmHg, P:0.03). Multivariate analysis showed that duration of HT and STAI score were the only independent predictors of MBPS. CONCLUSION: Patients' anxiety level is associated with MBPS which is an independent risk factor for cardiovascular complications. Assessment and control of anxiety seems to be worthy in effective treatment of hypertension.

Evaluation of the clinical success of class I cavities prepared by an Er:YAG laser-5-year follow-up study.

The purpose of this study was to evaluate, after 5 years, the clinical success of preparing class 1 composite resin restorations with an Er:YAG laser. Sixty-five teeth of 30 patients were included in the study, and an Er:YAG laser emitting at a wavelength of 2.94 µm was used for the class I cavity preparations with not more than one third of the mesiodistal width of the occlusal surfaces of each tooth. All cavities were restored with a light-cured composite resin, following a single bond application. After the baseline examination, restorations were reevaluated by the same experienced clinician after 5 years, using the modified Ryge criteria. At the end of 5 years, 41 of the 65 restorations were evaluated in 22 patients and scored. With respect to marginal discoloration, anatomic form, color match, and surface texture, significant differences were found between baselines tested after 5 years. Clinical evaluation of postoperative sensitivity showed that 90.2 % were rated as alpha. All restorations evaluated in this study demonstrated acceptable clinical performance within the evaluation period based on the alpha and bravo ratings for clinically satisfactory restorations. Further evaluations are necessary for a better clinical performance analysis.

A new device for paravalvular leak closure.

Percutaneous closure of a prosthetic paravalvular leak (PVL) is a challenging procedure. Operators must use devices constructed for other applications. We present the use of a device which is specifically designed for PVL closure. To the best of our knowledge, there is no publication in MEDLINE reporting the use of the device.

Inadvertent implantation of pacemaker lead in the left ventricle: kill two birds with one stone.

We report an asymptomatic patient in whom the intravenous pacemaker (PM) lead was inadvertently implanted in LV through the perforated interventricular septum. He had no embolic events during the last 9 years after the implantation. Possible explanation of the uncomplicated follow-up period is that the patient had been taking warfarin because of mechanical mitral valve prosthesis.

In vitro protection of adipose tissue-derived mesenchymal stem cells by erythropoietin.

Mobilization of stem cells and their differentiation into cardiomyocytes are known to have protective effects after myocardial infarction. The integrity of transplanted mesenchymal stem cells for cardiac regeneration is dependent on cell-cell or cell-matrix interaction, which is adversely affected by reactive oxygen species in an ischemic environment. Treatment with erythropoietin was shown to protect human adipose tissue derived mesenchymal stem cells in an ischemic injury in vitro model. The analyses indicated that expression of erythropoietin receptors played a pivotal role in erythropoietin mediated cell survival. In this study, the anti-apoptotic effect of erythropoietin on stem cells was analyzed in apoptosis-induced human mesenchymal stem cells. Apoptosis was induced in cultured adult human adipose tissue derived mesenchymal stem cells by hydrogen peroxide. A group of cultured cells was also treated with recombinant human erythropoietin in a concentration of 50 ng mL(-1). The degree of apoptosis was analyzed by flow-cytometry and immunohistochemical staining for Caspase 3. The average percentages of apoptotic cells were significantly higher in H2O2-induced stem cells than in cells co-cultured with erythropoietin (63.03 ± 4.96% vs 29 ± 3.41%, p<0.01). We conclude that preconditioning with erythropoietin suppresses apoptosis of mesenchymal stem cells and enhances their survival.