Effect of protective coating agents on microleakage and flexural strength of glass ionomer cement and zirconomer. an in vitro study

PURPOSE

The objective of this study was to assess the microleakage and flexural strength of glass ionomer cement (GIC) and modified GIC (Zirconomer) when coated with protective coating agents such as COAT-IT and G-COAT plus.

METHODS

Sixty tooth specimens were grouped into two groups based on the type of restorations (GIC (n = 30) and Zirconomer (n = 30)). The samples were further divided into three subgroups (n = 10) based on the protective coating agent (Petroleum jelly, G-COAT Plus, or COAT IT) applied. This study evaluated the microleakage at the occlusal and cervical margins of class V restoration after being subjected to dye penetration and sectioning. Each specimen was viewed under a 40 × microscope and was given scores based on the depth of dye penetration. They were statistically analyzed using the Kruskal-Wallis test and compared within the groups using the Mann- Whitney Test. In addition, flexural strength was assessed using standardized cuboid (25 × 2 × 2 mm) specimens of restorative materials with and without protective coating agents. The mean flexural strength data of all the subgroups were statistically evaluated using a one-way analysis of variance (ANOVA) and compared within the subgroups using the student t test.

RESULTS

A statistically significant difference was found when occlusal margin microleakage scores were evaluated with G-COAT Plus demonstrating the lowest occlusal margin microleakage when applied over GIC restoration. The increasing order of occlusal margin microleakage scores is as follows: GIC with G-COAT Plus, Zirconomer with COAT-IT, GIC with COAT-IT, GIC, Zirconomer with G-COAT Plus, and Zirconomer. However, the cervical margin microleakage scores revealed no significant difference. While flexural strength was found to be highest for the GIC group coated with G-COAT Plus, it was observed that there was a significant improvement in the flexural strength of both GIC and Zirconomer when coated with either of the protective coating agents.

CONCLUSION

Within the limitations of this in vitro study, it was observed that the application of protective coating agents can significantly reduce the potential microleakage and improve the flexural strength of the restorative material especially when zirconia-reinforced GIC is the restorative material.

The Immune System Response to Porphyromonas gingivalis in Neurological Diseases

Previous studies have reported an association between oral microbial dysbiosis and the development and progression of pathologies in the central nervous system. Porphyromonas gingivalis (Pg), the keystone pathogen of the oral cavity, can induce a systemic antibody response measured in patients' sera using enzyme-linked immunosorbent assays. The present case-control study quantified the immune system's response to Pg abundance in the oral cavities of patients affected by different central nervous system pathologies. The study cohort included 87 participants: 23 healthy controls (HC), 17 patients with an acute neurological condition (N-AC), 19 patients with a chronic neurological condition (N-CH), and 28 patients with neurodegenerative disease (N-DEG). The results showed that the Pg abundance in the oral cavity was higher in the N-DEG patients than in the HC (p = 0.0001) and N-AC patients (p = 0.01). In addition, the Pg abundance was higher in the N-CH patients than the HCs (p = 0.005). Only the N-CH patients had more serum anti-Pg antibodies than the HC (p = 0.012). The inadequate response of the immune system of the N-DEG group in producing anti-Pg antibodies was also clearly indicated by an analysis of the ratio between the anti-Pg antibodies quantity and the Pg abundance. Indeed, this ratio was significantly lower between the N-DEG group than all other groups (p = 0.0001, p = 0.002, and p = 0.03 for HC, N-AC, and N-CH, respectively). The immune system's response to Pg abundance in the oral cavity showed a stepwise model: the response diminished progressively from the patients affected with an acute condition to the patients suffering from chronic nervous system disorders and finally to the patients affected by neurodegenerative diseases.

Changes in orthopaedic operating theatre practice, monitored using settle plates

INTRODUCTION

The importance of ultraclean air in reducing deep infection was studied by Charnley who showed that the rate decreased as the airborne bacterial load was reduced. The effectiveness was shown in a large Medical Research Council (MRC) trial, but registry data have not shown a consistent benefit. Because we treat patients with rheumatoid arthritis, we decided to look at our theatre air quality.

METHODS

In phase 1 we monitored air quality using settle plates, exposed for one hour after the incision, on the instrument trolleys in a joint replacement theatre. In phase 1 the scrub person did not wear a body exhaust system. In phase 2 all three staff used a body exhaust system, and we played close attention to the orientation and position of the surgical lights and trolleys.

RESULTS

In phase 1 we grew 0.24 colonies/plate/hour in the ultraclean zone, which is comparable to the Charnley trial findings. In the second phase we grew 0.03 colonies/plate/hour (p<0.001). When plates were placed on the trolleys in controlled positions there was a tendency for the colonies to appear on the corners of the trolleys at the edge of the clean zone (NS).

DISCUSSION

The study showed that in phase 1 colony counts comparable to the original Charnley studies were achieved. Colony counts of 0.03 colonies/plate/hour can be achieved in contemporary practice, with all team members using body exhausts.

Evaluation of cell transplant-mediated attenuation of diffuse injury in experimental autoimmune encephalomyelitis using onVDMP CEST MRI

The development and translation of cell therapies have been hindered by an inability to predict and evaluate their efficacy after transplantation. Using an experimental autoimmune encephalomyelitis (EAE) mouse model of multiple sclerosis (MS), we studied attenuation of the diffuse injury characteristic of EAE and MS by transplanted glial-restricted precursor cells (GRPs). We assessed the potential of on-resonance variable delay multiple pulse (onVDMP) chemical exchange saturation transfer (CEST) MRI to visualize this attenuation. Allogeneic GRPs transplanted in the motor cortex or lateral ventricles attenuated paralysis in EAE mice and attenuated differences compared to naïve mice in onVDMP CEST signal 5 days after transplantation near the transplantation site. Histological analysis revealed that transplanted GRPs co-localized with attenuated astrogliosis. Hence, diffuse injury-sensitive onVDMP CEST MRI may complement conventional MRI to locate and monitor tissue regions responsive to GRP therapy.

Aspirin and the prevention of venous thromboembolism following total joint arthroplasty: commonly asked questions

The number of arthroplasties being performed increases each year. Patients undergoing an arthroplasty are at risk of venous thromboembolism (VTE) and appropriate prophylaxis has been recommended. However, the optimal protocol and the best agent to minimise VTE under these circumstances are not known. Although many agents may be used, there is a difference in their efficacy and the risk of bleeding. Thus, the selection of a particular agent relies on the balance between the desire to minimise VTE and the attempt to reduce the risk of bleeding, with its undesirable, and occasionally fatal, consequences.

Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis following arthroplasty. Many studies have shown its efficacy in minimising VTE under these circumstances. It is inexpensive and well-tolerated, and its use does not require routine blood tests. It is also a ‘milder’ agent and unlikely to result in haematoma formation, which may increase both the risk of infection and the need for further surgery. Aspirin is also unlikely to result in persistent wound drainage, which has been shown to be associated with the use of agents such as low-molecular-weight heparin (LMWH) and other more aggressive agents.

The main objective of this review was to summarise the current evidence relating to the efficacy of aspirin as a VTE prophylaxis following arthroplasty, and to address some of the common questions about its use.

There is convincing evidence that, taking all factors into account, aspirin is an effective, inexpensive, and safe form of VTE following arthroplasty in patients without a major risk factor for VTE, such as previous VTE.

Cite this article: Bone Joint J 2017;99-B:1420–30.

Linked Records of Children with Traumatic Brain Injury. Probabilistic Linkage without Use of Protected Health Information

OBJECTIVE

Record linkage may create powerful datasets with which investigators can conduct comparative effectiveness studies evaluating the impact of tests or interventions on health. All linkages of health care data files to date have used protected health information (PHI) in their linkage variables. A technique to link datasets without using PHI would be advantageous both to preserve privacy and to increase the number of potential linkages.

METHODS

We applied probabilistic linkage to records of injured children in the National Trauma Data Bank (NTDB, N = 156,357) and the Pediatric Health Information Systems (PHIS, N = 104,049) databases from 2007 to 2010. 49 match variables without PHI were used, many of them administrative variables and indicators for procedures recorded as International Classification of Diseases, 9th revision, Clinical Modification codes. We validated the accuracy of the linkage using identified data from a single center that submits to both databases.

RESULTS

We accurately linked the PHIS and NTDB records for 69% of children with any injury, and 88% of those with severe traumatic brain injury eligible for a study of intervention effectiveness (positive predictive value of 98%, specificity of 99.99%). Accurate linkage was associated with longer lengths of stay, more severe injuries, and multiple injuries.

CONCLUSION

In populations with substantial illness or injury severity, accurate record linkage may be possible in the absence of PHI. This methodology may enable linkages and, in turn, comparative effectiveness studies that would be unlikely or impossible otherwise.

Identification of pathologically small fetuses using customized, ultrasound and population-based growth norms

OBJECTIVES

Fetal growth restriction is a strong risk factor for stillbirth. We compared the performance of three fetal growth curves - customized, ultrasound (Hadlock) and population - in identifying abnormally grown fetuses at risk of stillbirth.

METHODS

We performed a case-control study of singleton stillbirths (delivered between 2000 and 2010) at one center. Four liveborn controls were randomly identified for each stillbirth. Ultrasound-estimated fetal weight within 1 month prior to delivery was used to calculate growth percentiles for each fetus using three fetal growth norms. Sensitivities and odds ratios for stillbirth, as well as odds of abnormal growth according to formula, were calculated.

RESULTS

There were 49 stillbirths and 197 live births. Using the customized norms, growth of the fetuses destined to be stillborn was bimodal, with both more small-for-gestational-age (SGA; < 10(th) percentile) and large-for-gestational-age (LGA; ≥ 90(th) percentile) fetuses. Odds of being abnormally grown were significantly higher using ultrasound compared with population norms (P = 0.02) but were not statistically different using ultrasound and customized norms (P = 0.21). Sensitivity for identification of SGA on ultrasound as a predictor of stillbirth was higher using customized (39%; 95% CI, 24-54%) or ultrasound (33%; 95% CI, 19-47%), rather than population (14%; 95% CI, 4-25%), norms.

CONCLUSIONS

Among fetuses destined to be stillborn, customized and ultrasound norms identified a greater proportion of both SGA and LGA estimated fetal weights. The customized norms performed best in identifying death among SGA fetuses. These results should be interpreted within the limitations of the study design.

An in-vitro assessment of erosive potential of a calcium-fortified fruit juice

AIM

To evaluate and compare the in vitro pH, buffer capacity and calcium loss from tooth enamel before and after calcium fortification of a packaged fruit juice.

METHODS

An approved brand of packaged mixed fruit juice was selected as a test drink on the basis of a pilot questionnaire. The test drink was fortified with 1,000 mg/l (0.1% w/v) of calcium citrate malate to obtain two test groups: Group 1: original beverage (serving as control) and Group 2: calcium-fortified drink. The pH and buffering capacity for the test drinks were measured before and after calcium fortification; 90 prepared enamel samples were divided and immersed into three test subgroups: (1) buffer solution pH 7 (positive control), (2) original fruit juice (negative control) and (3) calcium-fortified fruit juice for 3 min. Calcium loss from the enamel of immersed teeth was measured as a quantitative estimate of tooth mineral loss.

RESULTS

After calcium fortification of the fruit juice the mean pH raised from 3.4 to 4.0 (p = 0.029), the mean buffer capacity decreased from 9.73 to 9.16 (p < 0.001) and the mean calcium loss from enamel specimens decreased from 3.5 to 0.26 mg/dl (p < 0.001).

STATISTICS

To compare the change in mean pH and buffering capacity between the subject groups, t test was used, and to compare the calcium loss from enamel specimens, among the three subgroups, ANOVA was used.

CONCLUSION

Calcium fortification of packaged fruit juice in vitro, improves its pH and buffering capacity. Consequently, the fortified juice causes significantly less mineral loss from human enamel. Fortifying juice with calcium may exert a significant protective potential against dental erosion particularly due to frequent exposure of acidic drinks.

The utility of imputed matched sets. Analyzing probabilistically linked databases in a low information setting

OBJECTIVE

To compare results from high probability matched sets versus imputed matched sets across differing levels of linkage information.

METHODS

A series of linkages with varying amounts of available information were performed on two simulated datasets derived from multiyear motor vehicle crash (MVC) and hospital databases, where true matches were known. Distributions of high probability and imputed matched sets were compared against the true match population for occupant age, MVC county, and MVC hour. Regression models were fit to simulated log hospital charges and hospitalization status.

RESULTS

High probability and imputed matched sets were not significantly different from occupant age, MVC county, and MVC hour in high information settings (p > 0.999). In low information settings, high probability matched sets were significantly different from occupant age and MVC county (p < 0.002), but imputed matched sets were not (p > 0.493). High information settings saw no significant differences in inference of simulated log hospital charges and hospitalization status between the two methods. High probability and imputed matched sets were significantly different from the outcomes in low information settings; however, imputed matched sets were more robust.

CONCLUSIONS

The level of information available to a linkage is an important consideration. High probability matched sets are suitable for high to moderate information settings and for situations involving case-specific analysis. Conversely, imputed matched sets are preferable for low information settings when conducting population-based analyses.

Oxford Scores as a Triage Tool for Lower Limb Arthroplasty Lead to Discrimination and Health Inequalities

The NHS Outcomes Framework 2011/12 from the Department of Health states that reducing health inequalities and promoting equality is central if the NHS is to deliver health outcomes that are among the best in the world. Assessment of patient reported outcome measures (PROMS) was introduced across the NHS in April 2009 both for hip and knee replacement surgery. PROMs are applied before and after certain elective health interventions funded by the NHS. In addition to the established use in assessment of outcomes, it has been suggested that preoperative instruments might be used to assess whether referrals for elective procedures are appropriate and also to identify inequalities in heathcare. For hip and knee replacement surgery, Oxford hip and knee scores are used as the measure of pain and disability.

New design space regainers: 'lingual arch crossbow' and 'double banded space regainer'

This article highlights the use of two new design space regainers--the "lingual arch crossbow" and the "double-banded space regainer." The former may be used for distalizing a mesially migrated mandibular first premolar, if it erupts prior to the canine. The latter may be used in conventional cases of interdental space loss. They both contain assemblies that function through the action of NiTi open coil springs.

Strength characteristics and marginal sealing ability of chlorhexidine-modified glass ionomer cement: an in vitro study

BACKGROUND

This study was done to compare and evaluate the compressive strength, diametral tensile strength, and microleakage of glass ionomer cement and chlorhexidine-modified glass ionomer cement. The glass ionomer cements used in the study were Fuji IX for group I and chlorhexidine-modified glass ionomer cement for group II.

MATERIALS AND METHODS

The strength characteristics (compressive and diametral tensile strengths) and microleakage of both the groups were evaluated after 24 h. Student's "t" test and Mann-Whitney test were used for statistical analysis of the difference in strength characteristics and microleakage.

RESULTS

There was no statistical difference (P>0.05) in the strength characteristics and microleakage of glass ionomer cement and chlorhexidine-modified glass ionomer cement.

CONCLUSION

The present study suggests that strength characteristics and marginal sealing capability of chlorhexidine-modified glass ionomer cement were similar to those of glass ionomer cement (Fuji IX). So, chlorhexidine-modified glass ionomer can be considered as a substitute for glass ionomer cements, especially in pediatric dentistry.

Differential expressions of bilaterally unerupted supernumerary teeth

This article presents a case of bilateral unerupted supernumerary teeth in the mandibular premolar region. Surgical removal of the right-sided supernumerary tooth had to be carried out as it was impeding the eruption of the mandibular first premolar. However, its supernumerary antimere, lay dormant.

Vertex occlusal radiography in localizing unerupted mesiodentes

The aim was to compare the vertex occlusal projection with the anterior maxillary occlusal projection in localizing the position of mesiodentes. Mesiodentes were observed in an 8-year-old boy with an anterior maxillary occlusal radiograph. A vertex occlusal radiograph was taken to compare it with the former in terms of mesiodentes localization with respect to the maxillary central incisors. The vertex occlusal radiograph provided greater details of the position and proximity of mesiodentes with respect to the long axis of maxillary central incisors in comparison to the anterior maxillary occlusal radiograph. Vertex occlusal radiography is an important diagnostic tool in diagnosing the presence, position, and proximity of mesiodentes with respect to the long axis of normally aligned maxillary central incisors. However, it is not recommended for routine use in a patient as its radiation dose is higher than conventional intraoral radiographic methods.

More than meets the eye: digital fraud in dentistry

INTRODUCTION

Digital photographs play a substantial role in the presentation and validation of clinical cases for documentation and research purposes in esthetically oriented professions such as dentistry. The introduction of sophisticated cameras and "easy to use" computer software readily available on today's market has enabled digital fraud to emerge as a common and widely used practice. Hence, it is essential that both dentists and editorial circles are aware and cautious with regard to the possibility of digital fraud.

MATERIALS AND METHODS

A set of 10 routine "pre-" and "post" treatment dental procedure photographs were taken and randomly manipulated using standard desktop software. A team of 10 dental professionals were selected and each one of them was individually requested to review and evaluate the authenticity of the photographs.

RESULTS

An assessment of expert opinion revealed an overall sensitivity of 60% and a sensitivity of 15% in correctly identifying a manipulated photograph, which is considered low. Furthermore, there was poor interobserver agreement.

CONCLUSION

Advanced technology that is easily available has resulted in adept digital fraud that is difficult to detect. There is a need for awareness among both dental practitioners and the editorial circle regarding misrepresentation due to image manipulation. It is therefore necessary to follow a skeptical approach in the assessment of digitalized photos used in research and as a part of clinical dentistry.

Use of a modified anterior inclined plane in the treatment on the dentoskeletal Class II division 2 patient

Class II malocclusions are seen due to the underdevelopment of the mandible in most of the cases. To compensate for the mandible retrusive position, there is flaring of the lower anterior teeth or retroclination of the central incisors as a compensatory mechanism seen in Class II division 2 type of malocclusion. This case report evaluates the skeletal and dental changes when a 12-year-old female patient with Class II div 2 malocclusion was treated with a modified anterior inclined plane. The postreatment data suggested that there were no significant changes in the vertical skeletal parameters. The upper central incisors were significantly realigned by proclination along with retroclination of the lateral incisors. There was significant increase in the mandibular length. The results revealed that the modified anterior inclined plane showed good results in the treatment of a case of Class II div 2 malocclusion.

Economic evaluation of ribosomal immunotherapy in patients with chronic ear, nose and throat and respiratory tract infections: results for Italy

OBJECTIVE

This study analyses the economic value of ribosomal immunotherapy in patients with chronic ear, nose and throat (ENT) infections and respiratory tract infections (RTI) as compared with patients not receiving prophylaxis. Specifically, the objective was to determine whether the incremental costs of ribosomal immunotherapy could be offset by healthcare savings through a reduction in recurrent episodes of acute infection.

DESIGN AND SETTING

The study was conducted from the payer perspective in the Italian healthcare setting. A 6-month time-frame was used in the decision analysis model, and costs reflect 1995 values. The model incorporated international clinical trial data and Italian resource use data for adult patients with chronic sinusitis and bronchitis and children with recurrent ENT infections.

MAIN OUTCOME MEASURES AND RESULTS

The findings indicate that ribosomal immunotherapy is capable of generating net direct cost savings over 6 months ranging between 280 000 and 1 100 000 Italian lire (L) per patient (L1700 approximately $US1) depending on the type of chronic disease studied (otitis media or rhinopharyngitis in children, sinusitis or bronchitis in adults). Threshold incremental efficacy of immunoprophylaxis required to achieve cost equivalence compared with no prophylaxis ranged between 2 and 20%, depending on the indication and the magnitude of treatment cost associated with an acute infectious episode (low/best/high estimate) considered. In view of the incremental efficacy rates observed in clinical trials ranging between 40 and 65% for patients with ribosomal immunoprophylaxis, prevention of recurrent ENT infections and RTI appears to be an economically meaningful therapeutic strategy, even when assuming that efficacy rates achievable in real clinical practice may be lower than those reported in clinical trials.

CONCLUSION

On the basis of these findings for Italy, physicians should give increased attention to ribosomal immunoprophylaxis of chronic respiratory diseases in children and adults.

The role of 9qh+ in phenotypic and genotypic heterogeneity in a Van der Woude syndrome pedigree

Van der Woude syndrome (VWS) (OMIM 119300) is a dominantly inherited developmental disorder that is characterized by pits and/or sinuses of the lower lip and cleft lip and/or cleft palate. Mutations in the interferon regulatory factor 6 gene (IRF6) have been recently identified in patients with VWS, with more than 60 mutations reported. We report the phenotypic variants of the syndrome in a family and present the application of the multicolor chromosome banding (mBAND) analysis in the identification of complex intrachromosome rearrangements of chromosome 9 in a child with VWS. The authors conclude that increased heterochromatin on chromosome 9 did not have any effect on the phenotypic expression of the syndrome in the family that was studied.

Evaluation of caries experience in 3-6-year-old children, and dental attitudes amongst the caregivers in the Ludhiana city

Early Childhood Caries (ECC) is a lifestyle disease that begins when the child's teeth erupt in the oral cavity. The distinctive pattern of decay rapidly spreads from one tooth to another and involves the surfaces of teeth that are usually not at risk. Detection of disease is crucial to control the oral condition using preventive and therapeutic regimes. The aim of this study was to determine the prevalence of caries in children of age 3-6 years in Ludhiana and to examine the relationship between age and caries experience. A total of 609 children in the age group of 3-6 years were examined using def index. To determine dental care seeking attitude, 105 caregivers were interviewed. Results revealed that 52.87% of children in the age group of 3-3.11 years, 45.1% of children in the age group of 4-4.11 years and 58.55% of children in 5-5.11 age groups suffered from caries. The mean def index was 1.82, 1.57 and 2.21, respectively. Interview of caregivers of children revealed that out of 105 only 12 (11.4%) children had previously been to a general dentist. None of them knew about Pedodontics as a specialty. The results of the present study can be used mainly for screening child populations in need of treatment, helping public workers and planners to develop dental health programs to aid early intervention and prevention.

Synergistic induction of local glucocorticoid generation by inflammatory cytokines and glucocorticoids: implications for inflammation associated bone loss

Objectives

Synovial fibroblasts and osteoblasts generate active glucocorticoids by means of the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme. This activity increases in response to proinflammatory cytokines or glucocorticoids. During inflammatory arthritis synovium and bone are exposed to both these factors. This study hypothesised that glucocorticoids magnify the effects of inflammatory cytokines on local glucocorticoid production in both synovium and bone.

Methods

The effects of inflammatory cytokines (IL-1β/tumour necrosis factor alpha; TNFα) and glucocorticoids, alone or combined, were assessed on the expression and activity of 11β-HSD1 in primary synovial fibroblasts, primary human osteoblasts and MG-63 osteosarcoma cells. A range of other target genes and cell types were used to examine the specificity of effects. Functional consequences were assessed using IL-6 ELISA.

Results

In synovial fibroblasts and osteoblasts, treatment with cytokines or glucocorticoids in isolation induced 11β-HSD1 expression and activity. However, in combination, 11β-HSD1 expression, activity and functional consequences were induced synergistically to a level not seen with isolated treatments. This effect was seen in normal skin fibroblasts but not foreskin fibroblasts or adipocytes and was only seen for the 11β-HSD1 gene. Synergistic induction had functional consequences on IL-6 production.

Conclusions

Combined treatment with inflammatory cytokines and glucocorticoids synergistically induces 11β-HSD1 expression and activity in synovial fibroblasts and osteoblasts, providing a mechanism by which synovium and bone can interact to enhance anti-inflammatory responses by increasing localised glucocorticoid levels. However, the synergistic induction of 11β-HSD1 might also cause detrimental glucocorticoid accumulation in bone or surrounding tissues.

Ca2+/calcineurin regulation of cloned vascular K ATP channels: crosstalk with the protein kinase A pathway

BACKGROUND AND PURPOSE

Vascular ATP-sensitive potassium (K(ATP)) channels are activated by cyclic AMP elevating vasodilators through protein kinase A (PKA). Direct channel phosphorylation is a critical mechanism, though the phosphatase opposing these effects is unknown. Previously, we reported that calcineurin, a Ca(2+)-dependent phosphatase, inhibits K(ATP) channels, though neither the site nor the calcineurin isoform involved is established. Given that the type-2 regulatory (RII) subunit of PKA is a substrate for calcineurin we considered whether calcineurin regulates channel activity through interacting with PKA.

EXPERIMENTAL APPROACH

Whole-cell recordings were made in HEK-293 cells stably expressing the vascular K(ATP) channel (K(IR)6.1/SUR2B). The effect of intracellular Ca(2+) and modulators of the calcineurin and PKA pathway on glibenclamide-sensitive currents were examined.

KEY RESULTS

Constitutively active calcineurin A alpha but not A beta significantly attenuated K(ATP) currents activated by low intracellular Ca(2+), whereas calcineurin inhibitors had the opposite effect. PKA inhibitors reduced basal K(ATP) currents and responses to calcineurin inhibitors, consistent with the notion that some calcineurin action involves inhibition of PKA. However, raising intracellular Ca(2+) (equivalent to increasing calcineurin activity), almost completely inhibited K(ATP) channel activation induced by the catalytic subunit of PKA, whose enzymatic activity is independent of the RII subunit. In vitro phosphorylation experiments showed calcineurin could directly dephosphorylate a site in Kir6.1 that was previously phosphorylated by PKA.

CONCLUSIONS AND IMPLICATIONS

Calcineurin A alpha regulates K(IR)6.1/SUR2B by inhibiting PKA-dependent phosphorylation of the channel as well as PKA itself. Such a mechanism is likely to directly oppose the action of vasodilators on the K(ATP) channel.

A Comparative Evaluation of Hydroxyapatite Crystals and Glutaraldehyde as Agents for Pulpotomy in Deciduous Molars

Purpose: To evaluate and compare clinically and radiographically use of hydroxyapatite crystals and 2% glutaraldehyde as a pulpotomy agent.

Method: Thirty deciduous molars were treated with pulpotomy using hydroxyapatite crystals and 2% glutaraldehyde.

Results: Clinical and radiographic findings were observed at three months and six months. The success rate was found to be 100% clinically and 80.33% radiographically in the hydroxyapatite crystals group and 100% clinically and radiographically in the glutaraldehyde group.

Clinical significance: The results of this study revealed that hydroxyapatite crystals is a potential pulpotomy agent for deciduous molars.

Bilateral fusion of mandibular primary teeth

The aim of the report was to highlight the rarity of occurrence of bilaterally fused mandibular primary lateral incisors and canines by virtue of the number of such cases reported in literature; to identify congenital absence of successor teeth;and to evaluate their pulpal morphologies to understand the type of fusion. Clinical observation along with an orthopantomograph and periapical radiographs were used to arrive at a diagnosis. The pulpal morphologies varied in each of the fused teeth although both were fusions of the Complete type. There was congenital absence of the permanent mandibular lateral incisors, bilaterally. It was a case of bilateral fusion of mandibular primary lateral incisors and canines of the Complete type with congenitally absent mandibular permanent lateral incisors. Only 13 such cases have been previously reported in literature.

11beta-hydroxysteroid dehydrogenases are regulated during the pulmonary granulomatous response to the mycobacterial glycolipid trehalose-6,6'-dimycolate

OBJECTIVE

Tuberculosis has a staggering influence on world health, resulting in nearly 2 million deaths per year. The influence of glucocorticoids during Mycobacterium tuberculosis infection has been under investigation for decades; however, the identity of mycobacterial factors and the mechanism by which glucocorticoids are tissue specifically regulated to influence immune function during acute granuloma formation are unknown.

METHODS

One factor implicated in initiating immunopathology during M. tuberculosis infection is trehalose-6,6'-dimycolate (TDM), a glycolipid component of the mycobacterial cell wall. Intravenous administration of TDM causes inflammatory responses in lungs of mice similar to M. tuberculosis infection and has been used as a successful model to examine proinflammatory regulation and early events involved in the manifestation of pathology.

RESULTS AND CONCLUSION

IL-6, IL-1alpha and TNF-alpha mRNA and protein peaked during the initiation of granuloma formation. Pulmonary corticosterone levels were elevated when the proinflammatory response was greatest, dropping to half of that upon the establishment of granuloma pathology on day 7. It is hypothesized that once corticosterone reaches the site of inflammation, the enzymes 11beta-hydroxysteroid dehydrogenases (11betaHSDs) can influence bioavailability by interconverting corticosterone and the inert metabolite 11-dehydrocorticosterone. RT-PCR demonstrated that pulmonary 11betaHSD type 1 mRNA decreased 4-fold and 11betaHSD type 2 (11betaHSD2) mRNA expression increased 2.5-fold on day 3 after injection, suggesting that corticosterone regulation in the lung, specifically the reduction of active corticosterone by 11betaHSD2, may influence the progression of granuloma formation in response to the mycobacterial glycolipid.

Syndromes associated with labiopalatine clefting: a report of three cases

Clefts of the lip and palate are a common craniofacial anomaly, The etiology is thought to be multifactorial, with both genetic and environmental factors playing a role. Because of the frequent manifestation of cleft lip and palate in association with some syndromes, it is essential that a detailed examination of these patients be carried out. This facilitates early formulation of preventive and treatment advice and aids in overcoming gross deformities in the early stages of development. In this paper, we review three such patients who presented with cleft lip and palate in association with a syndrome.

In vitro-clinical correlations for amphotericin B susceptibility in AIDS-associated cryptococcal meningitis

Reliable measures of antifungal drug susceptibility are needed. We tested the susceptibility of Cryptococcus neoformans from patients treated with amphotericin B. In vitro susceptibility employed a modified broth macrodilution method. We demonstrate a strong correlation between the quantitative measures of in vitro amphotericin B susceptibility and the quantitative response observed in patients.

Sprouting of mossy fibers and presynaptic inhibition by group II metabotropic glutamate receptors in pilocarpine-treated rat hippocampal slice cultures

Mossy fibre sprouting (MFS) is a phenomenon observed in the epileptic hippocampus. We have studied MFS, in 7, 14 and 21 day in vitro (DIV) organotypic slice cultures, or in slice cultures treated with pilocarpine (0.5 mM) or pilocarpine and atropine (0.1 mM or 0.5 mM) for 48-72 h at 5 DIV and tested at 21 DIV. Acute application of pilocarpine directly activated hilar neurons and elicited epileptic-like discharges in CA3 pyramids and mossy cells of 5-8 DIV cultures, without causing substantial cell death, as assessed by lactate dehydrogenase measurements. Timm staining revealed increases in MFS in chronic pilocarpine-treated cultures, which was prevented by prior application of atropine. Extracellular synaptic responses were recorded in the granule cell layer and elicited by antidromic mossy fibre stimulation. The GABA(A) antagonist 6-imino-3-(4-methoxyphenyl)-1(6H)-pyridazinebutanoic acid (1 microM) induced a greater increase in the coastline bursting index in pilocarpine-treated cultures than in 21 DIV controls. However, there was no significant increase in the frequency of spontaneous or miniature synaptic events recorded in granule cells from pilocarpine-treated cultures. Granule cells were filled with biocytin and morphometric analysis revealed that the length of axon collaterals in the granule and molecular layer was longer in pilocarpine-treated cultures than in 21 DIV controls. Dual recordings between granule cells and between granule and hilar neurons showed that pilocarpine-treated cultures had a larger proportion of monosynaptic and polysynaptic connections. The group II metabotropic glutamate receptor (mGluR) agonist LY354740 (0.5 microM) suppressed excitatory but not inhibitory monosynaptic currents. LY354740 also inhibited antidromically evoked action currents in granule cells from pilocarpine- and to a lesser extent in pilocarpine and atropine-treated cultures, suggesting that group II mGluRs can reside along the axon and suppress action potential invasion. We provide direct evidence for the development of functional MFS and suggest a novel, axonal mechanism by which presynaptic group II mGluRs can inhibit selected synapses.

Catastrophic presentation of mitochondrial disease due to a mutation in the tRNAHis gene

The authors describe a patient who presented with headache, seizures, and severe cerebral edema in whom they identified a novel mutation in the mitochondrial (mt-) tRNAHis gene. This G12147A transition is heteroplasmic, predicted to disrupt a highly conserved base pair, and segregates with the cytochrome c oxidase deficiency in single muscle fibers.

Both light-dependent protochlorophyllide oxidoreductase A and protochlorophyllide oxidoreductase B are down-regulated in the slender mutant of barley

The gibberellin-insensitive overgrowth mutant of barley, slender, exhibits altered expression of a number of nuclear genes in comparison with the wild type. There is a particularly marked reduction in slender seedlings of transcript encoding protochlorophyllide oxidoreductase (POR), the enzyme which catalyses the penultimate and only light-requiring step in chlorophyll biosynthesis. The expression of the two barley genes encoding light-dependent POR, PORA and PORB was investigated. Expression of both genes was found to be reduced in slender seedlings relative to the wild type, in both etiolated and light-grown leaf tissue; this was most marked in the zone of rapid cell extension. Western blot analysis showed that POR protein was also less abundant in etiolated and in light-grown slender than in the equivalent wild-type leaf tissue, although the effect was less pronounced than at the transcript level. Protochlorophyllide content in etiolated slender seedlings was reduced in comparison with wild-type seedlings, though chlorophyll content in light-grown leaf blades was unaffected. The reduction in POR expression in slender barley may reflect a novel response to the constitutive activation of gibberellin signalling in this mutant. Despite the consequences of the mutation for POR gene expression, slender seedlings develop apparently normal chloroplasts in the light, and etioplasts with well-defined prolamellar bodies when grown in continuous darkness. This suggests that the POR content of wild-type barley seedlings is well in excess of the minimum required for normal plastid development.

In vivo measurements of glutamine + glutamate (Glx) and N-acetyl aspartate (NAA) levels in human partial epilepsy

OBJECTIVE

To investigate whether cerebral levels of N-acetyl aspartate (NAA), and glutamine + glutamate (Glx), are interictally altered in the epileptogenic regions of patients with partial seizures.

MATERIAL AND METHODS

NAA, Glx, creatine (Cr), choline (Cho) and myo-inositol (mI) was measured in 28 patients with partial epilepsy and 10 healthy controls using localized 1H magnetic resonance spectroscopy. According to the multimethodological consensus, the epileptogenic region was mesial temporal in 18 and neocortical in 10 patients.

RESULTS

The Glx/NAA and Glx/Cr ratios in epileptogenic regions were higher, and the NAA/Cr ratios lower than in the homologous regions (P=0.013, P=0.002 and P<0.0001). Applying the 95% confidence interval of controls, 17 of the 20 mesial temporal epileptogenic regions were correctly identified by an increased Glx/NAA and 15 of 20 by a decreased NAA/Cr ratio. Among patients with neocortical epilepsy the Glx/NAA ratio was increased in 8 of the 10 epileptogenic regions, whereas the NAA/Cr ratio was decreased in three.

CONCLUSION

Both Glx and NAA are useful to identify the epileptogenic zone. The Glx/NAA ratios may be particularly useful to indentify neocortical epileptogenic regions.

Disturbances of endometrial bleeding with hormone replacement therapy

Breakthrough bleeding is a common problem in postmenopausal women taking hormone replacement therapy (HRT) and is often the single most important factor deterring women from continuing to use HRT, or from starting it in the first place. The mechanisms which underlie this unscheduled bleeding are poorly understood. The benefits of HRT in terms of longevity and quality of life are becoming increasingly apparent, and a greater understanding of why this bleeding occurs and how we can prevent or treat it, will undoubtedly enable more women to reap the potential considerable benefits of long-term oestrogen and progestogen replacement. What sets postmenopausal women apart from their counterparts in the mid-reproductive years is the increased likelihood of endometrial adenocarcinoma in which unscheduled bleeding is the presenting symptom. Therefore, spontaneous postmenopausal bleeding must always be appropriately evaluated. Hence, the occurrence of unscheduled bleeding with HRT may provide a dilemma with diagnosis as well as a challenge to acceptability. Combined HRT regimens tend to be predominantly progestogenic, and there is increasing evidence to suggest that some of the vascular changes seen in women taking long-term, low-dose progestogen-only contraceptives may also occur in women taking HRT.

Fear of intimacy among dating couples

Fear of intimacy among heterosexual dating couples was examined with the Fear-of-Intimacy Scale (FIS) and the Personal Assessment of Intimacy in Relationships (PAIR). Following a 6-month interval, couples were again contacted to determine whether they continued to date. Males reported higher FIS scores than females, and FIS scores were positively correlated within couples. Also, FIS scores of males and females were significantly correlated with indices of actual and desired intimacy; however, for females, correlations of FIS scores with desired intimacy were significantly lower than correlations with actual intimacy. Females who were no longer in the dating relationship at the 6-month follow-up had higher FIS scores than those who were continuing in their dating relationship. These findings increase our understanding of fear of intimacy, especially gender differences in dating couples.

Personal toll of trichotillomania: behavioral and interpersonal sequelae

Patients suffering from trichotillomania are at risk for significant mood and interpersonal problems. Using a clinical sample, this study sought to clarify the nature and types of problems experienced by patients and to examine how these problems might be interrelated. The charts of 67 patients who sought treatment for trichotillomania were reviewed. The majority of patients reported problems with affect and interpersonal relationships. Public and social activities (e.g., haircuts, sexual activities) were avoided by a large number of patients. Self-esteem, shame, feelings of unattractiveness, depressed affect, and secretiveness were all interrelated, suggesting that these issues might best be conceptualized as a cluster that needs to be considered in the etiology, effects, and treatment of trichotillomania.

Evidence that high-density lipoprotein cholesterol is an independent predictor of acute platelet-dependent thrombus formation

Plasma total and low-density lipoprotein (LDL) cholesterol are established risk factors for atherosclerotic vascular disease and may also contribute to a prothrombotic risk via enhanced platelet reactivity. This study examines whether high-density lipoprotein (HDL) cholesterol, which is inversely correlated with coronary artery disease, is associated with a reduced thrombogenic potential. Platelet thrombus formation was evaluated by exposing porcine aortic media placed in Badimon perfusion chambers to flowing nonanticoagulated venous blood for 5 minutes at a shear rate of 1,000 s(-1). Forty-five subjects, 23 normal (LDL 104 +/- 31, HDL 50 +/- 15 mg/dl) and 22 hypercholesterolemic (LDL 181 +/- 45, HDL 41 +/- 10 mg/dl) patients without coronary artery disease were studied. Platelet aggregation and CD62 antigen expression, and assay for circulating prothrombotic factors were also performed. In univariate analysis platelet thrombus formation correlated with weight (r = 0.33, p = 0.03), diastolic blood pressure (r = 0.39, p = 0.01), HDL cholesterol (r = -0.45, p = 0.003), total/HDL cholesterol (r = 0.43, p = 0.004) and LDL/HDL (r = 0.38, p = 0.01) ratios, and platelet CD62 expression (r = 0.41, p = 0.02). In multiple regression analysis only HDL cholesterol showed significant correlation with platelet thrombus formation (p = 0.03). Platelet aggregation and circulating prothrombotic factors did not correlate with platelet thrombus formation. A comparison between normal and hypercholesterolemic subjects revealed enhanced thrombus area (0.026 +/- 0.20 vs 0.045 +/- 0.039 mm2/mm; p = 0.04), resting CD62 expression (6 +/- 7% vs 15 +/- 10% positive platelets, p = 0.02), and platelet aggregation (16.7 +/- 5.2 vs 21.7 +/- 6.7 ohms, p = 0.04) in hypercholesterolemic subjects. Our results demonstrate that HDL cholesterol is a significant independent predictor of ex vivo platelet thrombus formation.

The structure and composition of chronic wound eschar

Wounds with a covering of eschar require debridement before optimal wound healing can proceed. There are several different methods available but these have been derived empirically with no direct evidence of the structure or composition of the tissue they are designed to remove, or of the potential autolytic mechanisms which are the targets for some of these treatments. The aim of this study therefore was to determine the composition of chronic wound eschar and hence identify potential targets for the induction of autolytic debridement. Chronic wound eschar was removed by surgical debridement and analysed using immunohistochemistry, polyacrylamide gel electrophoresis (PAGE) and gelatin zymography. Immunohistochemistry using antibodies specific for extracellular matrix (ECM) proteins revealed a definite tissue structure, consisting of many fibrous regions and fine fibrillar elements separated by areas of tissue which were of a more irregular and amorphous nature. An antibody specific for all leucocytes revealed the presence of leucocytes in the region of tissue closest to the wound bed. The presence of this leucocyte population correlated to elevated levels of gelatinase activity as identified by gelatin zymography. PAGE analysis identified various protein species in the range 3.5-60 kDa molecular weight. These data indicate that wound debridement is likely to require multiple enzyme specificities to degrade the eschar and that these enzymes may be supplied by inflammatory leucocytes infiltrating the eschar from the wound bed. The various protein species demonstrated by PAGE may represent ECM proteins, those with lower molecular weight possibly representing the degradation products of autolytic debridement.

Comorbidity of headache and depressive disorders

The goal of the present study was to investigate the clinical profile of patients with primary headache syndromes who also suffer from mood disorders. Four-hundred-and-seventy headache outpatients (170M, 300F) and 150 age- and sex-matched healthy subjects were screened using a specific questionnaire that included the Hamilton rating scales for anxiety and depression. The average scores of the Hamilton rating scales for anxiety and depression were significantly higher in headache sufferers (17.4 and 14.2, respectively) than in healthy people (6.8 and 5.7, respectively). The frequency of headache attacks, the history of headaches, and gender (women more than men) were correlated with the score of the Hamilton rating scale for both anxiety and depression. Sixteen headache patients (3.4%) achieved the DSM-IV criteria for major depression or dysthymia versus one among headache-free subjects (0.6%; OR 5.2). Patients suffering from drug-overuse and migraine with aura showed the higher odds ratios (35 and 17, respectively). These results suggest that those headache patients with long history and high frequency of headaches, or patients suffering from migraine with aura and drug-overuse might benefit from psychiatric evaluation.

Alzheimer testing at Silver Years

Early last year, the GenEthics Consortium (GEC) of the Washington Metropolitan Area convened at George Washington University to consider a complex case about genetic testing for Alzheimer disease (AD). The GEC consists of scientists, bioethicists, lawyers, genetic counselors, and consumers from a variety of institutions and affiliations. Four of the 8 co-authors of this paper delivered presentations on the case. Supplemented by additional ethical and legal observations, these presentations form the basis for the following discussion.

The role of radiology in pulmonary infectious disease

This review of recently published papers focuses on the recent tious disease. Despite advances in thoracic imaging, the chest roentgenogram combined with the clinical history remain the cornerstone in the diagnosis, staging, and follow-up of pulmonary infectious disease. Examination of all prior films to document preexistent anatomic pulmonary or cardiac disease and to establish the progression or regression of the pulmonary infiltrate is essential prior to proceeding with more costly imaging.

Amphotericin B colloidal dispersion combined with flucytosine with or without fluconazole for treatment of murine cryptococcal meningitis

Studies with animals and in vitro studies have demonstrated that flucytosine plus amphotericin B or fluconazole has significantly improved mycologic activity against meningitis caused by Cryptococcus neoformans compared to the activity of amphotericin B or fluconazole used alone. However, few doses have been tested in combination. This study evaluated the antifungal efficacy of amphotericin B colloidal dispersion (ABCD) combined with flucytosine with and without fluconazole in a murine model of cryptococcal meningitis. The following dosages were tested: ABCD at 0 to 12.5 mg/kg of body weight given intravenously 3 days/week, flucytosine at 0 to 110 mg/kg/day, and fluconazole at 0 to 50 mg/kg/day. Meningitis was established in male BALB/c mice by intracerebral injection of C. neoformans. Treatment with flucytosine with or without fluconazole dissolved in the sole source of drinking water was started on day 2; animals were sacrificed at 16 days, and the numbers of fungal colonies in the brain were quantified. A survival rate of 100% was achieved with ABCD plus flucytosine without fluconazole; however, the addition of fluconazole was required to prevent weight loss (P < 0.00001) and to achieve the maximum antifungal effect (P < 0.00001). The only region of dose combinations for which the 99% confidence intervals were less than 100 CFU/g of brain was defined by ABCD at 5.0 to 7.5 mg/kg combined with flucytosine at 20 to 60 mg/kg/day and fluconazole at 30 to 40 mg/kg/day. The triple combination of ABCD plus flucytosine and fluconazole was necessary to achieve the greatest antifungal activity.