Effect of different beverages and polishing techniques on colour stability of CAD/CAM composite restorative materials.

Objectives: The aim of this article was to compare the colour stability of short fibre-reinforced computer-assisted design/computer-assisted manufacturing (CAD/CAM) composite (SFRC CAD) to commercially available CAD/CAM materials following prolonged immersion in a variety of beverages. Furthermore, the influence of the polishing technique was evaluated. Materials and methods: A total of 120 rectangular specimens (10 mm length × 14 mm width × 2 mm thickness) were prepared from SFRC CAD, IPS e-max, Cerasmart 270, Celtra Duo, Enamic, and Brilliant Crios. The specimens underwent polishing through either a laboratory polishing machine equipped with 4000-grit silicon carbide paper or chairside polishing using Sof-Lex spiral. Twenty specimens of each tested CAD/CAM material were randomly divided into four groups (n = 5) based on the staining solution used in order to evaluate the colour stability of the materials. Group 1: distilled water, Group 2: coffee, Group 3: red wine, Group 4: coke. Using a spectrophotometer, the colour changes (∆E) of all CAD/CAM materials were assessed at baseline, and after 1 and 12 weeks of staining. Three-way analysis of variance was used to analyse the data (α = 0.05). Results: The staining solution and material type showed a significant influence on the CAD/CAM specimens' colour stability (p < 0.05), while polishing method had no significant influence (p > 0.05). The average ∆E values for specimens submerged in wine were considerably higher (p < 0.05) than those for the other solutions. SFRC CAD, Cerasmart 270, and Enamic displayed the highest ∆E values in wine (p < 0.05). Conclusions: The colour stability of tested SFRC CAD was comparable to other composite-based CAD/CAM materials, while IPS e.max exhibited the highest level of colour stability.

Hotspots of Floating Plastic Particles across the North Pacific Ocean.

The pollution of the marine environment with plastic debris is expected to increase, where ocean currents and winds cause their accumulation in convergence zones like the North Pacific Subtropical Gyre (NPSG). Surface-floating plastic (>330 µm) was collected in the North Pacific Ocean between Vancouver (Canada) and Singapore using a neuston catamaran and identified by Fourier-transform infrared spectroscopy (FT-IR). Baseline concentrations of 41,600-102,700 items km-2 were found, dominated by polyethylene and polypropylene. Higher concentrations (factors 4-10) of plastic items occurred not only in the NPSG (452,800 items km-2) but also in a second area, the Papaha̅naumokua̅kea Marine National Monument (PMNM, 285,200 items km-2). This second maximum was neither reported previously nor predicted by the applied ocean current model. Visual observations of floating debris (>5 cm; 8-2565 items km-2 and 34-4941 items km-2 including smaller "white bits") yielded similar patterns of baseline pollution (34-3265 items km-2) and elevated concentrations of plastic debris in the NPSG (67-4941 items km-2) and the PMNM (295-3748 items km-2). These findings suggest that ocean currents are not the only factor provoking plastic debris accumulation in the ocean. Visual observations may be useful to increase our knowledge of large-scale (micro)plastic pollution in the global oceans.

Analytical Performance Evaluation of Siemens Sysmex CS-2500 and Sekisui CP-3000.

BACKGROUND: Automatic coagulation analyzers have been used in the last 50 years and have been developed considerably. Newly developed tests and methods cannot be conducted in routine laboratories without evaluating their performance. Therefore, their performance must be evaluated and approved before being used routinely. The aim of this study is to evaluate the analytical performance of Sysmex Coagulation System-2500 (CS-2500) and Sekisui CP-3000 automatic coagulation analyzer (CP-3000). METHODS: For APTT, PT, and D-dimer tests, reference range verification study, a method comparison study was performed in both analyzers in accordance with CLSI protocols, and precision and accuracy were evaluated using internal and external quality control samples. In the evaluation of precision and accuracy, CV% and bias% values were calculated. Bland-Altman, Passing-Bablok regression analysis, and correlation coefficient were used in the comparison study. RESULTS: The CV% values calculated for APTT and PT in both analyzers were found to be below the CLSI recommendation of 5%. D-dimer test results meet the quality criteria recommended by CLSI. Accuracy for both analyzers was within the acceptable limits. The reference ranges recommended by the manufacturer have been veryfied. Regression equations for APTT, PT, and D-dimer are y = -3.313 + 1.188x, y = -0.0399 + 1.048x, and y = 0.155 + 0.655x, respectively, and r values were 0.904, 0.978, and 0.974, respectively. CONCLUSIONS: CS-2500 and CP-3000 analyzers are suitable for laboratory use for routine coagulation. Since the CP-3000 device is newly used in our country, it needs to be supported by more comparison studies.

Validity of negative bone biopsy in suspicious bone lesions.

BACKGROUND: The presence of malignant cells in bone biopsies is considered gold standard to verify occurrence of cancer, whereas a negative bone biopsy can represent a false negative, with a risk of increasing patient morbidity and mortality and creating misleading conclusions in cancer research. However, a paucity of literature documents the validity of negative bone biopsy as an exclusion criterion for the presence of skeletal malignancies. PURPOSE: To investigate the validity of a negative bone biopsy in bone lesions suspicious of malignancy. MATERIAL AND METHOD: A retrospective cohort of 215 consecutive targeted non-malignant skeletal biopsies from 207 patients (43% women, 57% men, median age 64, and range 94) representing suspicious focal bone lesions, collected from January 1, 2011, to July 31, 2013, was followed over a 2-year period to examine any additional biopsy, imaging, and clinical follow-up information to categorize the original biopsy as truly benign, malignant, or equivocal. Standard deviations and 95% confidence intervals were calculated. RESULTS: 210 of 215 biopsies (98%; 95% CI 0.94-0.99) showed to be truly benign 2 years after initial biopsy. Two biopsies were false negatives (1%; 95% CI 0.001-0.03), and three were equivocal (lack of imaging description). CONCLUSION: Our study documents negative bone biopsy as a valid criterion for the absence of bone metastasis. Since only 28% had a confirmed diagnosis of prior cancer and not all patients received adequately sensitive imaging, our results might not be applicable to all cancer patients with suspicious bone lesions.

The global threat from plastic pollution.

Plastic pollution accumulating in an area of the environment is considered "poorly reversible" if natural mineralization processes occurring there are slow and engineered remediation solutions are improbable. Should negative outcomes in these areas arise as a consequence of plastic pollution, they will be practically irreversible. Potential impacts from poorly reversible plastic pollution include changes to carbon and nutrient cycles; habitat changes within soils, sediments, and aquatic ecosystems; co-occurring biological impacts on endangered or keystone species; ecotoxicity; and related societal impacts. The rational response to the global threat posed by accumulating and poorly reversible plastic pollution is to rapidly reduce plastic emissions through reductions in consumption of virgin plastic materials, along with internationally coordinated strategies for waste management.

Analytical performance evaluation of Sysmex CS-2500 and Stago STA Compact.

: The Sysmex Coagulation System-2500 (CS-2500) is a fully automated coagulation analyzer that uses the optical reaction method. In this study, we aimed to evaluate performance characteristics of the CS-2500 in two coagulation tests [prothrombin time (PT) and activated partial thromboplastin time (aPTT)] at our hospital laboratory. PT and aPTT measurements were performed using the CS-2500 and STA-Compact Diagnostica Stago coagulometers (STA-Compact). Then, precision, accuracy, reference range verification, and method comparison statistics were performed. In the precision study, which was performed with normal and pathologic controls for the PT-international normalized ratio (INR) and aPTT tests, all coefficient of variation% were found less than 3.5%. In the comparison study, the Passing-Bablok regression analysis demonstrated the good agreement between each analyzer for PT-INR (y = -0.081 + 1.07x and r = 0.962) and for aPTT (y = 5.498 + 0.86x and r = 0.944). Both analyzers exhibited less than 9.9% bias in the accuracy study. The reference range verification analyses revealed that the manufacturer ranges were acceptable. The verification studies of the CS-2500 coagulation system were acceptable; however, in the comparison studies, there were small differences between STA-Compact. Overall, we propose that these differences could be eliminated in future standardization studies performed to use the same reference ranges for all systems.

Tying up Loose Ends of Microplastic Pollution in the Arctic: Distribution from the Sea Surface through the Water Column to Deep-Sea Sediments at the HAUSGARTEN Observatory.

Recent studies have shown that despite its remoteness, the Arctic region harbors some of the highest microplastic (MP) concentrations worldwide. Here, we present the results of a sampling campaign to assess the vertical distribution of MP particles (>11 µm) at five stations of the HAUSGARTEN observatory. Water column samples were taken with large volume pumps by filtering 218-561 L of seawater at two to four depth strata (near-surface, ∼300 m, ∼1000 m, and above seafloor), and sediment samples were taken with a multiple corer. MP concentrations in the water column ranged between 0 and 1287 N m-3 and in the sediment from 239 to 13 331 N kg-1. Fourier transform infrared spectroscopy (FTIR) imaging with automated data analysis showed that polyamide (39%) and ethylene-propylene-diene rubber (23%) were the most abundant polymers within the water samples and polyethylene-chlorinated (31%) in sediments. MPs ≤ 25 µm accounted for more than half of the synthetic particles in every sample. The largest MP particle recorded was in the 200 µm size class. The concentrations of fibers were not reported, as fiber detection by FTIR imaging was not available at the time of analyses. Two- and three-dimensional simulations of particle transport trajectories suggest different pathways for certain polymer types. A positive correlation between MP size composition and particulate organic carbon indicates interactions with biological processes in the water column.

White and wonderful? Microplastics prevail in snow from the Alps to the Arctic.

Microplastics (MPs) are ubiquitous, and considerable quantities prevail even in the Arctic; however, there are large knowledge gaps regarding pathways to the North. To assess whether atmospheric transport plays a role, we analyzed snow samples from ice floes in Fram Strait. For comparison, we investigated snow samples from remote (Swiss Alps) and populated (Bremen, Bavaria) European sites. MPs were identified by Fourier transform infrared imaging in 20 of 21 samples. The MP concentration of Arctic snow was significantly lower (0 to 14.4 × 103 N liter-1) than European snow (0.19 × 103 to 154 × 103 N liter-1) but still substantial. Polymer composition varied strongly, but varnish, rubber, polyethylene, and polyamide dominated overall. Most particles were in the smallest size range indicating large numbers of particles below the detection limit of 11 µm. Our data highlight that atmospheric transport and deposition can be notable pathways for MPs meriting more research.

Plastic ingestion by juvenile polar cod (Boreogadus saida) in the Arctic Ocean.

One of the recently recognised stressors in Arctic ecosystems concerns plastic litter. In this study, juvenile polar cod (Boreogadus saida) were investigated for the presence of plastics in their stomachs. Polar cod is considered a key species in the Arctic ecosystem. The fish were collected both directly from underneath the sea ice in the Eurasian Basin and in open waters around Svalbard. We analysed the stomachs of 72 individuals under a stereo microscope. Two stomachs contained non-fibrous microplastic particles. According to µFTIR analysis, the particles consisted of epoxy resin and a mix of Kaolin with polymethylmethacrylate (PMMA). Fibrous objects were excluded from this analysis to avoid bias due to contamination with airborne micro-fibres. A systematic investigation of the risk for secondary micro-fibre contamination during analytical procedures showed that precautionary measures in all procedural steps are critical. Based on the two non-fibrous objects found in polar cod stomachs, our results show that ingestion of microplastic particles by this ecologically important fish species is possible. With increasing human activity, plastic ingestion may act as an increasing stressor on polar cod in combination with ocean warming and sea-ice decline in peripheral regions of the Arctic Ocean. To fully assess the significance of this stressor and its spatial and temporal variability, future studies must apply a rigorous approach to avoid secondary pollution.

Citizen scientists reveal: Marine litter pollutes Arctic beaches and affects wild life.

Recent data indicate accumulation areas of marine litter in Arctic waters and significant increases over time. Beaches on remote Arctic islands may be sinks for marine litter and reflect pollution levels of the surrounding waters particularly well. We provide the first quantitative data from surveys carried out by citizen scientists on six beaches of Svalbard. Litter quantities recorded by cruise tourists varied from 9-524gm-2 and were similar to those from densely populated areas. Plastics accounted for >80% of the overall litter, most of which originated from fisheries. Photographs provided by citizens show deleterious effects of beach litter on Arctic wildlife, which is already under strong pressure from global climate change. Our study highlights the potential of citizen scientists to provide scientifically valuable data on the pollution of sensitive remote ecosystems. The results stress once more that current legislative frameworks are insufficient to tackle the pollution of Arctic ecosystems.

High Quantities of Microplastic in Arctic Deep-Sea Sediments from the HAUSGARTEN Observatory.

Although mounting evidence suggests the ubiquity of microplastic in aquatic ecosystems worldwide, our knowledge of its distribution in remote environments such as Polar Regions and the deep sea is scarce. Here, we analyzed nine sediment samples taken at the HAUSGARTEN observatory in the Arctic at 2340-5570 m depth. Density separation by MicroPlastic Sediment Separator and treatment with Fenton's reagent enabled analysis via Attenuated Total Reflection FTIR and µFTIR spectroscopy. Our analyses indicate the wide spread of high numbers of microplastics (42-6595 microplastics kg-1). The northernmost stations harbored the highest quantities, indicating sea ice as a possible transport vehicle. A positive correlation between microplastic abundance and chlorophyll a content suggests vertical export via incorporation in sinking (ice-) algal aggregates. Overall, 18 different polymers were detected. Chlorinated polyethylene accounted for the largest proportion (38%), followed by polyamide (22%) and polypropylene (16%). Almost 80% of the microplastics were ≤25 µm. The microplastic quantities are among the highest recorded from benthic sediments. This corroborates the deep sea as a major sink for microplastics and the presence of accumulation areas in this remote part of the world, fed by plastics transported to the North via the Thermohaline Circulation.

Cauterization for epistaxis in hereditary hemorrhagic telangiectasia.

UNLABELLED: PROBLEM/OBJECTIVES: Epistaxis is the most common manifestation of hereditary hemorrhagic telangiectasia (HHT); it is present in >90% of HHT patients > 45 years old. Depending on severity, treatment consists of managing bleeding via medical and surgical methods. The aim of our study was to evaluate the efficacy and safety of endonasal surgical arterial cauterization to treat chronic epistaxis in patients with HHT who are no longer responding to first-line therapies. METHODOLOGY: Five patients were included in our study. The day before surgery, all patients underwent devascularization embolization of the external carotid arterial branches involved in nasal bleeding. The primary efficacy endpoint of treatment was assessed by the Epistaxis Severity Score (ESS), which was systematically evaluated preoperatively in our department, as well as every 3 months postoperatively. Data were collected retrospectively from the medical records of patients. RESULTS: Endonasal surgical arterial cauterization was associated with a ≥ 50% reduction in the ESS up to 9 months postoperatively. In one of our patients, cerebrospinal fluid (CSF) leakage occurred intraoperatively during cauterization of the posterior ethmoid artery. Closure of the dural skull base defect was successfully performed intraoperatively. DISCUSSION: Although our results are preliminary and included few patients, they support a role for endonasal surgical arterial cauterization as a second-line treatment method for chronic epistaxis in patients with HHT.

[Not Available]. / Résultats du traitement radiochirurgical Gamma Knife des malformations artério-veineuses cérébrales.

Gamma Knife treatments of arteriovenous malformations (AVM) are performed for about 40 years. This article presents the results of 123 patients treated for a brain AVM at the Gamma Knife Center ULB-Hôpital Erasme. Radiosurgical treatment is proposed following multidisciplinary discussion of the best therapeutic strategy based on specific parameters of the AVM. Gamma Knife irradiation was achieved for an AVM residue after endovascular embolization for 84% of patients, after microsurgery for 7% of patients, or after previous radiosurgical irradiation for 6% of patients. The whole volume of the nidus was irradiated in a single session for all patients. A mean margin dose of 22.3 Gy was delivered to the nidus, which had a mean volume of 3.3 cc. The maximum dose ranged from 30 Gy to 50 Gy (mean 44.1 Gy). All patients were prospectively followed after treatment with serial angio-MR and/or conventional angiography. A retrospective analysis shows complete obliteration of the AVM for 109 patients (89%) after 6 to 52 months (mean 32 months). For 14 patients the nidus was only partially obliterated from the radiosurgical procedure; for 9 patients a second irradiation was performed with subsequent complete occlusion of the AVM in all cases. So, 118 of 123 patients (96%) irradiated by Gamma Knife in 1 or 2 sessions were cured. Four patients bled after irradiation and before complete occlusion of the AVM, with neurological deficit for 2 patients. Transient neurological symptoms develop after treatment for 12 patients (10%), associated with postradic edema treated with corticoids. Permanent neurological worsening occurred in 5 patients (4%). Gamma Knife treatment of cerebral arteriovenous malformations is a highly efficient and low-risk therapy when used by a multidisciplinary team.

WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Long-Term Results in a European Series.

BACKGROUND AND PURPOSE: Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms. The stability of aneurysm occlusion after this treatment was evaluated in the short and midterm, but not in the long term. This retrospective multicenter European study is the continuation of an already published series dealing with short- and midterm anatomic results and analyzes long-term data in patients treated with the WEB-DL. MATERIALS AND METHODS: Twelve European neurointerventional centers initially participated in the study. In addition to data collected for the initial publication, images obtained at long-term follow-up were collected and independently analyzed by the same experienced interventional neuroradiologist. RESULTS: Of the initial 45 patients, 26 (20 women and 6 men; 35-73 years of age; mean, 55.2 ± 10.6 years; median, 55.5 years) with 26 aneurysms treated with the WEB-DL device had long-term follow-up (median, 27.4 months). Three of 26 patients (11.5%) were retreated between short- and midterm follow-up, and none, between mid- and long-term follow-up. Long-term aneurysm occlusion in the 19 patients treated with the WEB only and not retreated during follow-up was complete occlusion in 13/19 patients (68.4%), including aneurysms with opacification of the proximal recess in 9/19 patients (47.4%), neck remnant in 3/19 patients (15.8%), and aneurysm remnant in 3/19 patients (15.8%). In all patients (100.0%), aneurysm occlusion was stable between midterm and long-term follow-up. CONCLUSIONS: The results suggest that WEB treatment of wide-neck bifurcation aneurysms offers long-term stable occlusion.

Silk flow-diverter stent for the treatment of intracranial aneurysms: a series of 58 patients with emphasis on long-term results.

BACKGROUND AND PURPOSE: The Silk flow-diverter stent is increasingly used to treat complex intracranial aneurysms including wide-neck, fusiform aneurysms. Sparse data are available concerning long-term results of this technique. We report our 5-year experience with Silk stent treatment of intracranial aneurysms. MATERIALS AND METHODS: A retrospective review of our prospectively maintained database identified all patients treated by the Silk stent in 2 institutions. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS: Between July 2009 and May 2014, we identified 58 patients with 70 intracranial aneurysms. Endovascular treatment was successful in 93% of patients with 32 treated with the first-generation Silk stent and 26 with the new Silk+ stent. Mean follow-up in 47 patients was 22 months. Despite an 11% delayed complication rate, overall permanent neurologic morbidity was 5.5%. All complications were seen with the first-generation Silk stent. There was no procedure-related mortality. Long-term anatomic results showed 73% with complete occlusion, 16% with neck remnants, and 11% with incomplete occlusion. No recanalization or retreatment was performed. The midterm intrastent stenosis rate was 57%, of which 60% improved or disappeared, 28% were stable, and 12% led to vessel occlusion. Seventy-four percent of stenosis and all vessel occlusions occurred with the first-generation Silk stent. CONCLUSIONS: Endovascular treatment of complex intracranial aneurysms with the Silk stent is an effective therapeutic option. Despite a high rate of delayed complications with the first-generation stents, the current Silk+ stent appears safer. This treatment achieves a high rate of adequate and stable occlusion at long-term follow-up.

WEB-DL endovascular treatment of wide-neck bifurcation aneurysms: short- and midterm results in a European study.

BACKGROUND AND PURPOSE: Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data in patients treated with WEB-DL. MATERIALS AND METHODS: Twelve European neurointerventional centers participated in the study. Clinical data and pre- and postoperative short- and midterm images were collected. An experienced interventional neuroradiologist independently analyzed the images. Aneurysm occlusion was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant. RESULTS: Forty-five patients (34 women and 11 men) 35-74 years of age (mean, 56.3 ± 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations were the middle cerebral artery in 26 patients, the posterior circulation in 13 patients, the anterior communicating artery in 5 patients, and the internal carotid artery terminus in 1 patient. Forty-two aneurysms were unruptured. Good clinical outcome (mRS < 2) was observed in 93.3% of patients at the last follow-up. Adequate occlusion (complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median, 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median, 13 months). Worsening of the aneurysm occlusion was observed in 2/28 patients (7.1%) at midterm follow-up. CONCLUSIONS: The results suggest that the WEB endovascular treatment of wide-neck bifurcation aneurysms offers stable occlusion in a class of aneurysms that are historically unstable. Additionally, our data show that opacification of the WEB recess can be delineated from true neck or aneurysm remnants.

WEB device for endovascular treatment of wide-neck bifurcation aneurysms.

BACKGROUND AND PURPOSE: The WEB is an intrasaccular flow disrupter dedicated to EVT of IA. We report our initial experience in a series of patients treated with this device. MATERIALS AND METHODS: This prospective study was approved by the authors' ethical committees. Nineteen patients with 20 unruptured wide-neck bifurcation IAs were treated by WEB placement. Technical issues, immediate posttreatment angiographic findings, and clinical and imaging follow-up at 3, 6, and 12 months were assessed. RESULTS: Failure of WEB placement occurred in 1 case because of unavailability of a suitably sized device. Embolization was successful in 18 patients with 19 IAs, and it required additional stent placement and/or coiling in 3 cases at the acute phase and in 1 case at follow-up. Two patients experienced a symptomatic complication, and 16 patients had normal neurologic examination findings at discharge. Immediate anatomic outcome showed 1 complete occlusion, 13 near-complete occlusions, and 5 incomplete occlusions. At follow-up, 17 patients had normal neurologic examination findings and 1 retained a hemiparesis. Angiographic controls were obtained in all patients (mean, 6 months), and they showed stable or improved results in all except 4 cases, including 2 complete occlusions, 15 near-complete occlusions, and 2 incomplete occlusions. CONCLUSIONS: In this initial series of patients, EVT of wide-neck bifurcation IAa with the WEB was feasible. Further studies are needed to evaluate the indications, safety, and efficacy of this new technique.

The role of interventional neuroradiology in the management of skull base tumours and related surgical complications.

The management of hypervascular skull base tumours is complex and requires a multidisciplinary approach. Skull base surgery may be challenging because of the risk of serious intra-operative bleeding and of potential injuries to lower cranial nerves and/or large cervical vessels. Over the last four decades, advances in neuro-interventional procedures have produced a range of adjunctive endovascular techniques in addition to conventional surgery. Digital subtraction angiography (DSA) allows for a better understanding of tumour vascularisation and its relationship with Surrounding vessels. Tumoural devascularisation and the occlusion of feeding arteries is a useful adjunct to surgery because it allows for the reduction of intra-operative blood loss and induces ischaemic necrosis of the tumour. Finally, surgery-related iatrogenic vascular lesions may be successfully treated with endovascular techniques. Nevertheless, endovascular procedures in the head and neck region are associated with infrequent but potentially serious complications. An extensive and comprehensive knowledge of head and neck vascular anatomy is therefore necessary. This article provides a review of the indications for, and results of, diagnostic, pre-operative and therapeutic endovascular procedures for the management of skull base tumours and related surgical complications.