Chemical etching of CAD-CAM glass-ceramic-based materials using fluoride solutions for bonding pretreatment.

The surface treatment of glass-ceramic-based materials, namely, lithium disilicate glass (IPS e.max CAD), feldspar porcelain (VITABLOCS Mark II), and a polymer-infiltrated ceramic network (VITA ENAMIC), using aqueous fluoride solutions and their influence on luting agent bonding were investigated. Six experimental aqueous fluoride solutions were applied to these materials, and their effects were assessed by surface topological analysis. The obtained results were compared using non-parametric statistical analyses. Ammonium hydrogen fluoride (AHF) etchant demonstrated the greatest etching effect. Subsequent experiments focused on evaluating different concentrations of the AHF etchant for the bonding pretreatment of glass-ceramic-based materials with a luting agent (PANAVIA V5). AHF, particularly at concentrations above 5 wt%, effectively roughened the surfaces of the materials and improved the bonding performance. Notably, AHF at a concentration of 30 wt% exhibited a more pronounced effect on both etching and bonding capabilities compared to hydrofluoric acid.

[Community Care Meetings Co-Managed by a University and Local Government].

The Long-Term Care Insurance System, revised in 2015, obliged utmost efforts to enforce community-based care meetings to establish the Community-based Integrated Care System. In Toyoake in Aichi Prefecture, Japan, the"Multidisciplinary Joint Care Conference,"a monthly community-based care meeting, has been held since April 2016. All participants have an equal relationship since no advisors are appointed. This conference is designed to share helpful knowledge about methods that can be applied in similar future cases instead of just reviewing the support methods used in previous cases. Continuing to hold this conference is expected to yield various satisfactory outcomes. Exchanging knowledge with experts in different fields has led to technology transfer among professions. Furthermore, sharing knowledge in areas where information was insufficient has allowed individuals to determine what they could contribute from their standpoint. They have cogitated about selecting cases and how the host progressed the conference. Because local governments' employees are often reshuffled, accurately taking over duties from their predecessors is a significant concern. As a result, to reduce such risks, the municipality decided to cooperate and manage the conference with a local university engaged in solving local problems. An online provision system was established early to continue conducting the meeting during the COVID-19 pandemic. Currently, this system is beneficial in accepting observation members from municipalities and professionals nationwide. We aspire to continue engaging in the Multidisciplinary Joint Care Conference. This allows individuals connected to the communities to share strategies and methods for achieving their goals and unite as a single problem-solving team.

Masqueraders Around Disaster: Clinical Features of Scrub Typhus in Fukushima, Japan.

Background: Scrub typhus (ST) is endemic in Fukushima, with the largest number of cases reported in Japan from 2009 to 2010. Although ST is highly treatable, its atypical clinical presentation impedes diagnosis, causing delays in treatment. Methods: We review the clinical features of ST in adults from 2008 to 2017 at Ohta Nishinouchi General Hospital in Fukushima, Japan. Results: Fifty-five cases (serotype Karp 24, Irie/Kawasaki 21, Hirano/Kuroki 10) of ST were confirmed via serology based on elevated immunoglobulin (Ig)M and IgG and polymerase chain reaction positivity of eschar samples. The mean age was 69 years, and 64% were female. The case fatality rate was 1.8% (1/55). Approximately 70% of cases (38/55) were not diagnosed as ST upon the initial clinic visit. Inappropriate use of antibiotics was identified in 22% of cases (12/55). In terms of atypical clinical features, 1 or more of the manifestations, fever, rash, and eschar, was absent in 31% of cases (17/55). Approximately 11% of cases presented without eschar (6/55; Karp 1, Irie/Kawasaki 1, Hirano/Kuroki 4). Moreover, severe complications were observed with shock and disseminated intravascular coagulation in 7% of cases (4/55), Thus, while 53% of cases presented with the typical triad (29/55), unusual complications and atypical features occurred in 40% (22/55). Conclusions: Diagnosis of ST becomes clinically challenging in the absence of typical features. In Fukushima, an endemic area of ST, an atypical presentation involving multisystem disease is common.

Bonding Pretreatment of Aesthetic Dental CAD-CAM Materials through Surface Etching with a Mixed Aqueous Solution of Ammonium Fluoride and Ammonium Hydrogen Sulfate.

Hydrofluoric acid (HF) is commonly used as an etchant for the pretreatment of dental computer-aided design/computer-aided manufacturing (CAD-CAM) materials, such as glass-ceramics and resin composites. Despite its effectiveness, the harmful and hazardous nature of HF has raised significant safety concerns. In contrast, ammonium fluoride (AF) is known for its relatively low toxicity but has limited etching capability. This study explored the potential of ammonium hydrogen sulfate (AHS), a low-toxicity and weak acid, to enhance the etching ability of aqueous AF solutions for the bonding pretreatment of CAD-CAM materials. This study investigated five types of aesthetic CAD-CAM materials: lithium disilicate glass, feldspathic porcelain, polymer-infiltrated ceramic networks, resin composites, and zirconia. Seven experimental etchants were prepared by varying the amount of AHS added to aqueous AF solutions, with each etchant used to etch the surfaces of the respective CAD-CAM materials. The treated surfaces were analyzed using scanning electron microscopy and confocal laser scanning microscopy. Additionally, the shear bond strength (SBS) of the CAD-CAM materials treated with a luting agent (resin cement) was evaluated. The results indicated that the AF1/AHS3 (weight ratio AF:AHS = 1:3) etchant had the most substantial etching effect on the surfaces of silica-containing materials (lithium disilicate glass, feldspathic porcelain, polymer-infiltrated ceramic networks, and resin composites) but not on zirconia. The SBS of the materials treated with the AF1/AHS3 etchant was comparable to that of the commercial HF etchant. Hence, an AF/AHS mixed solution could effectively etch silica-containing CAD-CAM materials, thereby enhancing their bonding capabilities.

Impact of CAD/CAM Material Thickness and Translucency on the Polymerization of Dual-Cure Resin Cement in Endocrowns.

The objective of this study is to evaluate the impact of the thickness and translucency of various computer-aided design/computer-aided manufacturing (CAD/CAM) materials on the polymerization of dual-cure resin cement in endocrown restorations. Three commercially available CAD/CAM materials-lithium disilicate glass (e.max CAD), resin composite (CERASMART), and a polymer-infiltrated ceramic network (ENAMIC)-were cut into plates with five different thicknesses (1.5, 3.5, 5.5, 7.5, and 9.5 mm) in both high-translucency (HT) and low-translucency (LT) grades. Panavia V5, a commercial dual-cure resin cement, was polymerized through each plate by light irradiation. Post-polymerization treatment was performed by aging at 37 °C for 24 h under light-shielding conditions. The degree of conversion and Vickers hardness measurements were used to characterize the polymerization of the cement. The findings revealed a significant decrease in both the degree of conversion and Vickers hardness with increasing thickness across all CAD/CAM materials. Notably, while the differences in the degree of conversion and Vickers hardness between the HT and LT grades of each material were significant immediately after photoirradiation, these differences became smaller after post-polymerization treatment. Significant differences were observed between samples with a 1.5 mm thickness (conventional crowns) and those with a 5.5 mm or greater thickness (endocrowns), even after post-polymerization treatment. These results suggest that dual-cure resin cement in endocrown restorations undergoes insufficient polymerization.

Development of zirconia-based polymer-infiltrated ceramic network for dental restorative material.

Polymer-infiltrated ceramic network (PICN) materials have gained considerable attention as tooth restorative materials owing to their mechanical compatibility with human teeth. However, the mechanical strength of contemporary PICN materials is lower than those of conventional resin composites and ceramics. This study aims to develop novel high-strength PICN for use as a dental restorative material. Zirconia-based PICN (EXP) was fabricated using 3 mol% yttria tetragonal polycrystalline zirconia powder and resin monomers via slip casting, followed by sintering and polymer infiltration. Comprehensive analyses of the microstructure, mechanical properties, and physicochemical properties of EXP were performed using scanning electron microscopy with energy-dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, inorganic content measurements, three-point bending test, Vickers hardness test, two-body wear test, shear bond strength (SBS) test, surface free energy analysis, and water sorption/solubility test. Commercially available computer-aided design/computer-aided manufacturing (CAD/CAM) materials, including resin composite (CERASMART), silicate-based PICN (ENAMIC), and zirconia ceramic (e.max ZirCAD), were used for comparison. The analyses highlight the dual network structure of EXP, which comprised a zirconia skeleton and an infiltrated resin phase. EXP exhibits a flexural strength of 346.0 ± 46.0 MPa, flexural modulus of 44.0 ± 3.7 GPa, and Vickers hardness of 440.1 ± 51.2 VHN. The mechanical properties of EXP are significantly higher than those of CERASMART and ENAMIC but lower than those of ZirCAD. Notably, the EXP hardness closely mimics that of the human enamel. The wear volume, SBS, and water sorption/solubility of EXP are comparable to those of CERASMART and ENAMIC. Therefore, EXP has potential applications as a tooth restorative material.

Adherence of denosumab treatment for low bone mineral density in Japanese people living with HIV: a retrospective observational study.

BACKGROUND: Long-term care issues, specifically metabolic bone disorders, are a concern for people living with human immunodeficiency virus (PLWH) who undergo life-long antiretroviral therapy (ART). Previous clinical trials with denosumab, an anti-RANKL antibody inhibitor, have revealed its effectiveness in increasing bone mineral density (BMD) in patients with osteoporosis. However, there are limited data on adherence and effectiveness of denosumab treatment for osteoporosis in PLWH. Hence, this study aimed to investigate the adherence and effectiveness of denosumab treatment for osteoporosis in Japanese PLWH. METHODS: This study is a retrospective exploratory analysis of 29 Japanese PLWH who initiated denosumab treatment for osteoporosis, between 2013 and 2021. The study included patients who received at least one dose of denosumab every 6 months. Adherence and persistence were defined as receiving two consecutive injections of denosumab 6 months ± 4 weeks apart and 6 months + 8 weeks apart, respectively. The primary outcome measure of the study was the adherence of denosumab treatment for 24 months. The secondary outcome measures included treatment persistence and BMD. The period after January 2020 was defined as the coronavirus disease 2019 (COVID-19) pandemic period, and its impact on adherence was investigated. RESULTS: The treatment adherence rates at 12 and 24 months were 89.7% and 60.7%, respectively. By contrast, the treatment persistence at 12 and 24 months was 100% and 85.7%, respectively. More patients in the group who initiated denosumab treatment after the COVID-19 pandemic reached non-adherence than in the group who initiated denosumab treatment before the pandemic. BMD at the lumbar spine and femoral neck significantly increased compared to that at baseline, with median percentage changes of 8.7% (p < 0.001) and 3.5% (p = 0.001), respectively. CONCLUSIONS: The results showed that patients in the study had a high rate of non-adherence but a lower rate of non-persistence. Additionally, PLWH on ongoing ART experienced increased BMD with denosumab treatment. This study provides an opportunity to improve future strategies for denosumab treatment in the Japanese PLWH.

Improved responsiveness for JKOOS+ compared to KOOS in Japanese patients undergoing total knee arthroplasty.

BACKGROUND: Existing knee related patient reported outcome measurements (PROMs) have overwhelmingly been developed and validated in western chair-based societies, suggesting a potential for a western bias in PROMs evaluation of patients with knee conditions. We, therefore, endeavor to evaluate the responsiveness of the previously developed culturally relevant Japanese version of the knee injury and osteoarthritis outcome score (JKOOS+). METHODS: We enrolled 114 patients scheduled for total knee arthroplasty (TKA) across 8 knee clinics in Japan. Patients completed the Oxford Knee Score (OKS) and JKOOS + both at the time of enrollment and again 1-year post-TKA. Responsiveness was evaluated using effect size and standardized response mean (SRM). An effect size or SRM >0.8 is considered adequately responsive. We further tested the difference in responsiveness between the original Japanese language KOOS activities of daily living (ADL) domain and the novel Japanese ADL (JADL) domain using the modified Jacknife test. RESULTS: All domains were adequately responsive with the exception of the KOOS sports and recreation domain, which has previously been ignored by TKA researchers due to its lack of applicability to elderly patients undergoing TKA. The JADL domain outperformed the ADL domain in both effect size (1.51 v. 1.45) and SRM (1.67 v. 1.57) (p < 0.001). The novel Knee Flexion (KF) domain was adequately responsive, though less responsive than other domains except sports and recreation (p < 0.01 v. all other PROMs domains). CONCLUSIONS: The JKOOS+ JADL domain is significantly more responsive than the Europe-developed ADL domain to TKA in Japanese knee patients suffering from knee osteoarthritis (OA). The KF domain, unique to the JKOOS+ and intended to assess difficulty with knee flexion, is adequately responsive to TKA in Japanese patients suffering from OA.

PIEZO1 promotes ATP release from periodontal ligament cells following compression force.

OBJECTIVES: Orthodontic mechanical force on the periodontal ligament induces extracellular adenosine triphosphate (ATP) release. However, mechanosensitive molecules have not been confirmed functionally in periodontal ligament cells. In the present study, we examined the roles of mechanosensitive PIEZO channels in the mechanically stimulated release of ATP in human periodontal ligament fibroblasts (HPdLFs). MATERIALS AND METHODS: To examine PIEZO expression in HPdLFs, we performed reverse transcription-quantitative polymerase chain reaction, fluorescent immunostaining, and Ca2+ imaging. ATP concentrations were measured in culture medium after applications of the PIEZO1 agonist Yoda1 and compression force in a newly developed in vitro weight-loaded cell model (IVWLC) using balance weights and a 48-well plate. The mechanosensitive channel inhibitor GsMTx4 and the ATP-releasing route inhibitors clodronic acid, meclofenamic acid, and probenecid were used. To suppress PIEZO1 expression, short interference RNA (siRNA) treatment of the PIEZO1 gene was performed. RESULTS: PIEZO1 mRNA was expressed more abundantly than PIEZO2 mRNA in HPdLFs. HPdLF cell bodies were immunoreactive to anti-PIEZO1 antibody. Yoda1 increased intracellular Ca2+ and extracellular ATP concentrations in a dose-dependent manner. ATP release was inhibited by GsMTx4 and inhibitors of ATP release routes. In the IVWLC, HPdLFs released ATP in response to compression force but not in response to hypoxic stimulation that was simultaneously applied to cells. Mechanically stimulated ATP release was inhibited by GsMTx4, inhibitors of ATP-releasing routes and siRNA treatment of PIEZO1. CONCLUSIONS: PIEZO1 on the cell membranes of HPdLFs is activated by compression force and then induces ATP release via intracellular Ca2+-dependent exocytosis and ATP-permeable channels.

Possible Delayed Foreign Body Reactions against Titanium Clips and Coating Materials after Unruptured Cerebral Aneurysm Surgery.

Delayed foreign body reactions to either or both clipping and coating materials have been reported in several small series; however, studies in the titanium clip era are scarce. This study aims to survey the contemporary status of such reactions to titanium clips and coating materials. Among patients who received a total of 2327 unruptured cerebral aneurysmal surgeries, 12 developed delayed intraparenchymal reactions during outpatient magnetic resonance imaging (MRI) follow-up. A retrospective investigation was conducted. The patients' average age was 58.6 (45-73) years, and 11 were women. The aneurysms were located in the middle cerebral artery (n = 7), internal carotid artery (n = 4), or anterior communicating artery (AComA, n = 1). In 10 patients, additional coating with tiny cotton fragments was applied to the residual neck after clipping with titanium clips; however, only the clipping with titanium clips was performed in the remaining two. The median time from surgery to diagnosis was 4.5 (0.3-60) months. Seven (58.3%) patients were asymptomatic, and three developed neurological deficits. MRI findings were characterized by a solid- or rim-enhancing lobulated mass adjacent to the clip with surrounding parenchymal edema. In 11 patients, the lesions reduced in size or disappeared; however, in one patient, an AComA aneurysm was exacerbated, necessitating its removal along with optic nerve decompression. In conclusion, cotton material is a strongly suspected cause of delayed foreign body reactions, and although extremely rare, titanium clips alone may also induce such a reaction. The prognosis is relatively good with steroid therapy; however, caution is required when the aneurysm is close to the optic nerve, as in AComA aneurysms.

Potentiometric-Type Gas Sensor Using MgFe2O4 Sensing Electrode for Detection of Hydrocarbon Based on Carbon Number.

Hydrocarbon (HC) monitoring is necessary for safe and effective operations in industries such as petroleum and gas. In this study, total hydrocarbons can be detected by using yttria-stabilized zirconia (YSZ)-based potentiometric-type gas sensor using MgFe2O4 sensing electrode (SE). The sensor was found to generate a similar response magnitude to those of hydrocarbons that have the same carbon number, irrespective of the type of carbon bond (total hydrocarbon detection). Aside from being capable of detecting total hydrocarbons sensitively and selectively with rapid response time, the sensor using MgFe2O4-SE also exhibited a linear relationship between sensor responses and carbon number. In addition to that, the developed sensor showed a logarithmically linear relationship between sensor responses and HC concentration in the range 20-700 ppm. These sensing characteristics were confirmed to be reproducible, and sensor responses toward HC were found to be repeatable and gradually decreased with increasing in O2 concentration in the range of 3-21 vol %.

Synthesis and Properties of Rubicene-Based Aromatic π-Conjugated Compounds as Five-Membered Ring Embedded Planar Nanographenes.

Polycyclic aromatic hydrocarbons consisting of two or three rubicene substructures were designed as π-conjugated compounds embedding five-membered rings. The target compounds with t-butyl groups were synthesized by the Scholl reaction of precursors consisting of 9,10-diphenylanthracene units, even though a partially precyclized precursor was required for the synthesis of the trimer. These compounds were isolated as stable and dark blue solids. Single-crystal X-ray analysis and DFT calculations revealed the planar aromatic framework of these compounds. In the electronic spectra, the absorption and emission bands were considerably red-shifted compared with those of the reference rubicene compound. In particular, the emission band of the trimer extended to the near-IR region while retaining the emissive property. The narrowed HOMO-LUMO gap with the extension of the π-conjugation was confirmed by cyclic voltammetry and DFT calculations.

Bond Strength of Sandblasted PEEK with Dental Methyl Methacrylate-Based Cement or Composite-Based Resin Cement.

Poly-ether-ether-ketone (PEEK) is commonly employed in dental prostheses owing to its excellent mechanical properties; however, it is limited by its low bond strength with dental resin cement. This study aimed to clarify the type of resin cement most suitable for bonding to PEEK: methyl methacrylate (MMA)-based resin cement or composite-based resin cement. For this purpose, two MMA-based resin cements (Super-Bond EX and MULTIBOND II) and five composite-based resin cements (Block HC Cem, RelyX Universal Resin Cement, G-CEM LinkForce, Panavia V5, and Multilink Automix) were used in combination with appropriate adhesive primers. A PEEK block (SHOFU PEEK) was initially cut, polished, and sandblasted with alumina. The sandblasted PEEK was then bonded to resin cement with adhesive primer according to the manufacturer's instructions. The resulting specimens were immersed in water at 37 °C for 24 h, followed by thermocycling. Subsequently, the tensile bond strengths (TBSs) of the specimens were measured; the TBSs of the composite-based resin cements after thermocycling were found to be zero (G-CEM LinkForce, Panavia V5, and Multilink Automix), 0.03 ± 0.04 (RelyX Universal Resin Cement), or 1.6 ± 2.7 (Block HC Cem), whereas those of Super-Bond and MULTIBOND were 11.9 ± 2.6 and 4.8 ± 2.3 MPa, respectively. The results demonstrated that MMA-based resin cements exhibited stronger bonding to PEEK than composite-based resin cements.

Impact of the COVID-19 Pandemic on Injury Incidence in Japanese Male Professional Soccer Players.

Background: The outbreak of the 2019 novel coronavirus disease (COVID-19) led to an enforced quarantine period and limited training and match activities for athletes. Purpose: To report the influence of the COVID-19 pandemic on the occurrence of injury in Japanese male professional soccer players. Study Design: Descriptive epidemiology study. Methods: In total, 21 clubs in the 2019 season and 28 clubs in the 2020 season from the Japan Professional Football League were prospectively followed, and 16 clubs in 2019 and 24 clubs in 2020 were analyzed in this study. Individual training, match exposure, and time-loss injuries were recorded using an electronic data capture system. The influence of COVID-19-related suspension during the 2020 season was retrospectively investigated via comparisons with the 2019 season. Results: Total activity time included 114,001 hours in training and 16,339 hours in matches in 2019 and 170,798 hours in training and 25,411 hours in matches in 2020. The mean training interruption period caused by COVID-19 in 2020 was 39.9 days (range, 3-65 days), and the mean game-interruption period was 70.1 days (range, 58-79 days). The total number of injuries was 1495 in 2019 and 1701 in 2020. The overall injury incidence per 1000 hours of exposure was 5.7 in 2019 and 5.8 in 2020. The overall injury burden per 1000 hours of exposure was 155.5 days in 2019 and 130.2 days in 2020. The muscle injury incidence was highest in May 2020, immediately after the suspension period. Conclusion: The overall injury incidence did not differ between 2019 and 2020. However, muscle injury incidence notably increased in the 2 months after the COVID-19 pandemic suspension period.

Supratentorial multifocal gliomas associated with Ollier disease harboring IDH1 R132H mutation: A case report.

Somatic mosaicism of isocitrate dehydrogenase 1/2 (IDH1/2) mutation is a cause of Ollier disease (OD), characterized by multiple enchondromatosis. A 35-year-old woman who was diagnosed with OD at age 24 underwent resection surgery for multifocal tumors located at the right and left frontal lobes that were discovered incidentally. No apparent spatial connection was observed on preoperative magnetic resonance imaging. Pathological examinations revealed tumor cells with a perinuclear halo in the left frontal lobe tumor, whereas astrocytic tumor cells were observed in the right frontal lobe tumor. Based on positive IDH1 R132H immunostaining and the result of 1p/19q fluorescent in situ hybridization, pathological diagnoses were IDH mutant and 1p/19q-codeleted oligodendroglioma in the right frontal lobe tumor and IDH mutant astrocytoma in the left frontal lobe tumor, respectively. The DNA sequencing revealed IDH1 R132H mutation in the peripheral blood sample and frontal lobe tumors. This case suggested that in patients with OD, astrocytoma and oligodendroglioma can co-occur within the same individual simultaneously, and IDH1 R132H mutation was associated with supratentorial development of gliomas.

Origin and diversification of pheretimoid megascolecid earthworms in the Japanese Archipelago as revealed by mitogenomic phylogenetics.

Megascolecid earthworms of the pheretimoid group are dominant detritivores of soil ecosystems in the Japanese Archipelago and East Asia. However, their diversity and phylogenetic relationships are poorly understood. We assembled whole mitogenome sequences for 197 megascolecid earthworms collected throughout Japan to study the phylogenetic relationships, phylogeography, divergence times, and diversification of important morphological characteristics among pheretimoid earthworms. Using 197 mitogenome sequences and 24 published mitogenome sequences from the East Asian mainland (221 sequences in total), we constructed a maximum likelihood tree and found that the pheretimoid earthworms currently assigned to Amynthas, Metaphire, Duplodicodrilus, and Manus are involved in the most senior genus Amynthas; thus, Amynthas can be treated as the sole genus encompassing all of the above genera. Within the Amynthas group, we identified three major lineages that led to four groups of endemic species in Japan. These lineages originated from different lineages on the East Asian mainland and Taiwan Island, indicating multiple colonization events from the East Asian mainland by different ancestral lineages, possibly after the Miocene. We also assembled nuclear ribosomal DNA sequences encompassing the 18S to 28S rRNA genes. The nuclear gene tree showed major groups consistent with the mitogenome tree except for different (and not well-resolved) relationships among major clades. Our molecular data covered 115-158 native and 7 non-native Amynthas group species in Japan in terms of DNA-based species delimitation. Our findings provide a basis for understanding the evolutionary relationships among diversified megascolecid earthworms in the Amynthas group in Japan and adjacent regions.

Influence of the thickening agent contained in a phosphoric acid etchant on bonding between feldspar porcelain and resin cement with a silane coupling agent.

Phosphoric acid (PA) etchants are widely used for the bonding pretreatment of teeth; however, their influences on the bonding between glass-ceramics and resin cement have not been clarified yet. This study investigated the effect of a thickening agent on the bonding strength between feldspar porcelain treated with a PA etchant and resin cement with a silane coupling agent. The experiments were performed using two PA etchants: commercial one and prepared one consisting a PA aqueous solution and poly(ethylene glycol) thickening agent. The samples were evaluated by shear bond strength testing, scanning electron microscopy, and Fourier-transform infrared spectroscopy. The obtained results revealed that the thickening agent adhered to the porcelain surface and inhibited cement bonding. Meanwhile, PA remained on the surface due to the presence of the thickening agent and activated the silane coupling agent. Overall, the PA etchant did not improve the bond durability.

Effect of phosphoric acid and sodium hydroxide on cleaning and bonding of saliva-contaminated feldspar porcelain.

Purpose Hydrofluoric acid has been used to remove salivary contamination in dental glass-ceramics before bonding treatment. However, alternative methods are required because hydrofluoric acid is harmful. This study examined the cleaning effects of phosphoric acid and sodium hydroxide on glass-ceramics for bonding pre-treatment.Methods Feldspar porcelain was divided into four groups: (C) cleaned porcelain without any contamination, (S) porcelain contaminated with saliva, (SPA) porcelain cleaned with 37% phosphoric acid after saliva contamination, and (SSH) porcelain cleaned with 10% sodium hydroxide after saliva contamination. Each sample was bonded to the resin cement using a silane-containing primer. They were then subjected to a shear bond strength (SBS) test. Each surface was analyzed by scanning electron microscopy (SEM), contact angle measurements, and Fourier transform infrared spectroscopy (FT-IR).Results The SBS of group SSH was comparable to that of group C but significantly higher than that of groups S and SPA. SEM observations showed that saliva-like structures remained on the samples of groups S and SPA, but not on the SSH group. The contact angles of groups C and SSH were comparable and significantly smaller than those of groups S and SPA, respectively. FT-IR analysis also revealed saliva in groups S and SPA, which was absent in the SSH group.Conclusions The saliva remained on the porcelain even after cleaning with phosphoric acid, and SBS was not restored to the same level as before the contamination. In contrast, sodium hydroxide eliminated saliva and restored SBS to the same level as before contamination.

Fulminant myocarditis with COVID-19 infection having normal C-reactive protein and serial magnetic resonance follow-up.

A 44-year-old woman who was quarantined for 5 days after the diagnosis of coronavirus disease of 2019 (COVID-19) was transferred to our hospital with the complaint of chest pain. The patient was unvaccinated. Electrocardiography revealed ST elevation in the lateral leads. Echocardiographic biventricular dysfunction with oedematous wall thickening was identified. Cardiac enzyme levels were elevated; however, C-reactive protein (CRP) levels, and the coronary angiogram were normal. The patient required mechanical circulatory support to stabilize haemodynamics and was treated with remdesivir, baricitinib, and intravenous methylprednisolone. She recovered after 13 days of mechanical support. Serial cardiac magnetic resonance imaging revealed acute myocardial oedema and subsequent fibrosis. An endomyocardial biopsy on admission showed mild interstitial inflammatory infiltrates with endomyocardial fibrous thickening and mild interstitial fibrosis of the myocardium. Normal CRP levels suggested minor involvement of interleukin (IL)-6, supporting the efficacy of baricitinib.

Multiple Myeloma with Hyperammonemia Treated with Novel Agents: A Case Series of Three Patients.

Multiple myeloma (MM) is a cancer characterized by the expansion of plasma cells in the bone marrow. Survival times of patients with MM have increased due to the development of novel therapeutic agents. We herein highlight three MM cases that had a poor prognosis despite treatment with novel therapeutic agents. Of note, all patients presented with hyperammonemia that led to a consciousness disorder. The outcome for patients with MM showing high levels of serum ammonia continues to be poor, even with the use of novel therapies. For such patients showing a consciousness disorder, hyperammonemia should be considered as a possible cause.