Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas.

BACKGROUND AND PURPOSE: Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas. MATERIALS AND METHODS: Patients 1-55 years of age with acute (≤7 days) spontaneous intracerebral hemorrhage were included. Two neuroradiologists reviewed CT and MR imaging data and assessed the characteristics of hematomas, including their shape (spherical/ovoid or not), their regular or irregular margins, and associated abnormalities including extralesional hemorrhage and peripheral rim enhancement. Imaging findings were correlated with etiology. The study population was randomly split to provide a training sample (50%) and a validation sample (50%). From the training sample, univariate and multivariate logistic regression was performed to identify factors predictive of cavernomas, and a decision tree was built. Its performance was assessed using the validation sample. RESULTS: Four hundred seventy-eight patients were included, of whom 85 had hemorrhagic cavernomas. In multivariate analysis, cavernoma-related hematomas were associated with spherical/ovoid shape (P < .001), regular margins (P = .009), absence of extralesional hemorrhage (P = .01), and absence of peripheral rim enhancement (P = .002). These criteria were included in the decision tree model. The validation sample (n = 239) had the following performance: diagnostic accuracy of 96.1% (95% CI, 92.2%-98.4%), sensitivity of 97.95% (95% CI, 95.8%-98.9%), specificity of 89.5% (95% CI, 75.2%-97.0%), positive predictive value of 97.7% (95% CI, 94.3%-99.1%), and negative predictive value of 94.4% (95% CI, 81.0%-98.5%). CONCLUSIONS: An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.

Accessory anterior ethmoidal nerve and artery: a cadaveric case report.

The anterior ethmoidal artery (AEA) is an important surgical landmark for procedures involving the anterior cranial fossa. Many variations in the location and branching pattern of the AEA have been reported throughout the literature. These anatomical variations are important for surgeons to be familiar with as injury to the AEA can lead to massive haemorrhage, orbital haematomas, and cerebrospinal fluid rhinorrhoea. Anatomical landmarks such as the ethmoidal foramen can be used to identify the location of the AEA; however, it is also important to consider that the foramen may have variable presentations. If there is ever difficulty with identification of the AEA, surgeons should pursue a high-resolution computed tomography to minimise the risk of surgical complications. In this report, we present a rare case of a variant accessory anterior ethmoidal artery and nerve, and variations in the ethmoidal foramen found during cadaveric dissection.

Effects of Material Thickness and Pretreatment on the Interfacial Gap of Translucent Zirconia Restorations with Self-adhesive Resin Cement.

PURPOSE: The first objective was to determine if the dual-curing of self-adhesive resin cement (SAC) with reduced light penetrating through zirconia had an effect on interfacial gap of zirconia restorations. The second purpose was to examine whether pretreatment methods for universal adhesive affected interfacial gap. The last aim was to compare the microhardness of SAC polymerized under different zirconia thicknesses. METHODS AND MATERIALS: This study evaluated self-adhesive resin cement (RelyX U200, 3M ESPE) after different pretreatment with universal adhesive (Single Bond Universal, 3M ESPE) under different polymerization conditions. CAD/CAM inlay cavities were prepared on extracted third molars. Translucent zirconia restorations were milled using Katana UTML (Kuraray). The teeth were divided into three groups: Groups I, II, and III in which the restoration thicknesses were 1, 2, and 3 mm. Each Group had three subgroups according to different pretreatment methods. For subgroup-1, no pretreatment was done on the prepared cavity. For subgroup-2, universal adhesive was applied and light-cured before cement placement (precure method). For subgroup-3, universal adhesive was applied; however, light-curing was done after cement placement (cocure method). After thermo-cycling, the interfacial gap at the restoration-tooth interface was investigated using swept-source optical coherence tomography imaging. Finally, microhardness was measured for SAC under different zirconia thicknesses. For statistical analysis, the interfacial gap was analyzed using two-way analysis of variance (ANOVA) to test the effect of cavity depth and pretreatment. In terms of each cavity depth and pretreatment, the interfacial gap was compared using one-way ANOVA and Scheffe's test. One-way ANOVA was also performed for comparison of the Vickers hardness results. RESULTS: Different thicknesses of the restoration resulted in differences in interfacial gaps except between the precure method of Groups I and II (p<0.05). The effect of universal adhesive pretreatment was different depending on the restoration thickness with exceptions in Groups I and III (p<0.05). Vickers hardness number decreased as the low radiant exposure of light was applied (p<0.05). CONCLUSION: Interfacial gap of zirconia restorations can differ depending on the material thickness, pretreatment, and activation mode. Reduced light intensity penetrating through zirconia may lead to higher interfacial gap percentage and lower microhardness of the self-adhesive resin cement. Application of a universal adhesive showed similar or reduced interfacial gaps in the cement space.

Dentin Discoloration and Pulpal Ion Concentrations Following Silver Diamine Fluoride and Potassium Iodide Treatment.

OBJECTIVE: The objective of this in vitro study was to evaluate the effects of potassium iodide on dentin discoloration and ion penetration into the pulp chamber after application of silver diamine fluoride (SDF). METHODS: Proximal surfaces of extracted one-rooted sound human teeth were polished to obtain flat dentin and treated with 17% EDTA for two minutes. Each tooth was then fixed to a test tube. The specimens were distributed into five groups according to the treatment: SDF (Advantage Arrest, Elevate Oral Care); SDF-KI (SSKI, Upsher-Smith); RV-SDF (Riva Star, SDI); and RV-SDFKI. The CIE L*a*b* color value for each proximal dentin was assessed using a colorimeter (CR200, Konica-Minolta) at baseline, after two minutes, 10 minutes, and 24 hours, and ΔE compared to baseline was calculated. Subsequently, the water-filled tube was inverted to collect the ions that had penetrated from the tooth surface into the pulp chamber. Silver, iodide, and fluoride in the pulp were measured using trace element analysis (ISMat) and fluoride ion-selective electrode (Orion, Thermo Scientific) at days 1, 2, 7, and 14. RESULTS: Dentin in both SDF-KI groups showed no visual change in color whereas the groups using only SDF exhibited gradual staining. The time, the treatment and their interaction had a significant effect on ΔE (p<0.001). The fluoride concentrations at day 1 and day 14 for group SDF and KI were significantly lower compared to SDF (p=0.044). There was a difference between control groups and other groups in silver and iodine (p<0.05), whereas there was no significant difference among groups with treatment after 14 days (p>0.05). CONCLUSION: The application of KI after SDF treatment could significantly reduce the dentin staining. The pulpal fluoride concentration in the groups using SDF-KI was lower compared to the ones using SDF only, whereas there was no difference observed in iodide and silver among the groups with treatment.

Comparison of magnetic resonance angiography techniques to brain digital subtraction arteriography in the setting of mechanical thrombectomy: A non-inferiority study.

INTRODUCTION: We performed a non-inferiority study comparing magnetic resonance angiography (MRA) techniques including contrast-enhanced (CE) and time-of-flight (TOF) with brain digital subtraction arteriography (DSA) in localizing occlusion sites in acute ischemic stroke (AIS) with a prespecified inferiority margin taking into account thrombus migration. MATERIALS AND METHODS: HIBISCUS-STROKE (CoHort of Patients to Identify Biological and Imaging markerS of CardiovascUlar Outcomes in Stroke) includes large-vessel-occlusion (LVO) AIS treated with mechanical thrombectomy (MT) following brain magnetic resonance imaging (MRI) including both CE-MRA and TOF-MRA. Locations of arterial occlusions were assessed independently for both MRA techniques and compared to brain DSA findings. Number of patients needed was 48 patients to exclude a difference of more than 20%. Discrepancy factors were assessed using univariate general linear models analysis. RESULTS: The study included 151 patients with a mean age of 67.6±15.9years. In all included patients, TOF-MRA and CE-MRA detected arterial occlusions, which were confirmed by brain DSA. For CE-MRA, 38 (25.17%) patients had discordant findings compared with brain DSA and 50 patients (33.11%) with TOF-MRA. The discordance factors were identical for both MRA techniques namely, tandem occlusions (OR=1.29, P=0.004 for CE-MRA and OR=1.61, P<0.001 for TOF-MRA), proximal internal carotid artery occlusions (OR=1.30, P=0.002 for CE-MRA and OR=1.47, P<0.001 for TOF-MRA) and time from MRI to MT (OR=1.01, P=0.01 for CE-MRA and OR=1.01, P=0.02 for TOF-MRA). CONCLUSION: Both MRA techniques are inferior to brain DSA in localizing arterial occlusions in LVO-AIS patients despite addressing the migratory nature of the thrombus.

Variant innervation of the mylohyoid muscle by the lingual nerve.

The nerve to mylohyoid muscle supplies the mylohyoid and the anterior belly of the digastric muscles, with terminal sensory branches that might innervate the submental skin and mandibular teeth. The nerve to mylohyoid muscle typically originates from the posterior surface of the inferior alveolar nerve right before entering the mandibular foramen. In rare cases, the nerve to mylohyoid muscle arises from the lingual nerve. The variations of the nerve to mylohyoid muscle might have led to failure of an inferior alveolar nerve blockade. During the routine dissection of a cadaveric head, a rare case was identified where the nerve to mylohyoid muscle had origins from both the inferior alveolar and lingual nerves. This case is reviewed and salient literature reviewed.

Interfacial Evaluation of CAD/CAM Resin Inlays on the Cavity Floor Using Swept-source Optical Coherence Tomography.

CLINICAL RELEVANCE: When a resin nanoceramic inlay is cemented using self-adhesive cement, a universal dentin adhesive can be applied to the prepared cavity. The application of the adhesive before self-adhesive cement placement provides similar or better interfacial adaptation than without the adhesive. SUMMARY: Purpose: The first objective of this study was to determine whether the luting material used for computer-aided design and computer-aided manufacture resin nanoceramic inlays affected interfacial adaptation. The second objective was to investigate whether application of a universal dentin adhesive before cementation affected interfacial adaptation. The final objective was to compare the inlay-side and dentin-side interfaces in the cement space.Methods and Materials: Seventy-four class I cavities were prepared on extracted human third molars. Cavities were optically scanned, and resin nanoceramic inlays were milled using Lava Ultimate blocks (3M ESPE). For the control groups, the fabricated inlays were cemented using Panavia V5 (Kuraray Noritake) or FujiCem 2 (GC). For the experimental groups, the teeth were randomly divided into groups I and II. Group I contained four subgroups using different luting materials; in all subgroups, the inlays were cemented and dual cured without pretreatment. Group II contained six subgroups in which inlays were cemented and dual cured after application of a universal dentin adhesive. After thermocycling, interfacial adaptation was measured using swept-source optical coherence tomography (SS-OCT) imaging and statistically compared among groups.Results: Interfacial adaptation was different depending on the luting material used (p<0.05). After application of a universal adhesive, some subgroups showed improved interfacial adaptation (p<0.05). In the comparison of inlay-side and dentin-side interfaces, no difference was found in interfacial adaptation (p>0.05).Conclusions: Interfacial adaptation for resin nanoceramic inlays differed with luting material. For some self-adhesive cements, application of a universal adhesive before cementation improved interfacial adaptation.

Combined analysis of MGMT methylation and dynamic-susceptibility-contrast MRI for the distinction between early and pseudo-progression in glioblastoma patients.

INTRODUCTION: Currently, no single diagnostic modality allows the distinction between early progression (EP) and pseudo-progression (Psp) in glioblastoma patients. Herein we aimed to identify the characteristics associated with EP and Psp, and to analyze their diagnostic value alone and in combination. MATERIAL AND METHODS: We reviewed the clinical, conventional magnetic resonance imaging (MRI), and molecular characteristics (MGMT promoter methylation, IDH mutation, and EGFR amplification) of glioblastoma patients who presented an EP (n=59) or a Psp (n=24) within six months after temozolomide radiochemotherapy. We analyzed relative cerebral blood volume (rCBV) and relative vessel permeability on K2 maps (rK2) in a subset of 33 patients using dynamic-susceptibility-contrast MRI. RESULTS: In univariate analysis, EP was associated with neurological deterioration, higher doses of dexamethasone, appearance of a new enhanced lesion, subependymal enhancement, higher rCBV and rK2 values. Psp occurred earlier after radiotherapy completion and was associated with IDH1 R132H mutation, and MGMT methylation. In multivariate analysis, rCBV, rK2, and MGMT methylation status were independently associated with EP and Psp. All patients with a methylated MGMT promoter and a low rCBV (<1.75) were classified as Psp while all patients with an unmethylated MGMT promoter and a high rCBV (≥1.75) were classified as EP. Among patients with discordant MGMT methylation and rCBV characteristics, higher rK2 values tended to be associated with EP. CONCLUSION: Combined analysis of MGMT methylation, rCBV and vessel permeability on K2 maps seems helpful to distinguish EP from Psp. A prospective study is warranted to confirm these results.

Potassium Iodide Reversal of Silver Diamine Fluoride Staining: A Case Report.

This article describes the clinical protocol of using potassium iodide (KI) to reverse staining caused by silver diamine fluoride (SDF). SDF contains silver, fluoride, and ammonia. It has been used to arrest dental caries mainly in pediatric applications. The major drawback of SDF application is the dark staining of both teeth and restorative materials. Hence, its use on adult dentition is limited. Improving the esthetic outcome by stain reduction would greatly enhance the opportunity for SDF's universal use. This case demonstrates how KI can effectively reverse the staining.

Observation and determination of periodontal tissue profile using optical coherence tomography.

BACKGROUND AND OBJECTIVE: Diagnosis is a crucial step in periodontal treatment. The aim of this study was to evaluate the effectiveness of optical coherence tomography (OCT) for observation and determination of periodontal tissue profiles in vivo. MATERIAL AND METHODS: In experiment 1, refractive indices of purified water, porcine gingiva and human gingiva at 1330 nm were determined for the analysis of OCT images of periodontal tissues. In experiment 2, OCT examination was performed in the midlabial apico-coronal plane of mandibular anteriors in 30 Asian volunteers with healthy gingiva. Sulcus depth was measured on intra-oral photographs taken during probing. In the OCT images, the gingival, epithelial and connective tissue thickness, and the position of alveolar bone crest were determined and finally, the biologic width was measured. RESULTS: Refractive indices of purified water, porcine gingiva and human gingiva were 1.335, 1.393 and 1.397, respectively. Cross-sectional images of gingival epithelium, connective tissue and alveolar bone were depicted in real-time. The sulcular and junctional epithelium could be visualized occasionally. Laser penetration and reflection were limited to a certain depth with an approximate maximal imaging depth capability of 1.5 mm and OCT images of the periodontal structure were not clear in some cases. The average maximal thickness of gingiva and epithelium and biologic width at the mandibular anteriors were 1.06 ± 0.21, 0.49 ± 0.15 and 2.09 ± 0.60 mm, respectively. CONCLUSION: OCT has promise for non-invasive observation of the periodontal tissue profile in detail and measurement of internal periodontal structures including biologic width in the anterior region.

Real-Time Imaging of Gap Progress during and after Composite Polymerization.

The aims of this study were to observe the behavior of composite and formation of gaps during and immediately after light polymerization using swept source optical coherence tomography (OCT) and to compare the interfacial integrity of adhesives in cavities through 3-dimensional (3D) image analysis. Forty tapered cylindrical cavities (4-mm diameter, 2-mm depth) were prepared in bovine incisors and restored using Bond Force (BF), Scotchbond Universal Adhesive (SBU), OptiBond XTR (XTR), or Clearfil SE Bond 2 (SE2), followed by Estelite Flow Quick flowable composite. Real-time imaging was performed at the center of restoration by the OCT system (laser center wavelength: 1,330 nm; frequency: 30 KHz) during and up to 10 min after light curing. The 3D scanning was performed 0, 1, 3, 5, and 10 min after light curing. The percentages of sealed enamel and dentin interface area (E%, D%) were calculated using Amira software. In real-time videos, the initial gaps appeared as a bright scattered area mainly on dentin floor and rapidly progressed along the cavity floor. The timing, rate, and extent of gap formation were different among the specimens. From 3D visualization, gap progress could be seen on both enamel and dentin even after irradiation; furthermore, typical toroidal gap patterns appeared at the dentin floor of BF and SBU. XTR and SE2 showed nearly perfect sealing performance on the dentin floor up to the 10 min that images were recorded. From quantitative analysis, SE2 and XTR showed significantly higher E% and D% than other groups. SBU showed the smallest E% and BF showed a significantly smaller D% than other groups ( P < 0.05). In conclusion, real-time observation of composite placement and 3D quantification of interfacial gaps were implemented within the experimental limitations. Interfacial gap formation during polymerization of the composite depended on the adhesive system used. The formed gaps continued to propagate after composite light curing finished.

Multifactorial logistic regression analysis of factors associated with the incidence of erosive tooth wear among adults at different ages in Tokyo.

OBJECTIVES: The aim of this study was to evaluate factors associated with the incidence of erosive tooth wear (ETW) among adults at different ages in Tokyo using multifactorial logistic regression analysis. MATERIALS AND METHODS: The study sample consisted of a total of 1108 subjects aged 15 to 89 years in Tokyo, Japan. Two examiners evaluated ETW in a full-mouth recording. The subjects were asked to complete a self-administered daily diet, habit, and health condition questionnaire. Subjects who had frequent acid consumption or gastric reflux and at least one tooth with initial enamel wear were placed in the ETW-positive group, and the remainder of the subjects was placed in the ETW-negative group. Logistic regression analyses were carried out to identify factors collectively associated with ETW. RESULTS: Logistic regression analysis showed that greater frequencies of carbonated or sports drink consumption were associated with higher incidence of ETW for all age groups except for 70-89 years. Adults in the 30-39-year group who reported suffering from heartburn were about 22.3 times more likely to develop ETW, while 40-49-year adults who had repeated vomiting were about 33.5 times more likely to exhibit ETW compared with those who did not experience vomiting. CONCLUSION: Age-specific dietary habits were clearly observed among adults at different ages in Tokyo, and there were significant differences in intrinsic and extrinsic factors between ETW-positive and ETW-negative groups for each age group. CLINICAL RELEVANCE: Both greater frequency of carbonated and sports drink consumption were associated with higher incidence of ETW among adults at different ages in Tokyo.

Three-Dimensional Analysis of Enamel Crack Behavior Using Optical Coherence Tomography.

The aim of this study was to nondestructively analyze enamel crack behavior on different areas of teeth using 3D swept source-optical coherence tomography (SS-OCT). Ten freshly extracted human teeth of each type on each arch ( n = 80 teeth) were inspected for enamel crack patterns on functional, contact and nonfunctional, or noncontact areas using 3D SS-OCT. The predominant crack pattern for each location on each specimen was noted and analyzed. The OCT observations were validated by direct observations of sectioned specimens under confocal laser scanning microscopy (CLSM). Cracks appeared as bright lines with SS-OCT, with 3 crack patterns identified: Type I - superficial horizontal cracks; Type II - vertically (occluso-gingival) oriented cracks; and Type III - hybrid or complicated cracks, a combination of a Type I and Type III cracks, which may or may not be confluent with each other. Type II cracks were predominant on noncontacting surfaces of incisors and canines and nonfunctional cusps of posterior teeth. Type I and III cracks were predominant on the contacting surfaces of incisors, cusps of canines, and functional cusps of posterior teeth. Cracks originating from the dental-enamel junction and enamel tufts, crack deflections, and the initiation of new cracks within the enamel (internal cracks) were observed as bright areas. CLSM observations corroborated the SS-OCT findings. We found that crack pattern, tooth type, and the location of the crack on the tooth exhibited a strong correlation. We show that the use of 3D SS-OCT permits for the nondestructive 3D imaging and analysis of enamel crack behavior in whole human teeth in vitro. 3D SS-OCT possesses potential for use in clinical studies for the analysis of enamel crack behavior.

In Silico and In Vitro Evaluation of Cytotoxic Activities of Farnesiferol C and Microlobin on MCF-7, HeLa and KYSE Cell Lines.

Background: Cancer is one of the leading causes of death worldwide. Despite certain advances in cancer therapy, still there is considerable demand for developing efficient therapeutic agents. Nowadays, there is a rising interest in the use of natural-based anti-cancer drugs. In this study, the cytotoxicity of farnesiferol C and microlobin isolated from Ferula szowitsiana was investigated against MCF-7, HeLa and KYSE cancer cell lines. In addition, the mechanism of binding of these compounds to apoptotic proteins (Bax, Bak and Bcl-2) was analyzed by an in silico method. Materials and methods: We used MTT assay in order to assess the cytotoxicity of compounds against cancer cell lines. For in silico study, the AutoDock 4 was adopted. Results and discussion: According to the in vitro findings, in general, farnesiferol C showed significant cytotoxicity at higher concentrations (>50 µM) following 48 and 72 h incubation with the selected cancer cells; however, microlobin exhibited almost no activity at concentrations up to 100 µM. The in silico results revealed that both compounds could bind to Bax more efficiently rather than to Bcl-2 or Bak proteins. Conclusion: The results obtained by our preliminary in vitro and in silico studies suggest that these compounds might induce apoptosis through Bax activation; however further studies, either in vitro or in vivo are needed to clarify these activities.

Thirty-six month clinical evaluation of a highly filled flowable composite for direct posterior restorations.

BACKGROUND: The aim of this randomized controlled study was to evaluate the clinical performance of a highly filled flowable composite compared to a conventional paste-type composite in direct posterior restorations after 36 months. METHODS: A total of 58 mid-size to extensive posterior composite restorations were randomly placed in 32 patients, mean age of 43.9 years (range 25-76), using either a conventional composite Estelite Sigma Quick (Conventional) or a highly filled flowable composite G-aenial Universal Flo with a two-step self-etch adhesive. The restorations were evaluated after placement (baseline) and at 6, 12, 24 and 36 months according to the FDI criteria. RESULTS: At the 36-month follow-up, 42 restorations were evaluated in 21 patients. After 36 months, the difference between highly filled flowable and conventional restorations was not statistically significant with respect to all evaluation parameters (p < 0.05). No secondary caries was observed. CONCLUSIONS: The highly filled flowable composite showed a comparable clinical effectiveness as the conventional paste composite in posterior restorations over 36 months.

Microgaps and Demineralization Progress around Composite Restorations.

This study investigated the influence of adhesives and marginal sealing on demineralization progress using optical coherence tomography (OCT). Cavities (4 × 2 mm) were prepared in bovine incisors and restored using Clearfil SE Protect (SP), Bond Force (BF), Scotchbond Universal (SB), or G-Bond Plus (GB), followed by Estelite Flow Quick flowable composite. The control group received no adhesive (n = 10). After 3-d incubation in artificial saliva and 10,000 thermal cycles, gaps at enamel and dentin margins were measured at 8 locations on cross-sectional images obtained from each restoration using swept-source OCT at 1310-nm wavelength. Specimens were demineralized using acidified gel (pH = 4.5) for 5 wk and scanned every week to monitor the lesion progress at the same marginal locations. Repeated-measures analysis of variance showed that demineralization period and adhesive type and their interaction had a significant effect on the lesion size in both substrates (P < 0.001). SP, BF, and SB had significantly lower enamel and dentin initial gaps than the control and GB (P < 0.05). Enamel lesion progress was slower in the fluoride-releasing adhesives SP and BF and significantly different from SB, GB, and the control (P < 0.001). SP and BF dentin lesions were significantly different from GB and the control (P < 0.001), but not from SB (P > 0.05). A significant positive correlation (P < 0.05) was found between initial gap length and formed lesion size in both substrates, which was stronger in enamel (r = 0.63) than dentin (r = 0.35). Microgaps forming at the margins of restorations depend on adhesives and significantly contribute to the progress of demineralization around the margins, while fluoride release may decrease the rate of progression.

Ultramorphological assessment of dentin-resin interface after use of simplified adhesives.

This study assessed dentin-resin interface integration in Class I cavities restored with simplified adhesives by using a focused ion-beam milling (FIB) and transmission electron microscope (TEM). Class I cavities (1.5-mm depth with dentin thickness of ∼0.5 mm, 4-mm length, and 2-mm width) were prepared on freshly extracted, sound human molars. Two all-in-one adhesive systems (Scotchbond/Single Bond Universal [SUD] and Xeno-V(+) [X5D]) were used and compared with a two-step etch-and-rinse system (Prime&Bond NT [NTD]). The adhesives were applied according to the manufacturers' guidelines. A universal resin composite (Filtek Z350 XT Universal) was used to restore the cavities in one bulk filling and was irradiated at 550 mW/cm(2) for 40 seconds by a quartz-tungsten-halogen light (Optilux 501). After exposure to liquid nitrogen coolant, the specimens were milled to nanoscale thickness by FIB to view and then assess the area of dentin-resin interface by TEM. Unlike the unfilled X5D, a noticeably smooth transition zone at the dentin-resin interface was shown for the SUD and NTD adhesives. The SUD demonstrated an uneven hybrid layer with clearly demineralized collagen bundles. Ultramorphologically, dispersed needlelike apatite crystals were detected within the partially demineralized dentin or the hybrid layer of both compositionally different all-in-one simplified adhesives. Conversely, these crystals were entirely absent from the hybrid layer of the etch-and-rinse NTD adhesive. In the X5D group, a bright band was noted beneath the hybrid layer. The methacryloxydecyl dihydrogen phosphate monomer containing ultramild self-etch adhesive (SUD) was still validated in terms of its capability in dentin adhesion.

Cutaneous basal cell carcinoma with endobronchial metastasis.

Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extremely rare. For this reason, many plastic surgeons, dermatologists and physicians dealing with skin malignancies consider this as a locally invasive malignancy. We present a rare case of metastatic basal cell carcinoma manifested as a bronchial tumour. This case highlights the fact that despite basal cell carcinoma's local invasive potential, the possibility of distant metastasis still exists and clinicians should therefore be cautious about interpreting extracutaneous symptoms. Chest physicians should always consider the possibility of this rare tumour in the lungs in patients with a history of large basal cell carcinomas in the head and neck region.