Search

Dysphagia is one of the postoperative complications of cervical degenerative disorders. However, few studies have evaluated the pre- and postoperative swallowing function in detail.To analyze pre- and postoperative swallowing dynamics kinetically and investigate factors associated with postoperative dysphagia in patients with cervical degenerative disorders.Retrospective review of prospectively collected data.A total of 41 consecutive patients who underwent an anterior approach (anterior cervical discectomy/corpectomy and fusion (ACDF, ACCF), hybrid surgery (ACDF+ACCF) and total disc replacement) and 44 consecutive patients who underwent a posterior approach (laminoplasty and laminoplasty/laminectomy with fusion).We compared the pre- and postoperative functional oral intake scale (FOIS), dysphagia severity scale (DSS), esophageal dysphagia, anterior/superior hyoid movement, upper esophageal sphincter (UES) opening, pharyngeal transit time, bolus residue scale (BRS), and the number of swallows.Videofluoroscopy was performed on the day before surgery and within two weeks after surgery. Data related to age, gender, disease, surgical procedure, surgical site, operative time, and blood loss were collected from the medical records. Pre- and postoperative data were compared for each item in the anterior and posterior approaches. The odds ratio of dysphagia after an anterior approach was also calculated.In the anterior approach, DSS, FOIS, the anterior and superior hyoid movements, maximum UES opening, BRS, and number of swallows worsened postoperatively (p.05, respectively). In the posterior approach, DSS, FOIS, the anterior hyoid movement, and BRS worsened postoperatively (p.05, respectively). The factors associated with dysphagia were a proximal surgical site above C3 (OR: 14.40, CI: 2.84-73.02), blood loss100 ml (OR: 9.60, CI: 2.06-44.74), an operative time200 min (OR: 8.18, CI: 1.51-44.49), and an extensive surgical field of more than three intervertebral levels (OR: 6.72, CI: 1.50-30.07). The decline in swallowing function after the posterior approach was related to aging (p = .045).Each approach may decrease swallowing function, especially because of the limitation on the anterior hyoid movement. Dysphagia after anterior approaches was associated with the operative site, operative time, and blood loss.

Introduction: There are various doses, durations, and strains of bacillus Calmette-Guérin (BCG) intravesical instillation therapy, but optimal treatment has not yet been established. We retrospectively investigated the efficacy and safety of low-dose BCG therapy for non-muscle-invasive bladder cancer (NMIBC) and carcinoma in situ (CIS) in a multicenter study. Methods: From 1991 to 2019, 323 patients who received BCG therapy to prevent recurrence of NMIBC were analyzed as group A. Similarly, 147 patients who received BCG therapy for the treatment of CIS were analyzed as group B. Patients received low- or full-dose Tokyo-172 strain or full-dose Connaught strain, and the three strains were compared. Survival curves were estimated by the Kaplan-Meier method, and independent risk factors for intravesical recurrence were examined by multivariate logistic regression. Results: Recurrence-free survival (RFS) in group A was significantly better for the Connaught strain than the low-dose Tokyo-172 strain (p = 0.026), but not between the low- and full-dose Tokyo-172 strains (p = 0.443). RFS of group B, cancer-specific survival, and progression-free survival in both groups did not show statistically significant differences. Logistic analysis of group A showed that for intravesical recurrence, only pT1 was a significant risk factor, and there were no differences between the BCG strain and dose and no significant factors in group B. There were also no differences in the completion rate in both groups, but adverse events such as urinary frequency and feeling of residual urine were significantly lower with the low-dose Tokyo-172 strain. Conclusion: There was no difference in efficacy between the low- and full-dose Tokyo-172 strains, but to minimize adverse events, the low-dose Tokyo-172 strain may be worth considering.

Introduction: The secretion of saliva, which is triggered by acid reflux into the esophagus via the esophagosalivary reflex, plays a crucial role in the defensive mechanisms of the esophagus. The volume of saliva secreted in patients with gastroesophageal reflux disease (GERD) is reduced. However, the effects of proton pump inhibitors (PPI) on the secretion of saliva have rarely been reported. Therefore, the present study investigated changes in the volume and pH of saliva after the cessation of PPI. Materials and Methods: We retrospectively reviewed the records of consecutive patients previously diagnosed with mild reflux esophagitis (RE) or non-erosive reflux disease (NERD) controlled with PPI (including vonoprazan) who performed the salivary secretion test before and after a 2-week cessation of PPI. The volume, pH, and pH after acid loading (buffering capacity) of saliva were compared before and after the cessation of PPI. Results: Thirty-two patients (25 NERD, 7 mild RE) were included. The second saliva test was performed a median interval of 14 months [12.0–15.3] after the first test. No significant differences were observed in the volume of saliva secreted before and after the cessation of PPI (before 4.0 mL [2.7–6.0] vs. after 4.0 mL [2.3–5.9], p = 0.894). No significant differences were noted in pH or changes in pH after acid loading before and after the cessation of PPI (pH: before 7.1 ± 0.24 vs. after 7.0 ± 0.24, p = 0.1. Delta pH after acid loading: before 1.0 [0.8–1.2] vs. after 1.0 [0.8–1.2], p = 0.844). Conclusion: The cessation of PPI did not appear to affect the volume, pH, or buffering capacity of saliva in patients with PPI-responsive mild RE and NERD.

Theobromine (TB) has been reported to promote tooth remineralization, strengthen tooth substance, and relieve dentin hypersensitivity. This study aimed to evaluate experimental tooth coating materials containing TB and surface pre-reacted glass-ionomer (S-PRG) fillers by examining the effects on bacterial adhesion and antibacterial properties. In addition, the amount of TB eluted from the coating material was measured. There was no significant difference in bacterial adhesion depending on the presence or absence of TB in the coating material, however, a significant decrease in the amount of bacterial adhesion was observed when S-PRG fillers were added to the coating material. The amount of eluted TB did not differ depending on the type of the filler in the coating material. It was suggested that TB could be used to develop a new dental material with the potential ability to inhibit the initiation and progression of dental caries.

The study aimed to evaluate the influence of the manipulation surfaces on the physical properties of one-step self-etch adhesives (1-SEAs). Scotchbond Universal (SBU), Clearfil Universal Bond Quick ER (UBQ), and an experimental adhesive (UBQexp) were manipulated on different surfaces: manufacturer’s Teflon-based dispensing dish (TD) or hydroxyapatite plate (HA). After manipulation of the adhesives, the pH of each 1-SEA was measured. Samples of each adhesive/manipulation surface were prepared and subjected to water sorption (WS)/solubility (SL) and flexural strength tests. The modulus of elasticity (E) was measured in dry and wet conditions before and after 24 h water storage, and the percentage of variation of E (ΔE) was calculated. Results were analyzed using the t-test with Bonferroni corrections (α = 0.05). When adhesives were manipulated on the HA plate, there was a significant increase in the adhesives’ pH. WS and SL of all 1-SEAs decreased when the HA was used. Only SBU showed higher flexural strength when manipulated on the HA compared to the manipulation on TD under dry and wet conditions. For each 1-SEA, the use of HA resulted in significantly higher E in dry and wet conditions. ΔE of all adhesives was smaller with the manipulation on HA than on TD. It was concluded that the manipulation of 1-SEA on a hydroxyapatite plate considerably affected the adhesives’ properties.

An investigation of alternatives to immune checkpoint inhibitors for advanced urothelial cancer (aUC), with biologic information, is urgently needed. Clinical data for 53 patients who received gemcitabine–paclitaxel therapy (GP) as 2nd-line chemotherapy for aUC refractory to platinum-based chemotherapy were retrospectively reviewed. The efficacy and tolerability of GP were evaluated, and the predictive value of phosphoglycerate kinase 1 (PGK1) immunostained in surgical specimens was investigated for treatment outcomes in 1st- and 2nd-line chemotherapy. GP was associated with an objective response rate of 35.8% and a median overall survival duration of 12.3 months. Multivariate analysis showed that PS2 and 1st- and 2nd-line non-response are independent predictors of worse progression-free survival and that PS2 and 1st-line non-response are independent predictors of worse overall survival. Adverse events were manageable, and no therapy-related deaths occurred. Non-response rates to 1st-line chemotherapy were significantly higher in patients with a high expression of PGK1 in the nucleus than in those with low expression (p = 0.006). Our study demonstrates the efficacy and tolerability of 2nd-line GP for patients with aUC who are refractory to platinum-based chemotherapy. Moreover, PGK1 in the nucleus was predictive values for resistance to platinum-based chemotherapy in aUC.

This study aimed to evaluate the bonding abilities and long-term durability of different repair agents when applied to lithium disilicate ceramics (LDS). Blocks of IPS e.max CAD were prepared and divided into four groups according to the surface treatment: Monobond EtchPrime (ME), K-etchant GEL+Clearfil Universal Bond (UB), Bondmer Lightless (BL), and K-etchant GEL+G-Multi Primer (GMP). All treated ceramic specimens were bonded to resin composite and light-cured. The micro-shear bond strength was measured after 24 h of water storage or 5,000 thermocycles. ME and BL showed significantly higher initial bond strengths than UB and GMP (p0.05). After 5,000 thermocycles, there was no significant difference in ME (p0.05), but BL and GMP showed considerable reduction in bond strength (p0.05); moreover, the samples of UB were all de-bonded before testing. ME and BL proved to be effective surface treatment materials for LDS.

Early detection of primary bladder cancer (BCa) is vital, because stage and grade have been generally accepted not only as categorical but also as prognostic factors in patients with BCa. The widely accepted screening methods for BCa, cystoscopy and urine cytology, have unsatisfactory diagnostic accuracy, with high rates of false negatives, especially for flat-type BCa with cystoscopy and for low-risk disease with urine cytology. Currently, liquid biopsy has attracted much attention as being compensatory for that limited diagnostic power. In this review, we survey the literature on liquid biopsy for the detection of BCa, focusing on circulating tumor cells (CTCs), urinary cell-free DNA (ucfDNA), and urinary microRNA (umiRNA). In diagnostic terms, CTCs and umiRNA are determined by quantitative analysis, and ucfDNA relies on finding genetic and epigenetic changes. The ideal biomarkers should be highly sensitive in detecting BCa. Currently, CTCs produce an unfavorable result; however, umiRNA and ucfDNA, especially when analyzed using a panel of genes, produce promising results. However, given the small cohort size in most studies, no conclusions can yet be drawn about liquid biopsy’s immediate application to clinical practice. Further large studies to validate the diagnostic value of liquid biopsy for clinical use are mandatory.

To evaluate the prevalence of non-carious cervical lesions (NCCLs) on teeth with or without erosive etiological factors across a broad range of ages of Japanese adults. The study sample consisted of a total of 1108 subjects aged 15 to 89 years in Tokyo, Japan. Two examiners evaluated NCCLs and dental erosion (DE) during a full-mouth examination. Subjects were asked to complete a self-administered daily diet, habits, and health condition questionnaire. Subjects who had frequent acid consumption or gastric reflux and at least one tooth with initial enamel wear were placed in the erosion present (EP) group, and the remainder of subjects were placed in the erosion not present (EN) group. Logistic regression analyses were carried out to identify etiological factors of NCCLs associated with DE. Overall prevalence of NCCLs was 60.2%; the prevalence increased with age. There were no statistical differences in the prevalence of NCCLs between the EP and EN groups, except for the 60–69 years group. Multiple logistic regression analysis showed the frequency of consumption of carbonated soft drinks, citrus juice, and acidic fruits such as oranges; tooth brushing pressure; and bruxism were associated with the presence of NCCLs. There were no statistical differences in the prevalence of NCCLs with or without erosive etiological factors except for the 60–69 years group. NCCL distribution increased with age, and erosive risk factors caused by change in dietary habits might affect the incidence of NCCLs for elders. UMIN000041982

This study aimed to assess the influence of different light curing units (LCUs) on the polymerization of various flowable resin composites. Three LCUs (Optilux 501, Elipar™ DeepCure-L LED and Bluephase®20i) and eight flowable resin composites: MI FIL Flow, Estelite Flow Quick, Estelite Universal Flow (medium), Estelite Universal Flow (super low), Beautifil Flow Plus, Clearfil Majesty ES Flow, Filtek Supreme Ultra flowable and TetricEvo Flow were tested. For Vickers microhardness (VHN) test and degree of conversion (DC), specimens were prepared and polymerized for 20 s. VHN test was performed at top surfaces (3 indentations) and DC for each specimen was measured using Fourier transform infrared (FT-IR) spectroscopy after 24 h dry storage in dark at 37˚C. The data were analyzed with 2-way ANOVA and t-test with Bonferroni correction. DC and hardness values showed a relationship between materials and LCUs. The curing efficacy of LCU type may depend on the material composition.

Radical nephroureterectomy (RNU) is the gold standard treatment for upper tract urothelial carcinoma (UTUC), but the usefulness of this surgery for older patients is rarely discussed. The prognosis following RNU for patients ≥80 years old remains controversial. We retrospectively investigated the prognosis of UTUC in patients ≥80 years old who underwent RNU.Between January 1990 and December 2015, 451 patients with UTUC underwent RNU at six hospitals affiliated with Kitasato University (Kanagawa, Japan), eight patients who underwent neoadjuvant chemotherapy and two patients with metastases before surgery were excluded. Patients were divided into three groups according to their age at the time of RNU: ≤64 years (n = 135), 65-79 years (n = 254), and ≥80 years (n = 52). Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) curves were estimated using Kaplan-Meier analysis for all patients and each pT stage. Independent prognostic factors for survival were examined via multivariate analysis.RFS and CSS did not significantly differ between the three groups, but OS was significantly poorer in patients ≥80 years old. Stratification by pT stage (≤pT1, ≥pT2, and ≥pT3) yielded the same results. In the multivariate analysis for OS, an age of ≥80 years was a significant independent risk factor (hazard ratio: 3.01, p = .01), but RFS and CSS did not significantly differ.Oncological outcomes showed the same anticancer effects in patients ≥80 years old who underwent RNU for UTUC compared with those of younger patients. Our study suggests that surgical treatment is a beneficial option for older patients who can tolerate radical surgery.

Background There is a high incidence of intravesical recurrence after transurethral resection of bladder tumor for non-muscle invasive bladder cancer (NMIBC). Intravesical instillation of bacillus Calmette-Guérin (BCG) is widely used to prevent recurrence and progression. There are two types of NMIBC: primary NMIBC and subsequent NMIBC after radical nephroureterectomy (RNU). We compared the clinical outcomes of BCG intravesical instillation therapy between the two types of NMIBC. Patients and Methods This study included a total of 357 patients, who received BCG intravesical instillation therapy to prevent recurrence of NMIBC (pTa/pT1) between 1991 and 2019. Among them, 34 patients had subsequent NMIBC after RNU and the remaining 323 patients had primary NMIBC. This retrospective study analyzed 68 patients extracted by propensity score matching. Survival curves were estimated using the Kaplan–Meier method, and independent prognostic factors for survival were examined by the Cox proportional hazards model. Results The 3-year recurrence-free survival (RFS) rates in patients with primary NMIBC and subsequent NMIBC after RNU were 70.7% and 54.8%, respectively (p = 0.036). However, there were no significant differences between the two groups in progression-free survival and cancer-specific survival. Multivariate analysis of RFS showed that only a previous history of upper tract urothelial carcinoma was an independent prognostic and predictive factor. Conclusion Patients with subsequent NMIBC after RNU treated with BCG intravesical instillation therapy have a higher risk of recurrence than those with primary NMIBC. Thus, stringent follow-up is necessary for patients with subsequent NMIBC after RNU.

Little data on the preoperative prognostic factors in radical cystectomy (RC) patients have made it difficult to choose the appropriate type of urothelial diversion (UD). This study aimed to investigate the prognostic role of UD, with a subgroup analysis of that of preoperative renal function. From 1990 to 2015, 279 patients underwent RC for bladder cancer at six hospitals affiliated with Kitasato University in Japan. All patients were divided into three groups: cutaneous ureterostomy (CU; n = 54), ileal conduit (IC; n = 139), and orthotopic neobladder (NB; n = 86). Patients were also stratified into three groups based on preoperative estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2): normal eGFR (> 60 mL/min/1.73 m2; n = 149), moderately reduced eGFR (45–60 mL/min/1.73 m2; n = 66), and severely reduced eGFR (

The purpose of this study was to evaluate the effects of two different concentrations of silver diammine fluoride (SDF) on dentin bonding performance. Human mid-coronal dentin was treated with either distilled water (control), 3.8%SDF or 38%SDF for 3 min. A two-step self-etch adhesive and resin composite were applied according to manufacturer's instructions. After thermocycling (TC) at 0, 5,000 and 10,000 cycles, microtensile bond strength (µTBS) testing and morphological assessment of resin-dentin bonding interface were performed. At 0 TC, µTBSs of 3.8% and 38%SDF were significantly reduced (p

Objective: To investigate the relationship between clinicopathological findings and membranous CD155 (mCD155) or cytoplasmic CD155 (cCD155) expression in bladder cancer (BC). Methods: We retrospectively analyzed 103 patients with BC who underwent radical cystectomy between 1990 to 2015 at Kitasato University Hospital. Immunohistochemical staining was performed to evaluate CD155 expression in tumor cells. Cases with > 10% expression on the membrane or cytoplasm of tumor cells were positive. The Fisher′s exact test was used for categorical variables and the Kaplan–Meier method was used for survival outcomes. Univariate and multivariate Cox regression hazard models were used to evaluate the survival risk factors. Results: Cases that were mCD155-positive were associated with high-grade tumors (p = 0.02), nodal status (p < 0.01), and pT stage (p = 0.04). No association with any clinicopathological factor was observed in the cCD155 cases. Kaplan–Meier analysis showed that mCD155-positive cases had shorter periods of recurrence-free survival (p = 0.015) and cancer-specific survival (p = 0.005). Only nodal status was an independent predictor for both cancer-specific survival and recurrence-free survival in multivariate analysis (p = 0.02 and p < 0.01, respectively). Conclusion: mCD155 expression may be a marker of an aggressive phenotype and a poor prognosis in patients with BC.

Chicago classification version 4.0 suggests additional maneuvers, such as upright testing, multiple rapid swallows (MRS), and the rapid drink challenge (RDC), for high-resolution manometry (HRM) to minimize ambiguity in the diagnosis of esophageal motility disorders. The present study investigated normative thresholds for these new metrics using the Starlet system as well as their diagnostic yields for relevant esophagogastric outflow disorders (EGJOD).In study 1, 30 asymptomatic volunteers prospectively performed HRM including MRS and RDC in the supine/upright positions. We calculated normative thresholds for the new metrics, such as upright integrated relaxation pressure (IRP), upright intrabolus pressure (IBP), and IRP during RDC (RDC-IRP). In study 2, we retrospectively analyzed the HRM tracings of 82 patients who underwent HRM in both positions at our hospital to assess the diagnostic yields of HRM metrics.Based on the results of study 1, we adopted the following normative thresholds: upright IRP 20 mmHg, upright IBP 21 mmHg, and RDC-IRP 16 mmHg. In study 2, 45 patients with dysphagia or chest pain were included in the analysis to identify predictive factors for clinically relevant esophagogastric outflow disorders (true EGJOD). Supine/upright IRP, RDC-IRP, and pan-esophageal pressurization 20 mmHg during RDC (RDC-PEP) predicted true EGJOD with RDC-PEP with the highest sensitivity of 91.7%.HRM with additional maneuvers may facilitate the diagnosis of clinically relevant EGJOD.

This study investigated the influence of application/wash-out times of sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) on dentin bond strength of one-step self-etch adhesives (1-SEAs). Human coronal dentin discs with a standardized smear layer were pretreated with 6% NaOCl or 100 ppm HOCl for 5 s, 15 s, or 30 s, and washed out with water for 5 s, 15 s or 30 s with or without the application of Clearfil DC Activator (CDA). No pretreatment was used as a control. The discs were bonded with a 1-SEA (Bond Force II or Clearfil Universal Bond Quick) and microtensile bond strength (µTBS) was measured after 24 h. Pretreatment with NaOCl for 15 s and 30 s significantly decreased µTBS (p0.05), irrespective of wash-out time. The application of CDA recovered µTBS but did not outperform the control group. Conversely, pretreatment with HOCl for 15 s and 30 s followed by 30 s wash-out time significantly increased µTBS of 1-SEAs (p0.05), regardless of CDA application.

Background In patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients. Methods In this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS). Results Multivariate analyses showed that liver metastasis after RC (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR 1.92; 95% CI 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy. Conclusions The present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.

The effects of deproteinization using sodium hypochlorite (NaOCl) and the subsequent application of an antioxidant (sodium p-toluenesulfinate, STS) onto the bonding durability of universal adhesives on eroded dentin were investigated. Untreated sound dentin served as the control, whereas eroded dentin, which had been prepared by pH-cycling in 1% citric acid and a remineralization solution, was either untreated, deproteinized with a 10% NaOCl gel or deproteinized with the 10% NaOCl gel and subsequently treated with an STS-containing agent. The dentin surfaces were bonded using a universal adhesive (Clearfil Universal Bond Quick, Scotchbond Universal or G-Premio Bond), and the micro-tensile bond strength (µTBS) test was performed after 24 h or 10,000 thermal cycles. The µTBS data were statistically analyzed using a three-way ANOVA and Tukey’s HSD post hoc tests. The lowest µTBS was measured on untreated eroded dentin (p &lt, 0.001). Deproteinization of eroded dentin resulted in µTBS similar to untreated sound dentin (p &gt, 0.05), but the highest µTBS was obtained if deproteinization was followed by the application of STS. Thermocycling significantly decreased µTBS in all groups (p &lt, 0.001), except for STS-treated, deproteinized, eroded dentin (p &gt, 0.05). This indicated that deproteinization, followed by the application of STS, could enhance the bonding durability of universal adhesives on eroded dentin.

The adhesion of composite resin to caries-affected dentin differs from the adhesion of resin to sound dentin. We evaluated the bond strengths of dual-cure resin composites applied to caries-affected root canal dentin under various clinical conditions and using several caries removal indicators. In the dye stain 1 group, caries were removed to a pale pink stain level using a caries detector. In the dye stain 2 group, caries were removed to a stain-free level using a caries detector. In the probing group, caries were removed to the level of hardness based on probing with a sharp explorer. Additionally, a sound dentin group was used as a control. We compared the resin composite microtensile bond strengths and failure mode distribution among the groups. The bond strengths (MPa) of the probing (64.6 ± 11.9) and the sound dentin (68.7 ± 11.1) groups were significantly higher than those of the dye stain 1 (46.9 ± 7.9) and 2 (47.5 ± 8.4) groups (p < 0.05). The removal of caries-affected dentin using a dentin-hardness-based technique showed higher tensile strength than that using a dye stain technique involving removal to any color level. Thus, the caries removal technique used on root canal dentin affects the bond strength of the resin composite.

Intravesical recurrence (IVR) after nephroureterectomy for upper tract urothelial carcinoma (UTUC) is relatively frequent, occurring in about 30-50% of patients. The aim of this study was to investigate the differences of the prognosis and IVR between open and laparoscopic surgery and to elucidate the risk factor of IVR.We retrospectively analyzed data from 403 patients with UTUC treated with laparoscopic or open nephroureterectomy at six affiliated hospitals between 1990 and 2015. The clinicopathological factors of each group were examined using Kaplan-Meier plots, and univariate and multivariate analyses.There was no difference in recurrence and cancer-specific mortality between open and laparoscopic surgery in univariate and multivariate analyses. There was no significant difference in IVR rate between the laparoscopic and open groups (p = .22). Among the patients with IVR, 84% of patients relapsed within 2 years. Univariate analysis of IVR showed a significant increase in patients with low-grade (p = .03, HR = 1.64) or low-stage urothelial carcinoma (pT1 or lower, p = .006, HR = 1.77) with no lymph node involvement (p = .002, HR = 10.3) or lymphovascular invasion (p = .009, HR = 1.79). Surgical modality was not an independent factor. In multivariate analysis, there was no independent predictive factor for IVR.There was no difference in recurrence, cancer-specific mortality, and IVR between open and laparoscopic surgery. On the other hand, our results suggested that the low malignant potential tumor may be a risk factor for IVR. This finding provides insight into IVR, which may help with the development of personalized prevention and treatment strategies.

OBJECTIVE The aim of this study was to assess the influence of different silicatization protocols with various silane treatment methods on the bond performance to high-translucent zirconia. MATERIALS AND METHODS High-translucent zirconia specimens were assigned to five groups according to mechanical surface pretreatment: as-sintered (Con), 0.2 MPa alumina sandblasting (AB2), tribochemical silica coating (TSC), 0.2 and 0.4 MPa glass bead air abrasion (GB2) and (GB4). Each group was subjected to 4 different cementation protocols: Panavia SA Universal (SAU), Panavia SA plus (SAP), silane + SAP (S-SAP), and Universal adhesive + SAP (U-SAP). Tensile bond strength (TBS) was measured after 24 h and 10,000 thermocycling (TC). Surface topography, surface energy, and elemental composition of the abraded zirconia surface analyses were completed. TBS data was analyzed using the Weibull analysis method. Surface roughness and surface energy were compared by one-way ANOVA analysis of variance (α = 0.05). RESULTS After 24 h, higher TBS was achieved with all cementation protocols in AB2 and TSC, also, in GB2 with all protocols except U-SAP, and in GB4 with SAU and S-SAP. After aging, GB4/S-SAP, GB2/S-SAP, AB2/U-SAP, and TSC/S-SAP showed the highest bond strength. GB groups showed the lowest surface roughness and highest surface energy. CONCLUSION Glass bead abrasion achieved the durable bond strength to high-translucent zirconia using a separate silane coupling agent while altered surface chemistry, surface energy, and roughness without effect on morphology. CLINICAL RELEVANCE Glass bead air abrasion is an alternative to alumina sandblasting and tribochemical silica coating and improves bond strength to high translucent zirconia.

Bladder cancer is extremely rare in young patients. We reported the clinicopathological outcomes in adolescent and young adult patients with bladder cancer, using age 35 as the cut-off. From 1972 to 2011, 1349 patients were treated with transurethral resection of bladder tumor. Thirty patients were ＜35 years of age and were divided into two groups : ＜30 and ≧30 years. We reviewed the initial symptoms, cystoscopic and pathological findings, and prognosis. Thirteen patients (0.96%) were ＜30 years of age and seventeen (1.3%) were ≧30 of age, with mean follow-up periods of 88.2 and 77.6 months, respectively. The most common complaint was gross hematuria. Most tumors were solitary (26 ; 86.7%) and papillary (29 ; 96.7%). Pathological stages were pTa 15, pT1 10, and pT2 3. Patients with pT2 cancer were ≧30 years of age (p ＝ 0.019). One patient died of bladder cancer. The majority of patients had low-grade, low pathological stage bladder cancer and a good prognosis. However, some pT2 cancers exhibited aggressive behavior.

Objective The influence of light-curing of a one-step self-etch adhesive (1-SEA) prior to the application of different bonding agents (BA) on the micro-tensile bond strength (μTBS) to dentin after 24 h and thermal cycling was investigated. Additionally, the degree of conversion was evaluated using Fourier-transform infrared spectroscopy. Methods Three ion-releasing BAs, BZF-21 (experimental BA), Clearfil SE Protect (CSP), and FL-Bond II (FL-II), were applied subsequently to G-Premio Bond (1-SEA, GPB). Prior to their application, GPB was either light-cured (10 s, 1000 mW/cm2) or remained uncured. GPB was used as a control and Clearfil SE Bond 2 (CSE2) as a gold-standard 2-step reference. After resin-composite build-up and 24-h water storage (24 h), half of the specimens were subjected to 15,000 thermal cycles (TC). Then, the specimens were sectioned into beams and tested under tensile load (1 mm/min). The acquired data were analyzed using a 2-way ANOVA and Student’s t-test with Bonferroni correction, and a two-parameter Weibull analysis, α = 0.05. Results The μTBS of GPB increased significantly in the uncured groups with BZF-21 (24 h: p Significance BZF-21 and CSP improved the μTBS of GPB to dentin both immediately and after TC. Higher μTBSs were obtained when GPB remained uncured prior to BA application.

The purpose was to evaluate the effect of a hydrophilic amide monomer on μTBS of one-step adhesive to dentin at different application times. Clearfil Universal Bond Quick (UBQ), experimental adhesive (UBQexp; same compositions as UBQ but hydrophilic amide monomer was replaced with 2-hydroxyethyl methacrylate), Clearfil SE ONE and Clearfil SE Bond were applied to midcoronal dentin prepared with 600-grit SiC at different application time (0, 10, 20 and 40 s). Water sorption (Wsp) and the ultimate tensile strength (UTS) of polymerized adhesives were also measured. UBQ showed significantly lower Wsp and higher UTS than UBQexp. At each application time, UBQ exhibited significantly higher μTBSs than UBQexp. UBQ showed the highest μTBS at 0 s application time among all the adhesives. When the application time was prolonged from 0 s to 10 s, only UBQ showed no significant difference. The hydrophilic amide monomer increased μTBS with reduction in Wsp and increase in the UTS and may allow a shortened application time.

Bond durability and resistance to acid-base challenge of dentin with dual-cure resin cement have been rarely investigated. The purpose of this study was to evaluate dentin bond strength and observe the adhesive-dentin interface after acid-base challenge using three different dual-cure resin cements.Thirty dentin surfaces from caries-free human premolars were ground and bonded with one of three dual-cure resin cements: PANAVIA V5 (V5), ESTECEM II (E II) and Rely X Ultimate (RXU) and thermocycled for 0, 5,000 and 10,000 cycles. A microtensile bond strength (μTBS) test was undertaken and the interface of the bonded specimens after acid-base challenge was examined by SEM.The μTBS of V5 exhibited a stable bond strength despite thermal cycling while the bond of EII and RXU after 10,000 cycles dropped significantly among all thermal cycle periods (p0.05). An acid-base resistant zone (ABRZ) was observed in all groups, however, the morphology of the bonded interface differed among the tested cements.Bonding durability to dentin and ABRZ morphologies differed among the cements evaluated. PANAVIA V5 cement system with tooth primer provided the most reliable bond strength and was best able to resist the acid-base challenge.

BACKGROUND New biomarkers may help us provide individualized prognosis and allow risk-stratified clinical decision making about radical treatment. OBJECTIVES This study aimed to determine the tumor necrosis factor of receptor superfamily 19 (TROY) expression in urothelial carcinoma and its relationship to clinicopathological findings. METHODS Immunohistochemical staining for TROY was carried out in 136 archival radical cystectomy specimens with immunoreactivity being stratified on a 0-9 scale. Expression scores for TROY were further stratified into negative (score 0) and positive (score 1 or greater). Median age was 65 years, and the median follow-up period was 50.7 months. RESULTS Expression of TROY was significantly associated with the pathological stage (p= 0.019) and expression of nestin (p= 0.013). Log-rank tests indicated that expression of TROY was significantly associated with disease progression and cancer-specific mortality (p= 0.044 and 0.008, respectively). In multivariate Cox regression analysis, lymph node status was the only independent prognostic factor for disease progression and cancer-specific survival. Expression of TROY was a marginal prognostic factor for cancer-specific survival. CONCLUSIONS TROY may therefore be a new molecular marker to aid in identifying and selecting patients undergoing radical cystectomy who could potentially benefit from multimodal treatment.