Scapholunate Ligament Partial Tears; Tear Localization, Extrinsic Ligament Injury Association and Conservative Treatment Responses Prior to Instability: Cross-Sectional Study.

PURPOSE OF THE STUDY Scapholunate interosseous ligament (SLIOL) tears with accompanying extrinsic ligament rupture have been associated with scapholunate (SL) instability. SLIOL partial tears were examined in terms of tear localization, grade and accompanying extrinsic ligament injury. Conservative treatment responses were scrutinized according to injury types. MATERIAL AND METHODS Patients with SLIOL tear without dissociation were evaluated retrospectively. Magnetic resonance (MR) images were reexamined in terms of tear localization (volar, dorsal or combined volar and dorsal tears), grade of injury (partial or complete) and extrinsic ligament injury accompaniment (RSC, LRL, STT, DRC, DIC). Injury associations were examined with MR imaging. All patients treated conservatively were recalled at their first year for re-evaluation. Conservative treatment responses were analyzed according to pre- and post-treatment first year visual analog scale for pain (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS In our cohort, 79% (n: 82/104) of patients had SLIOL tear and 44% (n: 36) of them had accompanying extrinsic ligament injury. The majority of SLIOL tears and all extrinsic ligament injuries were partial tears. In SLIOL injuries, volar SLIOL was most commonly damaged portion (45%, n: 37). DIC (n: 17) and LRL (n: 13) were most frequently torn ligaments, radiolunotriquetral (LRL) injury generally co-existed with volar tears and dorsal intercarpal ligament (DIC) with dorsal tears regardless of injury time. Extrinsic ligament injury accompaniment was associated with higher pre-treatment VAS, DASH and PRWE scores than isolated SLIOL tears. Injury grade, location and extrinsic ligament accompaniment had no significant effect on treatment responses. Test scores reversal was better in acute injuries. CONCLUSIONS On imaging SLIOL injuries, attention should be paid to the integrity of secondary stabilizers. In partial SLIOL injuries, pain reduction and functional recovery can be achieved with conservative treatment. Conservative approach can be the initial treatment option in partial injuries especially in acute cases regardless of tear localization and injury grade if secondary stabilizers are intact. Key words: scapholunate interosseous ligament, extrinsic wrist ligaments, carpal instability, MRI of wrist, wrist ligamentous injury, volar and dorsal scapholunate interosseous ligament.

Don't Let Our Operating Theatre to Be Desert.

PURPOSE OF THE STUDY The purpose of this study is to reveal the waste of water by medical staff hand scrubbing preoperatively in the operation theatre, draw attention to the water consumption with small precautions. The study compares motion-sensitive sensor tap with an uncensored classic tap, to assess the difference of water consumption during hand scrubbing. MATERIAL AND METHODS The presented study compared two groups; hand scrubbing with sensory tap was enrolled as group A and classic tap with running water was enrolled as group B. Three participants were included in each group. Operation faucets with a motion-sensitive sensor and timekeeper were used in group A. Running water from a tap in 10 seconds was measured with the help of a measuring cup. The water amount after 3 minutes of washing was also measured. The difference between the two obtained data was compared. The obtained data were also multiplied to the global surgical data. RESULTS Measurements were performed with a measuring cup and it was measured that 1,250 ml of water is running from faucets in 10 seconds. In group A, faucets were open for 23 seconds whereas in group B faucets were open for 180 seconds. In group A, water utilization was 2,875 ml per person (8,625 ml for three), in group B was the water utilization of 22,500 ml per person (67,500 ml for three). Regarding this data for a single operation, the consumption difference between the two groups was measured as 58,875 ml. The total count of major surgery worldwide per year is reported to 321,500,000. When this number is multiplied with the obtained data, it is calculated that the total amount of water to be saved between the two groups is 18,928,313 m3. That is equal to one year of water consumption of a city with 125,000 inhabitants. CONCLUSIONS In conclusion, as healthcare professionals, it is possible to save enough water as a medium-sized city by changing our handwashing habits in the operation rooms. As a result, water-conserving systems and hand scrubbing education can be very effective in using the natural resources economically and protecting these resources. Key words: water, operation theatre, washing.

The Evaluation of Results of Repair using All-Soft Suture Anchor in the Treatment of Chronic Tendinous Mallet Finger Surgery.

PURPOSE OF THE STUDY The purpose of this study is to evaluate the results of chronic tendinous mallet finger repair with all soft suture anchors. MATERIAL AND METHODS In this retrospective study we evaluated 14 patients. Data included age, side of surgery, the degree of extensor lag, the ratio of the damaged articular surface, postoperative recovery period and time to return to work. We recorded extensor lag and Crawford scores of all patients at the last follow-up. RESULTS Mean follow-up period was 22.07 months. The preoperative and postoperative extensor lags were 27.2 (15-35) and 3 (0-19), respectively. Crawford scores of patients were moderate in 1 patient, fair in 2 patients and excellent in 10 patients. We observed only one skin complication in the postoperative period. CONCLUSIONS All-soft suture anchors have high patient satisfaction rates and functional results. Thus, they could be used in the treatment of patients with chronic tendinous mallet finger. The low complication rate is a major advantage. Key words: tendinous mallet finger, hand surgery, all-soft anchor. Level of evidence: Level-4, Retrospective case-control study.

Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Repair with Mini Soft Suture Anchor (JuggerKnot™).

PURPOSE OF THE STUDY We aimed to investigate the functional outcomes and complications of a new approach, the primary UCL repair using JuggerKnot™ Soft Anchor-1.0 mm Mini (Zimmer-Biomet). MATERIAL AND METHODS This study included a total of 12 patients with acute UCL injury who were operated with primary repair with JuggerKnot™ Soft Anchor-1.0 mm Mini between January 2012 and September 2016. All patients were operated on using the same surgical technique. The thumb pinch and grip strengths, articular range of motion, and Glickel functional score were recorded for all patients. The pinch grip strength and articular range of motion were compared with the intact side. Early and late postoperative complications were recorded. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). The grip strength and the pinch strength were 94.3% and 92.27%, respectively, of the contralateral side. Articular range of motion attained the same level as the contralatereal side in all patients at the final visit, and no patient suffered from any complication. The patients returned to work at a mean of 5.45 weeks, and the Glickel score was good in 1 patient and excellent in the remainder 11 patients. CONCLUSIONS Surgical repair using the JuggerKnot™ Soft Anchor-1.0 mm is an effective alternative treatment method for acute total ulnar collateral ligament (UCL) rupture. Key words:ulnar collateral ligament, acute total injury, thumb, soft suture anchor, JuggerKnot™.

Results from the Survey of Antibiotic Resistance (SOAR) 2002-09 in Turkey.

OBJECTIVES: To investigate changes in antibiotic susceptibility of Streptococcus pneumoniae and Haemophilus influenzae from the Survey of Antibiotic Resistance (SOAR) in community-acquired respiratory tract infections (CA-RTIs) between 2002 and 2009 in Turkey. METHODS: Previously published SOAR data were used for this analysis. MICs were determined using Etest(®) gradient strips or disc diffusion. Susceptibility against a range of antimicrobial agents was assessed using CLSI breakpoints. RESULTS: A total of 900 S. pneumoniae isolates were analysed: 2002-03 (n = 75), 2004-05 (n = 301) and 2007-09 (n = 524). Four antibiotics were tested consistently throughout and three showed a statistically significant decrease in susceptibility (P < 0.0001): penicillin (74.7% susceptible in 2002-03; 67.8% in 2004-05; and 47.2% in 2007-09); cefaclor (85.3% in 2002-03; 78.7% in 2004-05; and 53.5% in 2007-09) and clarithromycin (85.3% in 2002-03; 82.7% in 2004-05; and 61.9% in 2007-09). Susceptibility to amoxicillin/clavulanic acid did not significantly change (100% in 2002-03; 98.7% in 2004-05; and 97.7% in 2007-09). A total of 930 H. influenzae isolates were analysed: 2002-03 (n = 133), 2004-05 (n = 379) and 2007-09 (n = 418). Four antibiotics were also consistently tested: ampicillin, amoxicillin/clavulanic acid, clarithromycin and cefaclor. All showed >90% susceptibility, but only cefaclor susceptibility significantly reduced (P < 0.0001) over time (99.2% in 2002-03; 96.3% in 2004-05; and 90.4% in 2007-09). CONCLUSIONS: In S. pneumoniae from Turkey, there has been a clear statistically significant reduction in susceptibility to key antibiotics since 2002, but not to amoxicillin/clavulanic acid (or amoxicillin). However, susceptibility in H. influenzae remained stable. Continued surveillance is required to monitor future changes in antibiotic susceptibility for CA-RTI bacteria.

The success of the different eradication therapy regimens for Pseudomonas aeruginosa in cystic fibrosis.

WHAT IS KNOWN AND OBJECTIVE: Antibiotic therapy aimed at eradicating Pseudomonas aeruginosa (Pa), and improved regimens to treat chronic Pa infection have played a major role in increasing the median survival of patients with cystic fibrosis (CF). However, different clinical centres use varying eradication regimens. The aim of this study was to evaluate the efficacy of multiple eradication treatments against initial Pa infection and to determine the factors affecting the treatment success. METHODS: This study was conducted at the Hacettepe University Department of Pediatric Pulmonology. We examined the demographic, clinical and microbiological data of 146 CF patients with first Pa isolation in sputum culture from all 630 patients with CF studied. We aimed to identify the factors that affected the eradication of Pa infection and assessed the success rates of the different eradication protocols used. RESULTS AND DISCUSSION: The mean age of the patients was 71·5 months (2 months-29 years) when Pa was first isolated; the mean duration from CF diagnosis to first Pa isolation was 40 months. The most common treatment choices consisted of 2 weeks of intravenous ceftazidim-amikacin for severe exacerbation or 3 months of inhaled gentamycin combined with 3 weeks of oral ciprofloxacin for mild exacerbation in asymptomatic patients. With these treatment regimens, eradication was observed in 47 patients (32%), intermittent colonization in 42 patients (28%) and chronic colonization in 57 patients (40%). Forced expiratory volume in 1 s decline was statistically significant in patients with chronic colonization (P = 0·006). Being older than 2 years of age or having symptoms at the first Pa isolation was negatively associated with the treatment success. WHAT IS NEW AND CONCLUSION: Early antibiotic treatment for Pa can eradicate the bacteria, prevent or delay the development of chronic colonization and improve the general health status. The acquisition of Pa at an older age and having symptoms at first isolation negatively affected the success of eradication. The use of intravenous antibiotics may increase the efficacy of therapy. Inhaled tobramycin for Pa eradication was approved for reimbursement in Turkey from August 2014. The relatively low eradication rate may be explained by a lack of reimbursement for inhaled tobramycin and colistin in our country during the study period.

A new laboratory model using bull and boar spermatozoa and fluorescent beads to assess a membrane's occlusive potential.

OBJECTIVES: The objective of the present study is to assess the potential of bull and boar spermatozoa and fluorescent beads to be used as a surrogate cell model to determine the cell occlusive potential in vitro using membranes of standardized porosities. MATERIALS AND METHODS: A two-chamber model system consisting of upper and lower chambers, which could be separated by membranes, was constructed. Isopore polycarbonate membranes with different standardized pore diameters were used to assess the mobile cellular penetration behavior of spermatozoa or the more passive non-cellular permeability of fluorescent particles (beads) of different diameter and color. In a first experiment, spermatozoa were placed in the lower chamber, whereas semen extender only was placed in the upper chamber. After 10 min of incubation at 37 °C, the sperm number was assessed in the latter. In a second experiment, a bead solution was drawn through resorbable collagen membranes from the upper into the lower chamber by vacuum using a syringe and bead number and size was analyzed by flow cytometry. All experiments were carried out in triplicates. A non-porous polyester membrane was used as negative control to assess the overall tightness of the setup. RESULTS: Boar and bull spermatozoa had average cell body lengths and widths of 9 × 5 µm and were unable to pass through pores ≤2 µm, whereas they were detectable at pore sizes ≥3 µm. Their number increased with increasing pore diameters, i.e., from minimal concentrations of 0.1 × 106/ml for boar and 0.5 × 106/ml for bull spermatozoa at 3 µm to maximal concentrations of 2.1 × 106/ml for boar and 13.1 × 106/ml for bull spermatozoa at 8 µm. The fluorescent beads followed the expected pattern of permeability reliably correlating bead and pore diameter. CONCLUSIONS: Within the limitations of this laboratory study and the xenogeneic cell surrogate material, the model allows to easily assess cell and particle penetration through porous structures like membranes. We hope to further assess, improve, and validate this model, which we aim to use for the screening of dental membranes after being exposed to different degradation methods. CLINICAL RELEVANCE: Convenient and rapid test procedures to evaluate membranes for regenerative procedures are still warranted.

In vitro evaluation of a novel biofilm remover.

OBJECTIVE: To evaluate a novel device for its efficacy in removing experimental biofilm from root surfaces and its potential for concomitantly removing/roughening the surface substance. METHODS AND MATERIALS: A novel acrylic rotary device (biofilm remover, BR) was tested in vitro in three experiments: surface loss, surface roughness [positive controls: Perioset (PS) and Proxoshape (PR)] and biofilm removal [positive controls: ultrasonic (US) and PS]. Surface loss/surface roughness was evaluated for dentin samples instrumented for three 20 s periods. The calcium removed during instrumentation was analysed after each interval and cumulatively, using atomic absorption spectrophotometry (AAS). Surface roughness was measured using profilometric analysis. Biofilm removal was evaluated on dentin specimens coated with a 64.5 h 6-species in vitro formed biofilm, after one 20 s treatment. Surface loss was analysed using anova with Scheffé post hoc test, and surface roughness/biofilm removal was analysed using Mann-Whitney test (all P ≤ 0.05). RESULTS: Significantly less substance loss [µg (± 1 SD)] was observed with the novel device at all time points, both interval and cumulative (1.0 (± 0.5) versus 9.3 (± 3.2) PS and 9.9 (± 1.9) PR at 60 s). Surface roughness [µm (95% CI)] was significantly lower for BR than for PS and PR [0.00 (-0.01, 0.08) 0.20 (0.16, 0.27) and 0.21 (0.19, 0.24) at 60 s]. Significantly less biofilm bacteria remained after treatment with both BR 4.5 (-0.1, 16.2) and US 1.9 (-0.2, 14.3), compared to PS 52 (27.9, 82.1). CONCLUSIONS: The novel biofilm remover was less damaging to dentin surfaces, while removing biofilm at least as effectively as devices used in this study.

Cerium chloride reduces enamel lesion initiation and progression in vitro.

AIM: Determination of the potential of cerium chloride to reduce artificial carious mineral loss and lesion depth progression. METHODS: A total of 160 enamel samples were prepared from 40 bovine lower central incisors. Crowns were sectioned into four pieces, embedded in acrylic resin, ground flat and allocated to eight groups (S1-S4 and D1-D4; n = 20). Specimens of groups D1-D4 were stored (for 7 days) in a demineralizing buffer solution to induce caries-like lesions. Afterwards, samples were treated for 30 s with one of the following solutions: placebo (S1 and D1), amine fluoride (S2 and D2), cerium chloride (S3 and D3) and a combination of fluoride and cerium chloride (S4 and D4). After another 7 (D1-D4) or 14 (S1-S4) days in demineralizing buffer solution, integrated mineral loss and lesion depth were determined by transversal microradiography and compared by Scheffé's post hoc tests. RESULTS: In groups S1-S4, the highest values for integrated mineral loss and lesion depth were observed for group S1 (placebo), the lowest values for group S4. The results in groups S2-S4 were not significantly different. In groups D1-D4, the highest values for integrated mineral loss and lesion depth were observed for group D1 (placebo), the lowest values in groups D3 and D4. In group D2, integrated mineral loss and lesion depth were significantly lower as compared to D1, but significantly higher compared to groups D3 and D4. CONCLUSION: Cerium chloride and its combination with fluoride are able to significantly reduce carious mineral loss and the progression of lesion depth.

Stability against brushing abrasion and the erosion-protective effect of different fluoride compounds.

This study aimed to analyse the impact of brushing on the protective effect of different fluoride solutions on enamel and dentin erosion. Bovine enamel and dentin specimens were rinsed once with TiF4, AmF, SnF2 (0.5 M F, 2 min) or water (control). Specimens were either left unbrushed or brushed with 10, 20, 50, 100 or 500 brushing strokes in an automatic brushing machine (2 N, non-fluoridated toothpaste slurry). Ten specimens per group were eroded with hydrochloric acid (HCl) (pH 2.3) for 60 s, and calcium release into the acid was determined by atomic absorption spectroscopy. Additionally, enamel and dentin surfaces were analysed by X-ray energy-dispersive spectroscopy (EDS) (n = 6/group) and scanning electron microscopy (SEM) (n = 2/group) before brushing and after 500 brushing strokes. Statistical analysis (p < 0.05) was performed by three- and one-way ANOVA (calcium release) or repeated measures ANOVA (EDS). TiF4, AmF and SnF2 reduced the erosive calcium loss in unbrushed specimens to 58-67% (enamel) and 23-31% (dentin) of control. Calcium release increased with increasing brushing strokes prior to erosion and amounted to 70-88% (enamel) and 45-78% (dentin) of control after 500 brushing strokes. Brushing reduced the surface concentration of fluoride (AmF), tin (SnF2) and titanium (TiF4). SEM revealed that surface precipitates were affected by long-term brushing. Brushing reduced the protective potential of TiF4, AmF and SnF2 solutions. However, considering a small number of brushing strokes, the protective effect of fluoride solutions is only slightly affected by brushing abrasion.

Primary assessment of a self-adhesive gutta-percha material.

AIM: To evaluate a prototype gutta-percha material (Bio-Gutta), which is claimed to work without sealer because of its incorporated ultrafine bioactive glass particles, in terms of its induction of pH and calcium phosphate (CaP) precipitates, and its self-adhesiveness in root canals. METHODOLOGY: Bio-Gutta was compared with conventional gutta-percha (GP, composition: 70 wt% ZnO, 30 wt% polyisoprene). Test and control materials (N = 3) were immersed in phosphate-buffered saline (PBS) at 37 °C for 30 days. The pH in the solution was monitored. Apparent CaP formation was assessed using scanning electron microscopy (SEM). The root canals of 33 single-rooted teeth were filled by vertical compaction of heated Bio-Gutta, 33 control canals were filled with vertically compacted GP without sealer. Push-out bond strengths associated with the filling materials in root cross-sections from middle root thirds was determined 1, 8, and 30 days after root filling (N = 11 per group). These values were compared between groups using one-way anova (α < 0.05). RESULTS: Bio-Gutta induced a high pH in the PBS solution, which plateaued at values between 11.4 and 11.8. Apparent CaP crystals covered the Bio-Gutta material after 30 days of immersion in PBS, whilst no such structures were observed on GP. Both materials under investigation had similar initial push-out bond strength values (P > 0.05). The adherence of Bio-Gutta increased from day 1 to 8 and was significantly higher than that of conventional GP at 8 and 30 days (P < 0.05). CONCLUSIONS: The experimental gutta-percha material under investigation was alkaline and caused CaP precipitates on its surface. It improved its adherence to the root canal wall within 1 week.

Prevention of erosive/abrasive enamel wear due to orange juice modified with dietary supplements.

OBJECTIVE: The aim of this study was to evaluate the erosive/abrasive enamel wear after contact with orange juices modified with different dietary supplements. METHODS: A total of 96 bovine enamel samples were prepared and allocated to eight groups (1-8; n = 12). Samples were eroded (120 s) in 200 ml of the following eight solutions: 1: water (control), 2: orange juice, 3: water + calcium effervescent tablet, 4: orange juice + calcium effervescent tablet, 5: water + 0.75 g acid/base regulating powder (Probase), 6: water + 0.375 g Probase, 7: orange juice + 0.75 g Probase and 8: orange juice + 0.375 g Probase. After erosion, the samples were brushed with 40 brushing strokes (load 2.5 N). Enamel wear was measured using surface profilometry after 20 and 40 cycles of erosion/abrasion respectively. RESULTS: Highest mean enamel wear (± SD) after 20 and 40 cycles of erosion/abrasion was observed for the unmodified orange juice (group 2) (0.605 ± 0.240 µm; 1.375 ± 0.496 µm respectively). The enamel wear in all other groups (3-8) was significantly lower (P < 0.0001 respectively) with no significant difference within these groups and compared with water (control). CONCLUSION: Erosive/abrasive enamel wear induces by orange juice and tooth brushing could be reduced significantly by modification with free available dietary supplements.

Biofilm reduction and staining potential of a 0.05% chlorhexidine rinse containing essential oils.

OBJECTIVES: To assess the biofilm reduction and discolouration potential of a new 0.05% chlorhexidine (CHX) digluconate solution, containing additional essential oil and alcohol components, compared with that of standard control CHX solutions (0.05% and 0.2% CHX). METHODS: The potential to reduce total viable counts of growing mixed microbial populations was examined using the Zurich biofilm model. Biofilms were created on sterile pellicle-coated hydroxyapatite discs and exposed to test substances at different time points. After 64.5 h, mean colony-forming units and SDs were determined. Colour change measurements using light reflection analysis were carried out on saliva preconditioned bovine dentin and enamel samples, as well as on composite and glass ceramic restorative materials, after successive immersions in a standardized tea brew and the CHX solutions. RESULTS: The test solution was able to reduce biofilm formation by 3 log steps compared with a negative (water) control. This was significantly less effective than the standard control CHX solutions, which reduced viable counts by 6 log steps. Both the test and control solutions exhibited staining on all surfaces. Staining was most pronounced on dentin, followed by enamel and to a significantly lesser degree on the restorative materials. Furthermore, the staining caused by the test solution on these restorative materials was generally lower than that caused by the control solutions. CONCLUSIONS: The test solution exhibited an antimicrobial activity. The composition, however, seems to hamper its effectiveness. Accordingly, it produced statistically significant, although by trend less, staining on restorative materials.

Comparison of the effects of TiF4 and NaF solutions at pH 1.2 and 3.5 on enamel erosion in vitro.

This study aimed to analyse and compare the protective effect of buffered (pH 3.5) and native (pH 1.2) TiF(4) in comparison with NaF solutions on enamel erosion. Bovine samples were pretreated with 1.50% TiF(4) or 2.02% NaF (both 0.48 M F) solutions, each at a pH of 1.2 and 3.5. The control group received no fluoride pretreatment. Twenty samples per group were eroded with HCl (pH 2.6) for 10 x 60 s. Erosion was either investigated by profilometry (n = 10) or by determination of calcium release into the acid (n = 10). Additionally, the elemental surface composition was quantified by X-ray energy-dispersive spectroscopy in fluoridated but not eroded samples (6 samples per group). Scanning electron microscopy was performed prior and after erosion (2 samples per group). Cumulative enamel loss (mum) and calcium release (nmol/mm(2)) were analysed by repeated-measures ANOVA. The Ti and F surface composition was analysed by one-way ANOVA separately for each element. Only TiF(4) at pH 1.2 reduced enamel surface loss significantly. Calcium release was significantly reduced by TiF(4) and NaF at pH 1.2, but not by the solutions at pH 3.5. Samples pretreated with TiF(4) at pH 1.2 showed a significant increase in Ti, while NaF increased F concentration significantly. Only TiF(4) at pH 1.2 induced the formation of a glaze-like layer, which was still present after erosion. Enamel erosion can be significantly reduced by TiF(4) at pH 1.2 but not at pH 3.5. TiF(4) at pH 1.2 was more effective in protecting against enamel erosion than NaF.

Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer.

AIM: To evaluate the effects of ethylenediaminetetraacetic (EDTA), etidronic (EA) and peracetic acid (PA) when used in conjunction with sodium hypochlorite (NaOCl) as root canal irrigants on calcium eluted from canals, smear layer, and root dentine demineralization after instrumentation/irrigation. METHODOLOGY: Single-rooted human premolars were irrigated as follows (n = 12 per group): (1) 1% NaOCl during instrumentation, deionized water after instrumentation, (2) 1% NaOCl during, 17% EDTA after instrumentation, (3) a 1 : 1-mixture of 2% NaOCl and 18% EA during and after instrumentation, and (4) 1% NaOCl during, 2.25% PA after instrumentation. Irrigant volumes and contact times were 10 mL/15 min during and 5 mL/3 min after instrumentation. The evaluated outcomes were eluted calcium by atomic absorption spectroscopy, smear-covered areas by scanning electron microscopy in secondary electron mode and apparent canal wall decalcifications on root transsections in backscatter mode. For the smear layer analysis, sclerotic dentine was taken into consideration. Results were compared using appropriate parametric and nonparametric tests, alpha = 0.05. RESULTS: The statistical comparison of the protocols regarding calcium elution revealed that protocol (1) yielded less calcium than (3), which yielded less than protocols (2) and (4). Most of the instrumented canal walls treated with one of the decalcifying agents were free of smear layer. Protocols (1) and (3) caused no decalcification of root dentine, whilst (2) and (4) showed substance typical demineralization patterns. CONCLUSIONS: The decalcifying agents under investigation were all able to remove or prevent a smear layer. However, they eroded the dentine wall differently.

Synthesis, characterization, and DFT study of novel metallo phtalocyanines with four carboranyl clusters as photosensitisers for the photodynamic therapy of breast cancer cells.

The synthesis and characterization of novel Zn(II) and Co(II) phthalocyanines 4 and 5, respectively containing four o-carboranyl units (40 boron atoms, 32.5% boron by weight) at the peripheral positions are described. The phthalocyanines (Pcs) were synthesized by cyclotetramerization of the previously prepared precursor 4­(2­thiol­o­carboranyl)thiolato­phthalonitrile 3 with the presence of metal salt in boiling dry DMF under a dry nitrogen atmosphere. They were characterized by elemental analysis, UV-Vis, FT-IR, MALDI-TOF mass and 1H NMR spectrometry. To elucidate the structural, spectroscopic and bonding properties of the obtained compounds, calculations with DFT/TD-DFT(Density Functional Theory/Time Dependent-Density Functional Theory) were performed. The cytotoxic effects of 4 and 5 on cancer cells and epithelial cells were determined. The targeted cytotoxicities of both compounds against cancer cells were analyzed with the cell viability test. Although, 4 caused less PDT (Photodynamic therapy) based decrease in cell viability of cancer cell line in comparison to 5, it showed comparatively high cytotoxicity against cancer cells but not epithelial cells. The IC50 (half maximal inhibitory concentration) values indicate that 4 with PDT shows 17.3 fold more cytotoxicity to breast cancer cells than epithelial cells. The selectivity in cytotoxicity of 4 makes it a good candidate for cancer treatment. Interestingly, 5 was found to be highly cytotoxic for both cancer and epithelial cell lines. Considerably, 5 might be used as a cancer drug when combined with targeting agents such as antibodies and aptamers.

Do bioactive glasses convey a disinfecting mechanism beyond a mere increase in pH?

AIM: To test whether bioactive glasses kill microbiota via mineralization or the release of ions other than sodium. METHODOLOGY: Flame-spray synthesis was applied to produce nanometric glasses of different sodium content and constant Ca/P ratio: 28S5, 45S5 and 77S. Calcium hydroxide and nanometric tricalcium phosphate (TCP) were used as controls. Apatite induction was monitored by Raman spectroscopy. Bovine dentine disks with adherent Enterococcus faecalis cells were exposed to test and control suspensions or buffered solutions for 1 h, 1 day and 1 week. Colony-forming units were counted and disks were inspected using scanning electron microscopy. Suspension supernatants and solutions were analysed for their pH, osmolarity, calcium and silicon content. RESULTS: Sodium containing glasses induced pH levels above 12, compared with less than pH 9 with sodium-free 77S. Calcium hydroxide, 45S5 and 28S5 killed all bacteria after 1 day and lysed them after 1 week. TCP caused the highest apatite induction and substantial calcification on bacteria adhering to dentine, but did not reduce viable counts. 77S achieved disinfection after 1 week without visible apatite formation, whilst the buffer solution at pH 9 caused only minimal reduction in counts. CONCLUSION: Bioactive glasses have a directly and an indirectly pH-related antibacterial effect. The effect not directly linked to pH is because of ion release rather than mineralization.

Treatment outcomes of archwise distraction osteogenesis in mandibular dentoalveolar retrognathia cases.

The aim of this study was to describe the treatment of class II malocclusion by sagittal advancement of the alveolar bone in the symphyseal area using an intraoral archwise distractor device and to determine the effects of this method on the dentoalveolar complex. Fifteen patients (10 female, five male) aged 16-20 years with a class II division 2 malocclusion, characterized by mandibular dentoalveolar retrusion and a prominent chin, underwent archwise alveolar distraction in the anterior mandible. Lateral cephalometric radiographs were obtained before distraction (T0), after 6 weeks of consolidation (T1), and after debonding (T2). Linear and angular skeletal, dental, and soft tissue measurements were performed. Forty-seven parameters were measured for each of the 15 subjects on pre- and postoperative lateral cephalometric radiographs (T0, T1, and T2). The distraction protocol was successful in all patients. Skeletally, the mandible showed a clockwise rotation. B-point moved forward significantly (P<0.05). Overjet decreased significantly (P<0.001). The total profile angle was unaffected, and the improvement in the submental fold was highly significant (P<0.001). The intraoral archwise distraction force that is applied through brackets and archwires is sufficiently effective for alveolar advancement. This procedure is simple and effective in the treatment of specific adult patients with a class II division 2 malocclusion, characterized by a prominent chin and severe mandibular dentoalveolar retrusion.

Genomic backgrounds of drug-resistant Streptococcus pneumoniae in Ankara, Turkey: Identification of emerging new clones.

Streptococcus pneumoniae exhibiting decreased susceptibility to penicillin are isolated with an increasing prevalence in Turkey during the last decade. This study was undertaken to investigate the molecular epidemiology of non-penicillin-susceptible pneumococci isolated in Ankara, Turkey. Among a population of 246 pneumococci, 90 pneumococci with penicillin MIC > or = 0.1 microg/ml were serotyped, genotyped by pulsed-field gel electrophoresis (PFGE), and sequence typed by multilocus sequence typing (MLST). The overall resistance to penicillin, cefotaxime, erythromycin, clindamycin, chloramphenicol, tetracycline, rifampicin, ciprofloxacin, and vancomycin were 36.6%, 4%, 27.6%, 10.9%, 5.3%, 22.4%, 4.5%, 2%, and 0, respectively. The most frequent serotypes were 14, 23B, 9V, 19F, 19A, and 23F. PFGE types represented 17 genetic clusters. PFGE and MLST data revealed that there were isolates identical or closely related to the Spain(9V)-3 ST 156 clone, Portugal(19F)- 21 ST 177 clone, and Spain(23F)-1 ST81 clone. Eleven serotype 14 isolates with emerging resistance to penicillin belonged to the ST 230 complex, a predominantly susceptible clone. Serotype 19A, 19F, and 7F variants of the ST 230 clone were also identified in the study population. Eight serotype 23B isolates with a new ST 1349 (18-13-8-6-3-6-8) created another clone with no relation to the currently defined international clones. Although the pandemic clones Spain(9V)-3, Portugal1(9F)-21, and Spain(23F)-1 are present in our region, the emergence of a new 23B clone with a unique ST and the emergence of resistance in the ST230 clone, has presumably contributed to the increase in the prevalence of drug-resistant pneumococci in Turkey.

Mechanisms of macrolide resistance in clinical pneumococcal isolates in a university hospital, Ankara, Turkey.

Macrolide resistance in Streptococcus pneumoniae is usually caused by the presence of the erm(B) or mef(A) resistance determinants. The aim of the present study was to identify the predominant macrolide resistance mechanisms among erythromycin-resistant S. pneumoniae isolated in a university hospital, Ankara, Turkey. A total of 669 S. pneumoniae strains were isolated from clinical specimens of patients admitted to the hospital between 1994--2002. The minimum inhibitory concentrations (MICs) of penicillin G, erythromycin A and clindamycin were determined by the agar dilution method according to NCCLS guidelines. Ninety-one (13.6%) isolates were resistant to erythromycin. Erythromycin-resistant isolates were examined for their macrolide resistance phenotypes by a triple disc diffusion assay. It assigned 57 (62.6%) of the 91 erythromycin-resistant pneumococci to cMLS(B) phenotype, 19 (20.9%) to iMLS(B) phenotype and 15 (16.5%) to M phenotype. All erythromycin-resistant isolates were analyzed by PCR for the presence of erm(B) and mef(A) determinants. The isolates were characterized for the underlying resistance genotype, with 83.5% having erm(B), 16.5% having the mef(A) genotypes. This study provides further evidence of the dissemination of macrolide-resistant mutants in pneumococci as the use of new, long-acting macrolides increases. This is the first article about MLS(B) resistance phenotypes and genotypes of S. pneumoniae from Turkey and it emphasizes the need for future epidemiological monitoring of macrolide-resistant pneumococci.