The effect of single-file reciprocating systems on Substance P and Calcitonin gene-related peptide expression in human periodontal ligament

AIM

To quantify the effect of two single-file reciprocating root canal preparation systems on Substance P (SP) and Calcitonin gene-related peptide (CGRP) expression in healthy human periodontal ligament (PDL).

METHODOLOGY

Forty PDL samples were obtained from healthy premolars where extraction was indicated for orthodontic reasons. Prior to extraction, 20 of these premolars were divided equally in two groups, and then, root canals were prepared using one of two different single-file systems: WaveOne and Reciproc. Ten premolars were prepared with hand files and served as a positive control group. The remaining 10 premolars where extracted without treatment and served as a negative control group. All PDL samples were processed, and SP and CGRP were measured by radioimmunoassay.

RESULTS

Greater SP and CGRP expression were found in the hand instrumentation group (1.220 pmol SP and 0.084 pmol CGRP per mg of PDL), followed by the WaveOne group (0.908 pmol SP and 0.046 pmol CGRP per mg of PDL) and the Reciproc group (0.511 pmol SP and 0.022 pmol CGRP per mg of PDL). The lower SP and CGRP values were associated with the intact control group (0.453 pmol SP and 0.018 pmol CGRP per mg of PDL). The Kruskal-Wallis test revealed significant differences between groups (P < 0.001). Post hoc Tukey HSD tests revealed significant differences in SP and CGRP expression between intact teeth in the control group and all the other groups (P < 0.001) except with the Reciproc group (P = 0.165 and P = 0.42 for SP and CGRP, respectively). Hand instrumentation was associated with significant differences with all the other groups (P < 0.001). Differences between the WaveOne and Reciproc groups were also significant (P < 0.001).

CONCLUSION

Substance P and CGRP expression in PDL cells increased when teeth were prepared with WaveOne as well as with hand instrumentation. Reciproc maintained SP and CGRP levels in line with the negative control group.

Redox method for the determination of stability constants of some trivalent metal complexes

Stability constants determination of very stable metal complexes using the redox method, based on the equilibrium of Fe (3+)Fe (2+) followed by a couple of platinum/reference electrodes, was undertaken and tested to complexes of some trivalent metal ions with well known polyaminopolycarboxymethylated linear ligands (edta, nta, cdta, dtpa and ttha) and also to some new macrocyclic ligands. SUPERQUAD program was used for the calculations, after adaptation of the experimental data. The method proved to be very useful for Fe(3+) and In(3+) complexes, if no polynuclear complexes are formed or/and if the kinetics of the complexation reaction is not very slow. However, for the Ga(3+) complexes the applicability of this method is very limited and the competition with OH(-) using the displacement reaction which occurs at pH higher than 6 with formation of Ga(OH)(4)(-) seems to give more accurate results. A complete data of stability constants for the case of the complexes of ttha with In(3+) is given.

The stability of the metal complexes of cyclic tetra-aza tetra-acetic acids

The stability constants of the complexes formed by three tetra-aza macrocyclic complexones (DOTA, TRITA and TETA) with Mn(2+), Fe(2+), Co(2+), Ni(2+), Cu(2+), Zn(2+), Cd(2+) and Pb(2+) were determined with an automated titration instrument with data acquisition and the calculations were performed with the Superquad program, confirming and extending the range of values previously available. Both 1:1 and 2:1 metal-to-ligand complexes were now considered including their protonated species. The results show that DOTA is a powerful but unselective ligand whereas TETA, although not so powerful as DOTA, is an interesting selective ligand for pairs of metal ions, e.g., Cd(2+) and Pb(2+).

Evaluation of genotoxicity and DNA protective effects of mangiferin, a glucosylxanthone isolated from Mangifera indica L. stem bark extract

Mangiferin is a glucosylxantone isolated from Mangifera indica L. stem bark. Several studies have shown its pharmacological properties which make it a promising candidate for putative therapeutic use. This study was focused to investigate the in vitro genotoxic effects of mangiferin in the Ames test, SOS Chromotest and Comet assay. The genotoxic effects in bone marrow erythrocytes from NMRI mice orally treated with mangiferin (2000 mg/kg) were also evaluated. Additionally, its potential antimutagenic activity against several mutagens in the Ames test and its effects on CYP1A1 activity were assessed. Mangiferin (50-5000 μg/plate) did not increased the frequency of reverse mutations in the Ames test, nor induced primary DNA damage (5-1000 μg/mL) to Escherichia coli PQ37 cells under the SOS Chromotest. It was observed neither single strand breaks nor alkali-labile sites in blood peripheral lymphocytes or hepatocytes after 1h exposition to 10-500 μg/mL of mangiferin under the Comet assay. Furthermore, micronucleus studies showed mangiferin neither induced cytotoxic activity nor increased the frequency of micronucleated/binucleated cells in mice bone marrow. In short, mangiferin did not induce cytotoxic or genotoxic effects but it protect against DNA damage which would be associated with its antioxidant properties and its capacity to inhibit CYP enzymes.

Moxifloxacin and pyrazinamide susceptibility testing in a complex case of multidrug-resistant tuberculosis

Multidrug-resistant tuberculosis (MDR-TB) is a public health problem of global concern. It is critical that drug susceptibility testing (DST) methods accurately predict clinical response. We present a patient with a challenging case of MDR-TB with additional resistance to quinolones and pyrazinamide. Treatment with a regimen including high-dosage moxifloxacin, based on additional genotypic and phenotypic DST, produced excellent results. This case highlights the possibility of treatment with high-dose fluoroquinolones despite apparent bacterial resistance to these agents. Improved DST methods are necessary for both agents. Development of genotypic approaches may offer a susceptibility profile rapidly, enabling early introduction of individualised treatments.

Evolution of organic matter fractions after application of co-compost of sewage sludge with pruning waste to four Mediterranean agricultural soils. A soil microcosm experiment

The effect of co-compost application from sewage sludge and pruning waste, on quality and quantity of soil organic carbon (SOC) in four Mediterranean agricultural soils (South Spain), was studied in soil microcosm conditions. Control soil samples (no co-compost addition) and soils treated with co-composts to a rate equivalent of 140 Mg ha(-1) were incubated for 90 days at two temperatures: 5 and 35 degrees C. The significances of incubation temperature and the addition of co-compost, on the evolution of the different fractions of SOC, were studied using a 2(3) factorial design. The co-compost amendment increased the amounts of humic fractions: humic acids (HA) (1.9 times), fulvic acids (FA) (3.3 times), humin (1.5 times), as well as the free organic matter (1.4 times) and free lipids (21.8 times). Incubation of the soils enhanced its biological activity mainly in the amended soils and at 35 degrees C, leading to progressive SOC mineralization and humification, concomitant to the preferential accumulation of HA. The incubation results show large differences depending on temperature and soil types. This fact allows us to select suitable organic amendment for the soil when a rapid increase in nutrients through mineralization is preferred, or in cases intending the stabilization and preservation of the SOC through a process of humification. In soils with HA of more than 5 E(4)/E(6) ratio, the incubation temperature increased rates of mineralization and humification, whereas lower temperatures limited the extent of both processes. In these soils the addition of co-compost in spring or summer is the most recommendable. In soils with HA of lower E(4)/E(6) ratio (<5), the higher temperature favoured mineralization but not humification, whereas the low temperature maintained the SOC levels and even increased the HA/FA ratio. In these soils the moment of addition of organic amendment should be decided depending on the effect intended. On the other hand, the lower the SOC content in the original soil, the greater are the changes observed in the SOC after amendment with co-compost. The results suggest that proper recommendations for optimum organic matter evolution after soil amendment is possible after considering a small set of characteristics of soil and the corresponding soil organic matter fractions, in particular HA.

Spanish radiobiological pattern of care in lung cancer: a GOECP/SEOR study

INTRODUCTION

A survey regarding radiobiological questions in the treatment of lung cancer (LC) was done to study the clinical aspects of radiotherapy in Spain, in order to standardise treatment decisions.

METHODS AND MATERIALS

From November 2007 to March 2008, a survey was performed among radiation oncologists in Spain specialising in LC treatment via e-mail, which included questions regarding different radiobiological aspects of radiotherapy LC treatment. The extent of the resulting material made it necessary to divide it into two parts; the first is presented in this article. The second, which includes items about alpha/beta-NTCP/TCP values and reirradiation criteria, will be reported elsewhere.

RESULTS

Thirty-one radiation therapists from 29 radiation oncology departments answered the survey. 77.4-93.5% of responders used the basic formula from the linear-quadratic model and/or computer software for radiobiological calculations; 100% used lung (mostly V20, median <30%) and spinal cord constraints (mostly a median of physical maximum dose <45.5 Gy); and 90.3% used heart and oesophagus constraints (very heterogeneous parameters in both organs).

CONCLUSIONS

Radiobiological considerations are clearly present in the planning process of radiotherapy of LC in Spain, with a high coincidence with the literature regarding lung and spinal cord constraints. The heterogeneity shown for oesophagus and heart results demonstrates the need for continuing investigation into the standardisation of clinical, dosimetric and radiobiologic aspects of the treatment of this cancer.

Conservative treatment with transurethral resection, neoadjuvant chemotherapy followed by radiochemotherapy in stage T2-3 transitional bladder cancer

PURPOSE

Organ preservation has been investigated in patients (p) with infiltrating transitional cell carcinoma (TCC) of the bladder over the past decade as an alternative to radical cystectomy. This is a trimodal schedule study, including transurethral resection of bladder tumor (TURB), neoadjuvant chemotherapy and concomitant radiochemotherapy (RTC).

PATIENTS AND METHODS

From April 1996 until August 2005, 29 evaluable patients (p) with T2-T3NXM0 bladder cancer were enrolled. After a transurethral resection of bladder tumor (TURB), we administered 2 cycles of induction chemotherapy with CMV (15 p) or Gemcitabine-Cisplatin (14 p) followed by radiotherapy 45 Gy 1.8 Gy/fraction and two cycles of concomitant cisplatin 70 mg/m(2). 2-3 weeks later, a cystoscopy with tumor-site biopsy was performed. If complete histological response, p were treated with consolidation radiotherapy until 64.8 Gy. For p with residual or recurrent tumor, cystectomy was performed.

RESULTS

We included 28 men and 1 women (median age 63, range 39-72 years) with PS (ECOG) 0-1. The stage was: 21 p T2; 6 p T3a; and 2 p T3b. Toxicity was higher in CMV compared with Gem- Cis: grade (3/4) neutropenia 4/15 (26%) vs 1/14 (7%); febrile neutropenia 3/15 (20%) vs 1/14 (7%); grade (3/4) trombocytopenia 2/15 (13%) vs 1/14 (7%). Toxicities with concomitant RCT were low-moderate: urocystitis (26%) and enteritis (18%).

RESPONSE

microscopically complete TURB was obtained in 20 p (69%), but not in 9 p (31%) (7 microscopic, and 2 macroscopic residual tumor). We found a complete histologic response after induction RCT in 25 p (86%). After a median follow-up of 69.4 months (m) (range: 8-97.7), there were 8 deaths, with a overall survival of 72%. Furthermore 14 of 29 p (48%) were alive with intact bladder, and median survival time with intact bladder was 63.6 m (50.1-77.2); were predictive of best outcome T2 stage vs T3 (p < 0.0001), and complete histologic resection in initial TURB vs residual tumor (p = 0.0004).

CONCLUSIONS

Combined treatment provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients with TCC. Patients with T2 stage and complete histologic resection in initial TURB had the best outcome.

Viral monitoring and successful treatment of a ganciclovir-resistant cytomegalovirus infection in a heart transplant recipient

We reported a ganciclovir (GCV)-resistant cytomegalovirus (CMV) infection in a heart transplant recipient. Genotypic and phenotypic susceptibility assays demonstrated an A594V mutation in the UL97 phosphotransferase gene and GCV IC(50)>96 microM. Low GCV concentration exposure, immunosuppressive treatment, donor-positive/recipient-negative CMV serostatus, viral reactivations within antiviral prophylaxis or treatment, contributed to GCV-resistant strain selection.

Interactions of polyphenols with the P450 system: possible implications on human therapeutics

Polyphenols are a family of natural compounds with many biological properties. This review focuses on their potential interaction on the cytochrome P450 system. Effects of phenolic acids, anthocyanins, stilbenes, catechins and other flavonoids on the drug metabolising function are revised. Their daily intake and presence in herbal medicines justify the study of potential drug-interaction to prevent undesirable clinical consequences.

[Preliminary results of the Spanish Society of Nephrology multicenter study of quality performance measures: hemodialysis outcomes can be improved]

INTRODUCTION

The Spanish Society of Nephrology "Quality in Nephrology Working Group" (QNWG) was created in 2002. The aims of this group are the identification, diffusion, implementation and consolidation of a systematic, objective and comprehensive set of quality performance measures (QPMs) to help along the improvement of patient care and outcomes on hemodialysis, by means of strategies of feedback and benchmarking, and the design of quality improvement projects. The objective of this study is to present the preliminary results of a set of quality performance measures obtained in a group of Spanish hemodialysis centers, as well as to evaluate the repercussion of the application of the aforementioned thecniques on the observed results.

METHODS

During 2007 a total of 28 hemodialysis units participated in the study; 2516 patients were evaluated. A specific software was designed and used to facilitate the calculation of CPMs in each unit. The clinical indicators used refered to dialysis adequacy; anemia; mineral metabolisme; nutrition; viral infections; vascular access; mortality, morbidity (number and days of hospital admissions); and renal transplant. Every three months each center received its own data and its comparison with the rest of the group.

RESULTS

Except for hemoglobin levels we observed a global improvement. The percentage of centers reaching the stablished standards defined by the QNWG passed from 65% to 90,9% for Kt/V Daugirdas II (> 1,3 in > that 80% of the patients); from 71,4 % to 77,2 % for PTH (> 30 % of patients with serum PTH between 150 and 300 pg/ml); and from 42,8 % to 63,5 % for phosphate (> 75 % of patients with a serum phsphate < 5,5 mg/dl). More than 50% of centers showed an improvement in their final results as compared with their own initial results in all analyzed CPMs. Those centers that did not obtained an improvement in their results started the study with better percentages of acomplishment than those that showed a significant improvement in QPMs. (80,6+/-15,4 versus 71,8+/-16,6 respectively; p<0,001)

CONCLUSIONS

We are starting to make progresses in our knowledge of clinical results in our hemodialysis units, although there is still a long way to go over. To monitor and share CPMs results within hemodialysis centers might help to improve their results as well as to reduce intecenters variability.

Effects of Mangifera indica L. aqueous extract (Vimang) on primary culture of rat hepatocytes

Vimang is an aqueous extract from stem bark of Mangifera indica L. (Mango) with pharmacological properties. It is a mixture of polyphenols (as main components), terpenoids, steroids, fatty acids and microelements. In the present work we studied the cytotoxic effects of Vimang on rat hepatocytes, possible interactions of the extract with drug-metabolizing enzymes and its effects on GSH levels and lipid peroxidation. No cytotoxic effects were observed after 24 h exposure to Vimang of up to 1000 microg/mL, while a moderate cytotoxicity was observed after 48 and 72 h of exposure at higher concentrations (500 and 1000 microg/mL). The effect of the extract (50-400 microg/mL) on several P450 isozymes was evaluated. Exposure of hepatocytes to Vimang at concentrations of up to 100 microg/mL produced a significant reduction (60%) in 7-methoxyresorufin-O-demethylase (MROD; CYP1A2) activity, an increase (50%) in 7-penthoxyresorufin-O-depentylase (PROD; CYP2B1) activity, while no significant effect was observed with other isozymes. To our knowledge, this is the first report regarding the modulation of the activity of the P450 system by an extract of Mangifera indica L. The antioxidant properties of Vimang were also evaluated in t-butyl-hydroperoxide-treated hepatocytes. A 36-h pre-treatment of cells with Vimang (25-200 microg/mL) strongly inhibited the decrease of GSH levels and lipid peroxidation induced by t-butyl-hydroperoxide dose- and time-dependently.

Prevalence and management of potential candidates for simultaneous pancreas-kidney transplantation in a provincial setting

INTRODUCTION

Simultaneous pancreas-kidney (SPK) transplantation is the best therapeutic option for correctly selected diabetic patients with advanced chronic kidney disease (CKD).

OBJECTIVES

The objectives of this study were to quantify in a Spanish province the prevalence and incidence of type 1 and 2 diabetics with stage IV-V CKD who are potential candidates for SPK, and to analyze the selection for SPK in clinical practice.

MATERIALS AND METHODS

All patients with diabetic neuropathy (DN) in predialysis, hemodialysis, or peritoneal dialysis (PD) in our transplantation referral area (population, 1.8 million; data collection ended December 7, 2005) were examined for basic SPK criteria (NTO 2005 Consensus). A new assessment was performed 9 months later, including new possible recipients, and patients were classified as: follows in study, excluded after study, added to SPK waiting list, or SPK-transplanted.

RESULTS

In 2005, there were 1371 patients in dialysis or predialysis, including 179 (13%) with DN (41 type 1 and 138 type 2 DM); only 16 of these patients (8.9% of DN patients), 8.9 per million population (PMP), met the basic criteria for SPK transplantation. There were 68 with DN in predialysis, including 8 (11.7%) possible SPK candidates; 7 with DN in PD, no candidates for SPK; and 104 patients with DN in hemodialysis, including 8 (7.2%) SPK candidates. After 9 months, 7 new potential candidates were identified (incidence of 5.1 PMP/y). Of 23 possible candidates, 3 refused SPK, 7 awaited completion of study, 8 were excluded after study, 1 was on the SPK waiting list, and 7 underwent SPK transplantation.

CONCLUSIONS

In our setting, approximately 9% of DN patients with stage IV-V CKD were potential SPK candidates in 2005 and 2006. After completion of studies, less than half were eventually included on the waiting list, generating an effective demand for SPK of 2-4 new patients PMP/y.

Lack of in vivo embryotoxic and genotoxic activities of orally administered stem bark aqueous extract of Mangifera indica L. (Vimang)

Mango (Mangifera indica L.) stem bark aqueous extract (MSBE) is a new natural product with antioxidant, anti-inflammatory and immunomodulatory effects known by the brand name of its formulations as Vimang. Previously, the oral toxicity studies of the extract showed a low toxicity potential up to 2000 mg/kg. This work reports the results about teratogenic and genotoxicologic studies of MSBE. For embryotoxicity study, MSBE (20, 200, or 2000 mg/kg/day) was given to Sprague-Dawley rats by gavage on days 6-15 of gestation. For genotoxicity, MSBE was administered three times during 48 h to NMRI mice. Cyclophosphamide (50 mg/kg) was used as a positive control. No maternal or developmental toxicities were observed when the rats were killed on day 20th. The maternal body-weight gain was not affected. No dose-related effects were observed in implantations, fetal viability or external fetal development. Skeletal and visceral development was similar among fetuses from all groups. No genotoxicity was observed in bone marrow erythrocytes and liver cells after administration. MSBE appears to be neither embryotoxic nor genotoxic as measured by bone marrow cytogenetics in rodents.

Interactive neuromonitoring methods of cochlea and auditory nerve during induced hypoxia and nerve manipulation

Methods and instrumentation were developed to monitor cochlea and auditory function during surgery. The system allows real time assessment of the cochlear function during auditory nerve manipulation. A specially designed optic probe, placed on the round window (RW) niche, enables simultaneous acquisition of cochlear blood flow (CBF) and electrocochleogram (ECochG). We developed the acquisition paradigms, signal processing methods and implement them in a computational platform. The neuromonitoring system performs an automatic extraction and analysis of cochlear microphonics (CM), compound action potentials (CAP) and sura mating potential (SP). The system uses envelope detection filters to detect the amplitude of the CM. The CAP signal is processed with zero phase shift spectral filters, tuned to enhance the action potential onset, which is sometimes embedded within the sura mating potential. An automatic peak detection and tracking algorithm is then applied to extract latency and amplitude of CAPs. Long-term assessment of the monitoring system was performed during experimental animal surgeries. The system allowed detailed study of the dynamics of CM, CAP and CBF during nerve manipulation and compression.

[Multidetector row CT in assessment of coronary artery calcification on hemodialisis]

Vascular calcification is a strong predictor of cardiovascular and all-cause mortality. Coronary artery calcification is more frequent, more extensive and progresses more rapidly in CKD than in general population. They are also considered a marker of coronary heart disease, with high prevalence and functional significance. It suggests that detection and surveillance may be worthwhile in general clinical practice. New non-invasive image techniques, like Multi-detector row CT, a type of spiral scanner, assess density and volume of calcification at multiple sites and allow quantitative scoring of vascular calcification using calcium scores analogous to those from electron-beam CT. We have assessed and quantified coronary artery calcification with 16 multidetector row CT in 44 patients on hemodialysis and their relationship with several cardiovascular risk factors. Coronary artery calcification prevalence was of 84 % with mean calcium score of 1580 +/- 2010 ( r 0-9844) with calcium score > 400 in 66% of patients. It was usually multiple, affecting more than two vessels in more than 50%. In all but one patient, left anterior descending artery was involved with higher calcium score level at right coronary artery. Advanced age, male, diabetes, smoking, more morbidity, cerebrovascular disease previous, and calcium-binders phosphate and analogous vitamin D treatment would seem to be associated with coronary artery calcification. Coronary artery calcification is very frequent and extensive, usually multiple and associated to modifiable risk factors in hemodialysis patients. Multi-detector-row CT seems an effective, suitable, readily applicable method to assess and quantify coronary artery calcification.

[Good virological response to pegylated interferon alfa monotherapy of chronic hepatitis C infection in hemodialysis patient]

Liver disease caused by hepatitis C virus infection is associated to significant morbidity and mortality among patient with end stage renal disease on maintenance hemodialysis (HD). Therapy in these patients consists of Interferon, preferably pegylated Interferon (pIFN), thus Ribavirin (RBV) is not recommended for patients with impaired renal function, outside its use in controlled trials. We report a case of 35 years young woman on HD treatment, renal transplantation candidate with chronic hepatitis C virus infection, HCV RNA positive (by PCR), genotype 3a, moderate viral load, light increase of aminotransferases. Pegylated Interferon alfa-2a (135 mcg/weekly/SC) was initiated. She achieved HVC RNA negative within 12 weeks, following with pINF as monotherapy to complete 24 weeks (6 months). Sustained virologic response persisted to 24 and 48 weeks. Most important side effects were light detriment of anemia, moderate neutropenia and thombocytopenia, transitory elevation of transaminases and "flu-like" syndrome. Adverse events were well tolerated with total compliance with pIFN dose, no requiring reduce or stop the treatment. These findings confirm that hemodialysis patients with chronic hepatitis C respond well to pegylated IFN monotherapy and a long-term sustained virologic response is achieved, appears to be better tolerated with less side effects, so combination therapy with pINF plus ribavirin is not necessary in all cases.