The role of MicroRNA as a potential diagnostic and prognostic biomarker for cerebral aneurysms.

OBJECTIVES: To identify the dysregulated functional miRNAs, miRNA-16, miRNA-143, and miRNA-200 as potential biomarkers of cerebral aneurysms(CAs) to aid in diagnosis and prognosis. METHODS: This is a prospective case-control study conducted among patients with CA. All patients' computed tomography angiography (CTA) and interventional angiogram were assessed and studied. The miRNAs were isolated and quantified from peripheral blood samples and the expression profiling was done using TaqMan chemistry on Real-Time PCR. RESULTS: A total of 37 samples were included. Three cases had double aneurysms and 10 cases presented with aneurysmal rupture. miRNA-16, miRNA-143, and miRNA-200 were upregulated with an absolute fold-change of >8 in the CA group in comparison to controls (p<0.05). miRNA-200 showed double expression in patients with single aneurysm. A statically significant increase was observed in the expression of miRNA-143 in patients who had an aneurysmal rupture with p<0.05. Diabetic patients showed an obvious increase in miRNA-200 (13.03 folds) and miRNA-16 (26.82 folds) expression. Also, there was a notable elevation in miRNA-16, miRNA-143, and miRNA-200 in patients who had hypertension in comparison to those who did not. CONCLUSION: miRNA-16, miRNA-143, and miRNA-200 showed statically significant higher expression among cases with cerebral aneurysms in comparison to controls. Thus, these preliminary results of miRNAs biomarkers are promising future tool to be used for aneurysmal screening.

Effect of self-etch adhesives on the internal adaptation of composite restoration: a CP-OCT Study.

Despite improvements in dental adhesive materials, internal adaptation remains a challenge in bonded restorations. The aim of this study was to compare microgaps and internal floor adaptation between two different self-etch adhesives in class-V cavities using cross-polarization optical coherence tomography (CP-OCT). In this in vitro study, standardized round class-V cavities were prepared in 20 non-carious human upper central incisor teeth. They were randomly divided into two groups, TN and SE, with each group receiving a different dental adhesive. In TN group, the adhesive used was all-in-one Tetric N-Bond Self-Etch (TN; Ivoclar/Vivadent, Liechtenstein), while SE group was bonded with two-step self-etch Clearfil SE Bond 2 adhesive (SE; Kuraray Noritake Dental Inc, Japan). The prepared cavities were restored with flowable composite and then stored in distilled water for 24 h. Next, they were immersed in silver nitrate, followed by immersion in a photo-developing solution. Optical comparison was carried out by CP-OCT to assess microgaps and composite adaptation at the cavity floor. A Mann-Whitney test was applied to the data, which showed a statistically significant difference in composite adaptation among the two groups (p < 0.001) with the SE group showing superior adaptation. CP-OCT is a reliable tool for non-invasive imaging that gives an insight into composite performance. Better adaptation was found with the two-step self-adhesive for the composite used in this study.

Dental cements: Bioactivity, bond strength and demineralization progression around restorations.

PURPOSE: To evaluate demineralization progression around indirect restorations placed with various cements using swept-source optical coherence tomography (OCT) and microshear bond strength (MSBS) to enamel and dentin. METHODS: Resin inlays in cervical preparations (4×2 mm) were luted with two glass ionomer luting cements, Fuji I (FI) and RelyX Luting Cement (RL) and two adhesive cements, Adshield RM (AD) and RelyX Unicem 2 (UC). After 7-day artificial saliva incubation and 10,000 thermal cycles, specimens were demineralized (pH 4.5). Lesion progression at enamel and dentin margins was measured on OCT images after 1, 3 and 5 weeks demineralization (n= 8). RESULTS: Repeated-measures ANOVA showed that demineralization period, cement type, and their interaction had a significant effect on lesion size in both substrates (P< 0.001). Enamel lesion progression was slower in RL, FI and AD, and was significantly different from UC and control (P< 0.001). RL dentin lesions were significantly different from FI and AD lesions (P< 0.05), which in turn were significantly different than UC and control lesions (P< 0.001). MSBS means of AD and UC were significantly higher than those of FI and RL (P< 0.001). CLINICAL SIGNIFICANCE: A bioactive cement combining bioavailable calcium, functional monomer and glass-ionomer formulations showed better lesion progression inhibition around restorations than the adhesive resin cement, and higher bond strength than the resin-modified and conventional glass-ionomer cements.

Noninvasive assessment of novel nanohybrid resin cement adaptation using cross-polarization optical coherence tomography.

OBJECTIVES: Zein-coated magnesium oxide nanoparticles (zMgO NPs) can potentially improve cement adaptation to the tooth-restoration interface, which would aid in minimizing marginal leakage and secondary caries. The aim of this study was to assess the effect of incorporating zMgO NPs on the adaptation of self-adhesive resin cement using cross-polarization optical coherence tomography (CP-OCT) and scanning electron microscopy (SEM). METHODS: Resin inlays were fabricated to be cemented in Class-I cavities of extracted human molars. All specimens were randomly divided into five groups (n = 10), and the resin inlays were cemented using self-adhesive resin cement with various concentrations of zMgO NPs (0% [control], 0.3%, 0.5%, 1%, 2%). Characterization was done by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and SEM. The specimens were examined for interfacial adaptation under CP-OCT. Floor and wall adaptation measurements were analyzed by software on 20 B-scans, and samples were sectioned for interfacial measurement by SEM. RESULTS: Results for CP-OCT and SEM showed a statistically significant increase of adaptation in the floor and wall of resin cement filled with zMgO NPs compared to the control. The samples enhanced with 0.3% and 0.5% showed a statistically significantly better adaptation in floor and wall in CP-OCT and SEM. However, there was no significant difference between the 1%, 2%, and control groups for CP-OCT and SEM analysis. SIGNIFICANCE: The incorporation of zMgO NPs in self-adhesive resin cement can enhance the cement's properties by significantly improving its wall and floor adaptation.

Medical management for cerebellar mutism syndrome following posterior fossa surgery: A systematic review.

INTRODUCTION: Cerebellar mutism syndrome (CMS) is a serious complication of posterior fossa surgeries affecting mainly pediatric age group. The pathophysiology is still not fully understood. It adversely affects the recovery of patients. There is no definitive and standardized management for CMS. However pharmacological therapy has been used in reported cases with variable effectiveness. We aim through this review to summarize the available evidence on pharmacological agents used to treat CMS. METHOD: A thorough systematic review until December 2022, was conducted using PubMed Central, Embase, and Web of Science, databases to identify case reports and case series of CMS patients who underwent posterior fossa surgery and received pharmacological treatment. Patients with pathologies other than posterior fossa lesions were excluded from the study. RESULTS: Of 592 initial studies, 8 studies met our eligibility criteria for inclusion, with 3 more studies were added through manual search; reporting on 13 patients. The median age of 13 years (Standard deviation SD=10.60). The most frequent agent used was Bromocriptine. Other agents were fluoxetine, midazolam, zolpidem, and arpiprazole. Most patients recovered within 48 hours of initiating medical therapy. The median follow-up period was 4 months (SD=13.8). All patients showed complete recovery at the end of follow-up period. CONCLUSION: Cerebellar mutism syndrome is reported after posterior fossa surgeries, despite attempts to identify risk factors, pathophysiology, and management of CMS, it remains a challenging condition with significant morbidity. Different Pharmacological treatments have been proposed with promising results. Further studies and formalized clinical trials are needed to evaluate available options and their effectiveness.

Effect of Antibacterial Agents on Dentin Bond Strength of Bioactive Restorative Materials.

Treating dentin surfaces with antibacterial agents prior to bonding bioactive restorations might affect their mechanical properties. In this study, we evaluated the effect of silver diamine fluoride (SDF) and chlorhexidine (CHX) on the shear bond strength (SBS) of bioactive restorative materials. Dentin discs were treated with SDF for 60 s or CHX for 20 s and bonded with four restorative materials, namely Activa Bioactive Restorative (AB), Beautifil II (BF), Fuji II LC (FJ), and Surefil One (SO). Control discs were bonded without treatment (n = 10). SBS was determined using a universal testing machine, and a scanning electron microscope (SEM) was used for the evaluation of the failure mode and the cross-sectional examination of adhesive interfaces. The SBS of each material between different treatments and of the different materials within each treatment were compared via a Kruskal-Wallis test. The SBS of AB and BF was significantly higher than that of FJ and SO in the control and CHX groups (p < 0.01). In the latter, SBS was higher in FJ than SO (p < 0.01). SO had a higher value with SDF compared to CHX (p = 0.01). The SBS of SDF-treated FJ was higher than that of the control (p < 0.01). SEM showed a more homogenous and improved interface of FJ and SO with SDF. Neither CHX nor SDF compromised the dentin bonding of bioactive restorative materials.

Management of postoperative cerebral vasospasm in skull base surgeries: A systematic review of case reports and series.

Background: This study provides a comprehensive overview of the management of postoperative vasospasm after skull base surgeries. This phenomenon is rare but can be of serious sequelae. Methods: Medline, Embase, and PubMed Central were searched, along with examining the references of the included studies. Only case reports and series that reported vasospasm following a skull base pathology were incorporated. Cases with pathologies other than skull base, subarachnoid hemorrhage, aneurysm, and reversible cerebral vasoconstriction syndrome were excluded from the study. Quantitative data were presented as mean (Standard Deviation) or median (range), accordingly, while qualitative data were presented as frequency (percentage). Chi- square test and one-way analysis of variance were used to assess for any association between the different factors and patient outcomes. Results: We had a total of 42 cases extracted from the literature. The mean age was 40.1 (±16.1) with approximately equal males and females (19 [45.2%] and 23 [54.8%], respectively). The time to develop vasospasm after the surgery was 7 days (±3.7). Most of the cases were diagnosed by either angiogram or magnetic resonance angiography. Seventeen of the 42 patients had pituitary adenoma as the pathology. Anterior circulation was nearly affected in all patients. For management, most patients received pharmacological with supportive management. Twenty-three patients had an incomplete recovery as a result of vasospasm. Conclusion: Vasospasm following skull base operations can affect males and females, and most patients in this review were middle-aged adults. The outcome of patients varies; however, most patients did not achieve a full recovery. There was no correlation between any factors and the outcome.

Subependymal Giant Cell Astrocytoma Apoplexy: A Case Report and Systematic Review.

Subependymal giant cell astrocytoma (SEGA) is the most common intracranial tumor in tuberous sclerosis (TS) patients. The tumor generally localizes in the proximity of Monro's foramen; as it grows, it subsequently causes hydrocephalus and increases intracranial pressure (ICP). However, acute symptoms of increased ICP due to intratumoral bleeding rarely manifest in SEGA patients. We present a 27-year-old male with TS who presented due to hemorrhagic complications of SEGA with intratumoral bleeding and vitreous orbital hemorrhage. We then conducted a systematic review with four databases (PubMed, Web of Science, Google Scholar, and Cochrane) to identify similar cases using the following keywords: "Subependymal giant cell astrocytoma," "Hemorrhage," "Haemorrhage," and "Bleeding." Our review identified 12 articles reporting 14 cases of hemorrhagic complications of SEGA in addition to our case report. The median age of diagnosis was 21 (range 5-79) years with unequal gender distribution (M:F ratio, 11:4). Headache was the most presented symptom, followed by hemiparesis, seizure, altered mental status, visual deterioration, and headache accompanied by seizure. TS was seen in most of the cases (80%). Gross total resection (GTR) was achieved in 53.5% of the patients. Regarding the clinical outcome, 66.7% had a good outcome, 20% died, and 13.3% had no report of their outcomes. No tumor recurrence was seen in the cases with a reported duration of follow-up. Catastrophic presentation of SEGA apoplexy is a rare occurrence. We present a case report with a systematic review and discuss SEGA apoplexy's possible pathophysiology and outcome.

Noninvasive Adaptation Appraisal of Antimicrobial Nano-Filled Composite.

OBJECTIVE: The aim of this research was to assess the effect of incorporating zein-coated magnesium oxide (zMgO) nanofillers to resin-based composite on the internal adaptation of the restorations using cross-polarisation optical coherence tomography (CP-OCT). METHODS: Thirty noncarious human molar teeth were used. Class V cavities (3 × 5 mm) were prepared on the buccal and lingual surfaces of each tooth. Clearfil SE Bond 2 was applied to all the cavities and then the teeth were divided into 3 groups (n = 10) as follows: group 1-restored with N-Flow composite; group 2 and group 3-restored with N-Flow composite mixed with different zMgO nanoparticle concentrations (0.3% and 0.5% by weight, respectively) and then light cured using an LED curing device. Specimens were examined for interfacial adaptation examination under CP-OCT. Characterisation of the dental composite incorporating zMgO was done by Fourier-transform infrared spectroscopy (FTIR), x-ray diffraction (XRD), and field emission scanning electron microscopy (FESEM). Results were analysed with Kruskall-Wallis test followed by Mann-Whitney U test, at a significance level of P < .05. RESULTS: XRD spectra exhibited the sharp peaks of zMgO in the composite enhanced with zMgO nanoparticles. FESEM analysis showed a uniform distribution of the zMgO nanoparticles in the composite and FTIR illustrated no change in the spectra. The gap percentage along the cavity floor was significantly lower in groups 2 and 3 in comparison to group 1 (P < .05). Also there was a significant difference in gap percentages between groups 2 and 3 (P < .05), with group 3 showing the lowest gap percentage. CONCLUSIONS: The incorporation of 0.3% and 0.5% zMgO nanoparticles in flowable composite assists in improving the internal adaptation of the composite to the tooth surface.

Do-not-resuscitate (DNR) Orders' Awareness and Perception Among Physicians: a National Survey.

Background: The concept of do-not-resuscitate (DNR) orders began when medical and surgical interventions increased the possibility of resuscitation in dying patients. Healthcare providers should start to care more about the quality of life rather than quantity. The acceptance of signing DNR orders varies among physicians owing to different reasons and conceptions. Objective: The aim of this national survey was to evaluate the extent of physicians' knowledge and attitude towards do-not-resuscitate (DNR) orders in different hospitals and specialties in Saudi Arabia. Methods: A cross-sectional study was conducted in Saudi Arabia and other Arab Gulf countries between March 2019 and May 2021. Results: A total of 409 physicians completed the questionnaire (53.3% male, 47% of the participants were less than 30 years of age). Most participants had their residency medical training in Saudi Arabia (73.6%, n=281); 33.5% were emergency medicine (EM) physicians. Among 409 patients, 92.7% (n=379 ) were familiar with the DNR (do-not-resuscitate) ter. Half of the participants had never discussed a DNR status with the patient or family (n=215, 52.6%), however, only 38.4% had read the policy. A total of 275 (67.2%) participants were aware that their institute had a DNR policy, and a lack of patient/family understanding was the most common barrier for the majority to initiate DNR orders (53.9%, n=222). Most of the participants (65.8%, n=269) acknowledged a lack of training and understanding of the concepts of DNR orders. Conclusion: Most physicians who participated in this study were aware of the DNR order concept; however, half of them had never discussed or signed a DNR order. Patients and their families' misunderstandings were considered the main barriers. In addition, the lack of training in the concepts of DNR orders was considered a major obstacle.

Progression of Enamel Demineralisation Around Fissure Sealants: Optical Coherence Tomography Study.

PURPOSE: To evaluate the progression of enamel demineralisation around fissure sealants using cross-polarisation optical coherence tomography (CP-OCT). MATERIALS AND METHODS: Three fissure sealants; Fuji Triage (FJ, GC), Beautisealant (BT, Shofu) and Helioseal resin sealant (HL, Ivoclar Vivadent) were placed in cavities (3 × 0.5 × 1 mm) prepared in bovine enamel blocks (n = 5). After 7-day artificial saliva incubation, specimens were subjected to demineralisation for 4 weeks (pH 4.5). CP-OCT scans (Santec) were acquired for each specimen after 1, 2 and 4 weeks of demineralisation and lesions were quantitatively measured to analyse lesion progression. RESULTS: Repeated-measures ANOVA demonstrated that lesion size was statistically significantly affected by demineralisation period, fissure sealant type, and their interaction (P < 0.001). At 4 weeks, the highest mean value of lesion size was observed in HL group while FJ group showed the lowest. The rate of lesion progression was slower in FJ and statistically significantly different from BT (P < 0.05), which in turn was statistically significantly different than HL (P < 0.001). CONCLUSION: Fissure sealants that actively release ions are capable of improving the acid resistance of adjacent enamel. Beautisealant showed increased demineralisation inhibition compared to conventional resin sealant, but less than that provided by glass-ionomer sealant.

Computer vision syndrome among Saudi population: An evaluation of prevalence and risk factors.

INTRODUCTION: In the recent era of technological evolution, electronic devices have become an essential part of our lives, not merely in professional work settings, but also in daily leisure activities. Although these devices have simplified our lives, they are associated with a wide variety of health complaints. Thus, the so-called computer vision syndrome (CVS) has become a growing public health problem and has gained significant attention as it plays an important role in the quality of life of each individual, which in turn has put an increased burden on the health care system. Eye symptoms are among the most reported, yet extraocular symptoms were frequently described as adding an extra load. METHOD: An electronic survey was distributed randomly through social media platforms among the general population in Saudi Arabia, between the period from July to December 2017, irrespective of their sociodemographic factors, aiming to determine the prevalence of CVS and to verify the most common associated risk factors. RESULTS: In total, 690 participants were involved in our study, with a mean age of 33.8 years. Of these, 77.6% suffer from CVS, with eye-burning being the most common ocular symptoms (71%), as well as itching (67.5%), blurred vision (65%), tearing (62.3%), and other eye symptoms being reported. Neck/shoulder pain was found to be the most prevalent extra ocular symptom (85.2%); also back pain and headache are frequently expressed (78% and 70% respectively). A significant positive correlation was observed between CVS symptoms and time spent using the devices (P-value: 0.002). CONCLUSION: As technology advances, electronic devices have become a common tool that is used for different purposes on daily basis. We found in our study that the so-called computer vision syndrome is a growing public health problem. Thus, community education about the impact of such a lifestyle for proper handling of electronic devices must be addressed to avoid such health complaints.

Phenytoin Seizure Prophylaxis Therapy Resulting in Severe Thrombocytopenia After Brain Tumor Debulking Surgery.

BACKGROUND Phenytoin is an antiepileptic drug that is usually prescribed as a prevention treatment for tonic-clonic seizures or partial seizures, and as a prophylaxis for the neurosurgical related seizures. Phenytoin administration has several drawbacks; one drawback phenytoin-induced thrombocytopenia, which is a rare and significant adverse event. We report a rare adverse event after phenytoin prophylaxis therapy after a brain tumor debulking surgery, which resulted in severe unpredicted thrombocytopenia. CASE REPORT A 40-year-old male with no known health problems started to have an on/off headaches and loss of memory. Clinical investigations revealed a right frontal brain lesion. On the first day of admission, the patient was managed on neurosurgical seizure prophylaxis therapy of 100 mg intravenous phenytoin every 8 hours and 4 mg oral dexamethasone every 6 hours. On the fifth day of hospital admission, the patient underwent tumor debulking surgery. Twenty-four hours post-surgery, the patient's platelet level dropped to 26×109/L. Severe thrombocytopenia was managed first by transfusion of 17 units of platelets and by cessation of intravenous phenytoin plus the starting of 500 mg levetiracetam orally twice daily. Further management included infusion of 34 grams (0.4 g/kg) intravenous immunoglobulin (IVIG) over 5 days. Five days later, the patient gradually recovered with a platelet count of 239×109/L. CONCLUSIONS Phenytoin-induced thrombocytopenia is considered a rare event, but it has life-threatening consequences. The first and cornerstone management of this event is the cessation of phenytoin, followed by consideration of appropriate management based on the level of thrombocytopenia severity, and avoiding concomitant therapy of phenytoin and the use of dexamethasone as neurosurgical-related seizure prophylaxis.

Bilateral uniportal video-assisted thoracoscopic sympathectomy for managing secondary Raynaud's in CREST syndrome: A case report.

INTRODUCTION: Secondary Raynaud's is a manifestation that can present in CREST syndrome as a variant of five different diseases: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Secondary Raynaud's presents as a result of an imbalance between vasoconstriction and vasodilation potentially leading to tissue ischemia. The mainstay treatment is medical while surgery treatment preserved as a last resort. PRESENTATION OF CASE: A 28-year-old female presented with secondary Raynaud's and was subsequently diagnosed with CREST syndrome. The patient failed to respond to medical treatment, and gangrene of the right fourth distal phalanx developed. Stellate ganglion block was successfully used as a bridge to surgery. Uniportal video-assisted thoracoscopic surgery (VATS) sympathectomy was performed via a 2-cm incision, the sympathetic ganglia were identified and transected by cauterization at the level of the 3rd, 4th, and 5th intercostal spaces extending for a distance of 5 cm to ensure that the nerve of Kuntz was transected. The postoperative outcome was satisfactory, and the condition of the patient improved in a few months. DISCUSSION: Different management modalities have been used to relieve the symptoms of secondary Raynaud's. The treatment ranges from lifestyle modification, medical treatment, and lastly surgical intervention. Sympathectomy has been suggested for the management of refractive secondary Raynaud's owing to its considerable clinical response. CONCLUSION: The use of uniportal VATS sympathectomy results in favorable cosmetic and clinical outcomes including reduced length of hospital stay and postoperative pain.

Spontaneous Regression of Pineal Region Arachnoid Cyst: A Case Report and Review of Literature.

Arachnoid cyst is a rare benign cerebrospinal fluid-filled cyst that can develop anywhere in the brain along the arachnoid membrane and usually unaccompanied by the anomalous development of the brain structure. These cysts are usually located in the middle cranial fossa. However, they are also denoted in other regions. Arachnoid cysts are mostly asymptomatic and diagnosed incidentally. Spontaneous regression of arachnoid cysts in different anatomical regions of the brain has been reported in the literature. However, to the best of our knowledge, this is the first case reporting an unusual spontaneous regression of arachnoid cyst in the pineal region in a 3-year-old child presented to our hospital with hydrocephalus without alarming signs and was treated conservatively as the patient was stable, and the cyst showed spontaneous regression. A comprehensive review of the literature regarding spontaneous regression of arachnoid cysts has been collected and discussed in this article.

A Case Report of Intraparenchymal Neurocysticercosis in a Postpartum Female in Saudi Arabia.

Neurocysticercosis is a neurologic disease caused by infection with larvae of Taenia solium. It is most commonly transmitted by consumption of pork, water contaminated with T. solium or poor hygiene habits. As only few cases of neurocysticercosis have been documented in Saudi Arabia, the authors report a case of neurocysticercosis in a young Indian female residing in Saudi Arabia who presented with generalized tonic-clonic seizures 6 days after a normal vaginal delivery. Her physical and laboratory investigations as well as chest X-ray and electroencephalogram were all normal. Computed tomography of the head revealed multiple calcified nodular lesions, and magnetic resonance imaging showed ring-enhancing lesion in the left frontoparietal area. Serum enzyme-linked immunosorbent assay (qualitative) was positive for immunoglobulin G antibodies for cysticercosis. A diagnosis of neurocysticercosis was made, and the patient was treated with dexamethasone and levetiracetam for 4 days before discharge. At the 3-month follow-up, the patient's condition had significantly improved, and her seizures had not recurred. This report recommends considering neurocysticercosis as a differential diagnosis in patients presenting with new-onset seizures, even if the symptoms do not initially indicate neurocysticercosis or if the patient resides in an area where the disease is rare.

Pathway-Affecting Single Nucleotide Polymorphisms (SNPs) in RPS6KA1 and MBIP Genes are Associated with Breast Cancer Risk.

BACKGROUND: Genetic mutations and polymorphisms play an important role in the transformation of primary cells to malignant cells as it may lead to disturbance of vital pathways regulating cell cycle, DNA damage repair, and apoptosis. In this study, we genotyped single nucleotide polymorphisms (SNPs) which were predicted to affect certain pathways and to increase the risk of breast cancer. METHODS: The study included 81 Saudi breast cancer patients and 100 matching healthy controls from the Eastern Province in Saudi Arabia. The following SNPs (rs3168891, rs2899849, rs2230394, rs2229714) were then genotyped by TaqMan genotyping assay and the allele and genotype distribution was compared. RESULTS: The minor allele frequency of the following SNPs (rs3168891, rs2899849, rs2230394, rs2229714) was T=0.17, A=0.28, A=0.22, and G=0.16 respectively. The G allele of the SNP rs3168891 was significantly associated with increased breast cancer risk (P = 0.00001) while the T allele of the same locus was associated with reduced risk of breast cancer in both heterozygous and homozygous states. The T allele of SNP rs2229714 which is located in the RPS6KA1 gene was also significantly associated with the increased risk of breast cancer. However, the rs2899849 SNP located in the Integrin beta-1 (ITGB1) gene was not associated with the increased risk of breast cancer in our study population. Haplotype analysis revealed the presence of three risk haplotypes that increases the risk of breast cancer (TGGT, TGTA, GATA). CONCLUSION: We showed that three, previously untested, SNPs are associated with increased risk of breast cancer in our population.  This may be added to the list of factors involved in breast cancer risk assessment studies. The benefit and the utility of the in-silico prediction of disease risk factors and their genetic association had been demonstrated in this study, yet the predicted risk alleles have to be tested in clinical studies.
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Evaluation of microleakage in class-II bulk-fill composite restorations.

BACKGROUND/PURPOSE: Despite the clinical appeal of restoring deep class II cavities in single increment using bulk-fill resin composite, sealing of bulk-filled composite restorations is a concern. This study evaluated interfacial adaptation of bulk-fill composite restoration to axial wall and gingival floor of class II cavities using cross-polarization optical coherence tomography (CP-OCT). MATERIALS AND METHODS: Box-shaped class II cavities were prepared in extracted molars and divided into three groups (n = 7) according to adhesive used; Clearfil SE Bond 2 (SE2), Tetric-N Bond Self-Etch (TSE) or Tetric-N Bond Universal (TNU). All adhesives were applied in self-etch mode and according to manufacturers' recommendation. Then, preparations were bulk-filled with Filtek Bulk Fill Posterior Restorative resin composite and immersed in a contrast agent. Tomographic images of axial wall and gingival floor of each restoration were obtained by CP-OCT (IVS-300, Santec) with a central wavelength of 1330 nm and were imported to an image analysis software to quantify microleakage. RESULTS: Mann-Whitney U test showed statistically significant difference in microleakage percentage between the groups at both axial wall and gingival floor (p < 0.05). SE2 group had the lowest percentage of microleakage (p < 0.05), as only few cross-sections showed areas of reflections from contrast agent penetrating into axial wall (8.23 ±â€¯6.8) and gingival floor (7.07 ±â€¯4.1), followed by TNU group (18.13 ±â€¯12.9 axially and 30.61 ±â€¯11.9 gingivally). Microleakage was frequently observed at the axial wall and gingival floor of TSE group, showing the highest percentages of 25.50 ±â€¯12.5 and 36.97 ±â€¯10.2, respectively (p < 0.05). CONCLUSION: All tested groups exhibited different extent of interfacial microleakage, however, two-step self-etch adhesive yielded superior adaptation in comparison to one-step self-etch adhesive and universal adhesive.

Effect of light irradiation condition on gap formation under polymeric dental restoration; OCT study.

OBJECTIVE: To investigate the effect of two light-curing systems; quartz tungsten-halogen (QTH) and light-emitting diode (LED), and irradiation time on interfacial gap formation of dental composite resin restorations bonded with an adhesive resin using optical coherence tomography (OCT). MATERIALS AND METHODS: Forty cavities were prepared in extracted human molar teeth and divided into four groups (n=10) based on the type of light curing system QTH (LITEX 680A) and LED (Demi Plus) and curing duration (10 s or 40 s). A single-step self-etching dental adhesive (Tetric® N-Bond; Ivoclar Vivadent AG, Schaan, FL, Liechtenstein) was applied and polymerized with QTH for 10 s (QTH-10), or for 40 s (QTH-40). Similarly, the adhesive in LED-10 and LED-40 groups was polymerized with an LED for 10 s or 40 s, respectively. Then, all specimens were restored with Filtek™ Z350 XT flowable composite (3M ESPE AG, St. Paul, MN, USA) and immersed in ammoniacal silver-nitrate contrasting solution. Cross-sectional images were recorded at every 250µm using cross-polarization OCT system (CP-OCT; IVS-300, Santec, Komaki, Aichi, Japan). Image analysis to quantify the percentage of gap at resin-dentin interface was performed using a custom plugin for ImageJ software. RESULTS: Data analysis using one-way ANOVA showed a significant difference in mean gap percentage between the four test groups (p<0.0001). Mean gap percentage values were 75.8%, 53.2%, 9.9% and 5.6%. The highest for LED-10 followed by LED-40 (p <0.05). QTH-40 revealed a slightly better adaptation compared with QTH-10, but the difference between them was not significant (p <0.05). CONCLUSION: CP-OCT with a contrast agent is a useful non-invasive imaging tool for dental composite resin materials. QTH showed better results than LED under the experimental conditions. When using an LED light-curing unit, prolonged irradiation improved interfacial adaptation of dental composite bonded with a self-etching adhesive.

Tumefactive multiple sclerosis masquerade as a central nervous system tumor: a case report.

INTRODUCTION: Tumefactive multiple sclerosis is a demyelinating disorder that appears tumor-like on MRI. To most physicians, diagnosing tumefactive MS by applying clinical, radiological, or laboratory examination like Cerebrospinal fluid (CSF) analysis, can be challenging and ultimately biopsy is necessary to confirm the diagnosis. CASE PRESENTATION: This paper reports a case of a 37-year-old woman who presented with progressive headache and a strong family history of cancer and was misdiagnosed as having a CNS glioma. After considering the MRI features, CSF analysis results and observing improvement with IV steroids, the diagnosis of tumefactive MS was made. The patient refused biopsy to rule out the possibility of tumor or abscess. Nine months later, she presented with another relapse and an injectable disease modifying treatment (DMT) was initiated, and her course has been stable in follow up. TAKE-AWAY LESSON: The overall clinical importance of this case report is to highlight the real possibility of being forced to decide between Tumefactive demyelinating lesions (TDLs) and brain tumors in clinical practice, in order to avoid unnecessary biopsy.