A Clinical Study on the Effect of Injection Sites on Efficacy of Anesthesia and Pulpal Blood Flow in Carious Teeth

This randomized clinical trial evaluated the efficiency of maxillary infiltration anesthesia in carious teeth at two different injection sites and their impact on the laser Doppler recordings of pulpal blood flow (PBF) during a caries excavation procedure. The null hypothesis tested was that there are no differences in the efficiency of anesthesia and PBF reduction between maxillary infiltrations at the two injection sites. One hundred twenty patients were divided into three groups according to the degree of carious lesion of their maxillary left central incisors (moderate caries, deep caries, or no caries). Forty patients in each group randomly received infiltrations over the root apex of maxillary left central incisors (site X) or over the midpoint of the line connecting the root apexes of both maxillary left central and lateral incisors (site Y) using 0.9 mL 2% lidocaine with 1:100,000 adrenaline. Teeth were pulp tested at five-minute intervals after injection except for the period of cavity cutting, which was done 12 minutes after injection. The PBF changes after injection were monitored by laser Doppler flowmetry. The observation period in this study was 60 minutes. Success of anesthesia was defined as no or mild pain on cavity cutting by visual analog scale recordings. Deep caries group showed significantly higher baseline PBF ( p<0.05). All groups showed 100% success of anesthesia and similar duration time ( p>0.05). Subgroups that had the injection at site Y showed significantly less reduction of PBF ( p<0.05). Cavity-cutting procedures increased the amplitude of the PBF around the lowest value after injection. Independent of the cavity depth, carious anterior teeth anesthetized by infiltration further from the apex had significantly less reduction on the pulpal blood flow compared with teeth anesthetized by infiltration at the apex.

Chemotherapy combined with target drugs in the treatment of advanced colorectal cancer: a meta-analysis based on Chinese patients

BACKGROUND

Colorectal carcinoma is one of most diagnosed solid malignant carcinoma. The chemotherapy combined with target drugs in the treatment of advanced colorectal cancer in not conclusive.

METHODS

The clinical studies reporting the activity and adverse events between chemotherapy alone versus chemotherapy combined with anti-epidermal growth factor receptor drugs were screened in the databases of Medline, the Cochrane Library, Wanfang and CNKI and included in this meta-analysis. The risk ratio (RR) and its 95% confidence interval (CI) for treatment response and adverse events were pooled by random or fixed effect model.

RESULTS

A total of 10 clinical studies reporting chemotherapy combined with the target in the treatment of advanced colorectal cancer were included in this study. The pooled RR was 3.26 (95% CI: 1.74-6.11, P < 0.05), 1.49 (95% CI: 1.23-1.80) and 1.65 (95% CI: 1.37-1.98) for complete response (CR), partial response and objective response rate, respectively. For nausea and vomiting events, the RR was 1.62 (95% CI: 1.33-1.97, P < 0.05) indicating higher incidence of nausea and vomiting was observed in the combined group compared with chemotherapy alone. However, the diarrhea (RR = 1.10, 95% CI: 0.86-1.42, P > 0.05), liver function damage (RR = 1.03, 95% CI: 0.74-1.42), myelosuppression (RR = 1.04, 95% CI: 0.83-1.31) and neurotoxicity (RR = 1.12, 95% CI: 0.93-1.35) were not different between the two groups.

CONCLUSION

For Chinese patients with advanced colorectal cancer, chemotherapy combined with target drug can improve the response rate, but also increase the risk of nausea and vomiting.

Apically extruded debris and irrigant with two Ni-Ti systems and hand files when removing root fillings: a laboratory study

AIM

To compare the amount of apically extruded debris and irrigant produced by two Ni-Ti instruments and hand files when removing root fillings, and to compare two experimental models.

METHODOLOGY

Sixty single straight root canals in human mandibular premolars were prepared with K-files and filled with gutta-percha and AH Plus sealer. The teeth were randomly divided into three groups of 20 for removal of the root filling material with Reciproc files (Group 1, RP), Mtwo retreatment files (Group 2, MR) or hand files (Group 3, H). Each group was then equally divided into experimental subgroups: A, with 1.5% agar gel model (AG); B, with empty tube model (ET). Apically extruded debris and irrigant was quantified by subtracting the initial weight of the test apparatus without a tooth from its weight after the root canal retreatment. Comparative analysis of the amount of apically extruded debris and irrigant for each of the instruments and the experimental models was performed. Time for gutta-percha removal was recorded. Data were statistically analysed using one-way analysis of variance.

RESULTS

Removal of root fillings with two Ni-Ti instruments produced less apically extruded debris and irrigant than hand files in both experimental models (P < 0.05). More apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the 1.5% agar gel model (P > 0.05). Significantly more apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the empty tube model (P < 0.05). The time required to remove the root fillings followed Reciproc<Mtwo R<hand files (P < 0.05).

CONCLUSIONS

All the instruments produced apically extruded debris and irrigant. The two Ni-Ti instruments produced less apically extruded debris and irrigant than hand files. A 1.5% agar gel can provide resistance to apically extruded debris and irrigant and may represent the clinical situation better than the empty tube model.

Comparative studies of potential cancer biomarkers carbon-11 labeled MMP inhibitors (S)-2-(4'-[11C]methoxybiphenyl-4-sulfonylamino)-3-methylbutyric acid and N-hydroxy-(R)-2-[[(4'-[11C]methoxyphenyl)sulfonyl]benzylamino]-3-methylbutanamide

(S)-2-(4'-[11C]methoxybiphenyl-4-sulfonylamino)-3-methylbutyric acid ([11C]MSMA) and N-hydroxy-(R)-2-[[(4'-[11C]methoxyphenyl)sulfonyl]benzylamino]-3-methylbutanamide ([11C]CGS 25966), carbon-11 labeled matrix metalloproteinase (MMP) inhibitors, have been synthesized for evaluation as new potential positron emission tomography (PET) cancer biomarkers. [11C]MSMA was prepared by appropriate precursor (S)-2-(4'-hydroxybiphenyl-4-sulfonylamino)-3-methylbutyric acid tert-butyl ester, which was synthesized in eight steps from amino acid (L)-valine in 39.4% chemical yield. This precursor was labeled by [11C]methyl triflate through O-[11C]methylation method at the hydroxyl position of biphenol under basic conditions, followed by a quick acid hydrolysis and isolated by solid-phase extraction (SPE) purification to produce pure target compound [11C]MSMA in 35-55% radiochemical yield, based on 11CO2, decay corrected to end of bombardment (EOB), and 20-25 min synthesis time. [11C]CGS 25966 was prepared in our previous work starting from amino acid (D)-valine. The biodistribution of [11C]MSMA and [11C]CGS 25966 were determined at 45 min post iv injection in breast cancer animal models MCF-7's transfected with IL-1alpha implanted athymic mice and MDA-MB-435 implanted athymic mice. The results showed the uptakes of [11C]MSMA and [11C]CGS 25966 in these tumors were 0.95 and 0.42%dose/g in MCF-7's transfected with IL-1alpha implanted mice, 0.98 and 1.53%dose/g in MDA-MB-435 implanted mice, respectively; the ratios of tumor/muscle (T/M) and tumor/blood (T/B) were 1.21 and 1.09 (T/M, MCF-7's), 0.99 and 0.84 (T/B, MCF-7's), 1.38 and 1.27 (T/M, MDA-MB-435), 1.27 and 1.95 (T/B, MDA-MB-435), respectively. The micro-PET images of [11C]MSMA and [11C]CGS 25966 in both breast cancer athymic mice were acquired for 15 min from a MCF-7's transfected with IL-1alpha and/or MDA-MB-435 implanted mouse at 45 min post iv injection of 1 mCi of the tracer using a dedicated high resolution (<3 mm full-width at half-maximum) small FOV (field-of-view) PET imaging system, Indy-PET II scanner, developed in our laboratory, which showed both tumors were invisible with both tracers. The results were compared. From our results, we concluded that both [11C]MSMA and [11C]CGS 25966 might be unsuitable as PET tracers for cancer imaging.

Synthesis of radiolabeled biphenylsulfonamide matrix metalloproteinase inhibitors as new potential PET cancer imaging agents

Novel matrix metalloproteinase (MMP) inhibitor radiotracers, (S)-3-methyl-2-(2',3',4'-methoxybiphenyl-4-sulfonylamino)-butyric acid [(11)C]methyl ester (1a-c), (S)-3-methyl-2-(2',3',4'-fluorobiphenyl-4-sulfonylamino)-butyric acid [(11)C]methyl ester (1d-f), and (S)-3-methyl-2-(4'-nitrobiphenyl-4-sulfonylamino)-butyric acid [(11)C]methyl ester (1g), a series of substituted biphenylsulfonamide derivatives, have been synthesized for evaluation as new potential positron emission tomography (PET) cancer imaging agents.

PET imaging of the pre-synaptic dopamine uptake sites in rapid-onset dystonia-parkinsonism (RDP)

BACKGROUND

Rapid-onset dystonia-parkinsonism (RDP) is a genetic movement disorder characterized by abrupt onset over hours to days of bradykinesia, postural instability, dysphagia, dysarthria, and severe dystonic spasms with decreased levels of the dopamine metabolite, homovanillic acid (HVA), in cerebrospinal fluid (CSF).

METHODS

We imaged the dopamine re-uptake system with [O-methyl-11C]beta-CFT ([11C]beta-CFT) in three severely affected individuals with RDP and four patients with idiopathic Parkinson's disease (IPD). Results were compared with those of age-matched normal volunteers.

RESULTS

Positron emission tomography images from those patients with IPD demonstrated a dramatic reduction in the volume of distribution of [11C]beta-CFT whereas patients with RDP showed slightly elevated values.

CONCLUSIONS

The data suggest that patients with RDP do not have a decrease in the number of dopamine re-uptake sites. Our findings suggest that, unlike the situation in IPD, low CSF HVA concentrations seen in RDP patients are not the result of degeneration of striatal dopamine terminals or loss of dopamine re-uptake sites.

Heterogeneous atrial denervation creates substrate for sustained atrial fibrillation

BACKGROUND

Heterogeneous electrophysiological properties, which may be due in part to autonomic innervation, are important in the maintenance of atrial fibrillation (AF). We hypothesized that heterogeneous sympathetic denervation with phenol would create a milieu for sustained AF.

METHODS AND RESULTS

After the determination of baseline inducibility, 15 dogs underwent atrial epicardial phenol application and 11 underwent a sham procedure. After 2 weeks of recovery, the animals had repeat attempts at inducing AF and effective refractory period (ERP) testing. Epicardial maps were obtained to determine local AF cycle lengths. ERPs were determined at baseline and during sympathetic, vagal, and simultaneous vagal/sympathetic stimulation. Dogs then underwent PET imaging with either a sympathetic ([11C]hydroxyephedrine, HED) or parasympathetic (5-[11C]methoxybenzovesamicol, MOBV) nerve label. None of the animals had sustained AF (>60 minutes) at baseline. None of the sham dogs and 14 of 15 phenol dogs had sustained AF at follow-up. Sites to which phenol was applied had a significantly shorter ERP (136+/-17.6 ms) than those same sites in the sham controls (156+/-19.1 ms) (P=0.01). Although there was no difference in the ERP change with either vagal or sympathetic stimulation alone between phenol and nonphenol sites, the percent decrease in ERP with simultaneous vagal/sympathetic stimulation was greater in the phenol sites (17+/-8%) than in the nonphenol sites (9+/-9%) (P=0.01). There was a significantly increased dispersion of refractoriness (21+/-6.4 ms in the sham versus 58+/-14 ms in the phenol dogs, P=0.01) as well as dispersion of AF cycle length (49+/-10 ms in the sham versus 105+/-12 ms in the phenol dogs, P=0.0001). PET images demonstrated defects of HED uptake in the areas of phenol application, with no defect of MOBV uptake.

CONCLUSIONS

Heterogeneous sympathetic atrial denervation with phenol facilitates sustained AF.

Characteristics of rat pancreatic regenerating protein

BACKGROUND

The pancreatic regenerating (reg) gene is an acinar cell product involved in islet formation and maintenance. Human reg protein is mitogenic to pancreatic beta and ductular cells, and its amino acid sequence predicts it to be a calcium-dependent lectin.

METHODS

We studied the biologic activity and cellular localization of rat reg I isolated from the acinar cell line AR42J and the lectin properties of reg from AR42J and pancreatic juice. Bioactivity was assayed by mitogenesis on the ductular cell line ARIP. Cellular localization was determined by differential centrifugation. Lectin properties were assessed by affinity chromatography.

RESULTS

Reg protein from crude AR42J cellular lysate and purified reg protein from AR42J induced thymidine incorporation to ARIP. Conditioned medium from AR42J and co-culture of AR42J with morphologically distinguishable ARIP, however, failed to induce mitogenesis. Reg protein was localized within the vesicle fraction of the cell and was not membrane bound. Affinity chromatography revealed that reg protein did not bind to mannose or galactose in the presence or absence of calcium. In pancreatic juice a previously undescribed mannose-binding protein was discovered at 25,000 to 30,000 daltons.

CONCLUSIONS

We conclude that reg produced in the acinar cell line AR42J is biologically active but not efficiently secreted, even though it localized within the cellular vesicles. Despite predictions based on its amino acid sequence, it does not appear to be a calcium-dependent lectin.

Improved synthesis of beta-CIT and [11C]beta-CIT labeled at nitrogen or oxygen positions

The important radiotracer precursor 2 beta-carbomethoxy-3 beta-(4-idophenyl)-tropane (beta-CIT, RTI-55) was made in 52% overall yield from cocaine. Key steps were improved conjugate Grignard addition to anhydroecgonine methyl ester with > 3.5:1 2 beta: 2 alpha-isomer selectivity, and a mild new direct aromatic iodination with I2 and silver triflate in CH2Cl2. The [11C]beta-CIT was labeled at either the N or O positions with [11C]methyl triflate; and efficient reversed-phase HPLC was used to preparatively separate [N-11C]beta-CIT from N-nor-beta-CIT for the first time, and a fast solid-phase extraction (SPE) method was applied to preparatively separate [O-11C]beta-CIT from beta-CIT-acid precursor.

[A study on location of vocalization centres in hawfinch (Coccothraustes coccothraustes)]

Vocal-control nuclei in hawfinch (Coccothraustes coccothraustes) were studied by HRP retrograde tracing and electrophysiological methods. Vocal control centres in hawfinch consist of four discrete nuclei. Hyperstriatum ventral, pars caudale (HVc) is the highest nucleus, with its efferent fibers projecting to the rubust nucleus of archistriatum (RA), which in turn projects to the nucleus intercollicularis (ICo) of midbrain and the nucleus intermedius (IM) of medulla oblongata IM innervating vocal organ (syrinx) also receives input from ICo. The both vocal control pathways are not strictly unilateral. ICo plays a relative independent role in vocal control. The stereotaxic coordinates for HVc RA, ICo, IM are tabulated in Table 2.