Analysis of current perioperative management with Haemate® P/Humate P® in von Willebrand disease: Identifying the need for personalized treatment.

INTRODUCTION: Patients with Von Willebrand disease (VWD) are regularly treated with VWF-containing concentrates in case of acute bleeding, trauma and dental or surgical procedures. AIM: In this multicentre retrospective study, current perioperative management with a von Willebrand factor (VWF)/Factor VIII (FVIII) concentrate (Haemate® P) in patients with VWD was evaluated. PATIENTS/METHODS: Patients with VWD undergoing minor or major surgery between 2000 and 2015, requiring treatment with a VWF/FVIII concentrate (Haemate® P), were included. Achieved VWF activity (VWF:Act) and FVIII during FVIII-based treatment regimens were compared to predefined target levels in national guidelines. RESULTS: In total, 103 patients with VWD (148 surgeries) were included: 54 type 1 (73 surgeries), 43 type 2 (67 surgeries) and 6 type 3 (8 surgeries). Overall, treatment resulted in high VWF:Act and FVIII levels, defined as ≥0.20 IU/mL above predefined levels. In patients with type 1 VWD, respectively, 65% and 91% of trough VWF:Act and FVIII levels were higher than target levels. In patients with type 2 and type 3 VWD, respectively, 53% and 57% of trough VWF:Act and 72% and 73% of trough FVIII levels were higher than target level. Furthermore, FVIII accumulation over time was observed, while VWF:Act showed a declining trend, leading to significantly higher levels of FVIII than VWF:Act. CONCLUSION: High VWF:Act and accumulation of FVIII were observed after perioperative FVIII-based replacement therapy in patients with VWD, both underlining the necessity of personalization of dosing regimens to optimize perioperative treatment.

Adhesive Cementation Promotes Higher Fatigue Resistance to Zirconia Crowns.

OBJECTIVE: The aim of this study was to investigate the influence of the cementation strategy on the fatigue resistance of zirconia crowns. The null hypothesis was that the cementation strategy would not affect the fatigue resistance of the crowns. METHODS AND MATERIALS: Seventy-five simplified molar tooth crown preparations were machined in glass fiber-filled epoxy resin. Zirconia crowns were designed (thickness=0.7 mm), milled by computer-aided design/computer-aided manufacturing, and sintered, as recommended. Crowns were cemented onto the resin preparations using five cementation strategies (n=15): ZP, luting with zinc phosphate cement; PN, luting with Panavia F resin cement; AL, air particle abrasion with alumina particles (125 µm) as the crown inner surface pretreatment + Panavia F; CJ, tribochemical silica coating as crown inner surface pretreatment + Panavia F; and GL, application of a thin layer of porcelain glaze followed by etching with hydrofluoric acid and silanization as crown inner surface pretreatment + Panavia F. Resin cement was activated for 30 seconds for each surface. Specimens were tested until fracture in a stepwise stress fatigue test (10,000 cycles in each step, 600 to 1400 N, frequency of 1.4 Hz). The mode of failure was analyzed by stereomicroscopy and scanning electron microscopy. Data were analyzed by Kaplan-Meier and Mantel-Cox (log rank) tests and a pairwise comparison (p<0.05) and by Weibull analysis. RESULTS: The CJ group had the highest load mean value for failure (1200 N), followed by the PN (1026 N), AL (1026 N), and GL (1013 N) groups, while the ZP group had the lowest mean value (706 N). Adhesively cemented groups (CJ, AL, PN, and GL) needed a higher number of cycles for failure than the group ZP did. The groups' Weibull moduli (CJ=5.9; AL=4.4; GL=3.9; PN=3.7; ZP=2.1) were different, considering the number of cycles for failure data. The predominant mode of failure was a fracture that initiated in the cement/zirconia layer. Finite element analysis showed the different stress distribution for the two models. CONCLUSION: Adhesive cementation of zirconia crowns improves fatigue resistance.

Gene expression phenotypes for lipid metabolism and intramuscular fat in skeletal muscle of cattle.

Gene expression phenotypes were evaluated for intramuscular fat (IMF) in bovine skeletal muscle as an alternative to traditional estimates of IMF%. Gene expression data from a time course of LM development in high- and low-marbling Bos taurus cattle crosses were compared to identify genes involved in intramuscular adipocyte lipid metabolism with developmentally similar gene expression profiles. Three sets of genes were identified: triacylglyceride (TAG) synthesis and storage, fatty acid (FA) synthesis, and PPARγ-related genes. In an independent analysis in the LM of 48 Bos indicus cattle, TAG and FA gene sets were enriched in the top 100 genes of which expression was most correlated with IMF% (P = 1.2 × 10(-24) and 3.5 × 10(-9), respectively). In general, genes encoding enzymes involved in the synthesis of FA and TAG in the intramuscular adipocytes were present in the top 100 genes. In B. indicus, effects of a steroid hormone growth promotant (HGP), 2 experimental sites [New South Wales (NSW) and Western Australia (WA)], and 3 tenderness genotypes on the expression levels of genes in the TAG gene set and the correlation of gene expression with IMF% were investigated. Although correlation between expression of 12 individual TAG genes and IMF% was observed in HGP-treated animals in both experimental sites (mean r = 0.43), correlation was not observed for untreated animals at the NSW site (mean r = -0.07, P < 3 × 10(-6)). However, TAG genes showed an average 1.6-fold (P < 0.0004) reduction in expression in the LM of HGP-treated cattle relative to untreated cattle, an effect consistent across both experimental sites. Cattle possessing the favored tenderness calpain 1 and 3 and calpastatin alleles exhibited a greater (P = 0.008) reduction in expression in NSW (1.8-fold reduction, P = 0.0002) compared with WA (1.2-fold reduction, P = 0.03). Tenderness genotype had no impact (P > 0.05) on the correlation of TAG genes with IMF%. In general, the interactions among genotype, treatment and location, and TAG gene set gene expression were consistent with the interactions among the same factors and IMF% detected using 255 animals, of which the 48 in this study were a subset. Thus, the TAG gene set constitutes a gene expression phenotype able to predict effects of different genotypes and treatments on IMF% using much smaller groups than current approaches, even in animals with very low IMF%.

Gene expression patterns during intramuscular fat development in cattle.

Deposition of intramuscular fat, or "marbling," in beef cattle contributes significantly to meat quality variables, including juiciness, flavor, and tenderness. The accumulation of intramuscular fat is largely influenced by the genetic background of cattle, as well as their age and nutrition. To identify genes that can be used as early biomarkers for the prediction of marbling capacity, we studied the muscle transcriptome of 2 cattle crossbreeds with contrasting intramuscular fat content. The transcriptomes of marbling LM tissue of heifers from Wagyu x Hereford (WxH; n = 6) and Piedmontese x Hereford (PxH; n = 7) crosses were profiled by using a combination of complementary DNA microarray and quantitative reverse transcription-PCR. Five biopsies of LM were taken from each animal at approximately 3, 7, 12, 20, and 25 mo from birth. Tissue was also collected from the LM of each animal at slaughter (approximately 30 mo). Microarray experiments, conducted on the first 3 biopsies of 2 animals from each crossbreed, identified 97 differentially expressed genes. The gene expression results indicated that the LM transcriptome of animals with high marbling potential (WxH) could be reliably distinguished from less marbled animals (PxH) when the animals were as young as 7 mo of age. At this early age, one cannot reliably determine meaningful differences in intramuscular fat deposition. We observed greater expression of a set of adipogenesis- and lipogenesis-related genes in the LM of young WxH animals compared with their PxH contemporaries. In contrast, genes highly expressed in PxH animals were associated with mitochondrial oxidative activity. Further quantitative reverse transcription-PCR experiments revealed that the messenger RNA of 6 of the lipogenesis-related genes also peaked at the age of 20 to 25 mo in WxH animals. The messenger RNA expression of ADIPOQ, SCD, and THRSP was highly correlated with intramuscular fat content of an individual in WxH animals. Our study provides clear evidence of early molecular changes associated with marbling and also identifies specific time frames when intramuscular fat development in cattle muscle can be detected by using gene expression. This information could be used by animal scientists to design optimal nutrition for high marbling potential. In addition, the genes found to be highly expressed during development of marbling could be used to develop genetic markers or biomarkers to assist with beef production strategies.

Influence of thermal expansion mismatch and fatigue loading on phase changes in porcelain veneered Y-TZP zirconia discs.

There is a rapidly growing interest for the use of Y-TZP zirconia as core material in veneered all-ceramic prostheses. It was hypothesized that a mismatch in coefficient of thermal expansion between the veneering porcelain and the Y-TZP zirconia core of these prostheses causes transformation of the tetragonal to the monoclinic structure in Y-TZP zirconia at the interface boundary when exposed to fatigue loading, resulting in fracture at the interface boundary. Y-TZP zirconia discs were veneered with three porcelains differing in coefficient of thermal expansion. Finite element analysis was used to investigate the stress distribution in the bi-layered discs because of the mismatch in thermal expansion. Two of these three groups were fatigued with the veneering ceramic in tension. X-ray diffraction was used to measure the intensity of monoclinic and tetragonal zirconia phase present at the zirconia core surface after sintering, airborne abrasion, veneering, and fatigue loading. It was found that the sintered tetragonal structure was converted to monoclinic up to a depth of 27 mum after airborne abrasion, and reversed back to tetragonal after porcelain veneering with porcelain. Fatigue loading of veneered discs did not, even with the highest possible thermal mismatch stress, cause any conversion from tetragonal to monoclinic phase.

The influence of specimen attachment and dimension on microtensile strength.

The higher microtensile bond strength values found for specimens with a smaller cross-sectional area are often explained by the lower occurrence of internal defects and surface flaws. We hypothesized that this aberrant behavior is mainly caused by the lateral way of attachment of the specimens to the testing device, which makes the strength dependent on the thickness. This study showed that composite bars of 1x1x10, 1x2x10, and 1x3x10mm attached at their 1-mm-wide side (situation A) fractured at loads of the same magnitude, as a result of which the microtensile strength ( micro TS), calculated as F/A (force at fracture/cross-sectional area), significantly increased for specimens with decreasing thickness. Attachment at the 1-, 2-, or 3-mm-wide side (situation B) resulted in equal micro TS values (P > 0.05). Finite element analysis showed different stress patterns for situation A, but comparable patterns for situation B. Both situations showed the same maximum stress at fracture.

The influence of surface roughness on porcelain strength.

OBJECTIVES: In order to adjust occlusion, the functional surfaces of porcelain restorations are often ground and mechanical machining is even an essential part of the CAD-CAM process for these restorations. The aim of this study was to investigate the influence of the finishing procedures on the biaxial flexure strength of four commercial porcelains. METHODS: Four commercial porcelains of which two are used for metal-ceramic restorations (Flexo Ceram Dentine and Vita VM K68) and two for veneers and inlays (Duceram LFC Dentine and Cerinate BODY) are used in this study. For each porcelain, sixty discs (Ø = 22 mm, h = +/- 2.0 mm) were produced using twelve different finishing procedures. Twenty discs were left untreated, twenty discs were milled, using a high-speed diamond disc, and twenty discs were machined in a high-speed grinding/polishing device. Half of the samples were glazed. In each of these six groups, half of the samples were stored for 16 h at 80 degrees C in a 4% acetic acid solution. The biaxial flexure strength was determined using the ball-on-ring method. In each group the roughness of the surface was determined and examined via SEM. RESULTS: With the exception of Flexo Ceram Dentine, a significant correlation was found between the roughness of the surface and the biaxial strength: the smoother the surface, the stronger the sample. The differences in biaxial strength may be attributed to the stress concentration of an applied load due to the roughness of the surface caused by mechanical finishing or chemical action. The fact that the strength of Flexo Ceram Dentine was not affected by the different surface treatments is probably due to the size of the leucite particles, which apparently induce more stress concentration than the surface flaws and the roughness of the surface. SIGNIFICANCE: It was concluded that surface roughness determines the strength of a porcelain material, except where the inner structure of the material causes greater stress concentration than that caused by the combination of surface roughness and surface flaws.

[A study of the psychological rejection risk factors in kidney transplant patients]. / 'n Ondersoek na sielkundige verwerpingsrisikofaktore by die nieroorplantingspasiënt.

Undergoing kidney transplantation has an impact on the physical and psychological well-being of the patient. This study focuses on the psychological aspect, and in particular on the personality structure of the transplant patient. The 16-Personality Factor Questionnaire was applied to 12 successful and 12 unsuccessful renal transplant patients at H. F. Verwoerd Hospital. A significant personality difference was noted between these two groups. The patients who rejected the kidney had a low score on factors Q1, Q2, B and Toughmindedness. This implies a lower crystallised intelligence, greater conservativeness, respect of established ideas as well as a tendency to go along with the group. This information is pertinent to the selection of patients who are psychologically suited to transplantation. Psychologists can play an important role in the selection, preparation and rehabilitation of these patients.