Effect on enamel shear bond strength of adding microsilver and nanosilver particles to the primer of an orthodontic adhesive

Background

The objective of this study was to determine whether the addition of microsilver or nanosilver particles to an orthodontic primer affects shear bond strength (SBS) and bracket/adhesive failure.

Methods

Bovine incisors were randomly divided into six groups with 16 specimens in each: In group 1 (control), brackets were bonded with Transbond? XT primer. In the experimental groups, microsilver (groups 2 and 3) and nanosilver (groups 4–6) particles of different sizes were added to Transbond XT primer and light cured for 15 seconds [group 2: 0.1% (w/w) microsilver particle size 3.5–18 μm; group 3: 0.3% (w/w) microsilver particle size 3.5–18 μm; group 4: 0.11% (w/w) nanosilver particle size 12.6–18.5 nm; group 5: 0.18% (w/w) nanosilver particle size 12.6–18.5 nm; group 6: 0.33% (w/w) nanosilver particle size 12.6–18.5 nm]. Thereafter, brackets were bonded by light curing the adhesive for 20 seconds. After 24 hours of storage in distilled water at 37°C, SBS was measured with a Zwicki 1120 testing machine. The adhesive remnant index and the prevalence of silver spots on the specimen surface were determined under 10× magnification. Statistical two-way analysis of variance was performed to compare SBS, and a chi-square test was used to compare ARI scores and the prevalence of silver spots.

Results

No significant differences in SBS (control: 16.59?±?6.82 MPa; group 2: 20.6?±?4.19 MPa; group 3: 16.98?±?4.84 MPa; group 4: 17.15?±?5.92 MPa; group 5: 20.09?±?3.35 MPa; group 6: 16.44?±?4.51 MPa; p?>?0.665) and ARI scores (p?=?0.901) were found between the control group and any experimental group. Only experimental groups with nanosilver particles revealed statistically more silver spots on the remaining adhesive.

Conclusions

Addition of small concentrations of microsilver or nanosilver particles affects neither SBS nor ARI scores. Addition of nanosilver particles results in silver spots in the remaining primer visible under 10× magnification. Further studies are needed to investigate the anti-caries potential and clinical performance of conventional orthodontic primer with incorporated nanosilver or microsilver particles.

     

Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial

Importance

Acute kidney injury (AKI) is characterized by severe loss of glomerular filtration rate (GFR) and is associated with a prolonged intensive care unit (ICU) stay and increased risk of death. No interventions have yet been shown to prevent AKI or preserve GFR in critically ill patients. Evidence from mammalian physiology and small clinical trials suggests higher amino acid intake may protect the kidney from ischemic insults and thus may preserve GFR during critical illness.

Objective

To determine whether amino acid therapy, achieved through daily intravenous (IV) supplementation with standard amino acids, preserves kidney function in critically ill patients.

Design, setting, and participants

Multicenter, phase II, randomized clinical trial conducted between December 2010 and February 2013 in the ICUs of 16 community and tertiary hospitals in Australia and New Zealand. Participants were adult critically ill patients expected to remain in the study ICU for longer than 2 days.

Interventions

Random allocation to receive a daily supplement of up to 100 g of IV amino acids or standard care.

Main outcomes and measures

Duration of renal dysfunction (primary outcome); estimated GFR (eGFR) derived from creatinine; eGFR derived from cystatin C; urinary output; renal replacement therapy (RRT) use; fluid balance and other measures of renal function.

Results

474 patients were enrolled and randomized (235 to standard care, 239 to IV amino acid therapy). At time of enrollment, patients allocated to receive amino acid therapy had higher APACHE II scores (20.2 ± 6.8 vs. 21.7 ± 7.6, P = 0.02) and more patients had pre-existing renal dysfunction (29/235 vs. 44/239, P = 0.07). Duration of renal dysfunction after enrollment did not differ between groups (mean difference 0.21 AKI days per 10 patient ICU days, 95 % CI ?0.27 to 1.04, P = 0.45). Amino acid therapy significantly improved eGFR (treatment group × time interaction, P = 0.004), with an early peak difference of 7.7 mL/min/1.73 m² (95 % CI 1.0–14.5 mL/min/1.73 m², P = 0.02) on study day 4. Daily urine output was also significantly increased (+300 mL/day, 95 % CI 145–455 mL, P = 0.0002). There was a trend towards increased RRT use in patients receiving amino acid therapy (13/235 vs. 25/239, P = 0.062); however, this trend was not present after controlling for baseline imbalance (P = 0.21).

Conclusion and relevance

Treatment with a daily IV supplement of standard amino acids did not alter our primary outcome, duration of renal dysfunction.

Trial registration

anzctr.org.au Identifier: ACTRN12609001015235.

     

Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients

Background

Hemorrhoidal disease is highly prevalent in the western world. Stapled hemorrhoidopexy also known as the procedure for prolapsed hemorrhoids (pph) has been shown to be superior to conventional hemorrhoidectomy with regard to postoperative pain, length of hospital stay and early return to work. Proctitis following stapled hemorrhoidopexy has not been reported previously. Herein, we report our experience with proctitis in patients following stapled hemorrhoidopexy and question if proctitis could be a complication of stapled hemorrhoidopexy.

Materials and methods

A retrospective analysis of the data of patients undergoing stapled hemorrhoidopexy with the PPH03 in the coloproctology unit of the department of surgery of a primary care hospital in Germany within a 5-year period was performed. All cases were managed and followed up by a single attending surgeon with expertise in coloproctology.

Results

129 patients were included for analysis including 21 cases with grade 2, 103 cases of grade 3 and 5 cases of grade 4 hemorrhoids. The median duration of surgery was 20 min. 17 complications including two recurrences were recorded. Post-pph proctitis was recorded in 14 cases (10.9 %). Post-pph proctitis was not associated with gender, extent of hemorrhoidal disease, BMI and ASA (p >0.05). All cases recovered within 4 weeks following management with nonsteroidal anti-inflammatory drugs and suppositories.

Conclusion

Proctitis could be a complication of stapled hemorrhoidopexy with a good response to conservative treatment with suppositories.

     

Are radiographic indices reliable indicators for quantitative bone mineral density and vitamin D status after femoral neck fractures? A retrospective study in 112 elderly patients

Background

Radiographic parameters and indices obtained from hip x-rays are a potential tool to promptly estimate bone quality in elderly hip fracture patients. Preoperative decision in whether to use cemented or cement augmented implants might be supported by this information and thus improve patient safety. Subsequently, this study was conducted to evaluate radiographic parameters as a prescreening tool for bone quality.

Methods

A retrospective analysis of 112 elderly patients with a femoral neck fracture after low-energy trauma was performed (81 % female, 19 % male). Three radiological indices were calculated on hip x-rays: cortical index antero-posterior CTI (ap), cortical index lateral CTI (lat) and canal to calcar ratio CCR. These indices were analyzed for correlations with DXA T-Scores and serum 25-hydroxyvitamin D (25(OH)D) using the Spearman test.

Results

Median age of patients was 80 (IQR 72–86) years. A linear correlation was found for CTI (lat) and T-Score at the total hip (p?<?0.001, r?=?0.589), femoral neck (p?=?0.005, r?=?0.405) and the lumbar spine (p?=?0.002, r?=?0.299). A significant correlation was also indicated between CTI (lat) and 25(OH)D (p?=?0.002, r?=?0.293). CTI (lat) at a cut-off level of 0.4 showed a sensitivity of 79 % and a specificity of 56 % in predicting a T-score?≤??2.5 at the total hip. Gender specific analysis revealed a higher sensitivity (100 %) and specificity (73 %) of CTI (lat) at a cut-off level of 0.4 for men. For severe vitamin D deficiency (<10 ng/ml) sensitivity and specificity were 75 % and 65 %.

Conclusion

Radiographic indices as the CTI (lat) exhibit a direct correlation to BMD and serum 25OH vitamin D levels. A CTI (lat) cut-off level of 0.4 is recommended for identifying patients at risk of osteoporosis expressed by T-Scores?≤??2.5 and severe vitamin D deficiency.

     

Parenchymal preserving anatomic resections result in less pulmonary function loss in patients with Stage I non-small cell lung cancer

Background

A suggested benefit of sublobar resection for stage I non-small cell lung cancer (NSCLC) compared to lobectomy is a relative preservation of pulmonary function. Very little objective data exist, however, supporting this supposition. We sought to evaluate the relative impact of both anatomic segmental and lobar resection on pulmonary function in patients with resected clinical stage I NSCLC.

Methods

The records of 159 disease-free patients who underwent anatomic segmentectomy (n?=?89) and lobectomy (n?=?70) for the treatment of stage I NSCLC with pre- and postoperative pulmonary function tests performed between 6 to 36 months after resection were retrospectively reviewed. Changes in forced expiratory volume in one second (FEV₁) and diffusion capacity of carbon monoxide (DLCO) were analyzed based upon the number of anatomic pulmonary segments removed: 1–2 segments (n?=?77) or 3–5 segments (n?=?82).

Results

Preoperative pulmonary function was worse in the lesser resection cohort (1–2 segments) compared to the greater resection group (3–5 segments) (FEV_{1(%predicted)}: 79% vs. 85%, p?=?0.038; DLCO_(%predicted): 63% vs. 73%, p?=?0.010). A greater decline in FEV₁ was noted in patients undergoing resection of 3–5 segments (FEV_{1 (observed)}: 0.1 L vs. 0.3 L, p?=?0.003; and FEV_{1 (% predicted)}: 4.3% vs. 8.2%, p?=?0.055). Changes in DLCO followed this same trend (DLCO_(observed): 1.3 vs. 2.4 mL/min/mmHg, p?=?0.015; and DLCO_{(% predicted)}: 3.6% vs. 5.9%, p?=?0.280).

Conclusions

Parenchymal-sparing resections resulted in better preservation of pulmonary function at a median of one year, suggesting a long-term functional benefit with small anatomic segmental resections (1–2 segments). Prospective studies to evaluate measurable functional changes, as well as quality of life, between segmentectomy and lobectomy with a larger patient cohort appear justified.

     

Proctologie pédiatrique courante

The reasons for children to consult in pediatric proctology are various, usually benign and non-surgical. The main infectious diseases are perianal abscess which management remains controversial, and perineal streptococcal infection which is often delayed in diagnosis and has a high recurrence in case of poor compliance or inappropriate treatment. Anal fissure and rectal prolapse are the most frequent non infectious diseases, and they are both related to constipation which must be treated effectively. Cystic fibrosis must be investigated in case of rectal prolapse. Perianal lesions secondary to sexual abuse are often really difficult to diagnose certainly and should not be under- or over-estimated because of a lack of knowledge in perianal findings in children.     

Three-Dimensional SVM with Latent Variable: Application for Detection of Lung Lesions in CT Images

The study aims to improve the performance of current computer-aided schemes for the detection of lung lesions, especially the low-contrast in gray density or irregular in shape. The relative position between suspected lesion and whole lung is, for the first time, added as a latent feature to enrich current Three-dimensional (3D) features such as shape, texture. Subsequently, 3D matrix patterns-based Support Vector Machine (SVM) with the latent variable, referred to as L-SVM^3Dmatrix, was constructed accordingly. A CT image database containing 750 abnormal cases with 1050 lesions was used to train and evaluate several similar computer-aided detection (CAD) schemes: traditional features-based SVM (SVM^feature), 3D matrix patterns-based SVM (SVM^3Dmatrix) and L-SVM^3Dmatrix. The classifier performances were evaluated by computing the area under the ROC curve (AUC), using a 5-fold cross-validation. The L-SVM^3Dmatrix sensitivity was 93.0 with 1.23 % percentage of False Positive (FP), the SVM^3Dmatrix sensitivity was 88.4 with 1.49 % percentage of FP, and the SVM^feature sensitivity was 87.2 with 1.78 % percentage of FP. The L-SVM^3Dmatrix outperformed other current lung CAD schemes, especially regarding the difficult lesions.     

Feasibility Study of a Sensor-Based Autonomous Load Control Exercise Training System for COPD Patients

Decision support systems (DSSs) which are able to automatically supervise and control physical exercise training of patients affected by chronic obstructive pulmonary disease (COPD) are regarded as a novel method to promote rehabilitation. The objective of our research work for this paper was to evaluate the feasibility of a rule-based DSS for autonomous bicycle ergometer training of COPD patients. Load control is based on real-time analysis of sensor parameters oxygen saturation and heart rate. Ten COPD patients have participated in a study, performing altogether 18 training sessions. On average, 7.4 rules were fired in each training session. Four sessions had to be stopped for different reasons. The average ergometer training load ranged between 31 and 47 W. The average percentage of heart rate in or lower than the intended target zone was 45.9 and 41.6 %, respectively. The average patient-perceived Borg value was 12.6?±?2.4. Patients reported a high satisfaction for the automatically controlled training. With the help of the DSS, patients may change their training place from a rehabilitation center to their own homes. More studies are needed to assess long-term clinical and motivational effects of the DSS in home environment.