Anatomical categorization of isolated non-focal dystonia: novel and existing patterns using a data-driven approach.

According to expert consensus, dystonia can be classified as focal, segmental, multifocal, and generalized, based on the affected body distribution. To provide an empirical and data-driven approach to categorizing these distributions, we used a data-driven clustering approach to compare frequency and co-occurrence rates of non-focal dystonia in pre-defined body regions using the Dystonia Coalition (DC) dataset. We analyzed 1,618 participants with isolated non-focal dystonia from the DC database. The analytic approach included construction of frequency tables, variable-wise analysis using hierarchical clustering and independent component analysis (ICA), and case-wise consensus hierarchical clustering to describe associations and clusters for dystonia affecting any combination of eighteen pre-defined body regions. Variable-wise hierarchical clustering demonstrated closest relationships between bilateral upper legs (distance = 0.40), upper and lower face (distance = 0.45), bilateral hands (distance = 0.53), and bilateral feet (distance = 0.53). ICA demonstrated clear grouping for the a) bilateral hands, b) neck, and c) upper and lower face. Case-wise consensus hierarchical clustering at k = 9 identified 3 major clusters. Major clusters consisted primarily of a) cervical dystonia with nearby regions, b) bilateral hand dystonia, and c) cranial dystonia. Our data-driven approach in a large dataset of isolated non-focal dystonia reinforces common segmental patterns in cranial and cervical regions. We observed unexpectedly strong associations between bilateral upper or lower limbs, which suggests that symmetric multifocal patterns may represent a previously underrecognized dystonia subtype.

Tooth discoloration induced by apical plugs with hydraulic calcium silicate-based cements in teeth with open apices-a 2-year in vitro study.

OBJECTIVES: To assess tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), including effects of blood and placement method. MATERIALS AND METHODS: Eighty bovine teeth cut to a length of 18 mm (crown 8 mm, root 10 mm) were randomly assigned to 10 groups (n = 8), receiving orthograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (Bi2O3) with and without bovine blood. Further, orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were obturated with gutta-percha and sealer, sealed with composite and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment versus 24 h, 1, 3, 6, 12, and 24 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by Shapiro-Wilk test, ANOVA with post hoc tests, Friedman test, t test, and post hoc tests with Bonferroni correction (α = .05). RESULTS: Tooth discoloration occurred in all groups with no significant differences between HCSCs (p > .05). After 24 months, color changes were prominent on roots but insignificant on crowns. Blood contamination induced a significantly decreased luminescence (p < .05). Blood had a stronger impact on tooth color than Bi2O3. No relevant effects of retrograde placement (p > .05) or preoperative dentin sealing (p > .05) were detected. CONCLUSIONS: Apical plugs of the tested HCSCs cause discoloration of bovine roots, but not discoloration of bovine tooth crowns within a 24-month period. CLINICAL RELEVANCE: APT should be performed carefully while avoiding direct contact with the coronal dentin, and in that case no aesthetic impairments occur.

The inconsistency and instability of Parkinson's disease motor subtypes.

INTRODUCTION: Tremor-dominant (TD), indeterminate/mixed (ID/M) and postural instability gait difficulty/akinetic-rigid (PIGD/AR) are commonly used subtypes to categorize Parkinson's disease (PD) patients based on their most prominent motor signs. Three different algorithms to determine these motor subtypes are used. Here, we examined if PD subtypes are consistent among algorithms and if subtype stability over time depends on the applied algorithm. METHODS: Using a large longitudinal PD database, we applied 3 published algorithms of PD motor subtype classification in two sets of analyses: 1) cross-sectional analysis in 1185 patients, determining the prevalence of subtypes in 5-year intervals of disease duration; 2) longitudinal analysis of 178 patients, comparing subtypes of individual patients at baseline (within 5 years of diagnosis) and at follow-up ≥ 5 years after baseline. RESULTS: Cross-sectionally, prevalence of subtypes varied widely among the 3 algorithms: 5-32% TD, 9-31% ID/M, and 59-75% PIGD/AR. For all 3 algorithms, cross-sectional analysis showed a marked decline of TD prevalence with disease duration and a corresponding increase in PIGD/AR prevalence, driven by increasing gait/balance scores over time. Longitudinally, only 15-36% of baseline TD patients were still categorized as TD at 6.2 ± 1.0 years of follow-up. In 15-39% of baseline TD patients, the subtype changed to ID/M, and 46-50% changed to PIGD/AR. This shift was observed using all 3 algorithms. CONCLUSION: PD motor subtypes determined by different established algorithms are inconsistent and unstable over time. Lack of subtype fidelity should be considered when interpreting biomarker-subtype correlation and highlights the need for better definition of PD subtypes.

Ultrafine particles in scanning sprays: a standardized examination of five powders used for dental reconstruction.

BACKGROUND: Intraoral matting sprays for chairside systems can release fine or ultrafine particles or nanoparticles at dentists' workplaces and cause work-related health problems by inhalation exposure. Until now, little is known about the magnitude of the ultrafine fraction, when using these scanning sprays. Hence, more information is needed for workplace risk assessments in dental practices. METHODS: Five commonly used dental spray-powders were examined under standardized conditions. Ingredients were taken from the respective safety data sheet. Particle number-size distributions and total number concentrations were analyzed with a fast mobility particle sizer, and reported graphically as well as mean particle fractions smaller than 100 nm. Based on these measurements, risk assessments were conducted, and particle depositions in the lung were modelled. RESULTS: The mean fraction of particles smaller than 100 nm varied between 9 and 93% depending on the matting agent and mode of application of the intraoral scanning spray. Propellants can represent a large fraction of these particles. Titanium dioxide, pigment-suspensions, talcum and others particles, which can pose relevant health risks, were listed as ingredients of scanning sprays in safety data sheets. Nevertheless, the deposited fraction of hazardous particles in the lung of employees in dental practices seems to be small (15%) during this dental procedure. CONCLUSIONS: Our results suggest that dentists' personnel can be exposed to hazardous fine and ultrafine particles. Though extensive standardized measurements and systematic evaluation of safety data sheets were used for this study, they cannot sufficiently assess and categorize potential workplace-related health risks.

Reporting infections in clinical trials of patients with haematological malignancies.

BACKGROUND: Infections are common among patients treated for haematological malignancies and are associated with significant morbidity and mortality. The completeness of reporting infectious complications in randomized controlled trials (RCTs) assessing treatments for haematological malignancies is unknown. OBJECTIVES: We aimed to evaluate the completeness of reporting infectious complications in RCTs assessing treatments for haematological malignancies. DATA SOURCE: A systematic literature search was performed in PubMed database. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: All primary published phase II/III RCTs between September 2016 and September 2018 evaluating treatments for haematological malignancies in adult patients were included. INTERVENTION: Reporting infectious complications. METHODS: A systematic review was conducted to evaluate the completeness of reporting. Study characteristics and data concerning reporting of infectious complications were collected by two independent reviewers. Quality of reporting was assessed using a modification of the CONSORT extension checklist for harms, including 15 items. RESULTS: One-hundred and seven RCTs were included. Most trials (97; 91%) provided some report on infections. Approximately half reported on each of pneumonia, sepsis and neutropenic fever; 12 trials (11%) reported on fungal infections. Only nine trials (8%) listed infections by type of pathogen (i.e. bacterial, fungal or viral) and 48 (45%) by source/type of infection (i.e. pneumonia, urinary tract infection, etc.). Most trials did not address infections in their title, abstract, introduction or discussion. Median number of items of the CONSORT modification reported was 7 points, (interquartile range (IQR) 6-9) for all included trials, with lower median for 34 acute leukaemia trials (median 6, IQR 5-8). CONCLUSIONS: Most trials evaluating treatment for haematological malignancies provide some data relating to infectious complications. The reports are mostly incomplete and rarely provided in a structured presentation.

Dipole-switch induced modification of the emissive response of carbon nanotubes.

The interaction of carbon nanotubes with the molecular dipole switch spiropyran is expected to affect the optical response of the tubes. Until now, the need of anchor groups to immobilize the switches on the tubes has hindered the experimental observation of the effects of switching on the emission behavior of the tubes. Here we present spiropyran-carbon nanotube complexes obtained by micelle swelling. This method does not require any anchor nor sophisticated chemistry to warrant close tube-switch proximity. For the first time, we observe the shifts predicted theoretically and their effect on the tubes' excitation and emission energies.

Intraoral scanning systems - a current overview.

There is no doubt today about the possibilities and potential of digital impression-taking with the aid of intraoral optical impression systems, and the past few years have seen a considerable increase in the range of optical intraoral scanners available on the market. On the strength of numerous innovations and a wider range of indications in orthodontics and implantology, intraoral scanning systems appear to be a highly promising development for the future. Digital impression-taking with intraoral scanners has already shown itself in some respects to be clearly superior to conventional impression- taking. Particularly worthy of mention is the versatile integration of digital impressions into diagnostic and treatment concepts to provide a customizable healthcare solution for the patient. It remains exciting to look forward to future developments that will allow us to observe digital impression-taking--as with other digital applications already established in everyday life--becoming firmly established in the routine of dentistry and dental technology. This article presents an overview of the benefits and limitations of digital impression-taking using intraoral scanning systems, and includes a summary of all the relevant intraoral scanners available on the market at present.

Tooth-colored CAD/CAM monolithic restorations.

A monolithic restoration (also known as a full contour restoration) is one that is manufactured from a single material for the fully anatomic replacement of lost tooth structure. Additional staining (followed by glaze firing if ceramic materials are used) may be performed to enhance the appearance of the restoration. For decades, monolithic restoration has been the standard for inlay and partial crown restorations manufactured by both pressing and computer-aided design and manufacturing (CAD/CAM) techniques. A limited selection of monolithic materials is now available for dental crown and bridge restorations. The IDS (2015) provided an opportunity to learn about and evaluate current trends in this field. In addition to new developments, established materials are also mentioned in this article to complete the picture. In line with the strategic focus of the IJCD, the focus here is naturally on CAD/CAM materials.

Adhesive luting of new CAD/CAM materials.

OBJECTIVE: To evaluate the adhesive bonding performance of recently introduced tooth-colored CAD/CAM materials after different pretreatment protocols and using different luting materials. MATERIALS AND METHODS: The CAD/CAM materials under investigation were e.max CAD (lithium disilicate glass ceramic; Ivoclar Vivadent, Schaan, Liechtenstein), Celtra Duo (zirconia-reinforced lithium disilicate ceramic; Dentsply DeTrey, Konstanz, Germany), Lava Ultimate (resin nano ceramic; 3M ESPE, Neuss, Germany), and Enamic (resin infiltrated ceramic; Vita, Bad Säckingen, Germany). A total of 240 blocks (n = 5) received various pretreatments (no pretreatment, silane, sandblasting, sandblasting + silane, hydrofluoric acid, hydrofluoric acid + silane), and then different classes of adhesive luting composites were applied (adhesive: Prime&Bond XP + SCA + Calibra; Dentsply DeTrey; self adhesive: RelyX Unicem; 3M ESPE). After 24 h water storage and 10,000 thermocycles (5°C/55°C), specimens were cut into beams and microtensile bond strengths were recorded. RESULTS: Bonding performance of recent CAD/CAM materials was clearly influenced by the pretreatment method (P < 0.05). In general, significantly higher µ-TBS values were recorded for the ceramic materials compared to the hybrid materials (P < 0.05). Among the hybrid materials, Enamic exhibited higher bond strengths than Lava Ultimate (P < 0.05). However, despite the differences found, all materials showed a high level of bonding performance, being sufficient to withstand intraoral chewing forces during mastication. CONCLUSION: When pretreated as recommended by the manufacturers, recent tooth-colored CAD/CAM materials show an encouraging bonding performance for adhesive luting.

Primary monophasic synovial sarcoma of the pancreas.

We report a case of synovial sarcoma of the pancreas in a 44-year-old male who presented with multiple episodes of retroperitoneal hemorrhage; the diagnosis was confirmed by histology. The patient underwent distal pancreatectomy without complication, and the hospital stay was nine days. No adjuvant treatment was administered. The patient is alive at 1 year.

Micro- and nano-spheres of low melting point metals and alloys, formed by ultrasonic cavitation.

Metals and alloys of low melting points (<430 °C) can be melted in hot silicone oil to form two immiscible liquids. Irradiation of the system with ultrasonic energy induces acoustic cavitation in the oil, which disperses the molten metals into microspheres that solidify rapidly upon cooling. This method has been applied to seven pure metals (Ga, In, Sn, Bi, Pb, Zn, Hg) and two eutectic alloys of gold (Au-Ge and Au-Si). The morphology and composition of the resulting microspheres were examined by SEM and EDS. Eutectic Au-Si formed also crystalline Au nanoparticles, which were separated and studied by HRTEM.

Examples of model-free implant restorations using Cerec inLab 4.0 software.

This case report demonstrates two ways to fabricate model-free implant restorations with the Cerec inLab 4.0 software. Because the patient, a woman with a history of periodontal disease, did not wish to have a removable partial denture, implant therapy was planned for the restoration of her edentulous areas 14/15 and 24/25. In addition, the restoration was to provide functional relief of the natural maxillary anterior teeth. The two implants for the first quadrant were planned as single-tooth restorations. Each was designed as a full contour implant supra-structure using the Cerec Biogeneric abutment design technique. After completing the design phase, each restoration proposal was split into two parts: a zirconia abutment and a lithium disilicate crown. For the restoration of the second quadrant, custom 20-degree-angled abutments were individualized and acquired with the Cerec camera. A block crown was then designed, milled in burn-out acrylic resin, and fabricated from a lithium disilicate glass-ceramic ingot according to the press ceramic technique. Additionally methods of provisional restorations are discussed.

Tuning the interaction between carbon nanotubes and dipole switches: the influence of the change of the nanotube-spiropyran distance.

The non-covalent functionalization of carbon nanotubes with spiropyran molecules, serving as optically addressable dipole switches, is reported. Two kinds of pyrene-spiropyran-based dyads with spacers of different lengths resulting in different switch-tube distances were investigated. While both surfactants were able to form stable carbon nanotube suspensions, the different distances between the switch and the tube affected both of the components' optical properties. In the case of the shorter spacer, the nanotubes' luminescence as well as the merocyanine absorption band were red-shifted and furthermore, the rate of the merocyanine → spiropyran thermal back isomerization was decreased.

Carbon nanotubes as substrates for molecular spiropyran-based switches.

We present a joint theory-experiment study investigating the excitonic absorption of spiropyran-functionalized carbon nanotubes. The functionalization is promising for engineering switches on a molecular level, since spiropyrans can be reversibly switched between two different conformations, inducing a distinguishable and measurable change of optical transition energies in the substrate nanotube. Here, we address the question of whether an optical read-out of such a molecular switch is possible. Combining density matrix and density functional theory, we first calculate the excitonic absorption of pristine and functionalized nanotubes. Depending on the switching state of the attached molecule, we observe a red-shift of transition energies by about 15 meV due to the coupling of excitons with the molecular dipole moment. Then we perform experiments measuring the absorption spectrum of functionalized carbon nanotubes for both conformations of the spiropyran molecule. We find good qualitative agreement between the theoretically predicted and experimentally measured red-shift, confirming the possibility for an optical read-out of the nanotube-based molecular switch.

InLab and Cerec Connect: virtual contacts in maximum intercuspation compared with original contacts--an in vitro study.

PURPOSE: The aim of this in-vitro study was to evaluate the accuracy of inLab and Cerec Connect software in simulating the maximum intercuspal contacts in comparison to the real situation on the respective gypsum casts. MATERIALS AND METHODS: Ten pairs of maxillary and mandibular casts were mounted in articulators in maximum intercuspal position. The contacts of the gypsum casts were marked and digital photographs of the mandibular casts were taken. Digital impressions of arches were made using two different software packages; inLab (Version 3.83) and Cerec Connect (Version 3.83) using the Cerec Acquisition Center. The intercuspal position of the teeth was captured by buccal images. Screenshots of the virtual casts showing the occlusal contacts were saved. The digital photographs of the contacts of the cast and the screenshots of the occlusal contacts were superimposed using an image processing program. The number of contacts of the virtual mandibular models that were identical with the contacts of the gypsum casts were determined and calculated as percentages in relation to the gypsum cast contacts, which were set as 100%. The null hypothesis tested was that the Cerec connect software delivers contacts that are closer to the real situation than contacts created with the inLab software. RESULTS: Cerec Connect showed a median percentage of 41.6% and Inlab a median percentage of 31.9%. The Wilcoxon test revealed statistically significant differences between the inLab software and Cerec Connect. Especially at the contra-lateral side of that side where the virtual buccal registration was done, the contacts showed the greatest deviations from the original. CONCLUSION: Cerec Connect more precisely virtually simulated the real contacts than did inLab when scanning full-arch dentitions.

What determines resilience in patients with Parkinson's disease?

OBJECTIVE: To investigate the relationship of resilience to disease severity, disability, quality of life (QoL) and non-motor symptoms in Parkinson's disease (PD). A secondary objective was to investigate whether resilience is distinct from other personality domains in PD. BACKGROUND: Resilience is the ability to reestablish emotional equilibrium in the face of adversity. It may play a pivotal role in disability and quality of life and has not been studied in PD. METHODS: 83 PD patients (Age 66.3 ± 10.6, Total Unified Parkinson's Disease Rating Scale (T-UPDRS) 36.9 ± 17.8) completed the Resilience Scale 15 (RS-15). Scales measuring disability, mental and physical health-related QoL, non-motor symptoms (depression, anxiety, somatization, apathy, fatigue), and personality domains were completed. Pearson's correlations were analyzed between these scales and the RS-15. RESULTS: Greater resilience correlated with less disability (r = -.30, p = .01), and better physical and mental QoL (r = .31, p < .01; r = .29, p = .01), but not with PD severity (T-UPDRS, r = -.17, p > .05). Among non-motor symptoms and personality domains, resilience strongly correlated with less apathy (r = -.66), less depression (r = -.49), and more optimism (r = .54, all p < .001). Moderate correlations were seen between more resilience, reduced fatigue (r = -.40) and anxiety (r = -.34; both p < .001). CONCLUSIONS: Resilience correlated with less disability and better QoL but not with PD severity. Resilience was also highly associated with both non-motor symptoms (less apathy, depression, fatigue) and a personality domain (more optimism). The role of resilience in helping patients adapt to living with symptoms of chronic disease may explain its lack of correlation with PD severity.