CAD-CAM approach to designing and fabricating a low-maintenance metal-acrylic resin implant-supported fixed complete dental prosthesis: A clinical report.

The metal-acrylic resin implant-supported fixed complete dental prosthesis (IFCDP) is a reliable restorative option. However, clinical complications and laboratory fabrication concerns are associated with these restorations. Maintenance and repair lead to increased chair time, but recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) materials and technology can improve efficiency and mitigate complications. In this clinical report, the existing design principles and CAD-CAM materials were combined to fabricate a metal-acrylic resin IFCDP that minimized individual tooth fracture and facilitated efficient resurfacing of worn surfaces.

A CAD-CAM approach for designing and fabricating a periodontal prosthesis: A clinical report.

The periodontal prosthesis is a successful retrievable fixed restoration provided for patients with a periodontally involved dentition who lack alternative fixed options. However, its popularity has declined due to the introduction of dental implants, as well as the cost and complexity of fabrication. Nonetheless, this remains a viable option for patients who cannot undergo implant surgery. This clinical report describes the use of computer-aided design and computer-aided manufacturing (CAD-CAM) technology to streamline the fabrication of a periodontal prosthesis.

Recovery in the Severely Impaired Arm Post-Stroke After Mirror Therapy: A Randomized Controlled Study.

OBJECTIVE: This study aimed to examine the effectiveness of mirror therapy on recovery in the severely impaired arm after stroke. DESIGN: Using single-blind randomized controlled design, patients with severely impaired arm within 1-month post-stroke were assigned to receive mirror therapy (n = 20) or control therapy (n = 21), 30 mins twice daily for 4 wks in addition to conventional rehabilitation. During mirror therapy and control therapy, subjects practiced similar structured exercises in both arms, except that mirror reflection of the unaffected arm was the visual feedback for mirror therapy, but mirror was absent for control therapy so that subjects could watch both arms in exercise. Fugl-Meyer Assessment and Wolf Motor Function Test were the outcome measurements. RESULTS: After the intervention, both mirror therapy and control therapy groups had significant arm recovery similarly in Fugl-Meyer Assessment (P = 0.867), Wolf Motor Function Test-Time (P = 0.947) and Wolf Motor Function Test-Functional Ability Scale (P = 0.676). CONCLUSION: Mirror therapy or control therapy, which involved exercises concurrently for the paretic and unaffected arms during subacute stroke, promoted similar motor recovery in the severely impaired arm.

Single-unit implant-supported restoration adjacent to multiple lithium disilicate restorations, an approach to an esthetic challenge: A clinical report.

This clinical report describes a method for predictably shade matching a highly opaque yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) implant restoration adjacent to relatively translucent lithium disilicate veneers in the maxillary anterior region. To achieve a satisfactory outcome, the milled Y-TZP abutment was layered with low-fusing feldspathic porcelain to match the stump shade of the adjacent prepared teeth; this layer subsequently facilitated adhesive bonding of a veneer to the abutment before insertion.

Corticomotor Excitability Effects of Peripheral Nerve Electrical Stimulation to the Paretic Arm in Stroke.

OBJECTIVE: This study aimed to examine the corticomotor excitability changes after peripheral nerve electrical stimulation (PNS) on the stroke-impaired arm. DESIGN: This randomized cross-over study included 32 subjects with chronic stroke. They received a 1-hr PNS or placebo PNS by random order to the ulnar and radial nerves of the paretic arm in separate sessions. The primary outcome was excitability of the corticospinal projections for the contralateral first dorsal interosseous hand muscle in terms of slope of the recruitment curve, peak motor-evoked potential amplitude, and duration of the cortical silent period, measured with transcranial magnetic stimulation on both cerebral hemispheres. Seventeen of the subjects were measured for their paretic hand dexterity (using Purdue Pegboard Test) and pinch strength as secondary outcomes. RESULTS: Peripheral nerve electrical stimulation, but not placebo PNS, increased recruitment curve slope and peak motor-evoked potential amplitude in both the lesioned and nonlesioned hemispheres and lengthened the cortical silent period duration in the nonlesioned hemisphere. Peripheral nerve electrical stimulation significantly improved hand dexterity scores compared with placebo PNS. Pinch strength was not changed by the interventions. CONCLUSIONS: A 1-hr PNS alone to the paretic arm could increase corticomotor excitability in both hemispheres, together with hand dexterity improvement in people presented with mild-to-moderate motor impairment in the paretic upper limb after stroke. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the readers should be able to: (1) Understand the effects of a stroke on the corticomotor excitability of the lesioned and intact hemisphere; (2) Describe the effect of peripheral nerve electrical stimulation on the lesioned and intact hemisphere corticomotor excitability following stroke; and (3) Understand the effect of peripheral nerve electrical stimulation on dexterity of the paretic hand following stroke. LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

[Introduction of the development of the mo- bile smartphone application, "PWH easyGo" to help patients and visitors to navigate differ- ent departments and facilities on the hospital premises with ease].

"PWH easyGo" is a mobile smartphone application (app) designed to help patients and visitors to look for different departments and facilities on the hospital premises. Posters with QR code are displayed at various hospital entrances. Users with the app installed can scan the QR codes printed on posters on site or manually select their current locations and destinations in the app, and the system will display the relevant routes with photos. It is the first such app developed by the Hong Kong Hospital Authority and is available for download at Apple store (iOS version) and Play Store (Android version).

Transcranial direct current stimulation to primary motor area improves hand dexterity and selective attention in chronic stroke.

OBJECTIVE: The aim of this study was to determine whether transcranial direct current stimulation (tDCS) applied to the primary motor hand area modulates hand dexterity and selective attention after stroke. DESIGN: This study was a double-blind, placebo-controlled, randomized crossover trial involving subjects with chronic stroke. Ten stroke survivors with some pinch strength in the paretic hand received three different tDCS interventions assigned in random order in separate sessions-anodal tDCS targeting the primary motor area of the lesioned hemisphere (M1lesioned), cathodal tDCS applied to the contralateral hemisphere (M1nonlesioned), and sham tDCS-each for 20 mins. The primary outcome measures were Purdue pegboard test scores for hand dexterity and response time in the color-word Stroop test for selective attention. Pinch strength of the paretic hand was the secondary outcome. RESULTS: Cathodal tDCS to M1nonlesioned significantly improved affected hand dexterity (by 1.1 points on the Purdue pegboard unimanual test, P = 0.014) and selective attention (0.6 secs faster response time on the level 3 Stroop interference test for response inhibition, P = 0.017), but not pinch strength. The outcomes were not improved with anodal tDCS to M1lesioned or sham tDCS. CONCLUSIONS: Twenty minutes of cathodal tDCS to M1nonlesioned can promote both paretic hand dexterity and selective attention in people with chronic stroke.

Reliability of transcranial magnetic stimulation induced corticomotor excitability measurements for a hand muscle in healthy and chronic stroke subjects.

Transcranial magnetic stimulation (TMS) has been used to evaluate neuroplastic changes in the brain in clinical trials. The purpose of this study was to establish the test-retest reliability of 4 TMS measures of corticomotor excitability - (1) resting motor threshold, (2) slope of input-output curve, (3) peak motor evoked potential amplitude, and (4) cortical silent period duration for the corticospinal projections to the first dorsal interosseous of the contralateral hand. Fourteen healthy subjects (mean age 27.4 years) and 27 subjects with stroke-induced upper limb hemiparesis (mean age 61.3 years) completed 2 repeated sessions of assessment of 1 week apart. Good to excellent test-retest reliability of the TMS measurements was confirmed in the stroke subjects for both hemispheres with the ICC ≥ 0.88. Measurement reliability was good (ICC ≥ 0.75) for the 4 outcome measures in healthy subjects. Contrary to the similarity in standard error of measurements in both hemispheres for outcome measures (1) to (3) in the stroke subjects, that of the cortical silent period duration was larger in magnitude in the lesioned hemisphere. The test-retest reliability coefficients determined for the four corticomotor excitability measurements allowed the estimation of 95% minimal detectable changes of these outcome variables for the respective subject group in future clinical trials.

Design concepts of a removable partial dental prosthesis with implant-supported abutments.

A clinical report is presented that describes the restoration of a severe anterior maxillary ridge defect and pneumatized sinuses with a rotation-path partial removable dental prosthesis and implant-supported abutments. Other treatment options were considered and rejected based on patient preferences and limitations, which included avoiding invasive surgeries. The principles of integrating fixed and removable prosthesis design were applied. However, the clasp design was modified to take into account the direct bone-to-implant contact of the abutments. An esthetic and functional outcome was obtained without any overly invasive surgery.

Electrical acupoint stimulation of the affected arm in acute stroke: a placebo-controlled randomized clinical trial.

OBJECTIVES: To determine whether adding electrical stimulation of upper limb acupoints to conventional rehabilitation during acute stroke could produce greater and longer lasting motor improvements of the arm. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Acute stroke wards, followed by rehabilitation hospitals and subjects' residences. PARTICIPANTS: Seventy-three patients ≤ 46 hours post stroke onset with moderate to severe weakness in the arm contralateral to the side of stroke. INTERVENTION: All subjects received conventional rehabilitation. Twenty-nine received additional electrical stimulation, 21 received additional placebo-electrical stimulation and 23 received conventional rehabilitation only, as control. Electrical stimulation or placebo-electrical stimulation was applied to acupoints GB20, LI15, LI11, LI10 and LI4, 60 minutes a day, five days a week, for four weeks. MEASUREMENTS: Primary outcome measures were hand grip and pinch strength, with Action Research Arm Test (ARAT) as secondary outcome measure. These were assessed on the affected arm at recruitment, then 4 (W4), 12 (W12) and 24 weeks (W24) afterwards. RESULTS: Post-hoc analysis showed that the electrical stimulation group had greater improvements than the control group in hand grip (P = 0.015) and pinch strength (P = 0.007) at W4, with the gains maintained at W12 and W24. In contrast, the placebo-electrical stimulation group did not differ from either the control or the electrical stimulation group. Between-group improvements in ARAT scores from baseline to W24 (by 16.8 in control, 27.6 in placebo-electrical stimulation group and 26.3 in electrical stimulation group) were not significant. CONCLUSIONS: Adding four weeks of electrical stimulation during acute stroke appears to produce greater and longer lasting hand grip and pinch strength improvements than administering conventional rehabilitation alone.

Integrated sample cleanup and microchip capillary array electrophoresis for high-performance forensic STR profiling.

Microfluidics has the potential to significantly improve the speed, throughput, and cost performance of electrophoretic short tandem repeat (STR) analysis by translating the process into a miniaturized and integrated format. Current STR analysis bypasses the post-PCR sample cleanup step in order to save time and cost, resulting in poor injection efficiency, bias against larger loci, and delicate injection timing controls. Here we describe the operation of an integrated high-throughput sample cleanup and capillary array electrophoresis microsystem that employs a streptavidin capture gel chemistry coupled to a simple direct-injection geometry for simultaneously analyzing 12 STR samples in less than 30 min with >10-fold improved sensitivity.

Anther, pollen and tapetum development in safflower, Carthamus tinctorius L.

In safflower, the anther wall at maturity consists of a single epidermis, an endothecium, a middle layer and the tapetum. The tapetum consists mainly of a single layer of cells. However, this single-layer appearance is punctuated by loci having 'two-celled' groupings due to additional periclinal divisions in some tapetal cells. Meiotic division in microsporocytes gives rise to tetrads of microspores. The primexine is formed around the protoplasts of microspores while they are still enveloped within the callose wall. Just prior to microgametogenesis, the microspores enlarge through the process of vacuolation, and the exine wall pattern becomes established. Microgametogenesis results in the formation of 3-celled pollen grains. The two elongated sperm cells appear to be connected. The exine wall is highly sculptured with a distinct tectum, columellae, a foot layer, an endexine and a thin intine. Similar to other members of the Asteraceae family, the tapetum is of the invasive type. The most novel finding of this study is that in addition to the presence of invasive tapetal cells, a small population of 'non-invasive' tapetal cells is also present. The tapetal cells next to the anther locules in direct contact with the microspores become invasive and start to grow into the space between developing microspores. These tapetal cells synthesize tryphine and eventually degenerate at the time of gametogenesis releasing their content into the anther locules. A smaller population of non-invasive tapetal cells is formed as a result of periclinal divisions at the time of tapetum differentiation. These cells are not exposed to the anther locules until the degeneration of the invasive tapetal cells. The non-invasive tapetal cells have a different cell fate as they synthesize pollenkitt. This material is responsible for allowing some pollen grains to adhere to each other and to the anther wall after anther dehiscence. This observation explains the out-crossing ability of Carthamus species and varieties in nature.

Short-form Tai Chi improves standing balance of people with chronic stroke.

BACKGROUND AND OBJECTIVE: Our previous findings showed that 4 weeks of intensive Tai Chi practice improved standing balance in healthy seniors. This study set out to investigate whether Tai Chi could improve standing balance in subjects with chronic stroke. METHODS: One hundred thirty-six subjects >6 months after stroke were randomly assigned to a control group (n = 62) practicing general exercises or a Tai Chi group (n = 74) for 12 weeks of training. Each week, 1 hour of group practice was supplemented by 3 hours of self-practice. We used a short-form of Tai Chi consisting of 12 forms that require whole-body movements to be performed in a continuous sequence and demands concentration. A blinded assessor examined subjects at baseline, 6 weeks (mid-program), 12 weeks (end-program), and 18 weeks (follow-up). The 3 outcome measures were (1) dynamic standing balance evaluated by the center of gravity (COG) excursion during self-initiated body leaning in 4 directions, (2) standing equilibrium evaluated in sensory challenged conditions, and (3) functional mobility assessed by Timed-up-and-go score. Mixed model repeated-measures analysis of variance was used to examine between-group differences. RESULTS: When compared with the controls, the Tai Chi group showed greater COG excursion amplitude in leaning forward, backward, and toward the affected and nonaffected sides (P < .05), as well as faster reaction time in moving the COG toward the nonaffected side (P = .014) in the end-program and follow-up assessments. The Tai Chi group also demonstrated better reliance on vestibular integration for balance control at end-program (P = .038). However, neither group improved significantly in Timed-up-and-go scores. CONCLUSIONS: Twelve weeks of short-form Tai Chi produced specific standing balance improvements in people with chronic stroke that outlasted training for 6 weeks.

Integrated sample cleanup-capillary electrophoresis microchip for high-performance short tandem repeat genetic analysis.

An integrated PCR sample cleanup and preconcentration process is developed for forensic short tandem repeat (STR) analysis using a streptavidin-modified photopolymerized capture gel injector for microchip capillary electrophoresis (microCE). PCR samples generated with one biotinylated primer and one fluorescent primer provide the input to the streptavidin-based affinity capture-microCE device. Monoplex PCR samples processed by the device exhibited approximately 10- to 50-fold increased fluorescence intensities, and DNA profiles generated using 9-plex STR samples displayed approximately 14- to 19-fold higher signal intensities compared to those analyzed using traditional cross injection. Complete STR profiles were obtained with as few as 25 copies of DNA template using the capture-microCE device. Four DNA samples with various degrees of degradation were also tested. Samples analyzed using the capture-microCE device resulted in a significant increase of successful allele detection. The ability of our capture-microCE device and method to remove contaminating ions, to concentrate the sample injection plug, and to eliminate electrokinetic injection bias provides a powerful approach for integrating sample cleanup with DNA separation.

Predicting recovery of dextrous hand function in acute stroke.

PURPOSE: To determine the clinical characteristics during acute stroke that predicted dextrous function in the paretic hand at 6 months post-stroke. METHOD: Fifty-seven patients within 5 days post-stroke were recruited in stroke wards. Recovery of dextrous hand function, indicated by a score of > or =35 of Action Research Arm Test, was assessed weekly in the first 4 weeks then monthly till 6 months post-stroke. The seven predictor candidates evaluated included side and site of brain infarct, stroke severity, cognition, spatial neglect, two-point discrimination (2-PD), muscle tone and muscle strength of the paretic upper extremity (UE). RESULTS: Site of infarct, stroke severity, 2-PD and UE muscle strength had independent association with dextrous hand function at 6 months post-stroke. Stepwise multiple logistic regressions showed that the best early predictor was 2-PD in week 1 to 3 (Odds ratio [OR] ranged from 0.51-0.83) and UE muscle strength during the first 2 months post-stroke (OR > or = 1.04). The strongest predictor was muscle strength at week 4 post-stroke, followed by combined 2-PD and muscle strength at week 2 post-stroke. CONCLUSIONS: Muscle strength and 2-PD in the paretic UE during the first month post-stroke were the best predictors of dextrous hand function recovery at 6 months.

Real-time forensic DNA analysis at a crime scene using a portable microchip analyzer.

An integrated lab-on-a-chip system has been developed and successfully utilized for real-time forensic short tandem repeat (STR) analysis. The microdevice comprises a 160-nL polymerase chain reaction reactor with an on-chip heater and a temperature sensor for thermal cycling, microvalves for fluidic manipulation, a co-injector for sizing standard injection, and a 7-cm-long separation channel for capillary electrophoretic analysis. A 9-plex autosomal STR typing system consisting of amelogenin and eight combined DNA index system (CODIS) core STR loci has been constructed and optimized for this real-time human identification study. Reproducible STR profiles of control DNA samples are obtained in 2h and 30min with

A forensic laboratory tests the Berkeley microfabricated capillary array electrophoresis device.

Miniaturization of capillary electrophoresis onto a microchip for forensic short tandem repeat analysis is the initial step in the process of producing a fully integrated and automated analysis system. A prototype of the Berkeley microfabricated capillary array electrophoresis device was installed at the Virginia Department of Forensic Science for testing. Instrument performance was verified by PowerPlex 16 System profiling of single source, sensitivity series, mixture, and casework samples. Mock sexual assault samples were successfully analyzed using the PowerPlex Y System. Resolution was assessed using the TH01, CSF1PO, TPOX, and Amelogenin loci and demonstrated to be comparable with commercial systems along with the instrument precision. Successful replacement of the Hjerten capillary coating method with a dynamic coating polymer was performed. The accurate and rapid typing of forensic samples demonstrates the successful technology transfer of this device into a practitioner laboratory and its potential for advancing high-throughput forensic typing.

Rapid determination of monozygous twinning with a microfabricated capillary array electrophoresis genetic-analysis device.

BACKGROUND: Microfabricated genetic-analysis devices have great potential for delivering complex clinical diagnostic technology to the point of care. As a demonstration of the potential of these devices, we used a microfabricated capillary array electrophoresis (microCAE) instrument to rapidly characterize the familial and genotypic relationship of twins who had been assigned fraternal (dizygous) status at birth. METHODS: We extracted the genomic DNA from buccal samples collected from the twin sons, the parents, another sibling, and an unrelated control individual. We then carried out multiplex PCR amplification of sequences at 16 short tandem repeat loci commonly used in forensic identity testing. We simultaneously separated the amplicons from all of the individuals on a microCAE device and fluorescently detected the amplicons with single-base resolution in <30 min. RESULTS: The genotypic analysis confirmed the identical status of the twins and revealed, in conjunction with the medical data, that their twin status arose from the rarer dichorionic, diamniotic process. CONCLUSIONS: The ability to rapidly analyze complex genetic samples with microCAE devices demonstrates that this approach can help meet the growing need for rapid genetics-based diagnostics.

Fluorescence energy transfer-labeled primers for high-performance forensic DNA profiling.

A fluorescence energy transfer (ET) dye-labeled STR typing system (ET 16-plex) is developed for the markers used in the commercial STR typing kit PowerPlex 16, and its performance assessed using a 96-lane microfabricated capillary array electrophoresis (muCAE) system. The ET 16-plex amplicons displayed 1.6-9-fold higher fluorescence intensities compared to those produced using the single-dye (SD)-labeled multiplex kits. The ET multiplex delivered full STR profiles from 62.5 pg of DNA; half the input required for the SD kits while maintaining a similar heterozygote allele balance. This increased sensitivity should improve typing of poor-quality DNA samples by making minor or imbalanced alleles more readily detectable at the low copy number (LCN) threshold. The ET 16-plex also generated complete profiles with only 28 PCR cycles; this capability should improve LCN typing by reducing the amplification time and drop-in allele incidence. To confirm the practical advantages of ET-labeled primers, six previously problematic casework samples were tested and only the ET 16-plex kit was able to capture additional allele data. The successful development and demonstration of ET primers for higher sensitivity STR typing offers a simple solution to improving current commercial multiplex typing capability. The superior spectral properties and universal compatibility with any primer sequence provided by ET cassettes will make future multiplex construction more facile and straightforward. The pairing of ET cassette technology with the muCAE system illustrates not only an enhanced STR typing platform, but a significant step toward a higher-efficiency forensic laboratory enabled by better chemistry and microfluidics.

Rapid and high-throughput forensic short tandem repeat typing using a 96-lane microfabricated capillary array electrophoresis microdevice.

A 96-channel microfabricated capillary array electrophoresis (muCAE) device was evaluated for forensic short tandem repeat (STR) typing using PowerPlex 16 and AmpFlSTR Profiler Plus multiplex PCR systems. The high-throughput muCAE system produced high-speed <30-min parallel sample separations with single-base resolution. Forty-eight previously analyzed single-source samples were accurately typed, as confirmed on an ABI Prism 310 and/or the Hitachi FMBIO II. Minor alleles in 3:1 mixture samples containing female and male DNA were reliably typed as well. The instrument produced full profiles from sample DNA down to 0.17 ng, a threshold similar to that found for the ABI 310. Seventeen nonprobative samples from various evidentiary biological stains were also correctly typed. The successful application of the muCAE device to actual forensic STR typing samples is a significant step toward the development of a completely integrated STR analysis microdevice.