A feasible, aesthetic quality evaluation of implant-supported single crowns: an analysis of validity and reliability

Objectives: To test the reliability and validity of six aesthetic parameters and to compare the professional‐ and patient‐reported aesthetic outcomes. Material and methods: Thirty‐four patients with 66 implant‐supported premolar crowns were included. Two prosthodontists and 11 dental students evaluated six aesthetic parameters, the Copenhagen Index Score (CIS): (i) crown morphology score, (ii) crown colour match score, (iii) symmetry/harmony score, (iv) mucosal discolouration score, (v) papilla index score, mesially and (vi) papilla index score, distally. The intra‐ and inter‐observer agreement and the internal consistency were analysed by Cohen's κ and Cronbach's α, respectively. The validity of CIS parameters was tested against the corresponding Visual Analogue Scales (VAS) scores. The Spearman correlation coefficients were used. Six aesthetic Oral Health Impact Profile (OHIP) questions were correlated to the CIS and the overall VAS scores. Results: The intra‐observer agreement was >70% in 2/3 and >50% in all observations. The inter‐observed agreement was >50% in 4/5 of all observations. The mucosal discolouration score had the overall highest observed agreement followed by the papilla index scores. The crown morphology and the symmetry/harmony scores had the overall lowest agreement. The Cronbach α value was over 0.8 for all observers. All CIS scores demonstrated significant (P<0.0001) correlation to the corresponding VAS scores. Low correlation coefficients (CIS/OHIP: r_s<0.36; VAS/OHIP: r_s >?0,24) were found between patient and professional evaluations. Conclusions: The feasibility, reliability and validity of the CIS make the parameters useful for quality control of implant‐supported restorations. The professional‐ and patient‐reported aesthetic outcomes had no significant correlation. To cite this article:
Hosseini M, Gotfredsen K. A feasible, aesthetic quality evaluation of implant‐supported single crowns: an analysis of validity and reliability.
Clin. Oral Impl. Res. 23 , 2012 453–458.
doi: 10.1111/j.1600‐0501.2011.02162.x     

Robot-assisted Radical Cystectomy: Description of an Evolved Approach to Radical Cystectomy

Background

Although open radical cystectomy (ORC) remains the gold standard of care for muscle-invasive bladder cancer, robot-assisted radical cystectomy (RARC) continues to gain wider acceptance. In this article, we focus on the steps of RARC, describing our approach, which has been developed over the past 10 yr. Totally intracorporeal RARC aims to offer the benefits of a complete minimally invasive approach while replicating the oncologic outcomes of open surgery.

Objective

We report our outcomes of a totally intracorporeal RARC procedure, describing step by step our technique and highlighting the variations on this standard template of nerve-sparing and female organ–preserving approaches in men and women.

Design, setting, and participants

Between December 2003 and October 2012, a total of 113 patients (94 male and 19 female) underwent totally intracorporeal RARC.

Surgical procedure

We performed RARC, extended pelvic lymph node dissection, and a totally intracorporeal urinary diversion (UD) in all patients. In the accompanying video, we focus on the standard template for RARC, also describing nerve-sparing and female organ–preserving approaches.

Outcome measurements and statistical analysis

Complications and oncologic outcomes are reported, including overall survival (OS) and cancer-specific survival (CSS) using Kaplan-Meier analysis.

Results and limitations

RARC with intracorporeal UD was performed in 113 patients. Mean age was 64 yr (range: 37–84). Forty-three patients underwent intracorporeal ileal conduit, and 70 had intracorporeal neobladder. On surgical pathology, 48% of patients had ≤pT1 disease, 27% had pT2 disease, 13% had pT3 disease, and 12% had pT4 disease. The mean number of lymph nodes removed was 21 (range: 0–57). Twenty percent of patients had lymph node–positive disease. Positive surgical margins occurred in six cases (5.3%). Median follow-up was 25 mo (range: 3–107). We recorded a total of 70 early complications (0–30 d) in 54 patients (47.8%), with 37 patients (32.7%) having Clavien grade ≥3. Thirty-six late complications (>30 d) were recorded in 30 patients (26.5%), with 20 patients (17.7%) having Clavien grade ≥3. One patient (0.9%) died within 90 days of operation from pulmonary embolism. Using Kaplan-Meier analysis, CSS was 81% at 3 yr and 67% at 5 yr.

Conclusions

Our structured approach to RARC has enabled us to develop this complex service while maintaining patient outcomes and complication rates comparable with ORC series. Our results demonstrate acceptable oncologic outcomes and encouraging long-term CSS rates.     

The impact of vitamin and/or mineral supplementation on lipid profiles in type 2 diabetes

OBJECTIVE: The purpose of the present study was to assess the impact of Mg + Zn, Vitamins C + E, and combination of these micronutrients on serum lipid and lipoprotein profiles in type 2 diabetic patients. MATERIALS AND METHODS: In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months; group M: 200 mg Mg and 30 mg Zn (n = 16), group V: 200mg Vitamin C and 150 mg Vitamin E (n = 18), group MV: minerals plus vitamins (n = 17), group P: placebo (n = 18). Fasting blood and urine samples were collected at the beginning and at the end of the trial. Serum triglyceride, total cholesterol, high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) were measured enzymatically. Apolipoproteins (apo) A1 and B were measured by immunoturbidimetric method. Adjustment for differences in baselines covariates and changes in variables during study were performed by analysis of covariance using general linear models. RESULTS: Results indicate that after 3 months of supplementation mean serum levels of HDL-c and apo A1 increased significantly in the MV group by 24% (50.4 +/-19.3 mg/dl versus 40.6 +/- 10.8 mg/dl) and 8.8% (169.8 +/- 33.8 mg/dl versus 156.1+ /- 23.9 mg/dl), respectively (P < 0.01). There were no significant changes in the levels of these parameters in the other three groups. Serum levels of total cholesterol, LDL-c, triglyceride, and apo B were not altered after supplementation in all four groups. CONCLUSION: It is concluded that since co-supplementation of Mg, Zn, Vitamins C and E significantly increases HDL-c and apo A1, supplementation of these micronutrients could be recommended for the type 2 diabetic patients based on their daily requirements.     

[3H]2-(2-Benzofuranyl)-2-imidazoline,a highly selective radioligand for I2-imidazoline receptor binding sites Studies in rabbit kidney membranes

2-(2-Benzofuranyl)-2-imidazoline (2-BFI) has recently been characterised as a selective ligand for the I₂-type of imidazoline-receptor binding site(s) (I₂-RBS). The present studies determined the relative levels of specific [³H]2-BFI binding to membrane homogenates of brain and kidney from rat, guinea pig and rabbit and identified the pharmacological characteristics of [³H]2-BFI binding sites in rabbit kidney membranes. Rabbit kidney membranes had the highest relative density of specific [³H]2-BFI binding of all tissues studied (2000?fmol/mg protein). Rabbit brain and guinea pig kidney had moderate levels of specific [³H]2-BFI binding (350–500?fmol/mg protein), while rat kidney and guinea pig and rat brain displayed much lower densities of binding (40–65?fmol/mg protein). Studies of [³H]2-BFI binding kinetics in rabbit kidney homogenates revealed binding to two distinct sites with K _d values of 0.10?±?0.01?nmol/l and 1.00?±?0.36?nmol/l respectively. Equilibrium saturation studies were also consistent with the presence of two binding sites – [³H]2-BFI (0.01–20?nmol/l) bound to sites with affinities of 0.10?± 0.01?nmol/l and 0.92?±?0.13?nmol/l and binding densities of 470?±?80 and 840?±?60?fmol/mg protein (n=3), representing 36 and 64% respectively. Drug inhibition studies revealed that l-adrenaline; α₁-adrenoceptor drugs (prazosin, l-phenylephrine) and α₂-adrenoceptor drugs (rauwolscine, methoxyidazoxan, 2-(2,4-(O-methoxyphenyl)-piperazin-1-yl)-ethyl-4,4-dimethyl-1,3-(2H,4H)-isoquinolindione (ARC-239) had extremely low affinities for [³H]2-BFI binding sites (IC₅₀?≥?10?μmol/l). Putative I₁-RBS compounds, p-aminoclonidine, moxonidine, imidazole-4-acetic acid and cimetidine, inhibited [³H]2-BFI binding to rabbit renal membranes with low to very low affinities (K _i values 3 to ≥100?μmol/l), suggesting [³H]2-BFI does not label I₁-RBS in rabbit kidney membranes. I₂-RBS compounds – 2-(4,5-dihydroimidaz-2-yl)-quinoline (BU224), 2-(4,5-dihydroimidaz-2-yl)-quinoxaline (BU239), idazoxan and cirazoline – potently inhibited [³H]2-BFI binding (K _i values 0.37–1.6?nmol/l), confirming the labelling of I₂-RBS. Inhibition of [³H]2-BFI binding by certain compounds was consistent with their interaction with two binding site populations – for example (drug, K _i values) guanabenz, 0.65?nmol/l and 0.17?μmol/l; naphazoline, 0.94?nmol/l and 2.8?μmol/l; amiloride, 76?nmol/l and 26?μmol/l rilmenidine, 150?nmol/l and 50?μmol/l; and clonidine, 230?nmol/l and 70?μmol/l. The high affinity of amiloride for a high proportion (85%) of the binding is consistent with the presence of the I_2A-subtype of I-RBS in rabbit kidney. These results demonstrate that [³H]2-BFI is a highly selective and high affinity radioligand for I₂-RBS which should be useful for the further characterisation of these sites in mammalian tissues.     

Cetyltrimethyl ammonium bromide effect on highly electrocatalysis of methanol oxidation based on nickel particles electrodeposited into poly (m-toluidine) film on the carbon paste electrode

In this work, m-toluidine is electropolymerized at the surface of carbon paste electrode using consecutive cyclic voltammetry in 20 mM monomer aqueous solution in the presence of 6 mM cetyltrimethyl ammonium bromide (CTAB) as surfactant. Then transition metal of nickel is incorporated into the polymer by electrodepositing of Ni (II) from 1.5 M NiSO₄ acidic solution using chronoamperometry technique (−1.0 V versus Ag|AgCl|KCl (3 M) for 15 min). In alkaline medium (i.e. NaOH 0.1 M) a good redox behavior of Ni (III)/Ni (II) couple at the surface of Ni/poly (m-toluidine) modified carbon paste electrode (Ni/PMT/MCPE) in the absence and presence of CTAB (Ni/CTAB-PMT/MCPE) can be observed. Electrocatalytic oxidation of methanol has been studied on Ni/PMT/MCPE and Ni/CTAB-PMT/MCPE. The results show that CTAB significantly enhances the catalytic efficiency of nickel particles on the oxidation of methanol in aqueous alkaline media. Moreover, the effects of various parameters such as concentration of CTAB, concentration of methanol, electrodepositing time, film thickness and monomer concentration on the electrooxidation of methanol as well as long-term stability of the Ni/CTAB-PMT/MCPE have also been investigated. This polymeric modified electrode can oxidize the methanol with high current density (over 40 mA cm⁻²).     

Electrocatalytic oxidation of hydrazine using glassy carbon electrode modified with carbon nanotube and terpyridine manganese(II) complex

Here, we report a simple and extremely effective method to modify a glassy carbon (GC) electrode with carbon nanotubes (CNTs) and [Mn(CH₃COO)(CH₃OH)₂(pyterpy)]ClO₄, (pyterpy = 4′-(4-pyridyl)-2,2′:6′,2′′-terpyridine) complex. The kinetics of the reaction between, the terpyridine manganese(II) complex, mediator and hydrazine has been characterized using cyclic voltammetry and rotating disk electrode voltammetry. The catalytic currents were proportional to the concentration of hydrazine giving rise to calibration curves characterized by two linear segments. The linear segment over the concentration range of 1.00 × 10⁻³–1.05 mM could be used with analytical purposes to determination of hydrazine with a detection limit of 0.50 μM and a sensitivity of 0.038 μA/μM. The heterogeneous rate constant, k′ for the oxidation of hydrazine at the surface of the modified electrode was determined by rotating disk electrode voltammetry using the Koutecky–Levich plot. The transfer coefficient (α) for electrocatalytic oxidation of hydrazine and the diffusion coefficient of this substance under the experimental conditions were also investigated. The resulting modified electrode retains its initial response for at least one month if stored dry in air.     

Aneurysm formation of pericardial patch in Manouguian procedure

Pericardial patch has been used to repair cardiac defects; however, its strength as an aortoplasty patch to tolerate systemic pressure is a matter of debate. We report an aneurysmal dilatation of pericardial patch in aortoplasty. Our patient was a 56-year-old female known case of rheumatic heart disease that underwent redoes mitral and aortic valve replacements along with Manouguian aortoplasty at the age of 44?years old. After 2?months, she was readmitted with a diagnosis of endocarditis. Echocardiography revealed a small cavity in the posterior wall of the aorta. She responded to medical therapy and discharged in a good condition. Twelve years later, she was scheduled to undergo reoperation due to a severe paraprosthetic aortic valve leakage and a pericardial patch aneurysm. The leaking prosthetic aortic valve was explanted and the aneurysmal tissue was replaced with a polyethylene terephthalate patch.