Microstructure of veneered zirconia after surface treatments: A TEM study

Objective

Clinical studies reveal that veneer chipping is one major problem associated with zirconia based dental restorations, the underlying mechanisms being still investigated. We semi-quantitatively analyzed the effects of different surface treatments (thermal etching, 35/105 μm sandblasting and coarse bur drilling (150 μm)) on the microstructure of a zirconia veneered dental ceramic.

Methods

The relative monoclinic content on zirconia surfaces was determined using X-ray diffraction (XRD). The microstructure at the zirconia–veneer interface has thereafter been investigated using transmission electron microscopy (TEM). Selected area electron diffraction (SAED) was used to qualitatively assess the depth of the stress-induced phase transformation.

Results

Sandblasting or bur drilling significantly roughened the zirconia surface. A reverse transformation of already transformed monoclinic zirconia grains back into the tetragonal polymorph has been observed after thermal veneering treatment. In TEM, the mechanically treated samples revealed a highly damaged area of 1–3 μm from the interface. The presence of monoclinic phase in veneered zirconia samples has been observed in SAED up to depths of 4 μm (35 μm sandblasted), 11 μm (105 μm sandblasted) and 9 μm (150 μm diamond drilled) below the interface.

Significance

Regardless of the treatment protocol and produced roughness, the veneering ceramic perfectly sealed the zirconia surface. XRD showed an increased amount of monoclinic phase on the surface treated zirconia. However after thermal treatment, the monoclinic phase was re-transformed into the tetragonal polymorph. TEM/SAED analysis has found indication for a greater extend of the monoclinic transformation into the bulk zirconia compared to the treatment related defective zone depth.     

Outcomes of mentored, grant-funded fellowship training in haemostasis /thrombosis: findings from a nested case-control survey study

Successful strategies by which to effectively recruit and retain academic subspecialists in benign haematology have not been established. To evaluate the effectiveness of a grant-funded, mentored fellowship with respect to retention and early career goals in haemostasis/thrombosis, we sought to compare outcomes for graduates of a grant-funded, mentored fellowship training programme in haemostasis/thrombosis [the National Hemophilia Foundation (NHF)-Baxter Clinical Fellowship Award] during conventional haematology/oncology fellowship training (cases), vs. their training peers who were graduates of conventional haematology/oncology fellowship training alone (controls), via a nested case-control survey study. Survey response rate was 85% (11/13) for cases and 90% (9/10) for controls. All respondents had pursued careers in academic haematology/oncology. Median (range) percent time spent in benign haematology postfellowship was 98% (70-100%) for cases vs. 0% (0-20%) for controls. Time spent in research was significantly greater among cases than controls (median 80% [range: 42-90%] vs. 55% [10-80%], respectively; P = 0.01). By years 3-4 postfellowship, median annual number of peer-reviewed publications was higher for cases than controls (3.5 vs. 1.0; P = 0.01). Cases were also more successful in grant funding (including K-awards). These data suggest that a grant-funded, mentored fellowship training programme in haemostasis/thrombosis may be superior to conventional haematology/oncology fellowship training alone with respect to outcomes of retention in clinical care/research, early-career grant funding and publication productivity.     

Techniques for self-measurement of blood pressure: limitations and needs for future research

Self blood pressure measurement (SBPM) improves the overall management of hypertension provided it is implemented with methodologic care. This concerns especially the accuracy and technical requirements of blood pressure (BP) measuring devices that should be validated according to internationally accepted protocols. The use of memory-equipped automatic home monitors is strongly recommended because they reduce observer bias, avoid patients' misreporting, and allow fully automatic analysis by software. For current use, simple software should be worked out that allow for analysis of readings in an objective manner. Miscuffing is also a frequent source of measurement error in obese arms when oscillometric devices are used. Modern automatic devices can overcome this problem because of special software algorithms that can provide accurate measurements over a wide range of arm circumferences when coupled with a single cuff of standard dimensions. Tronco-conical-shaped cuffs are a key component of this instrumentation because they better fit on large conical arms frequently present in obese individuals. Semi-rigid cuffs should be increasingly used because they ensure that the proper amount of tension is applied without the intervention of the user. Continuous technology improvement of instrumentation for SBPM can be achieved through close cooperation between manufacturers and validation centers.     

IMI Impact of Myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.