Effect of Thickness and Translucency on Color Change and Masking Ability of Ceramic Materials used for Laminate Veneers.

This study evaluated the effect of the thickness and translucency of lithium disilicatebased glass ceramics on resin composite substrates on color change and masking effect. Laminate veneers were fabricated using IPS e.max CAD (A1) blocks with two different light transmittance values (High translucent [HT], Low translucent [LT]). Slices of two different thicknesses (0.3 mm, 0.5 mm) were obtained (n=10) and laminate veneers were cemented on the resin composite substrates of two different shades (A2, A3.5). The color change (ΔE values) was evaluated with the CIELab color system using a spectrophotometer, while the masking effect was calculated. The data were analyzed using independent-samples t-test and two-way analysis of variance. The ceramic thickness and translucency had a significant effect on final color and masking. When HT was used, and the laminate veneer thickness decreased (0.3 mm), the masking effect in ΔE values were lower (p⟨0.05). The ΔE values (⟩3.7) were clinically unacceptable. With the increase in thickness, translucency of porcelain laminate veneers decreases showing better color masking ability. Veneer thickness seems to be more effective on the restoration's masking ability than the shade of the substrate and translucency. Cinically, in case a 0.5-mm or thinner laminate veneer is planned, tooth color, resin cement and ceramic type should be considered.

Evaluation of fibrin, cyanoacrylate, and polyurethane-based tissue adhesives in sutureless vascular anastomosis: a comparative mechanical ex vivo study.

The stability of a microvascular anastomosis is an important prerequisite for successful tissue transfer. Advances in tissue adhesives are potentially opening new avenues for their use in sutureless microsurgical anastomosis, however they have not yet gained clinical acceptance. In this ex vivo study, a novel polyurethane-based adhesive (PA) was used in sutureless anastomoses and its stability compared with that of sutureless anastomoses performed with fibrin glue (FG) and a cyanoacrylate (CA). Stability was assessed using hydrostatic (15 per group) and mechanical tests (13 per group). A total of 84 chicken femoral arteries were used in this study. The time taken to create the PA and CA anastomoses was significantly faster when compared to the FG anastomoses (P < 0.001): 1.55 ± 0.14 min and 1.39 ± 0.06 min, respectively, compared to 2.03 ± 0.35 min. Both sustained significantly higher pressures (289.3 mmHg and 292.7 mmHg, respectively) than anastomoses using FG (137.3 mmHg) (P < 0.001). CA anastomoses (0.99 N; P < 0.001) and PA anastomoses (0.38 N; P = 0.009) could both withstand significantly higher longitudinal tensile forces compared to FG anastomoses (0.10 N). Considering the background of an in vitro study, the PA and CA anastomosis techniques were shown to be similar to each other and superior to FG, due to their stability and faster handling. These findings need to be validated and confirmed in further in vivo studies.

Biomechanical Properties and Biocompatibility of Implant-Supported Full Arch Fixed Prosthesis Substructural Materials.

OBJECTIVES: The purpose of this study was to investigate the fracture resistance, biocompatibility, hardness, and transverse strength of non-precious metal alloy (chromium-cobalt; Cr-Co), titanium (Ti), zirconia (Zr), polymethylmethacrylate (PMMA), and polyetheretherketone (PEEK) when employed as substructure materials according to the implant supported full arch fixed prosthesis treatment concept. MATERIALS AND METHODS: In total, 150 Cr-Co, Ti, Zr, PMMA, and PEEK samples (n = 30 per material) measuring 25 × 2 × 2 mm in size were produced. Of the samples, 50 (n = 10 for each material, all having dimensions of 6 × 3 mm) were subjected to biocompatibility tests. The Vickers hardness test and three-point bending test were performed; fracture resistance measurements were taken and the biocompatibility of the samples was evaluated by the XTT assay. RESULTS: Vickers hardness was highest for Zr (p < 0.05). PEEK and PMMA had the lowest (and similar) fracture resistance values (p < 0.05). Cell proliferation on the surfaces of the materials was similar between PEEK and Zr (p > 0.05), which were the most biocompatible materials. CONCLUSIONS: Within the limitations of this study, the most favorable materials in terms of biocompatibility were found as PEEK and Zr. When biomechanical properties are evaluated, the most durable materials can be specified as Cr-Co and Zr. Also, further studies are needed to improve material stability.

Changes in the temporomandibular joint position depending on the sagittal osteotomy technique and extent of mandibular movement.

The bilateral sagittal split osteotomy (BSSO) and high oblique sagittal split osteotomy (HSSO) are common techniques for mandibular movement in orthognathic surgery. The aim of this study was to evaluate the influence of both techniques, as well as movement distances and directions, on the position of the temporomandibular joint (TMJ). A total of 80 mandibular movements were performed on 20 fresh human cadaver heads, four on each head. Pre- and postoperative cone beam computed tomography was used to plan the surgical procedure and analyse the TMJ. Reference measurements included the anterior, superior, and posterior joint spaces, intercondylar distances and angles in the axial and coronal planes, and the sagittal, coronal, and axial angulations of the proximal segment. Only minor differences were found between the BSSO and HSSO techniques, particularly in terms of the intercondylar angle in the axial plane (P < 0.03) and the condylar angle of the proximal segment in the sagittal plane (P < 0.011). Observed changes in the TMJ were mostly opposite when moving the mandible forwards and backwards and increased with increasing movement distance. BSSO and HSSO result in similar changes in TMJ position. The extent of the movement distance influences the position of the condyle more than the osteotomy technique.

Traumatic Displacement of Maxillary Teeth into the Nasal Cavity: A Diagnosis Delayed for 15 Years

ABSTRACT Intrusion is defined as displacement of a tooth into the alveolar bone. In this report, we presented a patient with 15 years of delayed diagnosis of maxillary teeth intrusion into the nasal cavity. A 30-year-old male presented to our clinic with nasal discharge. He had been in a traffic accident 15 years ago. Radiographic examination revealed intrusion of two anterior teeth into the nasal cavity. In patients with maxillofacial trauma, the possibility of having an accompanying dentoalveolar trauma must always be kept in mind. While a computerized tomography (CT) scan is useful in diagnosis of such traumas, it must be performed in all patients with maxillofacial trauma to avoid misdiagnosis.

An Atypical Presentation of Tuberculosis Lymphadenitis

ABSTRACT Tuberculosis (TB), one of the oldest diseases of human, remains a global health problem especially in developing countries. Tuberculosis is classified as pulmonary or extrapulmonary. Tuberculosis lymphadenitis is the most common form of extrapulmonary TB. In this report, we present a patient with TB lymphadenitis who had atypical multiple lymph node involvement similar to malignancies without symptoms of lung disease. An 81-year-old male presented with a 3-month history of a growing swelling in the cervical region. In the month prior to presentation another swelling developed in the right axillary region. Physical examination revealed multiple lymphadenopathies in the cervical and axillary regions. A computerized tomography revealed lymphadenopathy at right axillary region 5 × 2 cm in diameter, a cystic mass or abscess at right posterior cervical region 3 × 2 cm in diameter and multiple lymphadenopathies in the cervical regions. Thoracic tomography revealed fibro-atelectasis, thick fibrotic bands and increased reticulonodular density in both lungs which were reported as reactivation of TB. An excisional biopsy was performed which revealed granulomatous inflammatory process with caseous necrosis. Acid-resistant bacteria were detected from microbiological assessment of both the pus of the mass and the nodular lesion via polymerase chain reaction. The diagnosis was reactivated TB lymphadenitis. Although multiple lymphadenopathies accompanied with weight loss suggest malignancies, TB must also be considered in the differential diagnosis.

Investigation of the barriers about insulin therapy in patients with type 2 diabetes.

AIMS: This study aimed to explore barriers regarding insulin initiation in patients with Type 2 diabetes and investigate the relationship of some demographic characters of patients. MATERIALS AND METHODS: A cross-sectional study was conducted with 142 patients with Type 2 diabetes whose doctors had recommended insulin therapy and who had been unwilling to comply. The participants were patients at an endocrine outpatient clinic in Kovancilar State Hospital in the rural area in Elazig, from November 2016 to May 2017. RESULTS: Half of the patients were illiterate, 60.6% of the participants were female, and the mean age was 57.33 ± 10.56. The most commonly reported barrier was injection-related anxiety (63.4%). In total, 58.5% of the patients refused insulin therapy because they felt it indicated that their disease had worsened and that they had failed at diabetes management. Female patients were 6.9 times more likely to think injection-related anxiety that affecting their decision about insulin therapy than male patients. Elderly patients were 8.2 times more likely to think of their disease worsened than younger patient. CONCLUSIONS: Patients' beliefs related to insulin therapy were very much influenced by their gender, educational status, and age. Giving patient-centered education is a cost-effective way to decrease negative health behaviors.

Effects of attachment type and palatal coverage on oral perception and patient satisfaction in maxillary implant-supported complete denture patients.

AIM: The effect of oral rehabilitation on the oral perception of implant-supported overdenture patients is a concern. This study evaluated the effects of the attachment type and palatal coverage on oral perception and patient satisfaction in maxillary implant-supported complete denture patients. SUBJECTS AND METHODS: The correlation between oral perceptual ability (OPA) and patient satisfaction in three groups was investigated. Group I consisted of dentate individuals (n = 40), Group II consisted of maxillary implant-supported complete denture patients with bar attachments and palatal coverage (n = 12), and Group III of maxillary implant-supported complete denture patients with magnetic attachments and palatal coverage (n = 14). In addition, implant-supported maxillary overdentures with bar attachments, with (Group II; n = 12) and without (Group IV; n = 18) palatal coverage, were examined in terms of patient satisfaction and OPA. The relationship between OPA and patient satisfaction was assessed with the Turkish version of the Oral Health Impact Profile-14 (OHIP-TR-14) satisfaction survey. To compare oral sensory function among the groups, tactile awareness and pressure awareness were assessed. RESULTS: There was no significant difference in OHIP-TR-14 scores between Groups II and III. In addition, there was no correlation between oral tactile function and patient satisfaction in Groups II and III. For patients with maxillary bar-retained implant-supported overdentures, palatal coverage did not affect the correlation between OPA and patient satisfaction, lateral pressure threshold, or tactile thickness threshold. CONCLUSION: According to the results of the study, whether maxillary implant-supported overdentures were made with a bar- or magnetic-type retainer, and whether bar-retained implant-supported overdentures had an open or closed palate did not affect the correlation between patient satisfaction and oral perception.

Factors Affecting Recurrence and Survival After Liver Transplantation for Hepatocellular Carcinoma.

INTRODUCTION: Liver transplantation (LT) remains the best treatment option for hepatocellular carcinoma (HCC). Patient selection is crucial and debated ever since the emerging of the Milan criteria in 1996. As live-donor LT is being more routinely performed worldwide, numerous new and/or expansions of the original criteria have been suggested to allow more patients to benefit from this superior treatment modality. This study aims to contribute to the ever-growing data in search for better coverage of patients with acceptable outcomes. METHODS: Medical recordings of 187 adult patients who underwent LT for HCC in a 6-year period were retrospectively collected. Patients were classified by Milan and University of California, San Francisco, criteria. Survival times as well as tumor, liver disease, and recurrence-related data were recorded for each patient and the outcomes were statistically analyzed. RESULTS: Factors significantly affecting recurrence and survival were histologic differentiation, number and the size of the tumor, and the presence of vascular invasion. Serum alpha-fetoprotein levels did not significantly affect outcomes. Among the patients exceeding both of the criteria, having a total tumor size of less than 160 mm was significantly associated with better outcomes (P = .007). CONCLUSION: HCC patients having tumors with vascular invasion, poor differentiation, exceeding 6 in number and 160 mm in total diameter demonstrate higher recurrence rates and worse outcomes.

The effects of aerobic exercise frequencies on liver fibrosis, α-fetoprotein and cytokeratin 19 in experimental type 2 diabetes-induced rats: an immunohistochemistry study.

We investigated using immunohistochemistry the effects of frequency of aerobic exercise on liver fibrosis and measured the expression of the oval cell marker, alpha fetoprotein (AFP), and the hepatocellular carcinoma marker, CK 19, in rats with early-period induced type 2 diabetes (T2DM). Rats were divided into four groups: control sedentary rats, diabetic sedentary rats, diabetic rats with continuous exercise (30 min/day, 5 days/week) and diabetic rats with short periods of exercise (3 x 10 min/day, 5 days/week). T2DM was induced using an intraperitoneal (i.p.) injection of nicotinamide (NA) and streptozotocin (STZ). Liver samples were obtained 8 weeks after injection. Tissue sections were stained with hematoxylin and eosin, periodic acid-Schiff and Masson's trichrome. We also used immunochemical staining for AFP, smooth muscle actin (α-SMA) and CK19. Continuous and short periods of aerobic exercise produced similar effects during the early period of liver damage in the STZ-NA model, i.e., decreased blood glucose levels and improved body weight, improved liver histology and reduced fibrosis, necrosis and steatosis; and reduced expression of AFP and α-SMA. Moderate aerobic exercise for 150 min/week appeared to reduce early liver damage in a rat model of T2DM.

The anti-inflammatory effects of erythromycin, clarithromycin, azithromycin and roxithromycin on histamine-induced otitis media with effusion in guinea pigs.

BACKGROUND: Otitis media with effusion is a clinical manifestation characterised by inflammation of middle-ear mucosa. This study investigated the therapeutic effect of erythromycin, clarithromycin, azithromycin and roxithromycin on a histamine-induced animal model of otitis media with effusion. METHODS: The animals were divided into five groups, receiving erythromycin, clarithromycin, azithromycin, roxithromycin or saline solution. The guinea pigs in the study groups received erythromycin (40 mg/kg/day), clarithromycin (15 mg/kg/day), azithromycin (10 mg/kg/day) or roxithromycin (10 mg/kg/day) for 3 days by gastric tube. Four hours after the end of the administration, histamine solution was injected into the right middle ear. RESULTS: The lowest neutrophil density value obtained using stereological techniques was in the azithromycin group (0.86 ± 0.25 × 10-5/µm3), while the highest value was observed in the control group (6.68 ± 3.12 × 10-5/µm3). The anti-inflammatory properties of clarithromycin, azithromycin and roxithromycin were similar to one another, but better than that of erythromycin. CONCLUSION: The use of macrolide antibiotics is recommended, as they show antibacterial and anti-inflammatory efficacy in otitis media with effusion.

Living-Donor Liver Transplantation for Budd-Chiari Syndrome: Case Series.

BACKGROUND: Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients. METHODS: Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed. RESULTS: Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient. CONCLUSIONS: Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors.

Parotid gland involvement as an initial presentation of papillary thyroid carcinoma.

Papillary thyroid carcinoma (PTC) is the most differentiated malignant thyroid neoplasm. Local metastases of PTC commonly occur in the regional lymph nodes, while distant metastases are mainly to the lung and bone. The case of a patient with PTC who presented with swelling of the parotid gland and neck, mimicking a primary parotid neoplasm, is presented herein. This case is unique due to the unexpected initial presentation of PTC with no signs of disease in the thyroid gland.

Large Cell Neuroendocrine Carcinoma of the Ovary and Its Skin Metastases: A Case Report and Review of the Literature.

Large cell neuroendocrine carcinoma in the gynaecological organs affects the uterine cervix and ovary. Large cell neuroendocrine carcinoma of the ovary is extremely rare, and prognosis is quite poor even when diagnosed at an early stage. These tumours respond poorly to standard chemotherapy regimens. The clinical observation of skin metastasis in patients with epithelial ovarian cancer is relatively uncommon, occurring in only 3.5% of patients. These lesions are observed mostly in skin of the abdominal wall adjacent to the primary ovarian tumours. Metastatic skin lesions on extremities are much more rare; it is reported that only 12% of epithelial ovarian carcinoma skin metastases occur on the limbs. Skin metastasis due to large cell neuroendocrine carcinoma of the ovary has not been previously reported. We report the case of a large cell neuroendocrine tumour of the ovary with skin metastases on extremities appearing two months after surgery in a 68-year old woman.

"Mustache sign" due to Stensen duct dilation.

An 80-year-old woman presented with a 5-year history of painless swellings of the left and right cheeks. The degree of swelling did not change with mastication. On palpation, the cheeks were soft, well defined, and movable. Compression and massage of the swollen areas caused increased salivary discharge from the orifices of the Stensen ducts. Three-dimensional computed tomography showed well-bordered, 15- to 20-mm wide, bilateral, tube-like dilatations of the ducts. The ductal origin of the swellings was explained to the patient, but she refused invasive procedures, thus no sialogram or surgical procedure was performed. We describe the clinical and radiographic features of a case of bilateral, congenital Stensen duct dilatation with bilateral swelling of the cheeks.

Lowering the dose in head CT using adaptive statistical iterative reconstruction.

BACKGROUND AND PURPOSE: While CT has found wide use in medical practice, it is also a substantial source of radiation exposure and is associated with an increased lifetime risk of cancer. There is an urgent need for new approaches to reduce the radiation dose in CT. In this regard, ASIR is an alternative method to FBP. We assessed the effect of ASIR on dose reduction in adult head CT. MATERIALS AND METHODS: We retrospectively evaluated a sample of 149 adult head CT examinations that were divided into 2 groups, STD and LD. We lowered the tube current and used ASIR in the LD group. SNR and CNR were analyzed. Dose parameters were recorded while subjective image noise, sharpness, diagnostic acceptability, and artifacts were graded. The Student t test, the Mann-Whitney U test, and κ statistics were used for statistical analyses. RESULTS: We achieved a dose reduction of 31% in the LD group (STD, 2.3 ± 0.1 mSv; LD, 1.6 ± 0.1 mSv; P < .001). There was no significant difference in the noise measured in the air between the 2 comparison groups (P = .273). Noise in the CSF was higher in the STD group (P < .001), while the noise in the WM was higher in the LD group (P < .001). Differences in the CNR between groups were insignificant, but the STD group displayed better SNR values. There was no significant difference in the modal scores of diagnostic acceptability (P = .062) and the artifacts (P = .148) between the 2 groups. Better scores for subjective image noise (P < .001) and sharpness (P = .04) were observed in the STD group. CONCLUSIONS: ASIR appears to be useful in reducing the dose in adult head CT examinations. While the effect of ASIR on noise reduction observed in the present study of head CT is less than that reported previously in abdomen and chest CT, these findings encourage further prospective studies in larger patient samples.