The use of neoadjuvant lobar radioembolization prior to major hepatic resection for malignancy results in a low rate of post hepatectomy liver failure

BackgroundNeoadjuvant yttrium-90 transarterial radioembolization (TARE) is increasingly being used as a strategy to facilitate resection of otherwise unresectable tumors due to its ability to generate both tumor response and remnant liver hypertrophy. Perioperative outcomes after the use of neoadjuvant lobar TARE remain underinvestigated.MethodsA single center retrospective review of patients who underwent lobar TARE prior to major hepatectomy for primary or metastatic liver cancer between 2007 and 2018 was conducted. Baseline demographics, radioembolization parameters, pre- and post-radioembolization volumetrics, intra-operative surgical data, adverse events, and post-operative outcomes were analyzed.ResultsTwenty-six patients underwent major hepatectomy after neoadjuvant lobar TARE. The mean age was 58.3 years (17–88 years). 62% of patients (n=16) had primary liver malignancies while the remainder had metastatic disease. Liver resection included right hepatectomy or trisegmentectomy, left or extended left hepatectomy, and sectorectomy/segmentectomy in 77% (n=20), 8% (n=2), and 15% (n=4) of patients, respectively. The mean length of stay was 8.3 days (range, 3–33 days) and there were no grade IV morbidities or 90-day mortalities. The incidence of post hepatectomy liver failure (PHLF) was 3.8% (n=1). The median time to progression after resection was 4.5 months (range, 3.3–10 months). Twenty-three percent (n=6) of patients had no recurrence. The median survival was 28.9 months (range, 16.9–46.8 months) from major hepatectomy and 37.6 months (range, 25.2–53.1 months) from TARE.ConclusionsMajor hepatectomy after neoadjuvant lobar radioembolization is safe with a low incidence of PHLF.     

Obstructive sleep apnoea and non-restorative sleep induced by the interface

Sleep and Breathing -     

Thermal cycling distortion of porcelain fused to metal fixed partial dentures

Statement of problem. The initial fit of porcelain fused to metal restorations deteriorates during the firing cycle of porcelain. Purpose. This study evaluated thermal cycling distortion of 3-unit porcelain fused to metal frameworks at different firing stages. Material and methods. A master model was designed to represent the 2 abutments of a 3-unit fixed partial denture replacing a missing mandibular molar. Standard techniques were used to fabricate 10 castings. Half of the copings were cast in a Ni-Cr alloy and the other half in a Pd-Cu alloy. Framework distortion was measured by means of inner fit changes, horizontal linear measurements of the framework length, and vertical fit changes of each retainer. Measurements were made (1) initially, (2) after degassing firing, and (3) after glaze firing. Differences between the firing cycles created distortion values of the retainers in 3 dimensions. Repeated measures ANOVA was used to analyze data statistically. Results. Measured differences between the 2 firing stages ranged from –47 to 81.7 μm. For both alloy groups, retainers showed increase in vertical gap that implied poorer vertical fit after porcelain application. Mean values of inner fit change recorded for porcelain application firing were higher in magnitude than the values of metal-conditioning firing. In addition, no statistically significant differences were found among alloy types. Conclusions. A 3-dimensional distortion was observed both in Pd-Cu and Ni-Cr frameworks during porcelain firing cycle. The distortion seen after porcelain application firing was significantly greater than that seen after metal-conditioning firing. This result can be attributed to these factors, contamination of porcelain to the inner surface of metal coping and reduction in resilience of metal. (J Prosthet Dent 1998;80:654-60.)     

The effect of desensitizing treatments on the bond strength of resin composite to dentin mediated by a self-etching primer

This study evaluated the bond strength of resin composite to dentin, mediated by a self-etching adhesive, following the application of various dentin desensitizing treatments and artificial saliva storage. The buccal cervical areas of 24 extracted human third molars were ground flat to expose cervical dentin. The dentin surfaces were polished with 1200-grit SiC paper, then the teeth were randomly assigned to six groups, five desensitizing treatments and one control: Group I-VivaSens; Group II-Fluor Protector; Group III-Isodan; Group IV-Futura Bond NR; Group V-Nd:YAG laser and Group VI-Control (without application of a desensitizing agent). After applying the desensitizing treatments and storing the molars in artificial saliva for 14 days at 37 degrees C, Futura Bond NR was used to bond resin composite to dentin. TPH composite build-ups were constructed incrementally to a height of 5 mm. The teeth were sectioned to obtain bonded slices of 0.7 mm thick specimens containing the resin-composite joint. The specimens were then trimmed into an hourglass shape and subsequently subjected to microtensile testing at a crosshead speed of 1 mm/minute. The data were analyzed using the Kruskal-Wallis analysis and multiple comparisons test. The control (Group VI) and Futura Bond NR self-etching treatment (Group IV) group yielded statistically significant higher bond strength values than the other desensitizing treatment groups tested (p < 0.005). While pretreatment of dentin surfaces with desensitizing agents (Fluor Protector, VivaSens and Isodan) and laser (Nd:YAG) reduced the bond strength values of the resin composite, higher bond strengths were achieved using a self-etching adhesive (Futura Bond NR) as a desensitizing agent.     

Effectiveness of scaling and root planing versus modified Widman flap on nitric oxide synthase and arginase activity in patients with chronic periodontitis

BACKGROUND: Nitric oxide (NO) is synthesized from the conversion of L-arginine to L-citrulline by NO synthase (NOS). Arginase, which is an arginine-depleting enzyme, can compete with NOS for the common substrate L-arginine and thus inhibit NO production. OBJECTIVES: In the present study, we aimed to examine the correlation between the arginase and NOS activity in patients with chronic periodontitis and to compare the effects of scaling and root planing and modified Widman flap procedures on enzyme activity. MATERIAL AND METHODS: The study included 13 patients diagnosed with chronic periodontitis. Using a split-mouth design, the defects showing>or=7 mm of attachment loss were treated either with scaling and root planing or with modified Widman flap. Gingival biopsies from both sites were obtained at baseline and 2 months after periodontal treatment. Immunohistochemical staining was performed for evaluating NOS expression and specific arginase activity was determined spectrophotometrically. RESULTS: Although inflamed periodontal tissues demonstrated a strong inducible NOS (iNOS) expression at baseline, immunostaining decreased after periodontal treatment. iNOS expression intensity and the number of inflammatory cells showing iNOS expression were found to be higher in the scaling and root planing group compared to the modified Widman flap group. The specific activity of arginase was measured as 0.18+/-0.07 IU/mg protein in the modified Widman flap group and 0.25+/-0.11 IU/mg protein in the scaling and root planing group at baseline. After periodontal therapy, the enzyme level was increased to 0.68+/-0.14 IU/mg protein in the modified Widman flap and to 1.10+/-0.23 IU/mg protein in the scaling and root planing group. CONCLUSION: This study was the first report of evaluating the involvement of the arginine-NO pathway in chronic periodontitis and this might be considered to be of value in understanding the periodontal disease mechanisms.     

Evaluation of the applicability of temporomandibular opening index in Turkish children with and without signs and symptoms of temporomandibular joint disorders

Limitation of mandibular movement is one of the cardinal signs of temporomandibular disorders. Temporomandibular Opening Index (TOI) is a new technique to determine the restricted mouth opening in temporomandibular joint dysfunction syndrome (TMD). The purpose of this study was to compare the TOI of Turkish children with and without TMD in primary, mixed, and permanent dentitions. In this study, a total of 270 children were evaluated. One hundred thirty-five (135) subjects had no signs or symptoms of TMD (Group 1), while the remaining 135 subjects did have signs and symptoms of TMD (Group 2). Forty-five (45) patients were selected for each dentition for two groups. "Maximum Voluntary Mouth Opening" (MVMO) values and TOI ranges were calculated. A Mann-Whitney U test and a Kruskal Wallis test were used to compare the data (p<0.05). TOI showed statistical differences between all dentitions with and without TMD (p<0.05). There were no significant differences between different dentitions or genders in Group 1 or Group 2 (p<0.05).     

Surgical and prosthodontic treatment using alveolar distraction osteogenesis and implant placement for a patient with mandibular prognathism: a clinical report

A 49-year-old patient presented with an Angle Class III malocclusion with a partially edentulous mandible, as diagnosed by orofacial examination and radiographic and cephalometric analyses. The patient refused orthognathic surgery; therefore, the treatment plan included the preparation of all teeth and fabrication of provisional restorations to reestablish optimal occlusion. To allow for the placement of 3 implants, the edentulous posterior mandibular ridge was improved via alveolar distraction. The patient was recalled 3, 6, 12, and 24 months after prosthodontic treatment. The oral situation was stable and patient satisfaction was reported as high.     

Sera of Peruvians with fever of unknown origins include viral nucleic acids from non-vertebrate hosts

Serum samples collected from 88 Peruvians with unexplained fever were analyzed for viral sequences using metagenomics. Nucleic acids of anelloviruses, pegivirus A (GBV-C), HIV, Dengue virus, and Oropouche virus were detected. We also characterized from two sera the RNA genomes of new species of partitivirus and dicistrovirus belonging to viral families known to infect fungi or arthropod, respectively. Genomic DNA of a putative fungal cellular host could be PCR amplified from the partitivirus-containing serum sample. The detection in human serum of nucleic acids from viral families not known to infect vertebrates may indicate contamination during sample collection and aliquoting or human infection by their presumed cellular host, here a fungus. The role, if any, of the non-vertebrate infecting viruses detected in serum in inducing fever is unknown.