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Patients present to the emergency department in various stages of chronic illness. Advance directives (ADs) aid emergency physicians in making treatment decisions, but only a minority of Americans have completed an AD, and the percentage of those who have discussed their end‐of‐life wishes may be even lower. This article addresses the use of common ADs and roadblocks to their use from the perspectives of families, patients, and physicians. Cases to examine new approaches to optimizing end‐of‐life conversations in patients who are chronically ill, such as the Improving Palliative Care in Emergency Medicine Project, a decision‐making framework that opens discussion for patients to gain understanding and determine preferences, and the Brief Negotiated Interview, a 7‐minute, scripted, motivational interview that determines willingness for behavior change and initiates care planning, are used.

Purpose: Micrometer-sized spherules formed of hydroxyapatite or whitlockite were identified within extracellular deposits that accumulate in the space between the basal lamina (BL) of retinal pigment epithelium (RPE) and the inner collagenous layer of Bruch’s membrane (sub-RPE–BL space). This investigation aimed to characterize the morphologic features, structure, and distribution of these spherules in aged human eyes with and without clinical indications of age-related macular degeneration (AMD)..Design: Experimental studyParticipants: Five human eyes with varying degrees of sub-RPE–BL deposits were obtained from the University College London Institute of Ophthalmology and Moorfield’s Eye Hospital Tissue Repository or the Advancing Sight Network. Two eyes were reported as having clinical indications of AMD (age, 76–87 years), whereas 3 were considered healthy (age, 69–91 years).Methods: Cadaveric eyes with sub-RPE–BL deposits were embedded in paraffin wax and sectioned to a thickness of 4-10 μm. Spherules were identified and characterized using high-resolution scanning electron microscopy (SEM), energy-dispersive x-ray spectroscopy, and time-of-flight secondary ion mass spectroscopy.Main Outcome Measures: High-resolution scanning electron micrographs of spherules, the size-frequency distribution of spherules including average diameter, and the distribution of particles across the central-peripheral axis. Elemental maps and time-of-flight secondary ion mass spectra also were obtainedResults: The precipitation of spherules is ubiquitous across the central, mid-peripheral, and far-peripheral axis in aged human eyes. No significant difference was found in the frequency of spherules along this axis. However, statistical analysis indicated that spherules exhibited significantly different sizes in these regions. In-depth analysis revealed that spherules in the sub-RPE–BL space of eyes with clinical signs of AMD were significantly larger (median diameter, 1.64 μm) than those in healthy aged eyes (median diameter, 1.16 μm). Finally, spherules showed great variation in surface topography and internal structure..Conclusions: The precipitation of spherules in the sub-RPE–BL space is ubiquitous across the central–peripheral axis in aged human eyes. However, a marked difference exists in the size and frequency of spherules in eyes with clinical signs of AMD compared to those without, suggesting that the size and frequency of spherules may be associated with AMD.

Extracellular vesicles (EVs), including exosomes, carry the genetic packages of RNA, DNA, and proteins and are heavily involved in cell-cell communications and intracellular signalings. Therefore, EVs are spotlighted as therapeutic mediators for the treatment of injured and dysfunctional tissues as well as biomarkers for the detection of disease status and progress. Several key issues in EVs, including payload content and bioactivity, targeting and bio-imaging ability, and mass-production, need to be improved to enable effective therapeutics and clinical translation. For this, significant efforts have been made recently, including genetic modification, biomolecular and chemical treatment, application of physical/mechanical cues, and 3D cultures. Here we communicate those recent technological advances made mainly in the biogenesis process of EVs or at post-collection stages, which ultimately aimed to improve the therapeutic efficacy in tissue healing and disease curing and the possibility of clinical translation. This communication will help tissue engineers and biomaterial scientists design and produce EVs optimally for tissue regenerative therapeutics.

Three-dimensional (3D) printing enhances the production of on-demand fabrication of patient-specific devices as well as anatomically fitting implants with high complexity in a cost-effective manner. Additive systems that employ vat photopolymerisation such as stereolithography (SLA) and digital light projection (DLP) are used widely in the field of biomedical science and engineering. However, additive manufacturing methods can be limited by the types of materials that can be used. In this study, we present an isosorbide-based formulation for a polymer resin yielding a range of elastic moduli between 1.73 GN/mm2 dependent on the photoinitiator system used as well as the amount of calcium phosphate filler added. The monomer was prepared and enhanced for 3D-printing using an SLA technique that delivered stable and optimized 3D-printed models. The resin discussed could potentially be used following major surgery for the correction of congenital defects, the removal of oral tumours and the reconstruction of the head and neck region. The surgeon is usually limited with devices available to restore both function and appearance and with the ever-increasing demand for low-priced and efficient facial implants, there is an urgent need to advance new manufacturing approaches and implants with a higher osseointegration performance.

OBJECTIVES: The etiology of the reduced marginal bone loss observed around platform-switched implant-abutment connections is not clear but could be related to the release of variable amounts of corrosion products. The present study evaluated the effect of different concentrations of metal ions released from different implant abutment couples on osteoblastic cell viability, apoptosis and expression of genes related to bone resorption. METHODS: Osteoblastic cells were exposed to five conditions of culture media prepared containing metal ions (titanium, aluminum, vanadium, cobalt, chromium and molybdenum) in different concentrations representing the amounts released from platform-matched and platform-switched implant-abutment couples as a result of an earlier accelerated corrosion experiment. Cell viability was evaluated over 21days using the Alamar Blue assay. Induction of apoptosis was measured after 24h of exposure using flow cytometry. Expression of interleukin-6, interleukin-8, cyclooxygenase-2, caspase-8, osteoprotegerin and receptor activator of nuclear factor kappa-B ligand (RANKL) by osteoblastic cells were analysed after exposure for 1, 3 and 21days using real-time quantitative polymerase chain reaction assay RESULTS: Metal ions in concentrations representing the platform-matched groups led to a reduction in cell viability (P

Summary This study demonstrated the utilization of unprocessed biodiesel waste as a carbon feedstock for Pseudomonas mendocina CH50, for the production of PHAs. A PHA yield of 39.5% CDM was obtained using 5% (v/v) biodiesel waste substrate. Chemical analysis confirmed that the polymer produced was poly(3‐hydroxyhexanoate‐co‐3‐hydroxyoctanoate‐co‐3‐hydroxydecanoate‐co‐3‐hydroxydodecanoate) or P(3HHx‐3HO‐3HD‐3HDD). P(3HHx‐3HO‐3HD‐3HDD) was further characterized and evaluated for its use as a tissue engineering scaffold (TES). This study demonstrated that P(3HHx‐3HO‐3HD‐3HDD) was biocompatible with the C2C12 (myoblast) cell line. In fact, the % cell proliferation of C2C12 on the P(3HHx‐3HO‐3HD‐3HDD) scaffold was 72% higher than the standard tissue culture plastic confirming that this novel PHA was indeed a promising new material for soft tissue engineering.

SUMMARY In recent years, legislation has been passed in many countries to reduce the trafficking of material from illegal logging sources. This legislation requiring companies to perform due diligence on products in their supply chain has led to a resurgence in interest of being able to reliably track logs from the forest to a processing facility to ensure that material is not from illegal sources in the country of origin. While emerging technologies including DNA and stable isotope analysis show promise for this purpose these technologies are often cost prohibitive and are not yet ready for large scale implementation. This manuscript focuses on the development of a new log tracking system that utilizes low technology and off-the shelf materials to allow companies to accurately track logs at a reasonable cost. The new system utilizes standard tree marking paint, with a microtaggant additive, applied to the cross sectional surface of a log in a large-format QR code format. This work details how this new sy...

Few chemotherapeutics have had such an impact on cancer management as cis-diamminedichloridoplatinum(II) (CDDP), also known as cisplatin. The first member of the platinum based drug family, CDDP’s potent toxicity in disrupting DNA replication has led to its widespread use in multi-drug therapies, with particular benefit in patients with testicular cancers. However, CDDP also produces significant side effects that limit the maximum systemic dose. Various strategies have been developed to address this challenge including encapsulation within micro- or nanocarriers and the use of external stimuli such as ultrasound to promote uptake and release. The aim of this article is to look at these strategies and recent scientific and clinical developments.

Objective: As the pulmonary rehabilitation service has developed, demand on resources has increased. Patient ‘opt-in’ sessions aimed at reducing initial patient assessment Did Not Attend (DNA) rate were introduced. It was also hoped that facilitating informed patient choice would increase programme completion rates.Method: For a period of one year ‘opt-in’ sessions – 30 minute education sessions co-facilitated by ‘expert patients’ explaining the specifics of pulmonary rehabilitation – were introduced. Expert patients are patients who have successfully completed the programme, have shown evidence of fully engaging with self-management and associated maintenance behaviours, and encourage others based on their own lived experiences. Assessment appointment attendance and group completion data were collected and compared for two patient cohorts over a period of 1 year prior to, and post, instigation of the opt-in sessions.Results: Initial assessment appointment DNA rate decreased from 22.4% (original s...

The aims were to compare the physico-chemical properties (zeta-potential, wettability, surface free energy) of stereolithography materials (STL) (Photopolymer, Accura) to dentine and to evaluate the potential of each material to develop Enterococcus faecalis biofilm on their respective surfaces. Eighteen samples of each test material (Photopolymer, Accura, dentine) were employed (total n = 54) and sectioned to 1 mm squares (5 mm x 5 mm) (n = 15) or ground into a powder to measure zeta-potential (n = 3). The zeta-potential of the powder was measured using the Nano-Zetasizer technique. The contact angle (wettability, surface free energy tests) were measured on nine samples using goniometer. The biofilm attachment onto the substrate was assessed on the samples of each material using microscope and image processing software. The data were compared using one-way ANOVA with Dunnett post-hoc tests at a level of significance P ≤ 0.05. Both STL materials showed similar physico-chemical properties to dentine. The materials and dentine had negative charge (Accura: −23.7 mv, Photopolymer: −18.8 mv, dentine: −9.11 mv). The wettability test showed that all test materials were hydrophilic with a contact angle of 47.5°, 39.8°, 36.1° for Accura, Photopolymer and dentine respectively, and a surface free energy of 46.6, 57.7, 59.6 mN/m for Accura, Photopolymer and dentine, respectively. The materials and dentine proved suitable for attachment and growth of E. faecalis biofilm with no statistical differences (P > 0.05). Stereolithography materials show similar physico-chemical properties and growth of E. faecalis biofilm to dentine. Therefore, they may be an alternative to tests requiring dentine.

Background: The COVID-19 pandemic caused >1 million infections during January-March 2020. There is an urgent need for reliable antibody detection approaches to support diagnosis, vaccine development, safe release of individuals from quarantine, and population lock-down exit strategies. We set out to evaluate the performance of ELISA and lateral flow immunoassay (LFIA) devices. Methods: We tested plasma for COVID (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2) IgM and IgG antibodies by ELISA and using nine different LFIA devices. We used a panel of plasma samples from individuals who have had confirmed COVID infection based on a PCR result (n=40), and pre-pandemic negative control samples banked in the UK prior to December-2019 (n=142). Results: ELISA detected IgM or IgG in 34/40 individuals with a confirmed history of COVID infection (sensitivity 85%, 95%CI 70-94%), vs. 0/50 pre-pandemic controls (specificity 100% [95%CI 93-100%]). IgG levels were detected in 31/31 COVID-positive individuals tested ≥10 days after symptom onset (sensitivity 100%, 95%CI 89-100%). IgG titres rose during the 3 weeks post symptom onset and began to fall by 8 weeks, but remained above the detection threshold. Point estimates for the sensitivity of LFIA devices ranged from 55-70% versus RT-PCR and 65-85% versus ELISA, with specificity 95-100% and 93-100% respectively. Within the limits of the study size, the performance of most LFIA devices was similar. Conclusions: Currently available commercial LFIA devices do not perform sufficiently well for individual patient applications. However, ELISA can be calibrated to be specific for detecting and quantifying SARS-CoV-2 IgM and IgG and is highly sensitive for IgG from 10 days following first symptoms.

Langerhans cell histiocytosis (LCH) is a rare, clinically heterogeneous disease that most commonly occurs in pediatric populations. Congenital self-limited LCH is a benign variant of LCH. It most commonly presents as a diffuse eruption and reports of single lesion cases are infrequent in the literature. Even in the case of congenital self-limited LCH, there is potential for future multisystem relapse, making long-term follow-up important. We present a case of single lesion self-limited LCH in a full-term male infant with interesting morphology. Physical examination revealed a painless, 6 millimeter, well-demarcated, papule encircled by erythema with central hemorrhage. An infectious workup was negative and a punch biopsy was obtained, which showed a dermal infiltrate of histiocytes consistent with a diagnosis of LCH. The lesion healed without intervention within three weeks. Our case highlights the need for dermatologists to consider LCH in the differential diagnosis for lesions of varying morphology in children, as proper identification is necessary to monitor for multisystem recurrence.

Aims: Irradiation of the internal mammary chain (IMC) is increasing following recently published data, but the need for formal delineation of lymph node volumes is slowing implementation in some healthcare settings. A field-placement algorithm for irradiating locoregional lymph nodes including the IMC could reduce the resource impact of introducing irradiation of the IMC. This study describes the development and evaluation of such an algorithm. Materials and methods: An algorithm was developed in which six points representing lymph node clinical target volume borders (based on European Society for Radiotherapy and Oncology consensus nodal contouring guidelines) were placed on computed tomography-defined anatomical landmarks and used to place tangential and nodal fields. Single-centre testing in 20 cases assessed the success of the algorithm in covering planning target volumes (PTVs) and adequately sparing organs at risk. Plans derived using the points algorithm were also compared with plans generated following formal delineation of nodal PTVs, using the Wilcoxon signed rank test. Timing data for point placement were collected. Multicentre testing using the same methods was then carried out to establish whether the technique was transferable to other centres. Results: Single-centre testing showed that 95% of cases met the nodal PTV coverage dose constraints (binomial probability confidence interval 75.1-99.9%) with no statistically significant reduction in mean heart dose or ipsilateral lung V-17Gy associated with formal nodal delineation. In multicentre testing, 69% of cases met nodal PTV dose constraints and there was a statistically significant difference in IMC PTV coverage using the points algorithm when compared with formally delineated nodal volumes (P < 0.01). However, there was no difference in axillary level 1-4 PTV coverage (P = 0.11) with all cases meeting target volume constraints. Conclusions: The optimal strategy for breast and locoregional lymph node radiotherapy is target volume delineation. However, use of this novel points-based field-placement algorithm results in dosimetrically acceptable plans without the need for formal lymph node contouring in a single-centre setting and for the breast and level 1-4 axilla in a multicentre setting. Further quality assurance measures are needed to enable implementation of the algorithm for irradiation of the IMC in a multicentre setting. (C) 2018 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Innovation is critical for firm success, including forest sector firms. However, historically forest sector firms have focused on process over product innovations. Additionally, research shows that forest sector firms often fail to have a structured new product development (NPD) process. The purpose of this work is to illustrate use of the lead-user method to identify user-lead ideas for innovation within the wood-window value chain, thereby demonstrating the potential of a modified lead-user approach as a NPD tool for the forest industry. Personal interviews with 22 individuals were conducted with sales agents, installation experts, homebuilders, and architects. Findings outline opportunities for the introduction of new products/services, thereby demonstrating the value of relying on lead-users for identifying potential products. This study also highlights the challenges associated with the lead-user methodology, including the varying definitions of a lead-user and the subjective nature of catego...

Summary There is a need for physical standards (reference materials) to ensure both reproducibility and consistency in the production of somatic cell types from human pluripotent stem cell (hPSC) sources. We have outlined the need for reference materials (RMs) in relation to the unique properties and concerns surrounding hPSC-derived products and suggest in-house approaches to RM generation relevant to basic research, drug screening, and therapeutic applications. hPSCs have an unparalleled potential as a source of somatic cells for drug screening, disease modeling, and therapeutic application. Undefined variation and product variability after differentiation to the lineage or cell type of interest impede efficient translation and can obscure the evaluation of clinical safety and efficacy. Moreover, in the absence of a consistent population, data generated from in vitro studies could be unreliable and irreproducible. Efforts to devise approaches and tools that facilitate improved consistency of hPSC-derived products, both as development tools and therapeutic products, will aid translation. Standards exist in both written and physical form; however, because many unknown factors persist in the field, premature written standards could inhibit rather than promote innovation and translation. We focused on the derivation of physical standard RMs. We outline the need for RMs and assess the approaches to in-house RM generation for hPSC-derived products, a critical tool for the analysis and control of product variation that can be applied by researchers and developers. We then explore potential routes for the generation of RMs, including both cellular and noncellular materials and novel methods that might provide valuable tools to measure and account for variation. Multiparametric techniques to identify “signatures” for therapeutically relevant cell types, such as neurons and cardiomyocytes that can be derived from hPSCs, would be of significant utility, although physical RMs will be required for clinical purposes.

Ultrasound imaging is a powerful tool in medicine because of the millisecond temporal resolution and submillimeter spatial resolution of acoustic imaging. However, the current generation of acoustic contrast agents is primarily limited to vascular targets due to their large size. Nanosize particles have the potential to be used as a contrast agent for ultrasound molecular imaging. Silica-based nanoparticles have shown promise here; however, their slow degradation rate may limit their applications as a contrast agent. Phosphate-based glasses are an attractive alternative with controllable degradation rate and easily metabolized degradation components in the body. In this study, biodegradable P2O5-CaO-Na2O phosphate-based glass nanospheres (PGNs) were synthesized and characterized as contrast agents for ultrasound imaging. The structure of the PGNs was characterized using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), (31)P magic angle spinning nuclear magnetic resonance ((31)P MAS NMR), and Fourier transform infrared (FTIR) spectroscopy. The SEM images indicated a spherical shape with a diameter size range of 200-500 nm. The XRD, (31)P NMR, and FTIR results revealed the amorphous and glassy nature of PGNs that consisted of mainly Q(1) and Q(2) phosphate units. We used this contrast to label mesenchymal stem cells and determined in vitro and in vivo detection limits of 5 and 9 μg/mL, respectively. Cell counts down to 4000 could be measured with ultrasound imaging with no cytoxicity at doses needed for imaging. Importantly, ion-release studies confirmed these PGNs biodegrade into aqueous media with degradation products that can be easily metabolized in the body.

To investigate in situ Enterococcus faecalis biofilm removal from the lateral canal of a simulated root canal system using passive or active irrigation protocols.Root canal models (n = 43) were manufactured from transparent resin materials using 3D printing. Each canal was created with an 18 mm length, apical size 30, a .06 taper and a lateral canal of 3 mm length, with 0.3 mm diameter. Biofilms were grown in the lateral canal and apical 3 mm of the main canal for 10 days. Three models from each group were examined for residual biofilm using SEM. The other forty models were divided into four groups (n = 10). The models were observed under a fluorescence microscope. Following 60 s of 9 mL of 2.5% NaOCl irrigation using syringe and needle, the irrigant was either left stagnant in the canal or activated using gutta-percha, sonic or ultrasonic methods for 30 s. Images were then captured every second using an external camera. The residual biofilm percentages were measured using image analysis software. The data were analysed using generalized linear mixed models. A significance level of 0.05 was used throughout.The greatest level of biofilm removal was obtained with ultrasonic agitation (66.76%) followed by sonic (45.49%), manual agitation (43.97%) and passive irrigation groups (38.67%), respectively. The differences were significant between the residual biofilm in the passive irrigation and both sonic and ultrasonic groups (P = 0.001).Agitation resulted in better penetration of 2.5% NaOCl into the lateral canal of an artificial root canal model. Ultrasonic agitation of NaOCl improved the removal of biofilm.

To investigate the effect of sodium hypochlorite concentration and needle extension on removal of Enterococcus faecalis biofilm, sixty root canal models were 3D printed. Biofilms were grown on the apical 3 mm of the canal for 10 days. Irrigation for 60s with 9 mL of either 5.25% or 2.5% NaOCl or water was performed using a needle inserted either 3 or 2 mm from the canal terminus and imaged using fluorescence microscopy and residual biofilm percentages were calculated using imaging software. The data were analysed using analysis of covariance and two-sample t-tests. A significance level of 0.05 was used throughout. Residual biofilm was less using 5.25% than with 2.5% NaOCl. Statistically significant biofilm removal was evident with the needle placed closer to the canal terminus. A greater reduction of available chlorine and pH was noted as the concentration increased. One-minute irrigation was not sufficient for complete biofilm removal.

Brain diseases including neurodegenerative disorders and tumours are among the most serious health problems, degrading the quality of life and causing massive economic cost. Nanoparticles that load and deliver drugs and genes have been intensively studied for the treatment of brain diseases, and have demonstrated some biological effects in various animal models. Among other efforts taken in the nanoparticle development, targeting of blood brain barrier, specific cell type or local intra-/extra-cellular space is an important strategy to enhance the therapeutic efficacy of the nanoparticle delivery systems. This review underlies the targeting issue in the nanoparticle development for the treatment of brain diseases, taking key exemplar studies carried out in various in vivo models.

Objective The purpose of this review was to systematically summarize the outcomes of laboratory-based studies investigated the effect of sodium hypochlorite application on bond strength of dentin to various materials. Data A comprehensive literature search was conducted using PubMed, Google Scholar, Cochrane Library and OpenThesis database. Then a manual search was also carried out for references from identified articles. Sources The search followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” statement. Two independent reviewers evaluated the collected studies for their eligibility according to the inclusion and exclusion criteria. Data abstraction and evaluation of risk of bias was then performed. Study selection A total of 164 articles were assessed for eligibility. Only 69 met the inclusion criteria. Most included studies presented a low (15.9%) to medium (68.1%) risk of bias. Only 15.9% presented high risk of bias. Because of heterogeneity of the included studies, Meta-analysis was not performed. Conclusion The outcome from low or high risk of bias studies revealed that sodium hypochlorite has no effect on bond strength of coronal or root canal dentin. While that from medium risk studies showed a reduction in bond strength of dentin.

Objective. Root canal irrigation is an important adjunct to control microbial infection. This study aimed primarily to develop a transparent root canal model to study in situ Enterococcus faecalis biofilm removal rate and remaining attached biofilm using passive or active irrigation solution for 90 s. The change in available chlorine and pH of the outflow irrigant were assessed. Methods. A total of forty root canal models (n = 10 per group) were manufactured using 3D printing. Each model consisted of two longitudinal halves of an 18mm length simulated root canal with size 30 and taper 0.06. E. faecalis biofilms were grown on the apical 3mm of the models for 10 days in Brain Heart Infusion broth. Biofilms were stained using crystal violet for visualization. The model halves were reassembled, attached to an apparatus and observed under a fluorescence microscope. Following 60 s of 9mL of 2.5% NaOCl irrigation using syringe and needle, the irrigant was either left stagnant in the canal or activated using gutta-percha, sonic and ultrasonic methods for 30 s. Images were then captured every second using an external camera. The residual biofilm percentages were measured using image analysis software. The data were analyzed using Kruskal–Wallis test and generalized linear mixed model. Results. The highest level of biofilm removal was with ultrasonic agitation (90.13%) followed by sonic (88.72%), gutta-percha (80.59%), and passive irrigation group (control) (43.67%) respectively. All agitation groups reduced the available chlorine and pH of NaOCl more than that in the passive irrigation group. Significance. The 3D printing method provided a novel modelto create a root canal simulation for studying and understanding a real-time biofilm removal under microscopy. Ultrasonic agitation of NaOCl left the least amount of residual biofilm in comparison to sonic and gutta-percha agitation methods.

The main hindrance in the use of polyhydroxyalkanoates (PHAs) as a replacement for existing petroleum-based plastics is their high production cost. The carbon source accounts for 50% of the cost for PHA production. Thus, increasing the yield and productivity of PHAs on cheap substrates is an important challenge for biotechnologists to support the commercialization and further applications of these polymers. In this study, we have investigated the use of an agricultural raw material, sugarcane molasses, as the main carbon source for poly(3-hydroxybutyrate) (P(3HB)) production by Bacillus cereus SPV. These studies were carried out in both shaken flasks and 2 L bioreactors. Various conditions were evaluated for their effects on biomass and P(3HB) accumulation. A high polymer yield was obtained, 61.07% dry cell weight (DCW) in a 1 L shaken flask study and 51.37% DCW in a 2 L fermenter study. These yields are 50% higher than previously observed with Bacillus cereus SPV. Hence, the results are encouraging and show that sugarcane molasses are a promising carbon source for an economical and commercially viable production of P(3HB).

P>AimTo evaluate the effect of irrigation with 5% sodium hypochlorite (NaOCl) alone and in conjunction with 17% ethylenediaminetetraacetic acid (EDTA) on tooth surface strain (TSS) and to analyse the influence of irrigation time, root morphology and dentine thickness.MethodologyThirty-six single-rooted pre-molars with single canals had their crown and enamel reduced and root canals prepared using a standardized protocol. Teeth were grouped according to anatomical criteria and randomly distributed to experimental irrigation groups: (A) saline (negative control); (B) 5% NaOCl (positive control); (C) 5% NaOCl alternated with 17% EDTA. TSS was measured using electrical strain gauges bonded to the cervico-proximal part of the tooth. Teeth, mounted in clear acrylic resin placed in a universal testing machine, were subjected to nine consecutive 10-min irrigation periods followed by non-destructive occlusal loading to record TSS. Statistical analysis was carried out using two-way hierarchical anova and post hoc multiple comparisons.ResultsTwo groups showed an increase in TSS from the baseline (initial 10-min irrigation with saline). Group A showed a negligible reduction of 1.2% (343-339 mu epsilon), which was not statistically significant (P = 0.7). Group B showed a highly significant (P = 0.001) increase in TSS by 53.7% (178-253 mu epsilon), and group C showed a significant (P = 0.02) increase in TSS by 17.4% (163-192 mu epsilon). The rate of change in TSS was significantly different between test groups. The length of the tooth (P = 0.04) as well as the mesio-distal (P = 0.05) width had significant effects on TSS.ConclusionsIrrigation with 5% with or without 17% EDTA increased TSS. The increase was significantly greater with 5% NaOCl alone than with 5% NaOCl alternated with 17% EDTA in contrast to previous findings with longer duration of irrigant exposure. Tooth length and mesio-distal root width significantly contributed to the increase in TSS.

Aim To evaluate the effect of irrigation regimens on tooth surface strain using saline, sodium hypochlorite (3% and 5% NaOCl) and ethylenediaminetetraacetic acid (17% EDTA), individually and in alternating combinations. Methodology Single-rooted premolar teeth with single canals prepared to standardized dimensions were grouped by anatomical features and randomly distributed amongst six experimental groups (n = 12 each). The six groups were: (1) saline; (2) 5% NaOCl; (3) 3% NaOCl; (4) 17% EDTA; (5) 3% NaOCl and 17% EDTA; (6) 5% NaOCl and 17% EDTA. All groups underwent four (group 1) or five (groups 2, 3, 4, 5, 6) sequential 30-min irrigation periods following each of which the tooth was subjected to a standard regime of cyclic, nondestructive, occlusal loading. Tooth surface strain was measured during each loading cycle using electrical strain gauges mounted cervico-proximally. The data were analysed by Hierarchical anova and post hoc multiple comparisons. Results Irrigation with 5% NaOCl alone or alternating with 17% EDTA significantly (P

Stuhlinkontinenz ist eine verbreitete und krankhafte Storung, oftmals verbunden mit einer Funktionsstorung des analen Sphinkters. Eine dreidimensionale (3-D) endoanale Hochfrequenzsonographie (EAUS) ermoglicht eine grosere raumliche Auflosung und longitudinale Beurteilung des Analkanals als die konventionelle zweidimensionale (2-D) Untersuchung. Notwendig fur Vergleichsuntersuchungen sind verlassliche Normalwerte, die Alter und Geschlecht berucksichtigen. Eine Gruppe von 30 gesunden mannlichen (n = 12) und weiblichen (n = 18) Freiwilligen (medianes Alter 49 Jahre; 31–63 Jahre) unterzog sich einer 3-D-EAUS mit einem Hochfrequenz-10-MHz-Schallkopf. Ein Datenzylinder wurde rekonstruiert, um eine Messung der Analkanalstrukturen in 2-D auf proximaler, mittlerer und distaler Analkanalhohe und in 3-D fur longitudinale Messungen vorzunehmen. Die Manner hatten einen signifikant langeren 3-D-externen analen Sphinkter (EAS) und internen analen Sphinkter (IAS) als die Frauen, insbesondere im anterioren Anteil des EAS (Mittel bei Mannern 2,5 cm, Mittel bei Frauen 1,6 cm; p < 0,0001). Bei der Analkanallange oder beim 2-D-Scanning der Dicke des EAS und des IAS gab es keine signifikanten Unterschiede zwischen den Geschlechtern. Es fanden sich auch keine signifikanten Unterschiede zwischen Frauen mit und ohne Entbindungen. Das Alter hatte keine signifikante Auswirkung auf die 3-D-Langenmessungen, die 2-D-EAUS-Messungen der Dicke von IAS und EAS nahmen jedoch mit dem Alter signifikant zu (Analkanalmitte; p = 0,004). Auf den Grundlagen dieser Daten wurden Normalwerte generiert. Die Sphinktermessungen mittels 3-D-Rekonstruktion unterscheiden sich je nach Alter und Geschlecht. Fur einen kunftigen Datenvergleich in verschiedenen Erkrankungsstadien wurden Normalwerte errechnet, die diese Unterschiede mit einbeziehen.

The filling material used to obturate root canal systems during the common dental procedure, root canal treatment, has popularly involved gutta-percha (GP) in one of its many forms for almost a 100 years. An optimal root filling material should provide a predictable seal, inhibit or kill residual bacteria, prevent re-contamination and facilitate periapical healing. Although the goal of obturation is stated as the creation of a "seal", its precise role still remains elusive and the seal offered suspect. The primary goal of the study was to develop a novel polycaprolactone/phosphate glass composite deliverable as a root filling and capable of releasing ionic species to enable a predictable seal in an aqueous environment.Different compositions of polycaprolactone-iron phosphate glass (Fe(2)O(3) 1, 3 and 5mol%) composites were produced and delivered into an ex vivo root canal model. Standardized root canals were prepared in extracted human teeth. The teeth were examined for root filling adaptation and precipitate formation (SEM), ion release (Na(+), Ca(2+), PO(4)(3-), P(2)O(7)(4-), P(3)O(9)(3-), and P(5)O(10)(5-)), and sealing ability. The experiments were controlled with teeth obturated with contemporary GP and a conventional zinc-oxide/eugenol sealer.Adaptation of the experimental material was statistically significantly better than the GP control groups. Precipitate formation was noted in some specimens but all released various ionic species in an inverse proportion to the iron oxide concentration. The experimental material exhibited significantly (P0.001) less leakage after 7 days immersion in saline compared with those not immersed, or the control GP group.PCL-phosphate glass composites showed good potential as a root filling material capable of producing a seal in an aqueous environment without a sealer.

BAckgroundNone of the proposed materials tested for the management of perianal fistulae has proven to be a definitive treatment.AimTo assess a new repair scaffold and drug delivery device conceived to target perianal fistula repair.MethodsPoly(d,l-lactide-co-glycolide) porous microspheres containing either antibacterial silver-releasing degradable phosphate glass or metronidazole were prepared using thermally induced phase separation.ResultsIon- and drug-release profiling of the microspheres revealed continued release of silver ions from microspheres filled with silver-doped phosphate glass and high encapsulation efficiency for metronidazole [78% and 82% for microspheres loaded with 2.5% and 1.3% (w/w), respectively]. Microbicidal activity was confirmed by growth inhibition of bacterial species (Staphylococcus aureus, Escherichia coli and Bacteroides fragilis), which characteristically dominate the colonization of perianal fistula tracts. Microspheres containing > 3 mol% silver or metronidazole resulted in strong bacterial inhibition/kill against B. fragilis; the presence of one sphere containing > 3 mol% silver had a potent inhibitory effect against all the microbes studied. Microspheres became rapidly integrated with host tissue following subcutaneous implantation into a rodent wound model.ConclusionsThe study demonstrates a novel scaffold for guided tissue regeneration providing local release of antimicrobial agents sufficient to counter bacterial colonization and warrants further investigation.

Titanium, as an implant material, is regarded to be durable and biocompatible, which allows functional replacement of missing teeth. Successful dental implantation depends on an osseointegration phenomenon, a direct structural and functional binding reaction between bone and implant. It is well known that physicochemical characteristics of the dental implant surface, such as roughness, topography, chemistry, and electrical charge affect the biological reactions occurring at the interface of tissue and implant. Therefore, considerable efforts have been made to modify the surface of titanium implants which are based on mechanical, physical and chemical treatments. Recently, biological molecules were introduced onto the surface of implants to stimulate osteogenic cells in the early stage of implantation and consequently accelerate bone formation around implant and subsequent rapid implant stabilization. A range of extracellular matrix components, designed peptides, and growth factors have been proposed as the biological moiety. In this review, we address several issues related to the biology of dental implants and discuss biomimetic modification of the implant surface as a novel approach to obtain successful osseointegration.

Prescription drug monitoring programs are statewide databases available to clinicians to track prescriptions of controlled medications. These programs may provide valuable information to assess the history and use of controlled substances and contribute to clinical decisionmaking in the emergency department (ED). The widespread availability of the programs raises important ethical issues about beneficence, nonmaleficence, respect for persons, justice, confidentiality, veracity, and physician autonomy. In this article, we review the ethical issues surrounding prescription drug monitoring programs and how those issues might be addressed to ensure the proper application of this tool in the ED. Clinical decisionmaking in regard to the appropriate use of opioids and other controlled substances is complex and should take into account all relevant clinical factors, including age, sex, clinical condition, medical history, medication history and potential drug-drug interactions, history of addiction or diversion, and disease state.

This article focusses on how the process of change impacts on team members. The intention is to improve the manager's understanding of what the key issues are for the people leaving and how the change will affect the people who stay.

The relationship between the application of die-spacer prior to wax pattern fabrication and metal removal from the inner surface of the casting on marginal and internal discrepancies of complete cast crowns was evaluated. One hundred and twenty complete crowns were cast with palladium-silver alloy melted by gas-oxygen torch or electrical resistance and cast with a centrifuge casting machine. After casting, the crowns were seated on each type of different marginal configuration dies (90-degree shoulder, 20-degree beveled shoulder, and 45-degree chamfered shoulder) with a static load of 90 N during 1 min. Evaluation of the marginal fit of the specimens was made using a digital micrometer. The crowns were embedded in acrylic resin and longitudinally sectioned to verify the internal discrepancy that occurred in lateral and occlusal interfaces with a digital micrometer. The data were submitted to ANOVA and Tukey's test with a significance level of 5%. The best marginal and inner fits were obtained with the gas-oxygen torch source. The 45-degree chamfered shoulder showed the best marginal and inner fit, and better internal relief was obtained in the crowns abraded with 50 µm Al2O3 particles. A relação entre a aplicação do espaçador antes do enceramento do padrão e alívio interno das coroas totais metálicas após a fundição foi verificada através da análise da discrepância interna e marginal. Cento e vinte coroas totais metálicas foram confeccionadas com liga de paládio/prata, fundidas com gás-oxigênio ou resistência elétrica numa centrifuga. Após a fundição, as coroas foram assentadas sobre seus respectivos troquéis com diferentes términos cervicais (ombro reto, ombro biselado em 20º e chanfro reto em 45º) com carga estática de 90 N por 1 minuto. Após, o conjunto foi embutido em resina acrílica e seccionado longitudinalmente para verificar a discrepância marginal ocorrida nas interfaces lateral e oclusal com o micrômetro digital. Os dados foram submetidos a análise de variância e ao teste de Tukey em nível de significância de 5%. Os melhores ajustes marginais e internos foram obtidos com a fonte de calor gás-oxigênio. O término cervical em chanfro reto de 45º mostrou os melhores ajustes, tanto cervical como interno, e o melhor alívio interno e marginal foram obtidos em coroas jateadas com partículas de Al2O3 com 50 µm.

Auditory function takes a major part in human life. While sensorineural hearing loss is related with many factors including genetic disorders, age and noise, the clear causes are not well understood. Even more, the currently available treatments with drugs cause side effects, which thus are considered suboptimal. Here, we communicate the delivery systems with biomaterials that can be possible therapeutic options to restore hearing and vestibular functions. We introduce briefly the various pathological factors related with hearing loss and the limitation of current therapies, detail the recent studies on delivery systems including nanoparticles and hydrogels and discuss future clinical availability.

It is the aim of this chapter, to give an overview of the current materials used in dentistry to regenerate hard tissue. In particular we will focus on the development of both synthetic and also naturally derived ceramic materials to be used for bone regeneration in the head and neck. This chapter will also describe in detail the processing methods utilized and the advantages and disadvantages that each method and resultant materials possesses.

In thoracic radiotherapy, a number of factors hinder the use of portal films and electronic portal imaging devices for measuring field placement errors (FPEs). The aim of this study was to assess the accuracy of treatment set-up using simulator check films (SCFs) in radiotherapy for lung cancer. Prospective evaluation was performed on 24 patients. During their radiotherapy, patients returned to the simulator weekly for a minimum of four SCFs, for which the parameters from the original simulator planning film were set, positioning being achieved without fluoroscopy. A total of 96 SCFs were taken. FPEs in left-right (L-R) and superior-inferior (S-I) direction, as well as coronal rotational errors, were measured. The mean absolute FPE was 0.35 cm in the L-R axis and 0.43 cm in the S-I axis. Statistically, the FPEs in the S-I direction were greater than those in the L-R direction (p0.001). A margin of 0.93 cm between the clinical target volume and the planning target volume would cover 95% of FPEs in the L-R direction, whilst a margin of 1.13 cm is needed for this degree of certainty in the S-I direction. Mean coronal rotational error was 1.6 degrees. Systematic errors were greater than random errors. This study demonstrated that the FPEs were within clinical tolerance (or = 0.7 cm) in 84.9% of the measurements. The planning margins used in our clinical practice compare favourably with the FPEs in this study.

Cisplatin forms the basis for many chemotherapy regimens, however the maximum permissible dose is limited by its systemic toxicity. Nanoencapsulation of drugs has been shown to reduce off-target side effects and can potentially improve treatment burden on patients. However, uptake of nanoformulations at tumor sites is minimal without some form of active delivery. We have developed a submicron, polymeric nanoparticle based on biocompatible and degradable poly(lactic-co-glycolic acid) (PLGA) capable of encapsulating cisplatin and which can be bound to the surface of a phospholipid coated microbubble. The acoustic behavior and stability of the resulting nanoparticle loaded microbubbles will be compared with those of unloaded microbubbles. Results will also be presented on the extravasation of particles in a tissue mimicking phantom using a novel long working distance confocal microscope that enables particle distributions to be measured in situ and in real time.

Brushite (dicalcium phosphate dihydrate) and monetite (dicalcium phosphate anhydrous) are of considerable interest in bone augmentation owing to their metastable nature in physiological fluids. The anhydrous form of brushite, namely monetite, has a finer microstructure with higher surface area, strength and bioresorbability, which does not transform to the poorly resorbable hydroxyapatite, thus making it a viable alternative for use as a scaffold for engineering of bone tissue. We recently reported the formation of monetite cements by a simple processing route without the need of hydrothermal treatment by using a high concentration of sodium chloride in the reaction mix of β-tricalcium phosphate and monocalcium phosphate monohydrate. In this paper, we report the biological responsiveness of monetite formed by this method. The in vitro behaviour of monetite after interaction and ageing both in an acellular and cellular environment showed that the crystalline phase of monetite was retained over three weeks as evidenced from X-ray diffraction measurements. The crystal size and morphology also remained unaltered after ageing in different media. Human osteoblast cells seeded on monetite showed the ability of the cells to proliferate and express genes associated with osteoblast maturation and mineralization. Furthermore, the results showed that monetite could stimulate osteoblasts to undergo osteogenesis and accelerate osteoblast maturation earlier than cells cultured on hydroxyapatite scaffolds of similar porosity. Osteoblasts cultured on monetite cement also showed higher expression of osteocalcin, which is an indicator of the maturation stages of osteoblastogenesis and is associated with matrix mineralization and bone forming activity of osteoblasts. Thus, this new method of fabricating porous monetite can be safely used for generating three-dimensional bone graft constructs.