Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia.

Muscle pain and weakness are frequent complaints in patients receiving 3-hydroxymethylglutaryl coenzymeA (HMG CoA) reductase inhibitors (statins). Many patients with myalgia have creatine kinase levels that are either normal or only marginally elevated, and no obvious structural defects have been reported in patients with myalgia only. To investigate further the mechanism that mediates statin-induced skeletal muscle damage, skeletal muscle biopsies from statin-treated and non-statin-treated patients were examined using both electron microscopy and biochemical approaches. The present paper reports clear evidence of skeletal muscle damage in statin-treated patients, despite their being asymptomatic. Though the degree of overall damage is slight, it has a characteristic pattern that includes breakdown of the T-tubular system and subsarcolemmal rupture. These characteristic structural abnormalities observed in the statin-treated patients were reproduced by extraction of cholesterol from skeletal muscle fibres in vitro. These findings support the hypothesis that statin-induced cholesterol lowering per se contributes to myocyte damage and suggest further that it is the specific lipid/protein organization of the skeletal muscle cell itself that renders it particularly vulnerable.

[Requirements for quality of approved plant medicines]. / Anforderungen an die Qualität zugelassener pflanzlicher Arzneimittel.

Herbal medicinal products differ substantially from drugs with synthetic active ingredients. Whereas the active ingredients of synthetic drugs are chemically well defined and pure substances, those of phytopharmaceuticals are plants, parts of plants or extracts. Therefore starting material of high quality and a standardised manufacturing procedure are particularly important for phytopharmaceuticals. Thus the documentation of the quality of a herbal medicinal product is crucial. The quality criteria aim to guarantee a phytopharmaceutical of high and constant quality and as well as a successful and reproducible therapy. The new Swiss Federal Law on Medicinal Products and Medical Devices (Law on Therapeutic Products--LTP) came into effect on 1 January 2002. The Intercantonal Office for the Control of Medicines IOCM which previously was in charge of herbal medicinal products was closed down and together with the Therapeutic Products Section of the Swiss Federal Office of Public Health SFOPH merged to create Swissmedic, the Swiss Agency for Therapeutic Products. Swissmedic is now responsible for affairs related to herbal medicinal products. The following article gives an overview of the current quality requirements of phytopharmaceuticals. These are now based on the LTP, but the essence remains largely unchanged.

Dynamic and cyclic fatigue of engine-driven rotary nickel-titanium endodontic instruments.

The absence of adequate testing standards for engine-driven nickel-titanium (NiTi) instruments necessitates further study of these instruments in all areas. This study examined three groups of engine-driven rotary NiTi endodontic instruments (Profile, Hero, and Quantec) and assessed the times for dynamic fracture in relation to the radius of curvature to which the instruments were subjected during preparation, with the instrument diameter determined by size and taper and the mode by which the fracture occurred. Ten instruments were randomly selected representing each size and taper for each group and for each radius of curvature: 600 in total. The instruments were rotated at 350 rpm and introduced into a tempered steel curve that simulated a canal. Two radii of curvature of canals were used: 5 and 10 mm. Time at fracture was noted for all files, and the fracture faces of each file were analyzed with scanning electron microscopy. Radius of curvature was found to be the most significant factor in determining the fatigue resistance of the files. As radius of curvature decreased, fracture time decreased. Taper of files was found to be significant in determining fracture time. As diameter increased, fracture time decreased. In all cases, fracture was found to be of a ductile nature, thus implicating cyclic fatigue as a major cause of failure and necessitating further analyses and setting of standards in this area.

Genetic variation of Cryphonectria hypoviruses (CHV1) in Europe, assessed using restriction fragment length polymorphism (RFLP) markers.

A total of 72 hypovirus-infected isolates of the chestnut blight fungus Cryphonectria parasitica were sampled from nine European countries between 1975 and 1997. The double-stranded RNA of the Cryphonectria hypoviruses (CHV1) was isolated and reverse transcription (RT)-PCR products were obtained for two different regions of the viral genome (ORF A and ORF B) using primer sequences of the type species CHV1-EP713. Both PCR products of each viral isolate were digested with four restriction endonucleases recognizing sequences of four nucleotides. The restriction fragment length polymorphism (RFLP) analysis revealed 41 genetically distinct RFLP types of CHV1 with 10 types occurring more than once. Identical RFLP types were detected nine times among viruses collected in the same location. Cluster analysis based on the RFLP banding patterns separated the viral isolates into five CHV1 clusters or subtypes. Most viral isolates (64 out of 72) grouped into one large cluster which comprised all viruses from Italy (including CHV1-EP747), Switzerland, Crotia, Bosnia, Hungary, Greece, and the French island Corsica, as well as five out of 11 isolates from continental France. Two additional subtypes of CHV1 were found in France (one related to CHV1-EP713) and one each in Spain and Germany. The Swiss samples collected over a period of 20 years showed that very little RFLP variation has evolved during this time. The results of this study are consistent with the hypothesis of multiple introductions of CHV1 into Europe.

A new method for the quantitative analysis of endodontic microleakage.

The aim of this in vitro study was to evaluate the apical seal obtained with three commonly used root canal sealing cements: Sealapex, AH Plus or Topseal, and Sealite, using a new method based on the quantitative analysis of 125I-radiolabeled lysozyme penetration. One hundred thirteen teeth with straight single root canals were instrumented to master apical point #25/30. These were divided into three groups: (i) negative control (4 roots) covered with two layers of nail polish, (ii) test group (105 roots) obturated by laterally condensed guttapercha with the three cements; and (iii) positive control (4 roots) obturated without cement. The groups were then immersed in 125I lysozyme solution for a period of 1, 7, 14, or 28 days. After removal, six sections of 0.8 mm length each were made of each root with a fine diamond wire. Each section was analyzed for activity by a gamma counter, corrected for decay, and used to quantify protein penetration. Leakage was high in the positive control and almost negligible in the negative control. AH Plus (Topseal) and Sealapex showed similar leakage behavior over time, with AH Plus (Topseal) performing better. Sealite showed acceptable leakage up until day 14, after which a large increase occurred, presumably due to three-dimensional instability.

Mechanical properties of nickel-titanium endodontic instruments and the effect of sodium hypochlorite treatment.

The purpose of this study was to assess the mechanical properties--torsional moment, maximum angular deflection, maximum bending moment, and permanent angular deflection--of four brands of nickel-titanium (NiTi) endodontic file, and compare them with a conventional stainless-steel instrument, both in the presence and absence of sodium hypochlorite (NaOCl). NiTi instruments from four manufacturers were randomly selected and subjected to NaOCl treatment for 12 or 48 h, or not at all. The mechanical properties under test were then measured automatically by a digital torque memocouple. Torsional moment and maximum angular deflection indicate the resistance to torsional fracture of an instrument, maximum bending moment the stiffness of the instrument, and permanent angular deflection the strength of the base alloy. All instruments evaluated complied with or exceeded ADA/ANSI Specification No. 28, with the sole exception of the Maillefer ISO size 40 for torsional moment. JS Dental and McSpadden NiTi files were the most resistant to torsional fracture, but all NiTi files were inferior when compared with stainless-steel files from a previous study. However, NiTi files were superior in flexibility, and Maillefer and Brasseler instruments were the best of the instruments tested. NiTi files also had negligible permanent deformation angles. Furthermore, for all properties tested, NaOCl had no statistically significant effect.

Cutting efficiency of nickel-titanium endodontic instruments and the effect of sodium hypochlorite treatment.

The purpose of this study was to assess the cutting efficiency of nickel-titanium (NiTi) files in the presence and absence of sodium hypochlorite (NaOCl) treatment, and compare them to a conventional stainless-steel K-type file. NiTi files from four manufacturers were randomly selected and exposed to NaOCl for 12 or 48 h, or not at all. Their cutting efficiencies were then assessed, using a new methodology: "mass of Plexiglass cut per energy used over 50 linear cutting motions." In the absence of NaOCl, Brasseler (318 micrograms/J) and Maillefer (280 micrograms/J) NiTi files were most efficient, followed by JS Dental (71.4 micrograms/J) and McSpadden (40 micrograms/J). These differences were significant (p < 0.0001), except for those between the latter two brands. Moreover, NaOCl treatment did not alter the cutting efficiency of any brand of instruments significantly. When compared with conventional stainless steel files, all NiTi files tested were less efficient.

Effects of cleaning, chemical disinfection, and sterilization procedures on the mechanical properties of endodontic instruments.

The aim of this study was to test and compare the values of torsional moment, torsional angular deflection, bending moment, and permanent angular deflection of three designs of root canal files (Unifile, Flexofile, and H-File) before and after cross-infection treatment procedures, according to ANSI/ADA specification no. 28. An increase in value for all mechanical properties tested was observed after the treatment procedures, with the exception of Flexofile wherein a decrease in permanent angular deflection was evident. Unifile showed a decrease in torsional moment and bending moment. The changes in mechanical properties after treatment procedures ranged from 0.1 to 63% from the control groups. Generally, the changes in values observed were insignificant and still well within ANSI/ADA specification no. 28. Thus, they do not have any clinical significance.

Measurement of the cutting efficiency of endodontic instruments: a new concept.

The cutting efficiency of endodontic instruments was measured using an original experimental technique that incorporates new concepts to simulate clinical conditions. Five designs of #ISO 030 endodontic instruments, K-reamer (Maillefer), Flexofile (Maillefer), Helifile (Micro-mega), K-flex (Kerr), and Unifile (De Trey), were chosen and their cutting efficiency assessed at their full working length of 16 mm on two Plexiglas parallelepipeds tilted to follow the 2% conicity of the instruments. For each instrument, four series of 25 cuts were carried out and each cut made on a new flat, smooth Plexiglas surface with an even hardness of 33 VHN. Instruments were tested under a simulated clinical condition of a quarter clockwise turn ROTARY MOTION followed by a PULL ACTION at 16 mm/s rate, with a fixed load on the instrument of 325 g. Water irrigation at a rate of 85 ml/s was supplied before each procedure. Cutting efficiency was evaluated in terms of mass of Plexiglas cut (using a Mettler analytic balance with accuracy of 3 x 10(-5) g) per unit of energy used by the instrument, i.e. mg/J. Unifile was found to have the best cutting efficiency of 0.80 +/- 0.01 (Mean +/- SD) and lowest cutting efficiency loss followed by Flexofile 0.70 +/- 0.03 then Helifile 0.36 +/- 0.01 then K-flex 0.51 +/- 0.07. K-reamer was found to have the lowest cutting efficiency of 0.16 +/- 0.05.

Effects of cleaning, disinfection, and sterilization procedures on the cutting efficiency of endodontic files.

The effects of various cleaning, chemical disinfection, and sterilization procedures on the cutting efficiency of endodontic instruments Unifile (De Trey, Bois Colombes, France), (Flexofile Maillefer, Ballaigues, Switzerland), and H-File (Maillefer)) were investigated. The cross-infection control treatment procedures investigated were as follows: chemical disinfection--NaOCl (2.5%) for 12 and 48 h, and NH4 (5%) for 1 and 4 h; ultrasonic cleaning for 4 and 16 cycles of 15 min; and sterilization methods with chemiclave for 5 and 10 cycles of 20 min, Poupinel for 5 and 10 cycles of 120 min at 180 degrees C and glass beads for 10 and 40 cycles of 40 at 250 degrees C. Cutting efficiency was evaluated as the mass of Plexiglas cut per unit of energy expended by the instrument in microgram/Joule. The cutting efficiency decreased from 1 to 77%, depending on the file design and type of treatment procedures. Heat sterilization (Poupinel) did not modify the cutting efficiency of Unifile and Flexofile. The decrease in cutting efficiency was independent of frequency and duration of treatment procedures.

In vitro efficiency of endodontic irrigation solutions on protein desorption.

The use of irrigating solutions is widely accepted as a necessary adjunct to biomechanical preparation to obtain adequate cleansing of the root canal system. In this study, the efficiency of three solutions was tested in an in vitro experimental system for the removal of protein from apatite surfaces: Salvizol (a bis-dequalinium acetate solution) and sodium hypochlorite at 0.5, 1, 3 and 6% at pH 7.4 and 11.5. Buffered Tris-HCl solutions at pH 7.4 and 11.5 were used as controls. All chemicals showed rapid kinetics effects since no variation of the process could be detected after 5 min. Salvizol was the least efficient solution since it induced only a 2% protein desorption. Sodium hypochlorite efficiency increased with concentration to reach a 70% protein desorption from the apatite surface. In general, alkaline solutions were more efficient than buffered ones, and the ionic strength did not appear to have a major effect on the protein desorption process.

Critical analysis of an experimental set-up generally used for the permeability evaluation of dental lining material.

The diffusion constants of iodide through dentine membranes were determined. The DI-values were within the range generally obtained by other investigators. When the estimation of the diffusion coefficient through a well defined polycarbonate membrane was calculated the value was strongly affected by the diffusion through the unstirred diffusion layer. By using such an experimental approach it seems necessary to develop a new cell equipped with a double stirring system (one in each compartment) in order to reduce strongly the thickness of the unstirred diffusion layer.

Dynamic fracture of hybrid endodontic hand instruments compared with traditional files.

The purpose of this study was to analyze in vitro the dynamic fracture of some endodontic hand instruments. The K file and H file were tested as reference traditional files; the K-Flex, Flexofile, Unifile, and Helifile were tested as newly developed hybrid instruments. The files were mounted in a lathe and rotated with cyclical axial motion in the lumen of a curved tempered steel groove until failure occurred. The results showed that the life span of instruments, the distance between the instrument tip and the rupture point, and the resistance to fracture were dependent on the size and design of the instruments. Moreover, scanning electron microscopic photographs revealed two types of breakage patterns. The K file, H file, Unifile, and Helifile showed a distinct fracture starting point with crack striations and ductile fractures. The K-Flex and Flexofile showed only plastic deformations and axial fissures.

[Magnetic resonance imaging and dentistry]. / L'imagerie par résonance magnétique et l'odontostomatologie.

At the present time, the research in and the utilization of magnetic resonance imaging in odontostomatology remains limited. It appeared interesting to access the advances made in this technic and to attempt an evaluation of the longrange perspectives of MRI in this field. In order to more clearly understand the images produced by this technic, the principles of nuclear magnetic resonance are summarized, followed by an account of the principle applications with respect to the buccal cavity and the temporo-mandibular joints. Studies showing the influence of different alloys used in dentistry on the quality of the nuclear magnetic images remain for the moment, rather limited. MRI of the oropharyneal area permits a glimpse of interesting perspectives such as the detection of tumorous lesions or the visualization of meniscus of the TMJ. Nevertheless, three factors constitute considerable obstacles in the broad utilization of MRI in the field of odontostomatology: the time lapse of image production, the relatively limited special resolution and finally the prohibitive cost of examinations.