Bonding of resin to dentin. Interactions between materials, substrate and operators

OBJECTIVES: The general aim of this thesis was to identify and study factors that affect bonding between resin and dentin, including operator variability. MATERIALS AND METHODS: Bonding sites were generated in vivo and in vitro and compared using SEM. The effects of experimental water- or acetone-based primers on shear bond strength to dentin were studied in vitro. Fourier transform infrared spectroscopy was used to establish any detrimental effects from water on polymerization by determining the degree of conversion of thin films of resin. The interaction between phosphoric acid and dentin was analyzed by measuring calcium leaching by use of atomic absorption spectroscopy. Bond strength of composite resin was measured to dentin with various degrees of demineralization. Gap formation adjacent to composite restorations in standardized dentin cavities was studied in vitro by confocal microscopy. RESULTS: A similar morphological appearance was found for bonding sites generated in vitro vs. in vivo. An acetone-based primer was more dependent on a moist bonding technique than was a water-based system. However, water might influence bonding by interfering with the polymerization of the resin. Calcium leaching from dentin can be predicted by use of a solubility phase diagram. No correlation could be established between calcium leaching and bond strength. Gap formation was more dependent on the operator than the choice of material. A simplified all-in-one adhesive showed less operator variability compared to more complex bonding systems. CONCLUSIONS: In vitro bond testing may well indicate the outcome of in vivo trials. The solvents used in bonding agents will influence the performance and, presumably, technique sensitivity. Water rinse time after etching might be a more important consideration than etch time. In spite of the relative importance of the results presented above, the outcome of the multi-operator trial could not be predicted.     

Extracting data from electronic medical records: validation of a natural language processing program to assess prostate biopsy results

Objective

The extraction of specific data from electronic medical records (EMR) remains tedious and is often performed manually. Natural language processing (NLP) programs have been developed to identify and extract information within clinical narrative text. We performed a study to assess the validity of an NLP program to accurately identify patients with prostate cancer and to retrieve pertinent pathologic information from their EMR.

Materials and methods

A retrospective review was performed of a prospectively collected database including patients from the Southern California Kaiser Permanente Medical Region that underwent prostate biopsies during a 2-week period. A NLP program was used to identify patients with prostate biopsies that were positive for prostatic adenocarcinoma from all pathology reports within this period. The application then processed 100 consecutive patients with prostate adenocarcinoma to extract 10 variables from their pathology reports. The extraction and retrieval of information by NLP was then compared to a blinded manual review.

Results

A consecutive series of 18,453 pathology reports were evaluated. NLP correctly detected 117 out of 118 patients (99.1 %) with prostatic adenocarcinoma after TRUS-guided prostate biopsy. NLP had a positive predictive value of 99.1 % with a 99.1 % sensitivity and a 99.9 % specificity to correctly identify patients with prostatic adenocarcinoma after biopsy. The overall ability of the NLP application to accurately extract variables from the pathology reports was 97.6 %.

Conclusions

Natural language processing is a reliable and accurate method to identify select patients and to extract relevant data from an existing EMR in order to establish a prospective clinical database.     

Comparative biomechanical study on three miniplates osteosynthesis systems for stabilisation of low condylar fractures of the mandible

Open reduction and fixation of low condylar fractures of the mandible can be achieved by many osteosynthesis systems that differ in size, shape, and site of placement according to the surgical approach. We investigated the maximum load and rigidity of 4 osteosynthesis systems: the standard double 4-hole straight miniplates, the inverted y-miniplate (with and without self-drilling screws), and the TriLock Delta condyle trauma plate. The standard double 4-hole straight miniplate osteosynthesis achieved the best fixation and resistance in view of a mean (SD) maximum load of 539.8 (100.2) N, followed by the inverted y-miniplate with the self-drilling screws (246.5 (23.8) N), the inverted y-miniplate with standard screws (242.4 (27.2) N), and finally the TriLock Delta plate (167.4 (39.2) N). Analysis of the slope of the force–displacement diagram from 80 N to 100 N in each group showed that the TriLock Delta miniplate had the highest values for rigidity (17.3 (5.1) N/μm), followed by the inverted y-miniplate groups with self-drilling screws (14.1 (6.4) N/μm), and with standard screws (12.6 (2.5) N/μm). The double 4-hole straight miniplate osteosynthesis had the lowest rigidity (8.7 1.4) N/μm). Despite the significant difference in the maximum load between the double 4-hole miniplates and other investigated osteosynthesis patterns, all groups had sufficient load for the fixation of low condylar fractures of the mandible when postoperative bite forces and the slowly increasing voluntary clenching during healing were considered.     

Gut inflammation and expression of ICC in a fetal lamb model of fetoscopic intervention for gastroschisis

Background

The pathogenesis of intestinal dysmotility in gastroschisis is not completely understood. Peel formation and disorganization of interstitial Cajal cells (ICC) have been proposed in humans. The aim of this study was to evaluate the impact of prenatal coverage of gastroschisis on gut inflammation and expression of ICC in a fetal lamb model.

Methods

Twenty-one German blackhead sheep with an abdominal wall defect that was created fetoscopically on day 77 of 145 days gestation were used in this study. Intrauterine surgery with the aim to cover the defect was performed 3 weeks later; two fetuses were covered completely, 5 partially and 11 remained uncovered. Three fetuses without gastroschisis were used as controls. All fetuses were retrieved by cesarean section at day 135. Samples of the small intestine were stained with hematoxylin and eosin for histologic analysis of peel formation and serosal and muscular thickness. For ICC detection, immunohistochemistry using anti-CD117 (c-Kit) antibody was used.

Results

In all samples with exposure to amniotic fluid, peel formation and significantly decreased ICC were found. Complete coverage reduced peel formation and disorganization of ICC compared to uncovered animals almost to the level of controls.

Conclusions

Peel formation and ICC derangement were significantly reduced by prenatal coverage of gastroschisis. Moreover, this animal model mimics the histopathological bowel changes as seen in human gastroschisis and may, therefore, be used for further research on the pathophysiology and fetal therapy of this malformation.     

Natural history of intraventricular meningiomas: systematic review

Review the data published on the subject to create a more comprehensive natural history of intraventricular meningiomas (IVMs). A Medline search up to March 2018 using “intraventricular meningioma” returned 98 papers. As a first selection step, we adopted the following inclusion criteria: series and case reports about IVMs, as well as papers written in other languages, but abstracts written in English were evaluated. Six hundred eighty-one tumors were evaluated from 98 papers. The majority of the tumors were located in the lateral ventricles (602–88.4%), fourth ventricle (59–8.7%), and third ventricle (20–2.9%). These tumors accounted for a mortality rate of 4.0% (25 deaths) and a recurrence rate of 5.3% (26 recurrences). The majority of the tumors were grade I (89.8%) and consisted of the following subtypes: fibrous, 39.7% (n = 171); transitional, 22.0% (n = 95); meningothelial, 18.6% (n = 80); angiomatosus, 3.2% (n = 14); psammomatous, 2.6% (n = 11); and others, 13.9% (n = 60). Forty-five patients (7.4%) presented with grade II (GII) tumors, and 17 patients (2.8%) presented with grade III (GIII) tumors. These tumors follow the histopathological distribution of meningiomas in general, with the exception of the higher prevalence of the fibrous subtype, possibly due to its embryonic origin. Recurrence and mortality were lower than in other localizations likely due to a complete surgical resection rate than in the convexity and skull base, which suggests that GTR is the gold standard for the management of IVMs.