Melanin-producing medullary thyroid carcinoma with transformation to melanoma: A case report

Only one case of melanoma arising from melanin-producing medullary thyroid carcinoma (MTC) has been reported previously. In the present study, a second such case was reported and compared with the previous one. The patient was an 86-year-old male who presented with a right anterior neck mass. Ultrasound revealed a nodule measuring 49x48x40 mm in the right lobe of the thyroid. The levels of serum calcitonin (2,298 pg/ml) and carcinoembryonic antigen (CEA; 27.0 ng/ml) were markedly elevated. Aspiration cytology revealed suspected malignant anaplastic thyroid carcinoma and total thyroidectomy without neck nodal dissection was performed. On gross observation, the nodule was well encapsulated, soft, solid and black. Light microscopy indicated that the nodule was composed mainly of large, occasionally huge, pleomorphic cells with a solid or alveolar growth pattern. On immunohistochemistry, these cells were positive for melan-A and S-100 protein, and negative for thyroid transcription factor 1, calcitonin, chromogranin A and CEA. In the subcapsular area, melanin-producing MTC was intimately intermingled with the pleomorphic cells. No primary site of the melanoma was detectable in other organs. At three years after surgery, the patient died due to metastasis of the melanoma to the brain. The previously reported case had no detectable recurrence or distant metastasis up to 11 years after surgery. In comparison with that case, the present case had a similar morphology but the outcome was poorer. Thus, the prognosis of melanoma that transforms from MTC appears to remain uncertain.

Clinicopathologic characteristics and A20 mutation in primary thyroid lymphoma

BACKGROUND

Primary thyroid lymphoma (PTL) is a rare disease frequently arising against a background of autoimmune thyroiditis. It has recently been reported that the inactivation of the NF-κB negative regulator A20 by deletion and/or mutation could be involved in the pathogenesis of subsets of B-cell lymphomas. This study investigated the clinicopathologic characteristics and A20 mutation in PTL.

METHODS

We analyzed the characteristics of 45 PTL patients (14 men and 31 women), with a median age of 71 (range, 35-90) years. A20 mutations were analyzed in DNA extracted from 20 samples consisting of 19 tumor tissues and 1 sample from Hashimoto's thyroiditis.

RESULTS

Thirty-five patients (82%) had a history of Hashimoto's thyroiditis and 29 (64%) had diffuse large B-cell lymphoma (DLBCL), presenting with larger tumors including bulky mass, elevated soluble interleukin-2 receptor levels, and longer history of Hashimoto's thyroiditis compared with mucosa-associated lymphoid tissue (MALT) lymphoma patients (n=16). A20 mutations were identified in 3 of 19 PTL patients (16%), 2 of 10 (20%) with DLBCL, and 1 of 9 (11%) with MALT lymphoma. Interestingly, all patients with A20 mutations had Hashimoto's thyroiditis. Furthermore, they had a common missense variant in exon 3 (rs2230926 380T>G; F127C), which is known to reduce the ability of A20 to inhibit NF-kB signaling.

CONCLUSION

Our study demonstrated that the histological features of PTL affect clinical outcomes, and that A20 mutations could be related to PTL pathogenesis in some patients with Hashimoto's thyroiditis.

Influence of Short-Term Dietary and Therapeutic Iodine Restriction on the Therapeutic Effects of Radioactive Iodine Therapy in Patients with Graves' Disease

Background: Several studies have investigated the factors affecting the effects of radioactive iodine (¹³¹I) treatment (RAIT) in patients with Graves' disease. However, the influence of dietary or therapeutic iodine on the effect of RAIT has not been fully elucidated yet. The aim of this study was to investigate whether dietary or therapeutic iodine before RAIT influences the therapeutic effects of RAIT with a fixed-dose regimen and a short-term restriction of iodine intake in an iodine-sufficient area. Materials and Methods: We retrospectively analyzed 81 Japanese patients with Graves' disease treated with the following RAIT regimen: dietary iodine restriction for 7 days as well as discontinuation of antithyroid drugs (ATDs), potassium iodine (KI), or both for 5 days before RAIT. On the day of RAIT, we measured urinary iodine content to estimate daily iodine intake. After RAIT, we adjusted the dose of ATDs, KI, or both according to serum thyroid hormone levels every 1-2 months. Using the data from these patients, we investigated the effect of dietary and therapeutic iodine on the therapeutic effects of RAIT. The therapeutic effects at 1 year after RAIT were evaluated based on the necessity of ATDs, KI, or both. Results: Dietary iodine intake was weakly correlated with ¹³¹I uptake (RAIU), but the dose of therapeutic iodine was not correlated with RAIU. The therapeutic effects of RAIT were strongly negatively associated with estimated thyroid volume before RAIT. Neither dietary iodine intake nor therapeutic iodine before RAIT affected this association. Conclusion: This study did not find an association between short-term dietary or therapeutic iodine restriction before RAIT and the therapeutic effects of RAIT in an iodine-sufficient area.

Exosomes Expressing Thyrotropin Receptor Attenuate Autoantibody-Mediated Stimulation of Cyclic Adenosine Monophosphate Production

Background: Exosomes or small extracellular vesicles secreted from cells are nanovesicles with a diameter of 40-150 nm, which play a number of roles in both physiologic and pathologic processes. In Graves' disease (GD), autoantibodies bind to the thyrotropin receptor (TSHR) on the surface of thyroid follicular epithelial cells and stimulate thyroid growth and thyroid hormone synthesis and secretion via cyclic adenosine monophosphate (cAMP) production. The present study aimed to confirm the existence of TSHR in exosomes secreted from thyroid cells and to define the role of TSHR exosomes in GD. Methods: Exosomes were isolated by differential centrifugation from the culture medium of the human thyroid follicular epithelial cell line (NTHY-ori 3-1) and thyroid carcinoma cell lines (8305C, 8505C, and FTC-133). TSHR expression in cell lysates and exosomes was evaluated by Western blot analysis. In order to study the function of TSHR exosomes, human embryonic kidney (HEK) 293 cells stably expressing TSHR (HEK/TSHR) were established. Using exosomes isolated from both HEK and HEK/TSHR cells, the binding capacity of the M22 human monoclonal autoantibody to TSHR exosomes and their effect on M22-mediated stimulation of cAMP production in HEK/TSHR cells were evaluated. As a positive control for the functional assay, human recombinant TSHR chimera protein capable of binding to TSH was used. Results: TSHR was detected in exosomes from cancer cells as well as normal epithelial cells. An in vitro binding assay showed that alkaline phosphatase-labeled M22 bound to TSHR exosomes in a dose-dependent manner. M22 dose-dependently stimulated intracellular cAMP production in HEK/TSHR cells. The addition of exosomes from HEK/TSHR cells but not those from parental HEK cells significantly ameliorated cAMP production stimulated by treatment with M22 in HEK/TSHR cells. A decoy effect similar to TSHR exosomes was observed for human recombinant TSHR chimera. Conclusions: The results suggest that exosomes expressing TSHR may be secreted from normal and cancerous thyroid cells. In the thyroid gland of patients with GD, TSHR exosomes may exert a decoy effect by sequestering autoantibody, thereby ameliorating autoantibody-mediated activation of thyroid function.

Monocyte and Basophil Counts as Predictors of Neutrophil Count Recovery in Patients with Thiamazole-Induced Agranulocytosis

Purpose: Thiamazole (MMI) is frequently used for the treatment of Graves' disease, but it occasionally induces agranulocytosis at the beginning of the treatment. To date, the predictive factors of recovery from MMI-induced agranulocytosis remain unclear. The primary aim of this study was to evaluate the predictive factor of the recovery time from MMI-induced agranulocytosis. Method: This was a retrospective cohort study performed in a university hospital and a thyroid hospital. We included 27 Japanese patients with Graves' disease with MMI-induced agranulocytosis diagnosed during follow-up. All patients were administrated recombinant human granulocyte colony-stimulating factor daily until they had a neutrophil count>1 000/μL, which was defined as recovery. The predictive factors associated with recovery time were estimated using multivariable regression analysis. Results: At the onset of agranulocytosis, the median administration period of MMI was 33 days, the average white blood cell count was 1 896/μL, and the median neutrophil count was 22/μL. The median recovery time was 4 days. Stepwise multivariate regression analysis identified the monocyte and basophil counts to be significant predictors of MMI-induced agranulocytosis. Conclusion: Patients with agranulocytosis and decreased monocyte and basophil counts at onset may recover late and require careful treatment.

Cutoff value of thyroid uptake of (99m)Tc-pertechnetate to discriminate between Graves' disease and painless thyroiditis: a single center retrospective study

Thyroid uptake of (99m)Tc-pertechnetate is a useful way to determine the cause of thyrotoxicosis. In daily clinical practice, (99m)Tc-pertechnetate uptake is used to discriminate between Graves' disease and painless thyroiditis when clinical information is not enough to make the distinction. However, since the optimal cutoff value of (99m)Tc-pertechnetate uptake has not yet been elucidated, our aim was to determine this value. We recruited patients with thyrotoxicosis in whom (99m)Tc-pertechnetate uptake was measured in clinical settings between 2009 and 2013. Three experienced endocrinologists (who were blinded to the value of (99m)Tc-pertechnetate uptake and initial treatment) diagnosed the cause of thyrotoxicosis based on thyrotropin, free triiodothyronine, free thyroxine, and thyrotropin receptor antibody levels, and by ultrasound findings and using images of thyroid uptake of (99m)Tc-pertechnetate without the actual values. Ninety-four patients diagnosed as having Graves' disease or painless thyroiditis were finally included. According to the diagnosis, the optimal cutoff value of (99m)Tc-pertechnetate uptake was determined by receiver operating characteristics analysis. A cutoff value of 1.0% provided optimal sensitivity and specificity of 96.6% and 97.1%, respectively. Then, its validity was confirmed in 78 patients with confirmed Graves' disease or painless thyroiditis diagnosed at another institute. Applying this cutoff value to the patients with thyrotoxicosis revealed positive and negative predictive values for Graves' disease of 100% and 88.9%, respectively. In conclusion, a cutoff value for (99m)Tc-pertechnetate uptake of 1.0% was useful to discriminate between Graves' disease and painless thyroiditis.

Amplification of the human epidermal growth factor receptor 2 gene in differentiated thyroid cancer correlates with telomere shortening

The human epidermal growth factor receptor 2 (HER2) proto-oncogene plays an important role in the development and progression of breast and gastric cancer. Monitoring of the HER2 status and treatment with trastuzumab was performed initially in breast cancer, and subsequently in gastric cancer. However, the HER2 status of thyroid cancer remains unexplored. Telomere alteration and telomerase activity have been observed in most human cancers and are known to be a feature of malignancy. The aims of this study were to clarify the HER2 status of thyroid cancer and to examine any correlations to various characteristics of malignancy. We investigated 69 cases of differentiated thyroid cancers with reference to: i) telomere length as measured using tissue quantitative fluorescence in situ hybridization (Q-FISH), ii) expression of human telomerase reverse transcriptase (hTERT) as determined by immunohistochemistry (IHC), and iii) overexpression of the HER2 protein as determined by IHC and amplification of the HER2 gene as determined by fluorescence in situ hybridization (FISH). The telomeres of thyroid cancers, especially follicular carcinomas, were significantly shorter compared to those of adjacent normal tissues. Positivity for hTERT expression and HER2 amplification were observed in approximately 70 and 22% of thyroid cancers, respectively. Our data demonstrated that telomeres in HER2-positive cancers were significantly shorter compared to those in HER2-negative cancers. These results suggest that highly malignant differentiated thyroid cancer can be detected by monitoring HER2 status and telomere shortening, and that trastuzumab therapy may be effective for refractory thyroid cancer.

Utilization of three-dimensional computed tomography for papillary thyroid carcinoma arising in the thyroglossal duct remnant: report of a case

This report presents a rare and interesting case of papillary thyroid carcinoma arising in a thyroglossal duct remnant (TDR) that was diagnosed by three-dimensional computed tomography (3DCT). The patient, a 61-year-old woman, presented with a painless mass in the anterior suprahyoid region that had gradually enlarged over a 2-year period. Three-dimensional CT successfully revealed the thyroglossal duct (TD) descending from the tumor to the isthmus of the thyroid. An ultrasonography-guided fine-needle aspiration biopsy of the tumor was positive for carcinoma. A total thyroidectomy was performed in addition to the Sistrunk procedure. The histological findings indicated papillary thyroid carcinoma arising in the TDR and thyroid papillary microcarcinoma in the left thyroid lobe. The patient underwent radioactive iodine ablation and thyroid suppression therapy. This is apparently the first reported case of papillary thyroid carcinoma arising in a TDR evaluated using 3DCT. Three-dimensional CT was able to clarify the relative locations of the tumor, TD, and thyroid in the present case, and visualization of the TD allowed a definitive preoperative diagnosis that would not otherwise have been possible using conventional imaging techniques. This case suggests that 3DCT may therefore play an important role in providing definitive information on patients with anterior neck masses that are difficult to diagnose.

Follicular carcinoma arising from the pyramidal lobe of the thyroid

We present a rare case of follicular carcinoma arising from the pyramidal lobe of the thyroid in a 21-year-old woman. Radical resection of the thyroid isthmus was performed, followed by adjuvant hormonal therapy with levothyroxine. After 15 months of follow-up, the patient remains disease-free. Thyroid carcinoma in children and adolescents is rare, and also rarely arises in the pyramidal lobe. To our knowledge, this is the first report of this type of neoplasm arising from the thyroid pyramidal lobe. We are following up this case carefully, and if recurrence or metastasis or both occur, we plan to perform total thyroidectomy and ablation with (131)I. This case suggests the importance of the differential diagnosis of midline cervical masses and the management of this type of neoplasm in adolescents.

A case of Sheehan's syndrome with panhypopituitarism due to the impairment of both the hypothalamus and the pituitary

Sheehan's syndrome is thought to be caused by pituitary necrosis associated with massive hemorrhage at delivery. We report here on a patient with Sheehan's syndrome, showing a rare type of panhypopituitarism suggesting dysfunction of both the hypothalamus and the pituitary. Although the basal level of plasma ACTH was normal, that of plasma cortisol was low. ACTH showed a delayed high response to CRH and a low response to insulin-induced hypoglycemia, while plasma cortisol showed a low response to CRH and no response to insulin-induced hypoglycemia. In the standard ACTH test, a normal rise of plasma cortisol was found. These results indicate that the primary site responsible for hypothalamic-pituitary-adrenocortical hypofunction may be the hypothalamus. In addition, the dysfunction of the pituitary itself is suggested by the hyposecretion of other pituitary hormones with impaired responses in their provocative tests and partially empty sella.

Determination of residual double bonds in resin-dentin interface by Raman spectroscopy

OBJECTIVES

The quality of the hybrid layer is believed to be more important than the thickness of this layer. The purpose of this study was to investigate a method to analyze the percentage of adhesive resin residual double bonds in the dentin-resin interface using laser Raman spectroscopy.

METHODS

Bovine dentin was treated with dentin adhesives and resin composite was bonded according to the manufacturers' instructions. The specimens were sectioned parallel to dentinal tubules and the surfaces were then polished to 1 microm diamond pastes. Raman spectra were recorded along a line perpendicular to the dentin-resin interface in steps of 0.2 microm. The measurement of residual C=C bond was made on a relative basis by comparing the C=C unpolymerized methacrylate stretching vibration (1638 cm(-1)) against the C=O stretching mode of the ester group (1719 cm(-1)). The percentage of residual double bonds including pendant and monomeric double bonds was calculated by comparing the obtained ratio with that of uncured adhesive resin.

RESULTS

The amount of residual double bonds in the hybrid layer varied from 10 to 25% compared to the uncured adhesives, a relatively higher percentage was detected for Fluoro Bond (12.3-23.6%) and Single Bond (9.5-21.8%), and lower for Mac Bond II (10.6-18.0%) and Mega Bond (10.7-16.3%). No relationship was seen between the percentage of remaining double bonds and the location within the resin-dentin interface.

SIGNIFICANCE

Laser Raman microscopy used was a useful tool for measuring the residual double bonds in the dentin-resin interface.

Analysis of the dentin-resin interface by use of laser Raman spectroscopy

OBJECTIVES

Adhesion of resin-bonding agents to dentin is currently believed to result from impregnation of adhesive resin into superficially demineralized dentin. The purpose of this study was to investigate the chemical composition of the resin-impregnated dentin (hybrid) layer using a micro-Raman spectroscopy.

METHODS

Resin composites were bonded to bovine dentin with the two-step bonding systems, and specimens were sectioned parallel to dentinal tubules. These surfaces were then polished down to 1 microm diamond pastes. Raman spectra were successively recorded along a line perpendicular to the dentin-adhesive interface by steps of 0.2 microm on a computer controlled X-Y stage. The relative amounts of hydroxyapatite (960 cm(-1), P-O), adhesive resin (640 cm(-1), aromatic ring), and organic substrate (1450 cm(-1), C-H) in the dentin-adhesive bonding area were calculated.

RESULTS

From the Raman spectroscopy results, the hybrid layer represents a gradual transition in the relative amount of adhesive from the resin side to dentin side. Evidence of poor saturation of the adhesive resin in the demineralized dentin with the one-bottle adhesive system was detected.

SIGNIFICANCE

From the results of this study, inhomogeneity of the hybrid layer composition was detected, and the degree of resin impregnation was found to be different between the bonding systems tested.

Adhesion of single application bonding systems to bovine enamel and dentin

Single application bonding systems have recently been developed in an effort to simplify and shorten bonding procedures. This study compared their bonding ability to enamel and dentin. Four commercial single application systems, Reactmer Bond (Shofu Inc), One-Up Bond F (Tokuyama Co), AQ Bond (Sun Medical Co, Japan) and Prompt L-Pop (ESPE, Germany) were used. F2000 compomer (3M Dental Products, St Paul, MN 55144, USA) was used as a control material. Bovine mandibular incisors were mounted in self-curing resin and the facial surfaces were ground to expose either enamel or dentin. Restoratives were bonded after adhesive application to tooth surface according to the manufacturer's instructions. Fifteen samples per test group were stored in 37degrees C water for 24 hours, then shear tested at a crosshead speed of 1.0 mm/minute. Statistical analysis was accomplished with a one-way ANOVA followed by the Duncan test (p<0.05) were done. The enamel bond strengths of the newly developed one step bonding systems were not significantly different from the compomer except for Prompt L-Pop, which showed the highest value. The dentin bond strengths of single application bonding systems did not differ from the compomer. The results of this study suggest that the adhesive properties of the newly developed single application bonding systems were comparable to a compomer restorative.

Enamel and dentin bond strengths of single application bonding systems

PURPOSE

To investigate the bonding ability to enamel and dentin of new single application bonding systems (Reactmer and One-Up Bond) and compare these with a commercial compomer (Clicker/F2000), and 2-step resin-based composite bonding systems (Fluoro Bond/Lite-Fil II A and Single Bond/Z100).

MATERIALS AND METHODS

Labial surfaces of extracted bovine teeth were ground on wet 600-grit SiC paper to expose a flattened area of enamel or dentin and then washed and dried with oil-free compressed air. These surfaces were treated according to each adhesive system's instructions and the restorative materials were condensed into a Teflon mold (2 mm height, 4 mm internal diameter) and then irradiated. The finished specimens were stored in 37 degrees C distilled water for 24 hours from the start of light exposure to the material. Then these specimens were tested in a shear mode at a crosshead speed of 1.0 mm/minute. The mean and standard deviation were subjected to an ANOVA followed by the Duncan test (P< 0.05).

RESULTS

The bond strengths of the single application bonding systems were 12.3 to approximately 14.5 MPa for enamel, and 13.7 to approximately 13.8 MPa for dentin. These values were comparable to those of the compomer (12.6 MPa for enamel, and 13.1 MPa for dentin), but lower than those of the two-step resin composite bonding systems (16.8 to approximately 21.7 MPa for enamel and 18.1 to approximately 18.4 MPa for dentin).

Influence of environmental conditions on dentin bond strengths of recently developed dentin bonding systems

A study was conducted to investigate the influence of temperature and relative humidity (RH) on the bond strengths of several recently developed dentin bonding systems. Six environmental conditions, (A) 25+/-0.5 degrees C, 50+/-5% RH, (B) 25+/-0.5 degrees C, 80+/-5% RH, (C) 25+/-0.5 degrees C, 95+/-5 % RH, (D) 37+/-0.5 degrees C, 50 +/-5 % RH, (E) 37+/-0.5 degrees C, 80+/-5% RH, (F) 37+/-0.5 degrees C, 95+/-5 % RH were used. Bovine mandibular incisors were mounted in self-curing resin and the facial surfaces were ground on wet #600 SiC paper to expose the dentin. After the tooth surface had been treated according to each manufacturer's instructions, adhesives were applied, followed by condensation of resin composites into a mold placed on the dentin surface. Fifteen specimens per group were stored in distilled water at 37 degrees C for 24 h, and then shear-tested at a cross-head speed of 1.0 mm/min. Statistical analysis was carried out with two-way ANOVA followed by Tukey's test (P<0.05). Dentin bond strengths decreased with increasing relative humidity but were not influenced by environmental temperature. Even though one-bottle adhesive systems require a wet dentin surface, their bond strengths are affected by an increase in environmental humidity.

A subpopulation of fibroblast growth factor-2-binding heparan sulfate is lost in human papillary thyroid carcinomas

We hypothesized that a change in composition of proteoglycans can regulate the bioactivity of fibroblast growth factor (FGF)-2 in the thyroid. In order to test this hypothesis, we established a simple and sensitive method for detecting FGF-2-binding heparan sulfates and characterized them in papillary thyroid carcinomas and normal thyroids. The thyroid extracts were applied to a Q-Sepharose anion exchange column. After the column was washed with 10 mM of phosphate buffer, 1 microgram of human recombinant FGF-2 was added onto the column. The column was eluted with a gradient of NaCl (0.3-1.5 M). Each fraction was blotted onto nitrocellulose membrane. Immunoreactivity of heparan sulfate and FGF-2 was revealed by the incubation of membranes with the specific antibodies, and quantitatively estimated by measuring the density of the color product. In normal thyroids, immunoreactivity of heparan sulfate was detected as two peaks at 0.7 and 0.9 M of NaCl. Heparan sulfate-containing fractions also showed FGF-2 immunoreactivity, indicating the complex formation of FGF-2 and heparan sulfate. In papillary thyroid carcinomas, immunoreactivity of heparan sulfate showed various elution profiles on Q-Sepharose chromatography, including single peak at 0.7 M of NaCl and the one similar to that of the normal thyroids. However, FGF-2 immunoreactivity was detected only in the fractions eluting at 0.7 M of NaCl. This loss of a subpopulation of FGF-2-binding heparan sulfate in human papillary thyroid carcinomas may lead to the increase of free FGF-2 bioavailable in extracellular matrix.

Effect of operator variability on dentin bond strength of two-step bonding systems

PURPOSE

To examine the influence of operator variability on adhesion to dentin of recently developed two-step bonding systems.

MATERIALS AND METHODS

A self-etching primer system, Fluoro Bond/Lite-Fil II A (FB) and a one-bottle adhesive system, Single Bond/Z100 (SB) were employed. Three groups, each consisting of 15 operators, were selected from the dentists at the university (Group 1), undergraduate students (Group 2), and general practitioners (Group 3). Labial surfaces of extracted bovine teeth were ground on wet 600-grit SiC paper and then washed and dried with oil-free compressed air. These surfaces were treated according to each adhesive system's instructions and the restorative resins were condensed into a Teflon mold (2 mm height, 4 mm internal diameter) and then light-cured. The finished specimens were stored in 37 degrees C distilled water for 1 hr. These specimens were tested in a shear mode at a cross-head speed of 1.0 mm/min. The mean and standard deviation were subjected to two-way ANOVA (P < 0.05).

RESULTS

Significant differences in bond strength of the two adhesives were found within each operator group. A wider variation in bond strength was seen for SB compared to FB for the three different groups. Mean bond strengths for the faculty group were statistically greater than those of the other two groups, which did not differ significantly. Even though the specimen preparation was done under in vitro conditions, the large coefficients of variation indicate it may be difficult to create suitable surface conditions for optimal bonding.

Durability of enamel bond strength of simplified bonding systems

The purpose of this study was to investigate the influence of thermal cycling on enamel bond strength of 2-step bonding systems. The systems used were self-etching primer systems; Imperva Fluoro Bond, Clearfil Liner Bond II, and Mac Bond II; and self-priming adhesive systems; One Step, OptiBond Solo, Prime & Bond 2.0, and Single Bond. Bovine mandibular incisors were mounted in self-curing resin and the facial surfaces were wet ground with #600 SiC paper. Enamel surfaces were treated following each manufacturer's instructions. Adhesives were applied and composites were condensed into a Teflon mold (phi 4 x 2 mm) and light cured. Bonded specimens were divided into four groups; stored in 37 degrees C water for 24 hours, followed by thermal cycling between 5 degrees C and 60 degrees C for 3,000, 10,000, and 30,000 cycles. Ten samples per test group were tested in shear mode at a crosshead speed of 1.0 mm/min. One-way ANOVAs followed by Duncan's multiple range test (p < 0.05) were done. For self-etching primer systems, a significant decrease in bond strength was observed for the thermal cycling groups. For the self-priming adhesive systems, a small decrease in bond strength was observed but no significant differences were found for thermal cycling groups. The changes in bond strength after thermal cycling were different between the bonding systems.

Resin-modified glass-ionomers: effect of dentin primer application on the development of bond strength

The purpose of this study was to investigate the rate of development of dentin bond strengths of resin-modified glass-ionomer cements (RMGIC) with use of dentin primers. The prepared dentin surface was treated according to each manufacturer's instruction or the dentin primer. Cements were condensed into a vinyl mold and light activated. The shear bond strengths were measured at a crosshead speed of 1.0 mm/min after 1, 5, 10, 30, 60 min, 2, 5, and 24 h storage in water at 37 degrees C. Presence of a significant difference between the mean bond strength at 1 min and each of the other test times was analyzed. The first time at which there was a significant increase in bond strength was defined as the "initial increasing time". As compared with the manufacturer's suggested dentin treatments, the bond strengths increased significantly when the dentin primers were used. The initial increasing times when the specimens were made following each manufacturer's instructions were 10 approximately 60 min. When dentin primer was used, the initial increasing time shortened to 5 approximately 10 min. It was concluded that the use of dentin primers for RMGIC restorations resulted in reduction of the initial increasing time.

Ectopic corticotroph adenoma in the cavernous sinus: case report

OBJECTIVE AND IMPORTANCE

Adrenocorticotropin (ACTH)-secreting pituitary adenomas causing Cushing's disease are often difficult to identify because of their variable locations and their small size. This report presents histological evidence of an ectopic ACTH-secreting adenoma located entirely within the cavernous sinus.

CLINICAL PRESENTATION

A 62-year-old woman presented with central obesity, hypertension, and osteoporosis. Endocrinological evaluation suggested the presence of an ACTH-secreting pituitary adenoma; however, imaging studies, including dynamic magnetic resonance imaging, did not reveal any visible lesions in the pituitary gland. Bilateral cavernous sinus sampling demonstrated a large central/peripheral ACTH gradient, with a right/left ACTH gradient. The patient was treated as having pituitary-dependent Cushing's disease, until she died suddenly as a result of acute respiratory failure.

INTERVENTION

In a postmortem histological examination, an ACTH-secreting adenoma was found in the right cavernous sinus, which was completely surrounded by dura mater and had no direct connection with the pituitary gland.

CONCLUSION

Although they are rare, such adenomas located in the cavernous sinus should be recognized as one of the reasons for inaccurate cavernous sinus sampling and the failure of transsphenoidal surgery for patients with ACTH-dependent Cushing's syndrome.

Influence of self-etching primer drying time on enamel bond strength of resin composites

OBJECTIVES

In clinical situations, a dentine primer is usually applied to enamel, in addition to dentine. This study was carried out to determine the influence of the air drying time of self-etching primers on their bond strength to enamel.

METHODS

Three self-etching primer systems, Fluoro Bond (FB, Shofu Inc.), Liner Bond II (LB, Kuraray Co.) and Mac Bond 2 (MB, Tokuyama Co.) were employed. Bovine mandibular incisors were mounted in self-curing resin and the enamel surfaces were wet ground with number 600 SiC paper. Following primer application, the enamel surface was dried with compressed air for 0, 2, 5, 10, 20, and 30 s from 10 cm above the enamel surface using a three-way syringe. Adhesives were applied and composites were condensed into a Teflon mold (4 x 2 mm) placed on the enamel and light activated. Ten samples per test group were stored in 37 degrees C water for 24 h, then shear tested at a crosshead speed of 1.0 mm min-1. One-way ANOVAs followed by Duncan tests (p < 0.05) were done.

RESULTS

The enamel bond strengths varied with the different air drying times and ranged from 8.2 +/- 3.2-17.4 +/- 3.0 MPa for LB, 10.9 +/- 2.8-16.3 +/- 3.3 MPa for FB, and 17.5 +/- 2.5-19.4 +/- 2.2 MPa for MB. For LB and FB, there appeared to be a minimum drying time of 10 s. LB was the most affected by drying time, while MB did not change.

CONCLUSIONS

The data suggests that the enamel bond strengths of these bonding systems can be influenced by the drying time of the primer applied prior to bond agent application and the tendency was different among the systems studied.

Overexpression of fibroblast growth factor receptor 3 in a human thyroid carcinoma cell line results in overgrowth of the confluent cultures

Recent reports indicate that a gain-of-function mutation in fibroblast growth factor receptor 3 (FGFR-3) inhibits cell growth in the cartilaginous growth plates. These results suggest that FGFR-3 may be the receptor transducing growth inhibitory signals. Using reverse transcription-PCR we examined seven papillary thyroid carcinomas to determine FGFR-3 expression. Six out of the seven papillary carcinomas expressed FGFR-3. To clarify the role of FGFR-3 in thyroid carcinoma, FGFR-3 was overexpressed in an established human papillary thyroid carcinoma cell line. High levels of FGFR-3 protein were identified in cells stably transfected with the vector containing FGFR-3 cDNA. The specific binding of 125I-FGF-2 of these cells was threefold higher than that of control cells. Growth rates of cells overexpressing FGFR-3 were similar to those of control cells. However, cells overexpressing FGFR-3 continued to grow beyond the density at which control cells stopped proliferating. These results suggest that FGFR-3 in thyroid carcinoma is not involved strongly in the cell proliferation mechanism but may contribute to the malignant extension of some of the carcinomas by modifying cell contact signaling.

Influence of light irradiation on the volumetric change of polyacid-modified resin composites

OBJECTIVES

Recently, a new restorative material called a 'compomer', which is classified as a polyacid-modified resin composite, has become available. The volumetric shrinkage of compomers may create marginal gaps that influence the bonding ability and longevity of a restoration. Since compomers have been introduced recently, their volumetric change during curing is not fully understood. The purpose of this study was to evaluate the volumetric change of compomers.

METHODS

Three compomers, Compoglass (Vivadent), Dyract (Dentsply), and Ionosit Fil (DMG) were employed. The material was placed into a Teflon mould, 4 mm in diameter and 2 mm height, and extruded into the dilatometer. Then the specimens were light activated and the change in the height of the meniscus of water was recorded using a CCD camera and VRC.

RESULTS

The average volumetric shrinkages of the compomers after 160 s were 2.4% for Compoglass, 2.7% for Dyract, and 2.1% for Ionosit-Fil. For all materials tested, there was a tendency of increasing volumetric shrinkage with increased irradiation time.

CONCLUSIONS

The results of this study indicate that the volumetric change of compomer is influenced by the duration of light exposure, light intensity, and environmental conditions to which the materials are exposed.

Influence of thermal cycling on dentin bond strength of two-step bonding systems

PURPOSE

To investigate the influence of thermal cycling on bond strength to dentin of 2-step bonding systems.

MATERIALS AND METHODS

The systems used were self-etching primer systems; Fluoro Bond (FB), Liner Bond II (LB), and Mac Bond II (MB); and self-priming adhesive systems; One-Step (OS), OptiBond Solo (OB), Prime & Bond 2.0 (PB), and Single Bond (SB). Bovine mandibular incisors were mounted in self-curing resin and the facial surfaces were wet ground with #600 SiC paper. Enamel and dentin surfaces were treated following each manufacturers' instructions. Adhesives were applied and composites were condensed into a Teflon mold (4x2 mm) placed on the dentin surface and light activated. Bonded specimens were divided into four groups; (a) stored in 37 degrees C water for 24 hours, (b) stored in 37 degrees C water for 24 hours followed by subjecting to thermal cycling between 5 degrees C and 60 degrees C for 3,000 times, (c) 10,000 times, and (d) 30,000 times. Twelve samples per test group were shear tested at a crosshead speed of 1.0 mm/minute. One-way ANOVAs followed by Duncan's multiple range test (P < 0.05) were performed.

RESULTS

For FB, LB, and MB, a small decrease in bond strength was observed and no significant differences were observed among the thermal cycling groups. For OS, OB, PB, and SB, a significant decrease in bond strength was observed for the 30,000 thermal cycling groups. The changes in bond strength after TC were different between the bonding systems.

Fibroblast growth factor-2 free from extracellular matrix is increased in papillary thyroid carcinomas and Graves' thyroids

Fibroblast growth factor (FGF)-2 is stored in the extracellular matrix (ECM). We hypothesized that FGF-2 is mobilized from the ECM and binds to receptors on the surface of FGF-2 responsive cells during thyroid enlargement. To test this hypothesis, we estimated levels of FGF-2 free from ECM in thyroids by comparing the efficiency of two methods for FGF-2 extraction (low salt and high salt). Because the high salt concentration (more than 1.5 M NaCl) is necessary to release FGF-2 from the normal ECM, FGF-2 extracted by low salt is indicative of ECM-free FGF-2. Human papillary thyroid carcinomas, normal part thyroid, and Graves' thyroid tissues were homogenized separately in an extraction buffer containing either 0 M NaCl (low salt) or 2.0 M NaCl (high salt), and the concentration of FGF-2 in the extracts was measured by enzyme-linked immunosorbent assay (ELISA). The yields of low and high salt extracts of immunoreactive (ir)FGF-2 from papillary carcinomas (low salt: 40.0 +/- 7.5, high salt: 233 +/- 53 ng/g tissue, mean +/- SE) were significantly higher than those of normal thyroid tissues extracted by the corresponding salt concentration (low salt: 14.6 +/- 1.8, high salt: 123 +/- 12 ng/g tissue). On the other hand, the extractable irFGF-2 from Graves' thyroid tissues (low salt: 25.2 +/- 2.5, high salt: 135 +/- 24 ng/g tissue) were not significantly different from that of normal thyroid tissues. However, the ratio of the extractable irFGF from carcinomas and Graves' thyroids by low salt to that by high salt (0 M/2 M ratio = 0.206 +/- 0.051, 0.209 +/- 0.025) were significantly higher than that of normal thyroids (0.120 +/- 0.014) (p < 0.05). These results suggest that intratissue ECM-free FGF-2 is increased in papillary thyroid carcinomas and Graves' thyroid tissues, and therefore a greater amount of FGF-2 may be available for stimulation of FGF-2 responsive cells.

Resin-modified glass ionomers: dentin bond strength versus time

Most dentin bond strength tests of resin-modified glass-ionomer cements have been conducted after at least 24 hours' storage in water. In a clinical situation, debonding might occur soon after the restoration was placed if subjected to stress. The purpose of this study was to investigate the rate of development of shear bond strength of resin-modified glass-ionomer cements, two Type IIs of which, Fuji II LC and Vitremer, were used. A conventional glass-ionomer cement, Fuji II, and a resin composite, Herculite XRV/OptiBond system, were also employed as controls. Bovine incisors were mounted in self-curing resin, and the facial surfaces wet ground with 600-grit SiC paper to expose dentin. Materials were condensed into a vinyl mold and bonded following the manufacturers' instructions. The shear bond strengths of 10 specimens per group were measured at a crosshead speed of 1.0 mm/minute after 1, 5, 10, 30, and 60 minutes' and 2, 5, and 24 hours' storage in water at 37 degrees C. One-way ANOVAs followed by the Dunnet test (P < 0.05) were used to test for significant differences between the mean bond strength at 1 minute and each of the other test periods. The test period when there was a significant increase in bond strength was defined as the "initial increasing time." The dentin bond strengths of all the materials tested increased with prolonged storage time. The initial increasing times were 10 minutes for Fuji II LC and OptiBond, 20 minutes for Fuji II, and 60 minutes for Vitremer. The differences in the initial increasing time might have clinical implications if the restoration is subjected to significant stress immediately after placement.

Evaluation of curing units used in private dental offices

It is well known that numerous factors influence the light output of curing units, but many dentists are unaware that the output of their curing lights are inadequate. This study was conducted to evaluate the light intensity of visible-light curing units in private dental offices and to assess their curing efficiency by measuring compressive strength of a light-cured resin. Also, in order to determine the maximum light intensity of the curing units, lamps, filters, and fiber optic bundles were replaced by new ones and curing efficiency remeasured. Light intensity was measured by employing a Quantum Radiometer LI-189 at a wavelength of 470 +/- 40 nm using a bandpass filter. Compressive strength of a light-cured resin using the light units was measured employing an Instron Testing Machine at a crosshead speed of 1.0 mm/min. From the evaluation of 105 light units, the light intensity ranged from 28 to 1368 W/m2 (0 approximately 500 W/m2; 41.9%, 500 approximately 1000 W/ m2; 45.7%, 1000 approximately 1500 W/m2; 12.4%). Light intensity of the light unit in private offices decreased 15.9 approximately 82.1% compared to brand-new units. Reduction of light intensity impaired compressive strength of the light-cured resin to varying degrees (148.3 approximately 279.9 MPa) compared with the highest value (317 MPa) obtained from brand-new light units. The replacement of the parts increased the light intensity, with maximum increases of 36.0% for lamps, 157.7% for filters, 46.2% for fiber optics, and 322.7% for all three parts. The results of this study indicated that the light intensities of the curing units used in private practice were lower than expected.

Reinforcement of acrylic resins for provisional fixed restorations. Part II: Changes in mechanical properties as a function of time and physical properties

In Part I, it was found that (i) 2 vol.% admixture of reinforcing elements in PMMA (Jet) resin matrix had a significant beneficial effects on the mechanical properties, and (ii) among these, zirconia exhibited the greatest improvements in modulus of elasticity, transverse strength, toughness, and hardness number. Using the best combination (i.e., PMMA resin matrix and 2 vol.% ZrO2), exothermic temperature raise and polymerization shrinkage were further investigated. Deterioration in mechanical properties due to prolonged water sorption were also studied for 5 weeks. The following can be concluded: (1) By increasing liquid/powder ratio for PMMA control samples, the peak temperature occurrence was retarded by 3 min and raised by 8 degrees C. (2) The effect of admixed oxide particles to PMMA resin matrix or the heat generated during polymerization was not significant. (3) The polymerization volumetric shrinkage was influenced by the a mixture of particles, with increases as large as 0.9% (or 0.3% in linear shrinkage). (4) PMMA resin admixed with 2 vol.% of zirconia particles showed a continuous weight gain due to water sorption, mechanical properties appears to be increasing up to 1-week sorption, followed by rapid drop of all properties. (5) Autopolymerizing acrylic resins are a resin-resin composite material of pre-polymerized beads embedded in a newly formed acrylic matrix. The main fracture modality appears to occur through the matrix and at the interface, although some trans-beads fractures were identified. (6) It was suggested that incorporating certain type of oxide particles into the pre-polymerized beads would provide stronger resin matrix.

Growth factors increase pericellular proteoglycans independently of their mitogenic effects on A10 rat vascular smooth muscle cells

Proliferation of vascular smooth muscle cells with the accumulation of proteoglycans in the extracellular matrix is one of the significant changes found in atherosclerotic lesions. In order to clarify the relationship between pericellular proteoglycan and cell growth, we established a simple method for quantitatively estimating the amount of pericellular proteoglycans and investigated the effects of various growth factors on the synthesis of pericellular proteoglycans by cultured A10 rat smooth muscle cells. Analysis of trypsin accessible [35SO4]-labeled material in the pericellular area of the A10 cell culture by Q-sepharose anion-exchange chromatography showed two peaks. One peak, eluted at 0.55 M NaCl, disappeared after treatment with 2 mU/ml of heparitinase, indicating that heparan sulfates (HS) were present. The other peak, which eluted at 0.65 M NaCl, disappeared with 20 mU/ml of chondroitinase ABC, indicating the presence of chondroitin sulfates and dermatan sulfates (CS/DS). We estimated the effects of several growth factors on the synthesis of the pericellular proteoglycans by measuring heparitinase- and chondroitinase-ABC-sensitive radioactivities. Although PDGF-AB significantly stimulated cell proliferation and the synthesis of pericellular CS/DS, its dose-dependent effect on the cell growth did not coincide with that on the proteoglycan synthesis. IGF-I (1 nM) increased pericellular CS/DS but not the cell number, while basic FGF (1 nM) and EGF (1 nM) increased the cell number but not pericellular CS/DS. All the growth factors we examined had no effect on the synthesis of pericellular HS. These results indicate that growth factors increase pericellular proteoglycans independently of their mitogenic effects.

Influence of environmental conditions on bond strength of a resin-modified glass ionomer

PURPOSE

To investigate the influence of temperature and relative humidity (RH) on the dentin bond strength of a resin-modified glass ionomer cement (Fuji II LC) and to evaluate the bonding efficacy of dentin primer.

MATERIALS AND METHODS

Four environmental conditions: (A) 25 +/- 1 degrees C, 50 +/- 5% RH, (B) 25 +/- 1 degrees C, 95 +/- 5% RH, (C) 37 +/- 1 degrees C, 50 +/- 5% RH, (D) 37 +/- 1 degrees C, 95 +/- 5% RH, were used to make the specimens. Bovine mandibular incisors were mounted in self-curing resin and the facial surfaces were ground on wet #600 SiC paper to expose dentin. Dentin Conditioner and OptiBond Prime were employed as treatment agents. After treating the dentin surface, the cement was condensed into a vinyl mold (4 x 2 mm) placed on the dentin and light cured. Ten samples per test group were stored in 37 degrees C water for 24 hours, then shear tested at a crosshead speed of 1.0 mm/minute. One-way ANOVA followed by Duncan test (P < 0.05) were done.

RESULTS

The dentin bond strengths of the no-conditioning group and Dentin Conditioner treatment group increased with increasing temperature but were not influenced by RH. With the use of the dentin primer, increased bond strengths and no influence of environmental conditions were observed. These data suggest the efficacy of employing dentin primer for application of the resin-modified glass ionomer cement regardless of temperature or RH.

Effect of light exposure on fracture toughness and flexural strength of light-cured composites

OBJECTIVES

This study was conducted to investigate the curing characteristics of light-cured composites and their related mechanical properties.

METHODS

Single-edge notch specimens [25 mm x 2.5 mm x 5 mm with a 5 mm notch (a/W = 0.5)] were prepared for fracture toughness measurements. For flexural strength testing, a stainless steel mold (25 mm x 2 mm x 2 mm) was used. Light-cured composites were condensed into the mold, and the middle third of the specimen was first activated for 30 s with 400 mW/cm2, for 60 s with 200 mW/cm2, or for 120 s with 100 mW/cm2. Then the remaining thirds were activated at the same intensity and curing time as the middle third. After 24 h storage in 37 degrees C water, three-point bending tests were performed with a span length of 20 mm at a crosshead speed of 0.5 mm/min. A one-way ANOVA, followed by a Newman-Keuls test (p < 0.05), were used to compare the data obtained from each group to test the effect of the curing conditions.

RESULTS

Fracture toughness, flexural strength, and flexural modulus varied with resin composites. Among the three curing conditions for each material, there were no significant differences in fracture toughness, flexural strength, or flexural modulus.

SIGNIFICANCE

The fracture toughness and the flexural strength were the same when irradiations with the same amount of energy (light intensity multiplied by curing time) were used. It was found that, at lower light intensity, longer curing was required to provide comparable mechanical properties. An accumulated irradiation energy obtained through a product of the light intensity and curing time may serve as a guideline to produce samples exhibiting equivalent fracture toughness as well as flexural strengths.

Effect of surface coatings on flexural properties of glass ionomers

The purpose of this study was to investigate the change in flexural strength and fracture toughness of light-cured glass ionomer cements after long-term immersion in water, and to investigate the effect of surface coatings on their properties. 2 resin-modified and 1 conventional glass ionomer cements were employed. For the flexural strength, a 25 x 2 x 2 mm stainless steel mold was used. For the fracture toughness (KtC), single edge notch specimens with dimensions 25 x 2.5 x 5 mm and a 0.5 mm notch (a/W = 0.5) were prepared in a stainless steel mold. Specimens were subjected to the 3 point bending at 0.5 mm/min after storage in 37 degrees C water for the periods of 1 h, 24 h, 1 wk, 1 month, and 6 months. The glass ionomer cements tended to exhibit an increase in mechanical properties over the 24-h period and then to maintain a constant strength. The surface protection of the resin-modified glass ionomer cement has some effect on the mechanical properties during early setting reactions, and it is desirable that the cement should be protected from direct water contact for at least 1 h after cement mixing.

Influence of dentin primer application methods on dentin bond strength

This study was carried out to determine the influence of dentin primer application methods on bond strength to human dentin. Two dentin bonding restorative systems, Imperva Bond/Lite-Fil II A (Shofu) and Scotchbond Multi-Purpose/Z-100 (3M) were employed. Human molars were mounted in self-cured resin and the buccal surfaces were prepared with #600-grit SiC paper. These surfaces were then conditioned according to each manufacturer's instructions. Two experiments were designed: (1) effect of the primer application procedures (inactive and active application), and (2) effect of the air drying time (0, 1, 5, 10, 20, and 30 seconds). The adhesives were applied and resin composites were bonded to the teeth. Ten samples per test group were stored in 37 degrees C deionized water for 24 hours, and shear tested with a circular knife edge at a crosshead speed of 1.0 mm/minute. A one-way ANOVA followed by the Newman-Keuls multiple comparison at P < 0.05 was done. For both restorative systems, the bond strengths for active application were higher than those for inactive application, but there was no significant difference between the two mean values. According to the air drying time, there appeared to be an optimal range of drying times, longer for Imperva Bond (10-30 seconds) than for Scotchbond MP (1-5 seconds). The data suggest that the bond strengths of employed dentin bonding systems were greatly influenced by the methods of the dentin primer application.

Influence of light irradiation of dentine primers on dentine-resin bond

OBJECTIVE

The purpose of this study was to examine the influence of light irradiation of dentine primers that contain camphoroquinone (CQ) on the shear bond strength to dentine and their contact angle.

METHOD

Three dentine bonding systems which contain CQ, Imperva Bond, OptiBond and XR-Bond; and Light Bond, which does not contain CQ, were employed. Labial surfaces of freshly extracted lower bovine incisors were ground with no. 600 grit SiC paper. Dentine primers were applied to the dentine surfaces in two groups, irradiated and non-irradiated. A shear bond strength test was performed and the direct contact angle was measured.

RESULTS

Statistical analysis (Newman-Keuls multiple comparison P < 0.05) of the data indicated that light irradiation of the dentine primer for systems containing CQ resulted in increased bond strength and decreased contact angle.

CONCLUSION

This study indicates that for these dentine bonding systems containing CQ in their primers, light irradiation of the dentine primer is effective in improving wettability and increasing the bond strength to dentine.

Influence of light intensity on shear bond strength to dentin

PURPOSE

To investigate the influence of light intensity on dentin bond strength of five dentin bonding systems.

MATERIAL AND METHODS

The light intensity used to polymerize specimens was controlled at the levels of 100, 200, 400, 600, 800, and 1000 W/m2 (470 +/- 40 nm). Labial surfaces of freshly extracted lower bovine incisors were ground with #600 grit SiC paper to expose dentin. After primer application, bonding agents were applied and bonded with resin composites. A shear bond strength test was performed and the data were analyzed by a one-way ANOVA followed by Newman-Keuls multiple comparison (P<0.05).

RESULTS

Statistical analysis of the data indicated that light intensity affected the bond strength to dentin. The mean bond strength of all bonding systems decreased with lower light intensity. The tendency of decreasing bond strength was different among the test materials and each test material had a threshold light intensity that resulted in statistically the same bond strength obtained using a light intensity of 1000 W/m2.

Influence of filler addition to bonding agents on shear bond strength to bovine dentin

OBJECTIVES

The purpose of this study was to investigate the influence of adding filler particles to a bonding agent on dentin bond strength and of the temperature change during curing in order to determine the optimum filler level for an experimental bonding agent.

METHODS

Experimental light-cured bonding agents with microfiller (average size: 0.05 micrometers) content of 0, 10, 20, 30, 40, 50, 60, and 70 wt% were used with the Imperva Bond / Lite-Fil II A (Shofu) restorative material. Bovine incisors were mounted in self-cured resin, and the facial surfaces were prepared with 600-grit SiC paper. After dentin surface pretreatment with dentin primer, experimental bonding agents were applied to the dentin surface and bonded with resin composite. Ten samples per test group were stored in 37 degrees C water for 24 h, then shear tested at 1.0 mm/min. The temperature change of the bonding agent was monitored during the exthothermic polymerization reaction according to the method of ISO standard #4049. The peak temperature and the time required to reach peak temperature were recorded.

RESULTS

Bond strength to dentin and the temperature change were greatly affected by the filler level. Maximum dentin bond strength (14.3 +/- 2.3 MPa) was obtained with a filler level of 10 wt% and decreased with filler level higher than 30 wt% (10.4 +/- 1.7 MPa - 5.3 +/- 2.6 MPa). Peak temperature decreased and the time required to reach peak temperature increased with the higher filler levels. There were strong correlations between the bond strength and temperature change of experimental bonding agents.

SIGNIFICANCE

The initial setting behavior of bonding agents containing filler particles may be one of the important factors influencing dentin bond strength. When bonding agents with filler particles are used, it is important to determine if optimum filler levels exist in order to optimize the dentin bond strength.

Suicide and aging in Japan: an examination of treated elderly suicide attempters

Although individuals aged 65 and over accounted for 12% of the total population of Japan in 1990, suicides in this age group consisted of 29% of all suicides. The elderly population of Japan is expected to grow rapidly to 24% of the total population by the year 2020, and suicide prevention for the elderly is an urgent mental health problem. Among a total of 1,216 elderly patients who were admitted to the Department of Psychiatry at Tokyo Metropolitan Geriatric Hospital between April 1980 and March 1990, 50 were hospitalized immediately after suicide attempts in order to study their psychosociomedical problems. Because early diagnosis of depression and initiation of proper treatment are indispensable--even if patients do not show obvious depressive symptoms--those who develop persistent somatization and/or delirium should be considered highly suicidal and given special attention. With the cooperation of mental health professionals, it is necessary to educate general practitioners, the public, and the elderly themselves about characteristics of psychiatric disorders and various problems associated with aging. Further research on other elderly Japanese populations, as well as research that examines suicide completion, is needed to confirm the findings of the present study.

Influence of irradiation sequence on dentin bond of resin inlays

The relationship between the order in which a dual-cured resin cement is light activated and the bond strength of resin inlay materials to dentin was examined. Also evaluated was the setting time with various irradiation sequences. Lite-Fil CR/Imperva Bond (Shofu) and Clearfil CR/CR Cement (Kuraray) were employed. Ten specimens, 4 mm in diameter by 4 mm deep, were made with each material for each condition and bonded to bovine dentin with the respective bonding agent and cement. Order of light activation was: 1) no light activation; 2) premix activation of only the liquid prior to mix, 3 seconds for Lite-Fil and 25 seconds for Clearfil; 3) postplacement activation, 30 seconds for Lite-Fil and 40 seconds for Clearfil; and 4) premix and postplacement activation, 3 seconds and 30 seconds for Lite-Fil and 25 seconds and 40 seconds for Clearfil. Samples were stored in water for 24 hours and shear strength tested. The setting time with no activation and premix activation was measured according to the ISO #7489 standards. Bond strengths (MPa) were 1) 4.41, 2) 13.07, 3) 6.34, and 4) 14.81 for Lite-Fil, and 1) 0.37, 2) 2.44, 3) 0.52, and 4) 2.51 for Clearfil. No light activation or only postplacement activation resulted in lower bond strengths with a 4.0 mm-thick specimen. The setting time of the cement mix with premix activation was shorter than with no activation. Light activation of these dual-cure cements is essential. Premix activation of only the liquid resulted in bond strengths similar to those obtained with combined pre- and postplacement activating.

Effect of D-Ala-D-beta Nal-Ala-Trp-D-Phe-Lys-NH2 (KP-102) on GH secretion in urethan-anesthetized rats

The effect of a newly developed growth hormone (GH)-releasing hexapeptide (KP-102) on GH secretion was studied in urethan-anesthetized adult male rats. Although KP-102 alone exerted a small influence on GH secretion, it produced a large plasma GH response in the presence of exogenous GH-releasing factor (GRF). During the continuous infusion of GRF, the somatotropes became refractory to a large bolus dose of GRF, but KP-102 induced a marked increase of plasma GH. The GH response to KP-102 alone or KP-102 with GRF was significantly augmented when antiserum to somatostatin (ASS) was previously administered. Although KP-102 and GRF acted synergistically on GH secretion in control animals, they acted additively in ASS-administered rats. The KP-102 effect on plasma GH was significantly attenuated in control animals and ASS-administered rats by prior i.v. injection of antiserum to GRF. Taken together, KP-102 stimulates GH secretion dependent on GRF and appears to act synergistically with GRF by antagonizing the SS effect.

Effect of die material hue and value on polymerization of indirect resin inlays

This study investigated the effects of hue and value of mold materials on the polymerization of resin composite inlays fabricated by an indirect process. Three colors of molds were used, and 10 specimens each of three resin composite materials were light polymerized on each of the die materials for each test. The specimens were postirradiation heat polymerized. Compressive strength, flexural strength, Knoop hardness, and bond strength to enamel and dentin were measured. Although differences in properties between specimens polymerized on different die materials were not always significant, the values obtained from the white mold were highest in all tests followed by those obtained on the gray and then the black molds. Correlations (r2) between lightness or value and compressive and flexural strength, hardness, and bond to enamel and dentin values were greater than 0.90. Die color and value appear to be important factors influencing the properties of indirect resin composite inlays even though they are heat polymerized after light activation.

Influence of argon laser curing on resin bond strength

Light cured resin composites are usually cured with halogen lamps whose light output decreases with time and distance to the resin surface. This study compared bond strengths of resins to tooth structure cured with either an argon laser or a conventional halogen light. The enamel and dentin of bovine incisors were ground on the buccal surface with wet #600 grit SiC paper. A 4 x 2 mm mold was placed on the tooth surface and Scotchbond 2/Silux and Clearfil Photobond/Photo Clearfil A were placed into the molds and cured using a Quick Light or an argon laser for exposure times of 10, 20, and 30 seconds, and distances of 0.0, 0.5, 1.0, and 1.5 mm from the resin surface. The intensity of the Quick Light was measured as 510 mW/cm2 at 470 +/- 15 nm and the intensity of the argon laser was adjusted to 510 mW/cm2 before curing. Shear bond tests at a crosshead speed of 1.0 mm/min were performed after 24 hours of storage in water. The bond strengths obtained with the halogen lamp and the laser were not significantly different at the same exposure times and at 0.0 or 0.5 mm from the resin surface. The laser cured bond strengths did not decrease with increasing distance whereas there was a significant decrease in halogen bond strengths at distances greater than 0.5 mm for both resins. The use of the laser might provide a clinical advantage in cases where the curing light source cannot be brought into proximity to the surface of the resin.

Dentin bond strength of light-cured glass-ionomer cements

The purpose of this study was to investigate the influence of surface treatments and irradiation conditions on the bond strength of light-cured glass-ionomer cements to dentin. The light-cured glass-ionomer cements used in this study were Vitrabond, XR Ionomer, and Fuji Lining LC. Three experiments were designed to study the influence of the following factors on bond strength to dentin: (1) effect of the surface treatment of the dentin, (2) effect of the irradiation time, (3) effect of an increase in the interval between mixing of the cement and irradiation. Samples were stored in water for 24 hours, after which shear bond testing was performed at a cross-head speed of 1 mm/min. For Vitrabond, the Scotchprep and Gluma 2 treatments gave the greatest shear bond strengths. For XR Ionomer and Fuji Lining LC, the Scotchprep treatment gave the greatest shear bond strengths. The bond strengths for all cements increased with prolonged irradiation time. Bond strengths decreased with a longer elapsed time between mixing and light-curing. This means that light-curing should be done soon after the cement is placed. The failure mode was found to be cohesive in the ionomer.

Effect of irradiation time to light-cured resin composite on dentin bond strength

This study examined the relationship between the irradiation time of three light-cured resin composites and their bond strength to dentin using two adherend surfaces. The light-cured resin composite systems selected were: Scotchbond/Silux, Scotchbond 2/Silux, and Clearfil Photo Bond/Photo Clearfil A. The adherend surfaces selected were a flat dentin surface and a box-shaped cavity. The greatest bond strength for all resin systems was recorded using the longest irradiation time. The bond strengths increased with an elevated irradiation time. When comparing the flat surface and a box-shaped cavity, the bond strength of the box cavity was greater than the flat surface with similar conditions except for 20 and 30 seconds of Scotchbond and 30 seconds of Clearfil. The correlation between bond strength and irradiation was greater for the flat surface than for the box-shaped cavity. This implied that the bond strength of the box-shaped cavity may be more susceptible to polymerization shrinkage.

Effect of filler content of light-cured composites on bond strength to bovine dentine

The bonding of light-cured composites to tooth tissues is known to be disturbed by polymerization shrinkage, and polymerization shrinkage is affected by the filler content of composites. This in vitro research examined the relationship between the filler content and bond strength to dentine of light-cured composites. Experimental light-cured composite systems with filler contents of 45, 55, 65 and 75 per cent by volume were used in both bond strength to dentine and shrinkage tests. The surfaces selected as substrates were a flat surface and a box-shaped cavity prepared in bovine dentine. The lowest bond strength was obtained with the 45 per cent filler content composite in the box-shaped cavity. Bond strength increased with increasing filler content. Volumetric polymerization shrinkage decreased with increasing filler content. The polymerization shrinkage at 120 s after light curing was 5.24 per cent for the 45 per cent filler content system, 4.77 per cent for the 55 per cent, 2.14 per cent for the 65 per cent and 1.68 per cent for the 75 per cent. The correlation between bond strength and shrinkage was greater for the cavity than it was for the flat surface. This implies that bond strength in the box-shaped cavity may have been affected more by polymerization shrinkage than with the flat surface. The findings lend support to the view that filler content is one of the important factors influencing the physical properties of composites.

Factors influencing bond strengths between unetched glass ionomers and resins

The use of glass-ionomer cements as a base beneath composite resins has become a popular restorative procedure often referred to as the "sandwich technique." Originally etching of the glass-ionomer surface was recommended to help create the necessary bond between glass-ionomer cement and composite resin. This study investigated the bond strength of various composite resins and their bond agents to unetched glass ionomer. The pH of the bond agents was measured and related as bond strength. The influence of time elapsed between mixing the glass-ionomer cement and placement of the bond agent was also studied. Bond strengths varied from 65.5 kg/cm2 for G-C Dentin Cement with Pyrofil Light Bond A to 3.2 kg/cm2 for G-C Dentin Cement with Bis-Fil-M. The pH range was from 2.28 for Pyrofil Light Bond to 7.62 for Durafill Bond. Low correlation coefficients between bond strength values and pH indicated only limited relationship between the two. The bond strength decreased as the time lapse between the end of the mix and application of the bond agent increased.

Factors of glass-ionomer cements influencing the bond strength to resin composites

The bond strength between composites and various particle sizes of glass-ionomer cements was investigated. The best bond strength was obtained after use of a small-particle cement and with the highest powder-to-liquid ratio employed for mixing the cement. In addition, use of a small-particle cement and the highest powder:liquid ratio produced cements with significantly stronger tensile strengths. Failure usually occurred within the cement. Consequently, the recorded bond strength actually reflected the tensile strength of the relevant cement.