Non-linear registration improves statistical power to detect hippocampal atrophy in aging and dementia.

OBJECTIVE: To compare the performance of different methods for determining hippocampal atrophy rates using longitudinal MRI scans in aging and Alzheimer's disease (AD). BACKGROUND: Quantifying hippocampal atrophy caused by neurodegenerative diseases is important to follow the course of the disease. In dementia, the efficacy of new therapies can be partially assessed by measuring their effect on hippocampal atrophy. In radiotherapy, the quantification of radiation-induced hippocampal volume loss is of interest to quantify radiation damage. We evaluated plausibility, reproducibility and sensitivity of eight commonly used methods to determine hippocampal atrophy rates using test-retest scans. MATERIALS AND METHODS: Manual, FSL-FIRST, FreeSurfer, multi-atlas segmentation (MALF) and non-linear registration methods (Elastix, NiftyReg, ANTs and MIRTK) were used to determine hippocampal atrophy rates on longitudinal T1-weighted MRI from the ADNI database. Appropriate parameters for the non-linear registration methods were determined using a small training dataset (N = 16) in which two-year hippocampal atrophy was measured using test-retest scans of 8 subjects with low and 8 subjects with high atrophy rates. On a larger dataset of 20 controls, 40 mild cognitive impairment (MCI) and 20  AD patients, one-year hippocampal atrophy rates were measured. A repeated measures ANOVA analysis was performed to determine differences between controls, MCI and AD patients. For each method we calculated effect sizes and the required sample sizes to detect one-year volume change between controls and MCI (NCTRL_MCI) and between controls and AD (NCTRL_AD). Finally, reproducibility of hippocampal atrophy rates was assessed using within-session rescans and expressed as an average distance measure DAve, which expresses the difference in atrophy rate, averaged over all subjects. The same DAve was used to determine the agreement between different methods. RESULTS: Except for MALF, all methods detected a significant group difference between CTRL and AD, but none could find a significant difference between the CTRL and MCI. FreeSurfer and MIRTK required the lowest sample sizes (FreeSurfer: NCTRL_MCI = 115, NCTRL_AD = 17 with DAve = 3.26%; MIRTK: NCTRL_MCI = 97, NCTRL_AD = 11 with DAve = 3.76%), while ANTs was most reproducible (NCTRL_MCI = 162, NCTRL_AD = 37 with DAve = 1.06%), followed by Elastix (NCTRL_MCI = 226, NCTRL_AD = 15 with DAve = 1.78%) and NiftyReg (NCTRL_MCI = 193, NCTRL_AD = 14 with DAve = 2.11%). Manually measured hippocampal atrophy rates required largest sample sizes to detect volume change and were poorly reproduced (NCTRL_MCI = 452, NCTRL_AD = 87 with DAve = 12.39%). Atrophy rates of non-linear registration methods also agreed best with each other. DISCUSSION AND CONCLUSION: Non-linear registration methods were most consistent in determining hippocampal atrophy and because of their better reproducibility, methods, such as ANTs, Elastix and NiftyReg, are preferred for determining hippocampal atrophy rates on longitudinal MRI. Since performances of non-linear registration methods are well comparable, the preferred method would mostly depend on computational efficiency.

How does upper extremity Fugl-Meyer motor score relate to resting-state EEG in chronic stroke? A power spectral density analysis.

OBJECTIVE: We investigated the potential added value of high-density resting-state EEG by addressing differences with healthy individuals and associations with Fugl-Meyer motor assessment of the upper extremity (FM-UE) scores in chronic stroke. METHODS: Twenty-one chronic stroke survivors with initial upper limb paresis and eleven matched controls were included. Group differences regarding resting-state EEG parameters (Delta Alpha ratio (DAR) and pairwise-derived Brain Symmetry Index (BSI)) and associations with FM-UE were investigated, as well as lateralization of BSI and the value of different frequency bands. RESULTS: Chronic stroke survivors showed higher BSI compared to controls (p < 0.001), most pronounced in delta and theta frequency bands (p < 0.0001; p < 0.001). In the delta and theta band, BSI was significantly negatively associated with FM-UE (both p = 0.008) corrected for confounding factors. DAR showed no differences between groups nor association with FM-UE. Directional BSI showed increased power in the affected versus the unaffected hemisphere. CONCLUSIONS: Asymmetry in spectral power between hemispheres was present in chronic stroke, most pronounced in low frequencies and related to upper extremity motor function deficit. SIGNIFICANCE: BSI is related to motor impairment and higher in chronic stroke patients compared to healthy controls, suggesting that BSI may be a marker of selective motor control.

Inter-rater agreement in glioma segmentations on longitudinal MRI.

BACKGROUND: Tumor segmentation of glioma on MRI is a technique to monitor, quantify and report disease progression. Manual MRI segmentation is the gold standard but very labor intensive. At present the quality of this gold standard is not known for different stages of the disease, and prior work has mainly focused on treatment-naive glioblastoma. In this paper we studied the inter-rater agreement of manual MRI segmentation of glioblastoma and WHO grade II-III glioma for novices and experts at three stages of disease. We also studied the impact of inter-observer variation on extent of resection and growth rate. METHODS: In 20 patients with WHO grade IV glioblastoma and 20 patients with WHO grade II-III glioma (defined as non-glioblastoma) both the enhancing and non-enhancing tumor elements were segmented on MRI, using specialized software, by four novices and four experts before surgery, after surgery and at time of tumor progression. We used the generalized conformity index (GCI) and the intra-class correlation coefficient (ICC) of tumor volume as main outcome measures for inter-rater agreement. RESULTS: For glioblastoma, segmentations by experts and novices were comparable. The inter-rater agreement of enhancing tumor elements was excellent before surgery (GCI 0.79, ICC 0.99) poor after surgery (GCI 0.32, ICC 0.92), and good at progression (GCI 0.65, ICC 0.91). For non-glioblastoma, the inter-rater agreement was generally higher between experts than between novices. The inter-rater agreement was excellent between experts before surgery (GCI 0.77, ICC 0.92), was reasonable after surgery (GCI 0.48, ICC 0.84), and good at progression (GCI 0.60, ICC 0.80). The inter-rater agreement was good between novices before surgery (GCI 0.66, ICC 0.73), was poor after surgery (GCI 0.33, ICC 0.55), and poor at progression (GCI 0.36, ICC 0.73). Further analysis showed that the lower inter-rater agreement of segmentation on postoperative MRI could only partly be explained by the smaller volumes and fragmentation of residual tumor. The median interquartile range of extent of resection between raters was 8.3% and of growth rate was 0.22 mm/year. CONCLUSION: Manual tumor segmentations on MRI have reasonable agreement for use in spatial and volumetric analysis. Agreement in spatial overlap is of concern with segmentation after surgery for glioblastoma and with segmentation of non-glioblastoma by non-experts.

Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation.

BACKGROUND: Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) techniques have been developed to reduce radiation damage to the hippocampus. An inter-observer hippocampus delineation analysis was performed and the influence of the delineation variability on dose to the hippocampus was studied. MATERIALS AND METHODS: For five patients, seven observers delineated both hippocampi on brain MRI. The intra-class correlation (ICC) with absolute agreement and the generalized conformity index (CIgen) were computed. Median surfaces over all observers' delineations were created for each patient and regional outlining differences were analysed. HA-PCI dose plans were made from the median surfaces and we investigated whether dose constraints in the hippocampus could be met for all delineations. RESULTS: The ICC for the left and right hippocampus was 0.56 and 0.69, respectively, while the CIgen ranged from 0.55 to 0.70. The posterior and anterior-medial hippocampal regions had most variation with SDs ranging from approximately 1 to 2.5 mm. The mean dose (Dmean) constraint was met for all delineations, but for the dose received by 1% of the hippocampal volume (D1%) violations were observed. CONCLUSION: The relatively low ICC and CIgen indicate that delineation variability among observers for both left and right hippocampus was large. The posterior and anterior-medial border have the largest delineation inaccuracy. The hippocampus Dmean constraint was not violated.

Benefits of Nonthermal Atmospheric Plasma Treatment on Dentin Adhesion.

OBJECTIVES:: This study aimed to evaluate the influence of two nonthermal atmospheric plasma (NTAP) application times and two storage times on the microtensile bond strength (µTBS) to dentin. The influence of NTAP on the mechanical properties of the dentin-resin interface was studied by analyzing nanohardness (NH) and Young's modulus (YM). Water contact angles of pretreated dentin and hydroxyapatite blocks were also measured to assess possible alterations in the surface hydrophilicity upon NTAP. METHODS AND MATERIALS:: Forty-eight human molars were used in a split-tooth design (n=8). Midcoronal exposed dentin was flattened by a 600-grit SiC paper. One-half of each dentin surface received phosphoric acid conditioning, while the other half was covered with a metallic barrier and remained unetched. Afterward, NTAP was applied on the entire dentin surface (etched or not) for 10 or 30 seconds. The control groups did not receive NTAP treatment. Scotchbond Universal (SBU; 3M ESPE) and a resin-based composite were applied to dentin following the manufacturer's instructions. After 24 hours of water storage at 37°C, the specimens were sectioned perpendicular to the interface to obtain approximately six specimens or bonded beams (approximately 0.9 mm2 in cross-sectional area) representing the etch-and-rinse (ER) approach and another six specimens representing the self-etch (SE) approach. Half of the µTBS specimens were immediately loaded until failure, while the other half were first stored in deionized water for two years. Three other bonded teeth were selected from each group (n=3) for NH and YM evaluation. Water contact-angle analysis was conducted using a CAM200 (KSV Nima) goniometer. Droplet images of dentin and hydroxyapatite surfaces with or without 10 or 30 seconds of plasma treatment were captured at different water-deposition times (5 to 55 seconds). RESULTS:: Two-way analysis of variance revealed significant differences in µTBS of SBU to dentin after two years of water storage in the SE approach, without differences among treatments. After two years of water aging, the ER control and ER NTAP 10-second groups showed lower µTBS means compared with the ER NTAP 30-second treated group. Nonthermal atmospheric plasma resulted in higher NH and YM for the hybrid layer. The influence of plasma treatment in hydrophilicity was more evident in the hydroxyapatite samples. Dentin hydrophilicity increased slightly after 10 seconds of NTAP, but the difference was higher when the plasma was used for 30 seconds. CONCLUSIONS:: Dentin NTAP treatment for 30 seconds contributed to higher µTBS after two years of water storage in the ER approach, while no difference was observed among treatments in the SE evaluation. This result might be correlated to the increase in nanohardness and Young's modulus of the hybrid layer and to better adhesive infiltration, since dentin hydrophilicity was also improved. Although some effects were observed using NTAP for 10 seconds, the results suggest that 30 seconds is the most indicated treatment time.

Do collagen cross-linkers improve dentin's bonding receptiveness?

OBJECTIVES: Dentin biomodification using collagen cross-linkers has been proposed as one of the strategies to improve bond durability of adhesives to dentin. However, literature is not very consistent regarding their benefit, in particular when cross-linkers are applied in clinically realistic application times. This study investigated the effect of three cross-linkers on the mini-interfacial fracture toughness (mini-iFT) of four adhesives bonded to dentin following either etch&rinse (E&R) or self-etch (SE) modes. METHODS: 60 molars were randomly divided in accordance with the three variables: cross-linker, adhesive and bonding mode (n=5). The cross-linkers glutaraldehyde (5wt%; GA), proanthocyanidin (6.5wt%; PA), or UVA-activated riboflavin (0.5wt%; RB), and distilled water (control) were applied on dentin for 60s after acid-etching (E&R) or before self-etching (SE). The 3-step E&R adhesive (3E&Ra) OptiBond FL (Kerr), the 2-step SE adhesive (2SEa) Clearfil SE Bond 2 (Kuraray Noritake) and the universal adhesives G-Premio Bond (GC) and Prime&Bond Active (Dentsply), the latter two employed in both E&R and SE modes, were applied following the respective manufacturer's instructions. Composite buildups (8×8×8mm) were made using Filtek Supreme XTE (3M) prior to 1-week storage in artificial saliva. After the teeth were sectioned into mini-specimens (1.5×2.0×18mm), a single notch was prepared at the adhesive-dentin interface. Half of the specimens were immediately loaded until failure by 4-point bending to determine the mini-iFT, while the remaining specimen set was tested upon 6-month aging. Data were statistically analyzed with a linear model (p<0.05). RESULTS: No significant decrease in mini-iFT was noted only for PA (p<0.05), while the mini-iFT decreased for both other cross-linkers and in quite a similar way as when solely water (Wa) was applied. SIGNIFICANCE: The cross-linker proanthocyanidin (PA) applied in clinically relevant conditions was able to maintain a stable mini-iFT after 6-month aging. The incorporation of UVA-activated riboflavin (RB) and glutaraldehyde (GA) in the dentin-bonding protocol appeared not effective to improve the stability of adhesive-dentin interfaces.

Microtensile Bond Strength of Composite Cement to Novel CAD/CAM Materials as a Function of Surface Treatment and Aging.

OBJECTIVES: To evaluate the effect of different surface treatments on the bond strength to a composite and a polymer-infiltrated ceramic CAD/CAM block after six-month artificial aging. METHODS AND MATERIALS: Two types of CAD/CAM blocks (Cerasmart, GC; Enamic, Vita Zahnfabrik) were cut in slabs of 4-mm thickness, divided into six groups, and subjected to the following surface treatments: group 1: no treatment; group 2: sandblasting (SB); group 3: SB + silane (Si); group 4: SB + Si + flowable composite (see below); group 5: 5% hydrofluoric acid etching (HF) + Si; and group 6: 37% phosphoric acid etching (H3PO4) + Si. Sections of the same group were luted together (n=3: 3 sandwich specimens/group) using a dual-cure self-adhesive cement for all groups, except for the sections of group 4 that were luted using a light-curing flowable composite. After three weeks of storage in 0.5% chloramine at 37°C, the sandwich specimens were sectioned in rectangular microspecimens and trimmed at the interface to a dumbbell shape (1.1-mm diameter). One half of the specimens was subjected to a microtensile bond strength (µTBS) test, and the other half was tested after six months of water storage (aging). Data were statistically analyzed with a linear mixed-effects model for the factors surface treatment, material type, and aging, together with their first-degree interactions (α=0.05). RESULTS: The lowest bond strengths were obtained in the absence of any surface treatment (group 1), while the highest µTBSs were obtained when the surface was roughened by either SB or HF, this in combination with chemical adhesion through Si. Loss in bond strength was observed after six-month aging when either surface roughening or silanization, or both, were omitted. CONCLUSIONS: Both the composite and polymer-infiltrated ceramic CAD/CAM blocks appeared equally bonding-receptive regardless of the surface treatment used. Creating a microretentive surface by either SB or HF, followed by chemical adhesion using Si, is mandatory to maintain the bond strength after six months.

Multimodal Source Imaging: Basic Methods, Signal Processing Techniques, and Applications.

Multimodal source imaging is an emerging field in biomedical engineering. Its central goal is to combine different imaging modalities in a single model or data representation, such that the combination provides an enhanced insight into the underlying physiological organ, compared to each modality separately. It requires advanced signal acquisition and processing techniques and has applications in cognitive neuroscience, clinical neuroscience and electrocardiology. Therefore, it belongs to the heart of biomedical engineering.

Lack of Buffering by Composites Promotes Shift to More Cariogenic Bacteria.

Secondary caries (SC) remains a very important problem with composite restorations. The objectives of this study were to test the acid-buffering ability of several restorative materials and to evaluate whether buffering of the restorative material has an impact on the microbial composition of the biofilm. Disk-shaped specimens of conventional composite, composite with surface prereacted glass-ionomer filler particles (so-called giomer), glass-ionomer cement (GIC), amalgam, and hydroxyapatite (HAp) (control) were exposed to aqueous solutions with pH 4, 5, 6, and 7 and to the medium containing bacteria-produced acids, and pH changes were recorded over several days. Next, material specimens were immersed in bacterial growth medium with pH adjusted to 5. After a 24-h incubation, the extracts were collected and inoculated with a cariogenic (Streptococcus mutans) and a noncariogenic (Streptococcus sanguinis) species. The bacterial growth was monitored both in a single-species model by spectrophotometry and in a dual-species model by viability quantitative polymerase chain reaction. Amalgam and HAp showed the strongest acid-buffering ability, followed by the GIC and the giomer, while the conventional composite did not exhibit any buffering capacity. Furthermore, due to the lack of acid-buffering abilities, composite was not able to increase the pH of the medium (pH 5), which, in the absence of antibacterial properties, allowed the growth of S. mutans, while the growth of S. sanguinis, a less aciduric species, was completely inhibited. A similar effect was observed when bacteria were cultured together: there was a higher percentage of S. mutans and lower percentage of S. sanguinis with the conventional composite than with other materials and HAp. In conclusion, conventional composites lack the ability to increase the local pH, which leads to the outgrowth of more acidogenic/aciduric bacteria and higher cariogenicity of the biofilm. Together with lack of antibacterial properties, lack of buffering may account for the higher susceptibility of composites to SC.

Structural and Chemical Analysis of the Zirconia-Veneering Ceramic Interface.

The interfacial interaction of veneering ceramic with zirconia is still not fully understood. This study aimed to characterize morphologically and chemically the zirconia-veneering ceramic interface. Three zirconia-veneering conditions were investigated: 1) zirconia-veneering ceramic fired on sandblasted zirconia, 2) zirconia-veneering ceramic on as-sintered zirconia, and 3) alumina-veneering ceramic (lower coefficient of thermal expansion [CTE]) on as-sintered zirconia. Polished cross-sectioned ceramic-veneered zirconia specimens were examined using field emission gun scanning electron microscopy (Feg-SEM). In addition, argon-ion thinned zirconia-veneering ceramic interface cross sections were examined using scanning transmission electron microscopy (STEM)-energy dispersive X-ray spectrometry (EDS) at high resolution. Finally, the zirconia-veneering ceramic interface was quantitatively analyzed for tetragonal-to-monoclinic phase transformation and residual stress using micro-Raman spectroscopy (µRaman). Feg-SEM revealed tight interfaces for all 3 veneering conditions. High-resolution transmission electron microscopy (HRTEM) disclosed an approximately 1.0-µm transformed zone at sandblasted zirconia, in which distinct zirconia grains were no longer observable. Straight grain boundaries and angular grain corners were detected up to the interface of zirconia- and alumina-veneering ceramic with as-sintered zirconia. EDS mapping disclosed within the zirconia-veneering ceramic a few nanometers thick calcium/aluminum-rich layer, touching the as-sintered zirconia base, with an equally thick silicon-rich/aluminum-poor layer on top. µRaman revealed t-ZrO2-to-m-ZrO2 phase transformation and residual compressive stress at the sandblasted zirconia surface. The difference in CTE between zirconia- and the alumina-veneering ceramic resulted in residual tensile stress within the zirconia immediately adjacent to its interface with the veneering ceramic. The rather minor chemical elemental shifts recorded in the veneering ceramic did not suffice to draw definitive conclusions regarding potential chemical interaction of the veneering ceramic with zirconia. Sandblasting damaged the zirconia surface and induced phase transformation that also resulted in residual compressive stress. Difference in CTE of zirconia versus that of the veneering ceramic resulted in an unfavorable residual tensile stress at the zirconia-veneering ceramic interface.

Dentin Bonding Testing Using a Mini-interfacial Fracture Toughness Approach.

Measurement of interfacial fracture toughness (iFT) is considered a more valid method to assess bonding effectiveness as compared with conventional bond strength testing. Common fracture toughness tests are, however, laborious and require a relatively bulky specimen size. This study aimed to evaluate a new simplified and miniaturized iFT (mini-iFT) test. Four dentin adhesives, representing the main adhesive classes, and 1 glass ionomer cement were applied onto flat dentin. Mini-iFT (1.5 × 2.0 × 16 to 18 mm) and microtensile bond strength (µTBS; 1.5 × 1.5 × 16 to 18 mm) specimens were prepared from the same tooth. For the mini-iFT specimens, a single notch was cut at the adhesive-dentin interface with a 150-µm diamond blade under water cooling; the specimens were loaded until failure in a 4-point bending test setup. Finite element analysis was used to analyze stress distribution during mini-iFT testing. The correlation between the mean mini-iFT and µTBS was examined and found to be significant; a strong positive correlation was found (r(2) = 0.94, P = 0.004). Weibull data analysis suggested the mini-iFT to vary less than the µTBS. Both the mini-iFT and the µTBS revealed the same performance order, with the 3-step etch-and-rinse adhesive outperforming the 2-step self-etch and 2-step etch-and-rinse adhesive, followed by the 1-step SE adhesive and, finally, the glass ionomer cement. Scanning electron microscopy failure analysis revealed the adhesive-dentin interface to fail more at the actual interface with the mini-iFT test, while µTBS specimens failed more within dentin and composite. This finding was corroborated by finite element analysis showing stress to concentrate at the interface during mini-iFT loading and crack propagation. In conclusion, the new mini-iFT test appeared more discriminative and valid than the µTBS to assess bonding effectiveness; the latter test nevertheless remains more versatile. Specimen size and workload were alike, making the mini-iFT test a valid alternative for the popular µTBS test.

Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions.

OBJECTIVE: The objective of this randomized controlled clinical trial was to evaluate the 13-year clinical performance of a mild two-step self-etch adhesive in non-carious cervical lesions with and without prior selective phosphoric acid-etching of the enamel cavity margins. METHODS: A total of 100 non-carious cervical lesions in 29 patients were restored with Clearfil AP-X (Kuraray Noritake). The composite restorations were bonded following two different approaches: (1) application of Clearfil SE Bond (Kuraray Noritake) following a self-etch approach (CSE-NE); (2) selective phosphoric acid-etching of enamel cavity margins before application of Clearfil SE Bond (CSE-E). The restorations were evaluated after 6 months, 1, 2, 3, 5, 8 and 13 years of clinical service regarding retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality and post-operative sensitivity. RESULTS: The patient recall rate at 13 years was 62%. Six restorations, 4 of the CSE-NE group and 2 of the CSE-E group, were clinically unacceptable due to loss of retention (1 CSE-NE, 1 CSE-E), a severe marginal defect (2 CSE-NE, 1 CSE-E) and caries occurrence in combination with a severe marginal defect (1 CSE-NE) leading to a clinical success rate of 86% (CSE-NE) and 93% (CSE-E). Ageing of the restorations was characterized by a further increase in the percentage of restorations with a clinically acceptable small marginal defect (CSE-NE: 87%; CSE-E: 83%) and/or superficial marginal discoloration (CSE-NE: 53%; CSE-E: 56%). The presence of small marginal defects (CSE-NE: 86%; CSE-E: 68%) and superficial marginal discoloration (CSE-NE: 41%; CSE-E: 20%) at the incisal enamel side was more frequently noticed in the CSE-NE group than in the CSE-E group. The difference, however, was not statistically significant (McNemar, p>0.05). SIGNIFICANCE: After 13 years, the clinical effectiveness of Clearfil SE Bond in non-carious Class-V lesions remained excellent, with selective acid-etching of the enamel cavity margins only having some minor positive effect on marginal integrity and absence of marginal discoloration.

Clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions. A systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the clinical effectiveness of contemporary adhesives for the restoration of non-carious cervical lesions (NCCLs) in terms of restoration retention as a function of time. METHODS: Medline Ovid and IADR abstracts were reviewed for NCCLs clinical trials from 1950 to 2013. The reference list of all eligible trials and relevant review articles was checked to find additional studies. The review did not have any language restrictions. Only randomized controlled clinical trials that evaluated at least two adhesives for a follow-up period of at least 18 months were included. Materials with adhesive potential were categorized into 6 main classes: 3-step etch&rinse adhesives (3E&Ra's), 2-step etch&rinse adhesives (2E&Ra's), 2-step self-etch adhesives (2SEa's), 1-step self-etch adhesives (1SEa's), glass-ionomers (GI's) and self-adhesive composites (SAC's). The first four can bond restorative composite to tooth tissue. Both 2SEa and 1SEa were further sub-divided in 'mild' and 'intermediately strong (1/2SEa_m), with a pH≥1.5, and 'strong' (1/2SEa_s), with a pH<1.5. From the restoration retention rates as a function of time the average annual failure rate (AFR) per adhesive and adhesive class was calculated. RESULTS: The lowest AFR scores [mean (SD)] were recorded for GI [2.0 (1.4)] shortly followed by 2SEa_m [2.5 (1.5)], 3E&Ra [3.1 (2)] and 1SEa_m [3.6 (4.3)] (Tukey Contrasts: p>0.05). Significantly higher AFR scores were recorded for 1SEa_s [5.4 (4.8)], 2E&R [5.8 (4.9)], and 2SEa_s [8.4 (7.9)] (p>0.05). In addition, significant differences in AFR were noticed between adhesives of the same class (Kruskal-Wallis sum test: p>0.05), except for GI (p=0.7) and 2SEa_m (p=0.1). Finally, selective enamel etching did not significantly influence the retention rate of SEa (AFR SEa_etch=0.43 (0.49), AFR SEa_non-etch=1.43 (1.77). SIGNIFICANCE: The adhesive approach significantly influences the clinical effectiveness of adhesives in NCCLs. Within each class, except for GI, there was a wide variation in clinical bonding effectiveness.

The use of fMRI to detect neural responses to cognitive interference and planning: evidence for a contribution of task related changes in heart rate?

fMRI signals during rest are strongly correlated with heart rate variations. These heart rate/fMRI associations may influence the results of brain activation studies, particularly if heart rate is affected by the task. To assess the contribution of task-related heart rate changes on fMRI brain activation related to executive processing, we co-registered the electrocardiogram with fMRI in 91 subjects during an interference task (color-word Stroop) and during a planning task (Tower of London; ToL). We found that both Stroop interference and ToL planning significantly increased heart rate in the scanner and confirmed significant main effects of heart rate regressors on the fMRI signals. Nevertheless, statistical contrasts that test for increased fMRI during Stroop interference and ToL planning were not significantly influenced by inclusion of heart rate regressors. We conclude therefore that fMRI changes associated with heart rate changes do not impact strongly on higher-order fMRI effects in these commonly used executive function tasks, but routinely adding a correction seems prudent.

Meta-analysis of bonding effectiveness to zirconia ceramics.

Dental zirconia can no longer be considered un-bondable to tooth tissue. In literature, an increasing number of papers indeed report on the bonding effectiveness of different luting techniques to zirconia. We aimed to disclose general trends in bonding to zirconia by systematically collecting zirconia bond-strength data. A search in PubMed and EMBASE revealed 1,371 bond-strength tests reported on in 144 papers. A macro-shear bond-strength protocol was most frequently used; it revealed significantly lower bond strengths and was less discriminative than the other test methods. Regarding luting technique, the combination of mechanical and chemical pre-treatment appeared particularly crucial to obtain durable bonding to zirconia ceramics. The cement choice was not revealed as a determining factor after aging conditions, as long as composite cement was used. Regarding test protocol, a tensile test appeared more discriminative, particularly when combined with 'water storage' aging.

Effect of evaporation on the shelf life of a universal adhesive.

OBJECTIVES: The purpose of this study was to evaluate how evaporation affects the shelf life of a one-bottle universal adhesive. METHODS: Three different versions of Scotchbond Universal (SBU, 3M ESPE, Seefeld, Germany) were prepared using a weight-loss technique. SBU0 was left open to the air until maximal weight loss was obtained, whereas SBU50 was left open until 50% of evaporation occurred. In contrast, SBU100 was kept closed and was assumed to contain the maximum concentration of all ingredients. The degree of conversion (DC) was determined by using Fourier transform infrared spectroscopy on different substrates (on dentin or glass plate and mixed with dentin powder); ultimate microtensile strength and microtensile bond strength to dentin were measured as well. RESULTS: DC of the 100% solvent-containing adhesive (SBU100) was higher than that of the 50% (SBU50) and 0% (SBU0) solvent-containing adhesives for all substrates. DC of the adhesive applied onto glass and dehydrated dentin was higher than that applied onto dentin. Even though the ultimate microtensile strength of SBU0 was much higher than that of SBU50 and SBU100, its bond strength to dentin was significantly lower. CONCLUSIONS: Evaporation of adhesive ingredients may jeopardize the shelf life of a one-bottle universal system by reducing the degree of conversion and impairing bond strength. However, negative effects only became evident after more than 50% evaporation.

Changes in functional network centrality underlie cognitive dysfunction and physical disability in multiple sclerosis.

BACKGROUND: Cognitive dysfunction in multiple sclerosis (MS) has a large impact on the quality of life and is poorly understood. OBJECTIVE: The aim of this study was to investigate functional network integrity in MS, and relate this to cognitive dysfunction and physical disability. METHODS: Resting state fMRI scans were included of 128 MS patients and 50 controls. Eigenvector centrality mapping (ECM) was applied, a graph analysis technique that ranks the importance of brain regions based on their connectivity patterns. Significant ECM changes were related to physical disability and cognitive dysfunction. RESULTS: In MS patients, ECM values were increased in bilateral thalamus and posterior cingulate (PCC) areas, and decreased in sensorimotor and ventral stream areas. Sensorimotor ECM decreases were related to higher EDSS (rho = -0.24, p = 0.007), while ventral stream decreases were related to poorer average cognition (rho = 0.23, p = 0.009). The thalamus displayed increased connectivity to sensorimotor and ventral stream areas. CONCLUSION: In MS, areas in the ventral stream and sensorimotor cortex appear to become less central in the entire functional network of the brain, which is associated with clinico-cognitive dysfunction. The thalamus, however, displays increased connectivity with these areas. These findings may aid in further elucidating the function of functional reorganization processes in MS.

3-year clinical effectiveness of one-step adhesives in non-carious cervical lesions.

OBJECTIVES: Despite representing an important component of current dental adhesives, HEMA has been said to negatively influence the long-term stability of adhesion to dentine and enamel. The aim of this randomised clinical trial was to evaluate the 3-year clinical performance of two one-step self-etch adhesives. METHODS: Thirty patients had 175 non-carious cervical lesions restored with composite (Gradia Direct Anterior, GC) using either the HEMA-rich adhesive Clearfil Tri-S Bond (C3S; Kuraray) or the HEMA-free adhesive G-Bond (GB; GC). The restorations were evaluated by two examiners at baseline, 6, 12, 24 and 36 months regarding retention, caries recurrence, marginal integrity and discoloration and post-operative sensitivity. The data were statistically analysed with GEE and McNemar tests (p<0.05). RESULTS: The recall rate at 6 and 12 months was 100% and decreased to 96.7% at 24 and 36 months. At 3 years, the retention rate was 93.8% for C3S and 98.8% for GB (p=0.14). A pairwise comparison showed no significant differences between the two adhesives for all the parameters evaluated, irrespective of the recall (p>0.05). After 3 years, both adhesives presented an increase in the percentage of clinically acceptable marginal discoloration (C3S: 32.9% and GB: 26.8%) normally associated to clinically acceptable marginal defects (C3S: 35.8% and GB: 26.5%). Only 1 dentine margin of a GB restoration presented a severe marginal defect (1.2%) and 1 C3S restoration presented caries recurrence. The overall 3-year clinical success rate was 92.6% for C3S and 97.6% for GB (p=0.16). CONCLUSION: Both one-step self-etch adhesives presented an equally favourable clinical effectiveness at 3 years. CLINICAL SIGNIFICANCE: HEMA is a monomer frequently present in dental adhesives in order to increase their wettability and hydrophilicity. However, this monomer negatively influences hydrolytic stability and durability of the adhesive interface complex. In this 3-year clinical trial no significant difference in bonding effectiveness was noticed between a HEMA-rich and HEMA-free one-step adhesive.