Age-specific incidence of joint disease in paediatric patients with haemophilia: A single-centre real-world outcome based on consecutive US examination.

INTRODUCTION: Joint health is one of the most important factors contributing to a healthy life in patients with haemophilia. Recent study revealed that starting early prophylaxis was not enough to prevent joint disease in most paediatric patients with haemophilia. AIM: In this study, we aimed to determine the age-specific incidence of acute joint disease during childhood at single haemophilia treatment centre (HTC). METHOD: The joint health in 48 patients was evaluated based on consecutive US testing for 5 years at annual multidisciplinary comprehensive care. RESULTS: During the study period, 23 patients (47.9%) had no joint disease since the initial examination, whereas 13 patients (27.0%) showed development from negative to positive findings. The incidence of joint disease increased with age: 0% in preschool, 5.3% in elementary school, 14.3% in junior high school and 35% beyond high school age. Among the 13 patients who developed joint disease, two experienced acquired synovitis that resolved during the follow-up period. Statistical analysis revealed that the patients who routinely underwent follow-up by the HTC exhibited a significantly lower incidence of joint disease than did those followed up at other institutions (p < .001). CONCLUSION: These results indicated that close check-up, including routine joint examination using US as well as frequent assessment of pharmacokinetic profile at the HTC, might play an important role in avoiding joint disease among paediatric patients with haemophilia.

Cutaneous complications after transcatheter arterial treatment for hepatocellular carcinoma via the internal mammary artery: how to avoid this complication.

PURPOSE: To lower the rate of cutaneous complications after transcatheter arterial treatment for hepatocellular carcinoma (HCC) via the internal mammary artery (IMA) we retrospectively assessed the complications. MATERIALS AND METHODS: We reviewed cutaneous complications in 14 patients with 18 HCCs who had undergone 17 treatment procedures via the IMA, including selective transcatheter arterial infusion chemotherapy with Lipiodol (Lip-TAI) (n = 3), selective Lip-TAI + transcatheter arterial embolization (TAE) (n = 3), nonselective Lip-TAI (n = 1), nonselective Lip-TAI + TAE (n = 5), and nonselective TAE (n = 5). The filling and nonfilling of subcutaneous vessels with Lipiodol was examined on postoperative computed tomography (CT) scans. RESULTS: Skin rash (n = 3) and ulceration (n = 1) occurred after 4 of 17 (24%) procedures: two of three selective Lip-TAI procedures and two of five nonselective Lip-TAI + TAE procedures. The doses of chemotherapeutic agents for tumor sizes in selective Lip-TAI procedures were higher than those in selective Lip-TAI + TAE procedures. Cutaneous complications were encountered after two of three procedures with filling but not after any of eight procedures without filling. CONCLUSION: A lower dose of chemotherapeutic agents may be less risky when undertaking a selective procedure via the IMA for HCC. If nonselective, TAE alone may be less risky. Postoperative CT may be helpful for predicting cutaneous complications.

Compatibility between self-etching adhesive and self-curing resin by addition of anion exchange resin.

OBJECTIVE: The aim was to investigate whether anion exchange resin powder in the OH(-) form, added to the amine component of self-cured resin can deprotonize acid groups of a self-etching adhesive and thus eliminate incompatibility caused by amine neutralization. METHODS: Shear bond strength (SBS) of a self-cured CorePaste (COP), bonded either with all-in-one adhesive iBond (IBO) or with IBO coated with a self-cured experimental resin (SCR), loaded with 0, 8, 16, or 32 wt% of anion exchange resin powder (AER) in OH- form, were determined on 80 enamel and dentin surfaces each after 24 h water storage. IBO specimens were either light-activated or not. Flexural modulus and strength of the four SCR resins were determined by three-point bending. Data was analyzed by one-way ANOVA and Duncan's post hoc test (p<0.05). RESULTS: Enamel SBSs of COP on IBO were 20-25 MPa, in combination with SCR (0 up to 32%) >25 MPa for activated or non-activated IBO. COP on IBO produced no bond on dentin, with the non-loaded SCR 5-10 MPa SBS was achieved, and 15 and 21 MPa were measured with the three AER-loaded SCRs on activated and non-activated IBO, respectively. Flexural moduli of SCR with 0 and 8% AER were higher than with 16 and 32%. Flexural strengths were not significantly different. SIGNIFICANCE: Addition of anion exchange resin to the amine component of self-cured resin is an effective means of enhancing the bond strength on dentin and to prevent amine neutralization through the acid groups of self-etching primer adhesives.