scholarly journals PERBEDAAN KEKERASAN PERMUKAAN ENAMEL SETELAH APLIKASI FLUORIDE VARNISH DAN CASEIN PHOSPO PEPTIDE-AMORPHOUS CALSIUM PHOSPHATE FLUORIDE (CPP-ACPF) (PENELITIAN IN VITRO)

2019 ◽  
Vol 7 (2) ◽  
pp. 130
Author(s):  
Sinta Puspita ◽  
Adioro Soetojo ◽  
Sri Kunarti
Keyword(s):  
Tooth Enamel ◽  
Surface Hardness ◽  
Enamel Surface ◽  
Fluoride Varnish ◽  
Initial Surface ◽  
Surface Microhardness ◽  
Demineralized Enamel ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Caries is a chronic, slowly progressing disease, with symptoms not detected at the onset of the disease but generally much later. Its initiation is associated with demineralization (calcium and phosphate loss) of subsurface tooth enamel, resulting in the formation of a subsurface lesion. To restore the natural equilibrium, either remineralization must be enhanced or demineralization must be retarded. There are some topical agents that can enhance remineralization such as topical fluor and casein phosphopeptide – amorphous calcium phosphate (CPP-ACP). Purpose: The aim of this study is to analyze the differences of the enamel surface microhardness after application of fluoride varnish and CPP-ACPF. Methode: 27 blocks bovine enamel were devided into 3 groups. Group 1 – control (No surface treatment), group 2 – fluoride varnish and group 3 – CPP-ACPF. Initial surface hardness enamel was measured for all enamel specimens. Artificial enamel carious lesions were created by immersing enamel samples to demineralization solution (pH 4,5) for 72 hours at temperature 370 C. The surface microhardness of demineralized enamel specimens was measured. A caries progression test (pH cycling) was carried out, which consisted of alternative demineralization (3 hours), remineralization with artificial saliva (21 hours) and application topical agent twice a day for 14 days. Then, the last surface enamel microhardness is measured. Result: Group 3 showed significantly highest Vickers hardness number (P<0,05) followed by group 2 and the lowest is group 1. Conclusions: This study proved that enamel surface microhardness after application of CPP-ACPF was higher than fluoride varnish.

Anticaries Potential of Commercial Dentifrices as Determined by Fluoridation and Remineralization Efficiency

2007 ◽  
Vol 8 (7) ◽  
pp. 1-10 ◽  
Author(s):  
Elias Casals ◽  
Tchilalo Boukpessi ◽  
Christina M. McQueen ◽  
Sandy L. Eversole ◽  
Robert V. Faller
Keyword(s):  
Surface Hardness ◽  
Reference Standard ◽  
Surface Microhardness ◽  
Fluoride Uptake ◽  
Human Enamel ◽  
Demineralized Enamel ◽  
Group 6 ◽  
Group 3 ◽  
Group 2

Abstract Aim The aim of this in vitro study was to investigate fluoride uptake in human enamel after use of commercially available toothpastes containing different fluoride compounds, or combinations of fluoride actives formulated into a single product, as a means of determining the efficiency of each formula for delivering caries preventing fluoride to demineralized (caries active) enamel. Methods and Materials Four test dentifrices and two controls were assessed and placed in groups as follows: Group 1: Lacer® (Spain); Group 2: Positive control-USP Reference Standard 1100 ppm F; Group 3: Fluocaril® Bi-Fluoré 250 (France); Group 4: Colgate Fluor Active (Denmark); Group 5: Elmex® (France); and Group 6: A placebo (formulated the same as the USP Reference Standard toothpaste with the exception that it contained < 1 ppm F). Cores 3 mm in diameter were removed from erupted human enamel specimens (extracted by local oral surgeons for orthodontic reasons) and stored in 1% Thymol solution prior to use. They were ground and polished to remove the natural fluoride rich enamel layer, then exposed to a demineralization solution, and assessed for surface microhardness to enable randomization for use in the study. Each group of five specimens underwent a daily pH cycling procedure that involved exposure to pooled human saliva (refreshed three times daily). The groups were then exposed to dentifrice slurries four times daily for one minute per exposure and to a demineralization solution for three hours. The cycling procedure was repeated for five days. Specimens were again analyzed for surface microhardness and fluoride uptake upon completion of five days of treatment. Results Average surface hardness: Groups 2 and 3 showed a statistically significant greater (p<0.05) change indicating greater remineralization compared to all other groups. The average change was 23.45 for Group 2 and 22.65 for Group 3. All other groups had changes ranging from 4.25-8.62. No other statistically significant differences were observed between groups. Fluoride uptake results: Groups 2 and 3 showed statistically significantly greater fluoride uptake versus all other groups (p <0.05). Groups 1 and 5 were significantly different from Group 6. No other statistically significant differences were observed for either analysis. Conclusions Of the marketed products included in the study, the Fluocaril® Bi-Fluoré 250 product formulation provided both the highest level of fluoride uptake and mineralization to the demineralized enamel. The clinical significance of these in vitro results is the confirmation Fluocaril® Bi-Fluoré 250 is effective at remineralizing enamel caries lesions. Citation Casals E, Boukpessi T, McQueen CM, Eversole SL, Faller RV. Anticaries Potential of Commercial Dentifrices as Determined by Fluoridation and Remineralization Efficiency. J Contemp Dent Pract 2007 November; (8)7:001-010.

scholarly journals The Influence of Post Bleaching Treatments in Stain Absorption and Microhardness

2016 ◽  
Vol 10 (1) ◽  
pp. 69-78 ◽  
Author(s):  
Horieh Moosavi ◽  
Fatemeh Darvishzadeh
Keyword(s):  
Color Change ◽  
Enamel Surface ◽  
Control Group ◽  
Surface Microhardness ◽  
Dental Bleaching ◽  
Tooth Color ◽  
Group 4 ◽  
Group 3 ◽  
Group 2

Objectives: This study investigated the effects of post bleaching treatments to prevent restaining and the change of enamel surface microhardness after dental bleaching in vitro. Methods: Sixty intact human incisor teeth were stained in tea solution and randomly assigned into four groups (n=15). Then samples were bleached for two weeks (8 hours daily) by 15% carbamide peroxide. Tooth color was determined both with a spectrophotometer and visually before bleaching (T1) and immediately after bleaching (T2). Next, it was applied in group 1 fluoride (Naf 2%) gel for 2 minutes, and in group 2 a fractional CO2 laser (10 mJ, 200 Hz, 10 s), and in group 3, nanohydroxyapatite gel for 2 minutes. The bleached teeth in group 4 remained untreated (control group). Then teeth placed in tea solution again. Color examinations were repeated after various post bleaching treatments (T3) and restaining with tea (T4) and color change values recorded. The microhardness was measured at the enamel surface of samples. Data was analyzed using ANOVA, Tukey HSD test and Dunnett T3 (α = 0.05). Results: Directly after bleaching (ΔE T3-T2), the treatment with nanohydroxyapatite showed significantly the least color lapse in colorimetric evaluation. In experimental groups, the color change between T3 and T4 stages (ΔE T4-T3) was significantly lower than control group (P < 0.05). Different methods of enamel treatment caused a significant increase in surface microhardness compared to control group (P < 0.05). Significance: Application of fluoride, fractional CO2 laser and nanohydroxyapatite as post bleaching treatments are suggested for prevention of stain absorption and increasing the hardening of bleached enamel.

scholarly journals Effect of Different Sintering Cycles on the Surface Hardness of Full Contour Monolithic Zirconia – An In Vitro Comparative Study

2021 ◽  
Vol 10 (28) ◽  
pp. 2089-2093
Author(s):  
Sanath Kumar Shetty ◽  
Feba Maria Varghese ◽  
Mohammed Zahid ◽  
Savitha Dandekeri ◽  
Fowzaan Feroz
Keyword(s):  
Surface Hardness ◽  
In Vitro Study ◽  
Group 4 ◽  
Cad Cam ◽  
Monolithic Zirconia ◽  
Group 3 ◽  
Group 2 ◽  
Cycle Group ◽  
Group 1

BACKGROUND This in-vitro study was conducted to compare the effect of different sintering cycles on the surface hardness of full contour monolithic Zirconia. METHODS In this in-vitro study, a total of 28 bar shaped Zirconia samples of final dimensions 20 x 4 x 2 mm were fabricated using Amann Girrbach CAD - CAM unit. These samples were randomly allocated into four groups with 7 samples in each group namely, Group 1, 2, 3 and 4 (Group 1: Long sintering cycle, Group 2: Intermediate sintering cycle, Group 3: Short sintering cycle, Group 4: Ultra-short sintering cycle) and sintered under the respective sintering cycles. The Ceramill® Therm sintering furnace provided 3 sintering cycles ranging from the longest Group - 1 (19 hours), to the short sintering cycle Group - 3 (8 hours), with an intermediate sintering cycle Group - 2 (15hours). The Zircom sintering furnace provided an ultra-short sintering cycle Group - 4 (2 hours). The testing of surface hardness was performed using TECSOL hardness tester. Statistical analysis of the collected data was performed by one - way ANOVA using SPSS software. Multiple comparison was done using post-hoc Tukey’s test. RESULTS One - way ANOVA showed statistically significant difference in the surface hardness of different samples (P < 0.05). The highest mean hardness was observed in Group 3 with 2713.757 + 233.89 VHN, followed by Group 2 with 2595.714 + 62.35 VHN, followed by Group 4 with 2518.600 + 103.65 VHN and Group 1 with the least, 1734.300 + 460.20 VHN. CONCLUSIONS The surface hardness of full contour monolithic Zirconia was influenced to some extent by various sintering cycles. The longest sintering cycle showed the least surface hardness whereas, the short sintering cycle showed the highest surface hardness. Also the ultra-short sintering cycle of 2 hours exhibited surface hardness comparable to the other sintering cycles with longer duration, making it a viable alternative to the conventional sintering cycles. KEY WORDS Monolithic Zirconia, CAD - CAM, Sintering, Hardness

scholarly journals Effect of Three Different Dentifrices on Enamel by Automated Brushing Simulator- In vitro Profilometric Study

2020 ◽  
pp. 1-12
Author(s):  
T. Keerthana ◽  
Sindhu Ramesh
Keyword(s):  
Oral Health ◽  
Dental Plaque ◽  
Enamel Surface ◽  
Group 3 ◽  
Plaque Control ◽  
Group 2 ◽  
Bacterial Plaque ◽  
3D Profilometer ◽  
Group 1

Bacterial plaque control is critical in maintenance of oral health because dental plaque is the primary etiological factor for both caries and periodontal disease. Toothbrush and dentifrices play an integral part in accomplishing plaque removal. The aim of the study was to assess the                enamel surface abrasion caused by three different dentifrices using automated brushing            simulator and profilometer. A total of 24 samples (N=24) which are extracted for orthodontic purposes were divided into three groups based on the dentifrices used. They are Group 1-Colgate Swarnavedsakthi (n=8), Group 2-Dabur Herbal(n=8),Group 3-Ayush(n=8). Samples were  subjected to take pre profilometric readings and brushing was done by an automated brushing simulator. A Laser 3D profilometer was used to detect the wear in the enamel surface.                  Pre and Post profilometric readings were compared. Statistically significant differences (p<0.05) were observed in the values of enamel abrasion among the Group 1(Colgate               Swarnavedsakthi) and Group 3(Ayush). After analysing the profilometric values, significant differences were found among the Ayush group while comparing with other groups such as Colgate Swarnavedsakthi and Dabur herbal. This indicates the higher enamel surface abrasion in the ayush group.

Scanning electron microscopy evaluation of the effect of etching agents on human enamel surface

2006 ◽  
Vol 30 (3) ◽  
pp. 247-250 ◽  
Author(s):  
Caio Zanet ◽  
Victor Arana-Chavez ◽  
Marcelo Fava
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Phosphoric Acid ◽  
Enamel Surface ◽  
Human Enamel ◽  
Group 3 ◽  
Group 2 ◽  
Scanning Electron ◽  
Adhesive Materials ◽  
Group 1

Acid etching promotes microporosities on enamel surface, which provide a better bonding surface to adhesive materials. The purpose of this study was to comparatively analyze the microstructure of enamel surface after etching with 37% phosphoric acid or with two self-etching primers, Non-rinse conditioner (NRC) and Clearfil SE Bond (CSEB) using scanning electron microscopy. Thirty sound premolars were divided into 3 groups with ten teeth each: Group 1: the buccal surface was etched with 37% phosphoric acid for 15 seconds; Group 2: the buccal surface was etched with NRC for 20 seconds; Group 3: the buccal surface was etched with CSEB for 20 seconds. Teeth from Group 1 were rinsed with water; teeth from all groups were air-dried for 15 seconds. After that, all specimens were processed for scanning electron microscopy and analyzed in a Jeol 6100 SEM. The results showed deeper etching when the enamel surface was etched with 37% phosphoric acid, followed by NRC and CSEB. It is concluded that 37% phosphoric acid is still the best agent for a most effective enamel etching.

scholarly journals Influence of Using Different Light Curing Devices on the Microhardness of a Bulk-Fill Resin

2021 ◽  
Vol 22 (3) ◽  
pp. 234-237
Author(s):  
João Marcos Carvalho Silva ◽  
Alina Barreto de Negreiros Ribeiro Silva ◽  
Ayrton de Sá Brandim ◽  
Mila Oliveira Santos Viana
Keyword(s):  
High Power ◽  
Composite Resin ◽  
Physical And Mechanical Properties ◽  
Composite Resins ◽  
Surface Microhardness ◽  
Hardness Tests ◽  
Light Curing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractBulk Fill resins are a class of resin composites widely used today and have low polymerization shrinkage. However, these materials need an appropriate light curing technique to have good physical and mechanical properties. The objective of this study was to evaluate the surface microhardness of Bulk Fill resins after their light-curing with two types of high- power light-curing devices, using three techniques. 30 specimens were made with a nanoparticulate composite resin Opus Bulk Fill (FGM) and were divided into three groups according to the device and intensity of light curing: Group 1 - light curing with the Emitter B device (Schuster); Group 2 - light curing with the Valo device (Ultradent) at Standard power; and Group 3 - light curing with the Valo device at high power. Higher values of top surface microhardness were observed in Group 3 (microhardness = 53.6 μm), followed by Group 2 (microhardness = 52.1 μm) and Group 1 (microhardness = 33.1 μm), with p values <0.05. Therefore, the Valo light curing unit, in the two powers used, provided greater surface microhardness for the studied specimens.Keywords: Polymerization. Composite Resins. Hardness Tests. Dentistry.ResumoResinas Bulk Fill são uma classe de compósitos resinosos bastante utilizados atualmente e apresentam baixa contração de polimerização. Entretanto, esses materiais necessitam de uma adequada técnica de fotopolimerização para que apresentem boas propriedades físicas e mecânicas. O objetivo deste estudo foi avaliar a microdureza superficial de resinas Bulk Fill fotopolimerizadas com dois tipos de aparelhos fotopolimerizadores de alta potência, em três técnicas de utilização. Foram confeccionados 30 corpos de prova com uma resina composta nanoparticulada Opus Bulk Fill (FGM) e divididos em três grupos de acordo com o aparelho e intensidade de fotopolimerização: Grupo 1 – fotopolimerização com o aparelho Emitter B. (Schuster), Grupo 2 – fotopolimerização com o aparelho Valo (Ultradent) na potência Standard, Grupo 3 – fotopolimerização com o aparelho Valo em alta potência, posteriormente foi realizado o teste de microdureza de Vickers na região superficial de topo dos corpos de prova. Observou-se maiores valores de microdureza superficial de topo no Grupo 3 (microdureza= 53,6 μm), seguido pelo Grupo 2 (microdureza= 52,1 μm) e Grupo 1 (microdureza= 33,1 μm), com valores de p<0,05. Assim sendo, o aparelho fotopolimerizador Valo, nas duas potências utilizadas, forneceu maior microdureza superficial para os corpos de prova estudados.Palavras-chave: Polimerização. Resinas Compostas. Testes de Dureza. Odontologia.

scholarly journals Effectiveness of a toothpaste and a serum containing calcium silicate on protecting the enamel after interproximal reduction against demineralization

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ascensión Vicente ◽  
Antonio J. Ortiz-Ruiz ◽  
Belén M. González-Paz ◽  
Yolanda Martínez-Beneyto ◽  
Luis Alberto Bravo-González
Keyword(s):  
Calcium Silicate ◽  
Control Group ◽  
Surface Microhardness ◽  
Sem Images ◽  
X Ray ◽  
Electron Scanning Microscopy ◽  
Group 3 ◽  
Group 2 ◽  
Enamel Reduction ◽  
Group 1

AbstractTo evaluate the effectiveness of a calcium silicate/phosphate fluoridated tooth paste and a serum compared with a toothpaste containing hydroxyapatite on protecting the enamel after interproximal reduction against demineralization. 3 sets of eleven incisors were created. The teeth underwent interproximal enamel reduction (IER) of 0.5 mm. Each set was allocated to one of three groups: (1) Brushing without toothpaste (control group); (2) Vitis toothpaste + Remin Pro; (3) Regenerate toothpaste + Regenerate Serum. The agents were applied three times a day and specimens subjected to demineralization cycles for 30 days. The weight percentages of calcium (Ca) and phosphorous (P) were quantified by X-ray microfluorescence spectroscopy. Surface microhardness measurements and electron scanning microscopy (SEM) observations were made. Ca data and the Ca/P ratio were significantly higher in Group 3 than the other groups (p < 0.017), while P was significantly lower in Group 3 (p < 0.017). No significant differences were found between Groups 1 and 2 (p > 0.017). Group 3 showed significantly higher microhardness values (p < 0.05) than Group 1. No significant differences were found for other comparisons between groups (p < 0.05). SEM images showed less demineralization in Group 3. The application of a calcium silicate/phosphate fluoridated tooth paste (Regenerate advance) and a dual serum (Regenerate advance enamel serum) protect the enamel with interproximal reduction against demineralization. Therefore, this treatment could be used to prevent the dissolution of hydroxyapatite after IER.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

2020 ◽  
pp. 64-75
Author(s):  
E. Burleva ◽  
O. Smirnov ◽  
S. Tyurin
Keyword(s):  
Postoperative Period ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Statistical Processing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

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