Glass-ionomer cement modifies the gene expression of Streptococcus mutans providing a lower virulent biofilm.

PURPOSE: To evaluate the effect of glass-ionomer cement (GIC) on gene expression (gtfC, gtfD, covR, and vicR) of Streptococcus mutans (S. mutans) biofilms at 2, 4 and 24 hours. METHODS: Six groups were tested according to the materials and time observation, as follows: ceramic (IPS Empress Esthetic), as the control group, and GIC (Ketac Molar Easymix); and time points of S. mutans biofilm formation (2, 4, and 24 hours). Round-shaped samples (10 x 2 mm) of each material were prepared according to the manufacturers' specifications. GIC discs were handled in a laminar flow hood under aseptic conditions and stored at 100% relative humidity at 37°C for 24 hours to complete setting reaction. The samples were placed in a 24-well plate and immersed in 1.5 ml BHI + 1% sucrose with an inoculum of S. mutans UA159 to allow biofilm growth during 2, 4, and 24 hours. Next, the samples were removed, vortexed and centrifuged to collect cell pellets (n=5) for each material and time point. Pellets were stored at -80°C. Then, RNA was purified using the RNeasy Mini Kit protocol. The RNA was converted in cDNA using iScript cDNA Synthesis according to the manufacturer's recommendations. Analysis of gtfC, gtfD, vicR, and covR expressions was performed using Step One Real-Time qPCR device with specific primers for each gene and the analysis normalized by 16S reference gene expression. Data from gtfC, gtfD, and vicR were analyzed by t-test to compare between groups while Mann-Whitney was used to analyze covR expression (α= 0.05). RESULTS: No significant differences at 2 and 4 hours between materials for all analyzed genes were noted. However, in the 24-hour period, a significant decrease in gtfC and vicR expressions were observed, while covR expression increased when GIC was compared to ceramic. CLINICAL SIGNIFICANCE: The use of glass-ionomer cement decreased the virulence of S. mutans biofilms, which may imply a reduced bacterial cariogenic potential.

Endovascular management of acute epidural hematomas: clinical experience with 80 cases.

OBJECTIVE Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions. METHODS The study group consisted of 80 consecutive patients harboring small- to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group. RESULTS The causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were seen in 10%; and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in size of the EDH was observed and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation. CONCLUSIONS This study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.

Early echocardiographic predictors of increased left ventricular end-diastolic pressure three months after myocardial infarction in rats.

BACKGROUND: The objective of this study was to determine the early echocardiographic predictors of elevated left ventricular end-diastolic pressure (LVEDP) after a long follow-up period in the infarcted rat model. MATERIAL/METHODS: Five days and three months after surgery, sham and infarcted animals were subjected to transthoracic echocardiography. Regression analysis and receiver-operating characteristic (ROC) curve were performed for predicting increased LVEDP 3 months after MI. RESULTS: Among all of the variables, assessed 5 days after myocardial infarction, infarct size (OR: 0.760; CI 95% 0.563-0.900; p=0.005), end-systolic area (ESA) (OR: 0.761; CI 95% 0.564-0.900; p=0.008), fractional area change (FAC) (OR: 0.771; CI 95% 0.574-0.907; p=0.003), and posterior wall-shortening velocity (PWSV) (OR: 0.703; CI 95% 0.502-0.860; p=0.048) were predictors of increased LVEDP. The LVEDP was 3.6±1.8 mmHg in the control group and 9.4±7.8 mmHg among the infarcted animals (p=0.007). Considering the critical value of predictor variables in inducing cardiac dysfunction, the cut-off value was 35% for infarct size, 0.33 cm2 for ESA, 40% for FAC, and 26 mm/s for PWSV. CONCLUSIONS: Infarct size, FAC, ESA, and PWSV, assessed five days after myocardial infarction, can be used to estimate an increased LVEDP three months following the coronary occlusion.