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Surface assessment of a novel acid-etching solution on CAD/CAM dental ceramics
Get PDFBackground: This study investigated a new multi-acid-etching formulation for zirconia ceramics, containing hydrochloric, hydrofluoric, nitric, orthophosphoric, and sulfuric acids. The solution was tested on polycrystalline (5Y-TZP zirconia), lithium disilicate, hybrid ceramic, and feldspathic porcelain to assess compatibility, etching selectivity, and surface conditioning. Methods: Two-hundred-and-forty CAD/CAM specimens were etched for 20 s, 60 s, 30 min, or 1 h, and their surface roughness and etching patterns ware evaluated using 3D optical profilometry and scanning electron microscopy (SEM). Results: A positive correlation was observed between etching time and surface roughness (Ra values). The most pronounced changes were observed in lithium disilicate and feldspathic porcelain, with Ra values increasing from 0.733 ± 0.082 µm (Group 5) to 1.295 ± 0.123 µm (Group 8), and from 0.902 ± 0.102 µm (Group 13) to 1.480 ± 0.096 µm (Group 16), respectively. Zirconia increased from 0.181 ± 0.043 µm (Group 1) to 0.371 ± 0.074 µm (Group 4), and the hybrid ceramic from 0.053 ± 0.008 µm (Group 9) to 0.099 ± 0.016 µm (Group 12). Two-way ANOVA revealed significant effects of material and etching time, as well as a significant interaction between the two factors (p < 0.001). SEM observation revealed non-selective etching pattern for the lithium disilicate groups, indicating a risk of over-etching. Conclusions: The tested etching solution increased surface roughness, especially for the lithium disilicate and feldspathic porcelain specimens. In zirconia, one-hour etching improved surface characteristics with minimal observable damage. However, additional studies are necessary to validate the mechanical stability and bond effectives of this approach
Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease : The SLIM Randomized Clinical Trial
Get PDFThe benefits of fractional flow reserve (FFR)-guided complete coronary revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain unclear.To compare FFR-guided complete revascularization of nonculprit lesions vs culprit-only revascularization in patients with NSTEMI and multivessel disease.This prospective, investigator-initiated, multicenter, international randomized clinical trial was conducted at 9 hospitals in Europe. Patients with NSTEMI and multivessel disease who had successful revascularization of the culprit lesion were enrolled between June 2018 and July 2024, and final follow-up was completed on July 21, 2025. The analysis was conducted on July 28, 2025. Eligibility criteria included the presence of at least 1 stenosis of at least 50% in a nonculprit lesion amendable for revascularization.Patients were randomized to receive either FFR-guided complete or culprit-only revascularization during the index procedure. Staged revascularization within 6 weeks after the index procedure was allowed in the culprit-only group.The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. Key secondary outcomes included individual components of the primary outcome, net adverse clinical events, all-cause death or nonfatal myocardial infarction, cardiac rehospitalization, and bleeding events.Among 478 randomized patients (mean [SD] age, 65.9 [10.6] years; 347 [72.9%] males), 240 were randomized to receive FFR-guided complete revascularization and 238 were randomized to receive culprit-only revascularization, with crossover occurring in 7 patients in the culprit-only group. The primary outcome occurred in 13 patients (5.5%) in the FFR-guided complete revascularization group vs 32 patients (13.6%) in the culprit-only group (hazard ratio [HR], 0.38 [95% CI, 0.20-0.72]; P = .003). Rates of any revascularization (3.0% vs 11.5%; HR, 0.24 [95% CI, 0.11-0.56]; P < .001) and net adverse clinical events (6.3% vs 15.3%; HR, 0.39 [95% CI, 0.21-0.70]; P = .002) were also significantly lower in the complete revascularization group, while there were no significant differences in the remaining secondary outcomes.FFR-guided complete revascularization during the index procedure resulted in a significant reduction in the composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. This was mainly driven by reduced repeat revascularization.ClinicalTrials.gov Identifier: NCT03562572
A Data-Driven ML Model for Sand Channel Prediction from Well Logs for UTES Site Optimization and Thermal Breakthrough Prevention: Hungary Case Study
Get PDFThis study presents a data-driven approach to predict the three-dimensional distribution of sand-rich channels in hydrocarbon reservoirs using well log data, aiming to optimize site selection for Underground Thermal Energy Storage (UTES) and manage hot and cold well pairs effectively. Leveraging detailed petrophysical datasets from 128 hydrocarbon exploration wells within the Szolnok Formation in southern Hungary, the developed machine-learning workflow—combining XGBoost regression and spatial residual correction—accurately delineated permeable channel systems suitable for thermal energy injection and extraction. The model achieved robust predictive performance (R2 = 0.92; RMSE = 0.24), and correlation analyses confirmed significant relationships between predicted channels and sand content and shale content. Clearly identified high-permeability channel zones facilitated strategic well placement, significantly reducing the risk of premature thermal breakthrough and enhancing the reliability and efficiency of UTES operations
Megszületés előtt diagnosztizált, szájüregi obstrukciót okozó, enteralis eredetű sublingualis cysta műtéti ellátása újszülöttkorban [Neonatal and surgical management of a prenatally diagnosed enteric sublingual cyst causing airway obstruction]
Get PDFA szájüreget érintő congenitalis térfoglaló folyamatok praenatalis felismerése és a neonatalis korban történő definitív ellátása a légút veszélyeztetettsége és a táplálási nehezítettség miatt nagy szakmai és technikai felkészültséget igénylő komplex, multidiszciplináris feladat. Esetismertetésünkben egy praenatalis ultrahangvizsgálat során felismert, súlyos szájüregi obstrukciót okozó cystosus terime sürgős ellátását, illetve neonatalis korban végzett definitív sebészi eltávolítását mutatjuk be. Az ultrahangvizsgálattal in utero nagy méretű szájüregi cystával diagnosztizált magzat a 38. terhességi héten, 3400 g születési súllyal, elektív császármetszéssel jött világra. A szájüregből előboltosuló, kb. 6 × 6 cm-es cysta miatt Mayo-tubussal azonnali légútbiztosítás, illetve a terime többszörös pungálása történt. Ezt követően az újszülött légútja teljes mértékben szabaddá vált. Táplálását nasogastricus szondán keresztül biztosítottuk. MR-vizsgálatot követően a sublingualis területről kiinduló cystát az újszülött 8 napos korában in toto eltávolítottuk. A posztoperatív időszakban szövődményt nem észleltünk. A per os táplálás két héttel a műtétet követően progresszíven megkezdhető volt. A szövettani vizsgálat a sublingualis régióban rendkívül ritkán kialakuló, enteralis eredetű duplikációs cystát véleményezett. A 11 hónapos utánkövetési idő alatt recidívára utaló jelet nem észleltünk. Nehézlégzés vagy táplálási nehezítettség nem jelentkezett. A csecsemő súly- és hosszgyarapodása megfelelő volt. A rendszeres várandósgondozás a magzati fejlődési rendellenességek kiszűrése szempontjából elengedhetetlen fontosságú. Potenciálisan légzési nehezítettséget okozó anomáliák esetén a tervezett császármetszés során készen kell állni a sürgősségi légútbiztosításra. A légzési vagy táplálási problémát okozó szájüregi terimék újszülöttkorban történő definitív ellátása lehetővé teszi a hospitalizációs időszak lerövidítését és az ismételt műtétekkel járó fizikális és pszichés terhek minimalizálását. Orv Hetil. 2025; 166(36): 1431–1437. | The prenatal detection and neonatal definitive management of congenital expansive lesions affecting the oral cavity
– due to potential airway compromise and feeding difficulties – represent a complex, multidisciplinary task requiring
high-level professional and technical expertise. In this case report, we present the urgent management and subse-
quent definitive surgical excision of a cystic mass causing severe oral obstruction in a neonate, identified prenatally by ultrasound examination. The fetus was delivered at 38 weeks of gestation via elective cesarean section with a birth
weight of 3400 g. Due to a protruding cyst approximately 6 × 6 cm in size arising from the oral cavity, immediate
airway management was performed using a Mayo tube, along with multiple punctions of the cystic mass. This inter-
vention successfully secured the airway. The infant was fed via a nasogastric tube. Following MR imaging, the cyst
originating from the sublingual area was completely excised in toto on day 8 of life. The postoperative period was
uneventful. Oral feeding was gradually initiated two weeks after surgery. Histopathological examination confirmed
an enteric duplication cyst, a rare occurrence in the sublingual region. During an 11-month follow-up period, no
signs of recurrence were observed. The infant experienced no breathing or feeding difficulties, and growth in weight
and length was appropriate for age. Prenatal care is essential for detecting fetal congenital anomalies. In these cases
with potential to cause respiratory compromise, expertise in emergency airway management during planned cesarean
delivery is critical. Definitive neonatal treatment of oral cavity masses causing respiratory or feeding difficulties can
shorten hospitalization and minimize the physical and psychological burden associated with repeated surgeries
Long Non-Coding RNAs in Psoriasis: A Comprehensive Review of Expression Profiles, Mechanistic Insights, Genetic Associations, and Their Clinical Implications
Get PDFPsoriasis is a chronic inflammatory skin disorder affecting approximately 2% of the global population, characterized by abnormal keratinocyte proliferation and dysregulated immune responses. This review examines the emerging role of long non-coding RNAs (lncRNAs) in psoriasis pathogenesis, highlighting their significance as regulatory molecules in disease initiation, progression, and chronicity. LncRNAs demonstrate distinct expression patterns in psoriatic lesions, with upregulated transcripts such as MALAT1, XIST, MIR31HG, and HOTAIR promoting keratinocyte hyperproliferation, inhibiting apoptosis, and amplifying inflammatory cascades through mechanisms including microRNA sponging and transcription factor modulation. These molecules primarily target key signaling pathways including NF-κB, STAT3, and PI3K/AKT. Conversely, downregulated lncRNAs like NEAT1, MEG3, and PRINS normally function as tumor suppressor molecules that maintain epidermal homeostasis through pro-apoptotic and anti-inflammatory mechanisms. Their reduced expression contributes to the pathological hyperproliferative phenotype characteristic of psoriatic skin. Importantly, genetic variants within lncRNA loci have been identified as significant contributors to psoriasis susceptibility and treatment responses across different populations. Single- nucleotide polymorphisms in genes such as TRAF3IP2-AS1, HOTAIR, and CDKN2B-AS1 demonstrate population-specific associations with disease risk and therapeutic outcomes, suggesting their potential utility as pharmacogenomic markers. The complex regulatory networks involving lncRNAs provide new insights into psoriasis pathogenesis and offer promising avenues for personalized treatment strategies. Integration of lncRNA profiling into clinical practice may enhance our understanding of disease heterogeneity and improve therapeutic outcomes for psoriatic patients
Long-Term Prognostic Value of Post-Revascularization Fractional Flow Reserve and Skin Perfusion Toe Pressure in Patients with Chronic Limb-Threatening Ischemia
Get PDFBackground and Objectives: The impact of peripheral below-the-knee (BTK) fractional flow reserve (FFR) on long-term clinical outcomes remains unknown. Materials and Methods: We enrolled 40 patients with severe BTK lesions (Rutherford 4–6). FFR (using 40 mg papaverin) and skin perfusion toe pressure (SPTP) by laser Doppler were measured during the index procedure. The primary outcomes were major adverse limb events (MALEs) (defined as reintervention on the index arterial segment or amputation of the index limb) and death during follow-up. Results: The median follow-up was 7 [IQR 4–8] years. After the index procedure, FFR increased significantly (p 97.8 mmHg was 100% specific for FFR ≥ 0.80. Conclusions: While there is no association between change in FFR and the risk of death or MALEs, lower FFR values either before or after revascularization were associated with higher long-term risk of MALEs. Moreover, a lower SPTP was associated with a higher risk of MALEs. Aiming for approximately 100 mmHg in SPTP represents a non-invasive surrogate of FFR ≥ 0.80. Larger studies are needed to validate the impact of post-revascularization FFR-SPTP-adjacent values on clinical outcomes
Long-term antithrombotic therapy practices in adult patients with short bowel syndrome following acute mesenteric ischemia: An international case-based survey
Get PDFBackground & aims: Long-term antithrombotic therapy is recommended for short bowel syndrome (SBS) after acute mesenteric ischemia (AMI). However, targeted recommendations on drug selection, dosing, duration and monitoring, are lacking. Current recommendations rely on data from other arterial diseases, often overlooking SBS-related drug absorption issues. To understand current practices, this survey aimed to assess the long-term antithrombotic therapy practices in AMI. Methods: An e-survey was disseminated to HAN-CIF (Home Artificial Nutrition – Chronic Intestinal Failure) database centers of ESPEN (European Society on Clinical nutrition and Metabolism) and coagulation specialists. It included ten cases with varying postsurgical intestinal anatomy, revascularisation and aetiology. Questions focused on drug class choice, administration route, dosing, duration and monitoring of antithrombotic therapy. Results: For patients with AMI of unknown aetiology, but with hypercholesterolaemia and smoking status, intestinal failure (IF) teams preferred anticoagulants (55.8–65.1 %) over antiplatelet therapy (27.9–37.2 %), while coagulation specialists favoured antiplatelet therapy (57.1 %). IF teams selected antiplatelet therapy more often in patients with type 3 anatomy (largest absorptive capacity). They favoured parenteral agents for patients with end-jejunostomy or duodenocolic anastomosis (51.2 % and 55.8 % respectively; lowest absorptive capacity), oral agents for those without IF (69.8 %; highest absorptive capacity), and both for patients with a jejunocolic anastomosis (48.8 % oral, 44.2 % parenteral; moderate absorptive capacity). Coagulation specialists consistently preferred oral therapy. Lifelong antiplatelet therapy was preferred by IF teams (71.4–100.0 %), while anticoagulants were prescribed either temporarily (16.7–59.1 %) or lifelong (40.9–83.3 %). Standard doses were used for all drug classes, irrespective of anatomy, revascularisation or comorbidities. Monitoring varied: IF teams monitored subcutaneous low molecular weight heparins and non-vitamin K oral anticoagulants (DOACs), whereas coagulation specialists only monitored DOACs. Both specialists commonly performed a 24-h Holter, transthoracic and transoesophageal echocardiograms for arterial mesenteric ischaemia (MI) and requested thrombophilia parameters more for venous MI, with antiphospholipid antibodies checked for both MI subtypes. Conclusion: We observed significant variation in long-term antithrombotic management in post-AMI SBS patients, with differing approaches between IF and coagulation specialists. A multidisciplinary position statement is necessary to standardise care. © 2025 European Society for Clinical Nutrition and Metabolis
