OBJECTIVES: The aims of this study were to conduct a systematic review of the microtensile bond strength (µTBS) of multi-mode adhesives to dentin and to perform a meta-analysis to assess the significance of differences in the µTBS of one of the most commonly used universal adhesives (Scotchbond Universal, 3M ESPE) depending on whether the etch-and-rinse or self-etch mode was used. MATERIALS AND METHODS: An electronic search was performed of MEDLINE/PubMed, ScienceDirect, and EBSCOhost. Laboratory studies that evaluated the µTBS of multi-mode adhesives to dentin using either the etch-and-rinse or self-etch mode were selected. A meta-analysis was conducted of the reviewed studies to quantify the differences in the µTBS of Scotchbond Universal adhesive. RESULTS: Only 10 studies fulfilled the inclusion criteria for the systematic review. Extensive variation was found in the restorative materials, testing methodologies, and failure mode in the reviewed articles. Furthermore, variation was also observed in the dimensions of the microtensile testing beams. The meta-analysis showed no statistically significant difference between the etch-and-rinse and self-etch modes for Scotchbond Universal adhesive (p > 0.05). CONCLUSIONS: Multi-mode ‘universal’ adhesives can achieve substantial bonding to dentin, regardless of the used modes (either etch-and-rinse or self-etch).
Adhesives* ; Dentin* ; Dentin-Bonding Agents

Methods: We assessed 23 patients with a mean age of 57.3±15 years. According to the Japanese Orthopedic Association (JOA) scale; eight patients had grade 0, nine had grade I, and six had grade II. All patients underwent plain radiography and magnetic resonance imaging of the cervical spine. The foramen magnum was involved in 10 patients, C1–2 in seven, C2–3 in four, and C3–4 in two. All patients were operated via the far-lateral approach. Results: Gross total resection was achieved in 21 patients. Sixteen lesions were psammomatous, five were fibroblastic, and two were meningothelial meningiomas. The mean operative duration was 135±40 minutes, while the mean operative blood loss was 450±210 mL, and the mean hospital stay was 4.3±2.2 days. At the final follow-up that was conducted at 27.6±21 months and as per the JOA score; 16 patients were classified into grade 0 and 7 into grade II. The condition of none of our patients deteriorated postoperatively. There was no significant correlation of the clinical outcome with tumor level, pathological subtype of the tumor, symptom duration, age, and sex. There was no significant correlation of tumor resection completeness with tumor level, tumor pathological subtype, or tumor topography (ventral or ventrolateral). Conclusions The far-lateral approach is a safe and effective access for ventral and ventrolateral cervical meningiomas. It allows direct access to tumor with no spinal cord or nerve roots traction, and thus may yield a fairly better outcome than the standard posterior approach.

The effect of four sub-lethal concentrations (400, 800, 1,200 and 1,600 microg/ml) of three amino acids such as isoluecine, aspartic acid and phenylalanine on vegetative growth and sexual and asexual reproduction of Achlya racemosa, A. proliferoides and Saprolegnia furcata was investigated. The density of vegetative growth and diameters of vegetative colonies of species of the Oomycetes fungi decreased with rising the concentration of the applied amino acid. Vegetative hyphae of treated fungi almost appeared branched in case of S. furcata, thick in case of A. racemosa and distorted in case of A. proliferoides as compared with control. The different treatments with amino acids depressed both sporangial formation and discharge, which were dependent on the tested species of zoosporic fungi, the amino acid and its dosage. Phenylalanine was the most effective amino acid in inhibiting sporulation and S. furcata was the most sensitive fungal species. Aspartic acid and isoleucine stimulated germination of discharged spores through the formation of germlings. Gemmae formation by the three fungi was reduced at the low concentrations of amino acids and nearly missed at high concentrations. Sex organs (oogonia and antheridia) were affected partly; rudiment oogonia were observed at low concentrations (400 and 800 microg/ml) and disappeared at higher concentrations, whereas antheridial branch formation was stimulated as the fungi were treated with isoleucine and to some extent phenylalanine.
Achlya* ; Amino Acids* ; Aspartic Acid ; Fungi ; Germination ; Hyphae ; Isoleucine ; Oogonia ; Oomycetes ; Phenylalanine ; Reproduction, Asexual ; Saprolegnia* ; Spores

The effects of different concentrations of three amino acids as carbon and or nitrogen sources on mycelial dry weights, changes in pH values of synthetic medium, ammonia secretion and extracellular protease activity by three zoosporic fungi, pathogens of fish and shellfish, were studied. As compared with the control, the addition of isoleucine and aspartic acid as nitrogen sources were generally stimulative for mycelial dry weight production whereas phenylalanine was inhibitory irrespective to the tested fungal species. When amino acids served as carbon and nitrogen sources, the mycelial dry weights of the three fungi were increased (mostly non-significantly) relative to untreated control but weights were decreased as the concentrations of the three amino acids raised. The addition of individual amino acids as carbon and nitrogen sources to the medium significantly increased pH values of the medium comparable to the control. The addition of each of the three amino acids as carbon and nitrogen sources to the medium significantly induced ammonia secretion by the three species of zoosporic fungi. Ammonia secretion in synthetic medium amended with amino acids as nitrogen source raised by the three zoosporic fungi relative to untreated control except in case of Achlya racemosa treated with isoleucine. Extracellular protease activity was almost promoted in case of Achlya proliferoides and Saprolegnia furcata cultures treated with isoleucine and aspartic acid individually in presence of glucose and vice versa in case of phenylalanine. However, extracellular protease activity of A. racemosa decreased compared with the control at various concentrations of isoleucine and both phenylalanine and aspartic acid assumed inconsistent effects. Extracellular protease activity of the three zoosporic fungi in the medium devoid of glucose varied depending upon zoosporic fungal species, the tested amino acid and the applied concentrations. The values of protease activity were approximately less two folds than that obtained in presence of glucose.
Achlya ; Amino Acids* ; Ammonia* ; Aspartic Acid ; Carbon ; Fungi ; Glucose* ; Hydrogen-Ion Concentration ; Isoleucine ; Nitrogen ; Oomycetes* ; Phenylalanine ; Saprolegnia ; Shellfish ; Weights and Measures

Epicoccum purpurascens stain 5615 AUMC was investigated for its biocontrol activity against root rot disease caused by Pythium irregulare. E. purpurascens greenhouse pathogenicity tests using three leguminous plants indicated that the fungus was nonpathogenic under the test conditions. The germination rate of the three species of legume seeds treated with a E. purpurascens homogenate increased significantly compared with the seeds infested with P. irregulare. No root rot symptoms were observed on seeds treated with E. purpurascens, and seedlings appeared more vigorous when compared with the non-treated control. A significant increase in seedling growth parameters (seedling length and fresh and dry weights) was observed in seedlings treated with E. purpurascens compared to pathogen-treated seedlings. Pre-treating the seeds with the bioagent fungus was more efficient for protecting seeds against the root rot disease caused by P. irregulare than waiting for disease dispersal before intervention. To determine whether E. purpurascens produced known anti-fungal compounds, an acetone extract of the fungus was analyzed by gas chromatography mass spectrometry. The extract revealed a high percentage of the cinnamic acid derivative (trimethylsiloxy) cinnamic acid methyl ester. The E. purpurascens isolate grew more rapidly than the P. irregulare pathogen in a dual culture on potato dextrose agar nutrient medium, although the two fungi grew similarly when cultured separately. This result may indicate antagonism via antibiosis or competition.
Acetone ; Agar ; Antibiosis ; Cinnamates ; Fabaceae ; Fungi ; Gas Chromatography-Mass Spectrometry ; Germination ; Glucose ; Pythium ; Seedlings ; Seeds ; Solanum tuberosum ; Sprains and Strains

The removal efficiency of the heavy metals Zn, Pb and Cd by the zoosporic fungal species Saprolegnia delica and the terrestrial fungus Trichoderma viride, isolated from polluted water drainages in the Delta of Nile in Egypt, as affected by various ranges of pH values and different temperature degrees,was extensively investigated. The maximum removal efficiency of S. delica for Zn(II) and Cd(II) was obtained at pH 8 and for Pb(II) was at pH 6 whilst the removal efficiency of T. viride was found to be optimum at pH 6 for the three applied heavy metals. Regardless the median lethal doses of the three heavy metals, Zn recorded the highest bioaccumulation potency by S. delica at all pH values except at pH 4, followed by Pb whereas Cd showed the lowest removal potency by the fungal species and vice versa in case of T. viride. The optimum biomass dry weight production by S. delica was found when the fungus was grown in the medium treated with the heavy metal Pb at pH 6, followed by Zn at pH 8 and Cd at pH 8. The optimum biomass dry weight yield by T. viride amended with Zn,Pb and Cd was obtained at pH 6 for the three heavy metals with the maximum value at Zn. The highest yield of biomass dry weight was found when T. viride treated with Cd at all different pH values followed by Pb whilst Zn output was the lowest and this result was reversed in case of S. delica. The maximum removal efficiency and the biomass dry weight production for the three tested heavy metals was obtained at the incubation temperature 20degrees C in case of S. delica while it was 25degrees C for T. viride. Incubation of T. viride at higher temperatures (30degrees C and 35degrees C) enhanced the removal efficiency of Pb and Cd than low temperatures (15degrees C and 20degrees C) and vice versa in case of Zn removal. At all tested incubation temperatures, the maximum yield of biomass dry weight was attained at Zn treatment by the two tested fungal species. The bioaccumulation potency of S. delica for Zn was higher than that for Pb at all temperature degrees of incubation and Cd bioaccumulation was the lowest whereas T. viride showed the highest removal efficiency for Pb followed by Cd and Zn was the minor of the heavy metals.
Biomass ; Egypt ; Fungi ; Hydrogen-Ion Concentration* ; Metals, Heavy* ; Protons ; Saprolegnia* ; Trichoderma*

Despite evidence showing that structured rehabilitation after stroke improves functional outcomes, providing seamless rehabilitation from hospital to community has been elusive. The service provided should be able to accommodate variable degree of impairments and needs of the stroke survivors. This study aimed to assess the outcome of a multidisciplinary-based outpatient rehabilitation service for stroke patients living in the community. Patients who were discharged from Universiti Kebangsaan Malaysia Medical Centre after an acute stroke were referred to the Combined Stroke Rehabilitation Clinic (CSRC). Post stroke patients were assigned individually designed programs which were problem based and used task specific activities to achieve desired goals. Patients were reviewed on a regular basis either up to completion of the 2 year-program, or are able to be discharged to the community, whichever is earlier. Modified Barthel Index (MBI) and Berg Balance Scores (BBS) were used for monitoring. A total of 68 patients were managed in CSRC for two years since its initiation, with mean age of 62.4 years (SD 12.4) with the mean duration of stroke when first reviewed in CSRC was 11.5 months (SD 11.9). Majority of patients (64.7%) received either two or three types of intervention. Both MBI and BBS demonstrated significant improvement over 12-months period (p value of 0.006 and 0.017 respectively). CSRC proved that structured rehabilitation intervention was beneficial in terms of functional status and improvement in balance to post-stroke patients.

Background: MDM2 and p53 are involved in a negative feedback loop where p53 regulates MDM2 at the transcriptional level. MDM2, in turn, downregulates p53. This co-ordinated interaction between these proteins is set to play an important role in the regulation of cell cycle progression following DNA damage to cells. The over-expression of both p53 and MDM2 has been reported in various cancers. However there are only few studies discussing the co-expression of MDM2 with p53 in oral squamous cell carcinoma Aim: The purpose of this study was to determine the correlation of co-expression of p53, MDM2, and Ki-67 proteins with clinico-pathological factors in oral squamous cell carcinoma (OSCC) and to conduct a systematic review of the co-expression of p53/MDM2. Method: This is a retrospective descriptive study and a systematic review. Formalin-fixed paraff inembedded tissues from 45 OSCC cases were stained by immunohistochemistry (IHC) for p53, MDM2, and Ki-67 proteins. Results: Immuno-reactivity for p53, MDM2, and Ki-67 was seen in 75.6%, 97.8%, and 62.2% cases of OSCC respectively. The co-expression of p53 and MDM2 (p53/MDM2) was detected in 97.1%, however there was no signif icant correlation between p53 and MDM2 expression. Notably, p53/MDM2 coexpression was significantly associated with tumour differentiation (p-value = 0.045). The Ki-67LI was not signif icantly associated with neither MDM2 nor p53/MDM2 co-expression (p-value = 0.268, 0.916 respectively). Conclusion: The expression of MDM2 was not signif icantly associated with p53 expression suggesting that MDM2 expression is mediated by p53-independent pathways or mutated p53 could not induce the expression of MDM2 in this set of OSCCs. The only clinico-pathological parameter that correlates significantly with co-expression of p53/MDM2 is tumour differentiation where it is suggestive that the co-expression of these 2 proteins is indicative of aggressive tumour behavior.

Managing chronic cough is diagnostically challenging especially in primary care. This case report highlights the difficulties experienced in approaching a case of chronic cough from a primary care perspective. The discussion also involves the clinical significance and treatment dilemma of M. fortuitum chelonae complex that was isolated from the sputum cultures of an elderly woman who presented with chronic cough for more than a year.
Mycobacterium Infections, Nontuberculous ; Mycobacterium fortuitum ; Primary Health Care

Background: Positron Emission Tomography and Computed Tomography (PET-CT) imaging is shown to influence a decision change in managing non-small cell lung carcinoma (NSCLC). The introduction of such a facility in Malaysia is relatively recent, and its impact from its utility is currently being assessed. Aim: In a tertiary referral centre possessing the only PET-CT facility in northern Peninsular Malaysia, we evaluated the potential roles of PET-CT in referred patients with non-small cell lung carcinoma. Methodology: Sixty eligible adult cases with NSCLC, between September 2005 and December 2007, were retrospectively reviewed. Relevant data was collected using standard questionnaire for indications, staging of disease, and outcomes in terms of recurrence and response to prescribed cancer-specific therapy. Results: The indications for PET-CT were: staging of a newly diagnosed non-small cell lung carcinoma (25.0%); post-operative restaging (21.7%); exclusion of recurrence or metastasis (18.3%); establishing diagnosis of carcinoma (13.3%); assessment of response to treatment (11.7%), and for surveillance (10.0%). The use of PET-CT was shown to induce a change in the staging, compared with non-PET conventional means in 69.2% of patients with newly diagnosed lung carcinoma (upstaged in 55.5%; downstaged in 44.5%) and in 65.0% of patients who underwent cancer-specific treatments (upstaged in 38.5%; downstaged in 61.5%). PET-CT detected recurrence in 62.5% who underwent the imaging to exclude a recurrence or metastasis. Conclusion: PET-CT has affected the staging of a large proportion of our local Malaysian patients. Like elsewhere, the availability of such a facility is likely to have important influence in overall management of NSCLC in Malaysia.