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Anjali Shetty,1 Rebekah Hanson,1 Peter Korsten,2 Munir Shawagfeh,3 Shiva Arami,1 Suncica Volkov,1 Olga Vila1 William Swedler,1 Abdel Naser Shunaigat,4 Sameer Smadi,4 Ray Sawaqed,5 David Perkins,1 Shiva Shahrara,1 Nadera J Sweiss11Department of Rheumatology, Pharmacy, Transplant, University of Illinois at Chicago, Chicago, IL, USA; 2Department of Nephrology and Rheumatology, University Medicine Göttingen, Göttingen, Germany; 3Anesthesia and Pain Management, King Hussein Cancer Center, Amman, Jordan; 4Liver Transplant, Kidney Transplant Royal Medical Services, Jordan; 5Cardiac Surgery Methodist Hospitals, Merrillville, IN, USAAbstract: Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by joint pain, swelling, stiffness, and progressive destruction of the small joints of the hands and feet. Treatment of RA has improved over the past decade. With multiple cytokines well-known now to play a role in the pathogenesis of RA, including tumor necrosis factor alpha, interleukin (IL)-1β, and IL-6, many targeted biological treatments against these cytokines have emerged, changing the treatment of this disease. Tocilizumab (TCZ) is a recombinant humanized monoclonal antibody against the IL-6 receptor and has been approved in many countries, including the United States, for the treatment of moderate to severe RA in patients who have not adequately responded to one or more disease-modifying antirheumatic drugs (DMARDs) or cannot tolerate other approved drug classes for RA. The aim of this review is to discuss the role of IL-6 in RA, and to provide an overview of the mode of action, pharmacokinetics, and safety of TCZ. Furthermore, efficacy studies of TCZ as both monotherapy and combination therapy will be evaluated. There have been several important clinical trials evaluating the efficacy and safety of TCZ in RA patients; this review summarizes this data from 14 key trials with emphasis on Phase III trials. Review of these trials provides strong evidence that its use, both as monotherapy and in combination with methotrexate or other DMARDs, is an effective treatment in reducing the signs and symptoms of RA. TCZ showed tolerable safety but care is required for its use since there are some important safety concerns including elevated liver enzymes, elevated low-density lipoprotein, infections, and gastrointestinal perforations. Additionally, given the efficacy of TCZ in the treatment of RA, this review discusses how TCZ may be beneficial in the treatment of other autoimmune diseases, spinal disease, cardiovascular disease, organ transplantation, and malignancies where elevated levels of IL-6 may play a role in the pathogenesis of these diseases.Keywords: tocilizumab, IL-6, rheumatoid arthritis, biologics

"nBackground and Aims: The main objective of this study was to determine the effect of polyethylene fibers and veneering composites in fiber-reinforced resin systems on the opacity (contrast ratio). "nMaterials and Methods: The specimens were divided into four groups. Two groups were used as the control groups, with no reinforcement. The fibers of polyethylene (Fibre-Braid) with special basement composites were used as the reinforced framework materials. Filtek Z250 and GRADIA (shade A2) were used as veneering materials. The total thickness of samples was 3 mm with 13 mm diameter. Specimens were prepared in disk shaped metal mold. The composite materials were light-cured according to their manufacturers' instructions. The contrast ratio (CR) of each specimen was determined on black and white backgrounds using reflection spectrophotometer. Reflectance was measured at intervals of 10 nm between 400 nm and 750 nm. Data were analyzed by two-way ANOVA and Tukey HSD test. "nResults: When contrast ratio were compared among the different types of materials statistically significant differences were observed in both veneering composites (P

"nBackground and Aims: The elution of residual monomers from cured dental composites to oral cavity has a harmful effect on human health and can affect their clinical durability. The purpose of this study was to evaluate the amount of eluted monomers (Bis-GMA, TEGDMA, UDMA) from two types of composites (Gradia and P60) after exposure to food simulating liquids such as ethanol (25, 50, 75 %) and heptane 50 % for 24 hours and 7 days. "nMaterials and Methods: Forty specimens of each composite were prepared. Equal numbers of each composite were immersed in tubes containing 2cc volumes of 25, 50, 75 % ethanole and 50 % heptane. The amount of eluted monomers in standard condition such as Bis-GMA, TEGDMA and UDMA was measured by GC/MS (Gas Chromatography/Mass Spectroscopy) and results were statistically analysed by three way and one way ANOVA. P

Background and Aims: In spite of the advances achieved in the field of dentin adhesives, the longevity of bond to dentin is still a challenge. According to recent studies, Matrix Metaloproteinase (MMP) inhibitors can increase clinical longevity of bonding and decrease leakage. The aim of this study was to evaluate the amount and pattern of doxycycline release from an experimental dentin adhesive containing this MMP inhibitor. Materials and Methods: In this experimental study, specimens containing 0.25 and 0.5 loading percent of doxycycline in an experimental monomer were prepared in cylindrical moulds of 12 mm diameter and 2 mm thickness. The adhesive monomer was composed of 12 wt% Bis-GMA, 10 wt% TMPTMA, 28 wt% HEMA and 50 wt% ethanol. Camphorquinone and amine were used as initiators. Results: Addition of 0.25 and 0.5 w% doxycycline showed linear release in both groups. Increasing the loading percent of doxycycline caused more release. The release continued during the test period. Conclusion: Doxycycline release was observed from the experimental adhesive. Further studies in this field will help in preparing adhesive systems with more clinical longevity.

"nBackground and Aim: Decreasing the hardness of dental restorative composites after curing in oral environment can influence their clinical durability. The aim of this study was to evaluate the effect of food-simulating liquids such as 25%, 50%, 75 % ethanol and 50 % heptane on surface hardness of two composites - (Gradia and P60) after curing and immersing time of 24 hours and 7 days."nMaterials and Methods: 45 specimens of each composite were prepared in a stainless steel mold with 6 mm diameter and 2 mm depth. 5 specimens of each composite were tested for microhardness immediately after curing as the control group. The other specimens of each composite were randomly divided into eight groups. Each specimen was immersed in one of the following solutions 25%, 50%, 75 % ethanol and 50 % heptane for either 24 hours or 7 days. Then the specimens were taken out of the solutions and washed and dried and transferred to the refrigerator until performing the test. In standard conditions, surface microhardness of specimens was evaluated by the microhardness device based on Vickers. The data were analyzed by one way ANOVA 3 way ANOVA and Tukey Post Hoc tests. The level of significance was set at p

"nBackground and Aim: The microbial cause of dental caries has been proved among its multifactorial etiologies. The prevention and control of dental caries is very critical because of high prevalence and cost especially in high risk patient such as xerostomia. Based on the world attraction to traditional treatment and importance of drug extraction of natural materials and plants, in this in vitro study effect of hydroalcoholic extract of Salvia officinalis and Pimpinella anisum which were very useful in traditional treatment of mouth and teeth disease has been determined against cariogenic bacteria. "nMaterials and Methods: In this experimental study, hydroalcoholic extracts have been prepared from Salvia officinalis and Pimpinella anisum with maceration method. Their antibacterial activity against Streptococcus mutans, Lactobacillus rhamnosus and Actinomyces viscosus have been evaluated with broth macrodilution method. Data were analyzed with Mann-Whitney test. "nResults: Minimum Inhibitory Concentration for Salvia officinalis and Pimpinella anisum for streptococcus mutans were respectively 6.25 and 12.5 µg/ml, for Lactobacillus rhamnosus were 1.56 and 12.5 µg/ml and for Actinomyces viscosus were 12.5 and 50 µg/ml. "nConclusion:Both extracts had growth inhibitory effect on all three bacteria. Salvia officinalis had significantly greater effect on inhibition of growth of all three bacteria. Both extracts had bactericidal effect in the range of concentration.

"nBackground and Aim: Amalgam is one of the mostly used restorative materials, but has some disadvantages. Microleakage is one of the short comings of amalgam which may lead to sensitivity and recurrent caries. The aim of this study was to evaluate the effect of three dentin bonding systems on reduction of microleakage in amalgam restorations. "nMaterials and Methods: Class II amalgam restorations were made in 40 noncarious molar and premolar teeth. Then the specimens were divided into four equal groups. Scotch Bond Multi Purpose, Single bond, "niBond, were used as liner in groups one to three respectively and in group four no liner was used. The teeth were restored with high copper spherical amalgam. After thermocycling for 500 cycles at 50C and 550C, the specimens were immersed in basic fuchsin for 24 hours, bisectioned mesiodistally and evaluated under stereomicroscope at X25 for dye penetration. The data were analyzed by Kruskal-wallis and Scheffe. P

"nBackground and Aim: Nonmetallic tooth- colored posts adhere to canal walls by dentin bonding agents and resin cements. Better retention and proper distribution of stress result from enough and proper bonding. The purpose of this study was to evaluate bond strength of D.T. Light - post with two different resin cements (self-cure & dual-cure) and to investigate the effect of irrigating solutions applied in root canal on bond strength of the resin cements and D.T.Light- post to root canal wall. "nMaterials and Methods: In this experimental study 40 single root teeth (maxillary canine & central) were selected and stored in 0.1% thymol solution for one week and transferred to distilled water. The teeth were decoronated 2mm above CEJ. The canal space was mechanically enlarged using k-files (up to # 70). The teeth were randomly divided into two groups. The first group was irrigated with 2.6% NaOCl, and the second was irrigated with normal saline. After drying, the teeth were filled with gutta percha cones using lateral condensing method. After two weeks the post space was prepared and D.T.Light- post was inserted in each subgroup using self or dual-cure cements according to manufacturer's instructions. After thermocycling, the apical part was cut 1cm below CEJ. The remained length was divided into 9 equal sequential sections. Each section was submitted to shear push-out test in universal testing machine. Statistical analysis of the bond strength data was performed using ANOVA and post hoc tests with p

"nBackground and Aim: Various studies have shown that reliable bond at the root - post - core interfaces are critical for the clinical success of post - retained restorations. Severe stress concentration at post - cement interface increases post debonding from the root. To form a bonded unit that reduces the risk of fracture, it is important to optimize the adhesion. Therefore, some post surface treatments have been proposed. The purpose of this study was to investigate the influence of various surface treatments of tooth - colored posts on the bonding of resin cement. "nMaterials and Methods: In this interventional study, 144 tooth colored posts were used in 18 groups (8 samples in each group). The posts included quartz fiber (Matchpost), glass fiber (Glassix), and zirconia ceramic (Cosmopost) and the resin cement was Panavia F 2.0. The posts received the following surface treatments: 1- No surface treatment (control group), 2- Etching with HF and silane, 3- Sandblasting with Cojet sand, 4- Sandblasting with Cojet sand and application of silane, 5- Sandblasting with alumina particles, 6- Sandblasting with alumina particles and application of silane. Then, posts were cemented into acrylic molds with Panavia F 2.0 resin cement. The specimens were placed in water for 2 days and debonded in pull - out test. Statistical analysis was performed using ANOVA followed by Tamhane and Tukey HSD. Failure modes were observed under a stereomicroscope (10 ). P

"nBackground and Aim: Because of polymerization shrinkage and high viscosity of posterior composites, there are some difficulties in using them in posterior restorations. Several methods have been represented to reduce the effect of shrinkage. The aim of this study was to investigate the effect of curing flowable composites under condensable ones in adaptation and microleakage reduction of posterior composite restorations. "nMaterials and Methods: In this experimental in vitro study, forty class II MO cavities were prepared on extracted intact molar and premolar human teeth. Gingival margins were placed 1 mm apical to CEJ. The teeth were divided into two groups. In group 1, flowable composite (Filek Flow, 3M, ESPE, USA) with 0.5-1 mm thickness was applied and cured following application of bonding agent (Single Bond, 3M, ESPE, USA). The rest of the cavity was filled by condensable composite (p60, 3M, ESPE, USA). In group 2 the flowable composite was not cured, and the condensable composite was applied in two increments. After light curing of composites, all the specimens were thermocycled and then immersed in 0.3% basic fuschin. Specimens were sectioned and evaluated for degree of dye penetration under a stereomicroscope. Data were analyzed by Mann-Whitney test with p

Background and Aim: The efficiency of disinfecting materials and procedures in removal of contamination from dental surfaces and equipments is essential. In authors' previous study, daily use of 2:100 dilution of 5% sodium hypochlorite in water and disposable covers were recommended since HBV contamination was found on semi-critical parts of the operative dentistry department. The aim of this study was to evaluate the HBV contamination following application of the recommended procedures.Materials and Methods: The study was conducted in two parts. In the first cross-sectional part, samples were collected from 17 sites of dental surfaces. In the second interventional part samples were collected from 10 sites of 9 dental and 3 sites of 2 light cure units, before and after disinfection with 5% sodium hypochlorite solution diluted to 2:100. Sterile cotton swabs moistened with sterile BSAS (Bovine Serum Albumin in Sodium Chloride) solution were used for sampling. Samples were tested by PCR technique in Pasteur Institute, Iran.Results: None of the samples collected in the first part of the study showed contamination. In the second part of the study, from 96 samples taken from various parts of dental and light cure units, before and after disinfection, there was only one HBV contaminated site before disinfection which showed no contamination after disinfection.Conclusion: Based on the results of this study, disinfecting procedure with 5% sodium hypochlorite solution diluted to 2:100 along with using disposable covers is effective in preventing HBV contamination.

Background and Aim: Infection control is an important issue in dentistry. Without an efficient infection control, pathogens left on instruments and working surfaces will have potential danger to patients’ health. In this research, antiviral effect of three disinfectants: 0.5% sodium hypochlorite 0.05% sodium hypochlorite and Deconex 50 AF, on HBV was investigated. Materials and Methods: In this interventional (before-after) study; serums of 26 HBV positive patients were analyzed by PCR HBV analysis and 9 contaminated species were obtained to test three disinfectants. 36 agar plates were prepared with the contaminated serums. 27 of the plates were disinfected in 3 separate groups with the above mentioned solutions. Nine remaining plates were not disinfected (control). Swabs wetted by BSAS (Bovine Serum Albumin Sodium Chloride) medium were applied on the surface of the plates and the were kept in the transferred medium and sent to virology-lab of Pasteur Institute. HBV DNA were detected by commercial kit of HBV PCR (polymerase chain reaction) method. Data were analyzed by Cochrane test with p

Statement of Problem: Considering that the role of collagen fibers in dentin adhesion has not been thoroughly established yet, the removal of exposed collagen fibers with a deproteinization agent such as sodium hypochlorite following etching may facilitate access of adhesive resins to a substrate that is more penetrable and less sensitive to water content which in turn would lead to a more durable bonding system. Furthermore, due to sodium hypochlorite clinical application as a cleanser or canal irrigator, its effects on the surface before etching may influence adhesive bonding strength. Purpose: The goal of this study was to evaluate the effects of a two-minute 5.25% NaOCL application on composite restorations microleakage, using two different adhesive systems. Materials and Methods: In this interventional experimental study, on seventy-two extracted boving incisors class V cavities were prepared on dentinal surfaces. The specimens were then randomly divided into six equal groups: A1) Acid etch (AE) dentin bonding Scontchbond Multipurpose Plus (SBMBP), A2) AE/ dentin bonding One Step (OS), B1) NaOCL/ AE/SBMPp, B2) NaOCL/AE/OS, C1) AE/NaOCL/SBMPp, C2) AE/NaOCL/OS. After bonding procedures according to the manufacturer’s instructions, cavities were restored using Z100 composite. Then, the specimens were thermocycled for 500 times in water baths of 5 and 55C. After thermocycling, the specimens were immersed in a 0.2% solution of basic fuchsin for 24 hours. A buccolingual section at the center of each restoration was obtained and examined with a stereomicroscope to evaluate color penetration into cavities. The data were subjected to two-way variance analysis. Results: The microleakage of group B was significantly less than those of A and C (P

Statement of Problem: Rapid increases in the population of hemodialyzed patients induce the dentists to acquire a complete understanding of the special therapeutic considerations for such patients. Purpose: The goal of this research was to study the amount of DMF in hemodialyzed patients, age ranging from 12-20 years, in the city of Tehran."nMaterials and Methods: In this cross- sectional and analytic- descriptive research, 50 kidney patients (27 mail and 23 females), with the age range of 12-20 years were selected. They had referred to one of the following hospitals for hemodialysis: Imam Khomeini, Children Medical Center Fayyazbakhsh, Haft-e-Tir, Ashrafi Esfahani, Labafinejad and Hasheminejad. The data, based on clinical examination, patient's answers, patient's medical files, parents replies, were collected and analyzed by Chi- Square test. Results: The average DMF, for. patients under study was 2.46, comparing to the normal subjects of the society, no significant difference was observed. Factors such as sex, Mother's education, oral hygiene and the number of daily brushing did not show any statistically significant difference about this index. The results also showed a 38% prevalence of severe gingivitis and 32% of moderate gingivitis. Conclusion: This restricted study emphasizes the necessity to use proper preventive methods and to improve the patient's and parents' knowledge about oral and dental health.

ObjectivesTo assess the reliability and the minimal clinically important differences (MCID) for FVC% predicted in the Scleroderma Lung Study I and II.MethodsUsing data from SLS I and II (N=300), we evaluated the test-retest reliability for FVC% predicted (FVC%; screening vs. baseline) using intra-class correlation (ICC). MCID estimates at 12 months were calculated in the pooled cohort (SLS-I and II) using 2 anchors: Transition Dyspnea Index (≥change of 1.5 units for improvement and worsening, respectively) and the SF-36 Health Transition question: "Compared to one year ago, how would you rate your health in general now?", where "somewhat better" or "somewhat worse" were defined as the MCID estimates. We next assessed the association of MCID estimates for improvement and worsening of FVC% with patient reported outcomes (PROs) and computer-assisted quantitation of extent of fibrosis (QLF) and of total ILD (QILD) on HRCT.ResultsReliability of FVC%, assessed at a mean of 34 days, was 0.93 for the pooled cohort. The MCID estimates for the pooled cohort at 12 months for FVC% improvement ranged from 3.0 % to 5.3% and for worsening from -3.0% to -3.3%. FVC% improvement by ≥MCID was associated with either statistically significant or numerical improvements in some PROs, QILD, and QLF, while FVC% worsening ≥MCID was associated with statistically significant or numerical worsening of PROs, QILD, and QLF.ConclusionFVC% has acceptable test-retest reliability, and we have provided the MCID estimates for FVC% in SSc-ILD based changes at 12 months from baseline in two clinical trials. Clinical trial registration available at www.clinicaltrials.gov, IDs NCT00004563 and NCT00883129.

The limited effectiveness of the conventional methods for cancer treatment makes the researchers to find novel safe and effective therapeutic strategies. One of these strategies is to use small interfering RNAs (siRNAs). A major challenge here is the siRNA delivery into the cells. The purpose of this study was to design and prepare a biocompatible, biodegradable, and safe nanosized particle for siRNA delivery into human breast cancer MCF-7 and leukemia K562 cells. Chemically synthesized magnetic nanoparticles containing polyethyleneglycol-lactate polymer (PEG-LAC), chitosan, and polyethyleneimine (PEI) were successfully prepared and used as a gene delivery vehicle. The nanoparticles were characterized by Fourier transform infrared spectroscopy and zeta potential. The Fe3O4-PEG-LAC-chitosan-PEI nanoparticle showed efficient and stable survivin siRNA loading in gel retardation assay. The cytotoxicity of the prepared nanoparticle was studied using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay and was compared with that of mitoxantrone (MTX) in combination with the prepared siRNA delivery system to evaluate the possible synergic effect of MTX and survivin siRNA. The nanoparticles with and without noncomplementary siRNA showed low toxicity against both cell lines; however, a twofold decrease was observed in cell survival percent after MTX addition to MCF-7 cells treated with either nanoparticle itself or complexed with noncomplementary siRNA. While survivin siRNA nanoplex caused threefold decrease in the cell survival percent, its combination with MTX did not result in a significant increase in the cytotoxic effect. Therefore, Fe3O4-PEG-LAC-chitosan-PEI nanoparticle should be considered as a potential carrier for enhanced survivin siRNA delivery into MCF-7 and K562 cells. [ABSTRACT FROM AUTHOR]

About 80 percent of Iran is arid and semi-arid and about 35 percent of this area is susceptible to desertification hazard. Therefore desertification assessment and identification of the most important criteria for the assessment of risk and a basis for development of management plans is essential. This research was conducted in the semi-arid region of Agh-Band in the Golestan province, Iran with an area of 3062.5 km2 aiming at preparation of the desertification hazard and risk maps and development of various management plans to control the desertification. In this study, the IMDPA model and geomorphologic facies were used to evaluate the desertification hazard. The work units (geomorphologic facies) were defined based on geology and land use maps, satellite images and field surveys. The risk map was developed with a combination of desertification hazard intensity and hazard elements and degree of vulnerability maps using the total risk equation. Desertification management plan was developed based on four management strategies including: no plan, maintains the status quo, avoid the risk and implement the control measures. The results indicated that soil and vegetation criteria with magnitudes of 2.67 and 2.54 fall into sever desertification category (III) and other criteria are within medium class (II). The average value of degree of desertification in the study area was 2.03 (class II). [ABSTRACT FROM AUTHOR]

Background: One of the issues that should be considered for methadone-treated patients is the quality of sleep in these patients. But the key question is, does the behavioral analysis approach affect the sleep quality of methadone-treated patients? Aims: The purpose of this study was to evaluate the effect of group training on behavioral analysis on improving sleep quality and its components in male patients treated with methadone. Method: The study was a quasi-experimental study with pre-test, post-test and follow-up and control group. The statistical population of this study consisted of all patients treated with methadone in one of Tehran's drug abuse treatment centers in 2015-2016. 40 patients were selected by convenience sampling method and randomly divided into experimental and control groups. (20 people) were replaced. The tools are: Pittsburgh Sleep Quality Questionnaire (Daniel J. Bayes et al., 1989) and Group Training Protocol on Mutual Behavior Analysis (Attadakht, Jafarian Dehkordi, Bashirpour & Narimani, 2015). Data were analyzed using covariance analysis test. Results: Interaction analysis approach had a significant effect on improving sleep quality of patients treated with methadone (P

Background and Aims: In spite of the advances achieved in the field of dentin adhesives, the longevity of bond to dentin is still a challenge. According to recent studies, Matrix Metaloproteinase (MMP) inhibitors can increase clinical longevity of bonding and decrease leakage. The aim of this study was to evaluate the amount and pattern of doxycycline release from an experimental dentin adhesive containing this MMP inhibitor. Materials and Methods: In this experimental study, specimens containing 0.25 and 0.5 loading percent of doxycycline in an experimental monomer were prepared in cylindrical moulds of 12 mm diameter and 2 mm thickness. The adhesive monomer was composed of 12 wt% Bis-GMA, 10 wt% TMPTMA, 28 wt% HEMA and 50 wt% ethanol. Camphorquinone and amine were used as initiators. Results: Addition of 0.25 and 0.5 w% doxycycline showed linear release in both groups. Increasing the loading percent of doxycycline caused more release. The release continued during the test period. Conclusion: Doxycycline release was observed from the experimental adhesive. Further studies in this field will help in preparing adhesive systems with more clinical longevity. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis B is an important infection route in dentistry requiring different disinfectants to prevent its transmission. The aim of this study was to compare the effects of chemical disinfectants (FD366, ISORAPID and 5% sodium hypochlorite 2/100) to remove Hepatitis B infections from the dental surfaces. Materials and Methods: In this experimental laboratory trial, serum of 10 HBV patients was poured into microtubes, FD366, ISORAPID and hypochlorite disinfectants were added to them. PCR experiments with viral diagnostic kits were used to diagnose the virus genome. Real time PCR was used to evaluate after incubation with the disinfectants. The reductions occurred in the viral load of Hepatitis B were statistically analyzed using Kruskal-wallis and Mann-Whitney U tests . Results: No significant antiviral efficacy was noted following the application of FD366 and ISORAPID disinfectants (P=0/07). However, hypochlorite showed the most efficacy to disinfect Hepatitis B and a significant difference was found among them (P