Influence of endodontic sealers on the bond strength of carbon fiber posts

Objective: The aim of this study was to verify the influence of endodontic sealers on the bond strength of an adhesive system and a resin cement used for carbon posts cementation. Methods: Thirty extracted human premolars were instrumented and randomly divided into three groups according to the tested sealer: EndoFill, Sealapex, or EndoREZ. Specimens were stored at 37 degrees C. After 48 h, half of specimens were prepared to receive the post and the others after 7 days. The posts were cemented with Adper Single Bond/Rely X ARC and stored in distilled water at 37 degrees C for 7 days. After this period, the specimens were sectioned in three slices (coronal, middle, and apical). The push-out test was performed in a universal machine and the debonded area was examined in a stereomicroscope. Results: Data were submitted ANOVA and Tukey test (alpha = 0.05). The EndoFill showed lower bond strength than other sealers (p < 0.01). The EndoREZ sealer was statistically greater than other groups for coronal and middle portions and similar for apical portion (P > 0.05). Coronal and middle portions showed the best results for all groups, mainly when the canal preparation was performed after 48 h (p < 0.01). Mixed failure occurs with more frequency (55.6%) followed by failure in adhesive-dentin interface (34.4%) and adhesive-post interface (10.0%). Conclusion: The use of EndoREZ sealer promoted higher bond strength in root coronal and middle portions when carbon post was fixed with a resin cement. (C) 2007 Wiley Periodicals, Inc.

Photoelastic Stress Analysis of Different Designs of Cement-Retained Fixed Partial Dentures on Morse Taper Oral Implants

There is no consensus in literature regarding the best plan for prosthetic rehabilitation with partial multiple adjacent implants to minimize stress generated in the bone-implant interface. The aim of this study was to evaluate the biomechanical behavior of cemented fixed partial dentures, splinted and nonsplinted, on Morse taper implants and with different types of coating material (ceramic and resin), using photoelastic stress analysis. A photoelastic model of an interposed edentulous space, missing a second premolar and a first molar, and rehabilitated with 4 different types of cemented crowns and supported by 2 adjacent implants was used. Groups were as follows: UC, splinted ceramic crowns; IC, nonsplinted ceramic crowns; UR, splinted resin crowns; and IR, nonsplinted resin crowns. Different vertical static loading conditions were performed: balanced occlusal load, 10 kgf; simultaneous punctiform load on the implanted premolar and molar, 10 kgf; and alternate punctiform load on the implanted premolar and molar, 5 kgf. Changes in stress distribution were analyzed in a polariscope, and digital photographs were taken of each condition to allow comparison of stress pattern distribution around the implants. Cementation of the fixed partial dentures generated stresses between implants. Splinted restorations distributed the stresses more evenly between the implants than nonsplinted when force was applied. Ceramic restorations presented better distribution of stresses than resin restorations. Based on the results obtained, it was concluded that splinted ceramic restorations promote better stress distribution around osseointegrated implants when compared with nonsplinted crowns; metal-ceramic restorations present less stress concentration and magnitude than metal-plastic restorations.

Surgical outcomes of a randomized prospective trial involving patients with a proximal femoral fracture

Background: An orthopaedic management/patient-focused care unit (OMPFCU) involving a dedicated orthopaedic-geriatrics liaison team was established at the Royal Brisbane Hospital in 1994 in an effort to safely accelerate rehabilitation of patients with proximal femoral fractures. Methods: The surgical outcomes of the patients were monitored in order to determine whether accelerated rehabilitation had any significant adverse effects on the surgical outcomes, measured by mortality, readmission to hospital, deep wound infection, fracture union delay, mobility and the revision surgery rate. Results: No significant difference was recorded in mortality and morbidity, deep wound infection and revision surgery rates between patients in the Royal Brisbane Hospital OMPFCU and those in standard care in the orthopaedic surgery wards. Conclusion: Accelerated rehabilitation for patients with a proximal femoral fracture in a major teaching hospital can be accomplished safely.

Towards a definition of "difference" in osteoarthritis

To assess existing information regarding detectable differences in osteoarthritis (OA), a systematic literature search was conducted up to December 1999. Thirty-three articles were considered methodologically relevant to the definition and categorization of detectable differences in OA. It was determined that the musculoskeletal literature contains a wealth of information that relates to observed changes, much of which is derived from the clinical trials literature, but there have been relatively few methodological studies that have systematically evaluated the nature, categorization, and relevance of the change. Furthermore, most of those that have been published take the perspective of an individual or groups of experts other than that of the patient. This summary of the current literature reveals that the diverse sources of information go part way towards developing an understanding of detectable differences and their importance in the area of OA research and clinical practice. Stakeholders' interests as well as factors that modulate perceptions of importance need to be taken under consideration. In particular, the patient's perspective of the importance of change at an individual level requires further evaluation. This area of clinical research is relatively underdeveloped, but there is considerable opportunity for progress.

The validity and heritability of self-report osteoarthritis in an Australian older twin sample

In order to investigate the genetic and environmental antecedents of osteoarthritis (CA), self-report measures of joint pain, stiffness and swelling were obtained from a population-based sample of 1242 twin pairs over 50 years of age. In order to provide validation for these self-report measures, a subsample of 118 twin pairs were examined according to the American College of Rheumatology clinical and radiographic criteria for the classification of osteoarthritis. A variety of statistical methods were employed to identify the model derived from self-report variables which would provide optimal prediction of these standardised assessments, and structural equation modelling was used to determine the relative influences of genetic and environmental influences on the development of osteoarthritis. Significant genetic effects were found to contribute to osteoarthritis of the hands, hips and knees in women, with heritability estimates ranging from 30-46% depending on the site. In addition, the additive genetic effects contributing to osteoarthritis in various parts of the body were confirmed to be the same. Statistically significant familial aggregation of osteoarthritis in men was also observed, but it was not possible to determine whether this was due to genetic or shared environmental effects.

Clinical assessment of HIV-associated lipodystrophy syndrome: bioelectrical impedance analysis, anthropometry and clinical scores

Background Diagnosis of the HIV-associated lipodystrophy syndrome is based on clinical assessment, in lack of a consensus about case definition and reference methods. Three bedside methods were compared in their diagnostic value for lipodystrophy. Patients and Methods. Consecutive HIV-infected outpatients (n = 278) were investigated, 128 of which also had data from 1997 available. Segmental bioelectrical impedance analysis (BIA) and waist, hip and thigh circumferences were performed. Changes in seven body regions were rated by physicians and patients using linear analogue scale assessment (LASA). Diagnostic cut-off values were searched by receiver operator characteristics. Results. Lipodystrophy was diagnosed in 85 patients (31%). BIA demonstrated higher fat-free mass in patients with lipodystrophy but not after controlling for body mass index and sex. Segmental BIA was not superior to whole body BIA in detecting lipodystrophy. Fat-free mass increased from 1997 to 1999 independent from lipodystrophy. Waist-hip and waist-thigh ratios were higher in patients with lipodystrophy. BIA, anthropometry and LASA did not provide sufficient diagnostic cut-off values for lipodystrophy. Agreement between methods, and between patient and physician rating, was poor. Conclusion: These methods do not fulfil the urgent need for quantitative diagnostic tools for lipodystrophy. BIA estimates of fat free mass may be biased by lipodystrophy, indicating a need for re-calibration in HIV infected populations. (C) 2001 Harcourt Publishers Ltd.

Body mass index-related human adipocyte agouti expression is sex-specific but not depot-specific

Objective: To determine if human adipocyte agouti signal protein (ASIP) mRNA expression is associated with obesity and is gender and/or depot specific. Research Methods and Procedures: Subjects included 8 men (64 +/- 3 years) and 14 women (56 +/- 15 years) undergoing elective abdominal surgery. ASIP mRNA levels in isolated omental and subcutaneous abdominal adipocytes were measured by quantitative reverse transcription polymerase chain reaction. Results: No significant depot difference was observed between genders; ASIP mRNA levels of omental and subcutaneous abdominal adipocytes were pooled for this analysis. BMI and ASIP gene expression were negatively correlated in men (p = -0.70; p < 0.05), whereas a positive relationship was observed in women (p = 0.48; p < 0.05). No significant difference was observed in age, body weight, body mass index (BMI), and waist circumference between groups. Hip circumference was significantly higher in women than in men (p < 0.05). Also, no significant difference in ASIP mRNA expression was observed between men and women, regardless of the fat depot. Discussion: These results show that men and women of similar age and BMI present similar ASIP mRNA levels in omental and subcutaneous abdominal adipocytes. However, a sexual dimorphism exists in the relationship between ASIP expression and BMI. If ASIP is involved in appetite regulation or energy homeostasis in humans, this observation may contribute to the recognized differences in these parameters between men and women.

A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 1 of 2): clinical results

Objective: First, to assess the clinical effectiveness of hylan G-F 20 in an appropriate care treatment regimen (as defined by the American College of Rheumatology (ACR) 1995 guidelines) as measured by validated disease-specific outcomes and health-related quality of life endpoints for patients with osteoarthritis (OA) of the knee. Second, to utilize the measures of effectiveness and costs in an economic evaluation (see accompanying manuscript). Design: A total of 255 patients with OA of the knee were enrolled by rheumatologists or orthopedic surgeons into a prospective, randomized, open-label, 1-year, multi-centred trial, conducted in Canada. Patients were randomized to 'Appropriate care with hylan G-F 20' (AC+H) or 'Appropriate care without hylan G-F 20' (AC). Data were collected at clinic visits (baseline, 12 months) and by telephone (1, 2, 4, 6, 8, 10, and 12 months). Results: The AC+H group was superior to the AC group for all primary (% reduction in mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale: 38% vs 13%, P=0.0001) and secondary effectiveness outcome measures. These differences were all statistically significant and exceeded the 20% difference between groups seta priori by the investigators as the minimum clinically important difference. Health-related quality of life improvements in the AC+H group were statistically superior for the WOMAC pain, stiffness and physical function (all P

Clinical evaluation of the WOMAC 3.0 OA Index in numeric rating scale format using a computerized touch screen version

Background: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index is a previously described self-administered questionnaire covering three domains: pain, stiffness and function. It has been validated in patients with osteoarthritis (OA) of the hip or knee in a paper-based format. Aim: To validate the WOMAC 3.0 using a numerical rating scale in a computerized touch screen format allowing immediate evaluation of the questionnaire. In the computed version cartoons, written and audio instruments were included in order facilitate application. Methods: Fifty patients, demographically balanced, with radiographically proven primary hip or knee OA completed the classical paper and the new computerized WOMAC version. Subjects were randomized either to paper format or computerized format first to balance possible order effects, Results: The intra-class correlation coefficients for pain, stiffness and function values were 0.915, 0.745 and 0.940, respectively. The Spearman correlation coefficients for pain, stiffness and function were 0.88, 0.77 and 0.87, respectively. Conclusion: These data indicate that the computerized WOMAC OA index 3.0 is comparable to the paper WOMAC in all three dimensions. The computerized version would allow physicians to get an immediate result and if present a direct comparison with a previous exam. (C) 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.

A comparative study of telephone versus onsite completion of the WOMAC 3.0 Osteoarthritis Index

Objective. Outcome assessment in clinical trials using the Western Ontario and McMaster University (WOMAC 3.0) Osteoarthritis Index is traditionally achieved through self-administration of the Index. However, in other areas of clinical measurement, telephone administration has been shown to be a reliable method of acquiring data that are both accurate and complete. To address this issue in knee osteoarthritis (OA), we conducted a comparative study of telephone administration by interviewer of WOMAC LK3.0 versus onsite self-completion at the hospital. Methods. Fifty consenting patients with knee OA were randomized to complete the WOMAC LK3.0 Index by telephone interview one day, followed by onsite completion the following day, or vice versa. Neither patients nor interviewers had access to any prior scores. Results. The mean age of the 50 patients was 66.3 years (range 44-82); 34 (68%) were female and 16 (32%) male. There was excellent agreement between the mean office and telephone scores, with mean differences for the WOMAC LK3.0 pain, stiffness, and function subscale scores and total score of 0.09, 0.12, 0.78, and 0.98, respectively. These differences were well within the respective protocol defined equivalence criteria of +/- 1.7, +/- 0.9, +/- 6.4, and +/- 9.1, and represented differences from office scores of 0.9, 2.6, 2.4, and 2.2%, respectively. Conclusion. The use of telephone interviews for the WOMAC LK3.0 Index is a valid method of obtaining OA outcome measurements. These observations have important implications for designing data acquisition strategies for future OA clinical trials and for longterm observational studies.

Effect of the movement speed of resistance training exercises on sprint and strength performance in concurrently training elite junior sprinters

The aim of this study was to determine the effects of 7 weeks of high- and low-velocity resistance training on strength and sprint running performance in nine male elite junior sprint runners (age 19.0 +/- 1.4 years, best 100 m times 10.89 +/- 0.21 s; mean +/- s). The athletes continued their sprint training throughout the study, but their resistance training programme was replaced by one in which the movement velocities of hip extension and flexion, knee extension and flexion and squat exercises varied according to the loads lifted (i.e. 30-50% and 70-90% of 1-RM in the high- and low-velocity training groups, respectively). There were no between-group differences in hip flexion or extension torque produced at 1.05, 4.74 or 8.42 rad . s(-1), 20 m acceleration or 20 m 'flying' running times, or 1-RM squat lift strength either before or after training. This was despite significant improvements in 20 m acceleration time (P < 0.01), squat strength (P< 0.05), isokinetic hip flexion torque at 4.74 rad . s(-1) and hip extension torque at 1.05 and 4.74 rad . s(-1) for the athletes as a whole over the training period. Although velocity-specific strength adaptations have been shown to occur rapidly in untrained and non-concurrently training individuals, the present results suggest a lack of velocity-specific performance changes in elite concurrently training sprint runners performing a combination of traditional and semi-specific resistance training exercises.