• Title/Summary/Keyword: Advanced Dentistry

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Effects of Head Posture on the Rotational Torque Movement of Mandible in Patients with Temporomandibular Disorders (두경부 위치에 따른 측두하악장애환자의 하악 torque 회전운동 분석)

  • Park, Hye-Sook;Choi, Jong-Hoon;Kim, Chong-Youl
    • Journal of Oral Medicine and Pain
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    • v.25 no.2
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    • pp.173-189
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    • 2000
  • The purpose of this study was to evaluate the effect of specific head positions on the mandibular rotational torque movements in maximum mouth opening, protrusion and lateral excursion. Thirty dental students without any sign or symptom of temporomandibular disorders(TMDs) were included as a control group and 90 patients with TMDs were selected and examined by routine diagnostic procedure for TMDs including radiographs and were classified into 3 subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Mandibular rotational torque movements were observed in four head postures: upright head posture(NHP), upward head posture(UHP), downward head posture(DHP), and forward head posture(FHP). For UHP, the head was inclined 30 degrees upward: for DHP, the head was inclined 30 degrees downward: for FHP, the head was positioned 4cm forward. These positions were adjusted with the use of cervical range-of-motion instrumentation(CROM, Performance Attainment Inc., St. Paul, U.S.A.). Mandibular rotational torque movements were monitored with the Rotate program of BioPAK system (Bioresearch Inc., WI, U.S.A.). The rotational torque movements in frontal and horizontal plane during mandibular border movement were recorded with two parameters: frontal rotational torque angle and horizontal rotational torque angle. The data obtained was analyzed by the SAS/Stat program. The obtained results were as follows : 1. The control group showed significantly larger mandibular rotational angles in UHP than those in DHP and FHP during maximum mouth opening in both frontal and horizontal planes. Disc displacement with reduction group showed significantly larger mandibular rotational angles in DHP and FHP than those in NHP during lateral excursion to the affected and non-affected sides in both frontal and horizontal planes(p<0.05). 2. Disc displacement without reduction group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening as well as lateral excursion to the affected and non-affected sides in both frontal and horizontal planes. Degenerative joint disease group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening, protrusion and lateral excursion in both frontal and horizontal planes(p<0.05). 3. In NHP, mandibular rotational angle of the control group was significantly larger than that of any other patient subgroups. Mandibular rotational angle of disc displacement with reduction group was significantly larger than that of disc displacement without reduction group during maximum mouth opening in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group or degenerative joint disease group during maximum mouth opening in the horizontal plane(p<0.05). 4. In NHP, mandibular rotational angles of disc displacement without reduction group were significantly larger than those of the control group or disc displacement with reduction group during lateral excursion to the affected side in both frontal and horizontal planes. Mandibular rotational angle of disc displacement without reduction group was significantly smaller than that of the control group during lateral excursion to the non-affected side in frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group during lateral excursion to the non-affected side in the horizontal plane(p<0.05). 5. In NHP, mandibular rotational angle of the control group was significantly smaller than that of disc displacement with reduction group or disc displacement without reduction group during protrusion in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of the disc displacement with reduction group or degenerative joint disease group during protrusion in the horizontal plane. Mandibular rotational angle of the control group was significantly smaller than that of disc displacement without reduction group or degenerative joint disease group during protrusion in the horizontal plane(p<0.05). 6. In NHP, disc displacement without reduction group and degenerative joint disease group showed significantly larger mandibular rotational angles during lateral excursion to the affected side than during lateral excursion to the non-affected side in both frontal and horizontal planes(p<0.05). The findings indicate that changes in head posture can influence mandibular rotational torque movements. The more advanced state is a progressive stage of TMDs, the more influenced by FHP are mandibular rotational torque movements of the patients with TMDs.

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Inhibitory effects of advanced glycation end products formation and free radical scavenging activity of Cirsium setidens (곤드레 추출물의 최종당화산물의 생성저해 및 라디칼소거 활성)

  • Kim, Taewan;Lee, Jaemin;Jeong, Gyeong Han;Kim, Tae Hoon
    • Food Science and Preservation
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    • v.23 no.2
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    • pp.283-289
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    • 2016
  • Naturally occurring antioxidants, such as polyphenols are widely found in fruits, vegetables, wines, juices, and other plant-based dietary sources and are divided into several sub classes, including phenylpropanoids, flavonoids, stilbenoids, and lignans. As part of the our ongoing search for bioactive food ingredients, the antioxidant and advanced glycation end products (AGEs) formation inhibitory activities of the methanolic extract of the aerial parts of Cirsium setidens were investigated in vitro bioassay system. The antioxidant properties were evaluated through radical scavenging assays using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) ($ABTS^+$) radicals. In addition, the activity of C. setidens against diabetes complications was also tested via AGEs formation inhibition assay. The total phenolic contents were determined using a UV-VIS spectrophotometric method. All tested samples showed a dose-dependent radical scavenging and AGEs inhibitory activities. In particular, the n-butanol (BuOH)-soluble portion showed the most potent radical scavenging activities against DPPH and $ABTS^+$ radicals with $IC_{50}$ values of $24.3{\pm}1.7$ and $25.0{\pm}3.3{\mu}g/mL$, respectively. Futhermore, the inhibition of AGEs formation by the n-BuOH-soluble portion ($IC_{50}$ value; $46.0{\pm}1.5{\mu}g/mL$) was higher than that those of the soluble portions for the other solvent. The results showed that C. setidens could be considered as an effective source of natural antioxidants and other ingredients.

GENE EXPRESSION PATTERNS INDUCED BY $TAXOL^{(R)}$ AND CYCLOSPORIN A IN ORAL SQUAMOUS CELL CARCINOMA CELL LINE USING CDNA MICROARRAY (cDNA Microarray를 이용한 구강편평세포암종 세포주에서 $Taxol^{(R)}$과 Cyclosporin A로 유도된 유전자 발현양상)

  • Kim, Yong-Kwan;Lee, Jae-Hoon;Kim, Chul-Hwan
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.3
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    • pp.202-212
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    • 2006
  • It is well-known that paclitaxel($Taxol^{(R)}$), which is extracted from the pacific and English yew, has been used as a chemotherapeutic agent for ovarian carcinoma and advanced breast carcinoma and Cyclosporin A, which is highly lipophilic cyclic peptide and isolated from a fungus, has been also used as an useful immunosuppressive drug after transplantation and is associated with cellular apoptosis. Since 1953, in which James Watson, Rosalind Franklin and Francis Crick discovered the double helical structure of DNA, a few kinds of techniques for identifying gene expression have been developed. In postgenomic period, many of researchers have used the DNA microarray which is high throughput screening technique to screen large numbers of gene expression simultaneously. In this study, we searched and screened the gene expression in the oral squamous cell carcinoma cell lines treated with $Taxol^{(R)}$, cyclosporin or cyclosporin combined with $Taxol^{(R)}$ using cDNA microarray. The results were as following; 1. It was useful that the appropriate concentration of Cyclosporin A and $Taxol^{(R)}$ used in oral squamous cell carcinoma cell line was under 1${\mu}g/ml$ and 3${\mu}g/ml$. 2. In the experimental group in which $Taxol^{(R)}$ and $Taxol^{(R)}$ + Cyclosporin A were used, the cell growth was extremely decreased. 3. In the group in which Cyclosporin A was used, the MTT assay was rarely decreased which means the activity of succinyl dehydrogenase is remained in mitochondria but in the group in which the mixture of Cyclosporin A and $Taxol^{(R)}$ were used, the MTT assay was extremely decreased. 4. In the each group in which Cyclosporin A(3 ${\mu}g/ml$) and $Taxol^{(R)}$(1 ${\mu}g/ml$) were used, the cell arrest was appeared in $G_2/M$ phase and in the group in which $Taxol^{(R)}$(3 ${\mu}g/ml$) was used, the cell arrest was appeared in both S phase and $G_2/M$ phase. 5. In the oral squamous cell carcinoma cell line treated with $Taxol^{(R)}$, several genes including ANGPTL4, RALBP1 and TXNRD1, associated with apoptosis, SUI1, MAC30, RRAGA and CTGF, related with cell growth, HUS1 and DUSP5, related with cell cycle and proliferation, ATF4 and CEBPG, associated with transcription factor, BTG1 and VEGF, associated with angiogenesis, FDPS, FCER1G, GPA33 and EPHA4 associated with signal transduction and receptor activity and AKR1C2 and UGTA10 related with carcinogenesis were detected in increased levels. The genes that showed increaced expression in the oral squamous cell carcinoma cell line treated with Cyclosporin A were CYR61, SERPINB2, SSR3 and UPA3A which are known as genes associated with cell growth, carcinogenesis, receptor activity and transcription factor. The genes expressed in the HN22 cell line treated with cyclosporin combined with $taxol^{(R)}$ were ALCAM and GTSE1 associated with cancer invasiveness and cell cycle regulation.

Comparison of the accuracy of intraoral scanner by three-dimensional analysis in single and 3-unit bridge abutment model: In vitro study (단일 수복물과 3본 고정성 수복물 지대치 모델에서 삼차원 분석을 통한 구강 스캐너의 정확도 비교)

  • Huang, Mei-Yang;Son, Keunbada;Lee, Wan-Sun;Lee, Kyu-Bok
    • The Journal of Korean Academy of Prosthodontics
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    • v.57 no.2
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    • pp.102-109
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    • 2019
  • Purpose: The purpose of this study was to evaluate the accuracy of three types of intraoral scanners and the accuracy of the single abutment and bridge abutment model. Materials and methods: In this study, a single abutment, and a bridge abutment with missing first molar was fabricated and set as the reference model. The reference model was scanned with an industrial three-dimensional scanner and set as reference scan data. The reference model was scanned five times using the three intraoral scanners (CS3600, CS3500, and EZIS PO). This was set as the evaluation scan data. In the three-dimensional analysis (Geomagic control X), the divided abutment region was selected and analyzed to verify the scan accuracy of the abutment. Statistical analysis was performed using SPSS software (${\alpha}=.05$). The accuracy of intraoral scanners was compared using the Kruskal-Wallis test and post-test was performed using the Pairwise test. The accuracy difference between the single abutment model and the bridge abutment model was analyzed by the Mann-Whitney U test. Results: The accuracy according to the intraoral scanner was significantly different (P < .05). The trueness of the single abutment model and the bridge abutment model showed a statistically significant difference and showed better trueness in the single abutment (P < .05). There was no significant difference in the precision (P = .616). Conclusion: As a result of comparing the accuracy of single and bridge abutments, the error of abutment scan increased with increasing scan area, and the accuracy of bridge abutment model was clinically acceptable in three types of intraoral scanners.

DOX-MTX-NPs Augment p53 mRNA Expression in OSCC Model in Rat: Effects of IV and Oral Routes

  • Abbasi, Mehran Mesgari;Khiavi, Monir Moradzadeh;Monfaredan, Amir;Hamishehkar, Hamed;Seidi, Khaled;Jahanban-Esfahlan, Rana
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.19
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    • pp.8377-8382
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    • 2014
  • Background: Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy worldwide. Cancer development and progression require inactivation of tumor suppressor genes and activation of proto-oncogenes. The well recognized mechanism of action demonstrated for chemotherapeutic agents is induction of apoptosis via reactivation of p53. In this context, we evaluate the efficacy of IV and oral routes of our novel PH and temperature sensitive doxorubicin-methotrexate-loaded nanoparticles (DOX-MTX NP) in affecting p53 profile in an OSCC rat model. Methods: In this study, 120 male rats were divided into 8 groups of 15 animals each. The new formulated DOX-MTX NP and free doxorubicin were IV and orally given to rats with 4-nitroquinoline-1-oxide induced OSCC. Results: Results showed that both DOX and DOX-MTX-NP caused significant increase in mRNA levels of P53 compared to the untreated group (p<0.000). With both DOX and DOX-MTX NP, the IV mode was more effective than the oral (gavage) route (p<0.000). Surprisingly, in oral mode, p53 mRNA was not affected in DOX treated groups (p>0.05), Nonetheless, both IV and oral administration of MTX-DOX NP showed superior activity (~3 fold) over free DOX in reactivation of p53 in OSCC (p<0.000). The effectiveness of oral route in group treated with nanodrug accounts for the enhanced bioavailability of nanoparticulated DOX-MTX compared to free DOX. Moreover, in treated groups, tumor stage was markedly related to the amount of p53 mRNA (p<0.05). Conclusion: Both oral and IV application of our novel nanodrug possesses superior activity over free DOX-in up-regulation of p53 in a OSCC model and this increase in p53 level associated with less aggressive tumors in our study. Although, impressive results obtained with IV form of nanodrug (-21 fold increase in p53 mRNA level) but both forms of nanodrug are effective in OSCC, with less toxicity normal cells.

An investigation into the effect of denture adhesives on incisal bite force of complete denture wearers using pressure transducers - a clinical study

  • Kalra, Pawan;Nadiger, Ramesh;Shah, Farhan Khalid
    • The Journal of Advanced Prosthodontics
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    • v.4 no.2
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    • pp.97-102
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    • 2012
  • Study was conducted to determine and assess the effect of different type of denture adhesives on the incisal bite force of complete denture wearers until the dislodgement of upper denture, using pressure transducer. MATERIALS AND METHODS. 30 patients out of 100 were included in the study. Based on the Kapur's method of scoring denture retention and stability, these patients were divided into 3 groups-Group A - Clinically good dentures; Group B - Clinically fair dentures; and Group C - Clinically poor dentures. A custom made occlusal force meter was constructed based on the load cell type of pressure transducers. Different adhesives (powder, paste and adhesive strips) were used in the study. Complete denture wearers were asked to bite on the load cell and the readings of incisal bite force were recorded. The readings of incisal bite force were subjected to statistical analysis using Repeated measures ANOVA followed by post-hoc bonferroni test. RESULTS. The result suggests that denture adhesives improved the incisal bite force of complete denture wearers significantly The incisal bite force (in kg) in Group A without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 2.48 (${\pm}0.16$), 3.43 (${\pm}0.11$), 6.01 (${\pm}0.11$), 3.22 (${\pm}0.09$) respectively. The incisal bite force (in kg) in Group B without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 1.87 (${\pm}0.18$), 3.35 (${\pm}0.14$), 5.34 (${\pm}0.18$), 3.21 (${\pm}0.12$) respectively. The incisal bite force (in kg) in Group C without using adhesives, with powder adhesive, with paste adhesive and with adhesive strips was found to be 1.00 (${\pm}0.17$), 3.07 (${\pm}0.14$), 4.37 (${\pm}0.26$), 2.99 (${\pm}0.14$) respectively. CONCLUSION. Within the limitations of the study, it was concluded that the use of denture adhesive was found to be significantly effective in improving the incisal bite force of complete dentures until the dislodgement of upper denture. Fittydent paste adhesive was found to be more effective than the powder and strips adhesives. The improvement in incisal bite force was found to be higher in Group C in comparison to that of Group A and Group B.

Evaluation of the stability of sandblasted, large-grit, acid-etched implants with tapered straight body design (테이퍼드 직선형 SLA 임플란트의 안정성 평가)

  • Kim, Yong-Gun;Lee, Kyu-Bok
    • Journal of Dental Rehabilitation and Applied Science
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    • v.34 no.2
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    • pp.80-88
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    • 2018
  • Purpose: Implant surface modification and implant design are the principle targets for achieving successful primary stability. The aim of this study was to measure implant stability quotient (ISQ) values of sandblasted, large-grit, acid-etched (SLA) implants with tapered straight body design during the healing period, and to determine the various factors affecting implant stability. Materials and Methods: To measure implant stability, resonance frequency analysis (RFA) was performed in 26 patients (13 women and 13 men) with 44 SLA implants with tapered straight body design. Implant stability (ISQ values) was evaluated at baseline and healing abutment connection (12 weeks), and the correlations between RFA and insertion torque (IT), bone quality, and jawbone were determined. Results: The mean ISQ value of the implants was $69.4{\pm}10.2$ at the time of implant placement (baseline) and $81.4{\pm}6.9$ at the time of healing abutment connection (P < 0.05). Significant differences were found between RFA and bone quality and between RFA and jawbone (P < 0.05). No significant differences were found between RFA and IT, insertion area, fixture diameter, and implant length (P > 0.05). Conclusion: ISQ values of SLA implants with tapered straight body design were high at baseline and healing abutment connection. It was concluded that SLA implants with tapered straight body design show improved primary and secondary stability, and that immediate or early loading may be applicable.

Elemental alteration of the surface of dental casting alloys induced by electro discharge machining (치과용 주조 합금의 방전가공에 따른 표면 성분 변화)

  • Jang, Yong-Chul;Lee, Myung-Kon
    • Journal of Technologic Dentistry
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    • v.31 no.1
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    • pp.55-61
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    • 2009
  • Passive fitting of meso-structure and super-structures is a predominant requirement for the longevity and clinical success of osseointegrated dental implants. However, precision and passive fitting has been unpredictable with conventional methods of casting as well as for corrective techniques. Alternative to conventional techniques, electro discharge machining(EDM) is an advanced method introduced to dental technology to improve the passive fitting of implant prosthesis. In this technique material is removed by melting and vaporization in electric sparks. Regarding the efficacy of EDM, the application of this technique induces severe surface morphological and elemental alterations due to the high temperatures developed during machining, which vary between $10,000{\sim}20,000^{\circ}C$. The aim of this study was to investigate the morphological and elemental alterations induced by EDM process of casting dental gold alloy and non-precious alloy used for the production of implant-supported prosthesis. A conventional clinical dental casting alloys were used for experimental specimens patterns, which were divided in three groups, high fineness gold alloy(Au 75%, HG group), low fineness gold alloy(Au 55%, LG group) and nonprecious metal alloy(Ni-Cr, NP group). The UCLA type plastic abutment patterns were invested with conventional investment material and were cast in a centrifugal casting machine. Castings were sandblasted with $50{\mu}m\;Al_2O_3$. One casting specimen of each group was polished by conventional finishing(HGCON, LGCON, NPCON) and one specimen of each group was subjected to EDM in a system using Cu electrodes, kerosene as dielectric fluid in 10 min for gold alloy and 20 min for Ni-Cr alloy(HGEDM. LGEDM, NOEDM). The surface morphology of all specimens was studied under an energy dispersive X-ray spectrometer (EDS). The quantitative results from EDS analysis are presented on the HGEDM and LGEDM specimens a significant increase in C and Cu concentrations was found after EDM finishing. The different result was documented for C on the NPEDM with a significant uptake of O after EDM finishing, whereas Al, Si showed a significant decrease in their concentrations. EDS analysis showed a serious uptake of C and Cu after the EDM procedure in the alloys studied. The C uptake after the EDM process is a common finding and it is attributed to the decomposition of the dielectric fluid in the plasma column, probably due to the development of extremely high temperatures. The Cu uptake is readily explained from the decomposition of Cu electrodes, something which is also a common finding after the EDM procedure. However, all the aforementioned mechanisms require further research. The clinical implication of these findings is related with the biological and corrosion resistance of surfaces prepared by the EDM process.

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A study on the correlation between oral health status and dental prosthetic treatment (구강보건 실태와 치과보철치료의 상관관계에 관한 연구)

  • Lee, Jong-Do;Kim, Jeoung-Sook
    • Journal of Technologic Dentistry
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    • v.30 no.1
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    • pp.109-119
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    • 2008
  • The Status of oral health and dental prosthetic treatment in Daegu and Gyoung Buk area was examined. To investigate the correlation between factors such as demographic and socioeconomic characteristics and status of oral health and knowledge about oral preventive measures, a survey was performed. After analyzing the effects of knowledge levels about dental prosthetic treatment on the oral health status and preventive measures, following results were obtained. A Total of 625 people participated in the survey for three months from October 2007 to January 2008. The responses from the survey were then analyzed to assess whether those with less knowledge of preventive measures tended to have more dental prosthetic work. Of those that took part in the survey: ${\cdot}$ 30.2% were in their twenties ${\cdot}$ 56.2% were married ${\cdot}$ 51.4% of respondents had at least a college degree ${\cdot}$ 42.4% had monthly incomes below one million Won ${\cdot}$ 24.3% were students ${\cdot}$ 55.8% were from urban areas After studying the relationship between oral health and various demographics, researchers concluded that respondents' sex, income, job and place of residence had no effect on the overall status of their oral health. However, those that were divorcees or widows (1.95${_+}/{_-}$ 0.32), over the age of 70 (1.67${_+}/{_-}$0.31), or had little education (0.82${_+}/{_-}$0.28), all demonstrated a statistically significant effect on their oral health with a significance level of 0.05.Cross analysis revealed a p-value of 0.000. The correlation between knowledge of oral preventive measures and other factors was examined. No difference was found between men and women but people who were divorced or lost their spouse, people over the age of 60, and people with no education, the results of knowledge of oral preventive measure was poor as 1.74$\pm$0.44, 1.85$\pm$0.40, 1.85$\pm$0.44,and 1.60$\pm$0.47 separately. Cross analysis showed that p-value was 0.000 and correlation between knowledge of oral preventive measures and those factors were statistically significant at significance level of 0.05. The status of dental prosthetic treatment was investigated. Women, people with higher income, and married people had more dental prosthetic treatment and it was related to education, income, residential area, and the status of dental prosthetic treatment. The returns of those factors was 32.7%. Respondents$^{\circ}{\emptyset}$ oral hygiene status and knowledge of oral preventive measures was related to demographic or socioeconomic factors. Therefore, a preventive program for oral health care needs to be developed in advanced countries. Knowledge of oral health is below the international average and more research and effort needs to be put in to develop public knowledge of dental prosthetic treatment. Government intervention such as enacting an oral health initiative or dental insurance that covers prosthetic treatments is urgently needed.

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Effect of denture cleansers on Candida albicans biofilm formation over resilient liners

  • Huh, Jung-Bo;Lim, Younghun;Youn, Hye-In;Chang, Brian Myung;Lee, Jeong-Yol;Shin, Sang-Wan
    • The Journal of Advanced Prosthodontics
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    • v.6 no.2
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    • pp.109-114
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    • 2014
  • PURPOSE. The purpose of this study was to analyze the effect of denture cleansers on Candida albicans biofilm formation over resilient liners and to evaluate compatibility between resilient liners and denture cleansers. MATERIALS AND METHODS. Acrylic resin (Lucitone 199$^{(R)}$) and 3 resilient liners (COE-SOFT$^{TM}$, GC RELINE$^{TM}$ and SOFRELINER TOUGH TOUGH$^{(R)}$) were incubated in denture cleansers (Polident$^{(R)}$ and Cleadent$^{(R)}$) for 8 hours a day and in unstimulated saliva for 16 hours a day (n=25/gp) for 60 days. Two-way and three-way repeated measures ANOVA were performed to compare the surface roughness (Ra), pH and C. albicans binding level by radioisotope (${\alpha}$=0.05). The statistical significance of the relation between Ra and adhesion was evaluated by correlation analysis. RESULTS. The degree of Ra was significantly decreased in the following order: COE-SOFT$^{TM}$, acrylic resin, GC RELINE$^{TM}$ and SOFRELINER TOUGH$^{(R)}$. The immersion in denture cleansers significantly increased Ra of resilient liners, except for SOFRELINER TOUGH$^{(R)}$ in Cleadent$^{(R)}$. No significant differences in pH curves were observed among groups immersed in distilled water and denture cleansers. The binding levels of C. albicans were significantly decreased in the following order: COE-SOFT$^{TM}$, GC RELINE$^{TM}$, SOFRELINER TOUGH$^{(R)}$, and acrylic resin. The immersion in Cleadent$^{(R)}$ seemed to decrease C. albicans binding level on GC RELINE$^{TM}$ and SOFRELINER TOUGH$^{(R)}$. CONCLUSION. Based on the C. albicans binding levels results, it is not recommended to immerse COE-SOFT$^{TM}$ in denture cleansers, and GC RELINE$^{TM}$ and SOFRELINER TOUGH$^{(R)}$ should be immersed in Cleadent$^{(R)}$.