Prevalence of Chronic Postsurgical Pain among Cancer Patients: A Cross-Sectional Study.

Background: Cancer patients accept surgeries as part of their treatment. They may not be aware of the possibility of surgical pain persisting long after the surgery. Understanding chronic postsurgical pain is essential for effective pain management. Aims: We aimed to assess the prevalence of chronic postsurgical pain in cancer patients and the associated symptom burden. Settings and Design: This study was carried out at a tertiary cancer center. It was a cross-sectional study. Materials and Methods: Participants who underwent surgeries were asked to provide feedback on the MD Anderson Symptom Inventory at 3 months. Statistical Analysis Used: Descriptive statistics were used. Statistical tests included Kruskal-Wallis test, Chi-square test, Fisher's exact test, and Spearman's correlation. Logistic regression was used to assess the influence of variables on the presence or absence of chronic postsurgical pain. Results: Nine hundred and eighteen participants completed the study. Ninety-two percent (n = 840) were asymptomatic. Eight percent (n = 78) had postsurgical pain. Chronic postsurgical pain was influenced by the type of surgery (P = 0.01), specifically orthopedic and thoracic surgeries. Patients who receive epidurals are three times less likely to continue to have pain at 3 months. Conclusions: The prevalence of chronic postsurgical pain at 3 months in this study is lower than the rates in the literature. It is still associated with symptom burden that interferes with daily life. The risk of developing chronic postsurgical pain increases with thoracic and orthopedic surgeries. The risk may be lowered with epidural analgesia.

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic.

BACKGROUND: Pain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management. AIM: Examine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication. METHODS: A sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit. RESULTS: Significant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001). CONCLUSIONS: Patients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.

A Retrospective Cohort Study to Evaluate the Association Between Types of Nonsyndromic Oral Clefts and a Child's Gender and Maternal Age.

AIMS: To evaluate the association between nonsyndromic cleft lip with or without cleft palate (NSCL±P) anomaly and the affected child's gender and maternal age. MATERIALS AND METHODS: Records of 141 newborns received at the orthodontic craniofacial clinic of the Jordanian Royal Rehabilitation Center between 2017 and 2019 were retrospectively analyzed. Two variables were paid attention to: child's gender and maternal age. Five cleft types were considered: unilateral CLP (right; URCLP and left; ULCLP), bilateral CLP (BCLP), isolated cleft palate (CP) and isolated cleft lip (CL). Maternal age was classified into four subgroups: "26-30" years, "31-35" years, "36-40" years, and "above 40" years. Chi-square test and multinomial logistic regression analysis were used to analyze the resultant data. RESULTS: A significant occurrence of the NSCL±P in females was found compared with males. The different cleft types were found to be significantly associated with the different maternal age groups investigated. The ULCLP was the most prevalent cleft type for affected children among all maternal age groups except the "31-35" group, at which the BCLP exceeded. CONCLUSIONS: The children's gender and the maternal age have a significant impact on defining the developing oral cleft types.

Tunneling Does Not Prevent Dislodgment of Epidural Catheters: A Randomized Trial.

BACKGROUND: Epidural analgesia is preferred in postoperative pain control, but dislodgment is a major factor for failure. Tunneling is well known to control displacement of catheters. In this study, we evaluated if we can depend on tunneling in preventing dislodgment of epidural catheters. AIMS: The aim is to study if tunneling is effective and safe in reducing the rate of epidural catheters' dislodgment. SETTING AND DESIGN: The study was carried out at a single tertiary cancer center. The trial was parallel, simple randomized, controlled, and single blind. Allocation of treatments was generated using random number tables. SUBJECTS AND METHODS: Two hundred patients undergoing major surgeries were randomized. Epidural catheters were affixed to the skin through subcutaneous tunneling to a length of 5 cm or using standard adhesive tape without tunneling. Patients were on follow-up for 6 days postsurgery according to policy. STATISTICAL ANALYSIS USED: Categorical variables were analyzed by Chi-square and Fisher's exact test. Student t-test was used for continuous variables. RESULTS AND CONCLUSION: A total of 200 patients were randomized, 92 patients received tunneled catheters and 108 received nontunneled catheters. Patients were between 20 and 85 years; 63% were male. The mean days of epidural analgesia were similar in both groups (2.7 compared to 2.5 days). About 7.6% of epidurals were dislodged in the tunneled group compared to 10.2% in the nontunneled group (P = 0.699). No differences were identified in the incidence of pain or adverse events between the groups. Tunneling did not improve the rates of dislodgment in epidural catheters. There were no safety concerns associated with tunneling epidural catheters.

Molecular characterisation of Panton-Valentine leucocidin-producing methicillin-resistant Staphylococcus aureus clones isolated from the main hospitals in Taif, KSA.

INTRODUCTION: Panton-Valentine leucocidin (PVL) is a bicomponent pore-forming cytolytic toxin encoded by the lukF-PV and lukS-PV genes. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) may carry the pvl genes which may be related to increased disease severity. This study aimed to characterise the PVL-producing MRSA recovered from different Taif Hospitals, Saudi Arabia. METHODS: The study included 45 hospital-acquired-MRSA (HA-MRSA) and 26 CA-MRSA strains which were identified from 445 S. aureus strains isolated from different clinical samples. MRSA strains were identified by standard oxacillin salt agar screening procedure and by the detection of the mecA gene by the polymerase chain reaction (PCR). Detection of the S. aureus-specific femA, mecA and pvl genes was performed by multiplex PCR. PCR-restriction fragment length polymorphism (PCR-RFLP) analysis was done for coagulase (coa) gene. RESULTS: The staphylococcal cassette chromosome mec types of the 45 HA-MRSA strains were Type I (n = 24), Type II (n = 7) and Type III (n = 14) whereas the 26 CA-MRSA strains were Type IV (n = 14), Type V (n = 11) and one isolate was non-typeable. All the HA-MRSA and six CA-MRSA strains were PVL-negative PCR-RFLP analysis of coa gene showed that PVL-positive MRSA (n = 20) isolates showed six different patterns, and five patterns were shared by PVL-positive methicillin-susceptible S. aureus (MSSA). The eighth pattern was the most frequent in both MRSA and MSSA. CONCLUSION: PVL is more frequent among CA-MRSA than MSSA. All the HA-MRSA and 25% of CA-MRSA strains were negative for PVL. The pvl gene was related to the severity of infection but not related to coa gene RFLP pattern.

Identification of Giardia lamblia and the human infectious-species of Cryptosporidium in drinking water resources in Western Saudi Arabia by nested-PCR assays.

The presence of Cryptosporidium and/or Giardia in drinking water represents a major public health problem. This study was the first report concerned with the occurrence of these protozoa in drinking water in Saudi Arabia. The study was undertaken in Al-Taif, a high altitude region, Western Saudi Arabia. Eight underground wells water, six desalinated water and five domestic brands of bottled water samples, 10 liter each, were monthly collected between May 2013 and April 2014. All samples (n = 228), were processed using an automated wash/elution station (IDEXX Laboratories, Inc.). Genomic DNA was directly isolated and purified from samples concentrates with QIAamp® Stool Mini Kit (Qiagen). The target protozoan DNA sequences were amplified using two previously published nested-PCR protocols. Of all the analyzed water, 31 samples (≈14%) were found contaminated with the target protozoa. Giardia lamblia was detected in ≈10% (7/72) of desalinated water and in ≈9% (9/96) of wells water. On the other hand, Cryptosporidium was identified in ≈8% (8/72) of desalinated water and in ≈7% (7/96) of wells water. All bottled water samples (n = 60) were (oo)cysts-free. Protozoan (oo)cysts were more frequently identified in water samples collected in the spring than in other seasons. The methodology established in our study proved sensitive, cost-effective and is amenable for future automation or semi-automation. For better understanding of the current situation that represent an important health threat to the local inhabitants, further studies concerned with (oo)cyst viability, infectivity, concentration and genotype identification are recommended.

Measles virus.

Measles was an inevitable infection during the human development with substantial degree of morbidity and mortality. The severity of measles virus (MV) infection was largely contained by the development of a live attenuated vaccine that was introduced into the vaccination programs. However, all efforts to eradicate the disease failed and continued to annually result in significant deaths. The development of molecular biology techniques allowed the rescue of MV from cDNA that enabled important insights into a variety of aspects of the biology of the virus and its pathogenesis. Subsequently these technologies facilitated the development of novel vaccine candidates that induce immunity against measles and other pathogens. Based on the promising prospective, the use of MV as a recombinant vaccine and a therapeutic vector is addressed.

An immune competent mouse model for the characterization of recombinant measles vaccines.

Today, immune compromised interferon-α-receptor deficient mice expressing hCD46 (IFNARCD46tg) are usually used for measles virus (MV) based vaccine characterization. However, for the development of MV-based recombinant vaccine candidates (rMV), an immune competent mouse model is desirable in order to induce and evaluate meaningful immune response. In this study, humoral and cellular immune response induced by rMV in immune competent mice expressing human MV receptor CD46 (hCD46tg) were compared with those induced in wild-type black/6, and IFNARCD46tg mice.   All three strains developed humoral and cellular response against MV, whereas only hCD46tg and IFNARCD46tg mice developed a humoral response against the transgene. Differences were observed in the magnitude of the response, where the IFNARCD46tg mice displayed the strongest immune responses, followed by the hCD46tg mice and the black/6 mice. Interestingly, hCD46tg and wt black/6 mice showed a predominant CD4(+) T-cell response against MV-N, whereas IFNARCD46tg mice developed both, CD4(+) and CD8(+) T-cell response against MV-N. Analysis of the cytokine profile of MV-N specific CD4(+) T-cells and transgene (SIVgag) specific CD8(+) T-cells revealed qualitative differences of the T-cell responses; noticeably a significant reduction of the frequency of CD4(+)IL-2(+) expressing cells in IFNARCD46tg mice as compared with hCD46tg or wt black/6 mice. We show in this study significant quantitative and qualitative differences in immune responses between immune competent and immune-compromised mice. Our results therefore highlight the importance of the animal model and support the use of hCD46tg mice as mouse model for the characterization of the immunological profile induced by recombinant measles virus vaccine candidates.

Association of serum cytokines levels, interleukin 10 -1082G/A and interferon-γ +874T/A polymorphisms with atopic asthma children from Saudi Arabia.

The aim of this study was to clarify the role of IL-4, IL-10, IL-13 and interferon (IFN) -γ levels in atopic asthma patients by studying the relation between their serum levels and severity of the disease. The effect of IL-10 -1082G/A and IFN-γ +874T/A SNPs was also studied. The study included 200 atopic children with asthma and 50 age- and gender matched healthy children as controls. The levels of both IL-4 and IL-13 were significantly (p<0.001) higher, while IFN-γ was significantly (p<0.001) lower in patients compared to that of the controls. There was a significant effect of gene polymorphisms of IL-10 (p<0.05) and IFN-γ (p<0.001) in occurrence of atopic asthma and increased IgE level. Polymorphism of IFN-γ gene had an effect on the serum level of IFN-γ. In conclusion, IFN-γ gene polymorphism at position +874 and IL-10 gene polymorphism at position -1082A/G are genetic determinants which contribute to susceptibility to atopic asthma in children from Saudi Arabia.

Occupational radiation monitoring at a large medical center in Japan.

Occupational radiation dose monitoring is a method of ensuring that radiation levels are within the regulatory limits. Our objective in this study was to evaluate the radiation doses experienced by personnel at a radiology facility between 2001 and 2010. Overall, 2418 annual dose records for workers who were categorized into four occupational groups were analyzed. The groups included: (1) radiologists, (2) radiologic technologists, (3) nurses, and (4) other workers, who belong to other hospital departments, but who participate partially in some radiologic procedures. The dose distribution was found to be skewed, with 76 % of personnel having received no measurable doses and almost 2 % having received doses of more than 2 mSv. The weighted-average annual doses ranged from 0.13 to 0.57, 0.9 to 2.12, 0.01 to 0.19, and 0.01 to 0.09 mSv for the radiologists, radiologic technologists, nurses, and the other workers, respectively. The radiologic technologists received the highest radiation exposure among the four groups. It was found that the average annual doses were decreasing over time for the radiologists, radiologic technologists, and others, whereas they were increasing for the nurses. Nurses play an important role in assisting radiologists and patients during various radiologic procedures, which might have increased their average annual dose. During the 10-year period of this study, there was no incidence of a dose exceeding the annual dose limit of 20 mSv. Furthermore, there was no detectable neutron exposure.

Relevance of a pre-existing measles immunity prior immunization with a recombinant measles virus vector.

Measles virus (MV) vectors are promising candidates for designing new recombinant vaccines since the parental live vaccines have a well-known safety and efficacy record. Like all viral vectors, the MV vector efficacy in inducing a protecting immune answer could be affected by the pre-existing immunity among the human population. In order to determine the optimal immunization route and regimen, we mimicked a MV pre-immunity by passively administrating MV neutralizing antibodies (MV-nAb) prior intramuscular (i.m.) and/or intranasal (i.n.) immunization with recombinant MV expressing the SIV-gag antigen (rMV-SIVgag). Our results revealed that 500 mIU of MV-nAb allowed the induction of a humoral and cellular immune response against the vector and the transgene, while higher titers of the MV-nAb were significantly inhibitory. In a prime-boost regimen, in the presence of MV-nAb, the intranasal-intramuscular (i.n.-i.m.) or intramuscular-intramuscular (i.m.-i.m.) routes induced higher humoral immune responses against the vector and the transgene (SIV-gag). In naive animals, cellular immune response was significantly higher by i.m. immunization; however, MV pre-immunity did not seem to affect the cellular immune response after an i.n. immunization.   In summary, we show that a pre-existing immunity of up to 500 mIU anti-MV neutralizing antibodies had little effect on the replication of rMV and did not inhibit the induction of significant humoral and cellular immune responses in immune-competent mice.

Sequence and immunogenicity of a clinically approved novel measles virus vaccine vector.

The measles virus vaccine (MVbv) is a clinically certified and well-tolerated vaccine strain that has been given both parenterally and mucosally. It has been extensively used in children and has proven to be safe and effective in eliciting protective immunity. This specific strain was therefore chosen to generate a measles viral vector. The genome of the commercial MVbv vaccine strain was isolated, sequenced and a plasmid, p(+)MVb, enabling transcription of the viral antigenome and rescue of MVb, was constructed. Phylogenic and phenotypic analysis revealed that MVbv and the rescued MVb constitute another evolutionary branch within the hitherto classified measles vaccines. Plasmid p(+)MVb was modified by insertion of artificial MV-type transcription units (ATUs) for the generation of recombinant viruses (rMVb) expressing additional proteins. Replication characteristics and immunogenicity of rMVb vectors were similar to the parental MVbv and to other vaccine strains. The expression of the additional proteins was stable over 10 serial virus transfers, which corresponds to an amplification greater than 10 ( 20) . The excellent safety record and its efficient application as aerosol may add to the usefulness of the derived vectors.

Correlation of tumor size with other prognostic factors in uterine serous carcinoma: a large multi-institutional study.

OBJECTIVE: Uterine serous carcinoma (USC) constitutes 10% of uterine cancers but ~40% of deaths. Tumor size is a known prognostic factor in other solid tumors. In endometriod cancers it is one element used to identify the need for complete staging, while its significance in USC is debated. Therefore tumor size was examined as an independent prognostic factor. METHODS: Clinical and pathologic variables were recorded for 236 institutional patients, and those patients in the SEER database with USC. Chi-square and Fisher exact t-tests were utilized and survival data generated via Kaplan-Meier method; multivariate analysis was performed via cox-regression. RESULTS: The patients' mean age was 67.2 years (range 40-91). Survival ranged from 0 to 184 months (mean 42.8). We used a tumor size cut-off of 1cm and noted significant associations with myometrial invasion (p<0.0001), angiolymphatic invasion (p<0.0001), peritoneal washings (p=0.03), stage (p=0.015) and positive lymph nodes (p=0.05). Furthermore, recurrence was associated with larger tumors (p=0.03). In multivariate analysis, extra-uterine disease was the only factor associated with both recurrence and survival. Review of the SEER database noted association of larger tumors with lymph node involvement and a significant survival advantage with tumors <1cm in both univariate and multivariate analysis. CONCLUSIONS: Treatment options for USC are often predicated on the surgical stage and therefore components of the staging are vitally important. The 1cm tumor-size cut-off should be studied prospectively as a prognostic indicator of survival and recurrence in USC and considered for inclusion in USC staging.

Applications and challenges of multivalent recombinant vaccines.

The exceptional discoveries of antigen/gene delivery systems have allowed the development of novel prophylactic and therapeutic vaccine candidates. The vaccine candidates employ various antigen-delivery systems, particularly recombinant viral vectors. Recombinant viral vectors are experimental vaccines similar to DNA vaccines, but they use attenuated viruses or bacterium as a carrier "vector" to introduce microbial DNA to cells of the body. They closely mimic a natural infection and therefore can efficiently stimulate the immune system. Although such recombinant vectors may face extensive preclinical testing and will possibly have to meet stringent regulatory requirements, some of these vectors (e.g. measles virus vectors) may benefit from the profound industrial and clinical experience of the parent vaccine. Most notably, novel vaccines based on live attenuated viruses combine the induction of broad, strong and persistent immune responses with acceptable safety profiles. We assess certain technologies in light of their use against human immunodeficiency virus (HIV).

Interleukin 13 receptors as biochemical markers in atopic patients.

BACKGROUND: Interleukin (IL) 13, a type 2 helper T cell (T(H)2), is an important regulator of inflammatory immune responses. It mediates its action through a receptor complex consisting of IL-13Ralpha1 and IL-4Ralpha. IL-13Ralpha2 binds IL-13 with high affinity and is thought to act primarily as a decoy receptor, sequestering IL-13 and thus inhibiting its action. Our aim was to clarify the role of these receptors in the diagnosis and follow-up of atopic patients. METHODS: We genotyped the 1398A>G polymorphism in the IL-13Ralpha1 gene using restriction fragment length polymorphism for causal genetic diversity and measured serum levels of IL-13Ralpha2 in 105 atopic patients suffering from atopic asthma, atopic dermatitis, and atopic rhinitis (35 each). We compared the results with those of 35 nonatopic control individuals. Total immunoglobulin (Ig) E and serum IL-13Ralpha2 were measured using enzyme-linked immunosorbent assay, and the eosinophil counts were recorded. RESULTS: A significant increase in serum IL-13Ralpha2 levels was recorded in the 3 atopic groups compared with the control group (P < .001), as well as a significant increase in total IgE levels and eosinophil counts. No significant association was found between 1398A>G and atopy other than a suggestive association between this polymorphism and raised total serum IgE levels in all 3 atopic groups (P < .001). CONCLUSIONS: These findings indicate that IL-13Ralpha2 plays an important role in atopy and that increased levels in different groups highlight its regulatory role in the development of atopic symptoms. The 1398A>G polymorphism might be involved in the production of IgE.

Interferon gamma gene polymorphism as a biochemical marker in Egyptian atopic patients.

OBJECTIVES: The aim of this study was to clarify the role of interferon (IFN) gamma in the diagnosis and follow-up of atopic patients. We genotyped the IFN-gamma polymorphism at position +874 to examine the relationship between serum levels of IFN-gamma and disease severity and the role of IFN-gamma as a biochemical and immunologic marker. METHODS: The study population comprised 75 patients suffering from atopic asthma, atopic dermatitis, and allergic rhinitis (25 each), and 25 control participants. Total immunoglobulin (Ig) E and serum IFN-gamma were measured by enzyme-linked immunosorbent assay, the IFN-gamma polymorphism at position +874 was determined by amplification refractory mutation system-polymerase chain reaction, and eosinophil counts were recorded. RESULTS: There was a significant association between genotype and the frequency of the A allele of the +874T/A polymorphism in atopic patients when compared with controls (P < .001). In all 3 groups, there was a significant increase in total IgE levels and eosinophil counts, and a decrease in serum IFN-gamma levels towards the presence of homozygous AA compared with homozygous TT. CONCLUSIONS: The IFN-gamma gene polymorphism at position +874 contributes to susceptibility to atopic diseases by decreasing the amount of IFN-gamma. Identification of variants of IFN-gamma gene signalling and its role in the development of atopic diseases provides a focus for the development of novel diagnostic and therapeutic strategies for these diseases.

Recombinant measles virus-HPV vaccine candidates for prevention of cervical carcinoma.

Cervical cancer is mainly associated with HPV genotype 16 infection. Recombinant measles virus (rMV) expressing HPV genotype 16 L1 capsid protein was generated by construction of an antigenomic plasmid, followed by rescue using the human "helper" cell line 293-3-46. In cell cultures the recombinant MV-L1 virus replicated practically as efficiently as the standard attenuated MV established as commercial vaccine, devoid of the transgene. The high genetic stability of MVb2-L1 was confirmed by 10 serial viral transfers in cell culture. In transgenic mice expressing the MV receptor CD46 the recombinant induced strong humoral immune responses against both MV and HPV; the antibodies against L1 exhibited mainly neutralizing capacity. Our data suggest that MV is a promising vehicle for development of inexpensive and efficient vaccines protecting from HPV infection.

Recombinant measles viruses expressing single or multiple antigens of human immunodeficiency virus (HIV-1) induce cellular and humoral immune responses.

Recombinant measles viruses (rMV) based on the live attenuated measles vaccine strain (MVb) expressing antigens of HIV-1 clade B were generated by reverse genetics. Recombinants expressing single or double antigens of HIV-1 (rMV-HIV) were genetically highly stable on human diploid cells. The production process of these viruses was essentially similar to the parental MV strain, yielding comparative end titers. Immunization of tg-mice by different regimens and formulations showed potent humoral and cellular immune responses against MV and HIV antigens. Recombinant MV-HIV expressing Gag protein conferred protective immunity in tg-mice after a high-dose pseudochallenge with recombinant vaccinia virus. In addition, rMV-HIV boosted anti-HIV antibodies, in the presence of pre-existing anti-vector antibodies.

Clinical evaluation of a self-etch adhesive in non-carious cervical lesions.

PURPOSE: To evaluate the clinical performance of a self-etching adhesive in Class V non-carious lesions with and without acid etching procedures. METHODS: A total of 125 Class V non-carious cervical lesions (NCCL) with incisal or occlusal margins in enamel and gingival margins in dentin/cementum were selected and restored with Clearfil SE Bond self-etch adhesive and Clearfil APX resin composite. All cavities were restored using two techniques; after etching the whole cavity for 20 seconds and without acid etching (control). The restorations were evaluated at baseline, 1- and 2-year using modified USPHS criteria. RESULTS: No loss of restorations was recorded after 1 and 2 years for the two restorative techniques. There was no significant difference between the baseline and 2-year results for any of the tested technique. However, restorations made after acid etching showed less marginal discoloration at the enamel margins.

Effect of hydrostatic pulpal water pressure on microtensile bond strength of self-etch adhesives to dentin.

PURPOSE: To evaluate the effect of pulpal pressure on the microtensile bond strength of four self-etch adhesives to dentin. A total-etch adhesive was added for comparison. METHODS: 60 freshly extracted human third molars were selected. For each tooth, the root was removed below the cemento-enamel junction. A second parallel section was made to remove the coronal enamel to form a crown segment. The root portion of the resulting crown segment was cemented to a Plexiglas platform using cyanoacrylate cement. The crown segment was then connected with a plastic tube to a water column to produce a pressure of 20 cm H2O at the prepared dentin surface of the crown segment. The adhesive materials were: a total-etch adhesive (Scotchbond 1) and four self-etch adhesives (Clearfil SE Bond, Hybrid Bond, Futurabond NR, and AdheSE Bond). The tested adhesives were applied to the dentin surface in three test procedures: applied to dentin without pulpal pressure, applied to dentin with pulpal pressure for 24 hours, and applied to dentin with pulpal pressure and the pressure was maintained for 6 months during storage. Grandio resin composite was placed in 3-4 layers to a height of 5-6 mm to form a crown segment. For bond strength measurement, the composite-dentin segment was removed from the Plexiglas. This segment was then sectioned to prepare the specimens for microtensile bond measurement. RESULTS: None of the tested adhesives showed bond strength reduction when applied to dentin supplied with water pressure. After 6 months of pulpal pressure, Scotchbond 1, Clearfil SE Bond and AdheSE Bond showed significant reduction in bond strength (P < 0.05). In contrast, Futurabond NR and Hybrid Bond were not significantly affected.