Effects of concentration of sodium hypochlorite as an endodontic irrigant on the mechanical and structural properties of root dentine: A laboratory study

alexandrossfakianakis shared this article with you from Inoreader Effects of concentration of sodium hypochlorite as an endodontic irrigant on the mechanical and structural properties of root dentine: A laboratory study via International Endodontic Journal Abstract Aim The use of high-concentration sodium hypochlorite (NaOCl) as an endodontic irrigant remains controversial because of its potential impact on the fracture strength of endodontically-treated teeth. This study evaluated the effects of using different NaOCl concentrations, with 2-min-ethylenediaminetetraacetic acid (EDTA) as the final active irrigant, on the biomechanical and structural properties of root dentine. Methodology A new test method, which is more clinically relevant, was utilized to calculate the fracture strength of root dentine. Bovine incisors were used to obtain root dentine discs. The root canals were enlarged to mean diameter of 2.90 mm with a taper of 0.06. The resulting discs were divided into 5 groups (n=20) and treated with different concentrations of NaOCl (5.25%, 2.5%, and 1.3%) for 30 min plus 17% EDTA for 2 min. The discs were then loaded to fracture by a steel rod with the same taper through the central hole. The fractured specimens were examined by scanning electron microscopy to evaluate changes in the dimensions of the remaining intertubular dentine and the tubular radius. Micro-hardness was also measured with a Knoop diamond indenter along a radius to determine the depth of dentine eroded by the irrigation. Results were analyzed by one-way ANOVA and the Tukey test. The level of significance was set at α = 0.05. Results The damage by NaOCl increased with its concentration. 5.25% NaOCl greatly reduced the fracture strength of root dentine from 172.10±30.13 MPa to 114.58±26.74 MPa. The corresponding reduction in micro-hardness at the root canal wall was 34.1%. The damages reached a depth of up to 400 μm (p < 0.05). Structural changes involved degradation of the intratubular wall leading to enlarged dentinal tubules and the loss of intertubular dentine. Changes in the microstructural parameters showed positive linear relationships with the fracture strength. Conclusions With the adjunctive use of EDTA, NaOCl caused destruction to the intratubular surface near the root canal and, consequently, reduced the root dentine's mechanical strength. The higher the concentration of NaOCl, the greater the effect. Therefore, endodontists should avoid using overly high concentration of NaOCl for irrigation to prevent potential root fracture in endodontically-treated teeth. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nutrition Education: Optimizing Preparation and Recovery for Benign Esophageal Surgery

alexandrossfakianakis shared this article with you from Inoreader Nutrition Education: Optimizing Preparation and Recovery for Benign Esophageal Surgery via Journal of Human Nutrition and Dietetics Abstract Background Patients requiring upper gastrointestinal surgery for benign esophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study to explore patients' perioperative food, nutrition, and educational experiences to guide future care. Methods Adult patients who had undergone elective, benign esophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analyzed with a reflexive form of inductive thematic analysis in addition to synthesized member checking. Results Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery a nd engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods, and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy. Conclusions Patients with benign esophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences. This article is protected by copyright. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Depatuxizumab-mafodotin in EGFR-amplified newly diagnosed glioblastoma: a phase III randomized clinical trial

alexandrossfakianakis shared this article with you from Inoreader Depatuxizumab-mafodotin in EGFR-amplified newly diagnosed glioblastoma: a phase III randomized clinical trial via Neuro-Oncology Advance Access Abstract Background Approximately 50% of newly diagnosed glioblastomas (GBMs) harbor EGFR gene amplification (EGFR-amp). Preclinical and early phase clinical data suggested efficacy of depatuxizumab mafodotin (depatux-m), an antibody drug conjugate (ADC) comprised of a monoclonal antibody that binds activated EGFR (overexpressed wild-type and EGFRvIII-mutant) linked to a microtubule-inhibitor toxin in EGFR-amp GBMs. Methods In this phase III trial, adults with centrally confirmed, EGFR-amp, newly diagnosed GBM were randomized 1:1 to radiotherapy, temozolomide, and depatux-m/placebo. Corneal epitheliopathy (CE) was treated with a combination of protocol-specified prophylactic and supportive measures. There was 85% power to detect a Hazard Ratio (HR) ≤0.75 for survival (OS) at a 2.5% one-sided significance level (i.e., traditional two-sided p ≤0.05) by log-rank testing. Results There were 639 randomized patients (median age 60, range 22-84; 62% men). Pre-specified interim analysis found no improvement in OS for depatux-m over placebo (median 18.9 vs. 18.7 months, HR 1.02, 95% CI 0.82-1.26, one-sided p= 0.63). Progression-free survival was longer for depatux-m than placebo (median 8.0 vs. 6.3 months; HR 0.84, 95% CI 0.70-1.01, p=0.029), particularly among those with EGFRvIII mutant (median 8.3 vs. 5.9 months, HR 0.72, 95% CI 0.56-0.93, p=0.002 one sided) or MGMT unmethylated (HR 0.77, 95% CI 0.61-0.97; p=0.012 one-sided) tumors but without an OS improvement. CE occurred in 94% of depatux-m treated patients (61% grade 3-4), causing 12% to discontinue. Conclusions Interim analysis demonstrated no OS benefit for depatux-m in treating EGFR-amp newly diagnosed GBM. No new important safety risks were identified. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Empagliflozin has favourable effect on frontal plane QRS‐T angle in diabetic patients with cardiovascular disease

alexandrossfakianakis shared this article with you from Inoreader Empagliflozin has favourable effect on frontal plane QRS‐T angle in diabetic patients with cardiovascular disease via Journal of Clinical Pharmacy and Therapeutics Empagliflozin treatment is associated with a significant decrease in the frontal plane QRS-T angle (fQRST) in patients with diabetes mellitus (DM). However, despite similar antihyperglycemic effect with empagliflozin treatment in patients with and without cardiovascular disease (CVD), the significant decrease in fQRST angle was observed only in patients with CVD and no significant decrease was observed in fQRST angle in patients without CVD. Therefore, as a sign of ventricular repolarization heterogeneity that can be easily measured from a standard 12-lead electrocardiography (ECG), fQRST angle may be a useful ECG parameter in the monitoring of cardiovascular effects of empagliflozin in type 2 DM patients with CVD. Abstract What is Known and Objective Empagliflozin treatment is significantly associated with lower risk of cardiovascular events in patients with diabetes mellitus (DM) independent of its antihyperglycemic effect. However, little is known regarding the impact of empagliflozin on electrocardiography (ECG) parameters. This study aimed to investigate whether empagliflozin has favourable effect on frontal plane QRS-T (fQRST) angle, which is an ECG sign of ventricular repolarization heterogeneity, in patients with type 2 DM. Methods We prospectively enrolled 111 patients with known diagnosis of type 2 DM who newly prescribed empagliflozin on top of their standard anti-diabetic therapy. Patients were divided into two groups according to presence or absence of cardiovascular disease (CVD) at baseline and followed-up for 6 months. The impact of empagliflozin treatment on fQRST angle was investigated and patient groups were compared regarding the pre- and post-treatment fQRST angle. Results and Discussion Among 111 patients, 32 (28.8%) had CVD and 79 (71.2%) had no CVD. Empagliflozin treatment lead a significant decrease in the mean fQRST angle throughout the study period and mean fQRST angle was significantly lower at 3- and 6-month follow-up visits compared to baseline values (62° ± 17.4° vs. 57.2° ± 14.8° vs. 50.5° ± 13.6°, p < 0.001 for all dual comparisons). However, despite similar antihyperglycemic effect with empagliflozin treatment in patients with and without CVD, the significant decrease in the mean fQRST angle was observed only in patients with CVD and no significant decrease was observed in the mean fQRST angle in patients without CVD. What is New and Conclusion Empagliflozin leads a significant narrowing in the fQRST angle in type 2 DM patients with known CVD. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anterior implant restorations with a convex emergence profile increase the frequency of recession: 12‐month results of a randomized controlled clinical trial

alexandrossfakianakis shared this article with you from Inoreader Anterior implant restorations with a convex emergence profile increase the frequency of recession: 12‐month results of a randomized controlled clinical trial via Journal of Clinical Periodontology Abstract Objectives To test whether or not the emergence profile (CONVEX or CONCAVE) of implant-supported crowns influences the mucosal margin stability up to 12 months post insertion of the final restoration. Materials and methods Forty-seven patients with a single implant in the anterior region were randomly allocated to one of three groups:1) CONVEX (n=15), implant provisional and an implant-supported crown both with a convex profile; 2) CONCAVE (n=16), implant provisional and an implant-supported crown both with a concave profile; 3) CONTROL (n=16), no provisional (healing abutment only) and an implant-supported crown. All patients were recalled at baseline, 6 and 12 months. The stability of mucosal margin along with clinical, aesthetic, profilometric outcomes as well as time and costs were evaluated. To predict the presence of recession multivariable logistic regressions were performed and linear models using generalized estimation equations (GEE) were conducted for the different outcomes. Results Forty-four patients were available at 12 months post-loading. The frequency of mucosal recession amounted to 64.3% in group CONVEX, 14.3% in group CONCAVE and 31.4% in group CONTROL. Regression models revealed that a CONVEX profile was significantly associated with the presence of recessions (OR:12.6, CI:95%: 1.82-88.48, p=0.01) compared to the CONCAVE profile. Pink aesthetic scores amounted to 5.9 in group CONVEX, 6.2 in group CONCAVE and 5.4 in group CONTROL, with no significant differences between the groups (p=0.756). Groups CONVEX and CONCAVE increased the appointments and costs compared to the CONTROL group. Conclusion The use of implant-supported provisionals with a CONCAVE emergence profile results in a greater stability of the mucosal margin compared to a CONVEX profile up to 12 months of loading. This is accompanied, however, by increased time and costs compared to the absence of a provisional and may not necessarily enhance the aesthetic outcomes. This article is protected by copyright. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.