Update on Enamel Bonding Strategies

Optimal strategies for the application of an adhesive differ between enamel and dentin because of the differences in their composition. The development of adhesive systems has mainly focused on the bonding of dentin, rather than on the enamel, by etching with phosphoric acid (PA). Dental adhesive technologies continue to rapidly advance, and various adhesive systems have been developed since the study of Buonocore in 1955. He introduced the enamel acid-etch technique. Then, the etch-and-rinse (ER) system was developed, and subsequently, the self-etch (SE) system. Universal adhesives are a new generation of one-bottle SE adhesives that can be applied with either ER mode or SE mode, or a combined system involving selective enamel etching mode. Since the combination of PA etching and the SE system differs from conventional ER systems, the enamel bonding strategy should be carefully considered. This concise review of the literature on reliable enamel bonding strategies should prove helpful to clinicians to choose an appropriate adhesive system to achieve optimal clinical outcomes

Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial

Background The appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels. Methods We performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low ( Results Of the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury. Conclusions Our results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels

Sodium p-Toluenesulfinate Enhances the Bonding Durability of Universal Adhesives on Deproteinized Eroded Dentin

The effects of deproteinization using sodium hypochlorite (NaOCl) and the subsequent application of an antioxidant (sodium p-toluenesulfinate, STS) onto the bonding durability of universal adhesives on eroded dentin were investigated. Untreated sound dentin served as the control, whereas eroded dentin, which had been prepared by pH-cycling in 1% citric acid and a remineralization solution, was either untreated, deproteinized with a 10% NaOCl gel or deproteinized with the 10% NaOCl gel and subsequently treated with an STS-containing agent. The dentin surfaces were bonded using a universal adhesive (Clearfil Universal Bond Quick, Scotchbond Universal or G-Premio Bond), and the micro-tensile bond strength (µTBS) test was performed after 24 h or 10,000 thermal cycles. The µTBS data were statistically analyzed using a three-way ANOVA and Tukey’s HSD post hoc tests. The lowest µTBS was measured on untreated eroded dentin (p 0.05), but the highest µTBS was obtained if deproteinization was followed by the application of STS. Thermocycling significantly decreased µTBS in all groups (p 0.05). This indicated that deproteinization, followed by the application of STS, could enhance the bonding durability of universal adhesives on eroded dentin

3D imaging of proximal caries in posterior teeth using optical coherence tomography

Optical coherence tomography (OCT) can create cross-sectional images of tooth without X-ray exposure. This study aimed to investigate the diagnostic accuracy of 3D imaging of OCT for proximal caries in posterior teeth. Thirty-six human molar teeth with 51 proximal surfaces visibly 6 intact, 16 slightly demineralized, and 29 distinct carious changes were mounted to take digital radiographs and 3D OCT images. The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) for the diagnosis of enamel caries and dentin caries were calculated to quantify the diagnostic ability of 3D OCT in comparison with digital radiography. Diagnostic accuracy was evaluated by the agreement with histology using weighted Kappa. OCT showed significantly higher sensitivity, AUC and Kappa values than radiography. OCT can be a safer option for the diagnosis of proximal caries in posterior teeth that can be applied to the patients without X-ray exposure

Destruxin E Decreases Beta-Amyloid Generation by Reducing Colocalization of Beta-Amyloid-Cleaving Enzyme 1 and Beta-Amyloid Protein Precursor

Alzheimer-disease-associated beta-amyloid (A beta) is produced by sequential endoproteolysis of beta-amyloid protein precursor (beta APP): the extracellular portion is shed by cleavage in the juxtamembrane region by beta-amyloid-cleaving enzyme (BACE)/beta-secretase, after which it is cleaved by presenilin (PS)/gamma-secretase near the middle of the transmembrane domain. Thus, inhibition of either of the secretases reduces A beta generation and is a fundamental strategy for the development of drugs to prevent Alzheimer disease. However, it is not clear how small compounds reduce A beta production without inhibition of the secretases. Such compounds are expected to avoid some of the side effects of secretase inhibitors. Here, we report that destruxin E (Dx-E), a natural cyclic hexadepsipeptide, reduces A beta generation without affecting BACE or PS/gamma-secretase activity. In agreement with this, Dx-E did not inhibit Notch signaling. We found that Dx-E decreases colocalization of BACE1 and beta APP, which reduces beta-cleavage of beta APP. Therefore, the data demonstrate that Dx-E represents a novel A beta-reducing process which could have fewer side effects than secretase inhibitors. Copyright (C) 2009 S. Karger AG, Base

カン focal nodular hyperplasia ニ タイスル フククウキョウカ カン セツジョジュツ

Recently, laparoscopic hepatectomy of the liver has been reported to be safe, with possible advantages to the patients such as reduced postoperative pain and shorter hospital stay. We report successful laparoscopic partial liver resections for two cases of focal nodular hyperplasia. Two cases of 43-year-old male and 69-year-old male, with chronic hepatitis C and without any symptoms, presented in each other a solitary mass 1.5 and 1.0 cm in size at the edge of the liver on diagnostic imagings. The patients underwent laparoscopic partial hepatectomy to rule out well differentiated hepatocellular carcinoma. The histopathological diagnosis was focal nodular hyperplasia. Each patient had an uneventful postoperative recovery and had been free from recurrence during the 6 years follow-up period. Laparoscopic partial hepatectomy is indicated in patients with benign solid mass located at the edge of the liver

A role for fungal β-glucans and their receptor Dectin-1 in the induction of autoimmune arthritis in genetically susceptible mice

A combination of genetic and environmental factors can cause autoimmune disease in animals. SKG mice, which are genetically prone to develop autoimmune arthritis, fail to develop the disease under a microbially clean condition, despite active thymic production of arthritogenic autoimmune T cells and their persistence in the periphery. However, in the clean environment, a single intraperitoneal injection of zymosan, a crude fungal β-glucan, or purified β-glucans such as curdlan and laminarin can trigger severe chronic arthritis in SKG mice, but only transient arthritis in normal mice. Blockade of Dectin-1, a major β-glucan receptor, can prevent SKG arthritis triggered by β-glucans, which strongly activate dendritic cells in vitro in a Dectin-1–dependent but Toll-like receptor-independent manner. Furthermore, antibiotic treatment against fungi can prevent SKG arthritis in an arthritis-prone microbial environment. Multiple injections of polyinosinic-polycytidylic acid double-stranded RNA also elicit mild arthritis in SKG mice. Thus, specific microbes, including fungi and viruses, may evoke autoimmune arthritis such as rheumatoid arthritis by stimulating innate immunity in individuals who harbor potentially arthritogenic autoimmune T cells as a result of genetic anomalies or variations

スイ カセイ ノウホウ ニ タイスル フククウキョウカ ノホウ イ フンゴウジュツ : イヘキ トノ ユチャク オ ゼンテイ ト シナイ アンゼンナ ジュツシキ

A forty seven-year-old male who had been in clinical follow-up for a pancreatic pseudocystunderwent a laparoscopic cystogastrostomy through the lesser peritoneal sac in 1996. Thisprocedure is performed by creating a cystotomy and posterior gastrotomy through whichan Endo GIATM is applied. The mouth of cystogastrostomy is closed using continuous suturesby Endo STITCHTM. This approach does not rely on adhesions between the pseudocyst andposterior wall of the stomach, and offers clear advantages over previously described techniquesin the management of pancreatic pseudocyst

Different Characteristics of Cognitive Impairment in Elderly Schizophrenia and Alzheimer's Disease in the Mild Cognitive Impairment Stage

We compared indices of the revised version of the Wechsler Memory Scale (WMS-R) and scaled scores of the five subtests of the revised version of the Wechsler Adult Intelligence Scale (WAIS-R) in 30 elderly schizophrenia (ES) patients and 25 Alzheimer's disease (AD) patients in the amnestic mild cognitive impairment (aMCI) stage (AD-aMCI). In the WMS-R, attention/concentration was rated lower and delayed recall was rated higher in ES than in AD-aMCI, although general memory was comparable in the two groups. In WAIS-R, digit symbol substitution, similarity, picture completion, and block design scores were significantly lower in ES than in AD-aMCI, but the information scores were comparable between the two groups. Delayed recall and forgetfulness were less impaired, and attention, working memory and executive function were more impaired in ES than in AD-aMCI. These results should help clinicians to distinguish ES combined with AD-aMCI from ES alone