Zirconia nanoparticles prepared by laser vaporization as fillers for dental adhesives

Zirconia nanoparticles prepared by laser vaporization were incorporated into the primer or into the adhesive of a commercial adhesive system in order to evaluate its effect on bond strength to dentin. Zirconia nanoparticles (20–50 nm) were prepared using a particular laser vaporization technique and incorporated into the primer (P) or into the adhesive (A) of the Adper Scotchbond Multi-Purpose (SBMP) system at 5, 10, 15 and 20 wt.% by means of mechanical mixing (stirring) and ultrasonication. Control (unfilled) and experimental groups (filled) were applied, according to the manufacturer’s instructions, onto flat mid-coronal human dentin. Composite crowns were built up, stored in distilled water for 24 h at 37 °C and cut into 0.65 ± 0.05 mm² beams following a non-trimming microtensile technique. Specimens were fractured in tension using a universal testing machine (Zwick) and examined by scanning electron microscopy for fractographic analysis. Microtensile bond strength (μTBS) data were analyzed using a two-way ANOVA and modified LSD test at α = 0.05. Analysis of the nanofiller distribution and ultramorphological characterization of the interface were performed by transmission electron microscopy (TEM). Zirconia nanoparticle incorporation into the primer or into the adhesive of SBMP significantly increased μTBS to dentin. Filler concentration only affected μTBS significantly in the P group. Statistically significant differences between groups P and A occurred only at 20 wt.% filler content, with a significantly higher μTBS in group P. TEM micrographs revealed nanoparticle deposition on top of a hybrid layer when incorporated into the primer, whereas they remained dispersed through the adhesive layer in group A. Zirconia nanoparticles incorporation into SBMP increased bond strength to dentin by reinforcing the interface adhesive layer. Nanofiller incorporation into the primer solution showed a tendency of increasing bond strength with increasing concentration. At high concentrations (20 wt.%) nanofiller incorporation was more efficient in increasing bond strength if incorporated in the primer solution. Adding nanofillers to the primer and to the adhesive solutions resulted in different particle distributions at the interface.     

Changes in stiffness of resin-infiltrated demineralized dentin after remineralization by a bottom-up biomimetic approach

This study examined changes in elastic modulus, mineral density and ultrastructure of resin-infiltrated dentin after biomimetic remineralization. Sixty demineralized dentin beams were infiltrated with Clearfil Tri-S Bond, One-Step or Prime&Bond NT. They were immersed in simulated body fluid (SBF) for 1 week to maximize water sorption before determining the baseline elastic moduli. For each adhesive (N = 20) half of the beams remained immersed in SBF (control). The rest were immersed in a biomimetic remineralization medium. The elastic moduli were measured weekly for 15 additional weeks. Representative remineralized specimens were evaluated by X-ray microtomography and transmission electron microscopy (TEM). The elastic moduli of control resin-infiltrated dentin remained consistently low, while those immersed in the biomimetic remineralization medium increased by 55–118% after 4 months. X-ray microtomography of the remineralized specimens revealed decreases in mineral density from the beam surface to the beam core that were indicative of external mineral aggregation and internal mineral deposition. Interfibrillar and intrafibrillar remineralization of resin-sparse intertubular dentin were seen under TEM, together with remineralized peritubular dentin. Biomimetic remineralization occurs by diffusion of nanoprecursors and biomimetic analogs in completely demineralized resin-infiltrated dentin and proceeds without the contribution of materials released from a mineralized dentin base.     

The inhibitory effect of polyvinylphosphonic acid on functional matrix metalloproteinase activities in human demineralized dentin

This study has examined the use of polyvinylphosphonic acid (PVPA) as a potential matrix metalloproteinase (MMP) inhibitor and how brief cross-linking of demineralized dentin matrix that did not affect its mechanical properties enhanced the anti-MMP activity of PVPA. The anti-MMP potential of five PVPA concentrations (100–3000 μg ml^–1) was initially screened using a rhMMP-9 colorimetic assay. Demineralized dentin beams were treated with the same five concentrations of PVPA to collagen and then aged for 30 days in a calcium- and zinc-containing medium. The changes in modulus of elasticity, loss of dry mass and dissolution of collagen peptides were measured via three-point bending, precision weighing and hydroxyproline assay, respectively. All tested PVPA concentrations were highly effective (P < 0.05) in inhibiting MMP-9. Ageing in the incubation medium did not significantly alter the modulus of elasticity of the five PVPA treatment groups. Conversely, aged dentin beams from the control group exhibited a significant decline in their modulus of elasticity (P < 0.05) over time. Mass loss from the dentin beams and the corresponding increase in hydroxyproline in the medium in the five PVPA treatment groups were significantly lower than for the control (P < 0.05). PVPA is a potent inhibitor of endogenous MMP activities in demineralized dentin. It may be used as an alternative to chlorhexidine to prevent collagen degradation within hybrid layers to extend the longevity of resin–dentin bonds.     

The importance of size-exclusion characteristics of type I collagen in bonding to dentin matrices

The mineral phase of dentin is located primarily within collagen fibrils. During development, bone or dentin collagen fibrils are formed first and then water within the fibril is replaced with apatite crystallites. Mineralized collagen contains very little water. During dentin bonding, acid-etching of mineralized dentin solubilizes the mineral crystallites and replaces them with water. During the infiltration phase of dentin bonding, adhesive comonomers are supposed to replace all of the collagen water with adhesive monomers that are then polymerized into copolymers. The authors of a recently published review suggested that dental monomers were too large to enter and displace water from collagen fibrils. If that were true, the endogenous proteases bound to dentin collagen could be responsible for unimpeded collagen degradation that is responsible for the poor durability of resin–dentin bonds. The current work studied the size–exclusion characteristics of dentin collagen, using a gel-filtration-like column chromatography technique, using dentin powder instead of Sephadex. The elution volumes of test molecules, including adhesive monomers, revealed that adhesive monomers smaller than ～1000 Da can freely diffuse into collagen water, while molecules of 10,000 Da begin to be excluded, and bovine serum albumin (66,000 Da) was fully excluded. These results validate the concept that dental monomers can permeate between collagen molecules during infiltration by etch-and-rinse adhesives in water-saturated matrices.     

Degradation in the dentin–composite interface subjected to multi-species biofilm challenges

Oral biofilms can degrade the components in dental resin-based composite restorations, thus compromising marginal integrity and leading to secondary caries. This study investigates the mechanical integrity of the dentin–composite interface challenged with multi-species oral biofilms. While most studies used single-species biofilms, the present study used a more realistic, diverse biofilm model produced directly from plaques collected from donors with a history of early childhood caries. Dentin–composite disks were made using bovine incisor roots filled with Z100^TM or Filtek^TM LS (3M ESPE). The disks were incubated for 72 h in paired CDC biofilm reactors, using a previously published protocol. One reactor was pulsed with sucrose, and the other was not. A sterile saliva-only control group was run with sucrose pulsing. The disks were fractured under diametral compression to evaluate their interfacial bond strength. The surface deformation of the disks was mapped using digital image correlation to ascertain the fracture origin. Fracture surfaces were examined using scanning electron microscopy/energy-dispersive X-ray spectroscopy to assess demineralization and interfacial degradation. Dentin demineralization was greater under sucrose-pulsed biofilms, as the pH dropped <5.5 during pulsing, with LS and Z100 specimens suffering similar degrees of surface mineral loss. Biofilm growth with sucrose pulsing also caused preferential degradation of the composite–dentin interface, depending on the composite/adhesive system used. Specifically, Z100 specimens showed greater bond strength reduction and more frequent cohesive failure in the adhesive layer. This was attributed to the inferior dentin coverage by Z100 adhesive, which possibly led to a higher level of chemical and enzymatic degradation. The results suggested that factors other than dentin demineralization were also responsible for interfacial degradation. A clinically relevant in vitro biofilm model was therefore developed, which would effectively allow assessment of the degradation of the dentin–composite interface subjected to multi-species biofilm challenge.     

An in vitro study on the maturation of conventional glass ionomer cements and their interface to dentin

The objective of the study was to investigate the influence of long-term storage (up to 1 year) and coating on the variation of micro-mechanical properties of four conventional restorative glass ionomer cements (GICs) within 3.5 mm deep class I cavities. Four commercially available GICs (Riva Self Cure (SDI), ChemFil Rock (Dentsply), Fuji IX Fast and Fuji IX GP Extra/Equia (GC)) were applied to 100 teeth. In each tooth, two similar 3.5 mm deep class I cavities were prepared and filled with the GICs, with and without resin coating. The samples were stored in artificial saliva at 37 °C for 1 week, 1 month, 3 months, 6 months and 1 year. The variation in mechanical properties (indentation modulus (E) and Vickers hardness (HV)) were determined in 100 μm steps starting from the filling surface, through the intermediate layer in between dentine and GIC, and ending 100 μm in dentin. HV and E were strongly influenced by the material (P < 0.05, partial eta-squared η_P² = 0.31 and 0.23) but less by aging duration (P < 0.05, η_P² = 0.02 and 0.12) and resin coating (P < 0.05, η_P² = 0.02 and 0.03). The depth of measurement (0–2 mm) has no influence on HV (P = 0.789). HV shows a gentle increase over the 1 year storage period (P = 0.002). A ～300 μm GIC zone at the areas close to dentin with weaker properties as those measured in dentin or GIC was identified in all fillings, irrespective of the presence of coating, and at all storage periods. The thickness of this zone is more strongly influenced by storage (P < 0.05, η_P² = 0.081) than by material type (P < 0.05, η_P² = 0.056), while coating showed no influence (P = 0.869). Filler morphology and dimension were similar to upper parts of the GIC filling; however, the amount of low cations was higher. We concluded that the development of an intermediate layer in between dentine and GIC with lower mechanical properties might be responsible for the bond quality of GIC to dentine. Moreover, class I GIC restorations are unlikely to feature constant mechanical properties throughout the cavity, regardless of conditions such as aging and coating.     

Unconfined compression properties of a porous poly(vinyl alcohol)–chitosan-based hydrogel after hydration

A poly(vinyl alcohol) (PVA) hydrogel composite scaffold containing N,O-carboxymethylated chitosan (NOCC) was tested to assess its potential as a scaffold for cartilage tissue engineering in a weight-bearing environment. The mechanical properties under unconfined compression for different hydration periods were investigated. The effect of supplementing PVA with NOCC (20 wt.% PVA:5 vol.% NOCC) produced a porosity of 43.3% and this was compared against a non-porous PVA hydrogel (20 g PVA: 100 ml of water, control). Under non-hydrated conditions, the porous PVA–NOCC hydrogel behaved in a similar way to the control non-porous PVA hydrogel, with similar non-linear stress–strain response under unconfined compression (0–30% strain). After 7 days’ hydration, the porous hydrogel demonstrated a reduced stiffness (0.002 kPa, at 25% strain), resulting in a more linear stiffness relationship over a range of 0–30% strain. Poisson’s ratio for the hydrated non-porous and porous hydrogels ranged between 0.73 and 1.18, and 0.76 and 1.33, respectively, suggesting a greater fluid flow when loaded. The stress relaxation function for the porous hydrogel was affected by the hydration period (from 0 to 600 s); however the percentage stress relaxation regained by about 95%, after 1200 s for all hydration periods assessed. No significant differences were found between the different hydration periods between the porous hydrogels and control. The calculated aggregate modulus, H_A, for the porous hydrogel reduced drastically from 10.99 kPa in its non-hydrated state to about 0.001 kPa after 7 days’ hydration, with the calculated shear modulus reducing from 30.92 to 0.14 kPa, respectively. The porous PVA–NOCC hydrogel conformed to a biphasic, viscoelastic model, which has the desired properties required for any scaffold in cartilage tissue engineering.     

Porous silicon oxide–PLGA composite microspheres for sustained ocular delivery of daunorubicin

A water-soluble anthracycline antibiotic drug (daunorubicin, DNR) was loaded into oxidized porous silicon (pSiO₂) microparticles and then encapsulated with a layer of polymer (poly lactide-co-glycolide, PLGA) to investigate their synergistic effects in control of DNR release. Similarly fabricated PLGA–DNR microspheres without pSiO₂, and pSiO₂ microparticles without PLGA were used as control particles. The composite microparticles synthesized by a solid-in-oil-in-water emulsion method have mean diameters of 52.33 ± 16.37 μm for PLGA–pSiO₂_21/40–DNR and the mean diameter of 49.31 ± 8.87 μm for PLGA–pSiO₂_6/20–DNR. The mean size, 26.00 ± 8 μm, of PLGA–DNR was significantly smaller, compared with the other two (P < 0.0001). Optical microscopy revealed that PLGA–pSiO₂–DNR microspheres contained multiple pSiO₂ particles. In vitro release experiments determined that control PLGA–DNR microspheres completely released DNR within 38 days and control pSiO₂–DNR microparticles (with no PLGA coating) released DNR within 14 days, while the PLGA–pSiO₂–DNR microspheres released DNR for 74 days. Temporal release profiles of DNR from PLGA–pSiO₂ composite particles indicated that both PLGA and pSiO₂ contribute to the sustained release of the payload. The PLGA–pSiO₂ composite displayed a more constant rate of DNR release than the pSiO₂ control formulation, and displayed a significantly slower release of DNR than either the PLGA or pSiO₂ formulations. We conclude that this system may be useful in managing unwanted ocular proliferation when formulated with antiproliferation compounds such as DNR.     

In vitro cytotoxicity evaluation of porous TiO2–Ag antibacterial coatings for human fetal osteoblasts

Implant-associated infections (IAIs) may be prevented by providing antibacterial properties to the implant surface prior to implantation. Using a plasma electrolytic oxidation (PEO) technique, we produced porous TiO₂ coatings bearing various concentrations of Ag nanoparticles (Ag NPs) (designated as 0 Ag, 0.3 Ag and 3.0 Ag) on a Ti–6Al–7Nb biomedical alloy. This study investigates the cytotoxicity of these coatings using a human osteoblastic cell line (SV-HFO) and evaluates their bactericidal activity against methicillin-resistant Staphylococcus aureus (MRSA). The release of Ag and the total amount of Ag in the coatings were determined using a graphite furnace atomic absorption spectrometry technique (GF-AAS) and flame-AAS, respectively. Cytotoxicity was evaluated using the AlamarBlue assay coupled with the scanning electron microscopy (SEM) observation of seeded cells and by fluorescence microscopy examination of the actin cytoskeleton and nuclei after 48 h of incubation. Antibacterial activity was assessed quantitatively using a direct contact assay. AlamarBlue viability assay, SEM and fluorescence microscopy observation of the SV-HFO cells showed no toxicity for 0 Ag and 0.3 Ag specimens, after 2, 5 and 7 days of culture, while 3.0 Ag surfaces appeared to be extremely cytotoxic. All Ag-bearing surfaces had good antibacterial activity, whereas Ag-free coatings showed an increase in bacterial numbers. Our results show that the 0.3 Ag coatings offer conditions for optimum cell growth next to antibacterial properties, which makes them extremely useful for the development of new antibacterial dental and orthopedic implants.     

Single-step electrochemical deposition of antimicrobial orthopaedic coatings based on a bioactive glass/chitosan/nano-silver composite system

Composite orthopaedic coatings with antibacterial capability containing chitosan, Bioglass® particles (9.8 μm) and silver nanoparticles (Ag-np) were fabricated using a single-step electrophoretic deposition (EPD) technique, and their structural and preliminary in vitro bactericidal and cellular properties were investigated. Stainless steel 316 was used as a standard metallic orthopaedic substrate. The coatings were compared with EPD coatings of chitosan and chitosan/Bioglass®. The ability of chitosan as both a complexing and stabilizing agent was utilized to form uniformly deposited Ag-np. Due to the presence of Bioglass® particles, the coatings were bioactive in terms of forming carbonated hydroxyapatite in simulated body fluid (SBF). Less than 7 wt.% of the incorporated silver was released over the course of 28 days in SBF and the possibility of manipulating the release rate by varying the deposition order of coating layers was shown. The low released concentration of Ag ions (<2.5 ppm) was efficiently antibacterial against Staphyloccocus aureus up to 10 days. Although chitosan and chitosan/Bioglass® coating supported proliferation of MG-63 osteoblast-like cells up to 7 days of culture, chitosan/Bioglass®/Ag-np coatings containing 342 μg of Ag-np showed cytotoxic effects. This was attributed to the relatively high concentration of Ag-np incorporated in the coatings.     

Effect of amorphous calcium phosphate and silver nanocomposites on dental plaque microcosm biofilms

A dental composite containing amorphous calcium phosphate nanoparticles (NACP) was developed that released calcium (Ca) and phosphate (PO(4)) ions and possessed acid-neutralization capability. There has been little study on incorporation of antibacterial agents into calcium phosphate composites. The objective of this study was to investigate the effect of silver nanoparticle (NAg) mass fraction in NACP nanocomposite on mechanical properties and dental plaque microcosm biofilm for the first time. NACP nanoparticles of 116 nm were synthesized via a spray-drying technique. NAg nanoparticles were synthesized using Ag 2-ethylhexanoate and 2-(tert-butylamino)ethyl methacrylate, yielding NAg of particle size of 2.7 nm that were well-dispersed in the resin. Five NACP nanocomposites were fabricated with NAg mass fractions of 0, 0.028, 0.042, 0.088, and 0.175%, respectively. Mechanical properties of NACP nanocomposites containing 0-0.042% of NAg matched those of a commercial composite without antibacterial activity. Live/dead assay of dental plaque microcosm biofilms showed complete coverage with live bacteria on commercial composite. However, there were increasingly more dead bacteria with higher NAg content in the NACP nanocomposite. Colony-forming unit (CFU) counts for total microorganisms, total streptococci, and mutans streptococci for NACP nanocomposite with 0.042% NAg were about 1/4 those of commercial composite. Lactic acid production on NACP nanocomposite with 0.042% NAg was 1/3 that on commercial composite. In conclusion, novel NACP-NAg nanocomposites were developed which possessed good mechanical properties and potent antibacterial properties, with substantially reduced biofilm viability and lactic acid production. Hence, the NACP-NAg nanocomposites are promising for dental restorations with remineralizing and antibacterial capabilities.     

Prevalence and risk factors for endogenous fungal endophthalmitis in adult patients with candidemia at a tertiary care hospital in the Republic of Korea over 13 years

BackgroundEndogenous fungal endophthalmitis (EFE) is a critical complication of candidemia. We conducted a study to investigate the prevalence and risk factors for EFE.MethodsAdult candidemia patients ≥ 19 years who underwent an ophthalmological examination at a tertiary care hospital in the Republic of Korea from 2006 to 2018 were enrolled.ResultsThere was a total of 152 adult candidemia patients analyzed. EFE was found in 29 patients (19.1%). Patients were categorized into two groups (Non-endophthalmitis [NE] and endophthalmitis [E]). Between the two groups, there was no significant difference in terms of age, sex, and underlying comorbidities. However, there were more Candida albicans candidemia, abnormal alanine aminotransferase (ALT) at the time of candidemia diagnosis, receipt of antifungal treatment ≥ 48 hours after onset of candidemia symptoms and blood culture sample (AOCS), and candidemia clearance ≥ 5 days after initiation of antifungal treatment (AIAT) in the E group. A predictive model for the E was created, which had an area of 0.811 under the receiver operating characteristics curve. In a multivariate logistic regression analysis, C. albicans candidemia, ALT at the time of candidemia diagnosis, receipt of antifungal treatment ≥ 48 hours AOCS, and candidemia clearance ≥ 5 days AIAT were significantly associated with EFE.ConclusionEFE occurred in 19% of adult patients with candidemia. Adult candidemia patients with C. albicans candidemia, abnormal ALT, receipt of antifungal treatment ≥ 48 hours AOCS, and candidemia clearance ≥ 5 days AIAT need to be closely monitored for the possibility of EFE.     

The stimulation of myoblast differentiation by electrically conductive sub-micron fibers

Myotubes assemble with bundles of myofibers to form the structural units in skeletal muscle. Therefore, myotube formation plays an important role in restoring muscular functions, and substrates to promote the differentiation of myoblasts to myotubes need to be developed for muscle tissue engineering. In this study, we developed electrically conductive composite fibers of poly(l-lactide-co-?-caprolactone) (PLCL) blended with polyaniline (PANi) using an electrospinning method, and then investigated the effect of these composite fibers on the differentiation of myoblasts. The prepared PLCL/PANi fibers showed no significant difference in fiber diameter or contact angle, regardless of the incorporation of PANi. The fibers containing 30% PANi (PLCL/PANi-30) maintained elastic properties of maximum elongation at break (160 ± 14.4%). The composite fibers were cytocompatible, as the DNA content on each fiber was similar for up to 8 days of C2C12 myoblast culture. After 4 days of culture, the number of cells positive for sarcomeric myosin was 3.6-times greater on the electrically conductive fibers (21 ± 1 and 19 ± 2 for PLCL/PANi-15 and -30 fibers, respectively) than on the PLCL/PANi-0 fibers (6 ± 2). Furthermore, the level of myogenin expression detected on day 8 of culture on PLCL/PANi-15 was approximately 1.6-fold greater than the PLCL/PANi-0 fibers. Similar results were observed for the expression of other genes including troponin T (2-fold greater) and the myosin heavy chain gene (3-fold greater). These results indicate that electrically conductive substrates can modulate the induction of myoblasts into myotube formation without additional electrical stimulation, suggesting that these fibers may have potential as a temporary substrate for skeletal tissue engineering.     

Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: A randomized clinical trial

ObjectiveThe use of evidence-based guidelines can improve the care for asthma patients. We implemented a computerized asthma management system in a pediatric emergency department (ED) to integrate national guidelines. Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system (Bayesian network) combined with an asthma management system embedded in the workflow decreases time to disposition decision.MethodsWe performed a prospective, randomized controlled trial in an urban, tertiary care pediatric ED. All patients 2–18 years of age presenting to the ED between October 2010 and February 2011 were screened for inclusion by the disease detection system. Patients identified to have an asthma exacerbation were randomized to intervention or control. For intervention patients, asthma management was computer-driven and workflow-integrated including computer-based asthma scoring in triage, and time-driven display of asthma-related reminders for re-scoring on the electronic patient status board combined with guideline-compliant order sets. Control patients received standard asthma management. The primary outcome measure was the time from triage to disposition decision.ResultsThe Bayesian network identified 1339 patients with asthma exacerbations, of which 788 had an asthma diagnosis determined by an ED physician-established reference standard (positive predictive value 69.9%). The median time to disposition decision did not differ among the intervention (228 min; IQR = (141, 326)) and control group (223 min; IQR = (129, 316)); (p = 0.362). The hospital admission rate was unchanged between intervention (25%) and control groups (26%); (p = 0.867). ED length of stay did not differ among intervention (262 min; IQR = (165, 410)) and control group (247 min; IQR = (163, 379)); (p = 0.818).ConclusionsThe control and intervention groups were similar in regards to time to disposition; the computerized management system did not add additional wait time. The time to disposition decision did not change; however the management system integrated several different information systems to support clinicians’ communication.     

Effect of low frequency electrical stimulation on spike and wave discharges of perioral somatosensory cortex in WAG/Rij rats

Low frequency electrical stimulation has been revealed that as a potential cure in patient with drug resistant to epilepsy. This study tries to evaluate the effect of low frequency electrical stimulation (LFS) on absence seizure of perioral region primary somatosensory cortex (S1po). Eighteen male WAG/Rij rats were received LFS (3 Hz, square wave, monophasic, 200 μs, and 400 μA) for 25 min into S1po for a period of five days. There is 6 animals per group .The stimulating electrodes were implanted according to stereotaxic landmarks and EEG recording was obtained 30 min before and after LFS to analyse frequency, number and duration of spike–wave discharges (SWD). The results showed that in animals with unilateral stimulating electrodes (Exp1) in first and second days and also in animals with bilateral stimulating electrodes (Exp2) in days 3rd and 4th. LFS had significant decrease effects (p < 0.05) on mean number of SWD between pre-LFS. In comparison pre-LFS to post-LFS, mean of duration in Exp2 decreased significantly. In continuous application of LFS (5 days) only the data of first day was differently significant (p < 0.05) but data of other days had no difference. Comparison of data between Exp1, Exp2 and control groups showed that the mean number of Exp1 was significantly different (p < 0.05) and mean pick frequency in Exp2 was significantly decreased in comparison with Exp1 group (p < 0.05). The LFS of S1po produces significant antiepileptic effect on absence seizure but it was not persistent till the next day and shows a short time effect.     

A natural functionally graded biocomposite coating – Human enamel

Human enamel has been found to be a coating with excellent mechanical performance, and has undergone extensive investigation and discussion. However, most of the reported studies consider the enamel as a homogeneous anisotropic biocomposite. The current study illustrated the graded properties of the biocomposite from its functional load-bearing direction. Within the thickness of the enamel, from the outer surface towards the enamel–dentin junction (EDJ), the elastic modulus (E(x)) and hardness (H(x)) of enamel exist in an exponential relationship with normalized thickness (x) as E(x) = 111.64x^0.18 (R² = 0.94) and H(x) = 4.41x^0.16 (R² = 0.87) GPa, respectively. Moreover, the creep ability of enamel increases towards the EDJ. The graded properties of the biocomposite can be explained by both microstructural and compositional changes along the thickness of the material towards the EDJ. Finite element analysis indicates that the graded properties of enamel have important roles in reducing the enamel–dentin interface stresses and maintaining the integrity of the multilayer tooth structure. The results provide a new angle to understand the excellent mechanical behaviour of the multilayer tooth structure and may inspire the development of new functionally graded materials and coating structures.     

Clinical features and outcome of patients with chronic pulmonary aspergillosis in China: A retrospective,observational study

Chronic pulmonary aspergillosis (CPA) is a confusing respiratory disease, with many fundamental questions unanswered. We retrospectively evaluated the clinical characteristics, treatment, and outcome of patients with CPA in a tertiary hospital in China. Forty-six patients with CPA, including 26 patients with chronic cavitary pulmonary aspergillosis (CCPA), 13 patients with subacute invasive pulmonary aspergillosis (SAIA) and 7 patients with simple pulmonary aspergilloma (SA), were diagnosed from January 2014 to December 2017. A total of 18 patients with CCPA and 8 patients with SAIA had completed triazole treatment. Patients with SAIA had lower body mass index than patients with CCPA (18.9 vs. 20.4, P = 0.011), and SAIA most frequently occurred in systematic diseases (62.5% vs. 11.1%, P = 0.014). The medians of white blood count and C-reactive protein in patients with SAIA were higher than those in patients with CCPA (P < 0.001). No significant difference was observed in the median of duration of treatment between patients with CCPA and SAIA (36.5 weeks vs. 27.5 weeks, P = 0.144). Based on a composite of clinical, radiological, and mycological criteria, global success was observed in 12 patients with CCPA (66.7%) and 6 patients with SAIA (75.0%) at the end of the treatment. During the 1-year follow-up, 9 of 26 patients with CPA (34.6%) had a relapse. To date, we face a tremendous lack of evidence on CPA, and no commonly accepted treatment endpoint definition has been defined. In the future, collaborative research activities are needed to meet these challenges.     

Biphasic calcium phosphate to repair nasal septum: The first in vitro and in vivo study

Our objective was to evaluate the cytocompatibility and biocompatibility of biphasic calcium phosphate (BCP) in the nasal respiratory airway. In vitro, the attachment rate was quantified on BCP disks with normal human epithelial cells at 1, 3 and 24 h by determining N-acetyl β-d-hexosaminidase activity. Proliferative activity of cells was indirectly assessed by MTT assay at 3, 9, 15 and 21 days. Plastic surfaces were used as positive control. In vivo, 15 rabbits underwent anterior nasal septum perforation and 10 septa were repaired with BCP disks. Five non-implanted animals were sacrificed at 3 months. Two groups of five implanted animals were sacrificed at 1 and 2 months. The surface of new airway mucosa covering BCP disks was evaluated macroscopically. During both steps, light microscopy, immunohistochemistry and scanning electron microscopy were performed. Statistical analysis was performed with the Mann–Whitney U-test. In vitro, at 1 and 3 h, the attachment rates were significantly better than on the plastic surface (p < 10^?2). Mitochondrial activity increased on both surfaces but began 6 days later than on plastic. After 21 days of culture, cells were confluent and formed a monolayer covering the implant even in the bottom of the pores. In vivo, no perforations in the control group closed spontaneously. The mean rate of closure was 63% in the 1 month group and 64% in the 2 month group (p > 0.05). Implants were invaded by inflammatory reaction covered by incomplete differentiated respiratory epithelium. Throughout the study, all immunohistochemical findings remained positive. These data suggest a good affinity between BCP and nasal epithelial cells. BCP could be used to rebuild nasal septa.     

On the R-curve behavior of human tooth enamel

In this study the crack growth resistance behavior and fracture toughness of human tooth enamel were quantified using incremental crack growth measures and conventional fracture mechanics. Results showed that enamel undergoes an increase in crack growth resistance (i.e. rising R-curve) with crack extension from the outer to the inner enamel, and that the rise in toughness is a function of distance from the dentin enamel junction (DEJ). The outer enamel exhibited the lowest apparent toughness (0.67 ± 0.12 MPa m^0.5), and the inner enamel exhibited a rise in the growth toughness from 1.13 MPa m^0.5/mm to 3.93 MPa m^0.5/mm. The maximum crack growth resistance at fracture (i.e. fracture toughness (K_c)) ranged from 1.79 to 2.37 MPa m^0.5. Crack growth in the inner enamel was accompanied by a host of mechanisms operating from the micro- to the nano-scale. Decussation in the inner enamel promoted crack deflection and twist, resulting in a reduction of the local stress intensity at the crack tip. In addition, extrinsic mechanisms such as bridging by unbroken ligaments of the tissue and the organic matrix promoted crack closure. Microcracking due to loosening of prisms was also identified as an active source of energy dissipation. In summary, the unique microstructure of enamel in the decussated region promotes crack growth toughness that is approximately three times that of dentin and over ten times that of bone.