P713 An incidental finding of a completely thrombosed left ventricular pseudoaneurysm: what is the next step?

Introduction

Left ventricular pseudoaneurysm is a rare complication of myocardial infarction. It is the result of ventricular rupture contained by the pericardial adhesions or thrombus. Although echocardiography is suitable as the initial method for diagnosis, multimodality imaging is often required in order to further characterize the pseudoaneurysm morphology and to plan the treatment.

Case report

A 56-year-old male patient with an old inferior myocardial infarction treated conservatively 6 years ago, was admitted in our department for atypical left laterothoracic pain. Three months before he had the same symptoms and an unexplained paracardiac mass was incidentally diagnosed by transthoracic echocardiography. At that time, he was evaluated by coronary angiography which showed no epicardial coronary artery stenosis. During admission, the ECG showed sinus rhythm, inferior myocardial scarring and right bundle branch block. The laboratory tests revealed cardiac enzymes within normal range, increased D-dimeri and elevated inflammatory markers. The echocardiography showed a nondilated left ventricle (LV) with preserved ejection fraction and akinesia of the inferolateral(IL) LV wall. Attached to the basal IL LV wall, an extensive mass was documented with an echogenic appearance and no color Doppler flow, suggesting a thrombosed pseudoaneurysm. A contrast enhanced computed tomography (CT) scan confirmed the diagnosis, but it was not able to establish whether the pseudoaneurysm was partially or completely thrombosed. For a more accurate morphologic and tissue characterization, a cardiac magnetic resonance imaging(CMR) was subsequently performed, that confirmed the presence of a completely thrombosed pseudoaneurysm, measuring 82x38mm. In this case, a conservative approach was initially suggested by the completely thrombosed chronic pseudoaneurysm (older than 3months and with no Doppler color flow). However, according to the literature a surgical approach should be considered when the pseudoaneurysm dimension is larger than 3 cm. Since the patient refused the surgical intervention, medical treatment was initiated with anticoagulants due to the high embolic risk, betablockers and angiotensin-receptor antagonists to maintain the blood pressure less than 120/80mmHg. At 1 month, his condition was stable. He will be reevaluated in 3 months, to monitor the possible pseudoaneurysm expansion. According to our knowledge, this is the first case of a completely thrombosed pseudoaneurysm described in the literature. Its echocardiographic, CT and CMR appearance is important for the differential diagnosis of all paracardiac masses (tumors, hiatus hernias, etc).

Conclusion

Completely thrombosed left ventricle pseudoaneurysm remains a challenging diagnosis since its echocardiographic appearance is atypical. Cardiac magnetic resonance imaging has a higher diagnostic yield and can provide important information that may influence the course of treatment.

Abstract P713 Figure. LV Pseudoaneurysm-multimodality imaging

Characterization of the novel HLA-C*16:97 allele in an Italian bone marrow donor

The HLA-C*16:97 allele differs from HLA-C*16:01:01:01 at position 666 of exon 4.

Summed and Weighted Summary Scores for the Medsger Disease Severity Scale Compared with the Physician’s Global Assessment of Disease Severity in Systemic Sclerosis

Objective.

To develop a weighted summary score for the Medsger Disease Severity Scale (DSS) and to compare its measurement properties with those of a summed DSS score and a physician’s global assessment (PGA) of severity score in systemic sclerosis (SSc).

Methods.

Data from 875 patients with SSc enrolled in a multisite observational research cohort were extracted from a central database. Item response theory was used to estimate weights for the DSS weighted score. Intraclass correlation coefficients (ICC) and convergent, discriminative, and predictive validity of the 3 summary measures in relation to patient-reported outcomes (PRO) and mortality were compared.

Results.

Mean PGA was 2.69 (SD 2.16, range 0–10), mean DSS summed score was 8.60 (SD 4.02, range 0–36), and mean DSS weighted score was 8.11 (SD 4.05, range 0–36). ICC were similar for all 3 measures [PGA 6.9%, 95% credible intervals (CrI) 2.1–16.2; DSS summed score 2.5%, 95% CrI 0.4–6.7; DSS weighted score 2.0%, 95% CrI 0.1–5.6]. Convergent and discriminative validity of the 3 measures for PRO were largely similar. In Cox proportional hazards models adjusting for age and sex, the 3 measures had similar predictive ability for mortality (adjusted R2 13.9% for PGA, 12.3% for DSS summed score, and 10.7% DSS weighted score).

Conclusion.

The 3 summary scores appear valid and perform similarly. However, there were some concerns with the weights computed for individual DSS scales, with unexpected low weights attributed to lung, heart, and kidney, leading the PGA to be the preferred measure at this time. Further work refining the DSS could improve the measurement properties of the DSS summary scores.

Modulation of Malaria Phenotypes by Pyruvate Kinase (PKLR) Variants in a Thai Population

Pyruvate kinase (PKLR) is a critical erythrocyte enzyme that is required for glycolysis and production of ATP. We have shown that Pklr deficiency in mice reduces the severity (reduced parasitemia, increased survival) of blood stage malaria induced by infection with Plasmodium chabaudi AS. Likewise, studies in human erythrocytes infected ex vivo with P. falciparum show that presence of host PK-deficiency alleles reduces infection phenotypes. We have characterized the genetic diversity of the PKLR gene, including haplotype structure and presence of rare coding variants in two populations from malaria endemic areas of Thailand and Senegal. We investigated the effect of PKLR genotypes on rich longitudinal datasets including haematological and malaria-associated phenotypes. A coding and possibly damaging variant (R41Q) was identified in the Thai population with a minor allele frequency of ~4.7%. Arginine 41 (R41) is highly conserved in the pyruvate kinase family and its substitution to Glutamine (R41Q) affects protein stability. Heterozygosity for R41Q is shown to be associated with a significant reduction in the number of attacks with Plasmodium falciparum, while correlating with an increased number of Plasmodium vivax infections. These results strongly suggest that PKLR protein variants may affect the frequency, and the intensity of malaria episodes induced by different Plasmodium parasites in humans living in areas of endemic malaria.

Growing skull fracture in a 2 months old child

A growing skull fracture, also called posttraumatic leptomeningeal cyst, is a rare complication of skull fractures - less than 1%, usually encountered in children younger than 3 years old. Although rare, this complication must be recognized early and treated to prevent permanent neurologic deficits. We present the case of a 2 months old child who had suffered a closed head trauma in a car accident 2 weeks before he was admitted in our clinic with a left parietal growing skull fracture. He was submitted to surgery and leptomeningeal cyst was evacuated, dural defect repaired and bone fragments fixed. Child was discharged 6 days postoperative without neurologic deficits. Growing skull fractures represent a rare complication of head trauma in small children. It is imperious to be recognized and treated in early phases to prevent debilitating permanent neurologic deficits in that category of population.

Adult quality of life in congenital hydrocephalus operated cases. A twenty years retrospective study

Congenital hydrocephalus is a health problem in many countries and in Romania the pediatric neurosurgical department of the Emergency Hospital “Bagdasar-Arseni” has a large number of such patients. This is a retrospective study and it includes the patients with congenital hydrocephalus operated between 1992 and 2012 in the pediatric neurosurgical department of the Emergency Hospital “Bagdasar-Arseni”. The functional outcome was assessed using Karnofsky Performance Scale, Hydrocephalus Outcome Questionnaire and Glasgow outcome scale. The total number of the patients was 372, with a predominance of boys (212 boys versus 160 girls) and at the time of our study 168 patients were over 16 years old. Functional outcome of the children over 16 years old assessed using Karnofsky Performance Scale, showed that 73 patients were above 80 and leading independent lives, and 95 were less than 80 points. The results would be better if all these patients would benefit from schooling for children with special needs.

A new HLA allele, HLA-B*08:122, described in an unrelated donor of Caucasian origin

A new human leukocyte antigen-B allele was found in an unrelated Italian donor.

Independent mutations at Arg181 and Arg274 of Vangl proteins that are associated with neural tube defects in humans decrease protein stability and impair membrane targeting

In vertebrates, Vangl proteins play important roles during embryogenesis, including establishing planar polarity and coordinating convergent extension movements. In mice, homozygosity for mutations in the Vangl1 and Vangl2 genes or combined heterozygosity for Vangl1/Vangl2 mutations causes the very severe neural tube defect (NTD) craniorachischisis. Recently, a number of patient-specific VANGL1 and VANGL2 protein mutations have been identified in familial and sporadic cases of mild and severe forms of NTDs. The biochemical nature of pathological effects in these mutations remains unknown. Of interest are two arginine residues, R181 and R274, that are highly conserved in Vangl protein homologues and found to be independently mutated in VANGL1 (R181Q and R274Q) and VANGL2 (R177H and R270H) in human cases of NTDs. The cellular and biochemical properties of R181Q and R274Q were established in transfected MDCK kidney epithelial cells and compared to those of wild-type (WT) Vangl1. Compared to that of WT, these mutations displayed impaired targeting to the plasma membrane and were instead detected in an intracellular endomembrane compartment that was positive for the endoplasmic reticulum. R181Q and R274Q showed impaired stability with significant reductions in measured half-lives from >20 h for WT protein to 9 and 5 h, respectively. These mutations have a cellular and biochemical phenotype that is indistinguishable from that of Vangl mutations known to cause craniorachichisis in mice (Lp). These results strongly suggest that R181 and R274 play critical roles in Vangl protein function and that their mutations cause neural tube defects in humans.

Genetic control of susceptibility to Candida albicans in SM/J mice

In the immunocompromised host, invasive infection with the fungal pathogen Candida albicans is associated with high morbidity and mortality. Sporadic cases in otherwise normal individuals are rare, and they are thought to be associated with genetic predisposition. Using a mouse model of systemic infection with C. albicans, we identified the SM/J mouse strain as unusually susceptible to infection. Genetic linkage studies in informative [C57BL/6JxSM/J]F2 mice identified a major locus on distal chromosome 15, given the appellation Carg5, that regulates C. albicans replication in SM/J mice. Cellular and molecular immunophenotyping experiments, as well as functional studies in purified cell populations from SM/J and C57BL/6J, and in [C57BL/6JxSM/J]F2 mice fixed for homozygous or heterozygous Carg5 alleles, indicate that Carg5-regulated susceptibility in SM/J is associated with a complex defect in the myeloid compartment of these mice. SM/J neutrophils express lower levels of Ly6G, and importantly, they show significantly reduced production of reactive oxygen species in response to stimulation with fMLF and PMA. Likewise, CD11b(+)Ly6G(-)Ly6C(hi) inflammatory monocytes were present at lower levels in the blood of infected SM/J, recruited less efficiently at the site of infection, and displayed blunted oxidative burst. Studies in F2 mice establish strong correlations between Carg5 alleles, Ly6G expression, production of serum CCL2 (MCP-1), and susceptibility to C. albicans. Genomic DNA sequencing of chromatin immunoprecipitated for myeloid proinflammatory transcription factors IRF1, IRF8, STAT1 and NF-κB, as well as RNA sequencing, were used to develop a "myeloid inflammatory score" and systematically analyze and prioritize potential candidate genes in the Carg5 interval.

The intracellular carboxyl terminal domain of Vangl proteins contains plasma membrane targeting signals

Vangl1 and Vangl2 are integral membrane proteins that play a critical role in establishing planar cell polarity (PCP) in epithelial cells and are required for convergent extension (CE) movements during embryogenesis. Their proper targeting to the plasma membrane (PM) is required for function. We created discrete deletions at the amino and carboxy termini of Vangl1 and monitored the effect of the mutations on PM targeting in Madin-Darby canine kidney cells. Our results show that the Vangl1 amino terminus lacks PM targeting determinants, and these are restricted to the carboxy terminus, including the predicted PDZBM motif at the C-terminus.

Chewing stress developed in upper anterior teeth with root end resection. a finite element analysis study

AIM

Because pulpless teeth have a higher risk of vertical root fracture, the present study investigated the additional effect of root end resection upon their mechanical resistence.

METHODS

Finite element analysis (FEA) was used to evaluate the stress and deformations of upper anterior teeth after root end resection while loading them at 100N and 300N.

RESULTS

Loading teeth with root end resection at 100N generates a mild increase of dentin stress. Even though von Misses stress is within the elastic range the whole toothbone structure is stressed while chewing. At higher load of300N the vertical and mesiodistal deformations cannot beany longer neglected. The highest stress occurs in vertical direction and involves the whole labial surface of the tooth crown. It is expressed as a compression stress (SY = 2.8 x 109N/m2) and comes close to the value of dentine Young’s modulus.

CONCLUSION

Loading the upper anterior teeth with root end resection at 100N lowers in a mild manner their mechanical resistance. A load of 300 N induces tooth deformations and a risky stress, mostly focused at tooth cervical area. The stress in the alveolar ridge bone is under the risk threshold of Young’s modulus.

Masticatory tensile developed in upper anterior teeth with chronic apical periodontitis. A finite-element analysis study

Commonly is accepted that a non-vital tooth has a higher risk of root fracture but there is a relatively little knowledge about the specific biomechanical behavior of non-vital frontal teeth with chronic apical periodontitis. The aim of our study was to evaluate the deformation and tensile generated in these teeth while vertically loading them because it is crucial to assess the moment when the absorbed occlusal forces exceed the elasticity of root dentine. Using the method of finite-element analysis, we highlighted the distribution patterns of the compressive and tension tensile, as well as their concentration areas. The vertical forces of 100 N generate deformations of no clinical risk in teeth with chronic apical periodontitis. The tensile developed in these teeth are higher than those in the vital teeth are but do not exceed the value of the elastic modulus of the radicular dentin. By increasing the force to 300 N occur elastic deformations, which cannot be neglected anymore. Even so, the 300 N forces do not generate deformations of the alveolar bone. The highest tensile at loading with 300 N was generated in vertical direction but in the cervical area of the tooth also developed tensile in lingual and mesiodistal direction that must be taken into consideration because they are near the risk limit of the elasticity modulus. The crack lines or fractures can appear both in case of excessive or even usual but accumulative occlusal forces that gradually alter the mechanical resistance of the tooth.

An expanding role of Vangl proteins in embryonic development

The mammalian Vangl1 and Vangl2 genes were discovered a decade ago through their association with neural tube defects, in particular the presence of Vangl2 mutations in independent alleles of the mouse mutant Loop-tail (Lp), a mouse model of the severe neural tube defect craniorachischisis. Vangl1 and Vangl2 variants have also been detected in familial and sporadic cases of spina bifida. Vangl proteins are highly conserved in evolution with relatives in flies, and distant invertebrates and vertebrates. In these organisms, they play a central role in planar cell polarity (PCP) and convergent extension (CE) movements. Over the past decade, these functional characteristics have also been established for mammalian Vangl genes. The careful analysis of mouse Vangl genes mutants has showed that these genes and the associated PCP pathway and CE movements are involved in many unexpected developmental processes, from morphogenesis of different tissues, left-right asymmetry, asymmetric cell division, and organization of many epithelial structures, as well as positioning and function of cellular appendages. Genetic studies in double mutants and biochemical studies of interacting proteins have started to elucidate the molecular pathways in which Vangl proteins participate and that regulate these complex events.

Loss of membrane targeting of Vangl proteins causes neural tube defects

In the mouse, the loop-tail mutation (Lp) causes a very severe neural tube defect, which is caused by mutations in the Vangl2 gene. In mammals, Vangl1 and Vangl2 code for integral membrane proteins that assemble into asymmetrically distributed membrane complexes that establish planar cell polarity in epithelial cells and that regulate convergent extension movements during embryogenesis. To date, VANGL are the only genes in which mutations cause neural tube defects in humans. Three independently arising Lp alleles have been described for Vangl2: D255E, S464N, and R259L. Here we report a common mechanism for both the naturally occurring Lp (S464N) and a novel ENU-induced mutation Lp(m2Jus)(R259L). We show that the S464N and R259L variants stably expressed in polarized MDCK kidney cells fail to reach the plasma membrane, their site for biological function. The mutant variants are retained intracellularly in the endoplasmic reticulum, colocalizing with ER chaperone calreticulin. Furthermore, the mutants also show a dramatically reduced half-life of ∼3 h, compared to ∼22 h for the wild-type protein, and are rapidly degraded in a proteasome-dependent and MG132-sensitive fashion. Coexpressing individually the three known allelic Lp variants with the wild-type protein does not influence the localization of the WT at the plasma membrane, suggesting that the codominant nature of the Lp trait in vivo is due to haploid insufficiency caused by a partial loss of function in a gene dosage-dependent pathway, as opposed to a dominant negative phenotype. Our study provides a biochemical framework for the study of recently identified mutations in hVANGL1 and hVANGL2 in sporadic or familial cases of neural tube defects.

Identification of a novel HLA-C*08 variant allele, C*08:31. Sequence analysis from exons 1 through 8

A novel allele, HLA- C*08:31 has been identified by sequence based typing in an Italian hematological patient undergoing bone marrow transplantation.

Molecular and cellular mechanisms underlying neural tube defects in the loop-tail mutant mouse

Loop-tail (Lp) mice show a very severe neural tube defect (craniorachischisis) caused by mutations in the Vangl2 gene (D255E, S464N). Mammalian Vangl1 and Vangl2 are membrane proteins that play critical roles in development such as establishment of planar cell polarity (PCP) in epithelial layers and convergent extension movements during neurogenesis and cardiogenesis. Vangl proteins are thought to assemble with other PCP proteins (Dvl, Pk) to form membrane-bound PCP signaling complexes that provide polarity information to the cell. In the present study, we show that Vangl1 is expressed exclusively at the plasma membrane of transfected MDCK cells, where it is targeted to the basolateral membrane. Experiments with an inserted exofacial HA epitope indicate that the segment delimited by the predicted transmembrane domains 1 and 2 is exposed to the extracellular milieu. Comparative studies of the Lp-associated pathogenic mutation D255E indicate that the targeting of the mutant variant at the plasma membrane is greatly reduced; the mutant variant is predominantly retained intracellularly in endoplasmic reticulum (ER) vesicles colocalizing with the ER marker calreticulin. In addition, the D255E variant shows drastically reduced stability with a half-life of approximately 2 h, compared to >9 h for its wild type counterpart and is rapidly degraded in a proteasome-dependent and MG132 sensitive pathway. These findings highlight a critical role for D255 for normal folding and processing of Vangl proteins, with highly conservative substitutions not tolerated at that site. Our study provide an experimental framework for the analysis of human VANGL mutations recently identified in familial and sporadic cases of spina bifida.

Characterization of the novel allele HLA-Cw*0331 by sequence-based typing

A novel allele HLA-C allele, Cw*0331, has been identified by sequence based typing in a German individual selected as a potential bone marrow unrelated donor.

Control of blood-transmitted infections in dentistry

As knowledge has accumulated on the blood-transmitted pathogenic agents, the contact with biological fluids (blood, plasma, saliva, etc.) from apparently healthy individuals has started to be regarded as a real professional risk for dentists. Theoretically, exposure to a contaminated biological specimen may have as a consequence transmission of infection from patient to dentist, from dentist to patient and from patient to patient via inadequately decontaminated and sterilized dental equipment. The present study is concerned with the analysis of the specific conditions that favor the occurrence of the epidemic process, the estimation of the risk degree of transmission of infections caused by hepatitis B, C viruses as well as of HIV infection in Romania. The data for the study were collected using two processes. First a self reporting survey and secondly an experimental procedure were performed. The testing of dentists' knowledge of blood transmissible diseases and infection control in their offices were performed using a questionnaire with 129 questions. The professional incidents/accidents representing a potential risk were counted using a questionnaire (with 37 questions). Serological markers were tested with ELISA kits. The monitoring of sterilization was accomplished with a questionnaire and biological tests. Many conclusions result from the study. There is an extremely reduced probability and infection transmission from the dentist to the patient. The transmission of infection from the patient to the dentist represents a low risk (for all that, the risk should not be minimized). The rigorous control and observation of infection prevention measures in dental offices is necessary to stop the infection transmission from patient to patient. The dentists' postgraduate training in infection control measures should be completed with knowledge regarding the blood transmissible infections epidemiology. Learning more about the epidemiological process enables the dentists to avoid wrong attitudes and behaviors.

A new HLA-DRB1*11 allele, DRB1*1144, identified by cloning and sequencing

We report here the identification of a novel DRB1*11 allele, DRB1*1144, identified during sequence-based HLA-DRB1 typing. Molecular cloning and direct sequencing confirmed that the new allele is identical to DRB1*110401 at exon 2, except for a single nucleotide substitution (GTG-->GCG) changing codon 38 from Valine to Alanine.

Recipient mHag-HA1 disparity and aGVHD in thalassemic-transplanted patients

In order to determine the influence of HA-1 minor histocompatibility antigen mismatch on BMT outcome, we analyzed a pool of 94 thalassemic transplanted patients all selected for the presence of HLA-A(*)0201 allele. The HA-1 typing was performed using SSP analysis. All the patients received bone marrow from HLA-identical MLC nonresponsive siblings. As graft-versus-host-disease (GVHD) prophylaxis, all patients received cyclosporin and short methotrexate. Grades II-IV GVHD occurred in five (33.3%) of the 15 patients with recipient HA-1 disparity compared with 14 (17.7%) of the 79 patients without HA-1 disparity. Despite the higher incidence of acute graft-versus-host-disease (aGVHD) in the group of patients with HA-1 incompatibility, these data were not statistically significant. However, it was interesting to observe that no GVHD developed in any of the 15 cases in which the recipient was HA-1 negative and the donor HA-1 positive.

A novel HLA-A*02 allele, A*02202, identified by nucleotide sequencing

In this paper we report the identification of a new HLA-A*02 allele in two members of an Afghan family. This novel allele, designed as A*02202, differs from A*02201 by a silent substitution at codon 66 (AAC-->AAT) in the alpha1 domain. A*02202 appears to be the result of a novel mutation (Note).

The importance of erythroid expansion in determining the extent of apoptosis in erythroid precursors in patients with beta-thalassemia major

Beta-thalassemia major is characterized by ineffective erythropoiesis leading to severe anemia and extensive erythroid expansion. The ineffective erythropoiesis is in part due to accelerated apoptosis of the thalassemic erythroid precursors; however, the extent of apoptosis is surprisingly variable. To understand this variability as well as the fact that some patients undergoing allogeneic marrow transplantation are resistant to the myeloablative program, we attempted more quantitative analyses. Two groups of patients totaling 44 were studied, along with 25 healthy controls, and 7 patients with hemolysis and/or ineffective erythropoeisis. By 2 flow cytometric methods, thalassemic erythroid precursors underwent apoptosis at a rate that was 3 to 4 times normal. Because thalassemic marrow has between 5- to 6-fold more erythroid precursors than healthy marrow, this translated into an absolute increase in erythroid precursor apoptosis of about 15-fold above our healthy controls. In searching for the causes of the variability in thalassemic erythroid precursor apoptosis, we discovered tight direct correlations between the relative and absolute extent of apoptosis and the extent of erythroid expansion as measured either by the absolute number of marrow erythroid precursors or by serum soluble transferrin receptor levels. These results could mean that the most extreme rates of erythroid proliferation lend themselves to cellular errors that turn on apoptotic programs. Alternatively, extreme rates of erythroid hyperplasia and apoptosis might be characteristic of more severely affected patients. Lastly, extreme erythroid hyperplasia could generate such numbers of apoptotic erythroid precursors that marrow macrophages are overwhelmed, leaving more apoptotic cells in the sample.

An unusual DRB1*1503 haplotype without a detectable DRB5 locus in a black African family

A DRB1*1503 allele not associated with DRB5 locus has been detected in an African family during routine HLA typing for bone marrow transplantation. PCR/SSOP analysis showed the DR2-associated alleles in all the family members but the DRB5 locus appeared to be absent in the patient and his brother. The samples were then analyzed for the presence of DRB6 pseudogenes and we found that the unusual haplotype was associated with DRB6*0101 allele. This finding strengthen the hypothesis of a recombination hot spot between DRB1 and DRB6 genes.

[Glass ionomer cementing in stomatological practice]

Glass ionomers cements represent a cement system which develops by a reaction between a polyalchenic acid, usually a homo- or a copolymer of acrylic acid and a ion donor, usually an aluminium fluorosilicate glass. Introduction of these ionomers in the stomatological practice was determined by their remarkable adherence to dentin, by pulpal and parodontal biocompatibility, and because of the fact that they deliver continuously fluorine over a long period of time. These cements provide a good marginal sealing of the obturation. In the last years a new generation of glass ionomers cements has been introduced, that "Cormat" cements, in which the glass powder is intimately linked to a pure silver metallic powder by a synthetization process, and this provides a greatly increased resistance to abrasion, as compared to conventional glass ionomer cements. Presently glass ionomer cements have become increasingly known in the stomatological practice and they are used preferentially for base obturations, under obturations with composites on lateral teeth, in the treatment of mylolysis and for coronary erosions determined by brushing, which do not need preparation of retention cavities. They are also used for coronary reconstruction, and the treatment of atopical microcavities of occluding decay processes on the lateral teeth that have induced limited enamel losses. The perspective of these cements in the stomatological practice depends however on an improved translucency, which, for the present at least, does not match that of silicates and composites, as well as on an improved resistance to bending, and even the "Cormat" cements are inferior to silver amalgam which is used in the obturation of classical class II cavities.

[Prevalence of chronic productive cough and obstructive ventilatory dysfunction in a rural community with minimal air pollution]

Results obtained during an epidemiological investigation on chronic cough and obstructive ventilatory dysfunction in subjects without bronchopulmonary affections of known etiopathogeny, carried out in a rural environment with minimal air pollution on 282 men aged between 40 and 69 years, indicate the following: --there was a lower prevalence of chronic cough in the rural environment as compared with the urban one (12.8:21.0). The percentage of heavy smokers being approximately similar in both environments, the difference could be explained by the variable intensity of air pollution, the impact of which was exerted on the large airways (hypertrophy of the serous-mucous glands resulting in hypercrinia with dyscrinia); --similar prevalence in the two environments of the obstructive ventilatory dysfunction (11,0:8,7) suggests that this abnormality, an expression of the narrowing of the small airways, could be due to other pathogenic factors. Functional pulmonary tests with sensitivity higher than the ratio between FEV 1.0 and VC (as, for instance VEmx 50% VC) could provide higher percentages of obstructive disturbances both among chronic coughing and non-coughing subjects, revealing the latent form of the obstruction, as opposed to the manifest one as evidenced by a decrease of the FEV 1.0/VC ratio.