Bonding Effectiveness of Saliva-Contaminated Monolithic Zirconia Ceramics Using Different Decontamination Protocols.

Objective: This research study investigated the effect of new decontamination protocols on the bonding capacity of saliva-contaminated monolithic zirconia (MZ) ceramics cemented with two different monomer-containing self-adhesive resin cements. Materials and Methods: Standardized tooth preparations (4 mm. axial height) were performed for eighty human maxillary premolars under constant water cooling system. Eighty monolithic zirconia crowns (Whitepeaks Supreme Monolith) (n = 8/10 groups) were manufactured by CAD-CAM. Specimens were kept in the artificial saliva at pH = 7.3 for 1 minute at 37°C except control groups. The specimens have not been prealumina blasted and grouped according to cleaning methods and resin cements: control groups (C) (no saliva contamination + GPDM + 4-META (N) (CN) and 10-MDP (M) containing resin cement (CM), alumina blasted (AL) + GPDM + 4-META (ALN) and 10-MDP containing resin cement (ALM), zirconium oxide containing universal cleaning agent (IC) applied + GPDM + 4-META (N) (ICN) and 10-MDP containing resin cement (ICM), pumice (P) applied + GPDM + 4-META (PN) and 10-MDP containing resin cement (PM), and air-water spray (AW) applied + GPDM + 4-META (AWN) and 10-MDP containing resin cement (AWM)). Monobond Plus was applied to all surfaces for 40 seconds before cementation. The thermal cycle was applied at 5,000 cycles after cementation. The crowns were tested in tensile mode at a speed of 1 mm/min. The mode of failure was recorded. SEM examinations were carried out at different magnifications. Data were analyzed using rank-based Kruskal-Wallis and Mann-Whitney tests. Results: No significant differences were found between the surface treatments and between the two types of resin cements. Interaction effects between surface treatments and resin cements were found to be significant by two-way ANOVA analysis. ICM group resulted in significantly better bond strength results compared with CN. ICM was found to result in better bond strength results compared with PM. The combination of universal cleaning agent and 10-MDP containing resin cement had significantly the highest cementation bond strength values. The increasing order of mean tensile bond strength values of decontamination protocols was C < AW < P < AL < IC. The mean tensile bond strength of 10-MDP containing resin cement was slightly higher than GPDM + 4-META containing resin cement. Conclusions: Universal cleaning agents can be preferred as an efficient cleaning method with 10-MDP-containing cement after saliva contamination for better adhesive bond strength of 4 mm crown preparation height of monolithic zirconia ceramics.

Effects of hormone receptor status on patient clinic and survival in HER2 positive breast cancer.

BACKGROUND: In the current study, the effect of hormone receptor (HR) status on clinical and survival in early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer was investigated. METHODS: Two hundred ninety-one patients with HER2- positive were examined in two categories as HR-positive and HR-negative. RESULTS: Of these, 197 (68%) were HR-positive and 94 (32%) were HR-negative with a mean follow-up period of 68 ± 2.7 months. The groups were found to be similar in terms of age, menopausal status, comorbidity, pathologic type, stage, T stage, N stage, lymphovascular invasion, presence and percentage of intraductal component, multicentricity/focality and extracapsular invasion. Family history (P = 0.038), stage 2 tumor rate (P < 0.001), and perineural invasion (P = 0.005) were significantly higher in the HR-positive group. In the HR-negative group, mean Ki-67 value (P = 0.014), stage 3 tumor rate (P < 0.001), tumor necrosis (P = 0.004) and strong (3+) HER2 staining on immunohistochemical staining (P = 0.003) were higher. The incidence of relapse and metastasis, and the localization of metastasis were similar in both patient groups. The rate of locoregional relapse during the first 2 years was higher in the HR-negative patients than in the HR-positive patients (P = 0.023). Overall survival (OS) and disease-free survival (DFS) did not differ between the groups in univariate analysis. However, HR status was determined as an independent prognostic factor (HR: 2.11, 95% CI: 1.17-3.79; P = 0.012) for OS was not found to be significant for DFS in multivariate analysis. CONCLUSION: Both clinicopathologic features and OS outcomes of HR-negative patients were worse than those of HR-positive patients.

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy.

BACKGROUND: There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). METHODS: A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. RESULTS: The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. CONCLUSION: Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.

Effects of 16% Carbamide Peroxide Bleaching on the Surface Properties of Glazed Glassy Matrix Ceramics.

OBJECTIVE: To determine the influence of the home bleaching agent, Opalescence PF, on the surface roughness and microhardness of glazed glassy matrix CAD-CAM ceramics. Materials and Methods. The 28 sintered leucite- and lithium disilicate-reinforced ceramic specimens (IPS Empress CAD and IPS e.max CAD) were divided into control and bleached groups. The home bleaching agent was applied to specimens of bleached groups for 7 days. The surface roughness and microhardness of all specimens were measured. A scanning electron microscope was used to evaluate the surface properties. The data were statistically analyzed by two-way ANOVA. RESULTS: The control e.max CAD showed the lowest surface roughness values. For both Empress and e.max CAD, surface roughness was significantly higher for the bleached group (p < 0.05). No significant differences in microhardness were observed. CONCLUSIONS: According to our study, patients should be careful when using home bleaching agents because whitening agents can affect the mechanical properties of full ceramic restorations like e.max CAD and Empress CAD. Ceramic polishing may be required in clinical situations where ceramic restorations are accidentally exposed to bleaching gels.

The Effect of Cuff Size on Blood Pressure Measurement in Obese Surgical Patients: A Prospective Crossover Clinical Trial.

AIM: This study aimed to determine the effect of a cuff properly sized for mid-upper arm circumference on blood pressure measurement in obese surgical patients. METHOD: This prospective crossover clinical trial was conducted with 100 patients who had body mass index ≥30 kg/m2 and mid-upper arm circumference ≥27 cm and were admitted to the general surgery unit of a medical faculty hospital in Istanbul, Turkey between January 1, 2015, and December 31, 2015. Blood pressure of the patients was measured using a small-sized adult cuff and a cuff properly sized for mid-upper arm circumference. RESULTS: Among the patients, 39% were morbidly obese and 67% had mid-upper arm circumference between 35 and 44 cm. Systolic blood pressure of the patients with a small adult cuff was 20.78 mmHg higher than that obtained with a cuff properly sized for mid-upper arm circumference, and their diastolic blood pressure was 10.15 mmHg higher on average (p<0.001). Only 6% of those with systolic hypertension according to the small adult cuff readings were found to have hypertension according to the cuff properly sized for mid-upper arm circumference (p<0.001). CONCLUSION: The results showed that, in obese surgical patients, blood pressure is measured inaccurately and found to be falsely high when measurements are not performed using a cuff properly sized for mid-upper arm circumference.

Evaluation of Flexural Strength of Different Denture Base Materials Reinforced with Different Nanoparticles.

PURPOSE: To evaluate the effect of adding Al2 O3 , SiO2 , and TiO2 nanoparticles in ratios of 1, 3, and 5 wt% to different acrylic resins on flexural strength. MATERIALS AND METHODS: A total of 210 specimens were prepared in 30 groups (n = 7/group) (Control, 1% Al2 O3 , 3% Al2 O3 , 5% Al2 O3 , 1% SiO2 , 3% SiO2 , 5% SiO2 , 1% TiO2 , 3% TiO2 , 5% TiO2 ). The specimens were polished with 200-, 400-, and 600-grit abrasive paper to provide a standard surface before testing and then suspended in distilled water for 30 days. Flexural strength was measured via three-point bending tests. Subsequently, SEM analysis was performed for one specimen from each group. Homogeneity of data was assessed by Kolmogov-Smirnov test followed by two-way ANOVA and Tukey HSD tests (α = 0.05). RESULTS: There was a significant increase in the flexural strength of polymethylmethacrylate (PMMA) after addition of 1% nanoparticles in both heat-polymerized and autopolymerized acrylic resins (p ˂ 0.05). The flexural strength values of the groups to which Al2 O3 and TiO2 nanoparticles were added exceeded those of the group with SiO2 addition (p ˂ 0.05). The electron microscopy images revealed that the nanoparticles were more homogeneously dispersed in PMMA with higher flexural strength. CONCLUSIONS: The mechanical properties of PMMA can be improved by the addition of nanoparticles to PMMA; however, the flexural strength values of PMMA decrease with the addition of nanoparticles at higher percentages (3-5%). Hence, the ideal filler ratio corresponds to 1%.

Effect of Home Bleaching on the Translucency of CAD/CAM Systems.

PURPOSE: To evaluate the effect of a home bleaching agent (Opalescence PF) on the translucency of CAD/CAM ceramic systems. MATERIALS AND METHODS: The 28 sintered ceramic specimens (IPS Empress CAD and IPS e.max CAD; 15 mm long, 10 mm wide, 1 mm thick) were divided into two subgroups as control and bleaching groups (n = 7). Carbamide peroxide (CP), 16%, home bleaching agent was applied onto the surface of each specimen for 6 hours per day for 7 days. A spectrophotometer (VITA Easyshade Advance) was used to measure the CIE L* a* b* coordinates and the reflectance value (Y) of the specimens on white and black backgrounds. The translucency parameter (TP), contrast ratio (CR), and opalescence parameter (OP) of the specimens were calculated. The data were statistically analyzed using Kolmogorov-Smirnov, one-way ANOVA, Tukey's test, and Pearson's correlation. RESULTS: Statistically significant differences in the TP values after 16% CP bleaching treatment were observed (p ˂ 0.05); however, no significant differences were found in the OP and CR values after the surface treatment (p ˃ 0.05). CONCLUSIONS: According to our study, patients who have all-ceramic restorations in their mouths should be careful when using home bleaching agents, because whitening agents can affect the translucency of all-ceramic restorations such as e.max CAD and Empress CAD.

Bond strengths of brackets bonded to enamel surfaces conditioned with femtosecond and Er:YAG laser systems.

The aim of this study was to compare femtosecond and Er:YAG laser systems with regard to enamel demineralization and bracket bond strength. Human-extracted premolars were randomized to three groups (n = 17) depending on the conditioning treatment used for the buccal surfaces: 37 % orthophosphoric acid, Er:YAG laser etching (MSP mode 120 mJ, 10 Hz, 1.2 W), and femtosecond laser etching (0.4 W, 800 nm, 90 fs/pulse, 1 kHz). Metal brackets were bonded with Transbond XT to the conditioned surfaces and light cured for 20 s. The samples were thermocycled (5000 cycles, 5-55 °C) and subjected to shear bond strength (SBS) testing using a universal testing machine. Failure types were analyzed under an optical stereomicroscope and SEM. The adhesive remnant index (ARI) was evaluated to assess residual adhesive on the enamel surface. The results revealed no significant differences in SBS between the Er:YAG laser (7.2 ± 3.3 MPa) and acid etching groups (7.3 ± 2.7 MPa; p < 0.05), whereas a significant difference was observed between the femtosecond laser etching group (3.3 ± 1.2 MPa) and the other two groups (p < 0.01). ARI scores were significantly different among the three groups. The results of our study suggest that laser conditioning with an Er:YAG system results in successful etching, similar to that obtained with acid. The sole use of a femtosecond laser system may not provide an adequate bond strength at the bracket-enamel interface.

The association of clinicopathological features and survival in colorectal cancer patients with kras mutation status.

BACKGROUND: KRAS mutations have a significant role in the consecutive activation of RAS.RAF.MEK.ERK pathway in colorectal cancer.Approximately 30.35% of sporadic colorectal cancers have KRAS mutation. While the predictive role of KRAS is commonly accepted at the present time, its prognostic role and association with different clinical and histopathological properties are currently unclear and inconsistent. The intent of this study, has been to evaluate the associations between KRAS gene mutations and clinicopathological features and survival times in Turkish colorectal cancer patients. MATERIALS AND METHODS: In this study, the file records of 115 metastatic colorectal cancer patients who applied to the Department of Medical Oncology between 2000 and 2011 were monitored; data on clinicopathological features and survival times were collected. DNA.sequencing method with PCR amplification from archival paraffin blocks were used for KRAS mutation status analysis. The associations between KRAS mutation status and clinicopathological features and survival times were compared statistically. RESULTS: While a significant association hadbeen determined between KRAS mutation status and tumor localization, there was no determined significant association with other clinicopathological properties. Similarly, there was no association between KRAS mutation status and survival parameters. CONCLUSIONS: As a result, the effect of KRAS mutation status on clinicopathological features, survival time and prognosis is unclear.

Effect of Different Surface Treatments on the Bond Strength of Lithium Disilicate Ceramic to the Zirconia Core.

OBJECTIVE: The aim of this study was to evaluate the effect of different surface treatments [sandblasting, Erbium:Yttrium-Aluminium-Garnet (Er:YAG), and femtosecond lasers] on the shear bond strength (SBS) of the CAD-on technique. BACKGROUND DATA: Although demand for all-ceramic restorations has increased, chipping remains one of the major problems for zirconia-based restorations. MATERIALS AND METHODS: Forty yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) zirconia plates (IPS e.max ZirCAD, Ivoclar Vivadent) were cut, sintered (12.4 × 11.4 × 3 mm) and divided into four groups according to the surface treatments (n = 10): a control group with no surface treatment (Group C), sandblasting with 50 µm Al2O3 (Group S), Er:YAG laser irradiation (Group E), and femtosecond laser irradiation (Group F). Also, 40 cylindrical (5 mm diameter, 2 mm height) lithium disilicate (IPS e.max CAD) veneer ceramics were cut and fused to all zirconia cores by a glass-fusion ceramic and crystallized according to the CAD-on technique. Specimens were subjected to shear force using a universal testing machine. The load was applied at a crosshead speed of 0.5 mm/min until failure. Mean SBS (MPa) were analyzed with one way ANOVA (p < 0.05). The failed specimens were examined under a stereomicroscope at ×20 to classify the mode of failure. RESULTS: The highest SBS was observed in Group F (36 ± 3.31 MPa), followed by Group S (33.03 ± 5.05 MPa), and Group C (32.52 ± 10.15 MPa). The lowest SBS was observed in Group E (31.02 ± 4.96 MPa), but no significant differences were found between the control and surface treated groups (p = 0.377). All the specimens showed a mixed type of failure. CONCLUSIONS: Femtosecond laser application increased the bond strength between zirconia-veneer specimens. However, the novel CAD-on technique with no surface treatment also showed high bonding strength. Thus, this technique could prevent ceramic chipping without additional surface treatments.

A different wax sculpture technique for implant-retained auricular prosthesis.

Replacement of missing ears is a challenging task in which extensive array of materials and techniques have been employed. This article describes a different and simplified procedure for fabricating auricular prostheses very similar to the intact left ear of the patient. A 65-year-old male patient was referred to the Department of Prosthodontics with the loss of the right ear. In this case, the impression was made using hydrocolloid material (alginate) from the both defected and the opposite side. After hardening of the stone casts, a custom-made transparent splint plate was designed for the left auricular side. The splint was reversed and a cast model of the right auricular side was obtained as pouring the dental stone into transparent orthodontic splint. After getting the impression from cast model, conventional wax pattern and try on process was done. Finally, silicone elastomer was polymerized and the retention of the prosthesis acquired with the magnetic attachments. The technique described is economical, conventional, and time-saving. Furthermore, the prosthesis imitates the patient's intact auricular tissue.

Clinical Significance of HER2 Overexpression in Gastric and Gastroesophageal Junction Cancers.

BACKGROUND: In this study, we investigated the rate of human epidermal growth factor receptor 2 (HER2) overexpression in gastric (GC) and gastroesophageal junction cancers (GEJCs) and the relationship with HER2 expression and clinical, pathological parameters and prognosis. METHODS: Surgery or biopsy specimen of 598 (436 males, 162 females) patients with GC or GEJC was evaluated for the presence of HER2 overexpression by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) methods. RESULTS: HER2 IHC scores were as follows: 418 (69.9%) IHC 0, 58 (9.7%) IHC 1+, 50 (8.4%) IHC 2+, 72 (12%) IHC 3+. Among 50 patients with IHC 2+, 18 (38.2%) were FISH positive, and 29 (61.7%) were FISH negative for HER2 amplification. Patients were regarded as HER2 positive in case of IHC 3+ disease or IHC 2+ disease with a positive FISH test result for HER2 amplification. In the primary analysis population, 90 (15%) were considered HER2 positive. HER2 positivity was higher in intestinal GC compared to diffuse GC (16.9 vs 6.6%, p = 0.014). HER2 positivity was significantly higher in well and moderately differentiated tumors than poorly differentiated tumors (p < 0.0001). HER2 positivity had no significant effect on median OS (23.2 vs 19.1 months, p = 0.44). But in the early stages (stages I and II), median OS of HER2-positive patients was shorter than HER2-negative patients (51.4 months vs not reach, p = 0.047). However, median OS was similar in patients with advanced stages (stages III and IV) HER2-positive and HER2-negative disease (16.2 vs 13.7 months, p = 0.72). CONCLUSIONS: Rate of HER2 positivity is similar in Turkish patients with GC and GEJCs. HER2 positivity is associated with poor prognosis in patients with early-stage disease.

Cytotoxicity evaluation of luting resin cements on bovine dental pulp-derived cells (bDPCs) by real-time cell analysis.

To evaluate the cytotoxicity of resin cements on dental pulp-derived cells (bDPCs), Bifix QM (BQM), Choice 2(C2), RelyX U200(RU200), Maxcem Elite(ME), and Multilink Automix(MA) were tested. The materials were incubated in DMEM for 72 h. A real-time cell analyzer was used to evaluate cell survival. The statistical analyses used were one-way ANOVA and Tukey-Kramer tests. BQM, RU200, and ME demonstrated a significant decrease in the bDPCs' index at 24 and 72 h (p≤0.001). These materials were found to be the most toxic resin cements, as compared to the control and other tested materials (C2 and MA). However, C2 and MA showed a better survival rate, compared to BQM, RU200, and ME, and had lower cell index than the control group. The cytotoxic effects of resin cements on pulpa should be evaluated during the selection of proper cements.

Cytotoxicity of temporary cements on bovine dental pulp-derived cells (bDPCs) using realtime cell analysis.

PURPOSE: To evaluate the cytotoxicity of temporary luting cements on bovine dental pulp-derived cells (bDPCs). MATERIALS AND METHODS: Four different temporary cements were tested: Rely X Temp E (3M ESPE), Ultratemp (Ultradent), GC Fuji Temp (GC), and Rely X Temp NE (3M ESPE). The materials were prepared as discs and incubated in Dulbecco's modified eagle's culture medium (DMEM) for 72 hours according to ISO 10993-5. A real-time cell analyzer was used to determine cell vitality. After seeding 200 µL of the cell suspensions into the wells of a 96-well plate, the bDPCs were cured with bioactive components released by the test materials and observed every 15 minutes for 98 hours. One-way ANOVA and Tukey-Kramer tests were used to analyze the results of the proliferation experiments. RESULTS: All tested temporary cements showed significant decreases in the bDPCs index. Rely X Temp E, GC Fuji Temp, and Rely X Temp NE were severely toxic at both time points (24 and 72 hours) (P<.001). When the cells were exposed to media by Ultratemp, the cell viability was similar to that of the control at 24 hours (P>.05); however, the cell viability was significantly reduced at 72 hours (P<.001). Light and scanning electron microscopy examination confirmed these results. CONCLUSION: The cytotoxic effects of temporary cements on pulpal tissue should be evaluated when choosing cement for luting provisional restorations.

Evaluation of the marginal fit of full ceramic crowns by the microcomputed tomography (micro-CT) technique.

OBJECTIVE: To evaluate the marginal gap (MG) and absolute marginal discrepancy (MD) of full ceramic crowns with two finish line designs, shoulder and chamfer, using microcomputed tomography (micro-CT) before and after cementation. MATERIALS AND METHODS: Sixty extracted human maxillary premolar teeth were divided into two groups based on the finish line design: Group I: 90° shoulder and Group II: 135° chamfer. The specimens were further grouped based on the type of full ceramic crown they received: Group A: Feldspathic Cerec inLab ceramic system, Group B: Cerec inLab aluminum oxide ceramic system and Group C: Lithium disilicate press ceramic system. Before cementation, five crowns from each group were scanned using micro-CT in two sections, sagittal and coronal, to determine the MG and MD values for four regions of the crown (sagittal buccal, sagittal lingual, coronal mesial and coronal distal). After cementation and thermal cycling, the scanning was repeated. Measurements were obtained from 10 points for each region, 80 points totally, to evaluate the MG and MD values. Files were processed using NRecon and CTAn software. Results were statistically analyzed using one- and two-way ANOVA and Tukey HSD tests (P = 0.05). RESULTS: Full ceramic systems showed clinically acceptable marginal adaptation values. The Feldspathic Cerec inLab ceramic system generally presented the lowest variance, except in the MG values of the coronal mesial region. The MG and MD values of all ceramics increased significantly after cementation, except in the shoulder preparation design (sagittal buccal region) for MG and in the chamfer preparation design (sagittal lingual region) for MD values. CONCLUSIONS: Full-ceramic crowns showed clinically acceptable marginal adaptation values. The Feldspathic Cerec inLab ceramic system (Vitablocs Mark II) generally presented the lowest variance when compared with the other ceramics, except for the MG values on the mesial surface of the coronal section.

Mechanical properties of zirconia after different surface treatments and repeated firings.

PURPOSE: This study investigated the influence of surface conditioning procedures and repeated firings on monoclinic content and strength of zirconia before cementation. MATERIALS AND METHODS: Sintered bar-shaped zirconia specimens were subjected to no surface treatment (control), air abrasion, or grinding (n=21). Their roughness was evaluated using a profilometer, and microscope analysis was performed on one specimen of each group. Then, 2 or 10 repeated firings (n=10) were executed, the monoclinic content of specimens was analyzed by X-ray diffraction, and a three-point flexural strength test was performed. Surface roughness values were compared using one-way analysis of variance (ANOVA) and Tukey honestly significant difference (HSD) tests, the monoclinic content values were tested using Kruskal-Wallis and Mann-Whitney U tests, and the flexural strength values were tested using two-way ANOVA and Tukey HSD tests (P=.05). Spearman's correlation test was performed to define relationships among measured parameters. RESULTS: Surface-treated specimens were rougher than untreated specimens and had a higher monoclinic content (P<.005), and the relationship between roughness and monoclinic content was significant (P<.000). Neither surface treatment nor firing significantly affected the flexural strength, but Weibull analysis showed that for the air-abraded samples the characteristic strength was significantly lower after the 10(th) firing than after the 2(nd) firing. CONCLUSION: After firing, a negligible amount of monoclinic content remained on the zirconia surfaces, and rougher surfaces had higher monoclinic contents than untreated surfaces. Multiple firings could be performed if necessary, but the fracture probability could increase after multiple firings for rougher surfaces.

Long-term outcomes and prognostic factors of high-risk malignant melanoma patients after surgery and adjuvant high-dose interferon treatment: a single-center experience.

BACKGROUND: Surgical excision constitutes an important part of the treatment of local advanced malignant melanoma. Due to the high recurrence risk, adjuvant high-dose interferon therapy is still the only therapy used in stage IIB and III high-risk melanoma patients. METHODS: One hundred two high-risk malignant melanoma patients who received high-dose interferon-α-2b therapy were evaluated retrospectively. The clinicopathological features, survival times, and prognostic factors of the patients were determined. RESULTS: The median disease-free and overall survival times were 25.2 and 60.8 months, respectively. Our findings revealed that male gender, advanced disease stage, lymph node involvement, lymphatic invasion, the presence of ulceration, and a high Clark level were significant negative prognostic factors. CONCLUSION: In light of the favorable survival results obtained in this study, high-dose interferon treatment as adjuvant therapy for high-risk melanoma is still an efficient treatment and its possible side effects can be prevented by taking the necessary precautions.

Relationship between epidermal growth factor receptor gene mutations and clinicopathological features in patients with non-small cell lung cancer in western Turkey.

BACKGROUND: To investigate epidermal growth factor receptor (EGFR) gene mutations in patients with non- small cell lung cancer (NSCLC) and to analyze any relationship with clinicopathological features and prognosis. MATERIALS AND METHODS: EGFR gene exons 18-21 in 48 specimens of paraffin-embedded tumor tissue from NSCLC patients were amplified by PCR, followed by direct sequencing and analysis of links to clinicopathological features and prognosis. RESULTS: EGFR mutations were detected in 18 of 48 (42.6%) patients with NSCLC. There were 9 cases of mutations in exon 20, 7 in exon 19 and 2 in exon 21. Mutations were more frequently observed in women (5/7 pts, 71.4%) than in men (13/41 pts, 31.7%) (p=0.086) and in non-smokers (5/5 pts, 100%) than smokers (13/43 pts, 30.2%). There was negative correlation of EGFR mutations with smoking status (p=0.005). EGFR mutations were more frequently observed with adenocarcinoma histology (13/32 pts, 40.6%) than in other types (5/16 pts, 31.3%) (p=0.527). The patients with EGFR mutations had better survival than those with wild- type EGFR (p=0.08). There was no association of EGFR mutations with metastatic spread. CONCLUSIONS: EGFR mutations in NSCLC were here demonstrated more frequently in females, non-smokers and adenocarcinoma histology in the western region of Turkey. Patients with EGFR mutations have a better prognosis.

Intranasal midazolam may prevent gagging reflex: a case report.

BACKGROUND: Gagging can become a conditioned response that makes dental treatment difficult or impossible for both the individual and the dentist. The aim of this study is to report a 50 year old female and two children (15 and 11 years old) with exaggerated gag reflex referred to Faculty of Dentistry of Selçuk University. METHODS: During obtaining records, taking impression procedure was elicited the patients' hypersensitive gagging reflex. Therefore, it was decided to administer intranasal midazolam to facilitate the taking of accurate dental impressions. After given verbal information about the procedure, 2.5 mg intranasal midazolam (Demizolam, Dem Medikal, Istanbul) were applied incrementally in both nostrils. RESULTS: Five minutes later; patients had no gagging reflex and allowed the clinician to take satisfying impressions. No serious adverse effects were observed and the patients remained cooperative during the entire procedure which was completed to the full satisfaction of all involved. The short absorption time and the fast relief process of anaesthetics transferred to the systemic circulatory system are important advantages of nasal application. CONCLUSIONS: Intranasal midazolam may be very useful for the treatment of gag reflex probably effecting on the depression of upper airway reflex sensitivity.