Retention of different all ceramic endocrown materials cemented with two different adhesive techniques.

OBJECTIVE: The purpose of this in vitro study was to evaluate the influence of two adhesive techniques on the retentive force of four all ceramic endocrowns. MATERIALS AND METHODS: Forty maxillary first molars of approximately similar size and shape were collected. The teeth were all decoronated 2 mm above the level of proximal cement-enamel junction (CEJ) and were all endodontically treated. The teeth were then randomly divided equally into four groups (10 each) according to all ceramic material used, as follows: Group I (VE) - Ten prepared molars were restored with hybrid ceramic (Vita Enamic); Group II (LU) - Ten prepared molars were restored with resin Nano-ceramic (Lava Ultimate). Group III (CD) - Ten prepared molars were restored with zirconia-reinforced lithium di-silicate ceramic material (Celtra Duo); Group IV (LZ) - Ten prepared molars were restored with zirconia ceramic (Lava Zirconia). Each group was then subdivided into two equal subgroups (n=5) according to the type of cement (adhesive technique) used for cementation. Subgroup A (RX ARC): the endocrowns were cemented with a total-etch adhesive resin cement (RelyX ARC). Subgroup B (RXU): the endocrowns were cemented with self-adhesive resin luting cement (RelyX UniCem). The restorations were designed with an outer cylindrical handle located on buccal and palatal surfaces to provide a mean for the removal of the endocrowns during the pull-out testing. The cemented endocrowns were thermocycled and then removed along the path of insertion using a universal testing machine at 0.5 mm/min. The retentive force was recorded, and the stress of dislodgement was calculated using the surface area of each preparation. RESULTS: The highest mean dislodgement stresses were 64.3 MPa for Group I (VE), whereas there was no statistically significant difference between Group I, II and III and LZ showed the lowest values with significant difference between the other three groups. Regarding the type of cement, there was a statistically significant difference between RelyX ARC (mean=60.09 MPa) and RelyX Unicem (mean=49.73 MPa). CONCLUSIONS: Retention of Vita Enamic, Lava Ultimate, and Celtra Duo are significantly higher than Lava Zirconia.

Marginal gap distance and cyclic fatigue loading for different all-ceramic endocrowns.

OBJECTIVE: The aim of the study was to evaluate the effect of the fabrication techniques of two types of glass ceramics on the marginal gap distance and the fracture resistance of endocrown restorations after cyclic loading. MATERIALS AND METHODS: Forty extracted mandibular first molars were root canal treated. Decoronation was done for all the endodontically treated teeth 2 mm above the cemento-enamel junction. The teeth were individually fixed vertically into epoxy resin mounting cylinders. All teeth were prepared to receive endocrown restorations. The prepared teeth were randomly divided into four equal groups (n=10) according to the all-ceramic materials and technique used for endocrown construction as follows: Group I (n=10): Pressable lithium disilicate glass ceramics (IPS e-max Press), Group II (n=10): Pressable zirconia-reinforced lithium disilicate glass ceramics (Celtra Press), Group III (n=10): Machinable lithium disilicate glass ceramics (IPS e-max CAD), Group IV (n=10): Machinable zirconia-reinforced lithium disilicate glass ceramics (Celtra Duo). The endocrowns were cemented using dual-cure resin cement. All endocrowns were subjected to fatigue loading. The cycles were repeated 120,000 times to clinically simulate one year chewing condition. Marginal gap distance of all endocrowns was measured directly using a digital microscope with x100 magnification. The load required to failure was recorded in Newton. Data were collected, tabulated, and statistically analyzed. RESULTS: Fracture resistance testing of all-ceramic crowns revealed a statistically significant difference between all different ceramic materials used in this study (p-value <0.001). On the other hand, there was a statistically significant difference between all the four ceramic crowns for the marginal gap distance either before or after fatigue cyclic loading. CONCLUSIONS: After considering the limitation of the current study, the following conclusions were given: endocrowns are considered one of the promising minimally invasive restorations for root canal treated molars. CAD/CAM technology revealed better results than heat press technology regarding the fracture resistance of glass ceramics. Heat Press technology revealed better results than CAD/CAM technology regarding the marginal accuracy of glass ceramics.

Clinical characteristics and liver profiles of Dubin-Johnson syndrome in neonates: Multicenter retrospective study.

OBJECTIVES: Dubin-Johnson syndrome (DJS) is a rare benign autosomal recessive disorder characterized by cholestasis in neonates. The aim of the present study was to describe the clinical characteristics, hepatic profiles, histopathology, gene mutations, and treatment outcomes of neonatal DJS. MATERIAL AND METHODS: A multicenter retrospective study was undertaken with patients who had DJS. The authors identified DJS in neonates and reviewed medical records for details. The diagnosis of DJS was based on the presence of unexplained prolonged conjugated hyperbilirubinemia and presence of a mutation in the ATP Binding Cassette Subfamily C Member 2 (ABCC2) gene detected in genomic DNA extracted from circulating blood cells. RESULTS: Eleven children with DJS were identified in the study. The study population comprised eight males and three females. The median age at presentation was 21 days. Dysmorphic features were not recorded in any of the patients. Cholestasis, high serum bile acids, and normal transaminase levels were found in all patients (100%). Serum alkaline phosphatase and gamma glutamyl transferase were elevated in four patients (36%). Hypoalbuminemia and coagulopathy were not noted in these patients. Consanguinity was present in nine patients (82%). All patients had normal abdominal ultrasound findings. Genetic molecular testing showed that 82% of the patients reported a pathogenic variant of the ABCC2 gene defect with the same variant c.2273G>T (Gly 758 val) chromosome 10. All patients were alive without liver transplantation. CONCLUSIONS: This is the largest study worldwide describing that neonatal DJS is a benign cholestatic disease with favorable outcomes. Low-grade direct hyperbilirubinemia, normal transaminases, and elevated serum bile acids are the main characteristic findings of DJS.

Association of pre- and early post-transplant serum amino acids and metabolites of amino acids and liver transplant outcome.

The aim of the present study was to investigate association of serum amino (AA) acids and metabolites of AAs with post-transplant outcome in liver transplant recipients. Eighty-nine patients with end-stage liver diseases and available pre- and early post-transplant serum were characterised as patients with (GI) and without one-year mortality (GII) and patients with and without early graft dysfunction (EAD). A panel of pre- and early post-transplant serum levels of AAs and early and metabolites of tryptophan were measured using tandem mass spectrometry. Patient groups had significantly higher pre-transplant serum levels of phenylalanine, tryptophan, and tryptophan metabolites than healthy controls (for all p<0.001). Pre-transplant serum levels of all these parameters were significantly higher in GI than in GII (for all p<0.001). GI had a higher MELD score and re-transplantation number than GII (p≤0.005 for both investigations). Serum bilirubin on day 5 and serum phenylalanine on day 10 post-transplant were associated parameters of mortality, whereas day 1post-transplant phenylalanine and kynurenine and female gender were associated parameters of EAD. Our results indicate that pre- and early post-transplant levels of phenylalanine, tryptophan and metabolites of tryptophan are increased in patients and are associated with EAD and one-year mortality in liver transplant recipients.

The role of interleukin-22 in pityriasis rosea.

BACKGROUND: Pityriasis rosea (PR) is an exanthematous disease related to reactivation of human herpes virus (HHV) types 6 and 7. The pathogenesis and cytokine profile of PR are still poorly understood.There is a large amount of evidence indicating a viral aetiology for PR. AIM: To measure the serum level of interleukin (IL)-22, a cytokine expressed by T helper (Th)17 cells in patients with PR to explore the possible association of IL-22 with the pathogenesis of the disease. METHODS: This case-control study enrolled 25 patients with PR (mean ± SD age 20 ± 12 years) and a control group of 25 apparently healthy individuals (mean age 18 ± 12.1 years). Blood samples were collected from both patients and controls to measure serum IL-22. Scoring of PR was performed using the Pityriasis Rosea Severity Score (PRSS). RESULTS: There was a statistically significant difference in IL-22 serum level between the patient and control groups. The IL-22 serum level increased with increase in disease severity (PRSS), extent and duration. CONCLUSION: Through its proinflammatory cytokines, IL-22 plays a role in the inflammatory process of PR.

Treatment-associated Fatigue in Cancer Patients Treated with Immune Checkpoint Inhibitors; a Systematic Review and Meta-analysis.

AIMS: Fatigue is one of the most prominent side-effects of immune checkpoint inhibition. Therefore, we assessed the risk of fatigue associated with inhibitors of the immune checkpoints. MATERIALS AND METHODS: We examined data from the Medline and Google Scholar databases. We also examined original studies and review articles for cross-references. Eligible studies included randomised phase II and phase III trials of patients with cancer treated with ipilimumab, nivolumab, pembrolizumab and tremelimumab. The authors extracted relevant information on participants(') characteristics, all-grade and high-grade fatigue and information on the methodology of the studies. RESULTS: In total, 17 trials were considered eligible for the meta-analysis. The odds ratio for all-grade fatigue for CTLA-4 inhibitors was 1.23 (95% confidence interval 1.07, 1.41; P = 0.003) and for high-grade fatigue was 1.72 (95% confidence interval 1.26, 2.33; P = 0.0005). Moreover, the odds ratio for all-grade fatigue for PD-1 inhibitors was 0.72 (95% confidence interval 0.62, 0.84; P < 0.0001) and for high-grade fatigue was 0.36 (95% confidence interval 0.23, 0.56; P < 0.00001). CONCLUSIONS: The analysis of data showed that CTLA-4 inhibitors seem to be associated with a higher risk of all- and high-grade fatigue compared with control regimens, whereas PD-1 inhibitors seem to be associated with a lower risk of all- and high-grade fatigue compared with control regimens.

Giant haemangioma of the liver with haemangiodudenal fistula: the first reported case in literature.

Giant liver haemangiomas are usually asymptomatic with normal liver function, which makes the course long and uneventful. The most commonly reported complications of giant haemangiomas are rupture with intraperitoneal haemorrhage that is either traumatic or non-traumatic, consumption coagulopathy, Budd-Chiari syndrome and congestive heart failure. We describe the first reported complications of a giant liver haemangioma as a fistula between the haemangioma and the gastrointestinal tract.

Adjuvant chemotherapy after reduced craniospinal irradiation dose in children with average-risk medulloblastoma: a 5-year follow-up study.

PURPOSE: This study was undertaken to determine the effect of adjuvant chemotherapy combined with reduced-dose craniospinal irradiation (CSI) on survival and neurocognitive sequelae of radiotherapy (RT) in patients with average- risk medulloblastoma above the age of 3 years. METHODS: Thirty-three children between 3 and 10 years of age with average-risk medulloblastoma were treated with postoperative reduced-dose CSI (24.0 Gy) and 30.6 Gy of local RT (total of 54.6 Gy) and then with adjuvant chemotherapy consisting of cisplatin, vincristine, and cyclophosphamide every 4 weeks for 8 cycles. RESULTS: At 5 years, event-free survival (EFS) was 79%, while overall survival (OS) was 85%. Sites of relapse were local in 3%, neuraxis in 9% and both local and neuraxis in 9% of the patients. Chemotherapy was well tolerated. Hematopoietic toxicity was the most predominant side effect followed by vomiting and ototoxicity. No grade III or IV nephrotoxicity or neurotoxicity and no treatment-related deaths were encountered. Insignificant decline of intelligence quotient (IQ) was reported in 28.6% of the patients. CONCLUSION: The preliminary results of adjuvant chemotherapy after reduced-dose CSI in average-risk medulloblastoma patients are encouraging and effective, and can be applied safely with acceptable toxicity.

Insulin-like growth factor-1 in psoriatic plaques treated with PUVA and methotrexate.

BACKGROUND: The pathogenesis of psoriasis is thought to depend on the activation of immune cells and their secreted cytokines, chemokines and growth factors like IGF-1 which may contribute to the epidermal hyperplasia of psoriasis. Treatment of psoriasis with PUVA and methotrexate are associated with clinical improvement and decrease in epidermal hyperplasia. OBJECTIVE: To examine the effects of PUVA and methotrexate therapy on IGF-1 expression in psoriatic plaques and whether this change correlates with clinical response. METHODS: For 24 psoriatic patients, the PASI score and levels of lesional IGF-1 and its mRNA were determined by RT-PCR before and after treatment with either methotrexate or PUVA. Skin biopsies from 12 healthy volunteers served as control for IGF-1 levels in normal skin. RESULTS: Lesional skin of psoriatic patients showed a statistically significant elevation in IGF-1 and its mRNA levels in comparison to control (P = 0.0001). Both methotrexate and PUVA treatment were associated with a significant decrease in both PASI scores and lesional IGF-1 after 10 month treatment. CONCLUSION: Both methotrexate and PUVA therapy for psoriasis are associated with a decrease in PASI score and IGF-1. The IGF-1 down-regulation may possibly be a consequence of the decrease in cytokines and inflammatory cellular infiltrate that occur following treatment with either modalities or due to their effect on local fibroblast activity and proliferation.

The relationship between sonographic fetal thymus size and the components of the systemic fetal inflammatory response syndrome in women with preterm prelabour rupture of membranes.

OBJECTIVE: To assess the relation between sonographic fetal thymus size and the components of fetal inflammatory response syndrome (FIRS) in women with preterm prelabour rupture of membranes (PPROM). DESIGN: Prospective cohort study. SETTING: University hospital from January through October 2006. POPULATION: Fifty-six women with PPROM. METHODS: In these women, fetal thymus perimeter was measured sonographically. At birth, cord venous plasma interleukin-6 (IL-6) level estimation and histopathological examination of the placentas and umbilical cords were performed. MAIN OUTCOME MEASURES: Small thymus size (< 5th percentile for gestational age) and its association with FIRS. RESULTS: From the 56 women with PPROM, 54% had chorioamnionitis (CA), 23% had funisitis. IL-6 level was > 11 pg/ml in 52% of women and > 18 pg/ml in 41%. A small thymus was more associated with male fetuses, shorter preterm prelabour rupture of membranes delivery interval, higher IL-6 level, higher frequency of funisitis and CA. When data were regressed for confounding, only IL-6 level and funisitis remained significant independent factors that influence the thymus size. In the subset of women (n = 19) who delivered within 1 week of first measurements, a small thymus had sensitivity and positive predictive value of 93%, specificity and negative predictive value of 75% and accuracy of 89% in the identification of FIRS (IL-6 >18 pg/ml and/or funisitis). CONCLUSIONS: An association exists between fetal thymic involution and components of FIRS in women with PPROM. Small fetal thymus size may be considered a reliable sonographic marker of fetal involvement in the inflammatory response.

Process analytical technology: non-destructive assessment of anastrozole entrapment within PLGA microparticles by near infrared spectroscopy and chemical imaging.

The objective of this study was to evaluate near-infrared (NIR) spectroscopy and imaging as approaches to assess anastrozole entrapment within PLGA microparticles. By varying the polymer concentration, three batches containing the same amount of the drug were prepared. The spectral features that allow NIR drug quantitation were evaluated and compared with a best fit line algorithm. Actual entrapment efficiencies (EEF) determined via a destructive method were used for construction of calibration models using partial least square regression (PLS) or the algorithm. On the other hand, a chemical imaging system based on array detector technology was used to rapidly collect high contrast NIR images of the formulated microparticles. A quantitative measure of anastrozole entrapped was determined by calculating the percentage standard deviation of the distribution of pixel intensities in the PLS score images and histograms. Concerning conventional NIR analysis, both methods were equivalent for the prediction of EEF over the range of polymer levels studied. Correlation coefficients of more than 0.992 were obtained for either the calibration or prediction of EEF by the two methods; 0.392% and 0.374% were the standard errors of calibration and prediction (SEC and SEP) obtained for the prediction of EEF using the fit line, respectively, whereas the prediction of the EEF by the partial least square regression showed a SEC of 0.195% and SEP of 0.179%. As a result, the spectral best fit algorithm method compared favourably to the multivariate PLS method, but was easier to develop. In contrast, NIR spectral imaging was capable of clearly differentiating the three batches, both qualitatively and quantitatively. The percentage standard deviation increased progressively by increasing the ratio of drug-to-polymer concentrations. In conclusion, both NIR approaches were capable of accurate assessment of drug entrapment within microparticles. In addition, the NIR spectral imaging system provides a rapid approach for acquiring spatial and spectral information on microparticles.

Quality by design: characterization of self-nano-emulsified drug delivery systems (SNEDDs) using ultrasonic resonator technology.

In the present work, a novel application of ultrasonic measurements is detailed to characterize nano-emulsion formulations as a part of the overall Quality by Design (QbD) goal. Ultrasonic resonator technology (URT) was utilized to measure sound velocity and absorption of self-nanoemulsified drug delivery systems (SNEDDs) consisting of various ratios of oil:surfactant:co-surfactant. A QbD concept was used to create different SNEDDs formulations utilizing sweet orange oil (oil), Emulphor-620 (surfactant), and Capmul (co-surfactant) by dissolving Cyclosporine A in oil. The mixture was emulsified in water and ultrasonic measurements were carried out in an ultrasonic resonator system isothermally for a period of about 15-20min. Compressibility of the individual components in the droplets, hydration of the droplets and the influence of the composition on droplet stability were studied by systematic ultrasonic measurements at a single resonator frequency. The adiabetic compressibilities for the oil, aqueous and interfacial components were 68, 44.6, and 53 [10(-11)Pa(-1)], respectively as calculated using Urick's equation. Also the ultrasonic absorption correlated droplet size of nano-emulsions linearly with R(2) of 0.84 indicating this can be used as an additional technique to measure the droplet size of nano-emulsions. Correlation of ultrasonic data with formulation components indicated that the ultrasonic velocity correlated negatively with increasing oil amount in the formulation as well as surfactant-to-cosurfactant ratios where as droplet diameter correlated positively with these formulation factors. It can be envisioned from the results that the compressibility of the media increases with the addition of the oily component and thus reducing the sound velocity. Thus URT enabled direct and convenient analysis of the physical properties as well as influence of formulation factors of nano-emulsions which is an important indication of stability of these nano-emulsions.

Selective Nerve Root Stimulation (SNRS) in the Treatment of End-Stage, Diabetic, Peripheral Neuropathy: A Case Report.

Spinal cord stimulation (SCS) for the treatment of painful peripheral neuropathy (PN) has been met with mixed results. It has been suggested that early-stage symptoms that are sympathetically maintained (SMP) are more likely to respond to SCS, while progressive sympathetically independent symptoms (SIP) will not. Peripheral nerve stimulation (PNS), however, has successfully treated certain SIP presentations. With the advent of new selective nerve root stimulation (SNRS) strategies, the possibility of utilizing epidural, peripheral neurostimulation was investigated in a patient with endstage, diabetic, "dying back" peripheral SIP.

Mycotic aneurysm of the abdominal aorta: CT finding in three patients.

We present three cases of mycotic aneurysms of the abdominal aorta that were initially diagnosed with computed tomography (CT). The accuracy of CT as the first imaging technique in the diagnosis of this condition is reviewed in light of our results and those reported in the literature.

Oestrogen and progesterone receptor assessment in core biopsy specimens of breast carcinoma.

AIMS: To assess the suitability of core biopsy specimens for the immunohistological assessment of oestrogen and progesterone receptors in breast carcinoma. METHODS: Thirty consecutive cases of clinically palpable breast carcinoma, from which both core and excision biopsy specimens were available, were examined. Routinely processed paraffin wax sections were stained using the specific monoclonal antibodies 1D5 (Dako) for oestrogen receptor and NCL-PGR (Novocastra) for progesterone receptor, after an antigen retrieval step using a pressure cooker. Staining results were assessed using the H score system with the results being expressed as negative, weakly positive, moderately positive or strongly positive. RESULTS: Twenty six biopsy specimens contained enough tumour tissue for assessment. Absolute agreement between scoring categories was seen in 19 (73%) cases for oestrogen receptors. However, when all positive categories were added together, agreement between core and excision biopsy specimens increased to 93% (24 cases). Disagreement was seen only in two cases which stained positive in the core biopsy specimens and negative in the excision biopsy specimens. For progesterone receptors, the absolute agreement between all scoring categories was seen only in 11 (42%) cases. When all positive categories were considered together, agreement increased to 69% (18 cases). Five cases were progesterone receptor positive in core but not in excisional biopsy specimens, while three cases were negative in core but positive in excisional biopsy specimens. CONCLUSIONS: The results suggest that core biopsy specimens can be reliably used for oestrogen receptor assessment, but are less reliable for progesterone receptor assessment, probably because of a greater heterogeneity of progesterone receptor staining.

Comparison of in-phase and opposed-phase GRE and conventional SE MR pulse sequences in T1-weighted imaging of liver lesions.

PURPOSE: Our goal was to compare in-phase (IP) and opposed-phase (OP) GRE and conventional SE sequences in T1-weighted (T1-W) imaging of the liver and to evaluate chemical shift GRE imaging in characterizing liver/lesions for fat content. METHOD: IP and OP T1-W GRE with fast low angle shot (FLASH) technique and T1-W SE sequences were compared in 162 patients at 1.0 T. Chemical shift GRE imaging was used to characterize lesions with fat content. Two hundred sixteen lesions were analyzed in three groups of liver: (a) "normal" liver (n = 74 with 110 lesions); (b) cirrhotic liver (n = 76 with 85 lesions); and (c) fatty liver (n = 12 with 21 lesions). Liver/lesion contrast and liver/lesion contrast-to-noise ratio were assessed for lesion detectability. The percentage of signal intensity variation (SIV) between IP and OP images was used to characterize lesions for fat content. RESULTS: The OP GRE sequence had significantly higher contrast for normal and cirrhotic livers (p < 0.001), and the IP GRE sequence had significantly higher contrast and contrast-to-noise ratio for fatty liver (p < 0.001). There were no significant differences between OP, IP, and T1-W SE imaging in cirrhotic cases for contrast-to-noise ratio (p < 0.28). Chemical shift imaging detected fat in 21 lesions (9.7%, mean SIV, 191.1%) (sensitivity and specificity 100% when compared with fine needle aspiration cytology). CONCLUSION: OP GRE sequences could replace conventional SE sequences in T1-W imaging in nonfatty livers, whereas in fatty livers, T1-W SE sequences could be obviated, but both OP and IP sequences are necessary. Chemical shift imaging (OP and IP) can be used to accurately characterize lesions for fat content.

Fatty metamorphosis of hepatocellular carcinoma: detection with chemical shift gradient-echo MR imaging.

PURPOSE: To assess the value of chemical shift gradient-echo (GRE) magnetic resonance (MR) imaging with the fast low-angle shot (FLASH) technique to detect fatty metamorphosis in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Sixty-three cirrhotic patients with 69 HCCs underwent MR imaging at 1.0 T with chemical shift GRE technique. Both opposed-phase and in-phase FLASH imaging with breath holding was performed, and the percentage variation in signal intensity of the nodules between the two images was calculated. RESULTS: Chemical shift GRE imaging depicted fat in 10 HCCs (14%). In these cases, the percentage variation in signal intensity increased notably and was 88.6%-369.3% (mean, 174.7%), which indicated fatty content (sensitivity, 100%; specificity, 100% when compared with fine-needle aspiration cytology). In the remaining 59 nodules, the percentage of signal intensity variation ranged from 12.7% to -19.1% (mean, -4.0%). CONCLUSION: Chemical shift GRE MR imaging can be used to detect fatty metamorphosis in HCC.

Hepatic angiomyolipoma: value of proton (fat/water) chemical shift fast low angle shot (FLASH) MR imaging technique in detecting fatty tissue content.

A case of angiomyolipoma of the liver in a 43-yr-old woman is reported. Findings on ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging techniques are presented and the usefulness of proton (fat/water) chemical shift FLASH imaging to confirm the presence of intratumoral fat is pointed out.