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BackgroundTreatment of cancer with chemotherapy decreases endurance capacity and muscle strength. Training during chemotherapy might prevent this. There are no clear guidelines concerning which type of training and which training dose are effective. This review aims to gain insight into the different training modalities during chemotherapy and the effects of such training to improve endurance capacity and muscle strength in order to obtain the knowledge to compose a future training program which trains cancer patients in the most effective way.Material and methodsA systematic search of PubMed was carried out. In total, 809 studies of randomized controlled trials studying the effects of training during chemotherapy on endurance capacity and muscle strength were considered. Only 14 studies met all the inclusion criteria. The studies were assessed on methodological quality by using Cochrane criteria for randomized controlled trials.ResultsThe quality of the studies was generally poor and the study populations varied considerably as the training programs were very heterogeneous. Variables of endurance capacity reported beneficial effects in 10 groups (59%). Increases due to training ranged from 8% to 31%. Endurance capacity decreased in nine of 13 control groups (69%), which ranged from 1% to 32%. Muscle strength improved significantly in 17 of 18 intervention groups (94%), ranging from 2% to 38%. Muscle strength also improved in 11 of 14 control groups (79%), but this increase was only minimal, ranging from 1.3% to 6.5%.ConclusionsThis review indicates that training during chemotherapy may help in preventing the decrease in muscle strength and endurance capacity. It is important to know which training intensity and duration is the most effective in training cancer patients, to provide a training program suitable for every cancer patient. Training should be based on good research and should be implemented into international guidelines and daily practice. More research is needed. [ABSTRACT FROM PUBLISHER]

Malignant tumours are the foremost complications of immunosuppressive treatment. They are a major challenge for organ transplant recipients and their treating physicians. This paper reviews the aetiology and current treatment of an unusual neuroendocrine skin cancer, Merkel cell carcinoma (MCC), caused by a Merkel cell polyomavirus infection. MCC occurs more frequently than expected in immunosuppressed subjects, especially in organ transplant recipients. The current literature comprises reports of 79 organ transplant recipients with MCC. The risk of MCC in organ transplant recipients is increased up to 66-182-fold compared with the general population. In addition to the increased risk of developing MCC, immunosuppressed individuals have poorer MCC-specific survival. The aim of this review article is to familiarize organ transplant doctors with this unique and clinically challenging skin cancer, and to provide recent data on the diagnosis and current treatment recommendations for an immunosuppressed population. [ABSTRACT FROM AUTHOR]

BackgroundThe incidence of melanoma is rising in Denmark. In the present paper we describe incidence, mortality and survival in Denmark from 1980 to 2012 focusing on age, comparing persons aged 70 years or more with those aged less than 70 years. Material and methodsMelanoma was defined as ICD-10 code C43. Data derived from the NORDCAN database with comparable data on incidence, mortality, survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up until the end of 2013. ResultsIn 1980, 21.4% of the patients diagnosed with melanoma were older than 70 years compared to 28.4% in 2012. In persons aged less than 70 years, the incidence rate was higher among women than in men, but men aged 70–89 years had an incidence rate almost twice that of women. Incidence rates were increasing, particularly among the elderly. In 1980, 32.6% of the patients who died from melanoma were older than 69 years compared to 56.2% in 2012. In 1980, the mortality rate was 121.4 per 100 000 person years, increasing to 353.1 in 2012. For the younger patients, the mortality rates are only slight increasing, but for the elder patients the mortality rates are increasing dramatically. In general the survival has increased for all age groups over the years. ConclusionThe incidence rates for all age groups are rising. The increase was mainly caused by a rising incidence among the elderly. Mortality among Danish patients with melanoma is increasing and especially the mortality in the elderly. This important knowledge must be kept in mind when future treatment strategies are planned. [ABSTRACT FROM PUBLISHER]

BackgroundColorectal cancer (CRC) is a disease of the older population. The current demographic ageing leads to more elderly patients and is expected to further increase the number of patients with CRC. The objective of the present paper is to outline incidence, mortality and prevalence from 1980 to 2012 and survival data from 1968 to 2012 in Danish CRC patients focusing on the impact of ageing. Material and methodsData were derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival in the Nordic countries, where the Danish data are delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. This study focuses on the elderly population categorized in six age groups. ResultsThe incidence of CRC has increased over the past three decades. Incidence rate has increased in patients with colon cancer, but showed a decreasing trend in the oldest patients with rectal and anal cancer. Mortality has diminished in younger patients with colon cancer, but increased with increasing age. However, mortality did not increase proportionally to incidence. In rectal and anal cancer mortality has decreased, except among the oldest patients. This correlates to a decreasing incidence rate. Prevalence is widely increasing mainly because of increased incidence and longer survival, which is reflected in the increasing one- and five-year age-specific relative survival after a diagnosis of colon, rectal and anal cancer. ConclusionThe incidence of CRC is increasing, especially in older citizens, and mortality increases with older age. There is limited knowledge on how to optimize treatment in older CRC patients and future focus must be how to select and tailor the treatment for older CRC patients. [ABSTRACT FROM PUBLISHER]

The aims of the present study were to evaluate the relative incidence of alveolar osteitis (AO) after mandibular third molar surgery, post-operative findings and local expression of bone markers and cytokines. In 445 patients, unilateral surgical third molars extractions were undertaken (584 teeth). Bone markers and cytokines were explored at the AO side and on the un-operated contralateral side and compared with the levels in samples from a control group of 18 persons without AO. The relative incidence of AO was 4.6%. Patients (n = 27) with AO were invited to participate in the study and 21 (77.8%) did so. Patients with AO had 1–4 extra visits for treatment of AO, the mean follow-up time was 2.6 days for all patients. There were significantly higher levels of bone markers and cytokines in the AO site compared with the un-operated contralateral site, except for Epidermal growth factor (EGF). No significant difference in expression of bone markers and cytokines between the AO and control groups was found. Lower maximum inter-incisor opening (MIO) was correlated with increased Macrophage inflammatory protein 1 alpha. A negative correlation between patients' complaint of trismus and MIO was seen. The relative incidence of AO was low in our patient group treated with surgical removal of third molars. AO was more frequently seen in female patients. Treatment of AO required up to four extra visits. The study provides some information on the role of cytokines in AO; but further studies are required. [ABSTRACT FROM AUTHOR]

Background and purpose — There is ongoing debate as to whether commercial funding influences reporting of medical studies. We asked: Is there a difference in reported tones between abstracts, introductions, and discussions of orthopedic journal studies that were commercially funded and those that were not commercially funded? Methods — We conducted a systematic PubMed search to identify commercially funded studies published in 20 orthopedic journals between January 1, 2000 and December 1, 2019. We identified commercial funding of studies by including in our search the names of 10 medical device companies with the largest revenue in 2019. Commercial funding was designated when either the study or 1 or more of the authors received funding from a medical device company directly related to the content of the study. We matched 138 commercially funded articles 1 to 1 with 138 non-commercially funded articles with the same study design, published in the same journal, within a time range of 5 years. The IBM Watson Tone Analyzer was used to determine emotional tones (anger, fear, joy, and sadness) and language style (analytical, confident, and tentative). Results — For abstract and introduction sections, we found no differences in reported tones between commercially funded and non-commercially funded studies. Fear tones (non-commercially funded studies 5.1%, commercially funded studies 0.7%, p = 0.04), and analytical tones (non-commercially funded studies 95%, commercially funded studies 88%, p = 0.03) were more common in discussions of studies that were not commercially funded. Interpretation — Commercially funded studies have comparable tones to non-commercially funded studies in the abstract and introduction. In contrast, the discussion of non-commercially funded studies demonstrated more fear and analytical tones, suggesting them to be more tentative, accepting of uncertainty, and dispassionate. As text analysis tools become more sophisticated and mainstream, it might help to discern commercial bias in scientific reports. [ABSTRACT FROM AUTHOR]

Nephrectomy for patients with primary metastatic clear cell renal cell carcinoma (MccRCC) has been discussed for decades. Too good for CARMENA: criteria associated with long systemic theraphy free intervals post cytoreductive nephrectomy for metastatic clear cell renal cell carcinoma. Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the SURTIME randomized clinical trial. [Extracted from the article]

Background and purpose — Hip precautions limiting flexion, adduction, and internal rotation have been prescribed traditionally to minimize dislocation rates following THA. We assessed the prevalence of hip dislocation following posterior approach total hip arthroplasty without postoperative hip precautions. Methods — A systematic review of multiple medical databases was performed using the PRISMA guidelines and checklist. All clinical outcome studies that reported dislocation rates and postoperative instructions following posterior approach, primary surgery, published within the last 6 years, were included. Results — 6,900 patients were included from 7 Level I–IV studies, with 3,517 treated with and 3,383 without precautions. There was no statistically significant difference in the rates of dislocation between groups (2.2% in restricted group vs. 2.0% in unrestricted group). All but 1 study demonstrated no statistically significant differences in patient-reported outcome scores between restricted and unrestricted groups, including those pertaining to return to function, confidence, and pain. Interpretation — The review found no impact on dislocation rates following total hip arthroplasty performed through a posterior approach, regardless of the use of hip precautions. We also found no impact of the prescription of hip precautions on patient-reported outcome scores. [ABSTRACT FROM AUTHOR]

Objective. To give an overview of the periodontal-systemic connection seen from a microbiologist. Methods. Original research papers, review articles and workshop proceedings were consulted. Results. Periodontal bacteria can cross epithelial cells, enter the circulation, invade endothelial cells, induce endothelial cell dysfunction and activate inflammatory and immune responses. Several studies support the association between periodontitis (PD) and cardiovascular disease. Severe PD involves a risk for development of type 2 diabetes. Maternal PD is moderately associated with adverse pregnancy outcome and pre-eclampsia. Dental plaque can contain respiratory pathogens able to promote chronic obstructive pulmonary disease and pneumonia. Periodontal bacterial DNA has been detected in synovial fluid of patients with rheumatoid arthritis. Minor evidence exists for associations between PD and chronic kidney disease, obesity, cancer, metabolic syndrome and cognitive impairment. Concerns can be raised as to the interpretation of some study results due to heterogeneity in definitions used for PD, too much weight upon in vitro studies with a few selected organisms and failing recognition that the majority of the periodontal microbiota is not yet cultivated. Conclusion. Periodontal bacteria may participate in extra-oral infections such as CVD, diabetes, APO, pre-eclampsia, COPD, pneumonia, RA, CKD, obesity, cancer, MetS and cognitive impairment. Most knowledge is based on associations which do not necessarily imply causality. Future studies should reach consensus on the definition of PD and systemic disease outcomes, recognize the full spectrum of the microbiota in PD and bacteremia, including not-yet-cultivated organisms and delineate the clinical significance of genetic strain variations and the role of periodontopathogenic vs gut organisms within atheromatous lesions. For demonstration of causality, large, long-term clinical studies should use well-defined criteria for PD and robust disease outcomes to elucidate the importance of PD intervention and prevention. [ABSTRACT FROM AUTHOR]

Radiotherapy costs are an often underestimated component of the economic assessment of new radiotherapy treatments and technologies. That the radiotherapy budget only consumes a finite part of the total cancer and healthcare budget does not relieve us from our responsibility to balance the extra costs to the additional benefits of new, more advanced, but typically also more expensive treatments we want to deliver. Yet, in contrast to what is the case for oncology drugs, literature evidence remains limited, as well for economic evaluations comparing new radiotherapy interventions as for cost calculation studies. Even more cumbersome, the available costing studies in the field of radiotherapy fail to accurately capture the real costs of our treatments due to the large variation in cost inputs, in scope of the analysis, in costing methodology. And this is not trivial. Accurate resource cost accounting lays the basis for the further steps in health technology assessment leading to radiotherapy investments and reimbursement, at the local, the national and the worldwide level. In the current paper we review some evidence from the existing costing literature and discuss how such data can be used to support reimbursement setting and investment cases for new radiotherapy equipment and infrastructure. [ABSTRACT FROM PUBLISHER]

Background.Intrafraction motion may compromise the target dose in stereotactic body radiation therapy (SBRT) of tumors in the liver. Respiratory gating can improve the treatment delivery, but gating based on an external surrogate signal may be inaccurate. This is the first paper reporting on respiratory gating based on internal electromagnetic monitoring during liver SBRT. Material and methods.Two patients with solitary liver metastases were treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was delivered in end-exhale with beam-on when the centroid of the three transponders deviated less than 3 mm [left-right (LR) and anterior-posterior (AP) directions] and 4mm [cranio-caudal (CC)] from the planned position. For each treatment fraction, log files were used to determine the transponder motion during beam-on in the actual gated treatments and in simulated treatments without gating. The motion was used to reconstruct the dose to the clinical target volume (CTV) with and without gating. The reduction in D95(minimum dose to 95% of the CTV) relative to the plan was calculated for both treatment courses. Results.With gating the maximum course mean (standard deviation) geometrical error in any direction was 1.2 mm (1.8 mm). Without gating the course mean error would mainly increase for Patient 1 [to -2.8 mm (1.6 mm) (LR), 7.1 mm (5.8 mm) (CC), −2.6 mm (2.8mm) (AP)] due to a large systematic cranial baseline drift at each fraction. The errors without gating increased only slightly for Patient 2. The reduction in CTV D95was 0.5% (gating) and 12.1% (non-gating) for Patient 1 and 0.3% (gating) and 1.7% (non-gating) for Patient 2. The mean duty cycle was 55%. Conclusion.Respiratory gating based on internal electromagnetic motion monitoring was performed for two liver SBRT patients. The gating added robustness to the dose delivery and ensured a high CTV dose even in the presence of large intrafraction motion. [ABSTRACT FROM PUBLISHER]

In the 1990s, 5-flourouracil (5-FU) was introduced as a treatment for keloids; however, there is still no consensus on its use. In order to guide clinical practice, a systematic review of the clinical evidence on the effectiveness of 5-FU in keloid treatment was carried out. Eight databases were searched on 10 September 2014 using the terms "keloid" and "5-FU", together with all synonyms of these terms. Two reviewers selected original research reports using 5-FU alone or combined with a maximum of 2 other therapies. Eighteen papers were found that reported either on intralesional 5-FU alone, or on 5-FU combined with triamcinolone acetonide (TAC:5-FU) or excision, including 482 patients. 5-FU treatment was effective in 45–96% of patients, but only TAC:5-FU may perform better than TAC alone. Due to a poor level of evidence, further research should establish the superiority of repeated intralesional TAC:5-FU injections over TAC alone with several doses and injection schedules. [ABSTRACT FROM AUTHOR]

With the advent of multimodality therapy, the overall five-year survival rate from childhood cancer has improved considerably now exceeding 80% in developed European countries. This growing cohort of survivors, with many years of life ahead of them, has raised the necessity for knowledge concerning the risks of adverse long-term sequelae of the life-saving treatments in order to provide optimal screening and care and to identify and provide adequate interventions. Childhood cancer survivor cohorts in Europe. Considerable advantages exist to study late effects in individuals treated for childhood cancer in a European context, including the complementary advantages of large population-based cancer registries and the unrivalled opportunities to study lifetime risks, together with rich and detailed hospital-based cohorts which fill many of the gaps left by the large-scale population-based studies, such as sparse treatment information. Several large national cohorts have been established within Europe to study late effects in individuals treated for childhood cancer including the Nordic Adult Life after Childhood Cancer in Scandinavia study (ALiCCS), the British Childhood Cancer Survivor Study (BCCSS), the Dutch Childhood Oncology Group (DCOG) LATER study, and the Swiss Childhood Cancer Survivor Study (SCCSS). Furthermore, there are other large cohorts, which may eventually become national in scope including the French Childhood Cancer Survivor Study (FCCSS), the French Childhood Cancer Survivor Study for Leukaemia (LEA), and the Italian Study on off-therapy Childhood Cancer Survivors (OTR). In recent years significant steps have been taken to extend these national studies into a larger pan-European context through the establishment of two large consortia - PanCareSurFup and PanCareLIFE. The purpose of this paper is to present an overview of the current large, national and pan-European studies of late effects after childhood cancer. This overview will highlight the strong cooperation across Europe, in particular the EU-funded collaborative research projects PanCareSurFup and PanCareLIFE. Overall goal. The overall goal of these large cohort studies is to provide every European childhood cancer survivor with better care and better long-term health so that they reach their full potential, and to the degree possible, enjoy the same quality of life and opportunities as their peers. [ABSTRACT FROM AUTHOR]

The article discusses a study aimed at testing the accuracy and precision of radiostereometric analysis (RSA) as applied to sacroiliac joint (SIJ) in a phantom model and in patients. Topics discussed include SIJ as a possible source of pain for 13-30% of patients with low back pain (LBP), the common characteristics in the clinical presentation of patients with pelvic girdle pain (PGP) including the location of the pain and surgery as an appropriate treatment option for patients with severe PGP.

In clinical practice, the term "paraneoplastic itch" is used to describe itch in patients with cancer. Patients with hematological or solid tumor malignancies can be affected. In general, paraneoplastic itch is considered a rare disorder. However, paraneoplastic itch in hematological malignancies such as polycythemia vera and lymphoma are relatively frequent while other forms of paraneoplastic itch are in fact extremely rare. The true frequency of this symptom is unclear, epidemiological data in this field are limited. Itch in malignant disease may additionally impair patients' quality of life. A population-based cohort study showed that chronic itch without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies. Paraneoplastic itch is rather resistant to treatment. In 2012, an interdisciplinary interest group of physicians and researchers was founded, aiming to generate a clear definition of paraneoplastic itch. In this paper we briefly review the current knowledge and aim to define what can be summarized under the term "paraneoplastic itch". [ABSTRACT FROM AUTHOR]

An editorial is presented on Nordic Arthroplasty Register Association (NARA) being established in 2007 by hip and knee arthroplasty registry leaders from Denmark, Norway, and Sweden. Topics include showing large dissimilarities between the participating countries coming to the practice of orthopedics; and reverse shoulder arthroplasty performed for rotator cuff tear arthropathy being low.

A systematic review of published data was conducted with the aim of assessing effects of xylitol and erythritol consumption on levels of mutans streptococci (MS) and the oral microbiota. Electronic and hand searches were performed to find clinical microbiological studies concerning the consumption of xylitol and erythritol chewing gum or candies, and published between 2000 and 2019. Prospective randomized controlled clinical trials conducted in healthy subjects were included in the review. The initial search identified 561 xylitol and 83 erythritol studies. After applying inclusion and exclusion criteria, 21 xylitol studies and one erythritol study were reviewed. The review identified nine xylitol studies with a fair or high quality, four conducted in children and five in adults, all demonstrating a decrease in MS levels in association with habitual consumption of xylitol. The three microbiota studies employing multispecies probe approaches revealed no effects for xylitol on the microbiota. The only erythritol study fulfilling the inclusion criteria showed no consistent effects on MS levels. Xylitol consumption is likely to decrease MS counts but it may not change the overall microbiota. Xylitol shows thus properties of an oral prebiotic. More studies are needed to demonstrate the effects of erythritol on MS. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effectiveness of an upper removable appliance in the treatment of an anterior crossbite in term of quality of life, effectiveness, treatment time, long term stability and cost minimization.Design: Systematic reviewData source: A search strategy was implemented using both manual hand search and electronic databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ScienceDirect, Scopus and Ebsco.Study eligibility criteria: Randomized controlled clinical trialsParticipants: Children in the early or late mixed dentition with an anterior crossbite affecting one or more incisors, and no underlying skeletal class III pattern.Interventions: Upper removable appliance compared with other orthodontic appliances.Study appraisal and synthesis: All potential articles were checked against the inclusion criteria independently, and in duplicate by two investigators. Risk of bias of eligible studies to be included in the final analysis was assessed independently by two authors using Cochrane risk of bias tool.Results: A total of 524 articles were identified in both manual and electronic searches as well as by checking the reference lists of the final articles to be included in the study. Only 7 reports of 3 RCTs met the inclusion criteria and thus were included in the final analysis. All but one of the 3 RCTs were judged to be of very low quality. No statistical methods were employed to combine the studies due to the heterogeneity of the studies.Conclusion: A fixed appliance was more cost-effective than a removable appliance in the correction of an anterior crossbite with a functional shift. There was no significant difference in terms of quality of life, pain intensity or long-term stability between the two appliances. On the other hand, both a removable appliance and cemented bite-pads were equally effective in the correction of an anterior dental crossbite without having any side effect. [ABSTRACT FROM AUTHOR]

Chronic pruritus is a frequent global condition. The pathophysiology, underlying aetiology, clinical manifestation, associated burden and response to therapy of chronic pruritus varies from patient to patient, making clinical research and management of this condition challenging. There are still several unmet needs, such as the need to standardize translational research protocols, diagnostic and therapeutic procedures and to enhance the knowledge of the humanistic and economic burden associated with chronic pruritus. Basic and clinical research is of the utmost importance to target these matters. Clinical research has the potential to identify new relevant mechanisms in affected patients, which may lead to identification of novel therapy targets. This article discusses in depth current shortcomings in the daily care of patients with chronic pruritus and the challenges clinical researchers and physicians treating chronic pruritus face in addressing these matters. [ABSTRACT FROM AUTHOR]

Investigating the prevalence of mandibular ORN in a single Swedish Oncology Center. A total of 450 patients, treated with radiotherapy for squamous cell carcinoma in the oropharynx between 2004 and 2014 were included. Three different techniques of radiotherapy were studied. ORN diagnosis was set when clinical signs according to Marx were observed, or if radiological signs were staged according to Schwartz and Kagan. Using the staging system, 90 patients (20%) were diagnosed with ORN. The mean age of the ORN patients was 56.6 years, the older the patient the lower the risk of developing ORN (p =.01). The risk of developing ORN for patients receiving Intensity Modulated Radiotherapy was lower compared to patients treated with the other techniques in the multivariable analysis. Brachytherapy significantly increases the risk of ORN. The risk of ORN increased by 8% each year after radiation (p =.04). The mean time to the ORN diagnosis was 3.9 years. In the multivariate analysis, the risk of ORN increased by 13% each year after radiation (p =.0013). The mean radiation dose was of greater importance for the risk of ORN than the maximum dose. Elderly people with oropharyngeal cancer were less prone to develop ORN. [ABSTRACT FROM AUTHOR]

Indication-specific optimum field-of-views (FOVs) have been assessed for CBCT scans of impacted maxillary canines and mandibular third molars, as 40∅ × 35 mm and 35∅ × 35 mm, respectively. The objective was to investigate possible changes in absorbed organs and effective doses, for these two imaging indications, performing CBCT examinations with optimum FOV sizes instead of commonly used FOVs. Additionally, radiation exposure-induced cancer risk was calculated for both imaging indications with optimum FOVs. An adult female head phantom (ATOM 702-D, CIRS, Norfolk, VA, USA) was scanned using Planmeca Viso G7 CBCT-device (Planmeca, Helsinki, Finland). Scanning factors, different FOV sizes, dose-area product (DAP) values and anatomical FOV locations were used for Monte Carlo PCXMC-simulation and ImpactMC software. In the PCXMC- simulation, 10-year-old child and 30-year-old adult phantoms were used to estimating effective and absorbed organ doses. The effective dose varied from 58 µSv to 284 µSv for impacted maxillary canines, and from 38 µSv to 122 µSv for mandibular third molars, the lowest dose value for each corresponding to optimum FOV. Effective dose reduction between the optimum FOV and the smallest common FOV of 50∅ × 50 mm, maintaining other scanning factors constant, was 33% for impacted maxillary canines, and 45% for mandibular third molars. At all examinations, the highest absorbed organ doses were in salivary glands or in oral mucosa. Optimum FOVs, 40∅ × 35 mm for impacted maxillary canine and 35∅ × 35 mm for mandibular third molar, could decrease effective doses received by young patients, and improve radiation safety in these common CBCT imaging procedures. [ABSTRACT FROM AUTHOR]

The aim was to examine what kinds of dental anxiety management techniques dentists use in the context of one-session treatment. The data consisted of videotaped treatment sessions for five dentally anxious adults. The treatment was conducted by two experienced dentists without formal training in the treatment of dentally anxious patients or behavioral management techniques. Theory-driven qualitative content analysis, based on the anxiety management classification of Milgrom et al. was used to identify and classify the techniques used during the treatments. Altogether, diverse categories of dental anxiety management techniques were identified under the main themes of enhancing trust and control and psychological management. Techniques that fell into enhancing trust and control included the categories of 'building a trustful relationship', 'informational control', and 'behavioral control'. These techniques were used consistently throughout the sessions. Additionally, psychological management techniques were identified and classified as 'behavioral strategies: relaxing the body' and 'cognitive strategies: relaxing the mind', which were regularly used in specific situations. The results indicate that a variety of dental anxiety management techniques were used during one-session treatments. The findings provide valuable insights for dentists in managing their patients with dental anxiety and improving their overall treatment experience. [ABSTRACT FROM AUTHOR]

Coffee is one of the most popular beverages in the world, with millions of people consuming it every day. The effect of coffee on teeth discoloration has long been a concern for both coffee drinkers and dental professionals. To address this concern, this study aimed to investigate the role of chlorogenic acids (CGAs) and the type of coffee in coffee-induced teeth discoloration. High-performance liquid chromatography with a photodiode array detector was used to determine the CGA contents of instant coffee produced by five manufacturers (Starbucks, Dunkin' Donuts, Kanu, Ediya, Coffee Bean). A total of 180 bovine tooth specimens were immersed in the coffee samples for varying durations (3, 9, 24, 48, and 72 h), and the discoloration levels were measured using a spectrophotometer. A linear mixed-effects model analysis was used to determine the significance of L*, a*, and b* values in relation to the duration of coffee immersion and coffee type. Both immersion time and coffee type had significant effects on tooth discoloration (p < 0.001), with some types of coffee being more strongly associated with tooth discoloration than others. The amount of CGAs present in coffee was found to be positively correlated with the degree of discoloration (p = 0.030). Prolonged exposure to coffee can exacerbate teeth staining, and different types of coffee can cause varying degrees of discoloration. Furthermore, coffee with higher levels of CGAs may lead to greater tooth discoloration. [ABSTRACT FROM AUTHOR]

Poorer survival in cancer patients with vs. without comorbidity has been reported for various cancer sites. For patients with colorectal cancer (CRC), limited data are available so far. Patients with CRC diagnosed between 2010 and 2018 were identified in a health claims database covering 20% of the German population. We assessed the prevalence of comorbidities at cancer diagnosis and categorized the patients into the groups: 'none', 'somatic only', 'mental only' or 'both' types of comorbidities. Hazard ratios (HR, with 95% confidence intervals) for five-year overall survival were estimated by Cox proportional hazard models, adjusted for age, sex and stage at diagnosis (advanced vs. non-advanced). We included 92,991 patients (females: 49.1%, median age: 72 years) with a median follow-up of 30 months. The proportions assigned to the groups 'none', 'somatic only', 'mental only' or 'both' were 24.7%, 65.5%, 1.4% and 8.4%. Overall, 32.8% of the patients died during follow-up. Compared to patients without comorbidities ('none'), the adjusted HR regarding death from any cause was 1.11 (95% CI: 1.07–1.14) in the group 'somatic only', 1.74 (95% CI: 1.58–1.92) in the group 'mental only' and 1.92 (95% CI: 1.84–2.00) in the group 'both'. For patients with 'mental only' comorbidities, the adjusted HR was higher in males than in females (HR = 2.19, 95% CI: 1.88–2.55 vs. HR = 1.55, 95% CI: 1.37–1.75). Our results suggest that patients with CRC and with mental comorbidities, particularly males, have a markedly lower overall survival compared to those without any or only somatic comorbidities. [ABSTRACT FROM AUTHOR]

Compared to non-smokers, smokers have reduced effects of cancer treatment, and increased risk of treatment-related toxicity. Quitting smoking can improve treatment effects and reduce side effects. This study reports on the potential impact of a smoking cessation program on smoking cessation rates among patients in cancer treatment. Cancer patients 18 years and older who smoked, with survival prognosis ≥12 months, not suffering dementia or other mental illness, and who were referred to cancer treatment at six Norwegian hospitals were invited to participate. The study took place from 2017 to 2020 and used a pre-test-posttest non-equivalent control group design. The intervention group received structured smoking cessation guidance based on Motivational Interviewing combined with cost-free nicotine replacement products, while the control group received standard smoking cessation treatment. Self-reported smoking status were registered at baseline and at 6 months' follow up. 76% of patients smoked at baseline and 44% at follow-up in the intervention group, correspondingly 72% and 49% in the control group. In an analysis of differences in within-person change, the reduction in the intervention group was 13 percentage points larger (95% CI = (0.25, −0.005), p = 0.041). Adjusting for gender, age, education, labour market participation and partnership status did not attenuate the estimated effect (18 percentage point difference, 95% CI = (−0.346, −0.016), p = 0.032). Demographic factors and dropout rate differed somewhat between the groups with a higher dropout rate in the intervention group, 54% vs. 51%, respectively). Offering a structured smoking cessation program based on Motivational Interviewing and cost-free nicotine replacement products to cancer patients can increase cessation rates in comparison to standard smoking cessation care. [ABSTRACT FROM AUTHOR]

Following neoadjuvant chemotherapy (NAC) for resectable gastric cancer, the prognostic adequacy of the UICC staging system needs to be investigated. In particular to explore whether the ypTNM curves for radically resected gastric cancer patients receiving NAC follow the stage-matched survival curves of radically resected chemo-naïve patients (pTNM). Further, to disclose any interaction between the TNM-response mode to NAC and stage-specific survival rates, i.e., whether survival for a particular pathological disease stage was dependent on whether this was reached through a downstaging or as stable disease following NAC. Retrospective study on radically resected patients ≤ 75 years of age with gastric adenocarcinoma stages I-III diagnosed during 2001–2016. The patients constitute two population-based cohorts; the SURG-group with n = 121 patients treated before 2007 when NAC was introduced, and the NAC-group with n = 126 patients diagnosed since early 2007, receiving NAC and subsequent radical resection. Long-term survival rates were similar when specific ypTNM-stages were compared to their corresponding pTNM chemo-naïve counterparts. The dichotomised N0 vs. N + had a substantial impact on the long-term survival rates in both groups, however, no discrepancy in long-term survival rates between pN0 vs. ypN0, and pN + vs. ypN + was found. The pathological stage determined long-term survival rates irrespective of the baseline disease stage, as no interaction between the response mode and stage-specific survival rates was found. Survival curves for specific ypTNM-stages following NAC did not differ from the corresponding survival curves of their chemo-naïve pTNM counterparts. The interpretation is that NAC affected the gastric cancer, lymph nodes, and micrometastases, in such a way that the final ypTNM-stage provided similar prognostic information as the chemo-naïve pTNM-stages. Survival rates were contingent on the final ypTNM-stages alone, and not influenced by the response mode to reach that particular disease stage, or predetermined by the original clinical TNM-stage. [ABSTRACT FROM AUTHOR]

The aim was to investigate the distribution of health problems in general practice (GP) among adolescent and young adult (AYA) survivors of lymphoma and to compare problem rates with the general population. All GP consultations between 2006 and 2020 were identified from the national GP claims register. Diseases and complaints presented 3–10 years after the cancer diagnosis were identified using the International Classification of Primary Care codes (ICPC-2) and compared by applying logistic regression models, presented with odds ratio (OR) and 95%CI. A total of 2,500,557 AYAs, of whom 1105 were diagnosed with lymphoma, and over 50 million GP consultations were included. The most common causes of consultation among AYA survivors of lymphoma were related to Hodgkin's disease (13%), pregnancy (11%), respiratory diseases (9%), psychological problems (8%), musculoskeletal system (6%) and fatigue (4%). Almost all these problems were significantly higher among AYA lymphoma survivors compared to the general population (OR ranging from 1.1 to 1.5). Compared to the general population, young lymphoma survivors have increased contact with the GP for a considerable number of health problems for up to 10 years post-diagnosis. This emphasizes the importance of robust follow-up and a good flow of information between hospital and primary care. [ABSTRACT FROM AUTHOR]

There are two main coping styles regarding information seeking under medical threat; monitoring (information-seeking) and blunting (information-avoiding). The aim of this study is to (1) determine factors associated with a monitoring or blunting coping style in gastro-intestinal stromal tumour (GIST) patients and (2) investigate its association with psychological distress, cancer-related concerns, health-related quality of life and satisfaction with healthcare. In a cross-sectional study, Dutch GIST patients completed the shortened version of the Threatening Medical Situations Inventory to determine their coping style, the Hospital Anxiety and Depression Scale, Cancer Worry Scale, EORTC QLQ-C30 and part of the EORTC QLQ-INFO25. A total of 307 patients were classified as blunters (n = 175, 57%) or monitors (n = 132, 43%). Coping style was not associated with tumour or treatment variables, but being a female (OR 2.5; 95%CI 1.5–4.1; p= <.001) and higher educated (OR 5.5; 95%CI 2.5–11.9, p= <.001) were associated with higher odds of being a monitor. Monitors scored significantly lower on emotional functioning (mean = 86.8 vs mean = 90.9, p=.044), which is considered a trivial difference, more often experienced severe fear of cancer recurrence or progression (53.0% vs 37.7%, p=.007), and had more concerns about dying from GIST in the future (60.6% vs 47.4%, p=.025). Compared to blunters, monitors were less satisfied with the received healthcare and information, and would have liked to receive more information. GIST patients with a monitoring coping style experience a higher emotional burden. Additionally, monitors exhibit a greater need for information. Although this need for information could potentially result in fears and concerns, recognising it may also create an opening for tailored communication and information. [ABSTRACT FROM AUTHOR]

This study aimed to develop fully automated script-based radiotherapy treatment plans for cervical cancer patients, and evaluate them against clinically accepted plans, as validation before clinical implementation. In this retrospective planning study, treatment plans for 25 locally advanced cervical cancer (LACC) patients with up to three dose levels were included. Fully automated plans were created using an in-house developed Python script in RayStation, and compared to clinically accepted manually made plans. Quantitatively, relevant dose statistics were compared, and average dose volume histograms (DVHs) were analyzed. Qualitatively, a blinded plan comparison was conducted between the clinical and automatic plans. The accuracy of treatment plan delivery was verified with the Delta4 Phantom+. The quantitative evaluation showed that target coverage was acceptable for all the automatic and clinical plans. The automatic plans were significantly more conformal than the clinical plans; median of 1.03 vs. 1.12. Mean doses to almost all organs at risk (OARs) were reduced in the automatic plans, with a median reduction of between 0.6 Gy and 1.9 Gy. In the blinded plan comparison, the automatic plans were the preferred plans or of equal quality as the clinical plans in 99% of the cases. In addition, plan delivery was excellent, with a mean gamma passing rate of 99.8%. Complete script-based plans were generated in 30–45 min; about four to ten times faster than manually made plans. The automatic plans had acceptable target coverage, lower doses to almost all OARs, more conformal dose distributions, and were predominantly preferred by the clinicians. Based on these results, our institution has implemented the script for clinical use. [ABSTRACT FROM AUTHOR]

Using real-world (RW) data from registries to mimic or substitute a comparator arm of clinical trials is increasingly investigated. The feasibility of using data sources for this purpose depends on the source's completeness of the wide spectrum of a disease characteristics and relevant endpoints, which could allow for proper matching of important variables. This is a Norwegian study using data from three population-based registries, the Cancer Registry (CRN), the National Patient Registry (NPR), and the Norwegian Prescribed Drug Registry (LMR). We assessed if the registries contained the information necessary for selecting a RW cohort of patients with characteristics that mimicked the inclusion and exclusion criteria from the control arm of the phase 3 trial (KeyNote-407) on patients with stage IV, squamous NSCLC. We did this both on an aggregated - and individual data level. We also described the survival in the RW-cohorts and compared it with the survival in the control arm of the KN-407 trial. Using aggregated data from the CRN allowed us to find the patients based on some clinically relevant inclusion criteria, but only to a limited extent could we apply the exclusion criteria of KN-407. When we used individual data from the CRN, NPR and the LMR we could create a patient cohort that shared more criteria corresponding to the eligibility criteria from KN-407, including exclusion criteria. Compared to the 11.3 months (CI 95% 9.5, 14.8) median survival in the control arm of KN-407, both RW-cohorts had a shorter median survival, 7.07 months (CI 95% 6.7, 9.5) (individual) and 8.0 months (CI 95% 5.8, 10.5) (aggregated). Even if we demonstrated that the registries contain clinically relevant information necessary to mimic the eligibility criteria of a selected RCT, the survival is shorter for RW patients compared to their control arm counterpart in the RCT. [ABSTRACT FROM AUTHOR]

Patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors (TKIs) often experience cutaneous adverse events, such as rashes and pruritus. In this study, we aimed to compare the risks of cutaneous adverse events between imatinib- and second-generation TKI-treated patients with CML. Paired reviewers independently obtained studies from PubMed, Embase, and Cochrane Library published until 15 March 2022. The following terms were searched: (Leukemia, Myelogenous, Chronic and BCR-ABL Positive), chronic myeloid leukemia, tyrosine kinase inhibitor, TKI, imatinib, dasatinib, nilotinib, bosutinib, and radotinib. Two independent reviewers screened the results and selected articles on cutaneous adverse events. RevMan 5.4 and the Cochrane Collaboration tool were used to perform the meta-analysis and risk of bias assessment. Eleven trials involving 4502 patients were analyzed in this study. Patients treated with second-generation TKIs were significantly more likely to experience cutaneous adverse events than those treated with imatinib with a relative risk (RR) of 1.62 (95% confidence interval [CI], [1.25–2.09]). Except dasatinib (RR [95% CI], 1.39 [0.75–2.56]), the risk of adverse events was more with second-generation TKIs than with imatinib as follows: nilotinib (2.11 [1.53–2.90]), bosutinib (1.41 [1.07–1.86]), and radotinib (1.87 [1.33–2.63]). Rash was the most common cutaneous adverse event that was observed in 21.6% of cases across all grades, followed by pruritus (5.7%) and alopecia (4.3%). In conclusion, our findings suggest that cutaneous adverse events occur more frequently with second-generation TKIs than with imatinib. Therefore, effective management of the cutaneous outcome is necessary to achieve high patient adherence to medication and successful treatment with TKIs. [ABSTRACT FROM AUTHOR]

Real-world clinical outcomes of anaplastic lymphoma kinase positive (ALK+) non-small cell lung cancer (NSCLC) patients vary. This study aimed to investigate the treatment and clinical outcomes of all ALK+ NSCLC patients in Denmark in the period 2011–2018, regardless of disease stage. A national pathology database with complete coverage was used to identify ALK+ NSCLC patients diagnosed between 2011 and 2018. Clinical data were obtained through retrospective chart reviews. Overall survival (OS) and duration of treatment (DOT) were analyzed using Kaplan-Meier methodologies. A total of 209 ALK+ NSCLC patients were included. The cohort had a slight overrepresentation of female patients (56.5%) with a mean age of 61.6 years. Most patients were adenocarcinoma cases (97%) and presented with an ECOG performance status of 0–1 (79%). Stage IIIb–IVb patients comprised 70% of the cohort. The use of ALK-tyrosine kinase inhibitors (TKIs) as first-line treatment increased over time, with the 1st generation ALK-TKI crizotinib being the predominant treatment in the 1st line. In 1st line treatment, 2nd generation ALK-TKIs had a median DOT more than twice the median DOT of crizotinib (25.1 and 9.1 months, respectively). The median OS for the entire cohort was 44.0 months. Patients with stage I–IIIA disease had a median OS that had not been reached, while those with stage IIIb–IVb disease had a median OS of 31.8 months. Patients with stage IIIb–IVb disease receiving an ALK-TKI as 1st line treatment had a median OS of 42.5 months with immature follow-up. Brain metastases at diagnosis or choice of 1st line treatment did not statistically significantly impact OS. This study gives insights into the treatment and outcome of ALK+ NSCLC patients in Denmark and provides a real-world confirmation of the superior disease control provided by 2nd generation ALK-TKIs as compared to the 1st generation ALK-TKI crizotinib. [ABSTRACT FROM AUTHOR]

For metastatic hormone naïve prostate cancer patients, androgen deprivation therapy (ADT) with escalation therapy including docetaxel and/or androgen targeting drugs is the standard therapy. However, de-escalation is preferable to avoid unnecessary side effects, especially from docetaxel, but markers to identify these patients are lacking. The purpose of the present study was to investigate the potential of PSA and Ki67 immunoreactive scores as prognostic and treatment-predictive markers. Prostate biopsies from 92 patients with metastatic hormone naïve PC (PSA > 80 ng/mL or clinical metastases) were immunohistochemically evaluated for PSA and Ki67. Gene expression analysis was performed with Clariom D microarrays to identify the phenotypic profile associated with the immunohistochemistry scores of biopsies. Cox regression analysis for progression free survival after ADT adjustment for age, ISUP, and serum PSA and Kaplan-Meier analyses were performed to assess prognostic values of Ki67, PSA, and the Ki67/PSA ratio. The immunohistochemical score for PSA was the strongest prognostic factor for progression-free and overall survival after ADT. Consequently, the ratio between Ki67 and PSA displayed a stronger prognostic value than Ki67 itself. Further, mRNA expression data analysis showed an association between high Ki67/PSA ratio, cell-cycle regulation, and DNA damage repair. In an exploratory sub-analysis of 12 patients treated with early docetaxel as addition to ADT and matched controls, a high Ki67/PSA ratio showed potential to identify those who benefit from docetaxel. PSA and Ki67 immunoreactive scores are prognostic in the metastatic hormone-sensitive setting, with PSA being superior. The combination of Ki67 and PSA did not give additional prognostic value. The results suggest immunohistochemical scoring of PSA to have potential to improve identification of patients responding well to ADT alone. [ABSTRACT FROM AUTHOR]

This Delphi study aimed to assess current perspectives on hormone receptor-positive/human epidermal growth factor receptor 2-negative(HR+/HER2−) advanced breast cancer (aBC) treatment strategies across the Nordics, and to establish where consensus exists across the Nordics on HR+/HER2− aBC treatment. A modified, three-round Delphi method was followed. A steering committee was appointed for study coordination, panellist selection, and questionnaire development. The questionnaires covered relevant topics on HR+/HER2− aBC treatment: treatment patterns in different lines of therapy (first [1L], second [2L], and third [3L]), oligometastatic disease, de novo aBC, brain metastases, age as influential factor, visceral crisis, radiotherapy, diagnostics, and clinical guidelines. Both open and closed-ended questions were included. Consensus was defined as at least 70% agreement. In total, 28 experienced BC oncologists participated in the study from all five Nordic countries. Overall, topics reaching consensus included: preferred treatment approach in 1L and 2L therapy, treatment of oligometastatic disease, visceral crisis, brain metastases, and age-related treatment considerations. No consensus was reached for 3L therapy and local treatment for primary tumour in de novo aBC. Endocrine therapy (ET) combined with a cyclin-dependent kinase (CDK)4/6 inhibitor was the treatment of choice for 1L and 2L therapy. Treatment patterns in clinical practice did not always follow recommendations in current Nordic guidelines, as seen in the case of recently approved treatments. ET in combination with a CDK4/6 inhibitor is the preferred frontline treatment for HR+/HER2− aBC in the Nordics. The observed discrepancy between current guidelines and clinical practice could be due to differences in the reimbursement of novel treatments in the Nordics. Collaborative research efforts are warranted for topics that lack consensus. [ABSTRACT FROM AUTHOR]

The present study aimed to assess the effectiveness of different final irrigation regimens (Cold Atmospheric Pressure Plasma Jet, MTAD, and EDTA) in removing the smear layer from intra-radicular dentin using a Scanning Electron Microscope (SEM). Eighty-four mandibular premolars were prepared with ProTaper Universal hand files and were equally divided into four groups i.e. Normal saline (control), EDTA, MTAD and CAP Plasma Jet. Prepared samples in the control, EDTA and MTAD groups were irrigated with 5 milliliters of the irrigant, and it was retained for 2 min. In the CAP Plasma Jet group, the plasma plume was directed towards the canal lumen for 2 min. The smear layer removal of all the groups was evaluated at the coronal, middle and apical thirds. Statistical analysis was performed using Kruskal–Wallis test followed by Dunn's test. Evaluation by SEM showed that the smear layer removal ability of MTAD and EDTA were significantly better than CAP Plasma Jet (p < 0.05). While CAP Plasma Jet showed results comparable to EDTA in the coronal third. In the middle and apical third of the canal, its effect was comparable to the control group (p > 0.05). MTAD and EDTA aided in better smear layer removal than the CAP Plasma Jet in the coronal, middle, and apical third of the test samples. CAP Plasma jet performed better in the coronal third. [ABSTRACT FROM AUTHOR]

In this article, we analyzed the important categories capable of interfering with the determinants of scientific advancement in the type of study, considering seven leading journals over a 20-year. A bibliometric review was performed at the website of well-established implant dentistry journals in five-time points defined to represent a 20-year period of observation. The measures associated with the type of study design were: the country of origin of the article, country income, continent of the corresponding author, inter-institutional collaboration, interdisciplinary collaboration, type of funding, and topic of research. Logistic regression was used in the multiple models to identify the exploratory factors associated with the type of study. From a total of 1,944 articles, 50.6% comprised clinical studies. High-income countries and continents stood out for developing more clinical research than others. Since research funders request more collaborative research, overall clinical studies depended upon more inter-institutional collaboration than the others. Most clinical studies were partly supported by research institutes or universities and by industry. About the research topic, the majority of the clinical and animal studies disclosed surgical procedures. High-income countries and continents are more likely to develop clinical studies in the surgical procedures field. The highest collaborations in terms of the number of institutions and funding sources are more prevalent in clinical research designs. Indeed, most in vivo studies in dental implant fields are performed to evaluate new materials or even new surgical procedures. [ABSTRACT FROM AUTHOR]

The aim of this study was to find the best growth conditions of Enterococcus faecalis on a dentinal substrate in order to be used for the development of a complex multispecies endodontic biofilm. Fifty two single rooted extracted human teeth and fifty two dentinal disks were mechanically prepared, sterilized, inoculated with Enterococcus faecalis and divided randomly into 8 groups where the substrate, the inoculation technique, the medium type, and the pre-treatment with collagen type I was varied. Bacterial count was evaluated and colonies were counted and confirmed by colony morphology observation on blood agar and Gram staining at 3,7, 14, 21, and 28 days. On day 14 of the culture, the bacterial count showed the highest values in all groups. Root canals and Type 1 collagen pre-treatment and glucose proved to have significant positive effects on the bacterial count compared to dentinal disks and BHI media only. The increase in bacterial count found with the direct inoculation technique was not significantly different from that of the indirect technique. [ABSTRACT FROM AUTHOR]

This study investigated the impact of luting procedure and restoration thicknesses on the flexural strength of CAD/CAM restorations. Traditional luting agents have been questioned in favor of pre-heated resin composites or flowable composites. 400 disc-shaped restorations (lithium disilicate [IPS e.max CAD] or resin composite [Tetric CAD, Ivoclar]) were cemented onto dentin analog discs using different procedures (n = 20): dual-curing resin cement (Panavia V5), light-curing resin cement (Panavia Veneer LC), pre-heated resin composite (Clearfil™ AP-X) with or without pre-heated restoration, and high-filled flowable composite (Clearfil Majesty™ Flow). The biaxial flexural strength was calculated. There were significant effects of material, thickness, and luting procedure on flexural strength (p < 0.001). Resin composite specimens exhibited lower flexural strength (90 MPa) compared to lithium disilicate specimens (571 MPa), with thicker restorations (338 MPa) being stronger than thinner ones (323 MPa). Light-curing cement showed the highest strength (408.8 MPa)A, followed by dual-curing cement (362 MPa)B, pre-heated cement with pre-heated composite (318 MPa)C, pre-heated composite (304 MPa)C, and flowable resin composite (259 MPa)D. The light-curing cement yielded similar results to the pre-heated resin composite associated or not with the pre-heated crown for the thicker lithium disilicate specimens, whereas for the thinner lithium disilicate specimens all luting procedures performed similarly. Thin resin composite discs showed higher flexural strength when luted with light-curing cement, whereas the luting procedure had less influence for the thicker restorations. Luting procedures impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations. Pre-heated resin composite, with or without pre-heated restoration, can replace dual-curing cement. Nevertheless, light-curing cement is superior for resin composite and 1.5 mm lithium disilicate restorations. Different luting procedures significantly impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations, with light-curing cement demonstrating superior performance for specific thicknesses. Pre-heated resin composites, either with or without pre-heated restorations, offer a viable alternative to conventional dual-curing cement for bonding indirect restorations, presenting potential clinical advantages. Restoration thickness plays a crucial role in the mechanical response of restorations, with thinner resin composite restorations benefiting from dual- or light-curing, while thicker ones are less sensitive to luting procedure variations. [ABSTRACT FROM AUTHOR]

With the purpose of further reducing surface free energy to achieve better anti-bacterial adhesion effect of fluorinated dimethacrylate (FDMA)/tricyclo (5.2.1.0) decanedimethanol diacrylate (SR833s) based dental resin composites (DS), 1H,1H-heptafluorobutyl methacrylate (FBMA) was used to partially replace SR933s as reactive diluent. According to the degree of substitution, the obtained resin composites were marked as DSF-1 (20 wt.% of SR833s was replaced by FBMA), DSF-2 (40 wt.% of SR833s was replaced by FBMA), and DSF-3 (60 wt.% of SR833s was replaced by FBMA). Bisphenol A glycidyl dimethacrylate (Bis-GMA)/triethylene glycol dimethacrylate (TEGDMA) based resin composite (BT) was used as control. The influence of FBMA concentration on double bond conversion (DC), contact angle, surface free energy, anti-bacterial adhesion effect against Streptococcus mutans (S. mutans), volumetric shrinkage (VS) and shrinkage stress (SS), flexural strength (FS) and modulus (FM), water sorption (WS) and solubility (SL) were investigated. The results showed that FBMA addition could reduce surface free energy from 44.6 mN/m for DS to 32.9 mN/m for DSF-3, and lead to better anti-bacterial adhesion effect (the amounts of adherent bacteria decreased from 2.03 × 105 CFU/mm2 for DS to 6.44 × 104 CFU/mm2 for DSF-3). The FBMA had no negative effects on DC, VS, SS, WS, and SL. Too high a concentration of FBMA reduced FS and FM before water immersion, but the values were still higher than those of BT. [ABSTRACT FROM AUTHOR]

To assess the influence of dentifrices with different abrasiveness levels on the properties of dental reconstructive materials. Forty-eight cylinders were obtained from four polymeric materials, being two CAD/CAM acrylic resins (Ivotion-Dent and Ivotion-Base), one injected acrylic resin (IvoBase-Hydrid) and one light-cured resin composite (Empress Direct). Specimens were allocated to four subgroups for toothbrushing simulation according to the dentifrice relative dentin abrasivity (RDA) and silica content: (i) RDA 0 = 0%; (ii) RDA 50 = 3%; (iii) RDA 100 = 10%; and (iv) RDA 120 = 25%. Specimens were then subjected to toothbrushing. Surface analyses [surface roughness Ra (SR) and scanning electron microscopy (SEM)] along with hardness and optical properties [translucency parameter (TP) and contrast ratio (CR)] were evaluated before and after toothbrushing. Statistical analyses were performed using ANOVA and Tukey test. A significant increase in SR was observed after toothbrushing with higher RDA toothpastes for Ivotion-Dent (100 and 120) and IvoBase-Hybrid (120). Ivotion-Base and Empress Direct presented no significant differences in SR when analyzed as a function of timepoint and RDA levels. Hardness was not influenced by toothbrushing with different RDA dentifrices, except for Empress Direct with RDA 0 toothpaste, where a decrease in the hardness was observed. TP of Ivotion-Dent and Empress Direct significantly decreased after toothbrushing with higher RDA dentifrices and CR of Ivotion-Dent, Empress Direct and IvoBase-Hybrid significantly increased with higher RDA dentifrices. The levels of dentifrice abrasiveness affected differently the SR, hardness and optical properties of polymeric reconstructive materials after toothbrushing. [ABSTRACT FROM AUTHOR]

To investigate the properties (tensile strength, roughness, abrasiveness) of different dental flosses and how these properties relate to subjective preference for floss by users. Four flosses of differing compositions were selected (polytetrafluoroethylene (PTFE), nylon, silk, and ultra-high-molecular-weight polyethylene (UHMWPE)). Tensile strength (TS) was measured utilising a universal testing machine (total n = 40). Surface roughness (Ra) was measured on 3D reconstructed models of scanning electron microscope and abrasiveness was measured through block-on-ring tests against human enamel. Subjective preference for floss was measured by asking a sample of 16 individuals to use each floss for an 8-day period using a split-mouth design. The highest TS was found in UHMWPE floss (194.18 ± 24.61 MPa) while the lowest TS was found in PTFE floss (11.78 ± 0.77 MPa). Silk floss had the highest Ra (0.304 ± 0.025 µm) while PTFE floss had the lowest (0.048 ± 0.003 µm). In-vitro abrasion testing of the flosses identified no significant differences between the flosses in causing wear on tooth enamel. Subjective ratings of flosses indicated PTFE floss to be most preferred and nylon floss to be least preferred. There was a difference in subjective preference between dental flosses composed of different materials. The PTFE floss was the overall most preferred while the nylon floss was the least preferred. There was also an association between the mechanical properties and preference for their usage, with PTFE floss being the most preferred but having the lowest surface roughness and tensile strength. This study compared a wide range of mechanical properties and subject preferences of commercially available dental floss. The results of this study can provide guidance for the recommendation of dental floss for oral hygiene routines. [ABSTRACT FROM AUTHOR]

Several in vitro studies utilizing 2-dimensional (2D) cell culture systems have linked 2-hydroxyethyl methacrylate (HEMA) with cytotoxic effects in oral mucosa and dental pulp cells. Although such studies are invaluable in dissecting the cellular and molecular effects of HEMA, there is a growing interest in the utilization of appropriate 3-dimensional (3D) models that mimic the structure of oral mucosa. Using a previously characterized 3D-organotypic co-culture model, this study aimed to investigate the cellular and molecular effects of HEMA on a 3D-co-culture model consisting of primary normal oral keratinocyte (NOK) grown directly on top of collagen I gel containing primary oral fibroblasts (NOF). The second aim was to examine the suitability of a 3D-co-culture system consisting of oral squamous cell carcinoma (OSCC) cells as a model system to investigate the biological effects of HEMA. We demonstrated that HEMA treatment led to reduced viability of NOK, NOF and OSCC-cell lines in 2D-culture. The keratinocytes in 3D-co-cultures of NOK and OSCC-cells reacted similarly with respect to cell proliferation and activation of autophagy flux, to HEMA treatment. Nevertheless, NOK was found to be more susceptible to apoptosis following HEMA treatment than OSCC in 3D-co-cultures. These results indicate that 3D-organotypic co-cultures of NOK might represent an appropriate model system for the investigation of the biological effects of HEMA and other dental biomaterials. Given the challenges in obtaining primary cultures of NOK and issues associated with their rapid differentiation in culture, the possible use of OSCC cells as an alternative to NOK for 3D models represents an area for future research. [ABSTRACT FROM AUTHOR]

This laboratory study aimed to measure the push-out bond strength of individually formed fiber-reinforced composite (FRC) post luted with flowable short fiber-reinforced composite (SFRC) and to evaluate the influence of post coating with light-cured adhesive. Post spaces (Ø 1.7 mm) were drilled into 20 single-rooted decoronated premolar teeth. Post spaces were etched and treated with light-cured universal adhesive (G-Premio Bond). Individually formed FRC posts (Ø 1.5 mm, everStick) were luted either with light-cured SFRC (everX Flow) or conventional particulate-filled (PFC) dual-cure luting cement (G-CEM LinkForce). Half of the posts from each group were treated with dimethacrylate adhesive resin (Stick Resin) for 5 min before luting. After storage in water for two days, the roots were sectioned into 2 mm thick disks (n = 10/per group). Then, a push-out test-setup was used in a universal testing machine to measure the bond strength between post and dentin. The interface between post and SFRC was inspected using optical and scanning electron microscopy (SEM). Data were statistically analyzed using analysis of variance ANOVA (p =.05). Higher bond strength values (p <.05) were obtained when flowable SFRC was used as a post luting material. Resin coating of a post showed no significant effect (p >.05) on bond strength values. Light microscope images showed the ability of discontinuous short fibers in SFRC to penetrate into FRC posts. The use of flowable SFRC as luting material with individually formed FRC posts proved to be a promising method to improve the interface adhesion. [ABSTRACT FROM AUTHOR]

To compare the cumulative impact of sequential wear on mechanical properties and appearance of a composite resin (CR), Filtek Z250®, a glass ionomer GI, Fuji IX GP®, and a glass hybrid (GH), Equia Forte®. Six equally sized specimens of each material were subjected to wear tests, i.e., simulation of brushing, chewing and acidic liquid exposure, mimicking at least 6 months of clinical exposure. Surface roughness, hardness, substance loss and degree of shade lightness were determined. Following wear tests, significant increase in surface roughness and decrease in hardness values were observed for all materials (p <.05). Significantly larger substance loss was found in Equia Forte® specimens compared to Filtek Z250® (p <.05), while that of Fuji IX® exceeded the measurement capacity of the instrument. Opposite to the two other materials, the shade of Filtek Z250® became darker. Sequential wear exposure mimicking abrasion, erosion and attrition to products representing CR, GI and GH, caused weakening and change in appearance of the materials. The composite resin was the most mechanically resistant to the sequential wear. [ABSTRACT FROM AUTHOR]