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Purpose: The objective of this study was to assess the microleakage and flexural strength of glass ionomer cement (GIC) and modified GIC (Zirconomer) when coated with protective coating agents such as COAT-IT and G-COAT plus. Methods: Sixty tooth specimens were grouped into two groups based on the type of restorations (GIC (n= 30) and Zirconomer (n= 30)). The samples were further divided into three subgroups (n= 10) based on the protective coating agent (Petroleum jelly, G-COAT Plus, or COAT IT) applied. This study evaluated the microleakage at the occlusal and cervical margins of class V restoration after being subjected to dye penetration and sectioning. Each specimen was viewed under a 40 × microscope and was given scores based on the depth of dye penetration. They were statistically analyzed using the Kruskal–Wallis test and compared within the groups using the Mann– Whitney Test. In addition, flexural strength was assessed using standardized cuboid (25 × 2 × 2 mm) specimens of restorative materials with and without protective coating agents. The mean flexural strength data of all the subgroups were statistically evaluated using a one-way analysis of variance (ANOVA) and compared within the subgroups using the student ttest. Results: A statistically significant difference was found when occlusal margin microleakage scores were evaluated with G-COAT Plus demonstrating the lowest occlusal margin microleakage when applied over GIC restoration. The increasing order of occlusal margin microleakage scores is as follows: GIC with G-COAT Plus, Zirconomer with COAT-IT, GIC with COAT-IT, GIC, Zirconomer with G-COAT Plus, and Zirconomer. However, the cervical margin microleakage scores revealed no significant difference. While flexural strength was found to be highest for the GIC group coated with G-COAT Plus, it was observed that there was a significant improvement in the flexural strength of both GIC and Zirconomer when coated with either of the protective coating agents. Conclusion: Within the limitations of this in vitro study, it was observed that the application of protective coating agents can significantly reduce the potential microleakage and improve the flexural strength of the restorative material especially when zirconia-reinforced GIC is the restorative material.

Recently, the use of metal-on-metal articulations in total hip arthroplasty (THA) has led to an increase in adverse events owing to local soft-tissue reactions from metal ions and wear debris. While the majority of these implants perform well, it has been increasingly recognised that a small proportion of patients may develop complications secondary to systemic cobalt toxicity when these implants fail. However, distinguishing true toxicity from benign elevations in cobalt ion levels can be challenging. The purpose of this two part series is to review the use of cobalt alloys in THA and to highlight the following related topics of interest: mechanisms of cobalt ion release and their measurement, definitions of pathological cobalt ion levels, and the pathophysiology, risk factors and treatment of cobalt toxicity. Historically, these metal-on-metal arthroplasties are composed of a chromium-cobalt articulation. The release of cobalt is due to the mechanical and oxidative stresses placed on the prosthetic joint. It exerts its pathological effects through direct cellular toxicity. This manuscript will highlight the pathophysiology of cobalt toxicity in patients with metal-on-metal hip arthroplasties.Take home message: Patients with new or evolving hip symptoms with a prior history of THA warrant orthopaedic surgical evaluation. Increased awareness of the range of systemic symptoms associated with cobalt toxicity, coupled with prompt orthopaedic intervention, may forestall the development of further complications.Cite this article: Bone Joint J2016;98-B:6–13.

As adverse events related to metal on metal hip arthroplasty have been better understood, there has been increased interest in toxicity related to the high circulating levels of cobalt ions. However, distinguishing true toxicity from benign elevations in cobalt levels can be challenging. The purpose of this review is to examine the use of cobalt alloys in total hip arthroplasty, to review the methods of measuring circulating cobalt levels, to define a level of cobalt which is considered pathological and to review the pathophysiology, risk factors and treatment of cobalt toxicity. To the best of our knowledge, there are 18 published cases where cobalt metal ion toxicity has been attributed to the use of cobalt-chromium alloys in hip arthroplasty. Of these cases, the great majority reported systemic toxic reactions at serum cobalt levels more than 100 μg/L. This review highlights some of the clinical features of cobalt toxicity, with the goal that early awareness may decrease the risk factors for the development of cobalt toxicity and/or reduce its severity.Take home message: Severe adverse events can arise from the release of cobalt from metal-on-metal arthroplasties, and as such, orthopaedic surgeons should not only be aware of the presenting problems, but also have the knowledge to treat appropriately.Cite this article: Bone Joint J2016;98-B:14–20.

The purpose of this study was to evaluate the effect of various non-operative modalities of treatment (transcutaneous electrical nerve stimulation (TENS); neuromuscular electrical stimulation (NMES); insoles and bracing) on the pain of osteoarthritis (OA) of the knee. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify the therapeutic options which are commonly adopted for the management of osteoarthritis (OA) of the knee.The outcome measurement tools used in the different studies were the visual analogue scale and The Western Ontario and McMaster Universities Arthritis Index pain index: all pain scores were converted to a 100-point scale. A total of 30 studies met our inclusion criteria: 13 on insoles, seven on TENS, six on NMES, and four on bracing. The standardised mean difference (SMD) in pain after treatment with TENS was 1.796, which represented a significant reduction in pain. The significant overall effect estimate for NMES on pain was similar to that of TENS, with a SMD of 1.924. The overall effect estimate of insoles on pain was a SMD of 0.992. The overall effect of bracing showed a significant reduction in pain of 1.34. Overall, all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee. This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee. However, much of the literature reviewed evaluates studies with follow-up of less than six months: future work should aim to evaluate patients with longer follow-up.Cite this article: Bone Joint J2016;98-B(1 Suppl A):89–94.

The aim of this study was to assess the effect of injecting genetically engineered chondrocytes expressing transforming growth factor beta 1 (TGF-β1) into the knees of patients with osteoarthritis. We assessed the resultant function, pain and quality of life. A total of 54 patients (20 men, 34 women) who had a mean age of 58 years (50 to 66) were blinded and randomised (1:1) to receive a single injection of the active treatment or a placebo. We assessed post-treatment function, pain severity, physical function, quality of life and the incidence of treatment-associated adverse events. Patients were followed at four, 12 and 24 weeks after injection.At final follow-up the treatment group had a significantly greater improvement in the mean International Knee Documentation Committee score than the placebo group (16 points; -18 to 49, vs8 points; -4 to 37, respectively; p = 0.03). The treatment group also had a significantly improved mean visual analogue score at final follow-up (-25; -85 to 34, vs-11 points; -51 to 25, respectively; p = 0.032). Both cohorts showed an improvement in Western Ontario and McMaster Osteoarthritis Index and Knee Injury and Osteoarthritis Outcome Scores, but these differences were not statistically significant. One patient had an anaphylactic reaction to the preservation medium, but recovered within 24 hours. All other adverse events were localised and resolved without further action. This technique may result in improved clinical outcomes, with the aim of slowing the degenerative process, leading to improvements in pain and function. However, imaging and direct observational studies are needed to verify cartilage regeneration. Nevertheless, this study provided a sufficient basis to proceed to further clinical testing.Cite this article: Bone Joint J2015;97-B:924–32.

We present an indium tin oxide/polymethylsilsesquioxane (ITO/PMSSQ) photonic crystal (PC) with grating structure. This topography exhibits multiple coupling resonances in specific regions of the solar spectrum, which can be controlled by tuning the angle and polarization of incident light as demonstrated through simulation and experimental results. The ITO/PMSSQ grating structures are prepared by simple soft lithography procedures using commercial HD-DVD and Blu-ray as template molds. The surface topography also includes geometrical singularities such as nanogaps and nanocones, which lead to further enhanced light trapping characteristics. Together, these singularity-embedded photonic crystal gratings result in concentrated electromagnetic fields at the aforementioned singularities, which could be especially helpful in separating the tightly bonded excitons in organic solar cells. Simulation shows an absorption enhancement over the full spectral range of ITO PCs-based solar cells with substantial increases closer to the band edge under s-polarized light.

Haemoptysis is an alarming symptom, and the management depends upon the aetiology. Emergency management depends upon localization of the site of bleeding by roentgenogram, computerized chest tompgraphy and bronchoscopy. We prospectively evaluated 52 patients with haemoptysis admitted to the Chest Hospital, Kuwait for 1 year (January 1998 to December 1998) and followed them up for 1 year (January 1999 to December 1999). There were 42 males (80·8%) and 10 (19·2%) females, with a mean age of 42·2 (16–86) years. Of these, 26·9% were Kuwaiti nationals, 36·5% were Arab non-Kuwaiti nationals, 34·6% were Asians and 1·9% were other nationals. The aetiologies of haemoptysis were bronchiectasis (21·2%), old pulmonary tuberculosis with bronchiectasis (17·3%), active pulmonary tuberculosis (15·4%), bronchitis (5·8%), aspergilloma, rheumatic heart disease and carcinoid (1·9%). Aetiology could not be identified in 25% of patients. The site of bleeding in haemoptysis could not be localized by the consultants in 18 (32%) by roentgenogram, 16 patients (37%) by CT scan and 23 patients (50%) by Fibreoptic bronchoscopy. Sequential estimation of hemoglobin showed a mean of 13·56 (

Objective: Cancer patterns and incidence rates for a rural population (359,674) resident in 384 villages spread over 2058 km2in Palani and Oddanchathram taluks of Dindigul District, Tamil Nadu, in South India, are described in this paper. Methods: A population-based cancer registry was established in 1995 to register incident invasive and in-situcancers. Cases were found and details abstracted by cancer registry staff visiting 26 data sources, comprising cancer hospitals, tertiary and secondary care hospitals, pathology laboratories and death registration offices. A customized version of CANREG-3 software was used for data entry and analysis. Results: During the period 1996–1998, 783 invasive cancers (310 male and 473 females) were registered, yielding an all-cancer crude incidence rate of 56.8/100,000 males and 88.5/100,000 females; the corresponding age standardized incidence rates (ASR) were 83.3 and 122.3 respectively. In males, mouth cancer (ASR 11.5) was the most frequently recorded malignancy followed by tongue (ASR 8.6), hypopharynx (ASR 7.8), esophagus (ASR 7.8) and larynx (ASR 7.8). Thus head and neck cancers accounted for half of the male cases. In females, cervical cancer (ASR 65.4) accounted for more than half of the cancers followed by breast (ASR 14.2) and mouth (ASR 10.2). Ambillikai Cancer Registry (ACR) reports the second highest incidence of cervical cancer in the world. More than four-fifths of cervical cancer cases were diagnosed in stages II B and III B; a third of these cancer patients either did not have, or did not complete, treatment. Conclusions: The observed cancer patterns in this population establish that measures directed at prevention and early detection (linked with treatment) of cervix and head and neck cancers are of paramount importance for cancer control in this and other rural populations of India where three-fourths of the total population live.

The primary invasive granulomatous form of fungal sinusitis, due to inhalation of aspergillus spores, is commonest in the Sudan and the Gulf states. This condition often presents clinically as a chronic, severe sinusitis which has not responded to antibiotics. On CT scanning, the major feature is a soft tissue mass, which is either homogeneous or has lower attenuation components. There may be erosion or expansion of the bony margins of the sinuses. Intraorbital and/or intracranial extension sometimes occur.

The synthesis of eupomatilone-6 (1) has been achieved by using Suzuki coupling, Sharpless asymmetric dihydroxylation, and intramolecular Horner−Wadsworth−Emmons reactions. The spectroscopic studies carried out on synthetic eupomatilone-6 do not agree with those reported for the natural product, and therefore revision of the assigned structure is warranted.

BackgroundThe Pipeline Embolization Device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. We sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes.MethodsFour institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PED. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases involving device prolapse into the aneurysm.ResultsA total of 413 intracranial aneurysms were treated with PED during the study period, by 5 neurointerventionalists. Large and giant aneurysms comprised 32 of these aneurysms. Among these, prolapse into the aneurysm occurred in 3 patients, with one of these being rescued and the other two left in situ. All 3 patients had aneurysms of 2 cm or larger. No patients suffered any neurological complications. The two patients in whom PED was left in situwere left on antiplatelet therapy.ConclusionsThe Pipeline Embolization Device may foreshorten or migrate during or after deployment, leading to prolapse into the aneurysm. This phenomenon appears to be associated with large and giant aneurysms, vessel tortuosity, short landing zones, and use of balloon angioplasty. Future study and follow-up is needed to evaluate this further, but some of the observations and techniques described here may help to prevent or salvage prolapsed devices.DisclosuresV. Srinivasan:1; C; Microvention. A. Carlson:None. M. Mokin:None. J. Cherian:None. S. Chen:None. A. Puri:None. P. Kan:1; C; Microvention. 2; C; Medtronic, Stryker.

IntroductionThe optimal management of intracranial arterial stenosis is unclear in particular in patients who have failed medical management. We now report a multicenter experience of endovascular recanalization of intracranial artherosclerotic stenosis refractory to medical therapy.MethodsRetrospective multicenter case series of consecutive endovascularly treated patients presenting with symptomatic (TIA or stroke) who have failed medical therapy. All of the patients were considered to be in the high-risk category with unstable symptomatic intracranial stenosis and progression or recurrence of their symptoms despite the best medical management who required endovascular intervention either with stenting and/or balloon angioplasty.ResultsFifty patients presented with recurrent TIAs (n=26) or strokes (n=24) were treated in 5 stroke centers from 2011 to 2017. All patients underwent best medical management in the decision of the stroke neurologist and were enroll in this study only if they had recurrent or progression of symptoms despite their medical therapy. The majority of lesions were located in the M1 segment (15/50). There was one periprocedural vessel perforation resulting in patient death, one case of groin hematoma, one intraprocedure hemorrhage, and one periprocedural stroke. Twelve patients (24%) had restenosis on follow up imaging and 80% (33/41) of patients were symptom free at 90 day follow-up. Three patients had a stroke in the territory of the stenosis and 5 patients had recurrent TIAs.ConclusionEndovascular recanalization of unstable intracranial atherosclerotic stenosis who have failed medical therapy is feasible and safe.DisclosuresP. Aguilar-Salinas:None. R. Hanel:1; C; Microvention. 2; C; Medtronic; Stryker; Microvention. 4; C; Blockade Medical. E. Sauvageau:None. D. Lopes:2; C; Microvention. A. Saied:None. T. Jovin:2; C; Medtronic. 3; C; Blockade Medical; Silk Road Medical. A. Jadhav:None. L. Kaustubh:None. L. Brasiliense:None. T. Dumont:None. J. Cherian:None. P. Kan:None. A. Aghaebrahim:None.

We present an indium tin oxide/polymethylsilsesquioxane (ITO/PMSSQ) photonic crystal (PC) with grating structure. This topography exhibits multiple coupling resonances in specific regions of the solar spectrum, which can be controlled by tuning the angle and polarization of incident light as demonstrated through simulation and experimental results. The ITO/PMSSQ grating structures are prepared by simple soft lithography procedures using commercial HD-DVD and Blu-ray as template molds. The surface topography also includes geometrical singularities such as nanogaps and nanocones, which lead to further enhanced light trapping characteristics. Together, these singularity-embedded photonic crystal gratings result in concentrated electromagnetic fields at the aforementioned singularities, which could be especially helpful in separating the tightly bonded excitons in organic solar cells. Simulation shows an absorption enhancement over the full spectral range of ITO PCs-based solar cells with substantial increases closer to the band edge under s-polarized light.