Deactivation of cardiovascular implantable electronic devices in patients nearing end of life : Reality or only recommendation?

BACKGROUND: Current guidelines recommend considering deactivation of cardiac implantable electronic devices (CIEDs) in patients nearing death. We evaluated the implementation of this recommendation in unselected deceased individuals with CIEDs. METHODS: Over a 7-month period in 2016, all deceased persons taken to the Rostock crematorium were prospectively screened for CIEDs and these were interrogated in situ. Pacing rate, pacing mode, and lead output were documented as well as patient data including location and time of death. In implantable cardioverter-defibrillators (ICDs), tachycardia therapy adjustment and occurrence of shocks 24 h prior to death were also recorded. RESULTS: We examined 2297 subjects, of whom 154 (6.7%) had CIEDs. Of these subjects, 125 (100%) pacemakers (PMs) and 27 (96.4%) ICDs were eligible for analysis. Death in persons with ICDs occurred most frequently in hospital (55.6%), while this was less frequently the case for individuals with PMs (43.2%). Furthermore, 33.3% of subjects with ICDs and 18.5% with PMs died in palliative care units (PCU). Shock therapies were switched off in three (60%) individuals with ICDs who died in the PCU, whereas antibradycardia therapy was not withdrawn in any PM patient in the PCU. Therapy withdrawal occurred in two patients with PMs (1.3%) who died in hospital. Patients with PMs had high ventricular pacing rates at the last interrogation (69 ± 36.0%) and often suffered atrioventricular block (39.2%). Six (25%) of the 24 active ICDs presented shocks near the time of death. CONCLUSION: Many CIED patients died in hospital; nonetheless, in practice, CIED deactivation near death is rarely performed and might be less feasible in subjects with PMs. However, there is still a need to consider deactivation, especially in individuals with ICDs, as one fourth of them received at least one shock within 24 h prior to death.

Individual programming of current multiprogrammable pacemakers : Still unsatisfactory?

BACKGROUND: Pacemaker (PM) technology has developed tremendously in recent decades. We evaluated the extent of individual programming in current PMs. METHODS: Over a 7-month period in 2016, all deceased persons taken to the Rostock crematorium were prospectively screened for cardiac implantable electronic devices (CIEDs) and these were interrogated in situ. Programming of patient data, leads, and study parameters including mode, lower rate, upper tracking or sensor rate (UTSR), ventricular refractory time, sleeping function, hysteresis, and PM-mediated tachycardia intervention were analyzed and compared with delivery settings. Alterations in atrial/ventricular capture management and atrial/ventricular sensing assurance as well as changes in sensitivity and lead output were evaluated. RESULTS: We examined 2297 subjects, of whom 154 (6.7%) had CIEDs, with 125 (81.2%) being PMs. Finally, 72 (57.6%) PMs were eligible for analysis with an operation time of 31.0 ± 27.0 months. We excluded 28 (18.2%) implantable cardioverter defibrillators (ICDs), 51 (41%) PMs presenting elective replacement indicator (ERI), two (1.6%) PMs with programming to insufficient function prior to death, and the left ventricle parameter of one (1.4%) cardiac resynchronization therapy pacemaker (CRT-P); further one CIED (0.6%) was not contactable. PMs offered in mean 75.2% of study parameters thereof 88.0% were to adjust manually, whereof 49.3% stayed unchanged to delivery mode. Lead output, UTSR, lower rate, and mode were the most frequently changed parameters (>85.7%, 65.3%, 54.2%, and 52.8%, respectively) compared with unmodified ventricular refractory time and hysteresis (91.7% and. 85.4%, respectively); 2.8% of PMs had out-of-the-box settings. The most frequent personalized data were last (88.9%) and first name (73.6%), while atrial and ventricular serial lead numbers were rarely entered (18.2% and 23.4%, respectively). CONCLUSION: The programming possibilities of PMs have advanced greatly. Nonetheless, improvements in individual PM programming are still needed as demonstrated by the findings in this study, e.g., PMs with manufacturer settings and lack of individual data.

Switching "on" and "off" the adhesion in stimuli-responsive elastomers.

The present work aims at the preparation of dry adhesives with switchable bonding properties by using the reversible nature of the [4πs+4πs] cycloaddition of anthracenes. Photo-responsive hydrogenated carboxylated nitrile butadiene rubber with photo-responsive pendant anthracene groups is prepared by one-pot synthesis. The formation of 3D networks relies on the photodimerization of the anthracene moieties upon UV exposure (λ > 300 nm). Controlled cleavage of the crosslink sites is achieved by either deep UV exposure (λ = 254 nm) or thermal dissociation at 70 °C. The kinetics of the optical and thermal cleavage routes are compared in thin films using UV-vis spectroscopy and their influence on the reversibility of the network is detailed. Going from thin films to free standing samples the modulation of the network structure and thermo-mechanical properties over repeated crosslinking and cleavage cycles are characterized by low-field NMR spectroscopy and dynamic mechanical analysis. The applicability of the stimuli-responsive networks as adhesives with reversible bonding properties is demonstrated. The results evidence that the reversibility of the crosslinking reaction enables a controlled switching "on" and "off" of adhesion properties. The recovery of the adhesion force amounts to 75 and 80% for photo- and thermal dissociation, respectively. Spatial control of adhesion properties is evidenced by adhesion force mapping experiments of photo-patterned films.

[Orthopaedic implants. Application outside of patient care?]. / Orthopädisch-Unfallchirurgische Implantate. Verwendungsmöglichkeiten außerhalb der Patientenversorgung?

Internal fracture fixation represents a widespread concept for the treatment of fractures. As the number of implants increases, person tracking may be possible. In spring 2010 near Rostock (Germany), human remains including a stainless steel nail were found. Forensic analysis considered the parts of skeleton to belong to a man of medium height, exposed to outdoor conditions for several years to a few decades. The tibial nail was analysed and according to the product identification number possible hospitals of implant placement and transportation paths were determined and screened. Furthermore a match analysis of the database of missing individuals of the last 15 years was undertaken and a DNA match analysis identified a local individual who had been missing since winter 2003. Equipped with the actual patient's identity, out of academic interest a survey of clinical documents such as discharge letters and operative reports was performed, but was inconclusive. Although technically feasible, tracking the patient in this case based on the implant product number itself was unsuccessful. In this case report, the feasibility, validity and efficiency of this option are presented and discussed.

[The surgically treated gunshot injury. Securing evidence in hospitals without primary participation of police or legal medicine]. / Die operierte Schussverletzung. Schussspurensicherung im klinischen Bereich ohne primäre Beteiligung der Polizei oder der Rechtsmedizin.

Against the background of a problematic reconstruction of a hunting accident, the question arises how such cases can be handled in hospitals and how exhibits can be adequately dealt with. After evaluating a questionnaire on current conditions of securing evidence in cases of surgically treated gunshot wounds from 26 surgical institutions in Mecklenburg-Western Pomerania and in consideration of the certified advanced training in the field of legal medicine, recommendations are given regarding the securing of evidence within the clinical setting without primary involvement of police or legal medicine.

Effects of transgenic endothelin-2 overexpression on diabetic cardiomyopathy in rats.

BACKGROUND: Transgenic overexpression of human endothelin-2 in rats was used to characterize the contribution of endothelin to diabetic cardiomyopathy. MATERIALS AND METHODS: Diabetes mellitus was induced by streptozotocin in transgenic rats and transgene-negative controls. Nondiabetic animals were included as well to form a 4-group study design. Heart morphological and molecular alterations were analysed following 6 months of hyperglycaemia. RESULTS: Plasma endothelin concentrations were significantly higher in both transgenic groups than in wild-type groups (nondiabetic: 3.5 +/- 0.4 vs. 2.1 +/- 0.2, P < 0.05; diabetic: 4.5 +/- 0.4 vs. 2.5 +/- 0.4 fmol mL(-1), P < 0.01). Diabetes induced cardiac hypertrophy in both wild-type and transgenic rats and showed the highest myocardial interstitial tissue volume density in diabetic transgenic rats (1.5 +/- 0.07%) as compared with nondiabetic transgenic (1.1 +/- 0.03%), nondiabetic wild-type (0.8 +/- 0.01%) and diabetic wild-type rats (1.1 +/- 0.03%; P < 0.01 for all comparisons). A similar pattern with the most severe changes in the enothelin-2 transgenic, diabetic animals was observed for hypertrophy of the large coronary arteries and the small intramyocardial arterioles respectively. Cardiac mRNA expression of endothelin-1, endothelin receptors type A and B were altered in some degree by diabetes or transgenic overexpression of endothelin-2, but not in a uniform manner. Blood pressure did not differ between any of the four groups. CONCLUSIONS: Overexpression of the human endothelin-2 gene in rats aggravates diabetic cardiomyopathy by more severe coronary and intramyocardial vessel hypertrophy and myocardial interstitial fibrosis. This transgenic intervention provides further and independent support for a detrimental, blood pressure-independent role of endothelins in diabetic cardiac changes.

Polymerization contraction stress in light-cured compomer restorative materials.

OBJECTIVE: The magnitude and kinetics of polymerization contraction stress build-up may be potential predictors of bond failure of adhesive restorations. The present study determined these properties of seven commercial compomers (Dyract, Dyract AP, F2000 Rasant, Hytac, Compoglass F, Luxat, Glasiosite). METHODS: Polymerization shrinkage was generated by 40 s light curing the test materials (800 mW/cm2). The contraction force induced was recorded for 300 s at room temperature (23-24 degrees C) by means of a Stress-Strain-Analyzer (C factor=0.33). Maximum contraction stress (MPa), coefficient of near linear fit of contraction force/time (gradient) and relative force rate (%/s) of each material were compared with that of two hybrid composites (Tetric Ceram, Prodigy). The statistical analysis was conducted by ANOVA (alpha=0.05) and post hoc Tukey's test. RESULTS: No statistically significant differences in the maximum stress between Glasiosite (2.27+/-0.06 MPa), Hytac (2.31+/-0.07 MPa) and Tetric Ceram (2.21+/-0.11 MPa), and between Compoglass F (2.60+/-0.18 MPa) and Prodigy (2.70+/-0.06 MPa) were found. The contraction stress of F2000 Rasant (3.41+/-0.09 MPa) and Luxat (3.33+/-0.08 MPa) were significantly highest, whilst Dyract exhibited the significantly lowest shrinkage stress (1.27+/-0.08 MPa) among the tested materials. SIGNIFICANCE: High contraction stress, early start of stress build-up and rapid contraction force development may lead to failure of bond to tooth structure. This study suggested that the contraction stress and kinetic behavior of compomers are generally similar to those of hybrid composites in a dry condition. Dyract might be superior in maintaining the bond with cavity walls compared to conventional hybrid composites in view of its low shrinkage stress.

Biological clearance of HEMA in guinea pigs.

No toxicokinetic data are available about the dental composite component 2-hydroxyethylmethacrylate (HEMA) in vivo in the literature. Therefore, the excretion of HEMA in feces and urine in vivo and, using the pendular perfusion technique with segments of jejunum and colon, in the biliary and enteric excretion in situ were investigated in anesthetized guinea pigs. In the in situ experiments, guinea pigs (n = 4) received HEMA (0.02 mmol/kgbw labelled with a tracer dose 14C-HEMA 0.3 kBq/gbw) injected into the jugular vein. In the in vivo experiments, guinea pigs (n = 4) received HEMA (+ 14C-HEMA, same dose as above) via gastric tube. Urine and feces were collected for 24h. In the in situ experiments, organs from guinea pigs were removed 60 min after the beginning of the experiment, and then the 14C-radioactivity was measured. During the 60 min perfusion period the calculated amount of 14C-activity excreted into the total jejunum and colon was 6.0 +/- 1.0% and 2.7 +/- 0.7% of the dose administered, respectively (mean +/- sem). Of the 14C-HEMA dose, 5.3 +/- 0.3% was found in the bile. Significantly (p < 0.05) higher bile/blood concentration ratios were found at 10-40 min after the injection of HEMA, as compared to the ratio at 60 min. The total 14C-recovery in all organs tested was 20.0 +/- 2.6%. During 24h the amounts of 14C-activity excreted in the feces and urine were 1.1 +/- 0.1% or 17.1 +/- 1.50% of the dose administered, respectively (mean +/- sem). The total 14C-recovery in all organs tested was 11.6 +/- 0.6%. In a second series of in vivo experiments, exhaled air from the animals was captured during the 24h experimental period. 14C was exhaled to 63.6 +/- 2.11% of the administered 14C-HEMA dose (mean +/- sem; n = 4) as 14C-carbondioxide. The results indicate a rapid clearance of 14C-HEMA and/or 14C-HEMA metabolite(s) from the organism, exhalation being the major route of elimination.

Toxicokinetic of HEMA in guinea pigs.

OBJECTIVE: Unconverted 2-hydroxyethylmethacrylate (HEMA) can be released from dental resin materials and can enter the body in humans. In the present study the uptake, distribution and excretion of 14C-HEMA applied via different routes were examined in vivo in guinea pigs. METHODS: HEMA (0.02 mmol/kg bw labelled with a tracer dose 14C-HEMA 0.3 Bq/g bw) was administered by gastric tube or by subcutaneous injection. Urine, feces, and exhaled carbon dioxide were collected for 24 h after administration. Guinea pigs were killed 24 h after the beginning of the experiment and various organs removed and 14C radioactivity measured. RESULTS: Low fecal 14C levels (about 2% of the dose) and urinary levels of about 15% after 24 h were noted with either route of administration. Direct measurement of exhaled CO(2) showed that about 70% of the dose left the body via the lungs. Two pathways for the metabolism of 14C-HEMA can be described. It is likely that 14C-pyruvate is formed in vivo resulting in the formation of toxic 14C-HEMA intermediates. 14C-HEMA was taken up rapidly from the stomach and small intestine after gastric administration and was widely distributed in the body following administration by each of the routes. CONCLUSIONS: Clearance from most tissues following gastric and intradermal administration was essentially complete within one day. The peak HEMA levels in all tissues examined after 24 h were at least onemillion-fold less than known toxic levels.

Three-year clinical evaluation of composite and ceramic inlays.

PURPOSE: To evaluate the 3-yr clinical performance of composite and ceramic inlays in posterior teeth. MATERIALS AND METHODS: 47 composite inlays (Tetric, Blend-a-Lux, Pertac) and 24 ceramic inlays (Empress) were placed by seven student operators under supervision of an experienced dentist. Clinical assessment of 58 inlays (81.7%) was performed after 3 yrs using amodified USPHS criteria and statistically analyzed with Mann-Whitney U test and Fisher's exact test. RESULTS: A total of 100% of the ceramic inlays and 89% of the composite inlays were assessed to be clinically excellent or acceptable. Three composite inlays failed during the first yr and one had to be replaced during the second evaluation period. All composite inlay failures were recorded on molars, revealing a significantly higher failure rate compared with premolars (Fisher's test, P = 0.041). Ceramic inlays revealed a significantly better "anatomic form of the surface" (P = 0.027) and "integrity of the restoration" (P = 0.035). Inlays in small cavities performed better for "marginal integrity" (P = 0.033) and "discoloration at the margin" (P = 0.038).

Marginal quality of tooth-colored restorations in class II cavities after artificial aging.

This in vitro study compared the proximal marginal adaptation of direct composite restorations with composite and ceramic inlays inserted with different resin cements. Standardized MOD Class II inlay cavities with one proximal box extending below and the other above the CEJ were cut in 48 extracted human molars and randomly assigned to six groups (n=8). Incrementally layered direct composite restorations (P60), composite inlays (P60) and ceramic inlays (Empress; Cerec Vitablocs Mark II) were placed in the cavities. Three different resin cements (RelyX ARC; Variolink II high viscosity; Panavia 21) were used for luting the composite inlays. All ceramic inlays were cemented with RelyX ARC. After finishing and polishing, the teeth were stored for 24 hours in Ringer solution at 37 degrees C before they were subjected to thermal and mechanical loading (5/55 degrees C, 2000x; 50 N vertical load, 50000x). Margins were evaluated on epoxy replicas using a scanning electron microscope at X200 magnification. Statistical analysis was performed with non-parametric test methods (alpha=0.05). The adhesive interfaces to enamel exhibited high percentages of perfect margins for all groups (91.8% to 96%) and a maximum of 5.2% marginal gap formation. Dentin-limited cavity segments demonstrated more marginal openings and less perfect margins than enamel-bound areas; however, this was only statistically significant for direct composite restorations and composite inlays inserted with Variolink II and Panavia 21. RelyXARC showed a significantly better adaptation to P60 inlays compared with the leucite-reinforced Empress ceramic but not the Vitablocs Mark II ceramic.

The suitability of packable resin-based composites for posterior restorations.

BACKGROUND: Packable composites, promoted for the restoration of stress-bearing posterior teeth, have captured clinicians' interest. METHODS: The authors tested three packable composites (Alert, Jeneric/Pentron; Solitaire, Heraeus Kulzer, Wehrheim, Germany; SureFil, Dentsply De Trey, Konstanz, Germany); a new packable organically modified ceramic, or ormocer (Definite, Degussa AG, Hanau, Germany); a hybrid composite (Tetric Ceram, Ivoclar Vivadent, Schaan, Liechtenstein) and an ion-releasing composite (Ariston pHc, Ivoclar Vivadent, Schaan, Liechtenstein). They determined modulus of elasticity according to EN 24049:1993 of the European Committee for Standardization. They measured Vickers hardness using a 200-gram load for 40 seconds. To determine the materials' depth of cure, they used both a scraping method (International Standards Organization standard CD 4049:1997) and a hardness profiling method. RESULTS: The authors calculated means and standard deviations from 10 replications of each test and used one-way analysis of variance and post hoc Tukey tests (alpha = .05). The materials had significant differences (P < .001) in all characteristics. Solitaire had the significantly lowest elastic modulus and microhardness; Alert had the highest values for these characteristics. Ariston pHc exhibited the significantly lowest depth of cure. There was a significant correlation between the two methods of measuring depth of cure (r2 = 0.9945; P = .021). CONCLUSIONS: The material group of packable composites is rather inhomogeneous in terms of mechanical and physical data. Our data suggest that bulk curing of packable composites in deep cavities still is not recommendable. CLINICAL IMPLICATIONS: The clinician needs to select packable composites carefully, as it seems that not all of these materials quality for stress-loaded posterior restorations.

Longevity of restorations in posterior teeth and reasons for failure.

PURPOSE: This article compiles a survey on the longevity of restorations in stress-bearing posterior cavities and assesses possible reasons for failure. MATERIALS AND METHODS: The dental literature predominantly of the last decade was reviewed for longitudinal, controlled clinical studies and retrospective cross-sectional studies of posterior restorations. Only studies investigating the clinical performance of restorations in permanent teeth were included. Longevity and annual failure rates of amalgam, direct composite restorations, glass ionomers and derivative products, composite and ceramic inlays, and cast gold restorations were determined for Class I and II cavities. RESULTS: Annual failure rates in posterior stress-bearing restorations are: 0% to 7% for amalgam restorations, 0% to 9% for direct composites, 1.4% to 14.4% for glass ionomers and derivatives, 0% to 11.8% for composite inlays, 0% to 7.5% for ceramic restorations, 0% to 4.4% for CAD/CAM ceramic restorations, and 0% to 5.9% for cast gold inlays and onlays. CONCLUSION: Longevity of dental restorations is dependent upon many different factors that are related to materials, the patient, and the dentist. The principal reasons for failure were secondary caries, fracture, marginal deficiencies, wear, and postoperative sensitivity. A distinction must be made between factors causing early failures and those that are responsible for restoration loss after several years of service.

Polymerization contraction stress in light-cured packable composite resins.

OBJECTIVE: Determination of the polymerization contraction stress of packable composites (ALERT, Surefil, Solitaire, Solitaire 2) and a packable ORMOCER material (Definite) in comparison with a conventional hybrid composite (Tetric Ceram). METHODS: Contraction force generated by the test materials (10 replications each) was measured by polymerizing the composites filled in a plastic tray between two aluminum attachments mounted in a Stress-Strain-Analyzer testing machine (specimen size: 4x4x2 mm, C-factor=0.33). Contraction force was recorded for 300s under a standard exposure condition (40s, 800mW/cm(2)). Maximum contraction stress (MPa), force rate (N/s), relative force rate (%/s) of each material were statistically analyzed by ANOVA (alpha=0.05) and post-hoc Tukey's test. RESULTS: Maximum contraction stresses of the packable materials were 4.60 +/- 0.32MPa (ALERT), 4.16 +/- 0.18MPa (Definite), 3.36 +/- 0.08MPa (Solitaire 2), 3.33 +/- 0.23MPa (Solitaire) and 3.13 +/- 0.18MPa (Surefil), which were significantly higher than that of Tetric Ceram (2.51 +/- 0.14MPa). Tetric Ceram exhibited the significantly lowest force rate. Force/time curves were S-shaped. Solitaire especially showed a longer pre-gelation phase before contraction force was recorded. SIGNIFICANCE: High contraction stress and rapid contraction force development can lead to failure of bond to tooth structure. This study suggested that, packable composite resins are less capable of reducing the contraction stress during the early setting stage, thus not superior in maintaining the bond with cavity walls to conventional hybrid composite Tetric Ceram.

Marginal quality and microleakage of adhesive class V restorations.

OBJECTIVES: The aim of this in vitro study was to determine the marginal quality and microleakage of composite resin class V restorations. METHODS: Standardized mixed class V cavities (diameter: 4mm, depth: 2mm) with half of the finish lines limited within dentin were cut in 90 freshly extracted human molars and randomly assigned to nine groups (n=10). After etching enamel and dentin, the cavities were restored with nine different restorative systems (Syntac Sprint/Tetric Ceram=SS, Syntac Single-Component/Tetric Ceram=SC, Onestep/Aeliteflo=OS, Aquaprep+Onestep/Aeliteflo=OA, Prime & Bond 2.1/TPH=PB, Optibond Solo/Prodigy=OP, Singlebond/Z100=SB, Tenure Quik/Marathon=TQ, Solobond M/Arabesk=SM) using a wet-bonding procedure. After finishing and polishing, the teeth were stored for 24h in distilled water at 37 degrees C before they were subjected to thermocycling (5/55 degrees C, 1000x). Epoxy replicas were made for margin analysis in the SEM. Specimens were stained in methylene blue, sectioned, and evaluated for microleakage. Dye penetration was scored on a 0-3 ordinal scale. RESULTS: Statistical analysis (Kruskal-Wallis H-test, Mann-Whitney U-test) revealed significant differences (P<0.05) among the groups at dentin and enamel margins for the microleakage scores as well as for the results of the quantitative SEM margin analysis. SC revealed a significantly higher percentage of perfect margins in the SEM than OS and SM in enamel and dentin, respectively. OA exhibited significantly more leakage in enamel than all other groups. CONCLUSIONS: None of the tested restorative systems achieved a perfect seal in dentin and enamel of mixed class V cavities. Marginal quality and sealing ability of adhesive systems to dentin, using a wet-bonding procedure, is still inferior compared with enamel margins.

Mollusc/algal chloroplast symbiosis: how can isolated chloroplasts continue to function for months in the cytosol of a sea slug in the absence of an algal nucleus?

A marine sea slug, Elysia chlorotica, has acquired the ability to carry out photosynthesis as a result of forming an intracellular symbiotic association with chloroplasts of the chromophytic alga, Vaucheria litorea. The symbiont chloroplasts (kleptoplasts) are functional, i.e. they evolve oxygen and fix CO(2) and actively transcribe and translate proteins for several months in the sea slug cytosol. Considering the dependency of plastid function on nuclear genes, the level of kleptoplast activity observed in the animal cell is quite remarkable. Possible factors contributing to this long-lasting functional association that are considered here include: the presence of an algal nuclear genome in the sea slug, autonomous chloroplasts, unusual chloroplast/protein stability, re-directing of animal proteins to the kleptoplast, and lateral gene transfer. Based on our current understanding, the acquisition and incorporation of intact algal plastids by E. chlorotica is aided by the robustness of the plastids and the long-term functional activity of the kleptoplasts appears to be supported by both plastid and protein stability and contributions from the sea slug.

Three-year clinical evaluation of direct and indirect composite restorations in posterior teeth.

STATEMENT OF THE PROBLEM: Objective long-term clinical data are necessary to assess the performance of modern posterior composites as direct and indirect restorations. PURPOSE: This prospective, long-term clinical trial evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface cavities and provided a survey on the 3-year results. MATERIAL AND METHODS: Under the supervision of an experienced dentist, 9 dental students placed 88 composite restorations (Tetric, blend-a-lux, Pertac-Hybrid Unifil), 43 direct composite restorations, and 45 indirect inlays. Clinical evaluation was performed at baseline and in yearly intervals after placement by 2 other experienced dentists, using modified USPHS criteria. A third follow-up of 60 restorations took place within 33 to 36 months after placement. RESULTS: A total of 93% of indirect and 87% of direct restorations were assessed to be clinically excellent or acceptable. During the third year, 1 direct restoration in a molar failed because of margin opening. Indirect inlays exhibited a significantly better anatomic form of the surface than direct composite restorations. Premolars revealed a significantly better marginal integrity and anatomic form of the surface than molars. Restorations in molars exhibited a significantly higher failure rate compared with premolars. CONCLUSION: Posterior composite restorations provided a satisfactory clinical performance over a 3-year period, even if placed by relatively inexperienced but supervised students.

Mollusc-algal chloroplast endosymbiosis. Photosynthesis, thylakoid protein maintenance, and chloroplast gene expression continue for many months in the absence of the algal nucleus.

Early in its life cycle, the marine mollusc Elysia chlorotica Gould forms an intracellular endosymbiotic association with chloroplasts of the chromophytic alga Vaucheria litorea C. Agardh. As a result, the dark green sea slug can be sustained in culture solely by photoautotrophic CO(2) fixation for at least 9 months if provided with only light and a source of CO(2). Here we demonstrate that the sea slug symbiont chloroplasts maintain photosynthetic oxygen evolution and electron transport activity through photosystems I and II for several months in the absence of any external algal food supply. This activity is correlated to the maintenance of functional levels of chloroplast-encoded photosystem proteins, due in part at least to de novo protein synthesis of chloroplast proteins in the sea slug. Levels of at least one putative algal nuclear encoded protein, a light-harvesting complex protein homolog, were also maintained throughout the 9-month culture period. The chloroplast genome of V. litorea was found to be 119.1 kb, similar to that of other chromophytic algae. Southern analysis and polymerase chain reaction did not detect an algal nuclear genome in the slug, in agreement with earlier microscopic observations. Therefore, the maintenance of photosynthetic activity in the captured chloroplasts is regulated solely by the algal chloroplast and animal nuclear genomes.

Mechanical properties of new composite restorative materials.

OBJECTIVE: Determination of flexural strength, flexural modulus, fracture toughness, Vickers hardness, and wear resistance of condensable composites (Solitaire, Surefil, Alert) and an ormocer (Definite) in comparison with a hybrid composite (Tetric Ceram) and an ion-releasing composite (Ariston pHc). METHODS: Flexural strength, flexural modulus, and fracture toughness were determined in 3-point bending. Single-edge notched-bend specimens were used to evaluate fracture toughness. Microhardness was measured with a Vickers indenter. Wear was determined in a pin-on-block-design with a Degusit antagonist at 50 N load and quantified by a replica technique after 6000, 10000, 30000, and 50000 load cycles using a 3D-laser scanner. All results were statistically analyzed with ANOVA and post hoc Tukey HSD tests. RESULTS: Alert exhibited the highest flexural modulus, K(IC), and hardness, but lowest wear resistance. Solitaire presented the highest wear resistance, but significantly lower flexural strength, flexural modulus, K(IC), and hardness than all other materials. No significant correlation could be detected between hardness and wear of the tested composites with Pearson's correlation coefficient. SIGNIFICANCE: The condensable composites differed significantly in their mechanical properties. This study suggested that, besides the filler content level and filler size, other factors like matrix-filler interactions highly influence the fracture and wear behavior of the materials.