Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods.

BACKGROUND: Same-day start removes barriers to contraceptive initiation and may reduce the risk of unintended pregnancy. It may be appropriate for all contraceptive methods, but we lack data comparing methods. OBJECTIVE: This study aimed to assess the frequency of same-day start with 6 contraceptive methods among new contraceptive users and describe the efficacy of same-day start in terms of first-cycle pregnancy risk overall and by each method. STUDY DESIGN: Using prospective data from the HER Salt Lake Contraceptive Initiative, we identified and assessed outcomes for participants initiating a new method of contraception beyond the first 7 days of their menstrual cycle (same-day start). Enrolled participants at 4 family planning clinics in Salt Lake County, Utah between September 2015 and March 2017 received their method of choice regardless of their cycle day or recent unprotected intercourse. All participants self-reported last menstrual period data and unprotected intercourse events in the previous 2 weeks. We excluded participants who received care immediately after or within 2 weeks of abortion care. Clinical electronic health records provided information on contraceptive method initiation and use of oral emergency contraception. Participants reported pregnancy outcomes in 1-, 3-, and 6-month follow-up surveys with clinic verification to identify any pregnancy resulting from same-day initiation. The primary outcomes report the frequency of same-day start use and first-cycle pregnancy risk among same-day start users of all contraceptive methods. The secondary outcomes include frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by method. We also report the frequency of unprotected intercourse within 5 days and 6 to 14 days of contraception initiation, frequency of concomitant receipt of oral emergency contraception with initiation of ongoing contraception, and pregnancy risk with these exposures. We analyzed pregnancy risk for each contraceptive method initiated on the same day and assessed the simultaneous use of oral emergency contraception. RESULTS: Of the 3568 individuals enrolled, we identified most as same-day start users (n=2575/3568; 72.2%), with 1 in 8 of those reporting unprotected intercourse in the previous 5 days (n=322/2575; 12.5%) and 1 in 10 reporting unprotected intercourse 6 to 14 days before contraceptive method initiation (n=254/2575; 9.9%). We identified 11 pregnancies among same-day start users (0.4%; 95% confidence interval, 0.2-0.7), as opposed to 1 (0.1%; 95% confidence interval, 0.002-0.6) among those who initiated contraception within 7 days from the last menstrual period. Users of oral hormonal contraception and vaginal hormonal methods reported the highest first-cycle pregnancy rates (1.0-1.2). Among same-day start users, 174 (6.8%) received oral emergency contraception at enrollment in conjunction with another method. Among the same-day start users who received emergency contraception at initiation, 4 (2.3%) pregnancies were reported. CONCLUSION: Same-day start is common and associated with a low pregnancy risk. Using the "any method, any-time" approach better meets contraceptive clients' needs and maintains a low risk of pregnancy.

Implementation and Monitoring of the Family Planning Elevated Contraceptive Access Program, Utah, 2018‒2019.

Family Planning Elevated (FPE) is a contraceptive access initiative in Utah. FPE designed and utilized a comprehensive monitoring system to identify and respond to challenges implementing our initiative as they arose. Here, we describe the components of our monitoring system, and highlight how FPE's monitoring system successfully identified that Utah's Medicaid expansion was not widely adopted by eligible individuals. We then describe how FPE adapted to this challenge. (Am J Public Health. 2022;112(S5):S528-S531. https://doi.org/10.2105/AJPH.2022.306935).

Attitudes of dentists toward maintaining, repairing, or replacing direct composite resin restorations.

This study aimed to report the reasons for replacement of direct composite resin restorations in dental practices in Brazil. The study used a convenience sample of 213 dentists. A questionnaire was developed from previously validated instruments and sent electronically to prospective participants. The questions pertained to professional characteristics; criteria most frequently used in determining whether a direct composite resin restoration warranted replacement; and respondents' choice of treatment options (maintain, repair, or replace the restoration) in various clinical scenarios based on FDI World Dental Federation evaluation criteria, which are categorized into 3 groups: esthetic, functional, and biological properties. The descriptive statistical analysis was conducted using percentage frequencies, and associations between variables were tested using chi-square tests (α = 0.05). According to 47.9% of respondents, staining was the esthetic property that most often warranted replacement. For the functional property, 53.8% of respondents reported that fracture of material and retention was the most important factor indicating the need for replacement. For the clinical scenarios, 41.7% of respondents chose restoration replacement when evaluating esthetic properties, 59.8% when evaluating functional properties, and 64.4% when evaluating biological properties. Replacement, rather than maintenance or repair, was the most frequently reported clinical decision, and the dentists' professional profiles influenced treatment recommendations, with specialists exhibiting a slightly lower frequency of recommendations for replacement of direct composite resin restorations.

Travel to Mexico and uropathogen-antibiotic susceptibility mismatch in the emergency department.

INTRODUCTION: International travel results in an increased risk of colonization and infection with multidrug-resistant organisms. This study aimed to determine if recent travel to Mexico affects the rate of uropathogen-antibiotic susceptibility mismatch (UASM) in outpatients treated for urinary tract infection (UTI) in a South Texas emergency department (ED). METHODS: A retrospective cohort of adult patients presenting to the ED and treated outpatient for UTI from October 1, 2014, to February 25, 2020, was conducted at a community hospital located within approximately 15 miles of the United States-Mexico border. Rates of UASM were compared between patients with a history of recent travel to Mexico and those who have not recently traveled. RESULTS: A total of 192 patients were included, with 64 in the travel to Mexico group and 128 in the no travel group. UASM was significantly higher in the recent travel to Mexico group when compared to the no travel group (RR 1.49, 95% CI 1.03-2.13). Antibiotics most commonly associated with UASM included fluoroquinolones, cephalexin, and sulfamethoxazole-trimethoprim. There was no significant difference between the rates of resistance to first-line agents for the treatment of UTI among the two groups. CONCLUSION: In addition to known antibiotic resistance risk factors, recent travel to Mexico may increase the risk of UASM for ED patients with UTI. Considering the potential consequences of UTI treatment failure, antimicrobial stewardship services in the ED should include screening for antibiotic resistance risk factors and urine culture follow-up to ensure appropriate outpatient antibiotic therapy, especially among patients with recent international travel.

Comparison of Dimensions of the Nasopharynx and Oropharynx Using Different Anatomical References: Is There Equivalence?

PURPOSE: To evaluate the equivalence of the volumes obtained using different anatomic references to measure the nasopharynx and oropharynx on cone-beam computed tomography (CBCT) scans. We hypothesized that no variations would be found in the nasopharynx and oropharynx dimensions when measured using different measurement methods. MATERIALS AND METHODS: A total of 40 CBCT scans of patients with skeletal Class I (age range, 20 to 50 years) were measured independently by 2 of us. The nasopharynx and oropharynx subregions were volumetrically measured using the adopted limits of 5 different measurement methods (3 for the nasopharynx and 2 for the oropharynx) and InVivoDental software, version 5.4 (Anatomage, San Jose, CA). The minimum area and the minimum area of localization were also evaluated. The intra- and interexaminer concordance for the measurements from the different methods were verified using the interclass correlation coefficient (ICC). The analysis of variance for repeated measures was used to compare the measurements from the 3 nasopharynx methods. The paired t test was used to compare the measurements from the 2 oropharynx methods. The statistical tests were performed at the 5% significance level using SPSS software, version 22.0 (IBM Corp, Armonk, NY). RESULTS: The intra- and interexaminer ICC values were greater than 0.8. We found a statistically significant difference in the volume measurements among the 3 nasopharynx methods (P = .001). However, no differences were found in the minimum area or minimum area of localization comparisons. Statistically significant differences were also observed for the volume, minimum area, and minimum area of localization between the 2 oropharynx methods (P = .001). CONCLUSIONS: Studies that have used different methods of measurement should not be directly compared. The different measurement methods used for nasopharynx and oropharynx evaluations should not be compared.

Influence of different application protocols of universal adhesive system on the clinical behavior of Class I and II restorations of composite resin - a randomized and double-blind controlled clinical trial.

BACKGROUND: Multimode adhesives incorporate the versatility of adapting to various clinical situations by its capacity to be used in different protocols. This study aimed to evaluate the clinical behavior of composite resin direct restorations (Class I and II) performed with different universal dentin adhesive application protocols comparing adapted FDI and adapted USPHS criteria. METHODS: The current study is a randomized, double-blind, split-mouth, and convenience sample controlled clinical trial. The participants (age ≥ 18 years) had restorative need of Class I and/or II due to the presence of carious lesions and/or unsatisfactory restorations in at least three dental elements. Each participant received three application protocols for Scotchbond Universal adhesive (3M ESPE), one in each tooth to be restored: ER = etch-and-rinse + adhesive (n = 50); SEE = selective enamel etch + adhesive (n = 50) and SE = self-etch adhesive (n = 50). All teeth were restored in a similar way using Filtek™ Supreme composite resin (3M ESPE). Restorations were evaluated using the adapted FDI and adapted USPHS criteria, at baseline after 7 to 21 (12.02 ± 5.68) days (T1; n = 50 per group) and after 12 to 20 (15.8 ± 2.7) months (T2; n = 46 per group) by two previously calibrated evaluators (Kappa > 0.80). The statistical tests were performed between groups (Friedman), intragroup (Wilcoxon), and between the criteria considering acceptable and not acceptable restorations (McNemar), α = 0.05. RESULTS: A statistically significant difference was observed only for the property "superficial staining", between groups at T2 (p = 0.01) for ER (n = 13 with score 2 or more) and SEE (n = 3 with score 2 or more) and intragroup for ER (T1, n = 1 with score 2 or more; T2, n = 13 with score 2 or more, p = 0.001) and SE (T1, n = 0 with score 2 or more; T2, n = 8 with score 2 or more p = 0.007). For the other comparisons between groups, intragroup, and between the adapted FDI and adapted USPHS criteria, there were no statistically significant differences (p ≥ 0.05). CONCLUSIONS: It can be concluded that the different application protocols of the universal adhesive resulted in clinically "acceptable" restorations after 15.8 ± 2.7 months of follow-up. Adapted FDI and adapted USPHS criteria provided similar results to each other. TRIAL REGISTRATION: Number in Brazilian Registry of Clinical Trials (ReBEC): RBR-9p3hdp. Registered 24 May 2015.

Resin Cement: Correspondence with Try-In Paste and Influence on the Immediate Final Color of Veneers.

PURPOSE: To assess the correspondence of shades between try-in pastes and resin cements and their influence on the final color of veneers. MATERIALS AND METHODS: Bovine teeth (n = 140) were prepared and divided into 2 groups (a or b) according to ceramic veneer thickness (0.35 or 0.70 mm). Seventy teeth (n = 70) were distributed in 7 groups (groups 1 to 7a and groups 1 to 7b; n = 10). Try-in pastes and their corresponding resin cements were used according to the value: groups 1a and 1b (value -3); groups 2a and 2b (-2); groups 3a and 3b (-1); groups 4a and 4b (0); groups 5a and 5b (+1); groups 6a and 6b (+2); groups 7a and 7b (+3). Color measurements were performed with spectrophotometer, and the coordinates L* , a* , and b* were obtained. The final color change (ΔE) was calculated from these coordinates: ΔE0 (trial - substrate), ΔE1 (cementation - substrate), and ΔE2 (cementation - trial). The data were analyzed using the Kolmogorov-Smirnov test, the Wilcoxon test, or t-test for paired samples and repeated-measures ANOVA, post hoc Bonferroni, or the Friedman test (p < 0.05). RESULTS: The results indicated no statistically significant difference between the groups comparing ΔE0 and ΔE1 for 0.35 mm thickness laminate veneers, except for groups 2a and 5a. For 0.70 mm thickness laminate veneers, no statistically significant differences were observed between the groups comparing ΔE0 and ΔE1. ΔE2 values for 0.35 mm and 0.70 mm thickness laminate veneers ranged from 1.77 ± 0.81 to 4.99 ± 3.80 and from 1.01 ± 0.73 to 4.66 ± 2.96, respectively. CONCLUSIONS: Try-in pastes correspond with their respective resin cements for most colors investigated. The color of the resin cement may influence the final color of laminate veneers. Thickness of the ceramic was the most relevant variable for color change.

Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery.

PURPOSE: To evaluate the effect of genioplasty on the size of the pharyngeal airway space (PAS) in a sample of patients without obstructive sleep apnea syndrome (OSAS) undergoing maxillomandibular advancement (MMA) surgery. MATERIALS AND METHODS: Lateral cephalometric radiographs of 52 patients who underwent orthognathic surgery for MMA were obtained before (T1) and after (T2) surgery. The radiographs were digitized and the anteroposterior dimensions of the PAS were measured at the nasopharynx, oropharynx, and hypopharynx levels. The sample was divided into 2 groups: MMA with genioplasty (n = 27; average age, 30.81 yr) and without genioplasty (n = 25; average age, 37.64 yr). Comparisons were made between T1 and T2 in patients with and without genioplasty. Horizontal and vertical changes of the maxilla, mandible, and chin were correlated to changes in the PAS. RESULTS: MMA resulted in an increased anteroposterior PAS at the 3 levels analyzed (P < .05), except in the hypopharynx, in cases without genioplasty (P = .141). When the groups with and without genioplasty were compared, there were no significant differences (P > .05) in the PAS. There was a statistically relevant correlation between horizontal mandibular change and the oropharynx (r = 0.484 and r = 0.509, respectively) and between vertical chin change and the hypopharynx (r = 0.434 and r = 0.455, respectively) for groups with and without genioplasty. There was a statistically relevant correlation between horizontal chin change and the hypopharynx (r = 0.586) for surgeries without genioplasty. CONCLUSION: Considering the limitations inherent to retrospective study designs, the results suggested that MMA surgery, with and without advancement genioplasty, can promote immediate gains to the PAS. A larger gain was possible in the hypopharynx for MMA with genioplasty. MMA without genioplasty could represent a greater gain in the nasopharynx and oropharynx. Further studies should evaluate functional parameters in patients with OSAS to measure the possible benefits of this increase in the PAS.

Four-year follow-up of a polymethyl methacrylate-based bone cement graft for optimizing esthetics in maxillary anterior implants: a case report.

Tooth loss promotes bone and gingival tissue remodeling, thus breaking the harmony between the residual ridge and natural teeth. This is critical in the anterior region of the mouth, and the integration of several dental specialties is often essential to successful rehabilitation with implants. This article describes a multidisciplinary approach to implant-supported oral rehabilitation in the maxillary anterior region, presenting a new technique for optimizing esthetics in implants. A 19-year-old woman was missing her central and lateral incisors and had 2 dental implants in the lateral incisor sites. The patient exhibited deficient thickness of the alveolar edge, loss of lip support, and absence of gingival architecture, and the implants were improperly placed. A multidisciplinary team created a correct emergence profile through a polymethyl methacrylate-based bone cement graft along with connective tissue grafts. This technique may be a useful therapeutic adjunct in dental implantology, showing good predictability and regular healing procedures.

Maxillary canine morphology: comparative and descriptive analysis from periapical radiographs and cone beam computed tomography.

The anatomical characteristics of permanent maxillary canines were evaluated through visual examination, periapical radiography, and cone beam computed tomography (CBCT), and measurements obtained from the images and directly on the teeth were compared. Fifty extracted human maxillary canines were classified according to the side of the mouth. The direction of root curvature and location of the apical foramen were also verified. Periapical radiographs and CBCTs of the specimens were obtained. The number of root canals was verified. Tooth length and the mesiodistal and buccopalatal widths of the root were measured directly on the specimens as well as on the radiographs and CBCTs. Data were analyzed by chi-square testing and analysis of variance (α = 0.05). All teeth-26 (52%) from the right side of the dental arch and 24 (48%) from the left-had only 1 main canal each. The apical foramen was located exactly in the root apex in 34 teeth (68%). Root curvature toward the distal side was observed in the apical third in 23 teeth (46%). There were no statistically significant differences between the canines' arch side and either the foramen location (P = 0.104) or the root curvature (P = 0.215). No statistically significant differences were found in measurements of tooth length (P = 0.669), mesiodistal root width (P = 0.517), or buccopalatal root width (P = 0.672) obtained from specimens and images. Both CBCTs and periapical radiographs were reliable for determining the tooth length, mesiodistal root width, and buccopalatal root width of maxillary canines and produced statistically similar measurements.

Ozone Gas Effect on Mineral Content of Dentin exposed to Streptococcus mutans Biofilm: An Energy-dispersive X-ray Evaluation.

AIM: This study aims to assess the effect of ozone gas on dentin exposed to Streptococcus mutans biofilm by evaluation of mineral content [log calcium-to-phosphorus (Ca/P)] using energy-dispersive X-ray (EDX) spectroscopy. MATERIALS AND METHODS: Five human third molars were sectioned into four slices of dentin and distributed in four groups: I - control (no treatment); II - ozone therapy; III - biofilm development; IV - ozone therapy followed by biofilm development. Mineral content (log Ca/P) was evaluated by EDX. Data were analyzed by analysis of variance and Tukey's test (p < 0.05). RESULTS: Results showed that the mineral content of control group (I) was similar to ozone group (II), and was statistically higher than biofilm (III) and ozone + biofilm (IV). The lowest log Ca/P was determined in biofilm group (III). CONCLUSION: It can be concluded that ozone gas did not grant preventive effects of demineralization by S. mutans biofilm on dentin surface. CLINICAL SIGNIFICANCE: Ozone gas therapy may be an alternative noninvasive treatment aiming to reduce the levels of caries-associated microorganisms. This therapy may, thereby, be an alternative and/or complementary treatment strategy in preventive dentistry.

Multi-center evaluation of the novel fully-automated PCR-based Idylla™ BRAF Mutation Test on formalin-fixed paraffin-embedded tissue of malignant melanoma.

The advent of BRAF-targeted therapies led to increased survival in patients with metastatic melanomas harboring a BRAF V600 mutation (implicated in 46-48% of malignant melanomas). The Idylla(™) System (Idylla(™)), i.e., the real-time-PCR-based Idylla(™) BRAF Mutation Test performed on the fully-automated Idylla(™) platform, enables detection of the most frequent BRAF V600 mutations (V600E/E2/D, V600K/R/M) in tumor material within approximately 90 min and with 1% detection limit. Idylla(™) performance was determined in a multi-center study by analyzing BRAF mutational status of 148 archival formalin-fixed paraffin-embedded (FFPE) tumor samples from malignant melanoma patients, and comparing Idylla(™) results with assessments made by commercial or in-house routine diagnostic methods. Of the 148 samples analyzed, Idylla(™) initially recorded 7 insufficient DNA input calls and 15 results discordant with routine method results. Further analysis learned that the quality of 8 samples was insufficient for Idylla(™) testing, 1 sample had an invalid routine test result, and Idylla(™) results were confirmed in 10 samples. Hence, Idylla(™) identified all mutations present, including 7 not identified by routine methods. Idylla(™) enables fully automated BRAF V600 testing directly on FFPE tumor tissue with increased sensitivity, ease-of-use, and much shorter turnaround time compared to existing diagnostic tests, making it a tool for rapid, simple and highly reliable analysis of therapeutically relevant BRAF mutations, in particular for diagnostic units without molecular expertise and infrastructure.

Abdominal aorta interruption and CHD.

We report a rare case of CHD and abdominal aorta interruption. Renal hypertension was the first sign of the abdominal aortic malformation. The aetiology of abdominal aortic interruption remains unclear, it could be congenital or acquired.

Comparison of the correlation of photoelasticity and digital imaging to characterize the load transfer of implant-supported restorations.

STATEMENT OF PROBLEM: Whether splinting or not splinting adjacent implants together can optimize the stress/strain transfer to the supporting structures remains controversial. PURPOSE: The purpose of this study was to compare the photoelasticity and digital image correlation (DIC) in analyzing the stresses/strains transferred by an implant-supported prosthesis. MATERIAL AND METHODS: A polymethylmethacrylate model was made with a combination of acrylic resin replicas of a mandibular first premolar and second molar and threaded implants replacing the second premolar and first molar. Splinted (G1/G3) and nonsplinted (G2/G4) metal-ceramic screw-retained crowns were loaded with (G1/G2) and without (G3/G4) the presence of the second molar. Vertical static loads were applied to the first molar implant-supported crown (50 N-photoelasticity; 250 N-DIC). The resulting isochromatic fringes in the photoelastic models were photographed, and a single-camera 2-dimensional DIC system recorded the deformation at the surface of the resin models. RESULTS: Residual stresses were present in the photoelastic model after screw fixation of the crowns. The following average photoelastic stress results (MPa) were found around the loaded implant: G1 (20.06), G2 (23.49), G3 (30.86), G4 (37.64). Horizontal strains (εxx, %) between the molars averaged over the length of the loaded implant were found by DIC: G1 (0.08 ± 0.09), G2 (0.13 ± 0.10), G3 (0.13 ± 0.11), G4 (0.16 ± 0.11). Splinted crowns transferred lower stresses to the supporting bone when the second molar was absent. The second molar optimized the stress distribution between the supporting structures even for nonsplinted restorations. CONCLUSIONS: Both methods presented similar results and seemed capable of indicating where issues associated with stress/strain concentrations might arise. However, DIC, while apparently less sensitive than photoelasticity, is not restricted to the use of light-polarizing materials.

Shade evaluation of ceramic laminates according to different try-in materials.

The porcelain laminate replaces the visible portion of enamel with a ceramic, which is attached to the dental surface. To enhance cosmetic results, a preliminary color matching procedure is performed prior to cementing the veneers. This procedure can be performed using water, water-soluble gel, or try-in paste. The different shades of cement and try-in pastes are intended to obtain better color and esthetics of the final restoration. This study sought to evaluate the shade of ceramic veneers produced by different try-in materials. Forty bovine teeth and 40 ceramic discs (0.6 mm thick) were prepared. The samples were divided into 4 groups (n = 10). For Group 1 samples, no material was used between the tooth and the ceramic, Group 2 interposed samples with water, Group 3 used a water-soluble gel, and Group 4 used try-in paste (value 0). The color was measured with a spectrophotometer, obtaining L*, a*, and b* values to calculate the color difference (ΔE*). The data were subjected to normality tests and 1-way ANOVA. No significant statistical differences were found among the groups, indicating that the different try-in materials had similar effects on the color of the ceramic laminates.

Socket shield technique: Stress distribution analysis.

Background: To analyze through finite element analysis the stress distribution in peri-implant bone tissues, implants, and prosthetic components induced by the socket shield (SS) technique in comparison to other techniques used to treat tooth loss. Materials and Methods: A three-dimensional model of a superior central incisor crown supported by implant was modeled and three different placement conditions were simulated: SS - 2.0-mm-thick root dentin fragment positioned between the alveolar buccal wall and implant; heterologous bone graft (HBG) - bovine bone graft positioned the alveolar buccal wall and implant; and control (C) - implant fully placed in bone tissue of a healed alveolus. The model was restricted at the lateral surfaces of the bone tissue and the following loads were simulated: Both oblique (45°) loads of 100 N on the lingual surface of the crown (maximal habitual intercuspation) and 25.5 N on the incisal edge of the crown (tooth contact during mandibular protrusion) were simultaneously applied. Tensile stress, shear stress, compression, and displacement were analyzed in the cortical bone, trabecular bone, dentin root fragment, and bone graft; while equivalent von Mises stresses were quantified in the implant and prosthetic components. Results: Stress values of SS and HBG in the bone tissues were higher than C, while slight differences within models were observed for dentin root fragment, bone graft, implant, and prosthetic components. Conclusions: The SS technique presented the highest stress concentration in the peri-implant tissues.

Clinical characterization of human bocavirus 1 infection in infants hospitalized in an intensive care unit for severe acute respiratory tract disease.

Acute respiratory infections represent the leading cause of morbimortality in children and viruses are the main etiological agents. Here we describe the clinical characteristics and evolution of infants admitted to intensive care unit with severe acute respiratory infection (SARI) due to Human Bocavirus 1 mono-infection in patients without previous comorbidity. We also compared them with respiratory syncytial virus (RSV) cases. Of 141 cases included (age 5.43 ± 4.54 months, 52% male), 80% had at least 1 virus detected. RSV was the most frequent in the series (71.6%) followed by HBoV1 (28%). Five cases of HBoV1 mono-detection were identified. Pediatric acute respiratory distress syndrome was present in both groups, HBoV1 and RSV. The clinical presentation and evolution of HBoV1 single infection was similar to RSV. HBoV1 should be included among the agents investigated in cases of SARI in infants.

The effect of the die material used in the indirect technique on the fracture resistance of a restored molar.

The aim of this study was to evaluate the effect of different die materials used in the indirect resin composite restorative technique on the fracture resistance and failure mode of restored molars and compare it with the direct resin composite restorative technique. Two flexible die silicone materials for dental models (Die Silicone - Voco and Scan die - Yller) and a type IV dental stone material (Fujirock EP - GC) were evaluated. Sixty third molars were selected and divided into four groups: indirect resin composite restoration - Die silicone (IRCR-DS); indirect resin composite restoration - Scan die (IRCR-SD); indirect resin composite restoration - Fujirock EP (IRCR-FR), and direct resin composite restoration (DRCR). Class II MOD cavities were prepared with 5 mm of buccolingual width and depth. The specimens were restored and subjected to an axial compression load until fracture, and the data were analyzed by one-way ANOVA and Tukey's HSD test (α=.05). The fracture mode was classified into restorable and unrestorable fractures. Fracture resistance values were influenced by the die material used for the IRCR fabrication and by the restorative technique (p<.001). Fracture resistance mean values and standard deviation were: IRCR-DS: 1835.5 ± 324.0 A; IRCR-SD: 1732.5 ± 384.1 AB; IRCR-FR: 1419.3 ± 318.8 BC; and DRCR: 1100.6 ± 224.9 C. Restorable fracture was more prevalent. IRCR with flexible die casts promoted higher fracture resistance and lower prevalence of unrestorable fractures.

Comprehensive NGS profiling to enable detection of ALK gene rearrangements and MET amplifications in non-small cell lung cancer.

Introduction: Next-generation sequencing (NGS) is currently widely used for biomarker studies and molecular profiling to identify concurrent alterations that can lead to the better characterization of a tumor's molecular landscape. However, further evaluation of technical aspects related to the detection of gene rearrangements and copy number alterations is warranted. Methods: There were 12 ALK rearrangement-positive tumor specimens from patients with non-small cell lung cancer (NSCLC) previously detected via fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and an RNA-based NGS assay, and 26 MET high gene copy number (GCN) cases detected by FISH, selected for this retrospective study. All 38 pre-characterized cases were reassessed utilizing the PGDx™ elio™ tissue complete assay, a 505 gene targeted NGS panel, to evaluate concordance with these conventional diagnostic techniques. Results: The detection of ALK rearrangements using the DNA-based NGS assay demonstrated excellent sensitivity with the added benefit of characterizing gene fusion partners and genomic breakpoints. MET copy number alterations were also detected; however, some discordances were observed likely attributed to differences in algorithm, reporting thresholds and gene copy number state. TMB was also assessed by the assay and correlated to the presence of NSCLC driver alterations and was found to be significantly lower in cases with NGS-confirmed canonical driver mutations compared with those without (p=0.0019). Discussion: Overall, this study validates NGS as an accurate approach for detecting structural variants while also highlighting the need for further optimization to enable harmonization across methodologies for amplifications.

Evaluation of the host immune response assay SeptiCyte RAPID for potential triage of COVID-19 patients.

Tools for the evaluation of COVID-19 severity would help clinicians with triage decisions, especially the decision whether to admit to ICU. The aim of this study was to evaluate SeptiCyte RAPID, a host immune response assay (Immunexpress, Seattle USA) as a triaging tool for COVID-19 patients requiring hospitalization and potentially ICU care. SeptiCyte RAPID employs a host gene expression signature consisting of the ratio of expression levels of two immune related mRNAs, PLA2G7 and PLAC8, measured from whole blood samples. Blood samples from 146 adult SARS-CoV-2 (+) patients were collected within 48 h of hospital admission in PAXgene blood RNA tubes at Hospital del Mar, Barcelona, Spain, between July 28th and December 1st, 2020. Data on demographics, vital signs, clinical chemistry parameters, radiology, interventions, and SeptiCyte RAPID were collected and analyzed with bioinformatics methods. The performance of SeptiCyte RAPID for COVID-19 severity assessment and ICU admission was evaluated, relative to the comparator of retrospective clinical assessment by the Hospital del Mar clinical care team. In conclusion, SeptiCyte RAPID was able to stratify COVID-19 cases according to clinical severity: critical vs. mild (AUC = 0.93, p < 0.0001), critical vs. moderate (AUC = 0.77, p = 0.002), severe vs. mild (AUC = 0.85, p = 0.0003), severe vs. moderate (AUC = 0.63, p = 0.05). This discrimination was significantly better (by AUC or p-value) than could be achieved by CRP, lactate, creatine, IL-6, or D-dimer. Some of the critical or severe cases had "early" blood draws (before ICU admission; n = 33). For these cases, when compared to moderate and mild cases not in ICU (n = 37), SeptiCyte RAPID had AUC = 0.78 (p = 0.00012). In conclusion, SeptiCyte RAPID was able to stratify COVID-19 cases according to clinical severity as defined by the WHO COVID-19 Clinical Management Living Guidance of January 25th, 2021. Measurements taken early (before a patient is considered for ICU admission) suggest that high SeptiScores could aid in predicting the need for later ICU admission.