Biomechanics of Central Incisor Endocrowns with Different Lengths and Milled Materials after Static and Vertical Loading: A Finite Element Study.

Purpose: The aim of this study was to compare and assess the stress distribution and failure possibility of endodontically treated central incisor protected with endocrowns with different heights, with various CAD-CAM blocks such as IPS e.max CAD, Katana Zirconia, and Zolid Fx Zirconia. Materials and Methods: A root canal-treated central incisor (plastic model) restored with an endocrown was scanned with a laser scanner to prepare a control model with a CAD software and then transferred to an FEA software. Proposed crown heights were 2, 4, and 6 mm. The model that was duplicated and restored with CAD-CAM blocks, IPS e.max CAD, Katana Zirconia, and Zolid Fx Zirconia were tested as endocrown materials. Bone geometry was simplified to be two coaxial cylinders in all models. Stress distributions under 50 N axial and oblique (with 135° angle from the vertical plane) loading were analyzed. Each model was then subjected to two occlusal loading conditions-the lingual slope of the incisal edge and the junction between incisal and middle thirds. Eighteen runs and calculations were performed to determine the endocrown height and material effect. Results: The results showed a minor or negligible effect of changing the endocrown material. Increasing endocrown height was shown to reduce stresses and deformations on most of the model components (bone, gutta-percha, periodontal ligament, and endocrown), except root and cement. Differences in deformations and stresses between the two models of 4 and 6 mm were relatively smaller (ranged between 1% and 30%) compared to those between the 2 and 4 mm models (ranged between 10% and 400%). Conclusions: The material used to fabricate endocrowns did not show considerable effect on the underlying structures. However, the endocrown design (2, 4, and 6 mm height) was shown to affect all components of the studied systems. Increasing endocrown height is recommended for bone, periodontal ligaments, and endocrown body, as it reduces stresses and deformations. On the other hand, it dramatically increases stresses on the root and cement layer. Smaller endocrown sizes represent an acceptable treatment option when there is a healthy periodontal state, while using larger sizes will be more suitable when there is a periodontal compromise with bone loss.

Comparison of Two Types of Preparation for Laminate Veneer with Three Types of All-Ceramic Materials.

OBJECTIVE: The objective of this study was to compare types of veneer preparations and their combination with three materials. MATERIALS AND METHODS: Two finite element models were specially prepared used representing window and wrap around preparation for veneers. The "central incisor" tooth geometry was acquired using a laser scanner, and then its surface was adjusted to form a solid model prior to the removal of each preparation separately. Three materials (Lava Ultimate, IPS e-max, and Celtra) were tested in combination with the preparation type. Bone geometry was simplified as two coaxial cylinders in all models. Each model was subjected to two loading conditions of occlusion (edge-to-edge bite and normal bite). STATISTICAL ANALYSIS AND RESULTS: It was observed that cortical, cancellous bone, and periodontal ligament are insensitive to preparation or materials. Their stresses and deformation were within physiological limits. Significant changes appeared on the central incisor tooth structure, cement layer, and veneer layer stresses and deformations under loading cases. CONCLUSIONS: Edge-to-edge bite stresses are severe with window-type preparation, and normal bite did not show any critical values on tooth structure, cement layer, or veneer layer. Veneer layer finish line and its contact with the cement layer and tooth structure play a role in the loading transfer mechanism. Preparation type alters the values of stresses on tooth structure, cement, and veneer layers. With window preparation, extreme stresses appear at finish line, while stresses appear under the loading site with wrap around preparation. Veneer and cement layers withstand the load energy with wrap around preparation and reduce tooth structure stresses. Thus, the lifetime of veneer and cement layers might be longer with window preparation.

Efficacy of Fiber Post Bonding To Root Dentin after Different Obturation Techniques and Cementation Timings: In Vitro Study.

OBJECTIVE: The aim of this in vitro study was to assess the effect of obturation technique and cementation timings on the bonding of fibre-reinforced posts to the root canal walls. METHODS: Twenty extracted teeth were randomly allocated to two groups according to the obturation technique and cementation timing. Central incisors with single canals were used after being decoronated. Every extracted tooth of the {vertical compaction group} (VC) group (n = 10) had been obturated using the {E & Q plus obturation system} with posts cemented in the same day; The other (CO) conventional group (n = 10) teeth were obturated using the conventional lateral compaction technique and posts cemented after one week. "SF" Fiber posts were used after bonding and cementation using Rely X ARC resin cement with all the endodontically treated teeth. The push-out test was performed in a universal testing machine. Data were analysed by 2 way analysis of variance with Statistical significance was set to 0.05. RESULTS: Heat softened gutta percha group showed more push out the bond strength of the bonded posts than the conventional obturation group (p < 0.05). In the middle region, there was no statistical significance between the two groups while there was significance in the coronal and apical thirds. CONCLUSION: The vertical compaction technique and early cementation improved the bond strength of the resin posts in comparison to the conventional obturation technique with late cementation.

Deletion of 8p is an independent prognostic parameter in prostate cancer.

Deletion of chromosome 8p is the second most frequent genomic alteration in prostate cancer. To better understand its clinical significance, 8p deletion was analyzed by fluorescence in-situ hybridization on a prostate cancer tissue microarray. 8p deletion was found in 2,581 of 7,017 cancers (36.8%), and was linked to unfavorable tumor phenotype. 8p deletion increased from 29.5% in 4,456 pT2 and 47.8% in 1,598 pT3a to 53.0% in 931 pT3b-pT4 cancers (P < 0,0001). Deletions of 8p were detected in 25.5% of 1,653 Gleason ≤ 3 + 3, 36.6% of 3,880 Gleason 3 + 4, 50.2% of 1,090 Gleason 4 + 3, and 51.1% of 354 Gleason ≥ 4 + 4 tumors (P < 0,0001). 8p deletions were strongly linked to biochemical recurrence (P < 0.0001) independently from established pre- and postoperative prognostic factors (P = 0.0100). However, analysis of morphologically defined subgroups revealed, that 8p deletion lacked prognostic significance in subgroups with very good (Gleason ≤ 3 + 3, 3 + 4 with ≤ 5% Gleason 4) or very poor prognosis (pT3b, Gleason ≥ 8, pN1). 8p deletions were markedly more frequent in cancers with (53.5%) than without PTEN deletions (36.4%; P < 0,0001) and were slightly more frequent in ERG-positive (40.9%) than in ERG-negative cancers (34.7%, P < 0.0001) due to the association with the ERG-associated PTEN deletion. Cancers with 8p/PTEN co-deletions had a strikingly worse prognosis than cancers with deletion of PTEN or 8p alone (P ≤ 0.0003). In summary, 8p deletion is an independent prognostic parameter in prostate cancer that may act synergistically with PTEN deletions. Even statistically independent prognostic biomarkers like 8p may have limited clinical impact in morphologically well defined high or low risk cancers.

Prevalence of chromosomal rearrangements involving non-ETS genes in prostate cancer.

Prostate cancer is characterized by structural rearrangements, most frequently including translocations between androgen-dependent genes and members of the ETS family of transcription factor like TMPRSS2:ERG. In a recent whole genome sequencing study we identified 140 gene fusions that were unrelated to ETS genes in 11 prostate cancers. The aim of the present study was to estimate the prevalence of non-ETS gene fusions. We randomly selected 27 of these rearrangements and analyzed them by fluorescence in situ hybridization (FISH) in a tissue microarray format containing 500 prostate cancers. Using break-apart FISH probes for one fusion partner each, we found rearrangements of 13 (48%) of the 27 analyzed genes in 300-400 analyzable cancers per gene. Recurrent breakage, often accompanied by partial deletion of the genes, was found for NCKAP5, SH3BGR and TTC3 in 3 (0.8%) tumors each, as well as for ARNTL2 and ENOX1 in 2 (0.5%) cancers each. One rearranged tumor sample was observed for each of VCL, ZNF578, IMMP2L, SLC16A12, PANK1, GPHN, LRP1 and ZHX2. Balanced rearrangements, indicating possible gene fusion, were found for ZNF578, SH3BGR, LPR12 and ZHX2 in individual cancers only. The results of the present study confirm that rearrangements involving non-ETS genes occur in prostate cancer, but demonstrate that they are highly individual and typically non-recurrent.

Clinical significance of different types of p53 gene alteration in surgically treated prostate cancer.

Despite a multitude of p53 immunohistochemistry (IHC) studies, data on the combined effect of nuclear p53 protein accumulation and TP53 genomic inactivation are lacking for prostate cancer. A tissue microarray including 11,152 prostate cancer samples was analyzed by p53 IHC and fluorescence in situ hybridization. Nuclear p53 accumulation was found in 10.1% of patients including 1.4% with high-level and 8.7% with low-level immunostaining. TP53 sequencing revealed that 17 of 22 (77%) cases with high-level p53 immunostaining, but only 3% (1 of 31) low-level p53 cases carried putative dominant-negative mutations. TP53 deletions occurred in 14.8% of cancers. Both deletions and protein accumulation were linked to unfavorable tumor phenotype and prostate specific antigen (PSA) recurrence (p<0.0001 each). The combination of both methods revealed subgroups with remarkable differences in their clinical course. Tumors with either TP53 deletion (14%) or low-level p53 positivity (8.7%) had identical risks of PSA recurrence, which were markedly higher than in cancers without p53 alterations (p<0.0001). Tumors with both p53 deletion and low-level p53 positivity (1.5%) had a worse prognosis than patients with only one of these alterations (p<0.0001). Tumors with strong p53 immunostaining or homozygous inactivation through deletion of one allele and disrupting translocation involving the second allele had the worst outcome, independent from clinical and pathological parameters. These data demonstrate a differential clinical impact of various TP53 alterations in prostate cancer. Strong p53 immunostaining-most likely accompanying dominant negative or oncogenic p53 mutation-has independent prognostic relevance and may thus represent a clinical useful molecular feature of prostate cancer.

A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt.

Inappropriate antibiotic use leads to increased risk of antibiotic resistance and other adverse outcomes. The objectives of the study were to determine the prevalence and characteristics of antibiotic use in Egyptian hospitals to identify opportunities for quality improvement. A point prevalence survey was conducted in 18 hospitals in March 2011. A total of 3408 patients were included and 59% received at least one antibiotic, with the most significant use among persons <12 years and intensive care unit patients (p < 0.05). Third generation cephalosporin were the most commonly prescribed antibiotics (28.7% of prescriptions). Reasons for antibiotic use included treatment of community-(27%) and healthcare-associated infections (11%) and surgical (39%) and medical (23%) prophylaxis. Among surgical prophylaxis recipients, only 28% of evaluable cases received the first dose within two hours before incision and only 25% of cases received surgical prophylaxis for <24 h. The prevalence of antibiotic use in Egyptian hospitals was high with obvious targets for antimicrobial stewardship activities including provision of antibiotic prescription guidelines and optimization of surgical and medical prophylaxis practices.

Integrative genomic analyses reveal an androgen-driven somatic alteration landscape in early-onset prostate cancer.

Early-onset prostate cancer (EO-PCA) represents the earliest clinical manifestation of prostate cancer. To compare the genomic alteration landscapes of EO-PCA with "classical" (elderly-onset) PCA, we performed deep sequencing-based genomics analyses in 11 tumors diagnosed at young age, and pursued comparative assessments with seven elderly-onset PCA genomes. Remarkable age-related differences in structural rearrangement (SR) formation became evident, suggesting distinct disease pathomechanisms. Whereas EO-PCAs harbored a prevalence of balanced SRs, with a specific abundance of androgen-regulated ETS gene fusions including TMPRSS2:ERG, elderly-onset PCAs displayed primarily non-androgen-associated SRs. Data from a validation cohort of > 10,000 patients showed age-dependent androgen receptor levels and a prevalence of SRs affecting androgen-regulated genes, further substantiating the activity of a characteristic "androgen-type" pathomechanism in EO-PCA.