Intraoral low-temperature degradation of monolithic zirconia dental prostheses: 5-year results of a prospective clinical study with ex vivo monitoring

OBJECTIVES

To investigate the 5-year intraoral evolution and kinetics of low-temperature degradation (LTD) of second-generation monolithic prostheses made of 3% molar yttrium-doped tetragonal zirconia polycrystal (3Y-TZP) and the influence of masticatory mechanical stresses and glaze layer on this evolution.

METHODS

A total of 101 posterior tooth elements were included in this prospective clinical study, which comprised ex vivo LTD monitoring (at baseline, 6 months, 1 year, 2 years, 3 years, and 5 years) using Raman spectroscopy (n = 2640 monoclinic phase measurement points per evaluation time) and scanning electron microscopy (SEM). Four types of areas (1-2 mm2 surface, six on molars, and four on premolars) were analysed on each element surface: occlusal, axial, glazed, or unglazed. Raman mapping, high-resolution SEM, and focused ion beam-SEM were performed on selected samples.

RESULTS

The dental prostheses developed a tetragonal-to-monoclinic transformation at the extreme surface of the material after six months in a buccal environment, and this process increased significantly over time. Over the five years of monitoring, the transformation developed nonuniformly with the presence of localised clusters of monoclinic grains. Tribological stresses generate grain pull-out from these clusters, which may raise questions regarding the release of 3Y-TZP nanoparticles into the body. The prosthesis fracture rate was 4.5% after 5 years.

SIGNIFICANCE

LTD developed in vivo on the surfaces of 3Y-TZP dental prostheses and progressed slowly but significantly over time, up to 5 years investigation. However, the effects of aging on the failure rate recorded and of zirconia nanoparticles released into the body require further investigation.

Intraoral low-temperature degradation of monolithic zirconia dental prostheses: Results of a prospective clinical study with ex vivo monitoring

OBJECTIVE

To investigate the intraoral development and kinetics of low-temperature degradation (LTD) in second-generation 3 mol.% yttria-doped tetragonal zirconia polycrystal (3Y-TZP) monolithic prostheses, as well as the influence of masticatory mechanical stress and glaze layer on it.

METHODS

A total of 101 posterior tooth elements were included in a prospective clinical study, which included ex vivo LTD monitoring (at baseline, 6 months, 1 year, and 2 years) using Raman spectroscopy (n = 2640 monoclinic phase measurement points per evaluation time) and SEM. Four types of areas (1-2 mm² surface, 6 on molars, and 4 on premolars) were analyzed on each element surface: occlusal, axial, glazed, or unglazed. Raman depth mapping and high-resolution SEM were performed on the selected samples.

RESULTS

LTD developed in 3Y-TZP monolithic restorations 6 months after intraoral placement and progressed with time. After two years, the tetragonal-to-monoclinic transformation was non-uniform, with the presence of localized clusters of transformed grains. In axial areas, the grain aspect was typical of the classical nucleation-growth process reported for LTD, which progresses from the surface to a depth of several tens of microns. However, in occlusal areas, tribological stress generated surface crushing and grain pull-out from the clusters, which induced an underestimation of the aging process when the evaluation was limited to monoclinic phase quantification. Glazing cannot be considered a protection against LTD.

SIGNIFICANCE

If LTD occurs in dental prostheses in the same way as in orthopedic prostheses, its clinical impact is unknown and needs to be further studied.

Intrinsic properties of osteomalacia bone evaluated by nanoindentation and FTIRM analysis

Osteomalacia is a pathological bone condition consisting in a deficient primary mineralization of the matrix, leading to an accumulation of osteoid tissue and reduced bone mechanical strength. The amounts, properties and organization of bone constituents at tissue level, are known to influence its mechanical properties. It is then important to investigate the relationship between mechanical behavior and tissue composition at this scale in order to provide a better understanding of bone fragility mechanisms associates with this pathology. Our purpose was to analyze the links between ultra-structural properties and the mechanical behavior of this pathological bone tissue (osteomalacia) at tissue level (mineral and osteoid separately, or global). Four bone biopsies were taken from patients with osteomalacia, and subsequently embedded, sectioned, and polished. Then nanoindentation tests were performed to determine local elastic modulus E, contact hardness Hc and true hardness H for both mineralized and organic bone phases and for the global bone. The creep of the bone was also studied using a special indentation procedure in order to assess visco-elasto-plastic (creep) bone behavior. This allowed a detailed study of the rheological models adapted to the bone and to calculate the parameters associated to a Burgers model. Ultra-structural parameters were measured by Fourier Transform InfraRed Microspectroscopy (FTIRM) on the same position as the indents. The use of rheological models confirmed a significant contribution from the organic phase on the viscous character of bone tissue. The elastic E and the elasto-plastic H_c deformation were correlated to both collagen maturity and Mineral/Matrix. The pure plastic deformation H was only correlated to the mineral phase. Our data show that mineral phase greatly affects mechanical variables (moduli and viscosities) and that organic phase (as illustrated in osteoid tissue) may play an important role in the creep behavior of bone. In conclusion, this study brings mechanical and physicochemical values for osteoid and mineral phases.

Survival and breeding interval of an endangered marine vertebrate, the leatherback turtle Dermochelys coriacea, in French Guiana

In the context of global change, endangered species such as sea turtles undergo strong population dynamics changes. Understanding demographic processes inducing such changes is critical for developing appropriate measures for conservation and management. Nesting females of the French Guiana population of leatherback sea turtles Dermochelys coriacea represented 40% of the world’s total in 2001; today, they represent only 10%. Here, we analyze data from the long-term monitoring program of leatherbacks in French Guiana, based on 28 yr of capture-mark-recapture data from 46051 individuals in northwestern French Guiana. We used multievent models (multistate capture-recapture models with state uncertainty) to represent the main peculiarity of the life cycle, intermittent reproduction, and to take advantage of the use of several different types of marks to account for mark loss and incomplete detection. The average annual adult survival probability (mean ± SE) 0.789 ± 0.009 is low compared to published estimates for this species. By combining the estimates of departure and return probabilities, we provide an estimate of the interval among laying seasons equal to 2.777 ± 0.118 yr, which matches previous findings. Taking survival into account, this interval translates into an average of 1.704 ± 0.034 further reproductive seasons for an adult female having just bred, which is remarkably low compared to other long-lived vertebrates. The representation of the life cycle and mark loss in our models provides a sound structure for broader and richer analyses to extract biological information from marked individuals and offers an invaluable source of demographic information on leatherbacks, a species for which only a small segment of the population is accessible to intermittent sampling.

Search for γ-Ray Line Signals from Dark Matter Annihilations in the Inner Galactic Halo from 10 Years of Observations with H.E.S.S

Spectral lines are among the most powerful signatures for dark matter (DM) annihilation searches in very-high-energy γ rays. The central region of the Milky Way halo is one of the most promising targets given its large amount of DM and proximity to Earth. We report on a search for a monoenergetic spectral line from self-annihilations of DM particles in the energy range from 300 GeV to 70 TeV using a two-dimensional maximum likelihood method taking advantage of both the spectral and spatial features of the signal versus background. The analysis makes use of Galactic center observations accumulated over ten years (2004-2014) with the H.E.S.S. array of ground-based Cherenkov telescopes. No significant γ-ray excess above the background is found. We derive upper limits on the annihilation cross section ⟨σv⟩ for monoenergetic DM lines at the level of 4×10^{-28}  cm^{3} s^{-1} at 1 TeV, assuming an Einasto DM profile for the Milky Way halo. For a DM mass of 1 TeV, they improve over the previous ones by a factor of 6. The present constraints are the strongest obtained so far for DM particles in the mass range 300 GeV-70 TeV. Ground-based γ-ray observations have reached sufficient sensitivity to explore relevant velocity-averaged cross sections for DM annihilation into two γ-ray photons at the level expected from the thermal relic density for TeV DM particles.

Aging resistance, mechanical properties and translucency of different yttria-stabilized zirconia ceramics for monolithic dental crown applications

OBJECTIVES

The dental market moves towards high-translucency monolithic zirconia dental crowns, which are usually placed either with - or without - a thin glaze layer. The microstructural features and the mechanical performances of these materials are still controversial, as well as their susceptibility to aging. This paper aims at studying these aspects in the current generation of zirconia dental crowns showing different degrees of translucency.

METHODS

Four different commercial zirconia materials were investigated, including one standard 'full-strength' 3Y-TZP and three grades with improved translucency. The microstructural features (phase composition and assemblage, grain size) were carefully studied, as well as mechanical properties (biaxial bending strength and indentation toughness), translucency and aging behavior (in autoclave at 134°C). Aging was conducted on crowns with and without glaze to better represent clinical uses.

RESULTS

Important differences are found in terms of microstructures among the materials in terms of cubic phase content and yttria in the tetragonal phase, leading to different optical, mechanical and aging resistance properties. We show that higher cubic phase content leads to better translucency and stability in water steam, but at the expense of strength and toughness. A compromise is always inevitable between translucency and aging resistance on one side and mechanical properties on the other side.

SIGNIFICANCE

Sub-surface assessment of hydrothermal ageing in zirconia-containing femoral heads for hip joint applications

Zirconia-based materials have been used in orthopaedics since the 1980s, with large success, mainly thanks to transformation toughening. On the other hand, their main drawback is their potential sensitivity to hydrothermal ageing, i.e. tetragonal to monoclinic phase transformation on their surface in the presence of water. Hydrothermal ageing may result in roughness increase and microcracking of the surface. In this article the hydrothermal ageing behaviour of three medical-grade zirconia-based materials is assessed at high temperature and extrapolated to room or body temperature. The degradation is also characterized by FIB/SEM nano-tomography to better assess sub-surface evolutions. In both zirconia and alumina-toughened zirconia (ATZ), ageing results in the presence of a homogenous transformed layer of constant thickness whose growth rate is about 8 times slower in ATZ than in zirconia. Microcracking occurs in the entire transformed layer in zirconia, but was much less relevant in ATZ. Zirconia-toughened alumina (ZTA) is much less prone to ageing. In ZTA ageing results in a thin transformed layer in which the monoclinic fraction decreases with depth. No microcracking was observed in ZTA.

STATEMENT OF SIGNIFICANCE

This article details the microstructural evolution of the surface of three zirconia-based ceramics when exposed to water (hydrothermal ageing), and establishes a time-temperature equivalences of these evolutions. It shows that different zirconia-alumina composites do not degrade the same way: zirconia and alumina-toughened zirconia present a homogeneous degraded zone of constant thickness, whereas zirconia-toughened-alumina presents a gradient of transformation. These new findings will help understanding better the hydrothermal degradation of zirconia based materials, and in particular will facilitate a better prediction of the durability of zirconia-based devices such as orthopaedic implants and dental devices (implants, crowns, abutments…).

Grain-Boundary Engineering for Aging and Slow-Crack-Growth Resistant Zirconia

Ceramic materials are prone to slow crack growth, resulting in strength degradation over time. Although yttria-stabilized zirconia (Y-TZP) ceramics have higher crack resistance than other dental ceramics, their aging susceptibility threatens their long-term performance in aqueous environments such as the oral cavity. Unfortunately, increasing the aging resistance of Y-TZP ceramics normally reduces their crack resistance. Our recently conducted systematic study of doping 3Y-TZP with various trivalent cations revealed that lanthanum oxide (La₂O₃) and aluminum oxide (Al₂O₃) have the most potent effect to retard the aging kinetics of 3Y-TZP. In this study, the crack-propagation behavior of La₂O₃ and Al₂O₃ co-doped 3Y-TZP ceramics was investigated by double-torsion methods. The grain boundaries were examined using scanning transmission electron microscopy and energy-dispersive spectroscopy (STEM-EDS). Correlating these analytic data with hydrothermal aging studies using different doping systems, a strategy to strongly bind the segregated dopant cations with the oxygen vacancies at the zirconia-grain boundary was found to improve effectively the aging resistance of Y-TZP ceramics without affecting the resistance to crack propagation.

H.E.S.S. Limits on Linelike Dark Matter Signatures in the 100 GeV to 2 TeV Energy Range Close to the Galactic Center

A search for dark matter linelike signals iss performed in the vicinity of the Galactic Center by the H.E.S.S. experiment on observational data taken in 2014. An unbinned likelihood analysis iss developed to improve the sensitivity to linelike signals. The upgraded analysis along with newer data extend the energy coverage of the previous measurement down to 100 GeV. The 18 h of data collected with the H.E.S.S. array allow one to rule out at 95% C.L. the presence of a 130 GeV line (at l=-1.5°, b=0° and for a dark matter profile centered at this location) previously reported in Fermi-LAT data. This new analysis overlaps significantly in energy with previous Fermi-LAT and H.E.S.S.

RESULTS

No significant excess associated with dark matter annihilations was found in the energy range of 100 GeV to 2 TeV and upper limits on the gamma-ray flux and the velocity weighted annihilation cross section are derived adopting an Einasto dark matter halo profile. Expected limits for present and future large statistics H.E.S.S. observations are also given.

Search for Dark Matter Annihilations towards the Inner Galactic Halo from 10 Years of Observations with H.E.S.S

The inner region of the Milky Way halo harbors a large amount of dark matter (DM). Given its proximity, it is one of the most promising targets to look for DM. We report on a search for the annihilations of DM particles using γ-ray observations towards the inner 300 pc of the Milky Way, with the H.E.S.S. array of ground-based Cherenkov telescopes. The analysis is based on a 2D maximum likelihood method using Galactic Center (GC) data accumulated by H.E.S.S. over the last 10 years (2004-2014), and does not show any significant γ-ray signal above background. Assuming Einasto and Navarro-Frenk-White DM density profiles at the GC, we derive upper limits on the annihilation cross section ⟨σv⟩. These constraints are the strongest obtained so far in the TeV DM mass range and improve upon previous limits by a factor 5. For the Einasto profile, the constraints reach ⟨σv⟩ values of 6×10^{-26}  cm^{3} s^{-1} in the W^{+}W^{-} channel for a DM particle mass of 1.5 TeV, and 2×10^{-26}  cm^{3} s^{-1} in the τ^{+}τ^{-} channel for a 1 TeV mass. For the first time, ground-based γ-ray observations have reached sufficient sensitivity to probe ⟨σv⟩ values expected from the thermal relic density for TeV DM particles.

CAPECO: Cost evaluation of community acquired pneumonia managed in primary care

BACKGROUND

Estimating the economic burden of community acquired pneumonia (CAP) managed in ambulatory setting is needed in France since no data are available.

METHOD

A retrospective study (CAPECO) was conducted based on a prospective French study describing patients with suspected CAP managed in primary care (CAPA). The aim of the CAPECO study was to estimate and explain medical costs of a disease episode in CAP patients only followed in ambulatory care and in hospitalised patients. Primary endpoints were the direct medical costs, impact on productivity and costs of incident CAP over one year. Secondary endpoint was to describe predictive factors of costs, hospital admission and stay length.

RESULTS

In this cohort of 886 patients, resulting in an incidence of CAP of 400 per 100,000 inhabitants per year, the mean direct medical cost of a disease episode of CAP was € 118.8 for strictly ambulatory patients with an equal weight for medical time, drugs, diagnostic procedures and tests. This direct cost was € 102.1 before admission for patients who were finally hospitalised. The mean cost of hospital admissions was € 3522.9. Main predictive factors of hospital admission and stay length were respectively a history of chronic respiratory disease and older age. Factors of direct medical cost were prescribing X-ray examination and having a positive X-ray. The impact of a disease episode on productivity was € 1980 (sd 1400) per ambulatory episode and € 5425 (sd 4760) per episode leading to hospital admission.

CONCLUSION

Costs per ambulatory episode were modest but increased substantially in hospitalised patients, who were more numerous when chronic respiratory disorders were present and in the elderly. Indirect costs were significant. Deciders should thus consider both direct and indirect costs when assessing preventive interventions in the context of this disease.

[Epileptic seizures and hematemesis in a young patient with sickle cell disease]

INTRODUCTION

Sickle cell disease is a multi-faceted disease, which can affect all organs. Here, we report the case of a young woman whose clinical presentation was confusing.

CASE REPORT

An 18-year-old patient from Martinique in Caribbean area presented to the emergency room with widespread pain, as part of a vaso-occlusive crisis. She reported being followed for SS sickle cell anemia, with a history of vaso-occlusive crises and exchange transfusions in the past. Her hemoglobin rate was 83g/L. She was treated with opioid analgesics. Then, she presented several generalized tonic-clonic seizures and major episodes of hematemesis, which proved to be simulated by the patient, whose hemoglobin electrophoresis result was finally AS.

CONCLUSION

This patient had therefore the Münchausen syndrome, mimicking sickle cell anemia, like eight other cases reported in the literature.

Natural extracts stimulate membrane-associated mechanisms of resistance in Gram-negative bacteria

Several mechanisms are involved in the bacterial resistance towards antimicrobial agents. The membrane-associated mechanisms of resistance were studied in Escherichia coli strains after incubation with Thymus maroccanus essential oil, its major components (carvacrol and thymol) or with certain antibiotics. The minimum inhibitory concentration (MIC) and the expression of membrane proteins, porins and efflux pumps were determined in wild type and derivative strains. Derivative strains adapted to different compounds displayed a high level of resistance to all tested antibiotics. The MIC increase is associated with an overexpression of an efflux pump immunorelated to AcrAB-TolC in various variants. Interestingly, the expression of outer membrane proteins slightly decreases in these strains. We demonstrate that the increase in antibiotic resistance correlates with membrane changes observed in the variants. This type of bacterial adaptation to natural compounds can occur in vivo providing the emergence/selection of bacteria less susceptible to clinically used antibiotics.

SIGNIFICANCE AND IMPACT OF THE STUDY

Thymus maroccanus essential oil and some major components are able to select variants that modify the expression of transporters involved in the influx (porins) and in the efflux (AcrAB family) of various drugs. Importantly, these membrane proteins are involved in the transport of natural compounds and several antibiotic families. This special 'membrane adaptation' can explain the persistence of less susceptible/tolerant bacteria in the environment where natural compounds are present and the continuous stimulation of efflux systems in these bacteria.

Combining ageing and wear to assess the durability of zirconia-based ceramic heads for total hip arthroplasty

The degradation of zirconia-based ceramic components for total hip arthroplasty (head and cup) has been the topic of many works. However, the correlation between what is measured in vivo and what is expected from in vitro simulations on hip simulators may be sometimes feeble, especially where zirconia component are concerned, mainly due to a lack of representativeness of in vitro experiments. The present study seeks to explore the combined effects of hydrothermal ageing and wear on zirconia components. It shows that hydrothermal ageing increases the roughness of zirconia components, which in turn might increase the wear rate of the polyethylene counterparts. Moreover, the friction during hip simulation increases the ageing rate of the zirconia components. This auto-accelerating degradation may explain some of the poor long-term in vivo results of zirconia hip prostheses reported in the literature. Finally, it is shown that zirconia-toughened alumina components may be free from this combined degradation.

Quantification of the pathological response and fate in the lung and pleura of chrysotile in combination with fine particles compared to amosite-asbestos following short-term inhalation exposure

The marked difference in biopersistence and pathological response between chrysotile and amphibole asbestos has been well documented. This study is unique in that it has examined a commercial chrysotile product that was used as a joint compound. The pathological response was quantified in the lung and translocation of fibers to and pathological response in the pleural cavity determined. This paper presents the final results from the study. Rats were exposed by inhalation 6 h/day for 5 days to a well-defined fiber aerosol. Subgroups were examined through 1 year. The translocation to and pathological response in the pleura was examined by scanning electron microscopy and confocal microscopy (CM) using noninvasive methods.The number and size of fibers was quantified using transmission electron microscopy and CM. This is the first study to use such techniques to characterize fiber translocation to and the response of the pleural cavity. Amosite fibers were found to remain partly or fully imbedded in the interstitial space through 1 year and quickly produced granulomas (0 days) and interstitial fibrosis (28 days). Amosite fibers were observed penetrating the visceral pleural wall and were found on the parietal pleural within 7 days postexposure with a concomitant inflammatory response seen by 14 days. Pleural fibrin deposition, fibrosis, and adhesions were observed, similar to that reported in humans in response to amphibole asbestos. No cellular or inflammatory response was observed in the lung or the pleural cavity in response to the chrysotile and sanded particles (CSP) exposure. These results provide confirmation of the important differences between CSP and amphibole asbestos.

n-3 polyunsaturated fatty acids in the maternal diet modify the postnatal development of nervous regulation of intestinal permeability in piglets

The intestinal epithelial barrier (IEB) plays a key role in the maintenance of gut homeostasis and the development of the immune system in newborns. The enteric nervous system (ENS), a key regulator of gastrointestinal functions, has been shown to be modulated by nutritional factors. However, it remains currently unknown whether maternal diet, in particular n-3 polyunsaturated fatty acids (n-3PUFAs), can impact upon the IEB in newborn piglets and whether the ENS is involved in this effect. Sows received either a control diet (lard based) or an n-3PUFA diet (linseed oil based) during gestation and lactation. Intestinal paracellular permeability was assessed in Ussing chambers on piglets at birth, 3, 7, 14, 21 and 28 postnatal days (PND). Basal jejunal permeability increased significantly and similarly in both groups until PND14 and decreased thereafter. However, at PND28, permeability was higher in n-3PUFA animals as compared to controls. In addition, a vasoactive intestinal peptide (VIP) receptor antagonist increased paracellular permeability in controls but not in n-3PUFA piglets. Conversely, atropine and hexamethonium decreased paracellular permeability in the n-3PUFA group but not in the control group. Moreover, the n-3PUFA diet increased the proportion of choline acetyltransferase (ChAT)-immunoreactive (IR) neurons and decreased the proportion of VIP-IR neurons in the submucosal plexus of piglet jejunum compared to controls. In addition, in primary culture of rat ENS, we showed that 20:5n-3 but not 18:3n-3 increased the proportion of ChAT-IR neurons and decreased the proportion of VIP-IR neurons. In conclusion, supplementation of the maternal diet with n-3PUFAs modified intestinal permeability probably via diet-induced neuroplastic changes in the ENS of newborn piglets.

The pathological response and fate in the lung and pleura of chrysotile in combination with fine particles compared to amosite asbestos following short-term inhalation exposure: interim results

The pathological response and translocation of a commercial chrysotile product similar to that which was used through the mid-1970s in a joint compound intended for sealing the interface between adjacent wall boards was evaluated in comparison to amosite asbestos. This study was unique in that it presents a combined real-world exposure and was the first study to investigate whether there were differences between chrysotile and amosite asbestos fibers in time course, size distribution, and pathological response in the pleural cavity. Rats were exposed by inhalation 6 h/day for 5 days to either sanded joint compound consisting of both chrysotile fibers and sanded joint compound particles (CSP) or amosite asbestos. Subgroups were examined through 1-year postexposure. No pathological response was observed at any time point in the CSP-exposure group. The long chrysotile fibers (L > 20 microm) cleared rapidly (T(1/2) of 4.5 days) and were not observed in the pleural cavity. In contrast, a rapid inflammatory response occurred in the lung following exposure to amosite resulting in Wagner grade 4 interstitial fibrosis within 28 days. Long amosite fibers had a T(1/2) > 1000 days and were observed in the pleural cavity within 7 days postexposure. By 90 days the long amosite fibers were associated with a marked inflammatory response on the parietal pleural. This study provides support that CSP following inhalation would not initiate an inflammatory response in the lung, and that the chrysotile fibers present do not migrate to, or cause an inflammatory response in the pleural cavity, the site of mesothelioma formation.

A new concept of gentamicin loaded HAP/TCP bone substitute for prophylactic action: in vivo pharmacokinetic study

Despite systemic prophylaxis, infection rates after orthopedic surgery can reach more than 1%. A new HAP/TCP bone substitute loaded with 125 mg of gentamicin was designed for prophylactic use. Its aim was to enhance the efficacy of systemic prophylactic treatments by increasing the local antibiotic concentration. The release rate of gentamicin from the bone substitute was investigated after implantation in the femoral condyle of five sheep. In order to investigate the local and systemic gentamicin concentrations, synovial fluids and blood samples were assessed over a 5-day period. The mean gentamicin concentration peak in blood was 4.2 μg/ml and the mean local concentration in synovial fluids during the first 8 h was 305 μg/ml. After 48 h, the concentrations in blood and synovial fluids were less than 0.5 μg/ml. No remaining gentamicin was detected in bone substitutes explanted after 8 days of implantation. The gentamicin release rate from the bone substitutes assessed corresponds to the recommendations for the prophylactic use of antibiotics: high local concentration but limited in time (less than 48 h) not to select antibiotic-resistant bacterial strains. Our results indicated that this implant should be an effective prophylactic tool in orthopedic surgery in combination with systemic prophylaxis.

Abstract P4-10-13: Therapeutic Delays, Mode of Diagnosis and Surgical Treatment of Operable Invasive Breast Cancer (BC) in Elderly Versus Non Elderly Patients in the Community

Background: National mammography screening program covers populations aged 50-74. We wondered whether breast cancer characteristics and treatment delays were influenced by age and screening method in a community-based breast unit.

Patients and Methods: We analyzed complete data of prospectively recorded community operable breast cancer cases in a single regional cancer center between Jan 1st, 2005 and Oct 10th, 2007. Pts were eligible if they i. had a final diagnosis of invasive BC ii. were operated as first trt for BC, iii. had no history of other previous malignancy within the past 5 year period. Logistic regression analyses (SAS) were used to determine factors influencing delays between first description of the lesion and first appointment at breast unit.

Results: 1044 pts met the inclusion criteria and had full data available. Age did not appear as a predictor of therapeutic delay, with both elderly and non-elderly pts having a median delay of 19 days between first screening/evidence of disease and 1st appointment at the breast unit. 59% of elderly and 65% of non-elderly pts had respectively had their breast cancer diagnosed through mammographic screening. As expected, mammographic screening as mode of discovery of the cancer was highest, among the 688 pts aged 50-74 (73%). Tumors characteristics and surgical treatment did not differ according to age categories elderly/non elderly as described in Table 1. Conservation rates were high in both populations.

Conclusion: Despite absence of national mammographic screening program in elderly populations, patterns of screening and care appear efficient in a community-based setting, with absence of therapeutic delays, similar tumor staging and similar accesss to conservative surgery as compared to younger populations.

Evaluation of a new press-fit in situ setting composite porous scaffold for cancellous bone repair: towards a "surgeon-friendly" bone filler?

In this study, a composite porous material obtained by coating a poly(ester urethane) foam with a calcium phosphate cement is proposed as novel cancellous bone filler with easy handling, in situ hardening and press-fitting properties. The coating can be applied to the foam in the surgical theater, allowing refinement of scaffold shape to the needs of the ongoing surgery. An innovative experiment was developed in order to determine the setting curve of the composite scaffold as well as the time of manipulation available to the surgeon without risk of material damage. This composite material is soft and can be press-fit in a cavity without damaging the scaffold in the first 5 min after coating application. The composite scaffold hardens quickly (22 min) and, once the cement has set, its compressive strength and fracture energy are increased by over an order of magnitude as compared to the initial poly(ester urethane) foam. This set of interesting properties makes calcium phosphate cement-coated elastomeric scaffolds a new promising strategy for cancellous bone filling.

Physiological characterisation of the efflux pump system of antibiotic-susceptible and multidrug-resistant Enterobacter aerogenes

Enterobacter aerogenes predominates amongst Enterobacteriaceae species that are increasingly reported as producers of extended-spectrum beta-lactamases. Although this mechanism of resistance to beta-lactams is important, other mechanisms bestowing a multidrug-resistant (MDR) phenotype in this species are now well documented. Amongst these mechanisms is the overexpression of efflux pumps that extrude structurally unrelated antibiotics prior to their reaching their targets. Interestingly, although knowledge of the genetic background behind efflux pumps is rapidly advancing, few studies assess the physiological nature of the overall efflux pump system of this, or for that matter any other, bacterium. The study reported here evaluates physiologically the efflux pump system of an E. aerogenes ATCC reference as well as two strains whose MDR phenotypes are mediated by overexpressed efflux pumps. The activities of the efflux pumps in these strains are modulated by pH and glucose, although the effects of the latter are essentially restricted to pH 8, suggesting the presence of two general efflux pump systems, i.e. proton-motive force-dependent and ABC transporter types, respectively.

Structure and rheology of SiO2 nanoparticle suspensions under very high shear rates

High shear rate experiments have been performed with capillary microviscometers onto SiO2 nanoparticles dispersed in alcohol (so-called nanofluids). The aim of these experiments was to investigate the processes of aggregation and dislocation of the nanoparticles in a shear flow under perikinetic and orthokinetic conditions. Shear rates as high as 2x10(5) s-1 were obtained in pressure-driven microchannels laminar flows. All the nanofluids under test have displayed a Newtonian behavior but with a strong enhanced viscosity, that is, the consequence of an effective volume concentration higher than the real one. It was possible to determine the average size of the aggregates and to find a correlation between their structure and the range of the hydrodynamic Peclet number at which experiments were performed. These results display a strong evidence of the role of aggregates and support the recent conclusions about the controversy of the thermal properties of nanofluids.

ATP-dependent paracrine communication between enteric neurons and glia in a primary cell culture derived from embryonic mice

The importance of dynamic interactions between glia and neurons is increasingly recognized, both in the central and enteric nervous system. However, apart from their protective role, little is known about enteric neuro-glia interaction. The aim was to investigate neuro-glia intercellular communication in a mouse culture model using optical techniques. Complete embryonic (E13) guts were enzymatically dissociated, seeded on coverslips and studied with immunohistochemistry and Ca(2+)-imaging. Putative progenitor-like cells (expressing both PGP9.5 and S-100) differentiated over approximately 5 days into glia or neurons expressing typical cell-specific markers. The glia-neuron ratio could be manipulated by specific supplements (N2, G5). Neurons and glia were functionally identified both by their Ca(2+)-response to either depolarization (high K(+)) or lysophosphatidic acid and by the expression of typical markers. Neurons responded to ACh, DMPP, 5-HT, ATP and electrical stimulation, while glia responded to ATP and ADPbetas. Inhibition of glial responses by MRS2179 suggests involvement of P2Y1 receptors. Neuronal stimulation also caused delayed glial responses, which were reduced by suramin and by exogenous apyrases that catalyse nucleotide breakdown. Conversely, glial responses were enhanced by ARL-67156, an ecto-ATPase inhibitor. In this mouse enteric co-culture, functional glia and neurons can be easily monitored using optical techniques. Glial cells can be activated directly by ATP or ADPbetas. Activation of neuronal cells (DMPP, K(+)) causes secondary responses in glial cells, which can be modulated by tuning ATP and ADP breakdown. This strongly supports the involvement of paracrine purinergic communication between enteric neurons and glia.

Determinants of therapeutic delays and their impact on axillary node involvement in operable invasive breast cancer (BC) patients (pts)

615

Background: International guidelines recommend rapid diagnostic and therapeutic procedures for suspect breast lesions. However, the impact of the interval between screening and treatment (trt) (STI) on the severity of the disease remains unclear. We explored the potential impact of STI on a surrogate of survival, axillary nodal involvement (N+), among 1,000 recently diagnosed BC pts, as well as the causes of potential delays. Methods: We collected complete data of prospectively recorded community BC cases in a single regional cancer center between January 1, 2005, and October 10, 2007. Pts were eligible if they i. had a final diagnosis of invasive BC ii. were operated as first trt for BC, iii. had no history of other previous malignancy within the past 5 year period. Logistic regression analyses (SAS) were used to determine factors predictive of N+ and those influencing intervals between first description of the lesion and first therapeutic surgery (STI). Candidate factors included socio-economic variables (marital status, occupation, county of living, country of birth), personal and familial medical history parameters, as well as BC characteristics. Results: 990 pts met the inclusion criteria and had full data available. Med age: 59 years, BI-RAD ACR3/4/5: 2/41/55%, med pathological tumor size (pT): 16 mm (2–100), N+: 41%, med delay between first description of the lesion and surgery: 67 days. Factors predicting longer STI were: Birad ACR<5 vs 5 (p = 0.0004), not palpable lesion vs palpable (p = 0.01), microcalcifications vs solid lesion (p = 0.0008), presence of important comorbidities (p=.04), single life vs couple (p = 0.001). However, STI had no effect on N+: med STI was 68 days in N- vs 66 days in N+ pts. Factors predictive of N+ were lymphovascular invasion (LVI) (p=.0001) and pT (p = 0.0001), while age, social conditions, screening mode, per-cutaneous biopsy vs FNAC, grade, HR and HER-2 status, had no effect. Among pts with grade III BC, LVI (p = 0.0001) and pT (p = 0.02) were the sole predictors of N+ as well. Conclusions: This study identifies for the first time factors able to negatively influence STI of women with invasive BC. However, longer STI does not appear to influence axillary nodal invasion, even in pts with high grade BC.

No significant financial relationships to disclose.

Intensive breast cancer screening programs including MRI influence prognosis and treatment of breast cancer among BRCA 1/2 gene mutation carriers

Abstract #5004

Background: Several studies have highlighted the potential benefit of early breast cancer (BC) diagnosis through breast MRI for high risk patients (pts). However, MRI is an expensive test with a low positive predictive value and has not been proven to reduce mortality rates in women carrying BRCA1/2 deleterious gene mutations (mut).&#x2028; At Institut Gustave Roussy, we started intensive BC screening programs for BRCA1/2 carriers (annual MRI + mammogram + bi-annual US) in 2001. The aim of this study was to compare the characteristics and prognostic features of BC in BRCA1/2 pts diagnosed inside or outside screening programs.&#x2028; Patients and Methods: All female BRCA1/2 mut carriers who have been treated for a new BC in our institution between 2001 and 2008, were entered into this study. All BRCA1/2 mut testing have been performed under the French guidelines and recommendations.&#x2028; We compared the clinico-pathological data, treatments and prognostic features between group 1 (pts diagnosed while on an intensive dedicated screening program) and group 2 (pts diagnosed outside these programs). Pts characteristics were compared using student T-test, and survival curves using Log-Rank tests.&#x2028; Results: 122 pts met the inclusion criteria: 20 in group 1, 102 in group 2. &gt; 95% of pts in group 2 were not aware of their BRCA1/2 mut at time of diagnosis. In group 1, 17 cancers were diagnosed primarily through MRI (85%), while 3 were self-detected interval BC. Pts in group 1 had tumors with significantly better prognostic factors and received less CT.&#x2028; 3-year DFS significantly differed between groups 1 (100%) and 2 (74% (IC: 64-81 (p=0.04). 3-years MFS was 100 and 80% (p= 0.08), 3-years OS was 100 and 94% (p=0.26) in groups 1 and 2.&#x2028; &#x2028; Conclusion: These early data strongly suggest an important benefit in terms of disease-free survival and treatment sparing for i. the knowledge of a BRCA1/2 mut; ii. inclusion into intensive BC screening programs including MRI.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5004.

A biopersistence study following exposure to chrysotile asbestos alone or in combination with fine particles

In designing a study to evaluate the inhalation biopersistence of a chrysotile asbestos that was used as a component of a joint-compound, a feasibility study was initiated to evaluate the short-term biopersistence of the chrysotile alone and of the chrysotile in combination with the sanded reformulated joint-compound. Two groups of Wistar rats were exposed to either 7RF3 chrysotile (Group 2) or to 7RF3 chrysotile combined with aerosolized sanded joint-compound (Group 3). In addition, a control group was exposed to filtered-air. The chrysotile used in the Ready Mix joint compound is rapidly removed from the lung. The chrysotile alone exposure group had a clearance half-time of fibers L > 20 microm of 2.2 days; in the chrysotile plus sanded exposure group the clearance half-time of fibers L > 20 microm was 2.8 days. However, across all size ranges there was approximately an order of magnitude decrease in the mean number of fibers remaining in the lungs of Group 3 as compared to Group 2 despite similiar aerosol exposures. Histopathological examination showed that the chrysotile exposed lungs had the same appearance as the filtered-air controls. This study uniquely illustrates that additional concurrent exposure to an aerosol of the sanded joint-compound, with large numbers of fine-particles depositing in the lungs, accelerates the recruitment of macrophages, resulting in a tenfold decrease in the number of fibers remaining in the lung. The increased number of macrophages in the chrysotile/sanded joint exposure group was confirmed histologically, with this being the only exposure-related histological finding reported.

Sintering behaviour of 45S5 bioactive glass

In this study, we report on the effect of Bioglass structural transformations on its sintering behaviour. While heating up to 1000 degrees C, five successive transformations occur: glass transition, glass-in-glass phase separation, two crystallization processes and a second glass transition. The sintering of the material exhibits two main shrinkage stages associated with the two glass transitions at 550 and 850 degrees C. At 580 degrees C, the glass-in-glass phase separation induces a decrease in the sintering rate immediately followed by the major crystalline phase crystallization (Na(2)CaSi(2)O(6)) between 600 and 700 degrees C, from the surface to the bulk of the particles. A complete inhibition of sintering takes place followed by a minor shrinkage effect due to crystallization. A plateau is then observed until the second glass transition temperature is reached. A modification of Frenkel's model allows the determination of the glass-in-glass phase separation kinetics and the identification of the structural transformations effects on sintering behaviour.