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Background: Down syndrome (DS) population has a very high prevalence of obstructive sleep apnoea (OSA), but this remains underdiagnosed. Hence, we aimed to evaluate caregiver's knowledge of OSA and related sociodemographic factors that could contribute to OSA screening patterns in this population. Methods: An online survey though the LuMind IDSC Foundation focused on OSA diagnosis, treatments and the number of sleep studies performed. Data were compared between subjects born before and after the American Academy of Pediatrics (AAP) recommendations for OSA screening. Results: Of the caregivers, 724 (parents 96.3%), responded to the survey. The median [interquartile (IQR)] age of the subjects with DS was 12 [20;7] years. The majority (84.3%) had sleep apnoea diagnosis, and half of them were initially referred for a sleep study due to disturbed sleep symptoms. Only 58.7% of the responders were aware of the AAP recommendations. This was linked to higher socioeconomic and/or educational level and to an earlier OSA diagnosis. The median (IQR) age of OSA diagnosis was lowered after the AAP guidelines publication compared with before its publication (3 [4;2] years vs. 10 [18;5] years, P < 0.000). Adenotonsillectomy (81.9%) and continuous positive airway pressure (61.5%) were the most commonly prescribed treatments. Few had discussed other new therapies such as hypoglossal nerve stimulation (16.0%). Only 16.0% of the subjects repeated the sleep study to monitor OSA with ageing, and 30.2% had to wait more than 4 years between studies. Conclusions: This study reinforces the need to improve OSA knowledge of caregivers and clinicians of individuals with DS to promote an earlier diagnosis and optimal treatment of OSA in this population. [ABSTRACT FROM AUTHOR]

Aim: To evaluate in a laboratory setting the antimicrobial properties and the potential to inhibit biofilm formation of novel remineralizing polymeric nanoparticles (NPs) when applied to dentine surfaces and to ascertain the effect of the functionalization of these NPs with zinc, calcium or doxycycline. Methodology: The antimicrobial activity and inhibition of biofilm formation of polymeric NPs were analysed on human dentine blocks that were infected with Enterococcus faecalis before or after application of NPs. LIVE/DEAD ® testing under Confocal Laser Scanning Microscopy and bacterial culturing were employed to analyse biofilm biovolume and bacterial viability. Field Emission Scanning Electron Microscopy was also employed to assess biofilm morphology. One‐way anova with Welch's correction and post hoc comparison by the Games–Howell test were performed for comparisons between groups. Results: The un‐functionalized NPs displayed the greatest antimicrobial activity against E. faecalis biofilms as they provided the lowest biovolume (3865.7 ± 2926.97 µm3; P < 0.001) and the highest dead/injured cells percentage (79.93 ± 18.40%; P < 0.001), followed by Dox‐NPs (biovolume: 19,041.55 ± 17,638.23 µm3, dead/injured cells: 45.53 ± 26.50%; P < 0.001). Doxycycline‐loaded NPs had the largest values of inhibition of biofilm formation with the lowest biofilm biovolume (8517.65 ± 7055.81 µm3; P < 0.001) and a high dead/injured bacterial percentage (68.68 ± 12.50%; P < 0.001). Un‐functionalized NPs did not reduce biomass growth (P > 0.05), but attained the largest percentage of compromised cells (93 ± 8.23%; P < 0.001), being able to disrupt biofilm formation. It also produced occlusion of dentinal tubules, potentially interfering with bacterial tubule penetration. Conclusions: A new generation of bioactive nano‐fillers (doxycycline‐functionalized polymeric NPs) had antibacterial activity and occluded dentinal tubules. Incorporating these NPs into endodontic sealers may have the potential to enhance the outcome of root canal treatment. [ABSTRACT FROM AUTHOR]

In view of the rapid proliferation of water infrastructures worldwide, balancing human and ecosystem needs for water resources is a critical environmental challenge of global significance. While there is abundant literature on the environmental impacts of individual water infrastructures, little attention has been paid to their cumulative effects in river networks, which may have basin‐to‐global impacts on freshwater ecology. Here we developed a methodological framework based on Pareto frontier analysis for optimizing trade‐offs between water withdrawal and ecological indicators. We applied this framework to a mountainous Ecuadorian headwater river network that is part of a continental water transfer for supply and demand management to optimize ecological conditions and the operation of 11 water intake structures used to provide potable water to the city of Quito. We found that the current water intake configuration has an important effect on the total length of fifth‐order stream sections (65% reduction compared to premanaged condition) and isolates 70.9% of the headwater stream length. The Pareto frontier analysis identified water intake portfolios (i.e., different combinations of intake sites) that decreased ecological impacts by 7.8% points (pp) and 13.0 pp for connectivity and stream order change, respectively, while meeting Quito's water demands. Additional portfolios accounting for monthly variability in water demand and resources further decrease the ecological impact up to 9.6 pp in connectivity and 13.4 pp in stream order. These eco‐friendly portfolios suggest that adaptive management at basin level may help optimize water withdrawal to fulfill urban demands while preserving ecological integrity. Key Points: We develop a methodological framework to perform trade‐off analyses between water withdrawal and ecological impacts at the basin scaleThrough a Pareto frontier analysis, the operation of 11 water intake structures used to provide potable water to Quito City is optimizedApplication of new water management practices are necessary to reach a more dynamic operation strategy to balance human and ecological needs [ABSTRACT FROM AUTHOR]

Abstract: Aim: To investigate if crystallinity and ultrastructure are modified when cervical dentine is treated with four different nanogels‐based solutions for remineralizing purposes. Methodology: Experimental nanogels based on polymeric nanoparticles (NPs) and zinc, calcium or doxycycline‐loaded NPs were applied to citric acid etched dentine to facilitate the occlusion of tubules and the mineralization of the dentine surface. Dentine surfaces were studied by X‐ray diffraction and transmission electron microscopy through selected area diffraction and bright‐field imaging. Results: Crystals at the dentine surface were identified as hydroxyapatite with the highest crystallographic maturity and crystallite size in dentine treated with Zn‐NPs‐based gel. Texture increased in all samples from 24 h to 7 days, except in dentine surfaces treated with Zn‐NPs gel. Polyhedral, plate‐like and drop‐like shaped apatite crystals constituted the bulk of minerals in dentine treated with Zn‐NPs gel, after 7 days. Polymorphic, cubic and needle‐like shaped crystals distinguished minerals, with more amorphous characteristics in dentine treated with Ca‐NPs gel after 7 days than that found when Zn‐NPs were applied. Doxycycline‐NPs produced the smallest crystallites with poor crystallinity, maturity and chemical stability. Conclusions: Crystalline and amorphous phases of newly formed hydroxyapatite were described in both types of dentine treated with Zn‐NPs as well as Ca‐NPs gels with multiple shapes of crystallites. Crystal shapes ranged from rounded/drop‐like or plate‐like crystals to needle‐like or polyhedral and cubic apatite appearance. [ABSTRACT FROM AUTHOR]

Aim To evaluate the remineralization ability of two endodontic sealer cements. Methodology Mid-coronal dentine surfaces were subjected to: (i) 37% phosphoric acid ( PA) or (ii) 0.5 mol L−1 ethylenediaminetetraacetic acid ( EDTA) conditioning prior to the application of two experimental hydroxyapatite-based cements, containing sodium hydroxide (calcypatite) or zinc oxide oxiapatite respectively. Samples were stored in simulated body fluid for 24 h or 21 days. Remineralization of the dentine surfaces were studied by Raman spectroscopy (mapping with K-means cluster and hierarchical cluster analysis) was undertaken. Nanoroughness and collagen fibril width measurements were performed with an atomic force microscopy. ANOVA and Student-Newman-Keuls test were performed (α=0.05). Results Phosphoric acid+oxiapatite promoted both the highest dentine mineralization ( P < 0.05) and crystallographic maturity at the dentine surface. Noncrystalline amorphous-like apatites were also formed. Dentine treated with PA+calcypatite attained the roughest surface ( P < 0.05) with minimal fibril width ( P < 0.05). Cross-linking of collagen only became greater in the group PA+oxiapatite after 21 days. The maximum relative mineral concentration and structure of collagen linked to the amide I and ratio amide III/ AGEs was obtained after using PA+calcypatite at 21-days time-point ( P < 0.05). EDTA produced a lower stoichiometric hydroxyapatite ( P < 0.05) with decreased maturity, at the expense of carbonate band widening, although it favoured the nucleation of carbonated calcium phosphate. Conclusions Dentine surfaces treated with PA+oxiapatite attained the highest dentine remineralization with both crystalline-stoichiometric and amorphous apatites, at 21 days. EDTA conditioning facilitated amorphous-bulk mineral precipitation. The amorphization was more intense after using oxiapatite and provided an ion-rich environment favouring in situ dentine remineralization. [ABSTRACT FROM AUTHOR]

This paper presents a model of power light emitting diodes (LEDs) based on electrical variables and considering the concept of LED 'equivalent resistance', which has previously been used in discharge lamp modelling and is suitable to achieve fast simulations of LED converter systems. The model can be obtained with only some simple electrical measurements, thus making its implementation quite straightforward. The proposed model is oriented to the electronic engineering area, and it has special application for the simulation of the electrical behaviour of LEDs and dc-dc converter systems by using software like Simulink. In addition, the proposed model can also be employed for the theoretical analysis and design of LED drivers. Experimental and simulation results are obtained proving the feasibility of the proposed model. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim To characterize three radiopaque Magnesium Phosphate Cements ( MPCs) developed for endodontic purposes. Methodology Three experimental MPCs containing Bi2O3 were formulated. The experimental cements, which consisted of mixtures of magnesium oxide with different phosphate salts, were characterized for setting time, injectability, porosity, compressive strength and phase composition. The long-term sealing ability of the experimental MPCs applied in single-rooted teeth as root canal filling material or as sealer in combination with gutta-percha was also assessed using a highly sensitive fluid filtration system. A mineral trioxide aggregate ( MTA) cement was used as control. Statistical analysis was performed with two- or three-way analysis of variance ( anova) and Tukey's test was used for comparisons. Results The addition of 10 wt% Bi2O3 within the composition of the MPCs provided an adequate radiopacity for endodontic applications according to ISO 6876 standard. The reaction products resulting from the MPCs were either struvite (Mg NH4 PO4·6H2O) or an amorphous sodium magnesium phosphate. The porosity of the three MPCs ranged between 4% and 11%. The initial setting time of the experimental cements was between 6 and 9 min, attaining high early compressive strength values (17-34 MPa within 2 h). All MPC formulations achieved greater sealing ability than MTA ( P < 0.05) after 3 months, which was maintained after 6 months for two of the experimental cements ( P < 0.05). Conclusions These MPCs had adequate handling and mechanical properties and low degradation rates. Furthermore, a stable sealing ability was demonstrated up to 6 months when using the cement both as root filling material and as sealer in conjunction with gutta-percha. [ABSTRACT FROM AUTHOR]

Background: Dentine hypersensitivity occurs easily on exposed dentine. This study aimed to evaluate the effectiveness of a novel bioactive glass-containing toothpaste on dentine permeability and remineralization. Methods: Thirty dentine discs were divided into three groups of 10 specimens each. The groups corresponded to the following brushing treatments: no brush, distilled water, and bioactive glass-containing toothpaste (Novamin). The toothpaste was applied twice a day for 7 days. Dentine permeability was measured after ethylene-diamine-tetraacetic acid (EDTA) etching, initial application, 3-day application, 7-day application and citric acid challenge, respectively. The dentine morphology was investigated using scanning electron microscopy (SEM). Attenuated total reflection Fourier transform infrared (ATR/FTIR) spectroscopy was performed to monitor the mineral variation on demineralized dentine. Qualitative information of elemental variation before and after treatments on completely demineralized dentine was detected by energy dispersive X-ray (EDX) analysis. Results: The bioactive glass-containing toothpaste significantly reduced dentine permeability after the 7-day treatment and showed, under SEM, excellent resistance to acid challenge compared to the other groups. ATR/FTIR and EDX revealed increased mineral content after treatment with Novamin. Conclusions: As the innovative bioactive glass-containing toothpaste occlude dentinal tubules and resist acid challenge, it may be useful for the treatment of dentine hypersensitivity and dentine remineralization. [ABSTRACT FROM AUTHOR]

Background: Apathy is an important and distressing behavioural symptom in Alzheimer’s disease and in various neuropsychiatric disorders. Recently, diagnostic criteria for apathy have been proposed. Objectives: In groups of patients suffering from different neuropsychiatric diseases, (i) to estimate the prevalence of patients meeting the proposed diagnostic criteria; (ii) to estimate the concurrent validity of the criteria with the neuropsychiatric inventory (NPI) apathy item; (iii) to identify the most frequently met criteria or sub-criteria in each specific neuropsychiatric disease and (iv) to estimate the inter-observer reliability of the diagnostic criteria for apathy. Methods: This cross-sectional, multicentric, observational study was performed on 306 patients. Each of the participating centres had to check the presence of apathy according to the diagnostic criteria for apathy in consecutive patients belonging to the following diagnoses list: Alzheimer disease (AD), mixed dementia, mild cognitive impairment (MCI), Parkinson’s disease (PD), Schizophrenia (DSM-IV) and major depressive episode. In addition to the clinical interview, the assessment included the Mini Mental Score Examination (MMSE) and the NPI. At the end of the visit, clinicians were required to check the diagnostic criteria for apathy. Results: Using the diagnostic criteria for apathy, the frequency of apathy was of 53% in the whole population, 55% in AD, 70% in mixed dementia, 43% in MCI, 27% in PD, 53% in schizophrenia and 94% in major depressive episode. In AD, mixed dementia, MCI and PD, the NPI apathy score was significantly higher for patient fulfilling the apathy criteria. Goal-directed cognitive activity (criteria B2-Cognition) was the most frequently observed domain followed by goal-directed behaviour (criteria B1—Behaviour) and emotion (criteria B3), respectively. Inter-rater reliability was high for the overall diagnostic (κ coefficient = 0.93; p = 0.0001) and for each criteria. Conclusion: This study is the first one to test the diagnostic criteria for apathy in clinical practice. Results make the diagnostic criteria useful for clinical practice and research. [ABSTRACT FROM AUTHOR]

Summary. Forty children (20 boys and 20 girls) aged 8-16 years with no previous experience of dental visits were included in the study. Three psychological variables were determined: anxiety (State-Trait Anxiety Inventory of Children), personality (Eysenck Personality Questionnaire-Junior) and intelligence (Wechsler Intelligence Scale for Children). The relationship between personality and intelligence factors and the levels of anxiety at the beginning of the first dental visit (before treatment) and at the end of the third visit (after treatment) were determined. There was no significant relationship between levels of dental anxiety and age. Dental anxiety both before and after treatment was higher among the girls than among the boys. Children with high intelligence quotients showed less dental anxiety at their first dental visit. There was no relationship between the children's anxiety and their own personality variables. Résumé. La peur du dentiste chez l'enfant: influence de l'intelligence et de la personnalité Quarante enfants (20 garçons et vingt filles) âgés de 8-16 ans, qui n'avaient jamais eu de soins dentaires, ont été étudiés. Trois variables psychologiques ont été déterminées à l'aide de tests: l'anxiété (inventaire des symptômes d'anxiété chez l'enfant), la personnalité (questionnaire d'Eysenck de personnalité pour jeunes) et intelligence (échelle d'intelligence de Wechsler pour enfants). Les relations entre la personnalité et l'intelligence et le niveau d'anxiété, au début de la première consultation (avant traitement) et à la fin de la troisième consultation (après traitement) on été notées. Il n'y avait pas de relation significative entre le niveau d' anxiété et l'âge. l'anxiété dentaire, avant et après traitement, était plus élevée chez les filles que chez les garçons. Les enfants, dont le quotient intellectuel était élevé, souffraient moins d'anxiété dentaire lors de la première consultation. Il n'y avait pas de relation significative entre l'anxiété des enfants et les variables de leur personnalité. Zusammenfassung. Kinder Angst vor den Zahnartzt: Der Einfluss der Intelligenz und Personalität Anhand von allgemein anerkannten Instrumenten wurden Kinder (20 Jungen und 20 Mädchen) im Alter zwischen 8 und 16 Jahren untersucht, die zuvor noch keine zahnärztliche Praxis besucht hatten. Es wurden die folgenden psychologischen Variablen analisiert: Ängstlichkeit (Test STAIC), Persönlichkeit (Test EPQ-J) und Intelligenz (Test WISC). Zwischen diesen psychologischen Factoren und der Ausprägung der Ängstlichkeit wurde eine Beziehung vor und nach unterschiedliechen zahnärztlichen Behandlungen hergestellt. Es besteht keine Beziehung zwischen der Ausprägung der Ängstliichekeit und dem Alter. Offensichtlich geben Kinder mit hohem Intelligenzkoefizient weniger Ängstlichkeit bei ihrem ersten zahnärztlichen Besuch Zu erkennen als diejenigen mit niedrigem Koefizient. Die Ängslichkeit vor dem Zahnarzt ist in der Gruppe der Mädchen höher ausgeprägt als bei den Jungen. Es kann keine Beziehung hergestellt werden zwischen der Ängstglichkeit der Kinder und der Variablen, die die eigene Persönlichkeit bestimmen. Resumen. Ansiedad dental en niños: influencia de los factores personalidad e inteligencia Se estudiaron 40 niños (20 varones y 20 hembras) de 8-16 años de adad sin visitas previas al consultorio dental. Se analizaron las siguientes variables psicológicas: ansiedad (test STAIC: State-Trait Anxiety Inventory of Children), personalidad (test EPQ-J: Eysenck Personality Questionnaire-Junior), e inteligencia (test de WISC: Wechsler Intelligence Scale for Children). No se detectó relación entre estos factores psicológicos y los niveles de ansiedad y la edad. La ansiedad fue mayor en las niñas que en los niños. Los niños con alto coeficiente intelectual manifestaron menos ansiedad en su primera visia dental que aquellos con dicho coeficiente más bajo. No se encontró relación entre la ansiedad de los niños y la variables que determinan su propia personalidad. [ABSTRACT FROM AUTHOR]

A simple electronic circuit for the characterisation of high-intensity discharge (HID) lamps in the frequency domain by obtaining the transfer function of the lamp impedance is presented. The circuit uses a low cost power amplifier to apply a sinewave to the current and the voltage in the lamp. Also, this circuit employs an ordinary igniter based on a high voltage transformer. This circuit is a good alternative when a ballast designer prefers to get a lamp model from experimental Bode plots, and when a low budget is available to build a test bench to characterise HID lamps. Simulations and experimental results obtained from an HPS lamp are shown. [ABSTRACT FROM AUTHOR]

Background: Ventilator-induced diaphragm dysfunction occurs rapidly following the onset of mechanical ventilation and has significant clinical consequences. Phrenic nerve stimulation has shown promise in maintaining diaphragm function by inducing diaphragm contractions. Non-invasive stimulation is an attractive option as it minimizes the procedural risks associated with invasive approaches. However, this method is limited by sensitivity to electrode position and inter-individual variability in stimulation thresholds. This makes clinical application challenging due to potentially time-consuming calibration processes to achieve reliable stimulation., Methods: We applied non-invasive electrical stimulation to the phrenic nerve in the neck in healthy volunteers. A closed-loop system recorded the respiratory flow produced by stimulation and automatically adjusted the electrode position and stimulation amplitude based on the respiratory response. By iterating over electrodes, the optimal electrode was selected. A binary search method over stimulation amplitudes was then employed to determine an individualized stimulation threshold. Pulse trains above this threshold were delivered to produce diaphragm contraction., Results: Nine healthy volunteers were recruited. Mean threshold stimulation amplitude was 36.17 ± 14.34 mA (range 19.38-59.06 mA). The threshold amplitude for reliable nerve capture was moderately correlated with BMI (Pearson's r = 0.66, p = 0.049). Repeating threshold measurements within subjects demonstrated low intra-subject variability of 2.15 ± 1.61 mA between maximum and minimum thresholds on repeated trials. Bilateral stimulation with individually optimized parameters generated reliable diaphragm contraction, resulting in significant inhaled volumes following stimulation., Conclusion: We demonstrate the feasibility of a system for automatic optimization of electrode position and stimulation parameters using a closed-loop system. This opens the possibility of easily deployable individualized stimulation in the intensive care setting to reduce ventilator-induced diaphragm dysfunction., (© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Objective: The aim of the study was to evaluate the effect of doxycycline- and dexamethasone-doped collagen membranes on the proliferation and differentiation of osteoblasts., Background: Collagen barrier membranes are frequently used to promote bone regeneration and to boost this biological activity their functionalization with antibacterial and immunomodulatory substances has been suggested., Methods: The design included commercially available collagen membranes doped with doxycycline (Dox-Col-M) or dexamethasone (Dex-Col-M), as well as undoped membranes (Col-M) as controls, which were placed in contact with cultured MG63 osteoblast-like cells (ATCC). Cell proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay and differentiation by measuring the alkaline phosphatase (ALP) activity using spectrophotometry. Real-time quantitative polymerase chain reaction was used to study the expression of the genes: Runx-2, OSX, ALP, OSC, OPG, RANKL, Col-I, BMP-2, BMP-7, TGF-β1, VEGF, TGF-βR1, TGF-βR2, and TGF-βR3. Scanning electron microscopy was used to study osteoblast morphology. Data were assessed using one-way analysis of variance or Kruskal-Wallis tests, once their distribution normality was assessed by Kolmogorov-Smirnov tests (p > .05). Bonferroni for multiple comparisons were carried out (p < .05)., Results: Osteoblast proliferation was significantly enhanced in the functionalized membranes as follows: (Col-M < Dex-Col-M < Dox-Col-M). ALP activity was significantly higher on cultured osteoblasts on Dox-Col-M. Runx-2, OSX, ALP, OSC, BMP-2, BMP-7, TGF-β1, VEGF, TGF-βR1, TGF-βR2, and TGF-βR3 were overexpressed, and RANKL was down-regulated in osteoblasts cultured on Dox-Col-M. The osteoblasts cultured in contact with the functionalized membranes demonstrated an elongated spindle-shaped morphology., Conclusion: The functionalization of collagen membranes with Dox promoted an increase in the proliferation and differentiation of osteoblasts., (© 2022 The Authors. Journal of Periodontal Research published by John Wiley & Sons Ltd.)

Background: Diaphragm muscle atrophy during mechanical ventilation begins within 24 h and progresses rapidly with significant clinical consequences. Electrical stimulation of the phrenic nerves using invasive electrodes has shown promise in maintaining diaphragm condition by inducing intermittent diaphragm muscle contraction. However, the widespread application of these methods may be limited by their risks as well as the technical and environmental requirements of placement and care. Non-invasive stimulation would offer a valuable alternative method to maintain diaphragm health while overcoming these limitations., Methods: We applied non-invasive electrical stimulation to the phrenic nerve in the neck in healthy volunteers. Respiratory pressure and flow, diaphragm electromyography and mechanomyography, and ultrasound visualization were used to assess the diaphragmatic response to stimulation. The electrode positions and stimulation parameters were systematically varied in order to investigate the influence of these parameters on the ability to induce diaphragm contraction with non-invasive stimulation., Results: We demonstrate that non-invasive capture of the phrenic nerve is feasible using surface electrodes without the application of pressure, and characterize the stimulation parameters required to achieve therapeutic diaphragm contractions in healthy volunteers. We show that an optimal electrode position for phrenic nerve capture can be identified and that this position does not vary as head orientation is changed. The stimulation parameters required to produce a diaphragm response at this site are characterized and we show that burst stimulation above the activation threshold reliably produces diaphragm contractions sufficient to drive an inspired volume of over 600 ml, indicating the ability to produce significant diaphragmatic work using non-invasive stimulation., Conclusion: This opens the possibility of non-invasive systems, requiring minimal specialist skills to set up, for maintaining diaphragm function in the intensive care setting., (© 2022 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

In the latest recommendations for the management of chronic-phase chronic myeloid leukemia suboptimal responses have been reclassified as "warning responses." In contrast to previous recommendations current guidance advises close monitoring without changing therapy. We have identified 198 patients treated with first-line imatinib, with a warning response after 12 months of treatment (patients with a complete cytogenetic response but no major molecular response [MMR]). One hundred and forty-six patients remained on imatinib, while 52 patients changed treatment to a second generation tyrosine kinase inhibitor (2GTKI). Changing therapy did not correlate with an increase in overall survival or progression-free survival. Nevertheless, a significant improvement was observed in the probability of a MMR: 24% vs. 42% by 12 months and 43% vs. 64% by 24 months (P = 0.002); as well as the probability of achieving a deep molecular responses (MR(4.5) ): 1% vs. 17% and 7% vs. 23% by 12 and 24 months, respectively (P = <0.001) .The treatment change to 2GTKI remained safe; however, we have observed a 19% of treatment discontinuation due to side effects. We have observed an improvement of molecular responses after changing treatment to 2GTKI in patients with late suboptimal response treated with imatinib first line. However, these benefits were not correlated with an improvement of progression free survival or overall survival., (© 2014 Wiley Periodicals, Inc.)

The aim of the study was to ascertain whether the addition of zinc to adhesives may decrease metalloproteinase-mediated collagen degradation without affecting bonding efficacy. Human dentin beams were treated with phosphoric acid, with Clearfil SE Bond Primer or with Clearfil SE Bond Primer plus ZnCl(2) (2 wt%). Acid-etched dentin was infiltrated with Single Bond, Single Bond plus ZnCl(2) (2 wt%), or Single Bond plus ZnO nanoparticles (10 wt%), and Clearfil SE Bond-primed dentin was infiltrated with Clearfil SE Bonding resin, Clearfil SE-Bonding resin with ZnCl(2) (2 wt%), or Clearfil SE-Bonding resin with ZnO nanoparticles (10 wt%). The C-terminal telopeptide concentrations were determined 24 h, and 1 and 4 wk after treatment. Microtensile bond strength to dentin was determined for the tested adhesives. Matrix metalloproteinases-mediated collagen degradation occurred in acid-etched and SE-primed dentin. Resin infiltration decreased collagen degradation. Lower collagen degradation was found for SE Bond than for Single Bond. Zinc-doped Single Bond resin always reduced collagen degradation, the ZnO particles being more effective than ZnCl(2) . Zinc-doped SE Bond reduced the liberation of C-terminal telopeptide only at 24 h. Bond strength to dentin was not decreased when Zn-doped resins were employed, except when ZnCl(2) was added to SE Primer. Zinc-doped resin reduced collagen degradation in Single Bond hybrid layers, but did not affect bond strength. The addition of zinc to SE Bond had no beneficial effects., (© 2011 Eur J Oral Sci.)

Dentin matrix metalloproteinases (MMPs) are involved in the degradation of collagen in resin-dentin interfaces. This study evaluated whether collagen degradation can be prevented by chlorhexidine digluconate (CHX) after different dentin demineralization procedures. The demineralization of human dentin was performed with phosphoric acid (PA), EDTA or acidic monomers (Clearfil SE Bond and Xeno V). Specimens were stored (for 24 h, or for 1 or 3 wk) in the presence or absence of CHX. In half of the groups, active MMP-2 was incorporated into the storage solution. At the end of each storage period, the C-terminal telopeptide (ICTP) concentration (which indicates the amount of collagen degradation) was measured in the storage solution. Collagen degradation was higher in PA- and EDTA-demineralized dentin. Chlorhexidine digluconate reduced collagen degradation in these groups only for 24 h. When dentin was demineralized with Clearfil SE Bond or Xeno V, collagen degradation was reduced by up to 30%, but the addition of exogenous MMP-2 significantly increased collagen degradation. In self-etchant-treated dentin, the inhibitory effect of CHX on MMPs lasted for up to 3 wk. Treating dentin with EDTA, PA or self-etching agents produces enough demineralization to permit cleavage of the exposed collagen. Monomer infiltration may exert protection on demineralized collagen, probably through immobilization of MMPs. The partial inhibitory action of CHX on MMP activity produced by self-etching adhesives was prolonged compared with the short-acting PA- or EDTA-treated dentin., (© 2011 Eur J Oral Sci.)

The effects of dentin surface treatments on the microtensile bond strengths and on the interfacial characteristics of self-adhesive resin cements were investigated. Flat dentin surfaces were obtained from human molars and were treated as follows: (i) no treatment of dentin; (ii) 0.1 M EDTA scrubbed for 60 s; or (iii) 10% polyacrylic acid applied for 30 s. Three self-adhesive cements were used to lute composite overlays on deep-coronal dentin surfaces in the presence of simulated pulpal pressure (15 cm of H(2)O). Bonded specimens were cut into beams 1 mm thick and stressed in tension until failure. Fractured sticks were examined under a scanning electron microscope. Additional specimens were stained with Masson's trichrome and observed under light microscopy for interfacial evaluations. The bond strength to dentin of the hydrophobic and solvent-free cement (RelyX Unicem) was unaffected by the tested dentin treatments. The bond strength of the 2-hydroxyethyl methacrylate (HEMA)-based cement (Bis-Cem) decreased after treatment of dentin with EDTA and/or polyacrylic acid. The hydrophilic and water-containing cement (G-Cem) attained a higher bond strength when luted on polyacrylic acid-conditioned dentin. In conclusion, smear layer removal, opening of dentinal tubules, and the water content of dentin differently influence the bond strengths and the interfacial characteristics of self-adhesive cement-dentin interfaces.

The hydrolytic stability of composite repairs is a desirable property. In the present study, the composite repair microtensile bond strength, failure mode distribution, and nanoleakage occurrence before and after thermocycling were evaluated. Standardized, 1-month-old composite substrates were roughened, cleaned, and randomly assigned to seven groups according to the intermediate agent applied. Resin-based, silane-based, and combined silane/adhesive coupling agents were investigated. The same resin composite as the substrate was used for repair. For each group, repaired samples were wet stored for 24 h (37 degrees C) or thermocycled (5,000 cycles, 5-55 degrees C). Failure mode and silver nitrate penetration were examined by stereomicroscopy. Intermediate agent, experimental condition, and their interaction were significant factors. Hydrophobic flowable composites resulted in statistically higher repair strengths, lower occurrence of adhesive failures, and good quality interfacial coupling without any silver uptake in both conditions. Light-curing, hydrophilic resin monomer-based intermediate agents, although not affected by thermocycling, showed a more pronounced silver penetration. The composite repair strength of a self-curing silane/adhesive agent was significantly affected by thermal stresses, despite the absence of silver uptake. A prehydrolized silane agent recorded the lowest repair strength, with minimal or no evidence of interfacial silver impregnation after thermocycling. In conclusion, flowability and hydrophobic nature can be considered important properties when selecting intermediate agents for composite repair.

Objective: To determine the incidence of focal head and neck posttransplant lymphoproliferative disorder (PTLD) in children, its clinical presentation, associated risk factors, and outcome following treatment., Study Design: Retrospective., Methods: The authors conducted a 5-year retrospective study of 61 children with liver transplants at the University of California, San Francisco. Suspected head and neck lesions were evaluated and biopsies were performed by an otolaryngologist. Diagnosis was made via histologic and immunohistochemical features and in situ Epstein-Barr virus (EBV) localization., Results: Eight patients (13.1%) developed PTLD, five (8.2%) in the head and neck. Four patients had large tonsils, and one presented with airway obstruction from a supraglottic mass. Negative pretransplant EBV serology was a risk factor for PTLD. Treatment consisted of antiviral therapy and decreased immunosuppression. All patients with head and neck PTLD are disease free with excellent liver function., Conclusions: A high incidence of PTLD was found, with 63% presenting in the head and neck. While Waldeyer's ring is most commonly involved, PTLD may also present in the supraglottis. Adjunctive antiviral therapy and decreased immunosuppression are effective forms of treatment. Given the increasing number of pediatric liver transplants being performed, otolaryngologists should be familiar with PTLD and have a high index of suspicion in this at-risk population.