[Simultaneous reconstruction of both anterior cruciate ligaments]. / Reconstrucción simultánea de ambos ligamentos cruzados anteriores.

INTRODUCTION: When there is injury to both knees of the anterior cruciate ligament (ACL), the surgeon has the option to reconstruct both in a staggered manner or simultaneously. There are some reports and case series where the ACL is performed simultaneously. In this manuscript we present a case and the result with simultaneous reconstruction. CLINICAL CASE: 40-year-old male with no history of importance with bilateral ACL injury; torniquet-free surgery was performed with autograft of hamstrings, secured with endobutton and interference screws. In the postoperative period, and an accelerated program of physical rehabilitation were immediately initiated. At five months of follow-up the patient is painless, with full, symmetrical knee range of motion. No complications reported. WOMACs functional scale dropped from 35 preoperative to 6 in the last visit. Until now, simultaneous reconstruction of the LCA was a safe procedure; however, we know that our follow-up is too short to make any other assertions.

INTRODUCCIÓN: Cuando existe una lesión en ambas rodillas del ligamento cruzado anterior (LCA), el cirujano tiene la opción de reconstruir ambos de manera escalonada o simultáneamente. Existen algunos reportes y series de casos donde se realiza la reconstrucción simultanea del LCA. En este trabajo, presentamos el caso y resultado con la reconstrucción simultánea de LCA. CASO CLÍNICO: Hombre de 40 años de edad sin antecedentes de importancia. Presentaba una lesión bilateral de LCA, por lo que se le realizó cirugía sin torniquete con autoinjerto de isquiotibiales, fijado con endobutton y tornillos de interferencia. En el postoperatorio, la marcha y un programa acelerado de rehabilitación física se inició de manera inmediata. A cinco meses de seguimiento, el paciente se encuentra sin dolor y con arcos de movilidad completos y simétricos, sin complicaciones reportadas. La escala funcional de WOMAC de 35 en el preoperatorio bajó a 6 en la última consulta. Hasta el momento, la reconstrucción simultánea del LCA fue un procedimiento seguro; sin embargo, sabemos que nuestro seguimiento es muy corto para emitir alguna otra aseveración.

Reconstrucción simultánea de ambos ligamentos cruzados anteriores / Simultaneous reconstruction of both anterior cruciate ligaments

Resumen: Introducción: Cuando existe una lesión en ambas rodillas del ligamento cruzado anterior (LCA), el cirujano tiene la opción de reconstruir ambos de manera escalonada o simultáneamente. Existen algunos reportes y series de casos donde se realiza la reconstrucción simultanea del LCA. En este trabajo, presentamos el caso y resultado con la reconstrucción simultánea de LCA. Caso clínico: Hombre de 40 años de edad sin antecedentes de importancia. Presentaba una lesión bilateral de LCA, por lo que se le realizó cirugía sin torniquete con autoinjerto de isquiotibiales, fijado con endobutton y tornillos de interferencia. En el postoperatorio, la marcha y un programa acelerado de rehabilitación física se inició de manera inmediata. A cinco meses de seguimiento, el paciente se encuentra sin dolor y con arcos de movilidad completos y simétricos, sin complicaciones reportadas. La escala funcional de WOMAC de 35 en el preoperatorio bajó a 6 en la última consulta. Hasta el momento, la reconstrucción simultánea del LCA fue un procedimiento seguro; sin embargo, sabemos que nuestro seguimiento es muy corto para emitir alguna otra aseveración.

Abstract: Introduction: When there is injury to both knees of the anterior cruciate ligament (ACL), the surgeon has the option to reconstruct both in a staggered manner or simultaneously. There are some reports and case series where the ACL is performed simultaneously. In this manuscript we present a case and the result with simultaneous reconstruction. Clinical case: 40-year-old male with no history of importance with bilateral ACL injury; torniquet-free surgery was performed with autograft of hamstrings, secured with endobutton and interference screws. In the postoperative period, and an accelerated program of physical rehabilitation were immediately initiated. At five months of follow-up the patient is painless, with full, symmetrical knee range of motion. No complications reported. WOMAC's functional scale dropped from 35 preoperative to 6 in the last visit. Until now, simultaneous reconstruction of the LCA was a safe procedure; however, we know that our follow-up is too short to make any other assertions.

Gene expression profile of pulpitis.

The cost, prevalence and pain associated with endodontic disease necessitate an understanding of the fundamental molecular aspects of its pathogenesis. This study was aimed to identify the genetic contributors to pulpal pain and inflammation. Inflamed pulps were collected from patients diagnosed with irreversible pulpitis (n=20). Normal pulps from teeth extracted for various reasons served as controls (n=20). Pain level was assessed using a visual analog scale (VAS). Genome-wide microarray analysis was performed using Affymetrix GeneTitan Multichannel Instrument. The difference in gene expression levels were determined by the significance analysis of microarray program using a false discovery rate (q-value) of 5%. Genes involved in immune response, cytokine-cytokine receptor interaction and signaling, integrin cell surface interactions, and others were expressed at relatively higher levels in the pulpitis group. Moreover, several genes known to modulate pain and inflammation showed differential expression in asymptomatic and mild pain patients (⩾30 mm on VAS) compared with those with moderate to severe pain. This exploratory study provides a molecular basis for the clinical diagnosis of pulpitis. With an enhanced understanding of pulpal inflammation, future studies on treatment and management of pulpitis and on pain associated with it can have a biological reference to bridge treatment strategies with pulpal biology.

Effects of two calcium silicate cements on cell viability, angiogenic growth factor release and related gene expression in stem cells from the apical papilla.

AIM: To evaluate the effects of two types of calcium silicate cements on viability, angiogenic growth factor release, and angiogenic and inflammation-related gene expression in human stem cells from the apical papilla (SCAP). METHODOLOGY: SCAPs were grown for 7 days with either ProRoot mineral trioxide aggregate (MTA) or Biodentine (BD). Cell viability and media concentrations of vascular endothelial growth factor (VEGF/VEGFA) and angiopoietin 1 (ANGPT1) were measured. The expression of genes related to angiogenic potential and inflammatory response was measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). One-way and two-way analyses of variance with multiple comparisons Tukey's test were performed (P < 0.05). RESULTS: Cells in contact with either cement were associated with increased cell viability compared with the no-treatment group at day 1 but there were no differences amongst groups at days 3 and 7. Exposure to either cement significantly increased VEGF concentrations at day 3; however, ANGPT-1 levels decreased significantly compared with the no-treatment group at day 3. Exposure to MTA and BD stimulated expression of VEGFA and FIGF/VEGFD. Furthermore, exposure to both cements significantly decreased the mRNA levels of ANGPT1 and FGF2 relative to the no-treatment group. CONCLUSIONS: Both MTA and BD stimulated the expression of angiogenic genes and release of VEGF, inducing similar expression patterns; however, they appeared to inhibit the expression of specific genes, including ANGPT1 and FGF2.

Diversidad específica bacteriana en murciélagos de distintos gremios alimenticios en la sierra sur de Oaxaca, México

Specific bacterial diversity in bats of different food guilds in Southern sierra Oaxaca, Mexico. Bats have different ecologic roles in variable ecosystems that have been already described. They have been linked to several zoonoses, however little is known about the relationship between bat microbiota and their diet, and studies on the bacterial ecology of the microbiota in bats are limited. To contribute with the description of this important interaction between microbiota and host, the aim of this work was to characterize the composi- tion and bacterial diversity in the oral and anal regions of 10 species of bats, in relation to food guild. For this, monthly samplings were conducted using four mist nets (19:00-24:00h) from February to October 2012; nets were reviewed every 45 minutes. Each captured organism was sampled in the oral and anal cavities with sterile swabs; these were placed in pre-enrichment media and stored at 4°C. Bacterial samples were studied which through selective media, chromogenic and biochemical tests. We obtained samples from 502 frugivorous, 29 hematophagous and 11 nectivorous bats. We found a total of 26 bacterial species, with the predominant phylum Proteobacteria and the family Enterobacteriaceae. Statistically significant differences were observed between oral and anal microhabitats: frugivorous (t=-3.516, g.l=14.761, p=0.003), hematophagous (t=-3.320, g.l=19.262, p=0.003), and nectivorous (t=-2.497, g.l=11.933, p=0.026), and in some guilds [frugivorous and nectivorous in the anal region (t=2.274, g.l=29.660, p=0.030), hematophagous and nectivorous anal region (t=2.077, g.l=29.904, p=0.049)]. It was also shown that there is bacteria specificity in some guilds such as nectivorous and frugivorous with Bacillus cereus, B. sp. X. sp., as well as, Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, S. epidermis, Aeromonas hydrophyla in hematophagous. Bacterial presence can be explained by the type of diet and/or by transfer of bacteria from their preys. These bacteria may be indigenous to these bats and play the role of mutual benefit, providing the host with stable growth conditions and supplemental nutrients, while the microbiota contributes to host nutrition, development of the immune system, stabilization of the microbial population and to avoid pathogens colonization. By understanding the importance of the relation- ship between host and its bacterial populations, the conservation efforts being made to protect species such as bats may be improved.

Los estudios sobre ecología bacteriana de la micro- biota en los murciélagos son limitados, dicha información es importante para determinar la importancia de esta interacción entre microbiota y hospedero, por tal motivo el objetivo de este trabajo es caracterizar la composición y diversidad bacteriana en las regiones orales y anales de 10 especies de quirópteros con relación al gremio alimenticio a través de medios selectivos, cromogénicos y pruebas bio- químicas. Se muestrearon 502 murciélagos frugívoros, 29 hematófagos y 11 nectívoros, fueron encontradas un total de 26 especies bacterianas, siendo predominantes el filo proteobacterias y la familia Enterobacteriaceae. Se observaron diferencias estadísticamente significativas entre el microhabitat oral y anal [frugívoros (t=-3.516, g.l=14.761, p=0.003), hematófagos (t=-3.320, g.l=19.262, p=0.003), y nectívoros (t=-2.497, g.l=11.933, p=0.026), así como en algunos gremios (frugívoros e nectívoros en la región anal (t=2.274, g.l=29.660, p=0.030), hematófago y nectívoros en la región anal (t=2.077, g.l=29.904, p=0.049)]. También se mostró que existe especificidad de bacterias en algunos gremios como: Bacillus cereus, B. spp. X. spp. en nectívoros y frugívoros, así como, Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, S. epidermis, Aeromonas hydrophyla en hematófagos que podría deberse al tipo de dieta que llevan o por transferencia de bacterias al contacto con sus presas. Los murciélagos han sido relacionados con varias zoonosis, sin embargo poco se conoce sobre la relación que existe entre el murciélago, su micro- biota y la dieta que llevan. Estas bacterias pudieran ser autóctonas de los murciélagos y jugar un papel de mutuo beneficio, proveyéndole al hospedero condiciones estables de crecimiento y nutrientes complementarios, mientras que la microbiota contribuye en la nutrición del hospedero, desarrollo del sistema inmune, estabilizando la población microbiana y prohibiendo la colonización de patógenos. Entender la importancia de la relación entre el hospedero y su población bacteriana puede ayudar a mejorar los esfuerzos de conservación que se vienen realizando para proteger especies como los murciélagos.

MiRNA-181a regulates Toll-like receptor agonist-induced inflammatory response in human fibroblasts.

MicroRNAs (miRNAs) regulate the synthesis of cytokines in response to Toll-like receptor (TLR) activation. Our recent microarray study comparing normal and inflamed human dental pulps showed that miRNA-181 (miR-181) family is differentially expressed in the presence of inflammation. Prior studies have reported that the dental pulp, which is composed primarily of TLR4/2+ fibroblasts, expresses elevated levels of cytokines including interleukin-8 (IL-8) when inflamed. In this study, we employed an in-vitro model to determine the role of the miRNA-181 family in the TLR agonist-induced response in human fibroblasts. TLR4/2+ primary human dental pulp fibroblasts were stimulated with lipopolysaccharide from Porphyromonas gingivalis (Pg LPS), a known oral pathogen, and IL-8 and miR-181 expression measured. An inversely proportional relationship between IL-8 and miR-181a was observed. In-silico analysis identified a miR-181a-binding site on the 3' untranslated region (UTR) of IL-8, which was confirmed by dual-luciferase assays. MiR-181a directly binds to the 3'UTR of IL-8, an important inflammatory component of the immune response, and modulates its levels. This is the very first report demonstrating miR-181a regulation of IL-8.

Neutrophils alter epithelial response to Porphyromonas gingivalis in a gingival crevice model.

A gingival crevice model (epithelial cell-Porphyromonas gingivalis-neutrophil) was established and used to profile gingipain, matrix metalloproteinase (MMP), MMP mediators [neutrophil gelatinase-associated lipocalin (NGAL) and tissue inhibitor of metalloproteinases 1 (TIMP-1)] and cytokine networks. Smoking is the primary environmental risk factor for periodontitis. Therefore, the influence of cigarette smoke extract (CSE) was also monitored in the same model. Porphyromonas gingivalis alone induced low levels of interleukin-1ß and interleukin-8 from epithelial cells, but high levels of both cytokines were produced on the addition of neutrophils. Exposure to CSE (100 and 1000 ng ml(-1) nicotine equivalency) significantly compromised P. gingivalis-induced cytokine secretion (both P < 0.05). P. gingivalis induced impressive secretion of NGAL (P < 0.05) that was not influenced by CSE. The influence of CSE on gingipain production was strain-specific. Purified gingipains effectively and rapidly degraded both TIMP-1 and MMP-9. Induction of large amounts of NGAL, degradation of TIMP-1, and increased gingipain activity would each be expected to prolong collagen degradation and promote disease progression. However, gingipains also degrade MMP-9. Hence, P. gingivalis exerts a complex influence on the proteolytic balance of a gingival crevice model. Exposure to CSE reduces the proinflammatory cytokine burden, which may be expected to promote P. gingivalis survival. In addition to novel findings that provide mechanistic insight into periodontal disease progression, these results are in keeping with the recognized clinical dogma of decreased inflammation/increased disease in smokers. This straightforward gingival crevice model is established as a suitable vehicle for the elucidation of mechanisms that contribute to susceptibility to periodontitis.

Gene expression dynamics during diabetic periodontitis.

Diabetes impairs the resolution of periodontal inflammation. We explored pathways altered by inflammation in the diabetic periodontium by using ligatures to induce periodontitis in type-2 diabetic Goto-Kakizaki rats. Ligatures were removed after 7 days, and rats were then treated with TNF inhibitor (pegsunercept) or vehicle alone and euthanized 4 days later. RNA was extracted from periodontal tissue, examined by mRNA profiling, and further analyzed by functional criteria. We found that 1,754 genes were significantly up-regulated and 1,243 were down-regulated by pegsunercept (p < 0.05). Functional analysis revealed up-regulation of neuron-associated and retina-associated gene clusters as well as those related to cell activity and signaling. Others were down-regulated by TNF inhibition and included genes associated with host defense, apoptosis, cell signaling and activity, and coagulation/hemostasis/complement. For selected genes, findings with microarray and rt-PCR agreed. PPAR-α was investigated further by immunohistochemistry due to its anti-inflammatory function and was found to be up-regulated in the gingiva during the resolution of periodontal inflammation and suppressed by diabetes. The results indicate that diabetes-enhanced inflammation both up- and down-regulates genes involved in cellular activity and cell signaling, while it predominantly up-regulates genes involved in the host response, apoptosis, and coagulation/homeostasis/complement and down-regulates mRNA levels of neuron, retina, and energy/metabolism-associated genes.

The host cytokine response to Porphyromonas gingivalis is modified by gingipains.

BACKGROUND/AIMS: Clinical studies indicate that primary proinflammatory cytokines, such as interleukin-1beta (IL-1beta) are elevated in the gingival crevice around teeth with periodontitis but the secondary cytokines and chemokines, IL-6 and IL-8, are not. The human gingival epithelial cells (HGECs) lining the gingival sulcus respond to perturbation by microbes of dental plaque by releasing a wide range of cytokines. Porphyromonas gingivalis, a putative periodontal pathogen, possesses numerous virulence factors some of which directly impact on the host response. In the present study, we sought to determine how P. gingivalis influences the inflammatory cytokine responses. METHODS: HGECs were challenged with P. gingivalis and other putative periodontal pathogens, and the resultant production of IL-1beta, IL-6, and IL-8 was assayed by enzyme-linked immunosorbent assay (ELISA). Culture supernatants and recombinant human cytokines were challenged with live P. gingivalis wild-type and gingipain-deficient strains and the resultant cytokine profile was assessed by ELISA and Western blot. RESULTS: We show here that primary HGECs challenged with live P. gingivalis result in high levels of IL-1beta but not the related secondary cytokines IL-6 and IL-8. We further demonstrate that cytokine response differences are the result of the action of P. gingivalis proteases, with lysine gingipain being the most effective. CONCLUSION: We conclude that P. gingivalis, through lysine gingipain, can subvert the protective host proinflammatory response by direct cytokine degradation. Changes in the crevicular cytokine profile have consequences in periodontal disease pathogenesis that should be considered in the development of diagnostic and therapeutic modalities.

Association of interleukin-1 receptor antagonist +2018 gene polymorphism with Japanese chronic periodontitis patients using a novel genotyping method.

Genetic variants at multiple loci have been shown to be associated with periodontitis risk. In this study, we have focused on nine functional gene polymorphisms encoding immunoregulation-related molecules such as cytokines (interleukin-1 (IL-1), transforming growth factor-beta1 (TGF-beta1)) and cell surface receptors (immunoglobulin G and A Fc receptors (Fc gamma R and Fc alpha R)). In total, 113 Japanese patients with chronic periodontitis (CP) and 108 race-matched healthy controls were genotyped with the modified serial invasive signal amplification reaction. There was a significant difference in the distribution of IL-1 receptor antagonist (RN) +2018 T/C allele between the patient and control groups, with enrichment of the +2018 C in controls (P = 0.021, odds ratio = 0.38). An increased frequency of the IL-1 haplotype comprising IL-1A +4845 G, IL-1B -31 C, and IL-1RN +2018 C was observed in controls (P = 0.004). Moreover, a multivariate logistic regression analysis revealed that subjects with IL-1RN +2018 C allele were less likely to have CP (P = 0.016, odds ratio = 0.29). These findings document the association of IL-1RN +2018 C with reduced susceptibility to CP in the Japanese.

Hypoglycemic, vasorelaxant and hepatoprotective effects of Cochlospermum vitifolium (Willd.) Sprengel: a potential agent for the treatment of metabolic syndrome.

Cochlospermum vitifolium (Willd.) Sprengel is a Mexican medicinal plant that is used in the folk medicine for the treatment of hypertension, diabetes, hepatitis and related diseases. The purpose of the present study was to assess the pharmacological properties of different extracts from Cochlospermum vitifolium bark as potential agent for the treatment of some factors related with metabolic syndrome (MS), a complex disease produced for several pathophysiological factors such as visceral fat obesity, insulin resistance, hypertension, dyslipidemia and liver steatosis. Hexane (HECv), dichloromethane (DECv) and methanol (MECv) extracts were subjected to some pharmacological assays to determine their vasorelaxant and hypoglycemic activity. On the other hand, MECv was also evaluated to determine its hepatoprotective effect on sub-chronic experimental assay. HECv showed a significant endothelium-independent relaxation on rat aorta rings (intact endothelium: IC(50)=14.42+/-5.90 microg/mL, E(max)=92.71+/-8.9%; denuded endothelium: IC(50)=27.94+/-4.0 microg/mL, E(max)=78.68+/-4.6%) and MECv produced an endothelium-dependent relaxation (IC(50)=21.94+/-6.87 microg/mL, E(max)=79.12+/-7.80%) on this tissue. Furthermore, HECv (at a dose of 120 mg/kg) also showed a significant decrease of blood glucose levels (p<0.05) on normoglycemic rats. Moreover, MECv (at a dose of 100 mg/kg) also was administered to bile duct-obstructed rats to determine its hepatoprotective activity, showing a statistically significant decrease of serum glutamic-pyruvic transaminase (PGT, 45%) and alkaline phosphatase (APh, 15%) (p<0.05). Finally, we obtained a crystalline polyphenolic compound from MECv by spontaneous precipitation. Those crystals were identified as (+/-)-naringenin by X-ray diffraction, NMR, IR and GC-MS techniques. Results suggest that Cochlospermum vitifolium could be used as a potential agent against MS since it shows hypoglycemic, vasorelaxant and hepatoprotective properties.

Interleukin-6 (IL-6)--373 A9T11 allele is associated with reduced susceptibility to chronic periodontitis in Japanese subjects and decreased serum IL-6 level.

We investigated whether interleukin-6 (IL-6) gene polymorphisms could be associated with chronic periodontitis (CP) and serum IL-6 level. One hundred and twelve CP and 77 non-CP Japanese subjects were analyzed for IL-6 -597 (G/A), -572 (C/G), -373 (A(n)T(m)), -190 (C/T), and -174 (G/C) polymorphisms. We could only detect -572 and -373 polymorphisms and found that the frequency and carriage rate of the -373 A9T11 allele were significantly higher in non-CP subjects. Enzyme-linked immunosorbent assay confirmed that the -572 and -373 G[A9T11] haplotypes were associated with lower serum IL-6 level. These findings suggest that IL-6 -373 A9T11 allele could be associated with reduced susceptibility to CP among Japanese subjects and decreased serum IL-6 level.

Polymorphisms in the IL-6 receptor (IL-6R) gene: strong evidence that serum levels of soluble IL-6R are genetically influenced.

We have investigated the association of the recently identified IL6R polymorphisms with the serum levels of soluble IL-6 receptor (sIL-6R). sIL-6R is generated by shedding of the membrane-bound receptor (IL-6Ralpha) or alternative mRNA splicing. In total, 115 healthy volunteers were genotyped, with 70 of them analyzed for sIL-6R levels. Using the PCR/RFLP methods, two important polymorphic sites were selected for genotyping: the 48892A/C (D358A) in exon 9 and the -183G/A in the promoter region. In exon 9, C allele carriers had higher sIL-6R level (P<0.0001) showing that this sequence variation, which corresponds to the proteolytic cleavage site of IL-6Ralpha, strongly influences the serum sIL-6R levels. In the promoter region, G allele carriers had lower sIL-6R levels (P<0.0082) compared with the A allele carriers. This could be attributed to the linkage disequilibrium (D'=0.54, chi2=51.3, P<0.0001) between the -183G/A and the 48892A/C gene polymorphisms.

[Acceptance or refusal of abortion for maternal reasons. Survey of 3021 employees of the Federal Government]. / Aceptación o rechazo del aborto por motivos maternos. Encuesta en 3021 empleados del Gobierno Federal.

A survey was conducted among 3021 employees from the Mexican Federal Government regarding their acceptance or rejection of abortion in five different circumstances. Socioeconomic information was obtained from the interviewed and the result was that 23% totally rejected abortion, and 6% accepted abortion in any situation. Abortion was accepted by 61% in case of pregnancy threatens the mother's life; 63% in case a single woman has been raped; 41% if there are so many children and such situation implies economic problems for the family; 13% if the couple prefers to wait for an economic improvement; and 18% if the couple has decided to have no more than two kids. Also from the interviewed, 16% pointed out that abortion must be an exclusive decision from the woman and 29% thought it must be a shared decision with the partner. Abortion is better accepted by young people, by couples with few children or living in free union and by people with higher education level and higher income. It is also better accepted by people with no religion, or people who do not attend religious services or by whom religion does not affect their decisions in life.

[Criteria on the legalization of abortion]. / Algunos criterios para la despenalización del aborto.

We revised ethical concepts related to abortion from the points of view of the mothers; life, health, and considerations are made concerning the embryo or fetus as a biological, ontological, moral, and potential person. Certain religious matters on abortion are described and commented on. Effects of abortion penalization in Mexico and the legislation in the Mexican states are examined, as well as the motives of depenalization in certain countries.

[Acceptance or rejection of euthanasia. Survey of 3021 Federal Government employees]. / Aceptación o rechazo de la eutanasia. Encuesta en 3021 empleados del gobierno federal.

A survey was conducted with 3021 employees of the Federal Government using self-administered questionnaires in order to collect data on the socioeconomic background of those surveyed (sex, age, civil status, number of children, religious, affiliation, educational level and monthly income), as well as their opinions about euthanasia. For the purposes of this study, three types of euthanasia were considered: 1) passive (the suspension of life support systems); 2) active (the application of immediate death causing means for people who suffer from incurable illnesses); and 3) active in the medium term (the application of substances which keep a patient sedated and comfortable while all food is withheld). Passive and medium-term active euthanasia were accepted by 40 percent of the population surveyed, while active euthanasia was accepted by 20 percent. These percentages were higher among young people, among those who were not heavily influenced by or did not practice religion, among professionals and among post-graduates.

Laparoscopic esophagomyotomy and antireflux procedure with intraoperative manometry.

We have been routinely performing laparoscopic cholecystectomy and antireflux procedures. Having this experience, we decided to assess the feasibility and safety of performing a laparoscopic esophagomyotomy and antireflux procedure. Here we present a case of a 37-year-old man with a history of progressive dysphagia and a diagnosis of achalasia, made on the basis of clinical, endoscopic, and manometric studies. Preoperative manometry reported a pressure of 52 mm Hg (normal, 15-25 mm Hg) for 4.5 cm (normal, > 3 cm). Laparoscopic esophagomyotomy and anterior fundoplication were performed. The esophagomyotomy included a 6-cm segment of distal esophagus and 2 cm of stomach; postoperative manometry was 18 mm Hg for 3 cm. Eight months postoperatively, a barium swallow demonstrated no reflux. Laparoscopic esophagomyotomy and antireflux procedure can be performed with efficacy and safety, with the advantage of a shorter hospitalization and an early recovery compared with the traditional procedure. Also, we emphasize the importance of the intraoperative manometry in the relevance of a concomitant antireflux procedure.

Effects of E-4716, a new antihistaminic with antiallergic properties, on chemical mediators induction of immunologic reactions.

The effects of E-4716 on chemical mediators were compared with those of classical antihistaminics and other second generation (nonsedating) drugs normally used in the therapy of allergic reactions, such as astemizole, terfenadine and ebastine, in a series of in vitro and in vivo tests. In vitro, antihistaminic activity was demonstrated in a test on isolated organs and a binding test on histamine receptors, with no anticholinergic activity observed. A high antihistaminic activity was also shown in in vivo tests on chemical mediators release by compound 48/80, histamine-induced bronchospasm in anesthetized guinea pigs and histamine-induced cutaneous reaction in beagle dogs. The antiallergic activity was studied in passive cutaneous anaphylaxis test using ovalbumin antibodies. Astemizole and E-4716 had similar activities with ED50 values of 0.8 and 0.5 mg/kg, respectively, whereas terfenadine (ED50 = 4.5) was less active. E-4716 also inhibited the vascular permeability response in histamine-stimulated conjunctivitis model after topical ocular administration (ED50 = 0.002, 0.0002, 0.015 and 1.2% at 30 min and 6, 12 and 24 h, respectively). E-4716 had a high and selective antihistaminic and antiallergic activity by all routes of administration (oral, i.v., i.p., topical ocular and inhalation). These results, combined with its low toxicity and lack of central effects, indicate that E-4716 has excellent potential for therapeutic use.

Deformation behavior of low-carbon Co-Cr-Mo alloys for low-friction implant applications.

The plastic flow behavior of wrought Co-27Cr-5Mo-0.05C alloy was investigated at 298 K as a function of grain size using uniaxial tension testing. The microstructures produced by deformation were characterized using X-ray diffraction, reflected light, and scanning electron microscopy. This study revealed that material with initially coarse face-centered cubic (fcc) grains exhibits larger uniform ductility than material with fine grain size. Typically, increasing the grain size from 7 to 70 microns reduces the yield strength by about 50% and increases the elongation to fracture from 12 to 30% with a small effect on the tensile strength. The material is capable of deforming uniformly to large strains without developing plastic instabilities until the point of fracture. This effect was found to be associated with the occurrence of transformation-induced plasticity (TRIP) in the coarse-grained material. TRIP enhances the material's ability to deform uniformly by maintaining a high rate of strain hardening during deformation. Smaller fcc initial grain size inhibits the transformation kinetics of the fcc-hexagonal close-packed phase transition according to the Olson-Cohen model.