Combined effects of electric toothbrushing and dentifrice on artificial stain removal: An in vitro study

Background

This in vitro study aimed to clarify the combined effect of electric toothbrushing and dentifrice on the removal of artificial stain.

Material and Methods

Twenty-five bovine incisors were cut at the cervix and the crown was embedded in auto-cured acrylic resin. Specimens were abraded using #240 SiC paper to obtain a flat enamel surface, and 20 specimens were treated with 10% citric acid / 3% ferric chloride solution followed by 1% tannic acid solution to produce surface staining. They were divided into four groups: 1) brushing with an electric toothbrush and whitening dentifrice (group S+B); 2) brushing with an electric toothbrush and fluoride dentifrice (group S+C); 3) brushing with an electric toothbrush and no dentifrice (group S); and 4) no brushing (control group). The remaining five specimens were used as a baseline. Color values (L*, a*, and b* were measured before brushing (0 min), and at 1 min, 5 min, 10 min, and 20 min using a microscopic area spectrophotometer. The color change (ΔE) was calculated by subtracting the baseline values from the final color values obtained at each time point. The data were statistically analyzed using two-way repeated-measures analysis of variance and Tukey’s honest significant difference test as a post hoc test (p<0.05).

Results

The L* values of groups S+B and S+C increased over time (p<0.05), but no significant differences were observed in group S and the control group at any of the time points (p>0.05). Groups S+B and S+C demonstrated greater ΔE values than group S.

Conclusions

The combination of electric toothbrushing and dentifrice removed the artificial stain more effectively than brushing without dentifrice. However, the stain removal was limited. The two dentifrices evaluated in this study exhibited similar stain removal effects.

Key words:Color change, stain removal, dentifrice, electric toothbrush, whitening effect.

Survival Benefit of Tolvaptan for Refractory Ascites in Patients with Advanced Cirrhosis

AIMS

The study aimed to evaluate the effects of tolvaptan treatment on survival of patients with decompensated liver cirrhosis with refractory ascites.

METHODS

This multicenter, retrospective, observational study included patients with cirrhosis who were treated with tolvaptan for hepatic ascites refractory to conventional diuretics. Patients who could and could not decrease accompanying diuretics within 1 month after tolvaptan administration were defined as the "Decreased" and "Not-decreased" groups, respectively.

RESULTS

Median body weight change 1 week after tolvaptan treatment was -1.95 kg, with the 50% of patients experiencing a 2 kg/week reduction. Spot urinary sodium was found to be a better predictor of tolvaptan response than liver function and liver fibrosis markers. Median survival was significantly longer (not reached versus 116 days, p = 0.005) and serum creatinine concentrations 12 weeks after tolvaptan administration significantly lower (0.99 vs. 1.55 mg/dL, p < 0.05) in the Decreased than in the Not-decreased group. Multivariate analysis showed that the presence of viable hepatocellular carcinoma (hazards ratio [HR] 2.14, p = 0.02) and a decrease in diuretics were independently prognostic of survival (HR 0.36, p < 0.01).

CONCLUSIONS

The maintenance of renal function is essential in enhancing survival of patients with cirrhosis. Doses of diuretics should be adjusted appropriately during tolvaptan treatment.

L-Carnitine for the Treatment of Overt Hepatic Encephalopathy in Patients with Advanced Liver Cirrhosis

Hepatic encephalopathy is a major complication in patients with advanced cirrhosis and is associated with poor prognosis. To evaluate the effectiveness of L-carnitine supplementation in patients with overt hepatic encephalopathy (OHE), outcomes were retrospectively analyzed in patients with OHE who were treated with intravenous branched-chain amino acids (BCAA), with or without intravenous L-carnitine. Twenty-six patients were treated with intravenous BCAA in addition to conventional agents such as lactulose and non-absorbable antibiotics (Group A), and 19 patients were treated with these agents plus intravenous L-carnitine (Group L). Changes in blood ammonia concentrations, hepatic coma grade and the Glasgow Coma Scale (GCS) were compared in the two groups. Recurrence-free survival (RFS) was evaluated in the two groups and in patients who were and were not administered oral L-carnitine supplementation. At baseline, GCS scores were significantly lower and deterioration in liver function greater in Group L. After 3 d of intravenous L-carnitine, however, GCS showed a significantly greater improvement in Group L than in Group A. Blood ammonia levels improved stably over time in Group L. Overall survival and RFS were similar in Group L and Group A, but median RFS was significantly longer in patients who did than did not receive oral L-carnitine supplementation (735 versus 497 d, p=0.03). Although these findings are preliminary, L-carnitine supplementation may be a therapeutic option for patients with OHE and disturbed consciousness.

Astaxanthin prevents ischemia-reperfusion injury of the steatotic liver in mice

Steatosis has a low tolerance against ischemia-reperfusion injury (IRI). To prevent IRI in the steatotic liver, we attempted to elucidate the protective effect of astaxanthin (ASTX) in the steatotic liver model by giving mice a methionine and choline-deficient high fat (MCDHF) diet. Levels of lipid peroxidation and apoptosis, the expression of inflammatory cytokines and heme oxygenase (HO)-1, in the liver were assessed. Reactive oxygen species (ROS), inflammatory cytokines, apoptosis-related proteins and members of the signaling pathway were also examined in isolated Kupffer cells and/or hepatocytes from the steatotic liver. ASTX decreased serum ALT and AST levels, the amount of TUNEL, F4/80, or 4HNE-positive cells and the mRNA levels of inflammatory cytokines in MCDHF mice by IRI. Moreover, HO-1 and HIF-1α, phosphorylation of Akt and mTOR expressions were increased by ASTX. The inflammatory cytokines produced by Kupffer, which were subjected to hypoxia and reoxygenation (HR), were inhibited by ASTX. Expressions of Bcl-2, HO-1 and Nrf2 in hepatocytes by HR were increased, whereas Caspases activation, Bax and phosphorylation of ERK, MAPK, and JNK were suppressed by ASTX. Pretreatment with ASTX has a protective effect and is a safe therapeutic treatment for IRI, including for liver transplantation of the steatotic liver.

Can Diet Modulate Helicobacter pylori-associated Gastric Pathogenesis? An Evidence-Based Analysis

Helicobacter pylori is involved in the pathogenesis of gastritis, peptic ulcer, and gastric cancer. The infection is prevalent in more than half of the world's population. Although the infection may lead to detrimental consequences, still the majority of the infected individuals only develop mild gastritis. Several factors are behind this paradoxical outcome including virulence of the infecting H. pylori strains, genetic background of the host, and factors related to lifestyle such as dietary habits. Among these, lifestyle including dietary factors was not in the limelight, until recently, as one of the important factors that could modulate H. pylori-linked gastric diseases. This review is directed to gather and elucidate the role of dietary components in augmenting or attenuating pathological processes initiated by H. pylori. Available evidence strongly supports the notion that the diet may play a critical role in defining the final outcome of H. pylori infection particularly if certain dietary components are taken on a regular basis for a long time. Despite a recent surge in research related to the role of dietary ingredients, further studies involving large-scale clinical trials are required to gain a better understanding of the precise role played by the dietary ingredients in H. pylori-associated pathogenesis.

Vanishing Tumor in a Liver Graft from a Hepatitis B Virus Surface Antigen-Positive Donor

We report a case of vanishing tumor considered as inflammatory pseudotumor (IPT) found in the liver after living donor liver transplantation (LDLT) from a hepatitis B virus surface antigen-positive donor. The radiological findings were similar to those of hepatocellular carcinoma (HCC). However, the tumor disappeared completely within several months and was suggested to have been an IPT. IPT is known to be associated with biliary duct operation or biliary infection, and it can show various enhancement patterns in radiological studies, sometimes resembling HCC. It should be considered in the differential diagnosis of a liver tumor in patients with LDLT.

Pathogenesis of Helicobacter pylori infection

Helicobacter pylori is responsible for the most commonly found infection in the world's population. It is the major risk factor for gastric cancer development. Numerous studies published over the last year provide new insights into the strategies employed by H. pylori to adapt to the extreme acidic conditions of the gastric environment, to establish persistent infection and to deregulate host functions, leading to gastric pathogenesis and cancer. In this review, we report recent data on the mechanisms involved in chemotaxis, on the essential role of nickel in acid resistance and gastric colonization, on the importance of adhesins and Hop proteins and on the role of CagPAI-components and CagA. Among the host functions, a special focus has been made on the escape from immune response, the ability of bacteria to induce genetic instability and modulate telomeres, the mechanism of autophagy and the deregulation of micro RNAs.

Strain elastography for assessment of liver fibrosis and prognosis in patients with chronic liver diseases

BACKGROUND

Estimation of liver stiffness is essential in the treatment of liver diseases. Various procedures alternative to liver biopsy have been developed, and transient elastography using shear wave is an established method for evaluating liver stiffness and has been shown to be a prognostic indicator. In contrast, strain elastography (SE) has been applied to evaluate liver stiffness, however the significance remains uncertain.

METHODS

We retrospectively analyzed 598 patients who underwent SE to evaluate the ability of estimating liver stiffness and the prognosis. Elasticity index (EI) was evaluated as an indicator of liver stiffness in this study.

RESULTS

EI was increased as histological fibrosis advanced. EI was significantly different between mild fibrosis (F0-2) and advanced fibrosis (F3, 4). In contrast, EI was similar among those with different activity scores. EI showed better diagnostic performance in estimating advanced fibrosis than other serological markers and good reproducibility. Furthermore, EI was shown to be an independent prognostic factor in patients with chronic liver diseases and also with hepatocellular carcinoma (HCC) with advanced stage.

CONCLUSIONS

SE could estimate advanced liver fibrosis without influence of liver inflammation unlike other serological liver fibrosis markers. SE might be a prognostic factor in chronic liver diseases and HCC.