Evaluation of a hydrophobic gel adhering to the gingiva in comparison with a standard water-soluble 1% chlorhexidine gel after scaling and root planing in patients with moderate chronic periodontitis. A randomized clinical trial

OBJECTIVES

To evaluate the clinical, microbiological and enzymatic activity of a hydrophobic chlorhexidine-based gingiva-adhering gel containing herbal ingredients, compared with a commercially available 1% chlorhexidine water-soluble gel, during non-surgical therapy of moderate chronic periodontitis.

METHODS

A total of 34 subjects participated in this 6-month blinded randomized parallel controlled trial (ISRCTN35210084). After scaling and root planing (SRP), test group received the gel, by rubbing on the gingiva, once every second day, for 14 days. The control group received the control gel twice daily. Clinical parameters considered were the approximal plaque index, simplified oral hygiene index, modified gingival index, bleeding on probing, probing depth and clinical attachment level (primary outcome), assessed at baseline, 3 and 6 months, together with the frequency of detection of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis (P.g.), Prevotella intermedia, Treponema denticola (T.d.), Tannerella forsythia (T.f.), and activity of neutrophil elastase and myeloperoxidase (secondary outcomes).

RESULTS

At 3 and 6 months, all clinical parameters improved significantly, without significant intergroup differences, except OHI-S, which improved at 3 months (P < 0.05). Microbiological data resulted in no significant intergroup differences at baseline and 6 months. At 3 months, significant differences for P.g., T.f. and T.d. were noted. A significant reduction of neutrophil elastase after 3 and 6 months was observed (P < 0.005), without significant intergroup differences. For myeloperoxidase, significant reductions were noted in both groups (P < 0.005 and P < 0.05), but no significant intergroup differences. The tested product seemed to have an increased efficacy, due to longer persistence on the gingiva, with reduced application frequency.

CONCLUSIONS

Both products had a relatively similar influence on the clinical, microbiological and enzymatic outcomes at 3 and 6 months after SRP.

Early dynamics of leptin plasma level in surgical critically ill patients. a prospective comparative study

BACKGROUND

Leptin (LPT), a hormone secreted by adipocytes,plays a role in inflammation and infection. Our study aimed to characterize the early dynamics of LPT in comparison with CRP and IL-6 during systemic inflammatory response syndrome(SIRS) and sepsis in surgical patients.

METHODS

Sixty patients were assigned into 3 equal groups:SIRS (SI) group with major abdominal elective surgery;sepsis (SE) group with community-acquired complicated intra-abdominal infection and controls (C). LPT, CRP and IL-6 were measured initially in all groups and repeated in groups SI and SE within 5 days after surgery (9 samples - 4 day 1, 2 day 2, 1 next 3 days).

RESULTS

LPT increased at 12-24 hours in SI group, but stayed within normal range in SE group. CRP and IL-6 had higher values in SE group versus SI group with an early peak for IL-6 and a late peak for CRP.

CONCLUSIONS

LPT has a different early dynamics during SIRS and sepsis. LPT measurement in association with CRP or IL-6 may be useful in the differential diagnosis and prognosis of surgical critical illness at different time courses.

The role of heart rate variability in assessing the evolution of patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (CPOD) is an important cause of morbidity and mortality. Cardiovascular involvement is the most common complication of the disease. Abnormalities of autonomic system, caused by this involvement, can lead to cardiac arrhythmias and sudden death. An important tool in assessing the dysfunction of the autonomic nervous system is the measurement of heart rate variability (HRV). In this article we systematically review the literature that addresses the role of heart rate variability as a maker of clinical evolution in patients with COPD. We focused on correlations between heart rate variability and pulmonary, muscular, cognitive and functional impairment. Heart rate variability has proven an important tool in assessing the cardiac function, the respiratory function, the muscular force, the cognitive capacity and the life quality of these patients. Until recently the problem of the cardiac autonomic dysfunction in patients with COPD could be identified only by invasive measures. At present the simple measuring of HRV is used as a noninvasive method in assessing the cardiac problems of these patients. HRV can be correlated with the severity of the disease, knowing that a dysfunction in autonomic nervous system can lead to potential fatal arrhythmias. Understanding the role of HRV in the evolution of COPD could be important in clinical practice and should be used more frequently.

How accurate replicates the Thermafil System the morphology of the apical endodontic space? An ex vivo study

AIM

To evaluate the morphology of the root canal in its apical third and the capacity of the Thermafil System to reproduce the entire morphology of the cleaned and shaped root canal.

MATERIALS AND METHODS

Thirty-two roots of periodontally compromised teeth were prepared using the ProTaper System to an apical size 30 and filled with the Thermafil obturation technique and sealer. The roots were surgically amputated and prepared for metallographic evaluation by incremental reductions of 0.5 mm each, starting with the apical foramen. Photomicrographs of each section were taken at a magnification of 500x and 100x. The images were analyzed and processed. The position of the apical foramen with respect to the anatomical apex was identified and marked. Additional morphological details as lateral canals and recesses were also recorded. The cross-sectioned area of the canal and gutta-percha, the total perimeter, the shaped perimeter and the filled perimeter were recorded for each sample and the results were expressed as percentages. Multiple images of successive sections were used to create a 3D reconstruction of the apical anatomy of the tooth. The ANOVA test was performed to assess mean differences between evaluations of perimeters/areas at different levels.

RESULTS

The anatomical apical foramen was found at the tip of the root in 50% of the evaluated samples. In the remaining samples, the foramen was located between 0.5 and 2.5 mm from the centre of the apex. Lateral canals, which opened in accessory foramens, were recorded in 25% of the evaluated samples. Statistical significant differences (p<0.05) were found between different levels of preparation and obturation.

CONCLUSIONS

The complex morphology of the apical third of the root canal is satisfactory microstructurally replicated by the Thermafil System. Moreover, polarized light microscopy and the 3D reconstruction offered a discriminative vision of morphological details as lateral canals, recesses, the gutta-percha and debris.

Computer-assisted photomicrographic evaluation of root canal morphology after removal of the filling material during retreatment

AIM

The purpose of this study was to evaluate the morphology of the apical third of the root canal and the effectiveness of rotary instrumentation for the removal of lateral condensed gutta-percha during endodontic retreatment.

MATERIALS AND METHODS

Thirty roots with canals with regular morphology were prepared to apical size #30 and were filled with gutta-percha/AHPlus using lateral condensation. Digital radiographs of teeth were captured. After two weeks, canals were retreated to size 40 using ProTaper rotary instruments, without solvent. Roots were embedded in resin blocks and reduced incrementally at four different apical levels (at 0.5, 1.0, 1.5 and 2.0 mm from the apical foramen). The sectioned surfaces were observed under a metallographic optical microscope and digital micrographic images were captured and processed. Perimeter covered with root-filling residue was expressed as percentage of total canal perimeter for all specimens.

RESULTS

Residue percentage was greater at 2.00 mm from apical level than at other levels. Most residue of filling material in all specimens was observed at 0.5 and at 2.0 mm from apex. The use of ProTaper instruments allowed the removal of gutta-percha and AHPlus sealer in the apical 2 mm in average 50% of the cases.

CONCLUSIONS

The resulting morphology of the prepared canals allowed root fillings performed with gutta-percha and AHPlus sealer that were efficiently removed by using rotary instruments. More material residue was found adhering to the canal walls in the apical segments of canals. The removal of this residue was enhanced by apical enlargement beyond the diameter of the canal before retreatment.

Prospective clinical study evaluating the long-time adjunctive use of chlorhexidine after one-stage full-mouth SRP

OBJECTIVES

Scaling and root planing are the causal procedure in the treatment of periodontitis. Many attempts have been made to improve the outcome. The aim of this study was to verify the influence of the extended use of chlorhexidine after one-stage full-mouth (FM) SRP in patients with chronic periodontitis on the clinical outcome after 3 months.

METHODS

Eighty-one patients with pockets > or =5 mm were treated by FM. All patients rinsed additionally with 0.2% chlorhexidine (CHX) twice daily over 3 months. Plaque index, bleeding on probing, probing depth (PD) and clinical attachment level (CAL) were recorded at baseline and after 1 and 3 months.

RESULTS

In the test group, all variables were significantly improved after 1 and 3 months. Mean reduction of PD and CAL gain was 2.25 +/- 1.08 and 1.67 +/- 1.08 after 1 and 2.99 +/- 1.11 and 2.33 +/- 1.31 after 3 months respectively.

CONCLUSIONS

Over 3 months of extended use of CHX mouth rinse after SRP showed slightly but statistically significant better results.

Intracellular sequestration of amiodarone: role of vacuolar ATPase and macroautophagic transition of the resulting vacuolar cytopathology

BACKGROUND AND PURPOSE

Tissue deposits of the anti-arrhythmic drug amiodarone are a major source of side effects (skin discoloration, etc.). We addressed the mechanism of the concentration of amiodarone in cells, and characterized the resulting vacuolar cytopathology and its evolution towards macroautophagy.

EXPERIMENTAL APPROACH

Sequestration of amiodarone in human cells (macrophages, smooth muscle cells, HEK 293a cells) was evaluated using its violet fluorescence and cytopathology using GFP-conjugated subcellular markers. Autophagic signalling was probed by immunoblotting for the effector protein LC3. A patient biopsy of amiodarone-induced blue-gray skin discoloration was investigated for the presence of macroautophagy (immunofluorescence for LC3).

KEY RESULTS

Most of the amiodarone (1-20 microM, 4-24 h) captured by cultured cells (macrophages were most avid) was present in enlarged vacuoles. The specific vacuolar ATPase (V-ATPase) inhibitors, bafilomycin A1 or FR167356, prevented vacuolization and drug uptake. Vacuoles in HEK 293a cells were positive for markers of late endosomes and lysosomes (GFP-Rab7, -CD63) and for an effector of macroautophagy, GFP-LC3. The vacuoles accumulated endogenous LC3 and filled with lipids (Nile red staining) following longer amiodarone treatments (> or =24 h). The electrophoretic mobility of both GFP-LC3 and endogenous LC3 changed, showing activation in response to amiodarone. Paraffin tissue sections of the pigmented skin exhibited granular LC3 accumulation in superficial dermis macrophages.

CONCLUSION AND IMPLICATIONS

Vacuolar sequestration of amiodarone occurs at concentrations close to therapeutic levels, is mediated by V-ATPase and evolves towards persistent macroautophagy and phospholipidosis. This cytopathology is not cell type specific, but tissue macrophages appear to be particularly susceptible.

Kinetic study of the indomethacin synthesis and thermal decomposition reactions

The kinetics of indomethacin synthesis (achieved through a new method) was studied at 80 degrees C. The reaction proceeds in four steps. In the first step, by the condensation of levulinic acid with p-chlorobenzoyl-p-methoxy-phenyl-hydrazine in homogeneous acidic catalysis an intermediate is formed. In the second step, by the isomerisation of this intermediate a hydrazo compound is formed. In the third step, the isomerisation is followed by the o-benzydinic transposition of the reaction product mentioned above. In the fourth step, indomethacin is formed through a cyclization reaction. The rate constant of the indomethacin synthesis reaction was determined assuming that the cyclization reaction constitutes the rate-determining step. Spectrophotometric methods were used both in order to investigate the kinetics of the synthesis reaction and to verify the proposed mechanism. Then, a thermogravimetric study was performed on the purpose of finding out the temperature range in which indomethacin is stable. From the thermogravimetric curve kinetic parameters have been derived, using different calculation techniques.

The control over the new obtaining procedeum of indomethacin

The synthesis of the indomethacin (1H-indole-3-acetic acid, 1(4-chlorobenzoyl)-5-methoxy-2-methyl) was achieved through a new method, which reduces some stages from the previous methods. Both the structure of the finished product and the structures of the intermediaries were investigated by chromatographic methods (TLC, chromatography on column, GC-MSD) and spectroscopic methods (UV, IR, 1H-NMR, 13C-NMR). The chromatographic and spectroscopic studies proved that these had a special analytical value and they serve to control synthesis and to identify the compounds in all the stages of the process.