A novel deep learning-based perspective for tooth numbering and caries detection.

OBJECTIVES: The aim of this study was automatically detecting and numbering teeth in digital bitewing radiographs obtained from patients, and evaluating the diagnostic efficiency of decayed teeth in real time, using deep learning algorithms. METHODS: The dataset consisted of 1170 anonymized digital bitewing radiographs randomly obtained from faculty archives. After image evaluation and labeling process, the dataset was split into training and test datasets. This study proposed an end-to-end pipeline architecture consisting of three stages for matching tooth numbers and caries lesions to enhance treatment outcomes and prevent potential issues. Initially, a pre-trained convolutional neural network (CNN) utilized to determine the side of the bitewing images. Then, an improved CNN model YOLOv7 was proposed for tooth numbering and caries detection. In the final stage, our developed algorithm assessed which teeth have caries by comparing the numbered teeth with the detected caries, using the intersection over union value for the matching process. RESULTS: According to test results, the recall, precision, and F1-score values were 0.994, 0.987 and 0.99 for teeth detection, 0.974, 0.985 and 0.979 for teeth numbering, and 0.833, 0.866 and 0.822 for caries detection, respectively. For teeth numbering and caries detection matching performance; the accuracy, recall, specificity, precision and F1-Score values were 0.934, 0.834, 0.961, 0.851 and 0.842, respectively. CONCLUSIONS: The proposed model exhibited good achievement, highlighting the potential use of CNNs for tooth detection, numbering, and caries detection, concurrently. CLINICAL SIGNIFICANCE: CNNs can provide valuable support to clinicians by automating the detection and numbering of teeth, as well as the detection of caries on bitewing radiographs. By enhancing overall performance, these algorithms have the capacity to efficiently save time and play a significant role in the assessment process.

Dental student application of artificial intelligence technology in detecting proximal caries lesions.

OBJECTIVES: This study aimed to investigate the caries diagnosis performances of dental students after training with an artificial intelligence (AI) application utilizing deep learning techniques, a type of artificial neural network. METHODS: A total of 1200 bitewing radiographs were obtained from the institution's database and two specialist dentists labeled the caries lesions in the images. Randomly selected 1000 images were used for training purposes and the remaining 200 radiographs were used to evaluate the caries diagnostic performance of the AI. Then, a convolutional neural network, a deep learning algorithm commonly employed to analyze visual imagery problems, called "You Only Look Once," was modified and trained to detect enamel and dentin caries lesions in the radiographs. Forty dental students were selected voluntarily and randomly divided into two groups. The pre-test results of dental caries diagnosis performances of both groups were recorded. After 1 week, group 2 students were trained using an AI application. Then, the post-test results of both groups were recorded. The labeling duration of the students was also measured and analyzed. RESULTS: When both groups' pre-test and post-test results were evaluated, a statistically significant improvement was found for all parameters examined except precision score (p < 0.05). However, the trained group's accuracy, sensitivity, specificity, and F1 scores were significantly higher than the non-trained group in terms of post-test scores (p < 0.05). In group 2 (trained group), the post-test labeling time was considerably increased (p < 0.05). CONCLUSIONS: The students trained by AI showed promising results in detecting caries lesions. The use of AI can also contribute to the clinical education of dental students.

Effect of perception of sustainability in local food experiences on healthy eating tendency: mediator and moderator effects.

Tourists who favor local food typically care about healthy food choices. Their view of locally produced food as healthy is related to perceptions of sustainability. This relationship can be explained by tourists' personality traits and tendency to eat local food. This study aimed to establish the effect of tourists' perceptions of sustainability in the context of local food experiences on healthy eating tendencies. In addition, we aimed to determine the role of tourists' personality traits and local eating tendencies and elucidate the moderating role of searching online for information on food choices. An online questionnaire (via e-mail and WhatsApp) was used to obtain data from 379 research participants, recruited using a non-probabilistic sampling technique. A research model and hypotheses were formed based on Hayes PROCESS Macro models 90 and 6, and moderator and mediator effects were analyzed using these models. Healthy eating was well-explained by the model, and the perception of social and environmental sustainability in local food experiences (LFE-SES) positively affected food-related personality traits (FRPT), local food eating tendencies (LFET), and healthy eating (HE). While food-related personality traits did not mediate the relationship between the perception of sustainability and healthy eating, local food eating tended to mediate this relationship. In addition, when food-related personality traits and local food eating tendencies were evaluated together, they had a mediating role between the perception of sustainability and healthy eating. Searching online for information had an insignificant moderating effect. These findings help promote an understanding of healthy eating tendencies. Within the context of local food, they suggest critical theoretical and practical implications for the relationship between the perception of sustainability, food-related personality traits, local food eating tendencies, and healthy eating.

The effect of perceived stress on organizational silence in emergency service doctors in Turkey: The mediating role of emotional intelligence.

Objectives: The purpose of this study is to determine the role of emotional intelligence in the relationship between the stress perceptions of emergency medicine doctors and their organizational silence behaviors. Methods: Data were collected digitally from 434 doctors working in emergency departments in Turkey. On the assumption that perceived stress was effective on organizational silence behavior and that emotional intelligence mediates this relationship, hypotheses were developed and a mediating effect model was established. The research model and hypotheses were shaped through Structural Equation Modeling (SEM). Hayes 4th model was used to test the research hypotheses. The research model was tested via SPSS Process v4.1 by Andrew F. Hayes. Results: According to the correlation analysis to determine the relationship between the variables, it was determined that perceived stress was positively correlated with organizational silence behavior, emotional intelligence was negatively correlated with perceived stress, and emotional intelligence was negatively correlated with organizational silence. As a result of the mediating effect model test, it was determined that emotional intelligence had a statistically significant mediating effect in the effect of perceived stress on organizational silence. Conclusion: Within the framework of the findings, it is thought that emotional intelligence is a key variable in turning the negative energy between stress and silence into positive.

Diagnosis of interproximal caries lesions with deep convolutional neural network in digital bitewing radiographs.

OBJECTIVES: This study aimed to investigate the effectiveness of deep convolutional neural network (CNN) in the diagnosis of interproximal caries lesions in digital bitewing radiographs. METHODS AND MATERIALS: A total of 1,000 digital bitewing radiographs were randomly selected from the database. Of these, 800 were augmented and annotated as "decay" by two experienced dentists using a labeling tool developed in Python programming language. The 800 radiographs were consisted of 11,521 approximal surfaces of which 1,847 were decayed (lesion prevalence for train data was 16.03%). A CNN model known as you only look once (YOLO) was modified and trained to detect caries lesions in bitewing radiographs. After using the other 200 radiographs to test the effectiveness of the proposed CNN model, the accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS: The lesion prevalence for test data was 13.89%. The overall accuracy of the CNN model was 94.59% (94.19% for premolars, 94.97% for molars), sensitivity was 72.26% (75.51% for premolars, 68.71% for molars), specificity was 98.19% (97.43% for premolars, 98.91% for molars), PPV was 86.58% (83.61% for premolars, 90.44% for molars), and NPV was 95.64% (95.82% for premolars, 95.47% for molars). The overall AUC was measured as 87.19%. CONCLUSIONS: The proposed CNN model showed good performance with high accuracy scores demonstrating that it could be used in the diagnosis of caries lesions in bitewing radiographs. CLINICAL SIGNIFICANCE: Correct diagnosis of dental caries is essential for a correct treatment procedure. CNNs can assist dentists in diagnosing approximal caries lesions in bitewing radiographs.

Effect of laser-assisted retrograde cavity preparation on push-out-bond-strength of mineral trioxide aggregate and calcium-enriched-mixture-cement / Efeito de preparo cavitário retrógrado assistido por laser na força de união de cimento de agregado trióxido mineral e cimento enriquecido com cálcio

Objective: This study aimed to determine the push-out-bond-strength(PBS) of mineral trioxide aggregate (BIOMTA+) and calcium-enriched-mixture-cement (CEM) in retrograde cavities prepared using Er: YAG laser and stainless-steel bur. Material and Methods: The root canals of 60 extracted single-rooted human teeth were prepared, filled and their apical portion of 3-mm were resected using a diamond bur and randomly divided into four groups according to technique of retrograde preparation and filling material as follows(n=15): Group1: bur/ BIOMTA+ ,Group2: bur/ CEM, Group3: Er:YAG laser/ BIOMTA+, Group4: Er:YAG laser/ CEM. PBS test were performed to specimens and failure modes were evaluated. The data were statistically analyzed with ANOVA, Post-Hoc Tukey and t tests (p< 0.05). Results: CEM was exhibited higher than bond strength compared to BIOMTA+ in retrograde cavity prepared using laser (p= 0.021) and BIOMTA+ in retrograde cavity prepared using bur was exhibited higher than bond strength compared to in retrograde cavities prepared using laser (p= 0.024). Failure modes were dominantly cohesive in all groups tested and one representative specimen each failure mode was examined in SEM and the general characteristics of the failure modes were confirmed. Conclusion: With in the limitations of the present study, when used CEM, Er: YAG laser-assisted retrograde cavity preparation positively affected the bond strength values compared to BIO MTA+. Considering its optimal adhesion, the calcium-enriched-mixture-cement (CEM) might be a good option as a filling material in retrograde cavities in clinical use. (AU)

Objetivo: O objetivo deste estudo foi determinar a força de união (PBS) de cimento de agregado trióxido mineral (BIO MTA+) e cimento enriquecido com cálcio (CEM) em preparos cavitários retrógrados realizados com: Laser Er-YAG e brocas de aço inoxidável. Material e Métodos: Canais radiculares de 60 dentes unirradiculares extraídos foram preparados, preenchidos e 3 mm de suas porções apicais foram ressecadas usando uma broca diamantada e divididos randomicamente em quatro grupos de acordo com a técnica de preparação retrógrada e o material de preenchimento (n=15): Grupo 1: Broca/BIO MTA+, Grupo 2: Broca/CEM, Grupo 3: Laser Er-YAG/BIO MTA+, Grupo 4: Laser Er-YAG/CEM. O teste de PBS foi realizado para as amostras e os modelos de falha foram avaliados. Os dados foram analisados estatisticamente pelos testes de ANOVA, Post-Hoc Tukey e testes t (p< 0.05). Resultados: CEM apresentou maior força de união que BIO MTA+ em cavidades retrógradas preparadas com laser (p= 0.021) e BIO MTA+ em cavidades retrógradas preparadas com brocas apresentou maior força de união quando comparado à cavidades retrógradas preparadas com laser (p= 0.024). Os modelos de falha foram predominantemente coesos em todos os grupos testados e um espécime representativo de cada modelo de falha foi examinado em MEV e as características gerais dos modelos de falha foram confirmadas. Conclusão: Com as limitações do presente estudo, quando usou-se CEM, o preparo de cavidades retrógradas através de Laser Er-YAG afetou positivamente os valores da força de união quando comparados com BIO MTA+. Considerando sua ótima adesão, o cimento enriquecido com cálcio (CEM) pode ser uma boa opção como um material de preenchimento em cavidades retrógradas no uso clínico.

The effect of SARS-CoV-2 effective mouthwashes on the staining, translucency and surface roughness of a nanofill resin composite.

PURPOSE: To evaluate the effect of SARS CoV-2 effective mouthwashes on the color change (ΔE), translucency parameter (TP) and average surface roughness (Ra) of a nanofill resin composite (Filtek Ultimate). METHODS: 91 composite specimens (10 mm in diameter, 1 mm thickness) were prepared using a stainless-steel mold and randomly divided to seven groups as follows: Group 1 (CHX) : 0.12% CHX digluconate + 0.15% benzydamine hydrochloride (96% alcohol), Group 2 (HAc): hypochlorous acid (500 ppm), Group 3 (PVP-I) : 1% povidone iodine, Group 4 (H2O2) : 1.5% hydrogen peroxide, Group 5 (CHX + C) : 0.09% chlorhexidine digluconate + cyclodextrin + citrox, Group 6 (CPC) : 0.075% cetylpyridinium hydrochloride, Group 7 (Control) : artificial saliva. The initial color values were determined by a spectrophotometer on both white and black backgrounds. The specimens were immersed in 20 mL mouthwash for 1 minute with a 12-hour interval. The Ra, ΔE and TP were determined after 1, 2 and 3 weeks. Data were analyzed using repeated measures ANOVA, one-way ANOVA, post-hoc Bonferroni and Tukey tests (P< 0.05). RESULTS: The highest and the lowest ΔE3 (after 3 weeks) value were observed in H2O2 (1.57± 0.29) and CHX (0.92± 0.17) groups, respectively. The CHX and CPC groups demonstrated significantly lower ΔE3 values than the control group (P< 0.05). CHX, HAc and PVP-I significantly affected the TP (P< 0.05). None of the groups demonstrated any significant changes of Ra scores (P> 0.05). CLINICAL SIGNIFICANCE: Within the limitations of this study some of the mouthwashes affected the ΔE and TP of the Filtek Ultimate nanofill resin composite. The Ra was not affected by any of the mouthwashes.

Repair bond strength and surface topography of resin-ceramic and ceramic restorative blocks treated by laser and conventional surface treatments.

This study intended to compare the repair bond strength of computer-aided design/computer-aided manufacturing (CAD/CAM) blocks consisting of resin and feldspathic ceramics following different surface treatments using the microtensile bond strength (µTBS) test. Ten specimens were prepared with 4 mm height for Vita Enamic (VE), Lava Ultimate (LU), Vita Mark II (VM), and thermocycled (10,000 cycle, 5-55°C). Each material was categorized into one of five subgroups according to following surface treatments: (a) bur grinding (BG), (b) hydrofluoric acid etching (HF), (c) neodymium-doped yttrium aluminum garnet (Nd:YAG or NY), (d) erbium-doped yttrium aluminum garnet (Er:YAG or EY), and (e) erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG or ECY) laser conditioning. After surface treatment procedures, specimens were properly restored to 4 mm high with a micro-hybrid composite resin. Bar specimens (1 × 1 × 8 mm) were obtained using a low-speed cutting machine and then thermocycled (10,000 cycle, 5-55°C). The µTBS was tested at 1 mm/min crosshead speed, and failure modes were evaluated. Data were analyzed with two-way ANOVA and post hoc Tukey tests. LU-BG showed significantly higher µTBS (32.94 ± 5.80 MPa) compared to LU-laser groups (p < .05). VE-BG showed significantly higher µTBS (22.06 ± 4.26 MPa) compared to other VE groups (p < .05). Among the laser groups, the NY laser produced the lowest (p < .05) µTBS for LU (13.42 ± 3.44 MPa) and VE (2.27 ± 0.85 MPa), while EY showed the highest (p < .05). Laser-treated VM groups were all prefailured. VM-HF produced a higher µTBS (18.73 ± 3.75 MPa) than VM-BG (5.05 ± 1.76 MPa) (p < .05).

Effect of Saliva Contamination on Microleakage of Open Sandwich Restorations.

OBJECTIVES: The purpose of the present study was to evaluate the microleakage of conventional glass-ionomer, resin modified glass-ionomer and glass hybrid ionomer Class II open sandwich restorations with or without saliva contamination. MATERIALS AND METHODS: Sixty extracted sound human molar teeth were used and 120 class II slot cavities were prepared in mesial and distal surfaces. The gingival margins were located 1 mm below the cementoenamel junction. All specimens were randomly divided in 4 groups (n=15): Group I: High-Viscous Glass Ionomer (Fuji IX GP) Group II: Resin Modified Glass Ionomer (Fuji II LC) Group III: Glass Hybrid Ionomer (Equia-fil Forte), Group IV: Composite Resin (G'aenial Posterior). In open sandwich restoration groups, glass ionomer materials were placed to gingival floor in 1 mm thickness and rest of the cavity was filled with resin composite. After the restorations in mesial surfaces had been performed, distal cavities were restored with the same protocol after saliva contamination. The specimens were thermo-cycled for 10000 cycles at 50C to 550C and immersed in methylene blue dye solution (% 0,5) for 24 hours. Then, they were sectioned vertically through the center of the restorations from mesial to distal surface with a water-cooled diamond saw with 1mm thickness. Subsequently, the dye penetration was evaluated with image analysis software. Data were statistically analyzed (p<0.05). RESULTS: There was a statistically significant difference between gingival microleakage scores in no contamination groups, between high-viscous glass ionomer, Fuji IX GP and other materials tested (p<0.05). In saliva contaminated groups, there was no statistically significant difference between gingival microleakage scores (p>0.05). Additionally, there was not a statistically significant difference between the no contamination and saliva contaminated groups regardless of dental materials tested (p>0.05). CONCLUSION: Within the limitations of this study, in open sandwich restorations, saliva contamination did not show an adverse effect on microleakage irrespective of dental materials tested. Glass hybrid ionomers and resin modified glass ionomers showed lower microleakage scores in gingival margins compared to high-viscous glass ionomer material in no contamination groups.

Evaluation of the repair capacities and color stabilities of a resin nanoceramic and hybrid CAD/CAM blocks.

PURPOSE: This study evaluated the color stabilities of two computer-aided design and computer-aided manufacturing (CAD/CAM) blocks and a nanofill composite resin and the microtensile bond strength (µTBS) between the materials. MATERIALS AND METHODS: Twelve specimens of 4 mm height were prepared for both Lava Ultimate (L) and Vita Enamic (E) CAD/CAM blocks. Half of the specimens were thermocycled (10,000 cycle, 5° to 55℃) for each material. Both thermocycled and non-thermocycled specimens were surface treated with one of the three different methods (Er,Cr:YSGG laser, bur, or control). For each surface treatment group, one of the thermocycled and one of non-thermocycled specimens were restored using silane (Ceramic Primer II), universal adhesive (Single Bond Universal), and nanofill composite resin of 4-mm height (Filtek Ultimate). The other specimens were restored with the same procedure without using silane. For each group, 1 × 1 × 8 mm bar specimens were prepared using a microcutting device. Bar specimens were thermocycled (10,000 cycle, 5° to 55℃) and microtensile tests were performed. Staining of the materials in coffee solution was also compared using a spectrophotometer. Data were analyzed using one-way ANOVA, t-test and post-hoc Scheffe tests. RESULTS: µTBS were found similar between the thermocycled and non-thermocycled groups (P>.05). The highest µTBS (20.818 MPa) was found in the non-thermocycled, bur-ground, silane-applied E group. Silane increased µTBS at some E groups (P<.05). Composite resin specimens showed more staining than CAD/CAM blocks (P<.05). CONCLUSION: CAD/CAM blocks can be repaired with composite resins after proper surface treatments. Using silane is recommended in repair process. Color differences may be shown between CAD/CAM blocks and the nanofill composite after a certain time period.

Evaluation of microleakage and the degree of conversion of three composite resins polymerized at different power densities / Avaliação da microinfiltração e do grau de conversão de três resinas compostas polimerizadas em diferentes densidades de potência

Objectives: This study aims to evaluate the degree of conversion (DC) and microlekage scores of three different composite resins polymerized with a LED curing device in standard and extra-power mode. Material and Methods: One bulk-fill (Tetric EvoCeram Bulk-Fill ­ TECBF) and two conventional composite materials (Clearfil Majesty Posterior ­ CMP and Tetric EvoCeram ­ TEC) were evaluated. A total of 30 specimens were prepared for six groups (N = 5). These groups were polymerized with a LED curing device as follows: TECBF-6: 3200mW/cm2 for six seconds, TECBF-20: 1000mW/cm2 for 20 seconds, CMP-6: 3200mW/cm2 for six seconds, CMP-20: 1000mW/cm2 for 20 seconds, TEC-6: 3200mW/cm2 for six seconds, TEC - 20: 1000 mW/cm2 for 20 seconds. After 24 hours of water storage, DC was measured by Raman spectroscopy. Microleakage scores of the six groups were bonded to various adhesive systems (Clearfil SE Bond or Adhese Bond Universal) were also evaluated at Class II box cavities (N = 10). Results: While the highest DC was found at the top (TECBF-20= 79.92% and TECBF-6= 79.02%) and bottom surfaces (TECBF-20 = 68.94% and TECBF-6= 71.04%) for TECBF groups, TEC groups (TEC-20top = 59.06%, TEC-6top=49.66%, TEC-20bottom = 43.72% and TEC-6bottom= 40.68%) showed the lowest DC for the both surfaces (p < 0.05). Polymerization of materials in standard or extra-power mode was similar to DC (p > 0.05). Microleakage scores were found to be similar (p > 0.05). Conclusion: According to the results of the study, different power densities of LED curing light did not affect the DC of composite resins and microleakage values of restorations at small Class II cavities (AU)

Objetivo: este estudo tem como objetivo avaliar os graus de conversão (DC) e microinfiltração de três diferentes resinas compostas polimerizáveis com um dispositivo de luz por LED nos modos padrão e no modo de alta-potência. Material e métodos: uma resina bulk-fill (Tetric EvoCeram Bulk-Fill - TECBF) e dois materiais resinosos convencionais (Clearfil Majesty Posterior - CMP e Tetric EvoCeram - TEC) foram avaliados. Um total de 30 espécimes foram preparados e divididos em seis grupos (N = 5). Esses grupos foram polimerizados com um dispositivo de luz de LED da seguinte forma: TECBF-6: 3200mW / cm2 por seis segundos, TECBF-20: 1000mW / cm2 por 20 segundos, CMP-6: 3200mW / cm2 por seis segundos, CMP20: 1000mW / cm2 por 20 segundos, TEC-6: 3200mW / cm2 por seis segundos, TEC - 20: 1000 mW / cm2 por 20 segundos. Após 24 horas de armazenamento em água, a DC foi medida por espectroscopia Raman. Os escores de microinfiltração dos seis grupos dos vários sistemas adesivos (Clearfil SE Bond ou Adhese Bond Universal) também foram avaliados nas cavidades Classe II (N = 10). Resultados: embora a maior CD tenha sido encontrada nas partes superior (TECBF-20 = 79,92% e TECBF-6 = 79,02%) e inferiores (TECBF-20 = 68,94% e TECBF-6 = 71,04%) para grupos TECBF, os grupos TEC (TEC-20top = 59,06%, TEC-6top = 49,66%, TEC-20bottom = 43,72% e TEC-6bottom = 40,68%) apresentaram as menores CD para as ambas as partes (p < 0,05). A polimerização de materiais no modo padrão ou alta-potência foi semelhante à DC (p > 0,05). Os escores de microinfiltração foram semelhantes (p > 0,05). Conclusão: de acordo com os resultados do estudo, diferentes densidades de potência da luz de LED não afetaram as CD das resinas compostas e os valores de microinfiltração das restaurações em pequenas cavidades da Classe II. (AU)

Minimally Invasive Approach for Improving Anterior Dental Aesthetics: Case Report with 1-Year Follow-Up.

Dental aesthetics have become highly important in recent years. Treating aesthetic demands with noninvasive or minimally invasive techniques can preserve the natural tissues. A 20-year-old female patient presented to the clinic with aesthetic concerns. After the clinical and radiographic examinations, hypomineralization was identified in the maxillary anterior teeth except the maxillary right canine. An external discoloration was also identified in the maxillary left canine tooth. Moreover, the right canine tooth was identified as a Turner's tooth according to the patient's anamnesis. The resin infiltration technique was applied to the maxillary anterior teeth except the maxillary right canine. The bleaching treatment was applied to the maxillary left canine tooth. Then, a laminate veneer restoration was applied to the upper right canine tooth with Turner's hypoplasia. Following the treatment, a satisfactory aesthetic restoration was achieved. After 1-year examination, no clinical failures were observed.

One-year clinical evaluation of different types of bulk-fill composites.

AIM: In the present study, we evaluated the 1-year clinical performance of a conventional posterior composite resin and three bulk-fill composite resins. METHODS: Fifty patients with four class II restorations under occlusion were enrolled in the present study. A total of 200 restorations were placed in the cavity, 50 for each material (Clearfil Photo Posterior, Filtek Bulk-Fill Flowable and Filtek P60, Tetric EvoCeram Bulk-Fill, and SonicFill). One operator placed the restorations in the cavity, and 1 week later the patients were called for baseline examination. Two calibrated examiners evaluated the restorations once every 3 months for 1 year, according to United States Public Health Service criteria. The data were analyzed using SPSS. Non-parametric tests (Kruskal-Wallis, Mann-Whitney U-test, and Friedman) were used for the analysis at a confidence level of 95%. RESULTS: The 1-year recall rate was 86%. All restorations showed minor modifications after 1 year. However, no statistically-significant differences were detected between the materials' performance at baseline and after 1 year for all criteria (P > 0.05). CONCLUSIONS: The bulk-fill composite resin materials showed similar clinical performance when compared with a conventional posterior composite resin. Further evaluations are necessary for the long-term clinical performance of these materials.

Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension.

AIM: To determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH). METHODS: In this prospective study, we evaluated the characteristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes. RESULTS: A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred. CONCLUSION: Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.

The Role of Fecal Calprotectin in Evaluating Intestinal Involvement of Behçet's Disease.

One of the regions of involvement of Behçet's disease (BD), a systematic inflammatory vasculitis with unknown etiology, is the gastrointestinal (GI) tract. Upper GI endoscopy, colonoscopy, and capsule endoscopy are frequently used methods to diagnose the intestinal involvement of BD. The aim of this study was to investigate the role of fecal calprotectin (FC) in the evaluation of intestinal involvement in BD. Material and Method. A total of 30 patients who were diagnosed with BD and had no GI symptoms and 25 individuals in the control group were included in this study. Results. Levels of FC were statistically significantly higher in patients with BD compared to the control group (p < 0.001). The correlation analysis performed including FC and markers of disease activity revealed a positive and statistically significant correlation between FC level and CRP and erythrocyte sedimentation rate (r: 0.255, p < 0.049, and r: 0.404, p < 0.001, resp.). FC levels in patients who were detected to have ulcers in the terminal ileum and colon in the colonoscopic examination were statistically significantly higher compared to the patients with BD without intestinal involvement (p = 0.01). Conclusion. The measurement of FC levels, in patients with BD who are asymptomatic for GI involvement, may be helpful to detect the possible underlying intestinal involvement.

Novel variant syndrome associated with congenital hepatic fibrosis.

Congenital hepatic fibrosis is part of many different malformation syndromes, of which oculo-encephalo-hepato-renal syndrome is the most common. These syndromes largely overlap, and so accurate classification of individual patients may be difficult. We present herein three syndromic siblings who were products of a consanguineous marriage. We investigated in detail at least six organ systems in these patients, namely the liver, brain, eye, kidneys, skeleton, and gonads. The common features observed in these three cases were congenital hepatic fibrosis, retinitis pigmentosa, truncal obesity, rotatory nystagmus, mental retardation, advanced myopia, and high-arched palate. The clinical dysmorphology in these patients was distinct and lacked the major features of the known syndromes associated with congenital hepatic fibrosis. Although some features of these presented cases are similar to those found in Bardet-Biedl syndrome (BBS), the absence of some major criteria of BBS (polydactyly, renal abnormality, and hypogonadism) suggests that this may be a new syndrome. All three patients remain under follow-up in the departments of Gastroenterology, Ophthalmology, and Neurology at Hacettepe University.

Transarterial chemoembolization for treatment of hepatocellular carcinoma: A single center experience.

BACKGROUND/AIMS: We aimed to determine the effect of transarterial chemoembolization treatment on survival in patients with hepatocellular carcinoma and to investigate the efficacy and tolerability of two different transarterial chemoembolization procedures, conventional transarterial chemoembolization and drug-eluting beads, in these patients. MATERIALS AND METHODS: A total of 40 patients with hepatocellular carcinoma treated with transarterial chemoembolization between January 2007 and March 2011 were included. Thirty-seven patients had Child-Pugh class A and the remaining 3 had class B. Intra-arterial administration of doxorubicin with lipiodol-based conventional transarterial chemoembolization or drug-eluting beads-transarterial chemoembolization was performed. Eighty sessions were performed with a median of 2 sessions. Sixteen patients were treated with conventional transarterial chemoembolization and 11 with drug-eluting beads-based transarterial chemoembolization, and 13 were treated with both treatment procedures in separate sessions. Primary outcome was defined as patient survival after treatment. RESULTS: The median follow-up was 19 months. The median overall survival of patients was 23.2 months. The survival of patients with Child-Pugh class A was significantly better than that of patients with class B (24 vs 6 months, p=0.004). No statistically significant difference in survival was observed between conventional transarterial chemoembolization and drug-eluting beads-based transarterial chemoembolization treatments (p>0.05). Baseline low serum albumin level (p=0.003) and the presence of portal vein thrombosis (p=0.011) negatively affected patient survival. Side effects of conventional transarterial chemoembolization and drug-eluting beads-based transarterial chemoembolization were similar. CONCLUSIONS: Based on the results of this study and in comparison with the findings in the literature, transarterial chemoembolization treatment was seen to improve overall survival and provide better outcome in selected patients with hepatocellular carcinoma. No differences in survival or side effects were observed between the two transarterial chemoembolization treatment modalities.

Taurodontism in a central anatolian population.

The aim of this retrospective study was to evaluate the frequency of the occurrence of taurodontism in a Turkish population with using panoromic radiographs. A retrospective study was performed using full-mouth periapical and panoramic radiographs of 6912 patients (3860 females and 3052 males) ranging in age from 15 to 50. A total of 97362 posterior (including third molars) were evaluated. A chi-square test was used to determine the difference in the prevalence of tauorodntism between genders. Eighteen patients were found to have a taurodont molar (10 women and 8 men [P = 0.98]). The overall incidence of patients with taurodont molars was 0.26 % and the prevalence of taurodont molars from all teeth examined was 0.024%, and the prevalence taurodonts were significantly more common in the mandibula compared with the maxilla (71.0% cf 29.0% respectively, P < 0.05). It was almost equally distributed between males and females. Taurodontism is not uncommon in Turkish population but further larger scale studies are required to assess its prevalence in the general population to compare it with other ethnic groups.