[Synthetic calcium phosphate ceramics in secondary alveoloplasty]

INTRODUCTION

Bone substitutes are rarely used in the reconstruction of cleft lip and palate. The graft material of choice is cancellous bone, harvested in the hip or tibia. Tibial harvesting may lead to postoperative morbidity, or even complications. This has lead surgeons to develop alternative solution. We present a secondary alveolar bone grafting technique using synthetic calcium phosphate ceramics.

OBSERVATION

A patient presenting with a complete unilateral cleft lip and palate was treated by alveolar bone grafting at the age of nine years, using a mixture of autologous bone, harvested on the operative field, and particles of biphasic calcium phosphate (BCP); the graft was included in a platelet rich plasma (PRP) gel. The patient was followed up for eight years after the procedure. No sign of early or late infection was observed. At the end of facial growth, the cuspid had erupted correctly in a safe periodontal environment. Sequential X-rays showed complete filling of the initial bone defect, progressive resorption of ceramics, and spontaneous eruption of the cuspid.

DISCUSSION

In this long-term follow-up report, the use of BCP mixed with autologous bone did not interfere with dental eruption or maxilla growth. A second bone-harvesting site was thus avoided. BCP could be a suitable alternative to autologous bone graft for secondary alveoloplasty.

Exercise-Induced Lung Disease: Too Much of a Good Thing?

Exercise in children has important health benefits. However, in elite endurance athletes, there is an increased prevalence of exercise-induced bronchoconstriction and airway inflammation. Particularly at risk are those who practice in cold weather, ice rinks, swimming pools, and air pollution. The inflammation is caused by repetitive episodes of hyperventilation of cold, dry air, allergens, or toxins such as chlorine or air pollution. Children may be particularly at risk for lung injury under these conditions because of the immaturity and ongoing development of their lung. However, studies in pediatric athletes and exercising young children are sparse. Epithelial injury associated with hyperventilation of cold, dry air has not been described in children. However, exercise in the presence of air pollution and chlorine is associated with airway injury and the development of asthma in children; the effect appears to be modulated by both atopy and genetic polymorphisms. While management of exercise-induced bronchoconstriction and asthma is well established, there is little data to guide treatment or prevention of remodeling in athletes or inhalational lung injury in children. Studies underscore the need to maintain high levels of air quality. More investigations should be undertaken to better define the natural history, pathophysiology, and treatment of exercise-induced pulmonary inflammation in both elite athletes and exercising children.

An in vitro study of two GAG-like marine polysaccharides incorporated into injectable hydrogels for bone and cartilage tissue engineering

Natural polysaccharides are attractive compounds with which to build scaffolds for bone and cartilage tissue engineering. Here we tested two non-standard ones, HE800 and GY785, for the two-dimensional (2-D) and three-dimensional (3-D) culture of osteoblasts (MC3T3-E1) and chondrocytes (C28/I2). These two glycosaminoglycan-like marine exopolysaccharides were incorporated into an injectable silylated hydroxypropylmethylcellulose-based hydrogel (Si-HPMC) that has already shown its suitability for bone and cartilage tissue engineering. Results showed that, similarly to hyaluronic acid (HA) (the control), HE800 and GY785 significantly improved the mechanical properties of the Si-HPMC hydrogel and induced the attachment of MC3T3-E1 and C28/I2 cells when these were cultured on top of the scaffolds. Si-HPMC hydrogel containing 0.67% HE800 exhibited the highest compressive modulus (11kPa) and allowed the best cell dispersion, especially of MC3T3-E1 cells. However, these cells did not survive when cultured in 3-D within hydrogels containing HE800, in contrast to C28/I2 cells. The latter proliferated in the microenvironment or concentrically depending on the nature of the hydrogel. Among all the constructs tested the Si-HPMC hydrogels containing 0.34% HE800 or 0.67% GY785 or 0.67% HA presented the most interesting features for cartilage tissue engineering applications, since they offered the highest compressive modulus (9.5-11kPa) while supporting the proliferation of chondrocytes.

Phosphate-dependent stimulation of MGP and OPN expression in osteoblasts via the ERK1/2 pathway is modulated by calcium

Inorganic phosphate (Pi) acts as a signaling molecule in bone-forming cells, affecting cell functions and gene expression. Particularly, Pi stimulates the expression of mineralization-associated genes such as matrix gla protein (MGP) and osteopontin (OPN) through the ERK1/2 pathway. With respect to the presence of elevated extracellular calcium and Pi levels during bone remodeling, we questioned whether calcium might play a role in the Pi-dependent effects in osteoblasts. We first showed by Western blot and real-time PCR that the concomitant presence of 10 mM Pi and 1.8 mM calcium is required to stimulate ERK1/2 phosphorylation and MGP/OPN genes expression. The mechanisms involved in the cellular effects of calcium in the presence of Pi were subsequently examined. Firstly, the use of the calcium-sensing receptor (CaSR) agonist gadolinium and the G-protein inhibitor pertussis toxin enabled us to determine that a CaSR mechanism is not involved in the Pi and calcium mediated cellular effects. By transmission electron microscopy, we next demonstrated that adding 10mM Pi to the culture medium containing 1.8mM calcium led to the formation calcium phosphate precipitates (CaPp). Moreover, treatment of osteoblasts with exogenous pre-synthesized CaPp stimulated ERK1/2 phosphorylation and MGP/OPN genes expression. In spite of high extracellular calcium and Pi concentrations, this stimulation was blunted in the presence of phosphocitrate, an inhibitor of crystal formation. Finally, we showed that despite that CaPp are not endocytosed, their effect on ERK1/2 phosphorylation and MGP/OPN genes expression were dependent on lipid rafts integrity. In summary, we showed that calcium is required for Pi-dependent ERK1/2 phosphorylation and regulation of mineralization-associated genes in osteoblasts and that its effect could originate from extracellular-related effects of CaPp that are dependent on the integrity of lipid rafts.

Inorganic phosphate stimulates apoptosis in murine MO6-G3 odontoblast-like cells

OBJECTIVE

Dental pathologies such as caries are the most prevalent disease worldwide with infectious and social complications. During the process of caries formation, the tooth is degraded and demineralization of enamel and dentine leads to the release of large amounts of inorganic phosphate (Pi) within dental tubuli. As Pi has been shown to induce apoptosis in skeletal cells, including osteoblasts and chondrocytes, we questioned whether high concentrations of Pi could affect odontoblast viability, proliferation and apoptosis.

DESIGN

Using the odontoblast-like MO6-G3 cell line as a model, we used cell counting and MTS-based colorimetric assays to measure cell viability and proliferation. Apoptosis was assessed using Hoechst nuclei staining and detection of the early apoptotic markers annexin V and Apo2.7.

RESULTS

We show for the first time that a high Pi concentration (7 mM) induced a decrease in odontoblast viability and proliferation together with a large increase in apoptosis. These effects were blunted in calcium-free medium, possibly due to the formation of calcium-phosphate crystals in the presence of high Pi concentrations.

CONCLUSION

This study contributes to clarifying the effect of Pi on odontoblast viability and apoptosis, which may improve our understanding of the role of Pi during caries formation.

In vitro characterisation of calcium phosphate biomaterials loaded with lidocaine hydrochloride and morphine hydrochloride

Calcium phosphate substitutes drug delivery systems are well known substances used in minor bone void-filling to release their therapeutic agent in situ. Few studies associating anaesthetics and analgesics have been performed to date. The aim of this work was to study the association of the analgesic, morphine, and the local anaesthetic, lidocaine, with a calcium deficient apatite matrix. Three types of biomaterials i.e. powders, granules and blocks, were prepared by isostatic compression, wet granulation and a combination of the two, evaluated and compared. The chemical structure of the associated therapeutic agent was studied and the characteristics of the drug delivery systems were appraised in terms of drug release. The integrity of the lidocaine hydrochloride structure, as determined by RMN (1)H, was confirmed regardless of the formulation technique used (isostatic compression or wet granulation). However, analyses of morphine hydrochloride by RMN (1)H revealed slight structural modifications. The association and formulation techniques that were used made it possible to obtain an in vitro release time varying from 1 to 4 days for lidocaine hydrochloride and from 1 to 3 days for morphine hydrochloride.

[Some signs of women applying for abortion]

OBJECTIVE

To discover the motivation of women for abortion.

DESIGN

Prospective questionary study.

SETTING

Department of Obstetrics and Gynecology, 1st Faculty of Medicine Charles University and General Faculty Hospital Prague.

METHODS

Special questionnaire centered on the social situation, sexual behavior, knowledge about contraception and the use of contraception, and a motivation for abortion was given to one hundred women attending our clinic for abortion for non-medical reasons. Results were discussed in comparison with population survey data.

RESULTS AND CONCLUSION

Although education and acces to modern contraceptive methods have induced the great progress in the area of family planning, abortion is still an important psychosocial problem. In our sample an earlier start of sexual intercourse, higher number of sexual partners, and substantialy lower number of hormonal contraception users were found.

[Sexual morbidity after surgery for gynaecologic cancer]

OBJECTIVE

Sexual dysfunctions after surgery for gynaecologic cancer.

DESIGN

Review article.

SETTING

Department of Gynaecology and Obstetrics, 1st Medical Faculty, Charles University, Prague.

METHOD

An overview of published data.

CONCLUSION

Sexual functions are the basic part of quality of life. Even there exist just limited studies dedicated to postsurgical sexual morbidity, it is conclusive in most of them, that surgical therapy for gynaecologic malignant tumours is connected with long-lasting anatomical and physiological changes, which can cause sexual dysfunctions in women. These are often complex and some of them last for more than two years after the operation. Well-timed sexuological counseling and openness of health care providers in sexual topics are very important parts of complex care of oncogynaecologic patients and their partners.

[Survey of contraceptive behaviour and attitude of Czech women towards different types of contraception]

OBJECTIVE

Survey of contraceptive behaviour and attitude of Czech women towards different types of contraception.

DESIGN

Representative survey.

METHODS

Anonymous questionnaire survey of the sample of 1011 Czech women aged from 15 to 50.

RESULTS

More than half of the women of our sample used some form of contraception during their first sexual intercourse. Most of the women used condom (41%), only a small part used hormonal contraception or withdrawal. Eighty percent of Czech women use some form of contraception with their stable partner, most often hormonal contraception (51%). One sixth of Czech women use condom. Using contraception is influenced mostly by age and religious belief: younger respondents show more responsible contraceptive behaviour at their first sexual intercourse, they use hormonal contraception with their stable partner more often. Furthermore, atheists protect themselves by some form of contraception more often than believers. The most used form is hormonal contraception.

CONCLUSION

Czech women show responsible contraceptive behaviour during their heterosexual intercourse. There is a significant increase of using hormonal contraception.

Developments in injectable multiphasic biomaterials. The performance of microporous biphasic calcium phosphate granules and hydrogels

Calcium phosphate bioceramic granules associated with hydrosoluble polymers were developed as bone substitutes for various maxillofacial and orthopaedic applications. These injectable bone substitutes, support and regenerate bone tissue and resorb after implantation. The efficiency of these multiphasic materials is due to the osteogenic and osteoconductive properties of the microporous biphasic calcium phosphate. The associated hydrosoluble polymers are considered as carriers in order to achieve the rheological properties of injectable bone substitutes (IBS). In this study, we used 2 semi synthetic hydrosoluble polymers of polysaccharidic origin. The hydroxy propyl methyl cellulose (HPMC), with and without silane, was combined with microporous BCP granules. The presence of silane induced considerable gelation of the suspension. The 2 IBS used (without gelation, IBS1, with gelation, IBS2) were implanted in critical size femoral epiphysis defects in rabbits. No foreign body reactions were observed in either sample. However, because of the higher density from gelation, cell colonisation followed by bone tissue ingrowth was delayed over time with IBS2 compared to the IBS1 without gelation. The results showed resorption of the BCP granule and bone ingrowth at the expense of both IBS with different kinetics. This study demonstrates that the hydrogel cannot be considered merely as a carrier. The gelation process delayed cell and tissue colonisation by slow degradation of the HPMC Si, compared to the faster release of HPMC with IBS1, in turn inducing faster permeability and spaces for tissue ingrowth between the BCP granules.

Vertical distribution of organochlorine pesticides in humus along Alpine altitudinal profiles in relation to ambiental parameters

In forest soils along vertical profiles located in different parts of the Alps, concentrations of persistent organic pollutants (POPs), namely organochlorine pesticides (OCPs) like dichlorodiphenyltrichloroethanes (DDTs), hexachlorobenzene (HCB), hexachlorocyclohexanes (HCH), heptachlor, aldrin, dieldrin and mirex, were measured. Though local characteristics of the sites are influenced by numerous factors like orographic and meteorological parameters, forest stand characteristics and humus parameters, we ascertained a marked vertical increase of concentrations of some organochlorine compounds in the soil. On the basis of climatological values of each site, we found that the contamination increase with altitude can be ascribed to a certain 'cold condensation effect'. In addition, the perennial atmospheric deposition of POPs is controlled by precipitation. Other key parameters explaining the accumulation of POPs are the soil organic carbon stocks, the turnover times, the re-volatilisation and degradation processes, which vary with altitude.

PCDD/F and PCB in spruce forests of the Alps

PCDD/F and PCB concentrations in remote mountainous spruce stands of the Central European Alps show strong geographic variation. Independent of the matrix (0.5 year old needles, humus or mineral soil), the highest pollutant levels were always found at the lateral zones of the mountain range. High levels coincided with strong precipitation, particularly along the northern margin of the study region. The most volatile PCB congener propagated farther into the colder, drier central Alps than the heavier species. Matrices with different accumulation history (needles and humus) repeatedly reflected different spatial emission patterns. Consistent with its much longer exposure, pollutant levels in humus exceeded those of needles by up to two orders of magnitude. Needle contamination varied with altitude but the vertical trends were highly variable between transsects and changed between years, too.

Novel sampling methods for atmospheric semi-volatile organic compounds (SOCs) in a high altitude alpine environment

High- and low-volume active air samplers as well as bulk deposition samplers were developed to sample atmospheric SOCs under the adverse conditions of a mountain environment. Active sampling employed separate filters for different European source regions. Filters were switched depending on daily trajectory forecasts, whose accuracy was evaluated post hoc. The sampling continued on three alpine summits over five periods of four months. The prevailing trajectories varied stronger between sampling periods than between stations. The sampling equipment (active and bulk deposition) proved dependable for operation in a mountain environment, with idle times being mainly due to non-routine manipulations and connectivity.

A comparison of Alpine emissions to forest soil and spruce needle loads for persistent organic pollutants (POPs)

The project MONARPOP analysed the concentrations of semivolatile organic compounds (SVOCs) in two important sink compartments, needles of Norway spruce (Picea abies [L.] Karst.) and forest soil from 40 remote Alpine forest sites in Austria, Germany, Italy, Slovenia and Switzerland. In the present study the load of PCDD/F, PCB, PBDE, PAH, HCB, HCH and DDT in the Alps calculated on the basis of measured data are compared with their estimated emissions in the Alpine region. It comes out that the masses of the studied pollutants stored in the forests are higher than the corresponding emissions in the Alpine area indicating that the Alps are a sink for POPs advected from surrounding areas. It is assumed that local emissions of PCDD/F and PAH deriving from biomass burning are probably underestimated and that the pool of these pollutants in the forests represents the accumulation over some decades.

Imitators of exercise-induced bronchoconstriction

Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.

[Knowledge of Czech and Romanian women about STIs. Representative survey]

OBJECTIVE

Survey of knowledge of Czech and Romanian women about STIs and their perception of sources of the information.

DESIGN

Representative survey.

METHODS

Anonymous questionnare survey of the sample of 1011 Czech and 1001 Romanian women aged 15 to 50.

RESULTS

The doctor or the psychologist is considered to be the most reliable source of information about STIs, the Czech women prefer information from books and papers, Romanian women consider the close persons to be more better source of information than Czech women. The Czech women know better the realy effective methods of STI prevention and situations which are risky from the possible HIV/AIDS infection, Romanian ones more often believe in non effective methods of prevention and more often are afraid of situations, which are not dangerous and more often were not able to answer the questions at all.

CONCLUSION

Romanian women have worse konwledge in the area of STIs than Czech ones. They are also more credulous to information from different sources, especially to those provided by experts or by close persons.