Total Spinal Anesthesia Following an Interscalene Block Treated with Intravenous Lipid Emulsion.

Total spinal anesthesia following interscalene block is a rare and life-threatening complication of regional anesthesia. A 56-year-old woman underwent an uncomplicated left shoulder bone spur removal under general anesthesia with an interscalene nerve block at an outpatient surgical center. Subsequently, she developed bilateral mydriasis, paralysis of all extremities, and respiratory arrest. She was intubated and transferred to the emergency department (ED) where she was given intravenous lipid emulsion (ILE) with complete recovery of neurological function. ILE therapy may be considered as a rescue treatment in addition to supportive therapy for total spinal anesthesia.

Porous media investigation before and after hydrochloric acid injection on a pre-salt carbonate coquinas sample.

Porous space characterization of carbonate rocks is an important aid in petroleum exploration from carbonate reservoir. In this study, X-ray microtomography technique was applied to evaluate total porosity of a coquina sample extracted from pre-salt reservoir, in Brazil, before and after acid injection. Two image processing program were used in order to assess performance. The results showed that microtomography has potential to compute porosity of coquina samples and provides information about rock porous network.

Expression of DLX5 during human embryonic craniofacial development.

Dlx (distal-less gene) homeogenes encode transcription factors that are involved in the patterning of orofacial skeleton derived from cephalic neural crest cells. In order to study the role of DLX genes during embryonic development in human, DLX5 expression pattern was investigated in 6- to 11-week-old human embryos. A DLX5 PCR fragment was amplified from a human dental cDNA library subcloned and used for in situ hybridization investigations. DLX5 gene expression was primarily detected in the mandible at 6 weeks and then, after in the maxilla. DLX5 gene expression became restricted to progenitor cells of developing tooth germs, bones and cartilages of mandible and maxilla. During odontogenesis from bud to late cap stages, DLX5 transcripts were present in both dental epithelium and mesenchyme tissues. DLX5 expression was restricted to few cells in the vestibular aspect of the dental epithelium, while DLX5 mRNA signal was more widely distributed in dental mesenchyme. The observed expression pattern of DLX5 homeogene extends the proposed site-specific combination of homeogene expression in neural crest derived cells to human specific dentition. Furthermore, during the bud and cap stages of tooth morphogenesis, the asymmetric expression of DLX5 in the dental epithelium and dental mesenchyme may contribute to the complex patterning of human tooth shape.

Characterization of cytokeratin patterns in the developing human tongue.

The characterization of cytokeratin (CK) in adult oral mucosa and developing teeth have been well documented in human. Cytokeratin distribution in developing oral mucosa has not yet been described. The aim of this study was to identify the expression of CK in human fetal tongue (week 10 to week 23) and to correlate the results with morphological maturation. Simple epithelial CK are expressed in all cell layers during the early stages, essentially in peridermal cells. From the 14th week, CK 18 is present only in the taste buds, making this polypeptide a reliable marker for this sensory organ. CK 4 and 13 are expressed from the 10th to the 23rd week by both ventral and dorsal lingual epithelia. Terminal differentiation keratins (CK 1, 2 and 10-11) can only be detected immunohistochemically at the 14th week in some cells on the external surface of some papillae. The number of these papillae and positive cells increase at the 19th and 23rd weeks. The terminal differentiation markers are expressed several weeks earlier than the formation of a well-distinguished keratinized layer.

Biomineralization, life-time of odontogenic cells and differential expression of the two homeobox genes MSX-1 and DLX-2 in transgenic mice.

Msx and Dlx homeobox genes encode for transcription factors that control early morphogenesis. More specifically, Msx-1, Msx-2, and Dlx-2 homeobox genes contribute to the initial patterning of the dentition. The present study is devoted to the potential role of those homeobox genes during the late formation of mineralized tissues, using the rodent incisor as an experimental system. The continuously erupting mandibular incisor allows (1) the coinvestigation of the whole sequences of amelogenesis and dentinogenesis, aligned along the main dental axis in a single sample in situ and (2) the differential characterization of transcripts generated by epithelial and ectomesenchymal odontogenic cells. Northern blot experiments on microdissected cells showed the continuing expression of Msx-2 and Dlx-2 in the later stages of dental biomineralization, differentially in epithelial and ectomesenchymal compartments. Transgenic mice produced with LacZ reporter constructs for Dlx-2 and Msx-1 were used to detect different components of the gene expression patterns with the sensitive beta-galactosidase histoenzymology. The results show a prominent epithelial involvement of Dlx-2, with stage-specific variations in the cells involved in enamel formation. Quantitative analyses identified specific modulations of Dlx-2 expression in ameloblasts depending on the anatomical sites of the incisor, showing more specifically an inverse linear relationship between the Dlx-2 promoter activity level and enamel thickness. This investigation extends the role of homeoproteins to postmitotic stages, which would control secretory cell activity, in a site-specific manner as shown here for Dlx-2.

Bioactive glass stimulates in vitro osteoblast differentiation and creates a favorable template for bone tissue formation.

In this study, we have investigated the behavior of fetal rat osteoblasts cultured on bioactive glasses with 55 wt% silica content (55S) and on a bioinert glass (60S) used either in the form of granules or in the form of disks. In the presence of Bioglass granules (55 wt% silica content), phase contrast microscopy permitted step-by-step visualization of the formation of bone nodules in contact with the particles. Ultrastructural observations of undecalcified sections revealed the presence of an electron-dense layer composed of needle-shaped crystals at the periphery of the material that seemed to act as a nucleating surface for biological crystals. Furthermore, energy dispersive X-ray (EDX) analysis and electron diffraction patterns showed that this interface contains calcium (Ca) and phosphorus (P) and was highly crystalline. When rat bone cells were cultured on 55S disks, scanning electron microscopic (SEM) observations revealed that cells attached, spread to all substrata, and formed multilayered nodular structures by day 10 in culture. Furthermore, cytoenzymatic localization of alkaline phosphatase (ALP) and immunolabeling with bone sialoprotein antibody revealed a positive staining for the bone nodules formed in cultures on 55S. In addition, the specific activity of ALP determined biochemically was significantly higher in 55S cultures than in the controls. SEM observations of the material surfaces after scraping off the cell layers showed that mineralized bone nodules remained attached on 55S surfaces but not on 60S. X-ray microanalysis indicated the presence of Ca and P in this bone tissue. The 55S/bone interfaces also were analyzed on transverse sections. The interfacial analysis showed a firm bone bonding to the 55S surface through an intervening apatite layer, confirmed by the X-ray mappings. All these results indicate the importance of the surface composition in supporting differentiation of osteogenic cells and the subsequent apposition of bone matrix allowing a strong bond of the bioactive materials to bone.

Abnormal incisor-tooth differentiation in transgenic mice expressing the muscle-specific desmin gene.

Immunocytochemistry and electron microscopic observations on the incisor-tooth organ of transgenic mice expressing the muscle-specific desmin gene under the direction of the vimentin promoter, reveal that the expression of the hybrid transgene occurs both in mesenchymal cells and differentiating odontoblasts. The muscle-specific desmin, as estimated by fluorescence intensity, is more expressed in immature mesenchymal cells than in postmitotic differentiated odontoblasts. The expression of the transgene generates alteration of the odontoblast-intermediate filament network and interferes with the secretory activity of both odontoblasts and ameloblasts. Our results are consistent with the hypothesis that odontoblasts have inductive properties on the differentiation of ameloblasts and that intermediate filaments among other factors play the role of cell and tissue organizer.

Rapid nodule evaluation computer-aided image analysis procedure for bone nodule quantification.

Using bone cell cultures, the effects of drugs on cell activities such as proliferation, differentiation, matrix formation, and mineralization can be explored. To quantify these parameters accurately and quickly, a kinetic reproducible computed image analysis procedure of culture dishes is proposed which could be conjointly used with biochemical analysis of the medium. In the present article, different mathematical procedures coupled either with or without histochemical staining are investigated and analyzed. Using serial cross sections and microradiographies of bone nodules, we demonstrated that the gray-level parameter is well correlated with bone mass and/or the mineralization status of the nodules. The procedure selected is a multistep procedure called rapid nodule evaluation (RNE), which uses a binary reconstruction program with different thresholds. To challenge this RNE procedure with the classical Von Kossa staining and quantification procedure, we cultured the cells in the presence of 10 nmol/L dexamethasone and compared the results using the two procedures. The RNE procedure appeared to be accurate and reproducible, and also has the advantage of speed and dynamic analysis over the classical Von Kossa quantification procedure.

Microcinematographic and autoradiographic kinetic studies of bone cell differentiation in vitro: matrix formation and mineralization.

Matrix formation and mineralization have been reported in vitro with cells isolated from rat calvaria bones by collagenase digestion (Nefussi et al., 1985). In the current study, kinetics of bone nodule formation and osteoblastic cell differentiation were studied in this in vitro system using an improved microcinematographic device and flash and follow-up labeling autoradiographic techniques. Microcinematographic analysis showed the formation of bone nodules within 24 h. The initial event observed was the change in the top cells layer which became alkaline phosphatase positive. Matrix synthesis occurred a few hours after this. The autoradiographic results demonstrated the formation of an integrated system where osteoblasts and osteocytes were active and synthesized a collagen matrix and mineralized it in a similar time sequence than in vivo.

Sequential expression of bone matrix proteins during rat calvaria osteoblast differentiation and bone nodule formation in vitro.

We investigated the expression of osteocalcin (OC), bone sialoprotein (BSP), osteonectin (ON), and alkaline phosphatase (ALP) during cell differentiation and bone nodule formation by fetal rat calvaria cells, using immunofluorescent and immunogold techniques at light and electron microscopic levels. Six hours after plating all proteins were expressed in calvaria cells. However, expression was not detected during the proliferation phase after plating. Cell morphological modifications were observed in osteoblastic cells expressing ALP, OC, and BSP, but not ON. During the matrix formation phase, all proteins were expressed with various intensities and OC was limited to differentiated osteoblastic cells. EM observations demonstrated that BSP was selectively associated with clusters of needle-like crystals, but not with collagen fibers, in mineralization foci and in the mineralized matrix. OC was localized intracellularly and in all the extracellular compartments, and was concentrated at the mineralization front. ON was distributed uniformly throughout the osteoid and mineralized matrix, which was intensely labeled. The results show that the expression of bone matrix proteins during differentiation of calvaria cells and nodule formation in vitro duplicate what is observed during osteogenesis in vivo.

Differential expression and activity of tissue-nonspecific alkaline phosphatase (TNAP) in rat odontogenic cells in vivo.

Among the four existing isoforms of alkaline phosphatase (AP), the present study is devoted to tissue-nonspecific alkaline phosphatase (TNAP) in mineralized dental tissues. Northern blot analysis and measurements of phosphohydrolase activity on microdissected epithelium and ectomesenchyme, in situ hybridization, and immunolabeling on incisors confirmed that the AP active in rodent teeth is TNAP. Whereas the developmental pattern of TNAP mRNA and protein and the previously described activity were similar in supra-ameloblastic and mesenchymal cells, they differed in enamel-secreting cells, the ameloblasts. As previously shown for other proteins involved in calcium and phosphate handling in ameloblasts, a biphasic pattern of steady-state TNAP mRNA levels was associated with additional variations in ameloblast TNAP protein levels during the cyclic modulation process. Although the association of TNAP upregulation and the initial phase of biomineralization appeared to be a basic feature of all mineralized tissues, ameloblasts (and to a lesser extent, odontoblasts) showed a second selectively prominent upregulation of TNAP mRNA/protein/activity during terminal growth of large enamel crystals only, i.e., the maturation stage. This differential expression/activity for TNAP in teeth vs bone may explain the striking dental phenotype vs bone reported in hypophosphatasia, a hereditary disorder related to TNAP mutation. (J Histochem Cytochem 47:1541-1552, 1999)

Epithelial Dlx-2 homeogene expression and cementogenesis.

The Dlx-2 (distal-less gene) homeoprotein transcription factor controls early tooth development but has not been studied during the late stages of biomineralization. Transgenic mice containing a Dlx-2/LacZ reporter construct were used to map the Dlx-2 expression pattern in cementoblasts, the dental cells most closely related to bone cells and therefore suggested to be uniquely positioned osteoblasts. During initial root formation, marked expression of Dlx-2 was evident in molar and incisor root epithelium, whereas dental papilla and follicle were negative. Dlx-2 was expressed in this epithelium from the apical loop to the area of its disruption. During acellular cementum formation in both incisors and molars, Dlx-2 expression was observed in the majority of differentiated cementoblasts from the apical region to the erupting zones. During cellular cementum formation, the presence of which characterizes growth-limited molars, Dlx-2 expression was restricted to the innermost cementoblasts and entrapped cementocytes. These data further support the hypothesis of a complex origin and fate of cementum-forming cells, as previously suggested by the expression patterns of a set of mesenchymal and epithelial markers, notably ameloblastin as shown here. Dlx-2 expression might constitute a landmark of cementoblast subpopulations of epithelial origin. (J Histochem Cytochem 48:277-283, 2000)

Collagen expression during teratocarcinoma cell line-induced endochondral bone tumor.

Collagen immunotyping by indirect immunofluorescence was performed in order to investigate the sequential development of bone formation. Osseous tumors were obtained after subcutaneous injection of 3/A/1D-1 teratocarcinoma cell line into 129/Sv mice (Nicolas et al., 1980). Frozen sections of developing tumors were incubated with specific antibodies directed against Types I, II, III, IV, and IX collagens. On Day 9, the expression of Type I and Type III collagens was correlated with the proliferation of mesenchymal cells. From Day 10, chondrogenesis was characterized by the occurrence of cartilaginous collagens, Types II and IX, in the cartilage matrix. Type IV collagen was also detected in focal areas and revealed vascular invasion of the tumor. On Day 13, osteogenesis was demonstrated by the presence of Type I collagen in the bone matrix coating the surfaces. Immunolocalization of Type III collagen on the hemopoietic elements corresponded with the bone remodeling. The sequential transitions of collagen types confirm the development of an endochondral bone tumor. These results suggest that 3/A/1D-1 teratocarcinoma cell line constitutes a valuable system for in vitro study of endochondral bone formation and cell differentiation.

Osteoblast adherence and resorption activity of isolated osteoclasts on calcium sulphate hemihydrate.

The adherence of osteoblast-like cells and the resorption activity of isolated osteoclasts on calcium sulphate hemihydrate (CSH) was investigated. After a 24 h incubation period, alkaline phosphatase staining showed that rat osteoblast-like cells ROS 17/2.8 attached on CSH. Neutral red (NR) and tartrate-resistant acid phosphatase (TRAP) staining revealed that osteoclasts attached on CSH. Furthermore, osteoclasts formed lacunae as revealed by scanning electron microscopy. Although the lacunae formed by osteoclasts on CSH were diverse in shape and form, the most common type had approximately a circular outline, with a well-defined margin similar to those formed on dentine. Less commonly, excavations appeared as a discontinuous area of resorbed CSH with the presence of a circular zone around the non-resorbed area. Finally, by using 10(-9) M calcitonin, evidence was obtained that NR-positive cells were osteoclasts (58.3% and 57.66% decrease of NR-positive mouse and rat cells detected on CSH after 24 h incubation). However, no inhibition was obtained with 10(-11) M calcitonin. The overall number of NR-positive osteoclasts adherent on 256 mm2 CSH was 43 +/- 14 and 42 +/- 3 for mice and rat, respectively. The overall number of TRAP-positive mouse osteoclasts was 67 +/- 12. Acetazolamide (10(-5) M), a carbonic anhydrase inhibitor, inhibited the number of adherent NR osteoclasts on CSH by 50.42% and 41.6% for mouse and rat, respectively. These results indicate that osteoblasts attach on CSH and osteoclasts resorb CSH in vitro.

Surface-reactive biomaterials in osteoblast cultures: an ultrastructural study.

The tissue/biomaterial interface reactions of three biomaterials selected as candidates for hard tissue replacement were studied at the electron microscopical level after incubation with enzymatically isolated rat bone cells. An electron-dense layer was routinely observed between hydroxyapatite, coral, cytodex polymer and the neighbouring cells. This layer was visible before bone formation occurred, and was collagen free. The ultrastructural features revealed a needle-shaped filamentous layer continuous with coral material, whereas hydroxyapatite or cytodex/tissue interface was granular in appearance. These different structures may indicate reactive surfaces, depending on the composition of the substrate.

Effects of acidic fibroblast growth factor and epidermal growth factor on fetal rat calvaria cell cultures.

An inhibitory effect of alkaline phosphatase (LP) activity on short and long term fetal rat calvaria cell cultures was recorded with both acidic fibroblast growth factor (aFGF) and epidermal growth factor (EGF) at a concentration of 30 ng ml-1. This inhibition was well correlated with the nodule number on long term culture, except for EGF treatment in subconfluent cell culture.

Evaluation of the osteogenic potential of biomaterials implanted in the palatal connective tissue of miniature pigs using undecalcified sections.

Calcium phosphate or calcium carbonate biomaterials are widely used as bone substitutes in periodontal surgery. This study evaluates the osteogenic potential of five different alloplastic biomaterials implanted in the connective tissue of the palatal papilla in miniature pigs. A porous hydroxyapatite (PHA), a dense hydroxyapatite (DHA), a semi-porous hydroxyapatite (SPHA), a tricalcium phosphate (TCP) and a calcium carbonate natural coral (NC) were implanted in a tunnel in the palatal papillae of seven miniature pigs. Undecalcified sections were examined histologically at 1, 2, 3, 4, 8, 12 and 24 wk intervals. Resorbable materials (TCP and NC) were totally resorbed by 24 wk. DHA, PHA and HA showed very limited resorption, although there were multinucleated giant cells in contact with PHA and SPHA. There was no histologically detectable bone formation in contact with or near any of the biomaterials tested. However, several particles of NC, and sometimes of PHA, were surrounded by a dense, mineralized matrix. It is concluded that none of these biomaterials, in their presently available forms, has any bone inducing capacity.

H-7 stimulates desmosome formation and inhibits growth in KB oral carcinoma cells.

Protein kinase inhibitor H-7 was reported to stimulate desmosome formation in normal keratinocytes and to inhibit proliferation of neural cell lines. In the present study, the effects of this inhibitor on adhesion and growth of KB human oral carcinoma cells were investigated. H-7 was found to enhance desmosome assembly, as evidenced by an increased punctate labeling for the major desmosomal markers. Immunogold labeling confirmed the formation of desmosomes both at the cell surface and in the cytoplasm. In order to assess cell proliferation and possible correlation with adhesion, confluent cultures were treated and both adherert and detached cell fractions were counted. Under serum-free conditions, H-7 significantly reduced cell detachment. In contrast, EGF stimulated cell detachment, and this effect was abolished when cells were simultaneously treated with both EGF and H-7. Total cell counts were also significantly reduced by H-7, both in the presence and absence of EGF. Using the TUNEL technique, labeled cells were increased after H-7 treatment, thus implicating protein kinase inhibition in cell death. These results indicate that H-7 inhibits growth and stimulates adhesion of KB carcinoma cells.

Freeze-dried skin allografts. A human clinical and histological study.

Free gingival autografts still remain the most predictable method for creating attached gingiva. However, a need exists for sources of connective tissue other than the patient's own connective tissue. Yukna et al. have proposed freeze-dried skin (FDS) allografts as a substitute for gingival autografts. The purpose of the present study was to evaluate FDS allografts on humans, clinically and histologically. Ten FDS allografts and two free gingival (FG) autografts were performed on ten patients, two of them receiving both FDS and FG grafts. Clinical measurements were made before surgery, immediately after surgery and then 2 and 6 months after surgery. After 4 and 24 months, biopsies were performed on both FG and FDS grafts. Routine histologic staining was done. The results show a mean gain of attached gingiva of 0.32 mm with a range from 0 to 0.8 mm. Compared biopsies sections of FDS allografts and FG autografts show that the tissue obtained with the FDS allografts do not display the histomorphologic pattern of attached gingiva. The FDS allografts do not seem to represent a good substitute to free gingival autografts. However, they might be used successfully as a biological bandage.

Glycoproteins expression in apical pathologic tissues: clinical incidences.

Indirect immunofluorescence was used for the localization of the primary collagens, fibronectin and laminin. Specimens were extracted from untreated teeth with periapical lesions from patients 20 to 30 years of age. An histological examination enabled the differentiation of granulomas and cysts, and 5 microns sections were used for the indirect immunofluorescence procedure. Antibodies against Type I, Type III, and Type V collagen and for fibronectin and laminin were obtained from glycoproteins of human cells. The antibody against Type IV collagen was prepared from Type IV collagen of beef retina. All the glycoproteins investigated were expressed in apical lesions. The intensity of the immunostaining appeared more positive at the external area compared with the center of the lesion. The type IV collagen was specific for the basement membrane of cysts. The immunofluorescence reactions of fibronectin and of laminin were similar in intensity in both granulomas and cysts.