Evaluation of corneal staining with an antihistamine-releasing contact lens.

CLINICAL RELEVANCE: Practitioners can be reassured that this antihistamine-releasing contact lens has no additional effect on corneal epithelial integrity. BACKGROUND: To evaluate the effect of an antihistamine-releasing soft contact lens on corneal epithelium integrity when worn on a daily disposable modality for 12 weeks. METHODS: Two clinical trials using the same randomised, double-masked, placebo-controlled, parallel-group design enrolled healthy contact lens wearers. Participants wore either etafilcon A with 0.019 mg ketotifen (test; n = 374) or etafilcon A with no added drug (placebo; n = 186). Assessments were conducted at baseline, 1 week and 4, 8, and 12 weeks. Slit-lamp evaluations of corneal staining (using sodium fluorescein) in all regions of the corneas of both eyes were graded on a 0-4 scale. Data from all randomised participants were analysed. RESULTS: Corneal staining was infrequent and, where present, was mild (Grade 2) or trace (Grade 1). There were no Grade 3 or 4 findings of corneal staining. The overall proportion of findings of Grade 0 corneal staining was 95.86% with the test lens and 95.88% with the placebo lens. The odds of no staining were not statistically different between the test and placebo lenses (Odds Ratio: 0.96, 95% Confidence Intervals: 0.76 to 1.20). There were no serious ocular adverse events or signs of ocular surface medicamentosa. CONCLUSION: Both test and placebo lenses were well tolerated by subjects during the 3 months of wear. The antihistamine-releasing contact lens does not significantly impact corneal epithelial integrity.

Ameliorative effect of ozagrel, a thromboxane A2 synthase inhibitor, in hyperhomocysteinemia-induced experimental vascular cognitive impairment and dementia.

The present study investigates the effect of ozagrel, a selective thromboxane A2 (TXA2) inhibitor, in rat model of hyperhomocysteinemia (HHcy)-induced vascular cognitive impairment and dementia (VCID). Wistar rats were administered L-methionine (1.7 g/kg/day; p.o. × 8 weeks) to induce VCID. Morris water maze (MWM) test was employed to assess learning and memory. Endothelial dysfunction was assessed in the isolated aorta by observing endothelial-dependent vasorelaxation and levels of serum nitrite. Various biochemical and histopathological estimations were also performed. L-methionine produced significant impairment in endothelium-dependent vasorelaxation and decreases serum nitrite levels indicating endothelial dysfunction. Further, these animals performed poorly on MWM, depicting impairment of learning and memory. Further, a significant rise in brain oxidative stress level (indicated by increase in brain thiobarbituric acid-reactive species and decrease in reduced glutathione levels), brain acetylcholinesterase activity, brain myeloperoxidase activity, brain TNF-α and IL-6 levels, and brain leukocyte (neutrophil) infiltration was also observed. Treatment of ozagrel (10 and 20 mg/kg, p. o.)/donepezil (0.5 mg/kg, i.p., serving as standard) ameliorated L-methionine-induced endothelial dysfunction, memory deficits, and biochemical and histopathological changes. It may be concluded that ozagrel markedly improved endothelial dysfunction, learning and memory, and biochemical and histopathological alteration associated with L-methionine-induced VCID and that TXA2 can be considered as an important therapeutic target for the management of VCID.

Budlein A methylacrylate demonstrates potent activity against triple-negative breast cancer by targeting IκBα kinase and exportin-1.

Triple-negative breast cancer (TNBC) remains the most challenging breast cancer subtype to treat because there are no targeted therapies. Currently, chemotherapy is the only clinical option for TNBC despite development of resistance. New therapeutic agents with unique mechanisms of action are urgently needed; therefore, this study investigated the potential anti-TNBC effects of budlein A methylacrylate (BAM), a natural sesquiterpene lactone isolated from plants of the Helianthus genus. We discovered that BAM selectively suppressed and induced apoptosis TNBC cell growth versus other breast cancer or normal mammary epithelial cells. Mechanistically, BAM co-inhibited inhibitor of nuclear factor κBα (IκBα) kinase subunit ß (IKKß) and exportin-1 (XPO-1; chromosome region maintenance 1, CRM1), which are two dysregulated onco-related proteins in TNBC cells, by covalently modifying key functional cysteine residues (Cys179 of IKKß, Cys528 of XPO-1). Dual inhibition led to the stabilization and nuclear retention of IκBα, impairment of NF-κB transcriptional activity, and consequent induction of TNBC cell apoptosis. In conclusion, this study provides evidence that co-inhibition of IKKß and XPO-1 by BAM was effective against TNBC, demonstrating it as a representative new generation inhibitor with potential for TNBC treatment.

Dimethylaminododecyl methacrylate inhibits Candida albicans and oropharyngeal candidiasis in a pH-dependent manner.

The prevalence of stomatitis, especially that caused by Candida albicans, has highlighted the need for new antifungal agents. We previously found that a type of quaternary ammonium salts, dimethylaminododecyl methacrylate (DMADDM), incorporated in dental materials inhibited the growth and hyphal development of C. albicans. However, how the quaternary ammonium salts inhibited the fungal pathogens and whether the oral condition, such as salivary pH variation under different diseases, can affect the antimicrobial capacity of quaternary ammonium salts is unknown. This study evaluated the antifungal effects of DMADDM at different pH in vitro and in vivo. A pH-dependent antifungal effect of DMADDM was observed in planktonic and biofilm growth. DMADDM enhanced antifungal activity at alkaline pH. Two pH-regulated genes (PHR1/PHR2) of C. albicans were correlated with the pH-dependent antifungal effects of DMADDM. The PHR1/PHR2 genes and pH values regulated the zeta potential of C. albicans, which then influenced the binding between C. albicans cells and DMADDM. The pH-dependent antifungal activity of DMADDM was then substantiated in a murine oropharyngeal candidiasis model. We directly demonstrated that the antifungal abilities of quaternary ammonium salts relied on the cell zeta potential which affected the binding between fungal cells and quaternary ammonium salts. These findings suggest a new antifungal mechanism of quaternary ammonium under different pH and that DMADDM can be a potential antifungal agent applied in dental materials and stomatitis therapy.Key Points • DMADDM has stronger antifungal activity in alkaline than in acidic pH conditions. • The pH values and pH-regulated genes can affect the zeta potential of fungal cells. • Zeta potential of fungal cells directly affect the binding between DMADDM and cells. Graphical abstract Schematic diagram of the antifungal activities of DMADDM at different pH values.

Ozagrel for Postoperative Management of Aneurysmal Subarachnoid Hemorrhages.

BACKGROUND: A number of pharmacological agents have been tried to circumvent the problem of delayed cerebral ischemia (DCI) with ozagrel sodium being one such agent aimed at the prevention of DCI. Ozagrel is an inhibitor of thromboxane synthetase. It has anti-platelet aggregation action and it dilates vessels. Ozagrel was not available outside Japan till recently. It is available now in India and we had the opportunity to use it among patients with aneurysmal subarachnoid hemorrhage (SAH). AIMS: To analyse the results of ozagrel administration for patients with aneurysmal SAH. SETTINGS AND DESIGN: Tertiary care neurosurgical center. MATERIALS AND METHODS: Retrospective analysis of the outcomes of patients who received ozagrel after microsurgical cllipping of aneurysm and comparison with a control grpup who received treatment as usual. STATISTICAL ANALYSIS: The t-test (two-tailed), Chi-square test, and Mann-Whitney U-test asymptomatic significance (two-tailed), were used respectively for continuous, categorical, and ordinal variables. The significance was determined at P = 0.05 level. RESULTS: A total of 106 patients underwent surgical clipping of their ruptured intracranial aneurysms over a period of 22 months. Forty two (39.6%) patients received ozagrel, and 62 (60.4%) received the standard treatment. Ozagrel was started at a median of one [interquartile range (IQR) 0.75] day after the surgery, and was given for a median of five (IQR 5) days after the surgery. There was no difference in age, postictal days, World Federation Neurosurgical Society grade, Fisher grade, and the size of ruptured aneurysm in patients who received ozagrel compared to the patients who did not receive ozagrel. Of the 42 patients who received ozagrel, 30 patients (71.4%) had preoperative angiographic vasospasm which improved after the administration of ozagrel. Fifteen (35.5%) patients who received ozagrel developed delayed cerebral ischemia compared to only 11 (17.2%) patients who did not receive ozagrel. Thirty-six (85.7%) patients who received ozagrel had favorable outcome at discharge compared to 52 (81.3%) patients who did not receive ozagrel. No adverse event was observed with ozagrel therapy. At 3-month follow-up, 37 patients (88.1%) who received ozagrel had favorable outcomes against 53 patients (82.8%) who did not receive ozagrel. CONCLUSION: Ozagrel may be a useful drug in the armamentarium to treat vasospasm after aneurysmal SAH. A future multicenter large cohort study may validate the findings of our study.

Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL - a randomized controlled clinical trial.

OBJECTIVE: The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs). MATERIAL AND METHODS: Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05). RESULTS: The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention. CONCLUSION: GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.

Successful treatment of vertical root fracture through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin.

BACKGROUND/PURPOSE: Vertical root fracture (VRF) is a complication in endodontically treated teeth. This study aimed to assess the clinical outcomes of treatment of 6 VRF teeth with intentional replantation and root fragment bonding with 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin. METHODS: A series of 6 complete VRF teeth (one incisor, one canine, one premolar, and 3 M) were treated through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin. RESULTS: This study included 6 VRF teeth in 6 patients (one man and 5 women; mean age, 44 ± 8 years). All 6 teeth had VRF in the bucco-lingual direction and one tooth had concomitant VRF in the mesio-distal direction. The root thickness was classified as thick in all 6 teeth. Of the 6 VRF teeth, 4 had biting, percussion, or palpation pain, 4 had gingival swelling, 3 had sinus tracts, 3 had discomfort, and one had tooth mobility. Radiographically, 5 of the 6 teeth had periradicular radiolucent lesions, 4 of which exhibited complete regression and one of which exhibited nearly complete regression after root fragment bonding therapy. Because all 6 treated teeth exhibited sound function in the oral cavity after a follow-up period ranging from 33 to 74 (mean, 50 ± 15) months, the clinical outcomes were all considered to be successful. CONCLUSION: For a VRF tooth, in addition to tooth extraction, intentional replantation combined with root fragment bonding with 4-META/MMA-TBB resin is a successful treatment modality that can be used to preserve a complete VRF tooth.

The effect of adipose-derived stem cells on enthesis healing after repair of acute and chronic massive rotator cuff tears in rats.

BACKGROUND: Chronic massive rotator cuff tears heal poorly and often retear. This study investigated the effect of adipose-derived stem cells (ADSCs) and transforming growth factor-ß3 (TGF-ß3) delivered in 1 of 2 hydrogels (fibrin or gelatin methacrylate [GelMA]) on enthesis healing after repair of acute or chronic massive rotator cuff tears in rats. METHODS: Adult male Lewis rats underwent bilateral transection of the supraspinatus and infraspinatus tendons with intramuscular injection of botulinum toxin A (n = 48 rats). After 8 weeks, animals received 1 of 8 interventions (n = 12 shoulders/group): (1) no repair, (2) repair only, or repair augmented with (3) fibrin, (4) GelMA, (5) fibrin + ADSCs, (6) GelMA + ADSCs, (7) fibrin + ADSCs + TGF-ß3, or (8) GelMA + ADSCs + TGF-ß3. An equal number of animals underwent acute tendon transection and immediate application of 1 of 8 interventions. Enthesis healing was evaluated 4 weeks after the repair by microcomputed tomography, histology, and mechanical testing. RESULTS: Increased bone loss and reduced structural properties were seen in chronic compared with acute tears. Bone mineral density of the proximal humerus was higher in repairs of chronic tears augmented with fibrin + ADSCs and GelMA + ADSCs than in unrepaired chronic tears. Similar improvement was not seen in acute tears. No intervention enhanced histologic appearance or structural properties in acute or chronic tears. CONCLUSIONS: Surgical repair augmented with ADSCs may provide more benefit in chronic tears compared with acute tears, although there was no added benefit to supplementing ADSCs with TGF-ß3.

Effect of MDP-Based Silane and Different Surface Conditioner Methods on Bonding of Resin Cements to Zirconium Framework.

PURPOSE: To determine the shear bond strength (SBS) between zirconium framework and resin cements after different surface conditioner methods and after application of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) based silane and a bonding agent mix. MATERIALS AND METHODS: 128 disc-shaped zirconium-oxide specimens were prepared. Specimens were placed in autopolymerizing acrylic resin. The bonding surface of specimens was smoothed consecutively with 600-, 800-, and 1200-grit silicon carbide papers under water cooling. Eight groups were prepared: CJ, Co-Jet; N, Nd-YAG laser; E, Er-YAG laser; NS, Nd-YAG laser + silane; ES, Er-YAG laser + silane; CJB, Co-Jet + bonding agent; NSB, Nd-YAG laser + silane + bonding agent; ESB, Er-YAG laser + silane + bonding agent. SEM analysis was performed under 2000× magnification. Dual- and self-cured resin cements were bonded to specimens, and shear force was applied. Data were analyzed with one-way ANOVA and Tukey's multiple comparison test (p < 0.05). RESULTS: The SBS values differed from each other among the groups. While the CJB group showed the highest values, the N group showed the lowest. The treatment with MDP-based silane and bonding agent mix increased SBS values of each cement belonging to each group. SB values of dual-cure resin cement were higher than those of self-cure resin cements. CONCLUSION: Different surface conditioner methods exhibit an important effect on the SBS of resin cements to zirconium. The application of MDP-based silane and bonding agent mix enhanced SB values.

Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL - a randomized controlled clinical trial

Abstract Objective The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs). Material and Methods Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05). Results The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention. Conclusion GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.

Chemical Interaction and Interface Analysis of Self-Etch Adhesives Containing 10-MDP and Methacrylamide With the Dentin in Noncarious Cervical Lesions.

OBJECTIVES: To characterize the chemical interactions and analyze the interface of adhesive systems containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and N-methacryloyl glycine (methacrylamide) functional monomers with the dentin in noncarious cervical lesions (NCCLs) compared with artificial defects (ADs). METHODS AND MATERIALS: Twenty human teeth with natural NCCLs on the buccal surface were used. Class V cavities, similar to NCCLs, were created on the lingual surface to serve as controls. Teeth were randomly allocated to two groups according to the functional monomer in the adhesive (N=10): G1, 10-MDP; and G2, methacrylamide. NCCLs and ADs were characterized by their mineral composition (MC) and degree of demineralization (DD) using micro-Raman spectroscopy, adhesive/dentin chemical interactions (CIs) were assessed with infrared photoacoustic spectroscopy, and interface morphology was evaluated with scanning electron and light microscopy. MC, CI, and DD data were submitted to Shapiro-Wilk and Student t-tests ( p<0.05). RESULTS: Compared with ADs, dentin in NCCLs was hypermineralized ( p<0.05). In G1, CI, and DD in the first 2 µm, and adhesive projections in NCCLs and ADs interfaces were similar. Additionally, a thin layer of dentin collagen was observed in ADs, while it was hardly present in NCCLs. In G2, although CI could not be identified, changes in the mineral components were observed. The DD in the ADs and NCCLs were statistically similar, while SEM showed a lack of adhesion at NCCLs interface. DD and collagen exposure in the ADs and NCCLs were more pronounced than in G1. CONCLUSIONS: Results suggest that the G1 adhesive could be applied directly on the superficial sclerotic layer in NCCLs. In contrast, previous cavity preparation should be conducted to improve the micromechanical interaction of G2 with the dentin.

Novel Technique for Improving Graft Unfolding in Vitrectomized Eyes Using a Temporary Diaphragm in Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To describe a new surgical technique for performing Descemet membrane endothelial keratoplasty (DMEK) using a temporary hydrophilic methacrylate sheet in the anterior chamber in cases of previous vitrectomy with complete removal of the vitreous body. METHODS: Medical records were reviewed for baseline and follow-up best spectacle-corrected visual acuity, endothelial cell count, and indication for DMEK using a temporary hydrophilic methacrylate sheet. Operative notes were analyzed in all cases to identify any specific intraoperative event. RESULTS: Seven eyes of 7 patients were included in this analysis. Mean age was 65.7 ± 18.2 years, and the mean follow-up duration was 11.5 months. All 7 patients had previously received pars plana vitrectomy with complete vitreous removal. All patients were pseudophakic. For 5 patients, it was their first DMEK surgery and 2 patients had DMEK surgery for a second time, due to a failed outcome in previous surgery. Best spectacle-corrected visual acuity improved from 1.5 ± 0.5 logMAR before surgery to 0.76 ± 0.37 logMAR after surgery during follow-up (P < 0.001). The mean endothelial cell count was 2442 ± 304 cells/mm and decreased to 1484 ± 279 cells/mm during follow-up (P < 0.001). No complications were observed in any of the cases at the unfolding stage using this method. All grafts remained clear at the last follow-up visit. CONCLUSIONS: This modified approach of DMEK surgery, using a temporary hydrophilic methacrylate sheet for flattening the anterior chamber and facilitating graft unfolding, could help overcome possible complications of DMEK in completely vitrectomized eyes.

Comparison of Cuspal Deflection and Microleakage of Premolar Teeth restored with Three Restorative Materials.

AIM: This study aimed to assess cuspal deflection and micro-leakage of mesio-occluso-distal (MOD) cavities in premolar teeth restored with three different tooth-colored restorative materials to determine the effect of polymerization shrinkage stress over time. MATERIALS AND METHODS: The MOD cavities (4 mm depth) were prepared in 30 sound human maxillary premolars. The teeth were randomly divided into three groups (n = 10). The teeth were then restored with Filtek P60 (group I), X-tra fil (group II), and Admira Fusion x-tra (group III). Cuspal deflection was assessed after 5 minutes, 24 hours, 48 hours, and 7 days by measuring the intercuspal distance. After restoring the teeth, they were subjected to 1,000 thermal cycles and were then immersed in 2% methylene blue for 24 hours. After vertical section of teeth, they were observed under a stereomicroscope to assess micro-leakage. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey's honest significant difference (HSD) post hoc test. Friedman test was used to compare different time points in each group and nonparametric Mann-Whitney test was applied to assess microleakage (a < 0.05). RESULTS: The mean cuspal deflection was significantly different in the three groups (p < 0.001). The highest deflection was noted in Filtek P60 (14.8 ± 1.9) and the lowest was noted in Admira Fusion x-tra (7.4 ± 1.4 µm). Cuspal deflection significantly decreased after 7 days, but did not return to the baseline value. Admira Fusion x-tra showed significantly less deflection after 7 days (p < 0.001), but the other two groups were the same (p = 0.3). Microleakage was not significantly different among the three groups (p > 0.05). CONCLUSION: The lowest cuspal deflection was noted in Admira Fusion x-tra, although marginal microleakage was not significantly different among the groups. CLINICAL SIGNIFICANCE: As the lowest cusp deflection was noted in Admira Fusion x-tra, this restorative material can be suitable for esthetic restoration of extensive posterior cavities.

Effect of Surface Sealant Reapplication on Clinical Performance of HEMA-containing and HEMA-free Self-etch Adhesives: Two-year Results.

PURPOSE: To evaluate the clinical performance of one-step self-etch adhesives over two years with and without the application of a surface sealant. METHODS AND MATERIALS: In total, 160 restorations in 40 patients were performed for occlusal caries. Each patient received four Class I restorations, which included a 2-hydroxyethyl methacrylate (HEMA)-containing (Clearfil S3 Bond) and HEMA-free (G-aenial Bond) one-step self-etch adhesive system with and without surface sealant. Half of the restored teeth received Fortify Plus (Bisco) surface sealant material, and the other half were polished with Sof-Lex discs only. Two experienced calibrated examiners clinically evaluated the restorations at baseline and at one- and two-year recalls according to the modified US Public Health Service criteria. The filled surface sealant material was reapplied at each evaluation period. RESULTS: After two years, none of the restorations had failed. There were no significant differences between the two dentin adhesives with or without a surface sealant application among the evaluation periods. Each dentin adhesive with and without surface sealant showed significant changes from the clinically ideal (Alfa) to clinically acceptable (Bravo) with regard to marginal discoloration, marginal adaptation, and surface texture. Sealed restorations exhibited lower ideal restoration rates with regard to color matching and surface texture and higher ideal restoration rates with respect to marginal adaptation compared with unsealed restorations. In addition, the surface sealant application reduced the marginal discoloration of the HEMA-free one-step self-etch adhesive. CONCLUSIONS: The two-year success rates of HEMA-containing and HEMA-free self-etch adhesives with and without surface sealing application were excellent. Although the surface sealant application was not effective with regard to changes in color matching and surface texture, it improved the marginal adaptation of the dentin adhesive and the marginal discoloration of a HEMA-free adhesive.

Effect of fiber inserts on gingival margin microleakage of Class II bulk-fill composite resin restorations.

This study evaluated the effect of fiber inserts combined with composite resins on enamel and dentin margin microleakage. The fiber inserts were used with high- (x-tra fil) and low-viscosity (x-tra base) bulk-fill composite resins and as well as conventional composite resins (Grandio and Grandio Flow). In 96 sound, recently extracted molars, 2 standardized Class II cavities were prepared. The teeth were randomly divided into 8 groups of 12 teeth each, based on composite resin type and presence or absence of fiber inserts: groups 1 and 2, x-tra fil with and without fiber inserts, respectively; groups 3 and 4, x-tra base with and without fiber inserts; groups 5 and 6, Grandio with and without fiber inserts; and groups 7 and 8, Grandio Flow liner (gingival floor)/Grandio (remainder of cavity) with and without fiber inserts. In all the groups, a 2-step etch-and-rinse adhesive was used. The specimens were processed in a dye penetration technique to determine microleakage percentages. Data were analyzed with analysis of variance, Tukey, and t tests. There was significantly less leakage at the enamel margins than the dentin margins. Fiber reinforcement significantly decreased enamel microleakage in all the groups, with no significant differences among the groups. Concerning dentin microleakage, there were no significant differences among the 4 groups without fiber inserts, while a significant difference was detected in groups 2 (x-tra fil plus fiber) and 8 (Grandio Flow plus fiber/Grandio). Fibers significantly improved dentin sealing in groups 2 and 8. These findings suggest that a fiber insert reinforcing bulk-fill and conventional composite resins might improve enamel sealing in shallow Class II cavi-ties. The effect of fiber reinforcement on the dentin margins of deep cavities depended on the viscosity of the composite resins; fiber reinforcement was effective for flowable bulk-fill and conventional composite resin restorations.

Retrospective Analysis of Argatroban in 353 Patients with Acute Noncardioembolic Stroke.

BACKGROUND: Argatroban is a thrombin inhibitor agent for acute noncardioembolic ischemic stroke in Japan. We studied the prognosis in patients with acute stroke treated by argatroban in comparison with the control group with ozagrel in our hospital. SUBJECTS AND METHODS: A total of 513 patients with acute noncardioembolic ischemic stroke were enrolled retrospectively from our hospital database. Of all patients with stroke, 353 were administered with argatroban. The other 160 control patients were administered with ozagrel. The patients were examined as to their stroke types, the neurological severity according to the National Institutes of Health Stroke Scale (NIHSS), and clinical outcomes on discharge were determined according to the modified Rankin Scale (mRS). RESULTS: A total of 353 patients with acute noncardioembolic stroke, including 138 with lacunar infarction (LIs) and 215 with atherothrombotic infarction (ATI) showed functional recovery by argatroban, but the effectiveness of argatroban was not superior to ozagrel therapy defined by the control group. A total of 255 patients with ATI who were treated with both argatroban and ozagrel showed improvement by 1 point. We could not find any significant difference between argatroban and ozagrel in the 2 stroke subtypes, LI and ATI. We also found that combination therapy of argatroban and edaravone was not superior to argatroban monotherapy in clinical outcome. CONCLUSIONS: Argatroban therapy was not superior to control with ozagrel therapy in acute noncardioembolic ischemic stroke, including LI and ATI, regardless of the use of edaravone.

Do HEMA-free adhesive systems have better clinical performance than HEMA-containing systems in noncarious cervical lesions? A systematic review and meta-analysis.

OBJECTIVES: To determine through a systematic review whether HEMA-free adhesive systems have better clinical performance than HEMA-containing systems in noncarious cervical lesion (NCCL) restorations. SOURCES: We systematically searched PubMed, The Cochrane Library, Scopus, Web of Science, and Open Grey databases using MeSH terms, synonyms, and keywords, with no language or date restriction. The reference lists of included articles were manually searched. STUDY SELECTION: Randomized controlled clinical trials comparing the effectiveness of HEMA-free and HEMA-containing adhesive systems in NCCL restorations were included. The risk of bias in the included studies was assessed and classified through the Cochrane Collaboration's common scheme for bias. Quantitative data were subgrouped according to the main clinical parameters evaluated, and heterogeneity was tested using I2 index. DATA: A total of 2889 potentially relevant studies were identified. After title and abstract examination, 51 studies remained. Finally, 22 studies were included in the systematic review, totaling to 997 participants. Thus, 13 studies were classified as "low" risk of bias and nine as "unclear". These 22 studies were also included in the meta-analysis, and no significant statistical difference was found between the clinical performances of HEMA-free and HEMA-containing adhesive systems for all parameters analyzed: retention risk difference (RD) 0.03 [-0.01, 0.07] (p = 0.13); marginal discoloration RD 0.02 [-0.01, 0.04] (p = 0.19); marginal adaptation RD -0.01 [-0.04, 0.01] (p = 0.34); caries RD 0.00 [-0.01, 0.01] (p = 0.92); or postoperative sensitivity RD -0.00 [-0.02, 0.01] (p = 0.72) and for overall effect RD 0.00 [-0.01, 0.01] (p = 0.65). CONCLUSIONS: HEMA-free and HEMA-containing adhesive systems showed a similar clinical performance in NCCL restorations. CLINICAL SIGNIFICANCE: Only the presence of HEMA does not indicate better clinical performance of adhesive systems.

Efficiency of Lasers and a Desensitizer Agent on Dentin Hypersensitivity Treatment: A Clinical Study.

AIM: The aim of this clinical study was to determine and compare the efficiency of the glutaraldehyde-containing agent (GCA), Nd:YAG, Er,Cr:YSGG lasers, and the combination of them on the dentin hypersensitivity (DH) treatment. SUBJECTS AND METHODS: This study was performed with the participation of 17 healthy adult patients having 100 teeth with DH; the patients were randomly divided into five groups according to the treatment protocol: (1) application of GCA on sensitive teeth, (2) Nd:YAG laser (1 W/cm2, 10 Hz) irradiation on sensitive teeth, (3) application of GCA on sensitive teeth and then Nd:YAG laser irradiation, (4) Er,Cr:YSGG laser (0.25 W/cm2, 20 Hz) irradiation on sensitive teeth, (5) application of GCA on sensitive teeth and then Er,Cr:YSGG laser irradiation. Sensitivity levels were assessed by the Yeaple probe on the buccal surfaces of the teeth at a force setting of 10 g. Measurements were performed for 30 min, after 7, 90, and 180 days of the therapy to assess the effects of desensitization. The evaluations were analyzed using the one-way analysis of variance and repeated measurement test (P < 0.05). RESULTS: After sessions, DH was significantly reduced in all groups at each measurement point. The Er,Cr:YSGG laser with or without GCA application were the most effective ones in DH treatment (P < 0.05). Comparison of the treatment regimens demonstrated that the scores achieved with the Yeaple probe were not significantly higher for the Nd:YAG laser groups than the GCA alone group. CONCLUSIONS: This clinical study shows that the Er,Cr:YSGG laser have promising potential for the treatment of DH.