The long-term effects of the fenestration in patients with extracardiac Fontan circulation-a multicenter Korean cohort study based on national Fontan registry.

Introduction: The long-term effects of fenestration in patients with Fontan circulation remain unclear. We aim to evaluate the fenestration impact on early and late outcomes in patients with extracardiac Fontan (ECF) using a propensity score matching analysis. Methods: We performed an extensive retrospective multicenter clinical data review of the Korean Fontan registry and included 1,233 patients with surgical ECF (779 fenestrated, 454 non-fenestrated). Demographics, baseline, and follow-up data were collected and comprehensively analyzed. Patients were divided into two groups according to the baseline presence or absence of surgical fenestration. Subsequently, patients were sub-divided according to the fenestration status at the last follow-up. Propensity-score matching was performed to account for collected data between the 2 groups using a multistep approach. The primary outcomes were survival and freedom from Fontan failure (FFF). We also looked at postoperative hemodynamics, cardiopulmonary exercise test results, oxygen saturations, and functional status. Results: After propensity-score matching (454 matched pairs), there was no difference in survival or FFF between the 2 groups. However, ECF patients with baseline fenestration had significantly lower oxygen saturation (p = 0.001) and lower functional status (p < 0.001). Patients with fenestration had significantly longer bypass times, higher postoperative central venous pressure, higher postoperative left atrial pressure, and less prolonged pleural effusion in the early postoperative period. The propensity score matching according to the fenestration status at the last follow-up (148 matched pairs) showed that patients with a persistent fenestration had significantly lower oxygen saturation levels (p < 0.001). However there were no intergroup differences in the functional status, survival and FFF. Conclusions: Our results showed no long-term benefits of the Fenestration in terms of survival and FFF. Patients with persistent fenestration showed oxygen desaturation but no difference in exercise intolerance was shown between the 2 groups.

Whitening Efficacy of Toothpastes on Coffee-Stained Teeth: An Enamel Surface Analysis.

AIM: This study aimed to identify the optimal toothpaste for removing coffee-induced stains while also evaluating its impact on tooth enamel through roughness and abraded depth parameters, providing a comprehensive understanding of their effects. MATERIALS AND METHODS: Three whitening toothpastes and 2 conventional toothpastes were prepared for a simulated brushing procedure on coffee-stained bovine enamel tooth specimens. Using a toothbrushing machine, up to 10,000 brushstrokes were completed, while spectrophotometric readings were taken at designated intervals. A mixed-effects model for statistical analysis determined the effects of toothpaste and brushing on colour change, roughness, and abraded depth. RESULTS: Whitening toothpastes significantly deviated from the control (P < .001, P < .001, and P < .003, respectively), whereas the conventional toothpaste did not exhibit a significant contrast (P < .081). Regarding colour restoration following coffee staining, whitening toothpastes showed higher restoration than conventional toothpastes. Surface roughness and abraded depth parameters increased with accumulated brushing. CONCLUSIONS: Sodium hexametaphosphate-containing toothpaste demonstrated the highest efficacy in removing coffee-induced stains and restoring tooth colour. Nevertheless, this stronger whitening effect was associated with increased abrasion. While conventional toothpastes exhibited some whitening effects, the most substantial improvement in lightness was consistently observed with whitening toothpastes. CLINICAL RELEVANCE: Understanding how whitening toothpaste affects enamel integrity is crucial for refining formulations and advancing dental care. This knowledge lays the groundwork for more effective oral care products and improved whitening procedures, ultimately enhancing the overall quality of dental treatments.

Three methods to measure the photopolymerization kinetics for different radiant emittance and composite type.

Photopolymerization kinetics affects the curing time, degree of conversion, polymerization shrinkage, and mechanical properties of composites. The aim of this study was to compare three methods (temperature, heat flow, and polymerization shrinkage) for photopolymerization kinetics measurement of composites. The photopolymerization kinetics of four composites (2 packable and 2 flowable) were measured with an LED light for 20 s (radiant emittance: 2,100 mW/cm2). For the two packable composites, photopolymerization kinetics was measured with varying the radiant emittance and exposure time. For each measurement method, peak times were determined as the time when maximum temperature rise, heat flow, and shrinkage rate occurred, respectively. The photopolymerization kinetics differed among the measurement methods. The photopolymerization kinetics of composites changed as the radiant emittance and composite type varied. In clinical practice and research on the composite restoration, the kinetics should be considered comprehensively with the complementary use of various measurement methods.

Long-term Outcomes of Polytetrafluoroethylene Bicuspid Pulmonary Valve Replacement.

BACKGROUND: In 2016 we reported promising midterm outcomes of bicuspid pulmonary valve replacement using 0.1-mm polytetrafluoroethylene (PTFE) membrane. This follow-up study analyzes long-term outcomes and risk factors for reintervention and structural valve deterioration (SVD). METHODS: We performed a retrospective review of the original 119 patients who underwent PTFE bicuspid pulmonary valve replacement. Median patient age was 16.9 years (range, 0.4-57.1). Reintervention was defined as any surgical or percutaneous catheter procedure on the PTFE valve. SVD was defined as development of a peak pressure gradient ≥ 50 mm Hg or at least a moderate amount of pulmonary regurgitation on follow-up echocardiography. RESULTS: The median follow-up duration was 9.5 years. The survival rate was 96.5% at 5 and 10 years, with 2 early and 2 late mortalities. Freedom from reintervention was 90.0% at 5 years and 63.3% at 10 years. Freedom from SVD was 92.8% at 5 years and 51.1% at 10 years, with regurgitation the predominant mode (64.6%). Freedom from both reintervention and SVD at 5 and 10 years were 89.1% and 49.5%, respectively. Multivariable analysis identified smaller valve diameter (hazard ratio, 0.82; P < .001) and more than trivial pulmonary regurgitation at discharge (hazard ratio, 5.81; P < .001) as risk factors for reintervention or SVD. CONCLUSIONS: Long-term results of the PTFE bicuspid pulmonary valve replacement were acceptable. However, improvements may be needed to reduce technical error and improve durability. Smaller valve diameter and more than trivial pulmonary regurgitation at discharge were risk factors for reintervention or SVD, warranting careful follow-up for timely reintervention.

Mg-incorporated sorbent for efficient removal of trace CO from H2 gas.

Removal of trace CO impurities is an essential step in the utilization of Hydrogen as a clean energy source. While various solutions are currently employed to address this challenge, there is an urgent need to improve their efficiency. Here, we show that a bead-structured Mg, Cu, and Ce-based sorbent, Mg13CuCeOx, demonstrates superior removal capacity of trace CO from H2 with high stability. The incorporation of Mg boosts sorption performance by enhancing the porous structure and Cu+ surface area. Remarkably, compared to existing pelletized sorbents, Mg13CuCeOx exhibits 15.5 to 50 times greater equilibrium capacity under pressures below 10 Pa CO and 31 times longer breakthrough time in removing 50 ppm CO in H2. Energy-efficient oxidative regeneration using air at 120 °C allows its stable sorption performance over 20 cycles. Through in-situ DRIFTS analysis, we elucidate the reaction mechanism that Mg augments the surface OH groups, promoting the formation of bicarbonate and formate species. This study highlights the potential of MgCuCeOx sorbents in advancing the hydrogen economy by effectively removing trace CO from H2.

Effect of translucency and absorbance of composite on temperature change during photopolymerization.

This study investigated the effect of translucency and absorbance of conventional (FiltekTM-Z350-XT) and bulk-fill (Tetric®-N-Ceram) composites on temperature change during photopolymerization, using a non-contact infrared sensor. Three shades from each composite were selected to prepare disk-shaped specimens (n=3), which then photopolymerized with LED-light for 20 s. A second light exposure was performed on the photopolymerized specimens. The first peak temperature rise during composite photopolymerization (ΔTtotal), second peak temperature rise by the light (ΔTlight), and net peak temperature rise by composite curing heat (ΔTcomposite) were obtained from the temperature change vs. time curve. The changes in ΔTtotal and ΔTlight with varying the composite shade were greater than those in ΔTcomposite. The conventional composite showed higher ΔTtotal and ΔTlight than bulk-fill composite. ΔTtotal and ΔTlight increased as translucency parameter decreased, and absorbance increased. The potential risk for heat-induced pulpal damage should be considered when selecting a composite shade, especially for deep cavities.

Historical Review and Future of Cardiac Xenotransplantation.

Along with the development of immunosuppressive drugs, major advances on xenotransplantation were achieved by understanding the immunobiology of xenograft rejection. Most importantly, three predominant carbohydrate antigens on porcine endothelial cells were key elements provoking hyperacute rejection: α1,3-galactose, SDa blood group antigen, and N-glycolylneuraminic acid. Preformed antibodies binding to the porcine major xenoantigen causes complement activation and endothelial cell activation, leading to xenograft injury and intravascular thrombosis. Recent advances in genetic engineering enabled knock-outs of these major xenoantigens, thus producing xenografts with less hyperacute rejection rates. Another milestone in the history of xenotransplantation was the development of co-stimulation blockaded strategy. Unlike allotransplantation, xenotransplantation requires blockade of CD40-CD40L pathway to prevent T-cell dependent B-cell activation and antibody production. In 2010s, advanced genetic engineering of xenograft by inducing the expression of multiple human transgenes became available. So-called 'multi-gene' xenografts expressing human transgenes such as thrombomodulin and endothelial protein C receptor were introduced, which resulted in the reduction of thrombotic events and improvement of xenograft survival. Still, there are many limitations to clinical translation of cardiac xenotransplantation. Along with technical challenges, zoonotic infection and physiological discordances are major obstacles. Social barriers including healthcare costs also need to be addressed. Although there are several remaining obstacles to overcome, xenotransplantation would surely become the novel option for millions of patients with end-stage heart failure who have limited options to traditional therapeutics.

Impact of Pulmonary Arterial Elastance on Right Ventricular Mechanics and Exercise Capacity in Repaired Tetralogy of Fallot.

BACKGROUND AND OBJECTIVES: Pathophysiological changes of right ventricle (RV) after repair of tetralogy of Fallot (TOF) are coupled with a highly compliant low-pressure pulmonary artery (PA) system. This study aimed to determine whether pulmonary vascular function was associated with RV parameters and exercise capacity, and its impact on RV remodeling after pulmonary valve replacement. METHODS: In a total of 48 patients over 18 years of age with repaired TOF, pulmonary arterial elastance (Ea), RV volume data, and RV-PA coupling ratio were calculated and analyzed in relation to exercise capacity. RESULTS: Patients with a low Ea showed a more severe pulmonary regurgitation volume index, greater RV end-diastolic volume index, and greater effective RV stroke volume (p=0.039, p=0.013, and p=0.011, respectively). Patients with a high Ea had lower exercise capacity than those with a low Ea (peak oxygen consumption [peak VO2] rate: 25.8±7.7 vs. 34.3±5.5 mL/kg/min, respectively, p=0.003), while peak VO2 was inversely correlated with Ea and mean PA pressure (p=0.004 and p=0.004, respectively). In the univariate analysis, a higher preoperative RV end-diastolic volume index and RV end-systolic volume index, left ventricular end-systolic volume index, and higher RV-PA coupling ratio were risk factors for suboptimal outcomes. Preoperative RV volume and RV-PA coupling ratio reflecting the adaptive PA system response are important factors in optimal postoperative results. CONCLUSIONS: We found that PA vascular dysfunction, presenting as elevated Ea in TOF, may contribute to exercise intolerance. However, Ea was inversely correlated with pulmonary regurgitation (PR) severity, which may prevent PR, RV dilatation, and left ventricular dilatation in the absence of significant pulmonary stenosis.

Effect of radiant emittance of an LED curing light on the cuspal deflection of a simulated tooth cavity in bulk-fill composite restoration: A novel simulation method.

In this study, a novel method for simulating human teeth was developed, with which the effect of radiant emittance of an LED curing light on the cuspal deflection was investigated. A mesio-occluso-distal (MOD) cavity was replicated using a heat-pressed ceramic and lost wax technique, and the cuspal compliance and cuspal deflection of the replicated ceramic teeth and extracted human teeth were evaluated. The replicated ceramic teeth were restored using a nano bulk-fill composite and photopolymerized using three different protocols. Data were analyzed with t-test and one-way ANOVA (α=0.05). The cuspal compliance and cuspal deflection of the replicated ceramic teeth and extracted human teeth were similar. Cuspal deflections did not differ significantly among the tested photopolymerization protocols. Thus, the replicated ceramic teeth were an effective simulation of human teeth. During bulk-fill composite restoration of the MOD cavity, cuspal deflection was not affected by changing the radiant emittance of the LED light.

Real-time measurement of transmittance changes during photo-polymerization of conventional and bulk-fill composites.

This study investigated transmittance changes during photo-polymerization of composites in real-time. The transmittance changes of one conventional micro-hybrid, three conventional nano-hybrid, and four bulk-fill composites were measured before, during, and after photo-polymerization, and the maximum rate of transmittance change was compared with that of polymerization shrinkage. A significant difference in transmittance of composite between before and after photo-polymerization was observed. The transmittance of composites except for one bulk-fill composite increased during photo-polymerization. There was a correlation between the maximum rate of transmittance change and the maximum rate of polymerization shrinkage. The transmittance analysis of composites gives very important information to know for the final aesthetic restoration and allows to evaluate polymerization kinetics.

Surgical and Electrical Anatomy of the Inter-Nodal and Intra-Atrial Conduction System in the Heart.

An anatomical understanding of the atrial myocardium is crucial for surgeons and interventionists who treat atrial arrhythmias. We reviewed the anatomy of the inter-nodal and intra-atrial conduction systems. The anterior inter-nodal route (#1) arises from the sinus node and runs through the ventral wall of the atrial chambers. The major branch of route #1 approaches the atrioventricular node from the anterior aspect. Other branches of route #1 are Bachmann's bundle and a vestibular branch around the tricuspid valve. The middle inter-nodal route (#2) begins with a broad span of fibers at the sinus venarum and extends to the superior limbus of the oval fossa. The major branch of route #2 joins with the branch of route #1 at the anterior part of the atrioventricular node. The posterior inter-nodal route (#3) is at the terminal crest and gives rise to many branches at the pectinate muscles of the right atrium and then approaches the posterior atrioventricular node after joining with the vestibular branch of route #1. The branches of the left part of Bachmann's bundle and the branches of the second inter-nodal route form a thin myocardial network at the posterior wall of the left atrium. These anatomical structures could be categorized into major routes and side branches. There are 9 or more anatomical circles in the atrial chambers that could be structural sites for macro re-entry. The implications of normal and abnormal structures of the myocardium for the pathogenesis and treatment of atrial arrhythmias are discussed.

Long-term Outcome of Fontan-Associated Protein-Losing Enteropathy: Treatment Modality and Predictive Factor of Mortality.

BACKGROUND AND OBJECTIVES: Protein-losing enteropathy (PLE) is a devastating complication after the Fontan operation. This study aimed to investigate the clinical characteristics, treatment response, and outcomes of Fontan-associated PLE. METHODS: We reviewed the medical records of 38 patients with Fontan-associated PLE from 1992 to 2018 in 2 institutions in Korea. RESULTS: PLE occurred in 4.6% of the total 832 patients after the Fontan operation. After a mean period of 7.7 years after Fontan operation, PLE was diagnosed at a mean age of 11.6 years. The mean follow-up period was 8.9 years. The survival rates were 81.6% at 5 years and 76.5% at 10 years. In the multivariate analysis, New York Heart Association Functional classification III or IV (p=0.002), low aortic oxygen saturation (<90%) (p=0.003), and ventricular dysfunction (p=0.032) at the time of PLE diagnosis were found as predictors of mortality. PLE was resolved in 10 of the 38 patients after treatment. Among medical managements, an initial heparin response was associated with survival (p=0.043). Heparin treatment resulted in resolution in 4 patients. We found no evidence on pulmonary vasodilator therapy alone. PLE was also resolved after surgical Fontan fenestration (2/6), aortopulmonary collateral ligation (1/1), and transplantation (1/1). CONCLUSIONS: The survival rate of patients with Fontan-associated PLE has improved with the advancement of conservative care. Although there is no definitive method, some treatments led to the resolution of PLE in one-fourth of the patients. Further investigations are needed to develop the best prevention and therapeutic strategies for PLE.

Exploring the synergistic role of crystal facet and phase at hetero-interface towards light-switchable chemoselective oxidation over bismuth-based catalysts.

The surface or interface facets design is a versatile strategy to improve essential catalytic features to enhance efficiency. Herein, a systematic study was conducted to explore the roles of exposed facets at the surface of a bare catalyst or interfaces of hybrid Bi-based catalysts. The facet- and phase-controlled catalysts were synthesized via hydrolysis. Zn+ cations on the optimized hybrid structure served as additional active sites. Their contributions to promoting charge transfer and inhibiting electron-hole recombination resulted in enhanced photo-oxidation. The catalytic and photocatalytic activities were measured in gaseous 2-chloroethyl ethyl sulfide (CEES) detoxification and liquid benzyl alcohol oxidation. A light-switchable chemo-selective change from dehydrohalogenation to oxidation was observed during CEES detoxification. Compared to degradation under dark, a significant enhancement in CEES degradation was observed under simulated solar light. The developed B-mBP-ZnO catalyst exhibited superior performances in photo-oxidation of CEES to chloroethyl ethyl sulfoxide and benzyl alcohol to benzaldehyde.

Long-Term Outcomes of Surgical Repair for Ventricular Septal Defect in Adults.

Data of the outcomes of ventricular septal defect (VSD) closure in adults are limited to establish recommendations. Therefore, we reviewed our experience with surgical VSD closure in adult patients. We retrospectively reviewed 152 patients who underwent surgical VSD closure between January 1996 and April 2020. The median age of the patients was 30.5 [interquartile range (IQR) 23.1-42.7] years. The median follow-up duration was 10.9 (IQR 4.8-16.1) years. VSDs were classified according to the Society of Thoracic Surgeons classification as type 2 (n = 66, 43.4%), type 1 (n = 59, 38.8%), and type 4 (n = 27, 17.8%). Aortic cusp prolapse (n = 86, 56.6%) and aortic valve regurgitation (AR, n = 75, 49.3%) were the most common indications for surgical closure. Four patients underwent late reoperation (2.6%) due to AR, infective endocarditis and residual VSD. In the log-rank test, preoperative trivial or more degree of AR (P = 0.004) and coronary cusp deformity (P = 0.031) was associated with late moderate or greater degree of AR. Preoperative moderate or greater AR was associated with reoperation (P = 0.047). Only concomitant aortic valve (AV) repair at the time of VSD closure was a significant risk factor for late significant AR progression in the multivariable analysis. VSD closure in adults can be performed with low mortality and morbidity rates. AR can progress after VSD closure because the aortic cusp may have irreversible damage from long-standing shunt flow exposure. We conclude that VSD with AV deformity or AR in adults should be treated aggressively before disease progression with irreversible damage occurs.

Effects of wall compliance and light-curing protocol on wall deflection of simulated cavities in bulk-fill composite restoration.

BACKGROUND/PURPOSE: Cuspal deflections in composite restoration have been investigated with considering wall compliance of human tooth cavity and light-curing protocol. The purpose of this study was to investigate effects of mold wall compliance and radiant emittance of LED light on the wall deflection of simulated aluminum mold cavities restored with a bulk-fill composite. MATERIALS AND METHODS: Sixty aluminum molds simulating a class II mesio-occluso-distal (MOD) cavity (6 W × 8 L × 4 D mm; W, width; L, length; D, Depth) were prepared and allocated to three groups with varying mold wall thicknesses of 1, 2, and 3 mm. The molds were bulk-filled with a bulk-fill composite and photo-cured. Four light-curing protocols were used: three duty ratios/exposure times: 100%/20 s, 50%/40 s, or an increasing mode (0 → 100%)/40 s with a pulse width modulated (PWM) LED curing light and one 20 s exposure time with a commercial LED light. RESULTS: Mean mold wall deflection at 2000 s decreased with increasing mold wall thickness (1, 2, and 3 mm) (p < 0.05). Wall deflections with 1- and 2-mm-thick molds exhibited no statistically significant differences among light-curing protocols (p > 0.05). However, in the 3-mm-thick mold, wall deflections with low radiant emittance were significantly lower than those with high radiant emittance (p < 0.05). CONCLUSION: In composite restoration of class II MOD cavities, lowering the radiant emittance of LED light can reduce the mold wall deflection only in low compliance cavities.

Tricuspid Valve Repair at Pulmonary Valve Replacement in Repaired Tetralogy of Fallot.

BACKGROUND: Pulmonary valve replacement (PVR) is often performed in patients with repaired tetralogy of Fallot (TOF). Concomitant tricuspid valvuloplasty (TVP) in those with tricuspid regurgitation (TR) at the time of PVR is still controversial. METHOD: We retrospectively reviewed clinical records of patients who underwent PVR between 2001 and 2012. We analyzed the impact of concomitant TVP on the tricuspid valve function and right ventricle function and size in mid-term. RESULTS: 119 patients with mild to moderate TR at the time of PVR were enrolled. 33 patients underwent concomitant TVP (TVP group) and 86 patients underwent PVR alone (no-TVP group). There was a significant reduction of TR (p < 0.001) and right ventricular end-diastolic volume index (RVEDVi) (p < 0.001). However, in patients who showed prosthetic pulmonary valve (PV) failure at the last follow-up, there was no significant decrease in TR regardless of concomitant TVP. In the patients with preserved prosthetic PV function, TR was significantly improved (p < 0.001 in both groups). The multivariable analysis showed that significant risk factors for recurrence of significant TR were preoperative moderate TR and prosthetic PV failure. CONCLUSIONS: After PVR in repaired TOF patients, there was an improvement in the degree of TR and the RVEDVi. Concomitant TVP at the time of PVR may not be able to prevent the recurrence of TR when prosthetic PV failure occurs; however, it may effectively preserve tricuspid valve function until that time.

Performance and Cost Analysis of Natural Gas Combined Cycle Plants with Chemical Looping Combustion.

The natural gas combined cycle (NGCC) is the most popular and efficient fossil fuel power plant; however, integrating a carbon capture system reduces its performance efficiency. The demand to reduce the carbon capture cost and improve eco-friendliness drives the development of alternatives. In this study, four alternative NGCC-based process schemes were designed: NGCC with amine carbon capture as a base configuration and NGCCs with three different chemical looping combustion (CLC) configurations. Detailed heat and material balances were evaluated for all four cases using the PRO/II simulation package. A comparative analysis of the gross and net power, plant efficiency, and carbon capture efficiency, which are imperative to optimizing the process configuration, was conducted for all of the proposed cases. All NGCC-CLC processes could produce higher net power than NGCC-MEA because the amine regenerator consumes a high amount of power in its operation. In the condition using an equal amount of natural gas supply, NGCC-CLC configurations using excess air could produce a net power of 510.1 MW with a plant efficiency of 44.35%. The excess air fed in both cases enabled the turbine to generate more power. NGCC-CLC using excess air with steam turbine integration has an investment cost of 132.9 $/net MWh, an operating cost of 56.7 $/net MWh year, and a levelized cost of electricity of 90.9 $/MWh. In addition, NGCC-CLC with excess air resulted in a carbon capture efficiency of 99.93% under 59.2 $/ton of CO2, which was higher than that of NGCC-MEA with a carbon efficiency of 95.1%. NGCC-CLC using excess air with steam turbine integration is considered as the most efficient process scheme for generating power from natural gas with regard to efficiency, cost, and environmental impact.

Efficient solar light facilitated photo-oxidative detoxification of gaseous 2-chloroethyl ethyl sulfide on ZrO2-doped g-C3N4 under dry and humid air.

Photo-oxidation of chemical warfare agents is considered a promising strategy to cope with threats from accidental or intentional release. In this study, heterostructure photocatalysts comprising different amounts of zirconium oxide (ZrO2) over carbon nitride (CN) were synthesized via simple thermal exfoliation, followed by a precipitation method. The successful photocatalytic detoxification activity of the as-prepared photocatalyst was analyzed against 2-chloroethyl ethyl sulfide (CEES) under simulated solar light and natural sunlight irradiation in dry and humid air. As the CN/ZrO2 demonstrated a high surface area and oxygen doping, the addition of small amounts of the ZrO2 phase could lead to enhanced photoreactivity in surface chemistry. The as-prepared (CN/ZrO2-II) degraded 95% of CEES under simulated solar light and 70% under natural sunlight within 90 min. The photo-detoxification of CEES was associated with the generation of holes (h+) and activation of oxygen to superoxide radicals (•O2). Based on analysis results, a reaction mechanism was suggested. The activity of the used photocatalyst could be recovered to 90% of the fresh photocatalyst activity via simple water washing. However, as sulfurous compounds were accumulated on the surface in subsequent cyclic tests, solvent washing was also suggested to maintain high detoxification performance.

Effects of cuspal compliance and radiant emittance of LED light on the cuspal deflection of replicated tooth cavity.

The aim was to investigate effects of compliance and radiant emittance on cuspal deflection. A mesio-occluso-distal cavity was replicated using a flowable composite and steel rods with different diameters. To investigate the effect of cuspal compliance on deflection, the replicated tooth and extracted human tooth cavities were bulk-filled with a micro-hybrid composite. The replicated cavities with 2.0-mm-diameter steel rods were restored with bulk-filling of the micro-hybrid or a nano bulk-fill composite and photo-cured with four protocols. The cuspal deflection was the highest in the replicated tooth without steel rod, followed by with 1.0-, 1.5-, and 2.0-mm steel rods, and significantly lower in the human tooth. Cuspal deflections showed no significant differences among light-curing protocols, and that in the micro-hybrid composite were higher than the nano bulk-fill composite. To reduce cuspal deflection of a high compliance cavity, selecting the proper composite based on physical properties is more important than light-curing protocol.