A Retrospective Clinical Study on 1075 Lithium Disilicate CAD/CAM Veneers with Feather-Edge Margins Cemented on 105 Patients.

PURPOSE: To evaluate the clinical performance of lithium disilicate (LiDiSi) computer-aided- design/computer-assisted-manufacturing (CAD/CAM) veneers with feather-edge margins. METHODS: Over 4 years (2015-2019), 1075 LiDiSi veneers with feather-edge margins were fabricated with a fully digital workflow and cemented on 105 patients. The outcome variables were survival of the restorations, colour matching, quality of the ceramic surface, presence of marginal discolouration and marginal integrity. The last four variables were assessed using the modified California Dental Association (CDA) and Ryge criteria. RESULTS: The mean observation period was 30.8 months. The cumulative survival rate was 99.83%. At the last follow-up control, the colour matching of the surviving 1074 restorations was rated Alpha (1064 veneers, 99.06%) and Bravo (10 veneers, 0.94%); the ceramic surface was rated Alpha (1070 veneers, 99.62%) and Bravo (4 veneers, 0.38%); the marginal discolouration was rated Alpha (1069 veneers, 99.53%) and Bravo (5 veneers, 0.47%); and the marginal integrity was rated Alpha (1070 veneers, 99.62%) and Bravo (4 veneers, 0.38%). CONCLUSION: CAD/CAM LiDiSi veneers with feather-edge margins fabricated with a fully digital workflow showed good clinical performance in terms of survival, colour matching, ceramic surface, marginal discolouration and integrity. Further, prospective and long-term studies are needed to confirm these positive results.

Continuous Scan Strategy (CSS): A Novel Technique to Improve the Accuracy of Intraoral Digital Impressions.

PURPOSE: To present the results obtained with the "Continuous Scan Strategy" (CSS), a direct intraoral scanning technique based on the connection of the implant scan bodies (SBs) with thermoplastic resin. METHODS: 40 patients were restored with 45 long-span monolithic implant-supported zirconia restorations (10 partial prostheses [PP] and 35 full arches [FA]) fabricated via a full-digital workflow after the capture of an intraoral impression (Trios3®) using the CSS technique. The primary outcomes were the marginal adaptation and passive fit of the superstructures, checked at T0 (intraoral try-in of polyurethane or metal replica of the final prosthesis) and T1 (delivery of the final zirconia restoration). The secondary outcomes, registered at T2 (2 years after the delivery of the final prosthesis), were implant survival, prosthetic success, and complications. A throughout statistical analysis was performed. RESULTS: At T0, 40/45 replicas demonstrated a perfect passive fit and adaptation. At T1, one prosthesis had fractured, and at T2, an additional prosthesis had fractured and one had chipped. The implant survival rate was 100%. The prosthetic success was 93.3%. CONCLUSIONS: CSS seems to represent a viable option for capturing accurate intraoral digital impressions for the fabrication of precise long-span implant-supported restorations.

Accuracy of 6 Desktop 3D Printers in Dentistry: A Comparative In Vitro Study.

PURPOSE: To compare the accuracy of 6 desktop 3D printers in dentistry. METHODS: A parallelepiped (PP) with known geometry and holes of different diameters was designed and printed with 6 desktop 3D printers (Sheraprint 40®; Solflex 350®; Form 2®; MoonRay D75®; Vida HD®; XFAB 2000®). For each printer, 9 PPs were printed with proprietary materials; these PPs were not cured and underwent dimensional analysis by optical microscopy and precision probing. A file representative of a dentate model (DM) was also printed with the aforementioned printers. For each printer, 3 DMs were printed with the proprietary materials. These DMs were cured and after 1 month, scanned with a desktop scanner and superimposed on the virtual reference model, to investigate trueness. RESULTS: Dimensional analysis by optical microscopy and precision probing highlighted the reliability of the 3D printed models; errors were compatible with clinical use. However, both linear and diameter measurements revealed statistically significant differences between the machines. The trueness of the DMs 1 month after printing was low, suggesting that they underwent dimensional contraction over time, albeit with differences between the printers. CONCLUSIONS: The 3D printed models showed acceptable accuracy, although statistically significant differences were found among them.

Human immunology studies using organ donors: Impact of clinical variations on immune parameters in tissues and circulation.

Organ donors are sources of physiologically healthy organs and tissues for life-saving transplantation, and have been recently used for human immunology studies which are typically confined to the sampling of peripheral blood. Donors comprise a diverse population with different causes of death and clinical outcomes during hospitalization, and the effects of such variations on immune parameters in blood and tissues are not known. We present here a coordinate analysis of innate and adaptive immune components in blood, lymphoid (bone marrow, spleen, lymph nodes), and mucosal (lungs, intestines) sites from a population of brain-dead organ donors (2 months-93 years; n = 291) across eight clinical parameters. Overall, the blood of donors exhibited similar monocyte and lymphocyte content and low serum levels of pro-inflammatory cytokines as healthy controls; however, donor blood had increased neutrophils and serum levels of IL-8, IL-6, and MCP-1 which varied with cause of death. In tissues, the frequency and composition of monocytes, neutrophils, B lymphocytes and T cell subsets in lymphoid or mucosal sites did not vary with clinical state, and was similar in donors independent of the extent of clinical complications. Our results reveal that organ donors maintain tissue homeostasis, and are a valuable resource for fundamental studies in human immunology.

Derivation of the uncontrolled donation after circulatory determination of death protocol for New York city.

Evidence from Europe suggests establishing out-of-hospital, uncontrolled donation after circulatory determination of death (UDCDD) protocols has potential to substantially increase organ availability. The study objective was to derive an out-of-hospital UDCDD protocol that would be acceptable to New York City (NYC) residents. Participatory action research and the SEED-SCALE process for social change guided protocol development in NYC from July 2007 to September 2010. A coalition of government officials, subject experts and communities necessary to achieve support was formed. Authorized NY State and NYC government officials and their legal representatives collaboratively investigated how the program could be implemented under current law and regulations. Community stakeholders (secular and religious organizations) were engaged in town hall style meetings. Ethnographic data (meeting minutes, field notes, quantitative surveys) were collected and posted in a collaborative internet environment. Data were analyzed using an iterative coding scheme to discern themes, theoretical constructs and a summary narrative to guide protocol development. A clinically appropriate, ethically sound UDCDD protocol for out-of-hospital settings has been derived. This program is likely to be accepted by NYC residents since the protocol was derived through partnership with government officials, subject experts and community participants.

Reaction of the thermo-labile triazenide Na[tBu3SiNNNSiMe3] with CO2: formation of the imido carbonate (tBu3SiO)(Me3SiO)C[double bond, length as m-dash]N-SitBu3 and carbamine acid (tBu3SiO)CONH2.

The thermo-labile triazenide Na[tBu3SiNNNSiMe3] was prepared by the reaction of Me3SiN3 with Na(thf)2[SitBu3] in pentane at -78 °C. Treatment of Na[tBu3SiNNNSiMe3] with an excess of carbon dioxide in pentane at -78 °C yielded the imido carbonate (tBu3SiO)(Me3SiO)C[double bond, length as m-dash]N-SitBu3 and the carbamine acid (tBu3SiO)CONH2 along with other products. From the reaction solution we could isolate the imido carbonate (tBu3SiO)(Me3SiO)C[double bond, length as m-dash]N-SitBu3 and carbamine acid (tBu3SiO)CONH2. At first single crystals of the carbamine acid (tBu3SiO)CONH2 (triclinic, space group P1[combining macron]) were grown from this solution at room temperature. A second crop of crystals were obtained by concentrating the solution. The second charge consisted of the imido carbonate (tBu3SiO)(Me3SiO)C[double bond, length as m-dash]N-SitBu3 (monoclinic, space group P21/n).

Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01.

Information is presented from 555 patients with Dukes B and C rectal cancers treated by curative resection who were entered into the National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol R-01 between November 1977 and October 1986. Their average time on study was 64.1 months. The patients were randomized to receive no further treatment (184 patients), postoperative adjuvant chemotherapy with 5-fluorouracil, semustine, and vincristine (MOF) (187 patients), or postoperative radiation therapy (184 patients). The chemotherapy group, when compared with the group treated by surgery alone, demonstrated an overall improvement in disease-free survival (P = .006) and in survival (P = .05). Employing the proportional hazards model, a global test was used to determine the presence of treatment interactions. Investigation of stratification variables employed in this study indicated that sex, and to a lesser extent age and Dukes stage, made individual contributions to the disease-free survival and the survival benefit from chemotherapy. When evaluated according to sex, the benefit for chemotherapy at 5 years, both in disease-free survival (29% vs. 47%; P less than .001; relative odds, 2.00) and in survival (37% vs. 60%; P = .001; relative odds, 1.93), was restricted to males. When males were tested for age trend with the use of a logistic regression analysis, chemotherapy was found to be more advantageous in younger patients. When the group receiving post-operative radiation (4,600-4,700 rad in 26-27 fractions; 5,100-5,300 rad maximum at the perineum) was compared to the group treated only by surgery, there was an overall reduction in local-regional recurrence from 25% to 16% (P = .06). No significant benefit in overall disease-free survival (P = .4) or survival (P = .7) from the use of radiation has been demonstrated. The global test for interaction to identify heterogeneity of response to radiation within subsets of patients was not significant. In conclusion, this investigation has demonstrated a benefit from adjuvant chemotherapy (MOF) for the management of rectal cancer. The observed advantage was restricted to males. Postoperative radiation therapy reduced the incidence of local-regional recurrence, but it failed to affect overall disease-free survival and survival.

Postoperative adjuvant chemotherapy or BCG for colon cancer: results from NSABP protocol C-01.

Data are presented from 1,166 patients with Dukes B and C carcinoma of the colon who were entered into the National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol C-01 between November 1977 and February 1983. Patients were randomized to one of three therapeutic categories: 1) no further treatment following curative resection (394 patients); 2) postoperative chemotherapy consisting of 5-fluorouracil, semustine, and vincristine (379 patients); or 3) postoperative BCG (393 patients). The average time on study was 77.3 months. A comparison between patients receiving postoperative adjuvant chemotherapy and those treated with surgery alone indicated that there was an overall improvement in disease-free survival (P = .02) and survival (P = .05) in favor of the chemotherapy-treated group. At 5 years of follow-up, patients treated with surgery alone were at 1.29 times the risk of developing a treatment failure and at 1.31 times the likelihood of dying as were similar patients treated with combination adjuvant chemotherapy. Comparison of the BCG-treated group with the group treated with surgery alone indicated that there was no statistically significant difference in disease-free survival (P = .09). There was, however, a survival advantage in favor of the BCG-treated group (P = .03). At 5 years of follow-up, patients randomized to the surgery-alone arm were at 1.28 times the risk of dying as were similar patients treated with BCG. Further investigation disclosed that this survival advantage in favor of BCG was a result of a diminution in deaths that were non-cancer related. When analyses were conducted on which events not related to cancer recurrence were eliminated, the survival difference between the BCG and control groups became nonsignificant (P = .40); the cumulative odds at 5 years decreased from 1.28 to 1.10. The findings from this study are the first from a randomized prospective clinical trial to demonstrate that a significant disease-free survival and survival benefit can be achieved with postoperative adjuvant chemotherapy in patients with Dukes B and C carcinoma of the colon who have undergone curative resection.

Characterization and partial purification of dihydroxyacetone kinase in Dunaliella salina.

Dihydroxyacetone kinase from Dunaliella salina is stabilized against inactivation by maintainance in the presence of 2 M glycerol. In the stabilized form a two-step purification procedure resulted in an enzyme preparation of about 440-fold purity which gave three bands (78 000--100 000 daltons) in the absence of denaturing agents on a polyacrylamide gel. The enzyme is specific for dihydroxyacetone and Mg2+-ATP complex as its substrates. It has sharp pH activity curve with pH optimum around 7.5 and little activity below 6. It is suggested that dihydroxyacetone kinase plays a central role in the mechanism of osmoregulation via glycerol in Dunaliella.

Randomized comparison of three adriamycin regimens for metastatic soft tissue sarcomas.

This study addressed two major questions regarding therapeutic use of Adriamycin ([Adr] Adria Laboratories, Columbus, OH) in adult soft tissue sarcomas: the influence of dosing schedule and the value of adding imidazole carboxamide (DTIC) to Adr. Patients with objectively measurable metastatic soft tissue sarcomas were randomized to Adr 70 mg/m2 intravenously (IV) day 1 and every 3 weeks (94 patients); Adr 20 mg/m2 IV day 1, 2, and 3, and 15 mg/m2 IV day 8 and weekly thereafter (89 patients); and Adr 60 mg/m2 IV day 1 and DTIC 250 mg/m2 days 1 to 5, repeated every 3 weeks (92 patients). The regimens using Adr as a single agent resulted in an equivalent response frequency (18% and 16%) and survival (median, 8.0 and 8.4 months). DTIC significantly increased (P less than .02) the overall response frequency of Adr to 30%. However, DTIC did not influence survival (median, 8.0 months) or increase the number of complete responses. The toxicities of the two single-agent regimens differed: Adr weekly resulted in more stomatitis (P = .09) and less hematologic toxicity (P less than .05). DTIC resulted in substantially increased toxicity, primarily gastrointestinal (P less than .002); overall, 98% of patients receiving Adr-DTIC experienced moderate or worse toxicity. To decrease the potential for error in interpretation of treatment results, histopathological confirmation of diagnosis was undertaken by a panel of reference pathologists; pathology slides were submitted on 97% of entered patients. The on-study clinical diagnosis was affirmed in 199 of 316 patients (63%) with a final review. In 23% of patients, the panel agreed with the diagnosis of soft tissue sarcoma, but not with the type. In 14%, the panel concluded that a diagnosis of mesenchymal malignancy could not be affirmed. Final treatment results were based on the 275 pathologically confirmed, eligible patients. The most common histological subtype entered was leiomyosarcoma (99 patients). The response to Adr-DTIC of this subtype was higher (44%) than that of any other subtype. However, this difference alone was not responsible for the overall superiority of the combination. This confirmed that the combination of DTIC plus Adr adds to the response rate of Adr alone in soft tissue sarcomas. Whether the increased response frequency, without an impact on survival, is worth the significantly greater toxicity remains a subjective judgement that must be made within the context of the individual patient.

Eastern Cooperative Oncology Group: a comparison of adjuvant doxorubicin and observation for patients with localized soft tissue sarcoma.

Forty-seven patients with stage I, II, or III soft tissue sarcoma were entered into a prospective randomized Eastern Cooperative Oncology Group (ECOG) adjuvant protocol. Eligibility included conservative or radical primary treatment for local cure. Patients were then randomized to control or Adriamycin (Adria Laboratories, Columbus, OH). Adriamycin was administered at 70 mg/m2 (slow push, every 3 weeks for seven courses for a maximum of 550 mg/m2). To date, 32 patients, 17 males and 15 females, with an age range of 17 to 75 years (median, 44 years) have been followed sufficiently long to be included in this analysis. Nine patients have died. The median follow-up of the remaining 23 patients is 30 months (range, 2 to 50 months). Survival was not significantly different between Adriamycin or control. However, the disease-free interval was slightly different in favor of observation. This preliminary report does not support the hypothesis that Adriamycin is an effective adjuvant therapy for soft tissue sarcoma. Due to the small numbers, these results must be interpreted in relation to our ability to detect a difference, if in fact one existed. These preliminary data suggest that adjuvant Adriamycin not be used outside the confines of a clinical trial such as the current intergroup adjuvant sarcoma study.

Measurement of glucose concentration in the presence of coreactants with a platinum electrode.

An implantable glucose sensor is being developed that is based on the use of a high-area platinum electrode. The sensor is operated in a controlled potential mode, in which the potential of the platinum working electrode versus an unpolarized reference electrode is periodically varied according to a preselected voltage-time regimen. The change in potential is accompanied by a flow of current between the platinum working electrode and a counter-electrode. This current serves to periodically rejuvenate the electrode surface and to provide a signal that is proportional to the glucose concentration. A method for analyzing this signal has been developed, the compensated net charge (CNC) method, that involves integration of the current over one complete potential cycle. This method significantly improves both the sensitivity and selectivity for determining glucose in the presence of the normal physiologic coreactants. For a solution containing glucose, amino acids, and urea, a change in glucose concentration from 50 to 150 mg/dl gives about a 50% change in the net charge. A change in the urea concentration from 20 to 40 mg/dl has no effect on the net charge. A change in the amino acids concentration from 35 to 65 mg/dl has little effect on the net charge above a glucose concentration of about 100 mg/dl. Negligible effects on the net charge have also been found for creatinine (0-1.5 mg/dl) and uric acid (0-4 mg/dl).

Adaptive and pathogenic aspects of sex-role stereotypes: implications for parenting and psychotherapy.

There has been considerable controversy concerning adaptive versus pathogenic effects of sex-role stereotypes on individual development. The author evaluates both the positive and negative consequences of sex-role stereotypes without regard for any particular sociocultural definition of masculinity or feminity. She hypothesizes that the degree to which sex-role stereotypes are adaptive and facilitative (as opposed to restrictive and pathogenic) is inversely related to the degree to which an individual has consolidated a comfortable and stable gender is identity. Implications for parenting and treatment are elaborated.

Hexasupersilyl-triprismo-hexastannane (tBu3 Si)6 Sn6 -The First Molecular Tin Compound Containing a Sn6 Prism.

Dark violet hexastannane (tBu3 Si)6 Sn6 displays a new framework motif for molecular tin compounds, in which six Sn atoms are located at the corners of a trigonal prism. The compound can be synthesized according to Equation (a). R*=SitBu3 .

The adjustable Harada-Ito procedure.

In four patients with superior oblique palsy, symptomatic excyclotorsion was present without a substantial vertical deviation. Surgery of anteriorizing and lateralizing the anterior fibers of the superior oblique tendon on an adjustable suture was performed (adjustable Harada-Ito procedure). the morning after surgery, adjustment of the suture was made to eliminate the torsional deviation. The suture was loosened when an overcorrection was present and was tightened when an undercorrection was present. Follow-up varied from two to 20 months. All patients remained free of torsional symptoms and no vertical deviation was induced. In addition, the eyes operated on had no limitation of elevation in adduction. The technique allows the surgeon to more exactly adjust the advanced fibers of the superior oblique tendon so as to minimize or eliminate the excyclotorsion and eliminate symptomatic complaints.

The technique of segmental mastectomy (lumpectomy) and axillary dissection: A syllabus from the National Surgical Adjuvant Breast Project workshops.

Surveys conducted by the American College of Surgeons indicate an increasing trend toward the treatment of primary breast cancer by segmental mastectomy and radiotherapy. This operation has never been formally taught in training programs, and scant standard descriptive material exists. The National Surgical Adjuvant Breast Project conducted a series of workshops to develop guidelines for the performance of the operation. The essential points are (1) pathologic control of margins to ensure complete surgical excision, (2) surgical principles of complete tumor excision, (3) attention to optimum cosmetic results, and (4) axillary dissection for accurate staging and regional control of the disease. This article summarizes the recommendations made at those workshops.

Radical surgery for the treatment of early invasive cervical carcinoma (stage IB): review of 15 years' experience.

From 1963 through 1977, 108 patients with stage IB cervical carcinoma were treated with radical hysterectomy and pelvic lymphadenectomy at the University of California, San Francisco. Forty-four of 48 patients followed for 5 or more years after surgery are known to be alive (5-year survival rate, 91.7%). The 5-year survival rate of all 108 patients using the life-table method is 93.4%. Complications in this series were few; only 1 patient developed a ureterovaginal fistula.

Doxorubicin chemotherapy in the treatment of soft-tissue sarcoma. Combined results of two randomized trials.

In 1978, there were initiated two independent randomized, prospective trials of adjuvant doxorubicin hydrochloride (Adriamycin) following primary therapy for soft-tissue sarcoma. The virtual identity of these two protocols permits their combination for analysis. A total of 75 patients (42 men, 33 women) with soft-tissue sarcoma (stages IIB to IVA) were randomized, after receiving optimal regional therapy, to receive either doxorubicin hydrochloride (450 mg/m2) (37 patients) or observation (38 patients). Follow-up has ranged from 16 to 80 months (median, 49 months). Twenty-five patients (33%) died, and two patients receiving doxorubicin developed cardiotoxicity. No significant differences in local control, metastasis-free survival, disease-free survival, and overall survival were observed for the two treatment arms. Despite temporary prolongation of disease-free survival with doxorubicin in some subgroups, we conclude that there is no advantage to the use of adjuvant doxorubicin in the treatment of soft-tissue sarcoma.

Object relations in borderline adolescents.

Although pathological object relations is a core aspect of borderline psychopathology, few studies have examined borderline object relations empirically, and none has focused on borderline adolescents. The present study examined four dimensions of object relations, as measured by the Thematic Apperception Test, in a sample of adolescent borderlines, psychiatric comparison subjects, and normals. These dimensions are complexity of object representations, affect-tone of relationship paradigms, capacity for emotional investment in relationships and moral standards, and understanding of social causality. Borderlines differed significantly from both comparison groups in several distinct ways, supporting some aspects of psychoanalytic theories of borderline object relations, while challenging others. Borderline adolescents have a malevolent object world, a relative incapacity to invest in others in a non-need-gratifying way, and a tendency to attribute motivation to others in simple, illogical, and idiosyncratic ways. Their object representations, however, can be quite complex, suggesting something other than a preoedipal arrest.