Demineralized Human Dentin Matrix as an Osteoinductor in the Dental Socket: An Experimental Study in Wistar Rats.

PURPOSE: This study evaluated the bone-forming potential of the demineralized human dentin matrix by performing histologic and morphometric analyses. The immunolabeling of osteopontin, a determinant protein for bone repair, was also evaluated. MATERIALS AND METHODS: Wistar rats were selected and submitted to the extraction of the right and left second molars. Tooth sockets were separated into two groups: the control group (right), which was filled with the blood clot, and the experimental group (left), which was filled with demineralized human dentin matrix. Animals were sacrificed at 5, 10, and 21 days. Histologic and histoquantitative analyses (analyses of variance [ANOVA] and Tukey's test) were performed, as well as immunostaining for osteopontin as an osteogenesis indicator. RESULTS: After 5 days, demineralized human dentin matrix was incorporated by new trabeculae. After 10 days, connective tissue organization and new trabeculae were observed in the experimental group, and intense staining for osteopontin close to demineralized human dentin matrix was observed in the experimental group. After 21 days, the experimental group was showing mature trabeculae. A statistical difference was observed (P < .05). There was a higher number of trabeculae in the experimental groups in all periods of analysis. The presence of osteopontin was observed more intensely at 10 days close to demineralized human dentin matrix. CONCLUSION: This study indicates that demineralized human dentin matrix implanted in tooth sockets induces the acceleration of osteogenesis.

Warm-Season (C4) Turfgrass Genotypes Resistant to Spittlebugs (Hemiptera: Cercopidae).

Screening for resistance to insect pests is one of the early stages of grass breeding programs. Pasture spittlebugs are sap-sucking insects that potentially cause severe damage to turfgrasses, including the loss of functional quality and perenniallity. The Brazilian flora has a large number of grass species with wide morphological variability and adaptability to different soil and climate conditions that can potentially be used as lawns. However, no study has screened turfgrass genotypes for resistance to spittlebug attack. In this study, we evaluated the intra- and interspecific variability of 35 turfgrass genotypes in the genera Paspalum, Axonopus, and Zoysia for resistance to the pasture spittlebugs, Deois flavopicta (Stal) and Notozulia entreriana (Berg) (Hemiptera: Cercopidae), as measured by damage scores, densities of nymphs and adults, and level of antibiosis resistance. Genotypes were grouped into three groups using cluster analysis and principal component analysis: GroupI had genotypes associated with low damage scores and high density of adult spittlebugs; GroupII had genotypes with intermediate damage scores and low density of nymphs and adults; and GroupIII was formed by genotypes with high damage scores and high nymph density. Intra- and interspecific genotypic variability was related to antibiosis resistance and morphological variation among genotypes with some indicating nonpreference resistance and others indicating tolerance resistance. Our results indicate that besides antibiosis resistance studies, it is essential to evaluate the morphological variability of grass genotypes when screening for resistance to insects. Further studies are needed to elucidate the intraspecific variability of Paspalum notatum Flüggé genotypes for resistance to spittlebug attack.

Vena cava filters in hospitalised patients with chronic obstructive pulmonary disease and pulmonary embolism.

In view of the high case fatality rates of patients with chronic obstructive pulmonary disease (COPD) who have pulmonary embolism (PE) we speculated that such patients might benefit from vena cava filters. To test this hypothesis we assessed the database of the Nationwide Inpatient Sample. From 1998-2009, 440,370 patients were hospitalised with PE and COPD who were not in shock or ventilator-dependent and did not receive thrombolytic therapy or pulmonary embolectomy. In-hospital all-cause case fatality rate among those with filters was 5,890 of 68,800 (8.6%) (95% confidence interval [CI] = 8.4-8.8) compared with 38,960 of 371,570 (10.5%) (95% CI = 10.4-10.6) (p<0.0001) who did not receive filters. Case fatality rate was age-dependent. Only those who were older than aged 50 years had a lower in-hospital all-cause case fatality rate with filters. Among such patients, absolute risk reduction was 2.1% (95% CI = 1.9-2.3). The greatest reduction of case fatality rate with vena cava filters was shown in patients >aged 80 years, 11,720 of 81,600 (14.4%) compared with 1,570 of 17,220 (9.1%) (p<0.0001). In conclusion, a somewhat lower in-hospital all-cause case fatality rate was shown with vena filters in stable patients with PE >aged 50 years who also had COPD. The benefit was greatest in elderly patients. The benefit in terms of a decreased case fatality rate would seem to outweigh the risks of vena cava filters in such patients.

Effect of compression stockings on venous blood velocity and blood flow.

The effects of graduated compression stockings (GCS) on venous blood velocity have not been established. In healthy subjects, most investigations showed no effect on blood velocity, but mixed results have been reported. In this investigation we to test the hypothesis that popliteal blood velocity is increased by properly fitted GCS. Time average peak velocity in the popliteal vein, as well as time average mean velocity, vein diameter and mean volumetric flow were measured by pulsed wave Doppler ultrasound in 25 healthy male volunteers without compression stockings and repeated with fitted thigh-length compression stockings. Measurements were obtained while supine and while sitting at rest and during ankle exercise. Thigh-length GCS did not increase popliteal vein blood velocity, diameter, or volumetric blood flow while supine or sitting, with or without ankle exercise.

Hypo-excitability of cortical areas in patients affected by Friedreich ataxia: a TMS study.

The aim of the study was to explore excitability of a motor and a non-motor (visual) area in patients affected by Friedreich ataxia and to correlate neurophysiological data with clinical parameters. Seven patients (3M/4F) and ten healthy controls (5M/5F) participated in the study. The hot-spot for activation of right abductor pollicis brevis was checked by means of a figure-of-eight coil and the motor threshold (MT) on this point was recorded. The phosphene threshold (PT) was measured by means of a focal coil over the occipital cortex as the lower intensity of magnetic stimulation able to induce the perception of phosphenes. The patients showed a significantly higher mean PT (p<.03) and MT values (p<.001) than controls. In all but one patient unable to perceive phosphenes (42% vs. 50% of controls), TMS at 100% intensity did not elicit motor response at rest. The difference in percentage of patients (57.1%) and controls (100%) with motor responses was nearly significant. The size of GAA1 expansion showed significant correlations with PT and MT values. The results of our study showed that FA patients had reduced cortical activation, involving both the motor and the visual cortex. The cortical involvement in these patients seems to be mainly genetically determined. The study provides the first evidence of cortical dysfunction in patients with genetically defined Friedreich ataxia.

The effects of state of alertness on the vestibulo-ocular reflex in normal subjects using the vestibular rotational chair.

Twenty-four subjects with normal vestibular function underwent horizontal sinusoidal harmonic acceleration (SHA) and step-velocity rotational chair assessment twice, first in a heightened state-of-alertness, and second, in a low state-of-alertness. The effects of alertness on vestibulo-ocular reflex gain and time-constant (Tc) were then examined. Although the negative effect on SHA gain had previously been widely reported, the effect on the Tc had not been studied. It was found that SHA gain and step-velocity Tc were significantly and artificially reduced with decreased alertness. On average, SHA gain was reduced by 0.1 at each test frequency and the Tc was reduced from 15.8 seconds to 10.5 seconds. Whilst on average, step-velocity initial gain was only a little affected reducing from 0.53 to 0.49. This very small difference of 0.04 was significant, however, it suggested that this measurement is less affected by patient alertness than SHA gain and Tc.

[The evolution of hospital mortality due to acute myocardial infarct in the first 2 GISSI studies. Participants in the GISSI 1 and GISSI 2 studies. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico]. / Evoluzione della mortalità ospedaliera per infarto miocardico acuto nei primi due studi GISSI. Partecipanti agli studi GISSI 1 e GISSI 2.

During the short while of 5 years, between 1984 and 1985, two large clinical trials have been performed in Italy concerning fibrinolytic therapy in Acute Myocardial Infarction: GISSI 1 and GISSI 2. They made possible to evaluate the evolution of demographic and clinical features, the in-hospital mortality rate, and the causes of death of a huge number of patients admitted to CCU throughout the whole country. Out of 31,826 patients with acute myocardial infarction admitted to 176 CCU participating to the GISSI 1 16.9% were 75 years old and 24.7% were females; 21.8% and 26.4% were the percentages in the 38,086 patients admitted to the 223 CCU participating in the GISSI 2. Despite the higher prevalence of the two demographic characteristic with the worse prognosis, the in-hospital mortality rates were respectively 12.2% in the GISSI 1 and 10.0% in the GISSI 2 studies, with a statistically significant decrease (RR 0.84; C.L. 0.80-0.88). The significant decrease in the in-hospital mortality concerns also the patients populations selected according to the same criteria of inclusion in the two trials (within 6 hours from the onset of symptoms and with only ST elevation at the ECG of admission) and to the treatment with fibrinolytic drug (SK or rtPA). As a matter of fact 468 patients died of the 4,696 (10.0%) treated with SK in the GISSI 1 against 1,092 patients of 12,381 (8.8%) enrolled in the GISSI 2 and treated with SK or rtPA (RR 0.87; L.C. 0.78-0.98). The reduction of in-hospital mortality may be explained by some differences in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Defibrotide versus heparin in the prevention of coronary reocclusion after thrombolysis in acute myocardial infarction.

A multicenter controlled study versus heparin was conducted to explore the activity of defibrotide, a polydesoxyribonucleotide drug, in preventing reocclusion after urokinase thrombolysis in patients with acute myocardial infarction (AMI). The study involved 137 consecutive patients with AMI and a time from the onset of symptoms < or = 6 hours, treated with urokinase (1,000,000 U intravenous bolus followed by 1,000,000 U slow-drip infusion over 12 hours). Immediately after thrombolysis, patients were allocated to treatment with defibrotide (group D: day 0, 3.6 g by intravenous infusion in 12 hours; days +1 to +6, 800 mg tid intravenously; days +7 to +10/+12, 400 mg tid intramuscularly), or heparin (group H: day 0, 1000 IU/hour infused over 12 hours; days +1 to +10/+12, 5000 IU tid subcutaneously). Coronary angiography was done, whenever possible, at +10/+12 days. The following parameters were assessed: (a) noninvasive estimate of myocardial reperfusion, through the analysis of CPK time-activity curves; (b) incidence of infarct-related artery (IRA) patency (TIMI scores 2-3) at coronary angiography. A total of 125 patients had a complete enzymatic curve (63 in group D and 62 in group H) and 106 had coronary angiography as well. IRA patency (the main end point) was observed in 63% of group D versus 43% of group H patients (p = 0.07). No statistically significant differences were found in the proportion of patients with indirect signs of early reperfusion (63% in group D versus 52% in group H patients).(ABSTRACT TRUNCATED AT 250 WORDS)

[Serological confirmation of HIV infections in hospital practice: analysis of indeterminate western blot results]. / Sérologie de confirmation de l'infection par le VIH en pratique hospitalière: analyse des western blots indéterminés.

Among 770 Western blots for HIV-1 confirmation on sera from subjects at high risk for HIV infection, 4.3% (33 cases) were indeterminate. Isolated, stable, reproducible anti-gp 160 reactivity, highly suggestive of a nonspecific reaction, was found in 16% of cases. There were three other probably nonspecific patterns with anti-gp 160 and either anti-gp 41 or anti-gp 120 reactivities and thin, atypical bands. Two patterns with anti-p24 and either anti-gp 160 or anti-gp 120 reactivities were consistent with HIV-1 seroconversion. Reactivity directed solely against gag products was seen in 18% of cases. The repeat test, performed in 16 cases, showed an identical pattern in 3 cases, a modified pattern in 3 cases, negative results in 9 cases, and seroconversion in 1 case. No case of HIV-2 infection was detected. Indeterminate Western blot results reflect nonspecific reactivity in most instances but should nevertheless lead to the exclusion of technical artefacts, seroconversion, and HIV-2 infection.

[A survey of cardiological emergencies in Piedmont]. / Indagine conoscitiva sulle emergenze cardiologiche in Piemonte.

OBJECTIVES AND DESIGN: In order to assess the current behavioural status of patients receiving emergency cardiological treatment and the emergency services in the Piedmont Region, our Division carried out a survey of the Region's DEA and first aid centres based on the compilation of a questionnaire for each patient who passed through these structures over a 5-month period. The study included only patients hospitalised within 12 hours of symptoms' onset. The questionnaire aimed to assess the time the patient took to reach a decision, the eventual call for a home visit, the type of doctor called, the time spent by the doctor, the use of either a private vehicle or of an ambulance for transport to hospital, the time taken to get to the hospital, and the overall time taken to admit the patient to the emergency cardiological ward. The statistical analysis of data was carried out using both single and multiple variables. The selection of prognostic variables was carried out using a stepwise method. RESULTS: Data presented in this study refer to 1705 records, collected in 39 Piedmontese hospitals (75% of those with DEA or First Aid Center). Patients with acute myocardial infarction were 970 (57%). A doctor was requested at home in nearly half of the cases (49.3%). There was no correlation between the type of emergency and the request for a home visit, whereas the latter varied in relation to the different geographical areas and to the patients' age. A small majority of patients used personal transport to get to the hospital (55.5%) in comparison to those using an ambulance (44.5%) (p less than 0.001). Time taken to reach a decision was related to the type of pathology (acute pulmonary edema less than acute myocardial infarction less than arrhythmia) and to geographical area; mean decision time in the overall sample was 125 +/- 158 minutes. The mean duration of doctors' intervention at home was 74 +/- 82 minutes. The mean time taken to reach the hospital using private transport was 22 minutes, and the time taken using ambulance was the same, but this should be added to the time taken for the ambulance to reach the patient (a mean total time of 15 minutes). Overall mean hospitalisation time was 192 minutes. CONCLUSIONS: The critical factors causing delay in hospitalisation time are the poor levels of health education of the population in general, and the poor activation capacity of certain peripheral parts of the National Health Service. In particular, it is worth drawing attention to the delay due to the intervention of the family doctor in the current organisational model. Doctors called from first aid stations are able to provide a more rapid intervention, but are currently unable to meet the requirements of patients needing emergency cardiological treatments. These data confirm the rationale for intervention projects in cardiological emergencies, considering on one hand that a fleet of special vehicles be created, and on the other that doctors from first aid stations be specifically trained and increasingly involved.

[Estimated biological markers of progression in human immunodeficiency virus infection]. / Marqueurs biologiques prévisionnels d'évolution au cours de l'infection par le virus de l'immunodéficience humaine.

The biological markers for determining as early as possible the progression in the infection by the human immunodeficiency virus (HIV) are very important for the health care of patients, and to adapt their anti-retroviral treatment. Among those, four independent biological markers for predicting a pejorative evolution in the following 36 months are used in medical practice: two specific for HIV, p24 antigenemia and serum titre of antibodies to the p24 core antigen, and two non-HIV specific surrogate markers, the beta 2-microglobulinemia and the absolute number of CD4 T cell in blood. P24 antigenemia corresponds to an active retroviral in vivo replication. The cut off for detection is about 10 pg/ml. It is difficult to detect in black people, and in the asymptomatic or pauci-symptomatic stages of the disease. The apparition or the increase of the serum p24 antigen levels suggest the occurrence of opportunistic infections. P24 antigenemia decreases or disappears during the treatment by zidovudine. The diminution or the disappearance of serum antibodies directed to the p24 core protein are secondary to the deficiency of the humoral immunity, and to an increase of the viral replication, which occur at the late stage of the disease. The diminution or the disappearance of serum antibodies to p24 precede the occurrence of AIDS by several months. The increase of the serum beta 2-microglobulin level is associated with the severity of the disease. In the San Francisco prospective cohort, the progression to AIDS in 36 months was 69% when beta 2-microglobulinemia was more than 5 mg/l, 33% when it was between 3.1 to 5 mg/l, and 12% when it was less than 3 mg/l. The beta 2-microglobulin intra-thecal synthesis level could serve as a marker for the specific HIV encephalitis. The CD4 lymphocyte count constitutes an independent provisional marker for progression to AIDS, probably the most important, but mainly of statistical value. A lymphocyte count of 200 CD4/mm3 is considered as the threshold of full blown AIDS. Beside these classic biological markers, numerous other parameters have been evaluated, without knowing their practical interest. Although the predictive markers for AIDS have a real statistical significance, their interpretation could be difficult or hazardous when applied to a sole individual. In a relatively short delay, the actual biological markers will probably be completed or changed, in the routine medical practice, by the use of direct virological markers evaluating the viral load (plasmatic or cellular viremia).

[Clinical results and modification of left ventricular function after emergency revascularization for acute myocardial infarction]. / Risultati clinici e modificazioni della funzione ventricolare sinistra dopo rivascolarizzazione d'emergenza per infarto miocardico acuto.

Results of emergency revascularization for evolving myocardial infarction have been evaluated in 43 consecutive patients operated between January 1985 and March 1988. Time interval between onset of symptoms and coronary bypass averaged 6.7 +/- 0.5 hours (0.75-48). Intravenous or intracoronary thrombolysis was attempted pre-operatively in 26 cases. Overall hospital mortality was 6.9% (3/43) but this decreased to only 2.7% if patients in cardiogenic shock were excluded. Follow-up averaged 20.6 +/- 9.5 months (4-42). Actuarial survival was 82.9 +/- 7.3% at 36 months. Of the 36 survivors, 28 were free from angina and reinfarction at control. Nineteen patients were evaluated with angiography at follow-up (averaging 10.1 +/- 5.7 months). Left ventricular and regional ejection fraction were calculated on pre- and post-operative angiograms; regional ejection fraction was determined with the centerline method. Left ventricular ejection fraction increased from 0.49 +/- 0.15 to 0.52 +/- 0.19 (NS), regional ejection fraction improved from 0.20 +/- 0.1 to 0.27 +/- 0.16 (35% increment, p less than 0.05). The analysis of left ventricular and regional ejection fraction variations with the time elapsed from the onset of symptoms to surgery identified two subgroups of patients: those operated within and after six hours. In the first subgroup, left ventricular ejection fraction increased from 0.52 +/- 0.16 to 0.62 +/- 0.13 (p less than 0.005) and regional ejection fraction from 0.19 +/- 0.08 to 0.36 +/- 0.14 (89% increment, p less than 0.0005). In the second subgroup, both left ventricular and regional ejection fractions decreased from 0.44 +/- 0.13 to 0.36 +/- 0.11 (NS) and from 0.20 +/- 0.13 to 0.12 +/- 0.08 (NS), respectively. These results lead to the conclusion that improved left ventricular performance may be achieved in selected groups of patients if they undergo surgery within six hours of the onset of pain.

[The Italian Group for the Study of Streptokinase in Myocardial Infarct: Evaluation of the enzymatic curve of creatine kinase]. / G.I.S.S.I.: Valutazione delle curve enzimatiche (CK).

Within the multicentre trial of the Italian Group for the Study of Streptokinase in Infarct (G.I.S.S.I.), a particular study was planned for the analysis of plasma creatine kinase curves (CK). Serial measurements of total plasma CK from 11,806 pts (5.905 treated with Streptokinase (SK) and 5,901 control pts (C)) were evaluated by the compartment method (Fig. 7), which is commonly used in pharmacological studies. By this method, the plasma enzyme curve is interpreted on the basis of the following kinetic parameters: the fractional rate of input (Ki) and of disappearance (Kd) of enzyme into and from the blood; the plasma cumulative CK activity (Dp); the time interval between the onset of symptoms and the beginning of the ascending CK curve (To); the time from To to the peak CK (Tp). The Dp/Ki ratio was employed for the estimate of myocardial infarct size. From the available data, acceptable CK curves could be derived in 7,632 cases (3,568 treated with SK, 4,064 control pts.). Compared with control group (Fig. 1--Tab. I) the SK treated pts presented increased Ki and Kd values and reduced To, (p greater than 0.001), Dp/Ki (p greater than 0.05). The earlier SK treatment was started, the higher difference (Fig. 2) was observed between the two groups (SK and C). No significant difference was found between the two groups (SK and C) with regard to sex (Fig. 3), age, history of previous myocardial infarct, re-infarction, early post-infarction angina. Statistically significant similar differences of the above parameters between SK and C groups, were also found when various infarct locations were considered, with the only exception of not-Q infarct (Fig. 4). In the cases complicated by pericarditis (Tab. II, Fig. 5), independently of treatment, reduced reperfusion related indexes and increased Dp/Ki ratio were observed. Severe left ventricular impairment (Killip class 4) tends to reduce (Tab. III) the differences in enzyme parameters between the two groups (SK and C). The patients who died (18 hours after the onset of symptoms) exhibited as the only significant difference compared to survivors the infarct-size related CK parameters (Dp/Ki), independently from the treatment. The mathematical model used in this study proved to be easily feasible and useful for the evaluation of the effect of the treatment in acute myocardial infarct.(ABSTRACT TRUNCATED AT 400 WORDS)

Hiperparatiroidismo primario por adenoma de localizacao intratimica em adolescente / Primary hyperparathyroidism by intra-thymic adenoma in adolescence

Os autores apresentam um caso de hiperparatiroidismo primario em adolescente, devido a adenoma da paratiroide localizado em situacao ectopica (mediastino anterior e no interior do timo). A seguir, ressaltam a origem embriologica comum (paratiroides e timo), a raridade da localizacao anomala do adenoma(intratimica) e fazem uma revisao sucinta de hiperparatiroidismo primario em criancas