Effect of gamma irradiation and restorative material on the biomechanical behaviour of root filled premolars.

AIM: To investigate ex vivo the influence of gamma irradiation therapy and restorative material on fracture resistance, fracture mode and strain of root filled human premolars. METHODOLOGY: Sixty extracted human maxillary premolar teeth were randomly divided into six groups (n = 10) determined by two study factors: (i) restorative materials: sound teeth, root filled teeth restored with composite resin, root filled teeth restored with amalgam; (ii) gamma irradiation: irradiated (subjected to 60 Gy of gamma irradiation in daily increments of 2 Gy) and nonirradiated. For the strain gauge test, two strain gauges per sample were attached on the buccal and palatal cusp surfaces (n = 5). Strain values were recorded during loading of 0-150 N. Fracture resistance (N) was assessed in a mechanical testing machine (n = 10). Strain gauge for each cusp and fracture resistance data were analysed by two-way anova (3 × 2) followed by the Tukey's honestly significant difference test (α = 0.05). The failure mode was evaluated using an optical stereomicroscope and classified according to the location of the failure. RESULTS: Gamma radiation therapy significantly reduced the fracture resistance of intact teeth. The strain was higher for teeth restored with amalgam than for those restored with composite resin. The teeth restored with composite resin had similar strain values to sound teeth. Nonirradiated teeth had more restorable failures than irradiated teeth. CONCLUSIONS: Gamma irradiation significantly reduced fracture resistance and increased cusp strain. The use of composite resin resulted in better biomechanical behaviour than amalgam for restoring root filled teeth whether or not they were submitted to radiotherapy.

Effect of anti-rotation devices on biomechanical behaviour of teeth restored with cast post-and-cores.

AIM: To test the hypothesis that the presence of an anti-rotation device (ARD) and its location can influence the biomechanical behaviour of root filled teeth restored with cast post-and-cores and metallic crowns. METHODOLOGY: Fifth two bovine incisor roots were selected and divided into four groups (n = 13): Nd- without ARD; Bd- buccal ARD; Ld- lingual ARD; BLd- buccal and lingual ARD. The specimens were restored with cast post-and-cores and metallic crowns. After a fatigue process (3 x 10(5) 50 N), three strain gauges were attached on the buccal, lingual and proximal surfaces and the samples of each group (n = 3) were submitted to a 0-100 N load. Fracture resistance was assessed in a mechanical testing machine (n = 10). Strain values and fracture resistance data were analysed by one-way anova and Tukey Honestly Significant Difference (HSD) test (alpha = 0.05). The failure mode was then evaluated under an optical stereomicroscope. Bidimensional models of each group were generated for finite element analysis (FEA) and analysed using the von Mises criteria. RESULTS: No significant difference in fracture resistance values and fracture modes occurred between the four groups. The BLd group had higher stress concentrations in the buccal dentine and higher strain values on the proximal surfaces. CONCLUSIONS: The anti-rotation devices did not influence significantly the fracture resistance and fracture mode. However, the stress-strain values were increased when the anti-rotation device was prepared on the buccal and lingual faces concomitantly.

Influence of Computer-aided Design/Computer-aided Manufacturing Diamond Bur Wear on Marginal Misfit of Two Lithium Disilicate Ceramic Systems.

CLINICAL RELEVANCE: Marginal misfit of monolithic lithium disilicate ceramic crowns obtained from a chairside computer-aided design/computer-aided manufacturing system is affected after successive millings using a single diamond bur set. This fact can be critical for the longevity of indirect restorations.

[Pneumopericardium caused by gastropericardial fistula]. / Neumopericardio por fístula gastropericárdica.

This is the case of a 56-year-old male who presented at our Emergency Room complaining of severe epigastric pain that radiated towards the left shoulder and neck. Pneumopericardium was diagnosed with plain chest X-rays, which indicated a gastropericardial fistula. A contrast X-ray film was taken using a water-soluble contrast. A full gastrectomy was performed with esophagojejunostomy reconstruction and pericardial drainage, which resulted in a favourable patient outcome.

[Perforation after colonoscopy: our 16-year experience]. / Perforación tras colonoscopia: experiencia en 16 años.

OBJECTIVE: the aim of this retrospective study was to evaluate the incidence of colon perforations from diagnostic and therapeutic colonoscopies, and to assess their management in our hospital. PATIENTS AND METHOD: perforations resulting from colonoscopy in our hospital were reviewed for the period January, 1991 to December, 2006. The study analyzed: purpose of procedure, lesion mechanisms, clinical and radiological presentations, delays in diagnosis, patient status, therapeutic handling, and outcome. RESULT: fifteen perforations (0.09%) (9 males and 6 females) out of a total of 16,285 colonoscopies carried out were seen to have taken place during the study period. Nine of these occurred after diagnostic colonoscopies, and 6 occurred after therapeutic endoscopies. Around 60% of perforations were detected by the endoscopist while carrying out the procedure (88.6% during diagnostic endoscopy, and 16.6% during therapeutic endoscopy). In 73.7% of cases abdominal pain and distension were the most frequent symptoms; extraluminal gas was seen in 100% of cases with imaging techniques. Delayed diagnosis (> 24 hours) occurred in 40% of patients (range: 1-6 days). Twelve patients were operated upon (80%), of whom 4 were ASA II and 8 were ASA III/IV. Postoperative morbidity was 44.44%, and mortality was 25%. The outcome of patients receiving conservative treatment was found to be satisfactory. CONCLUSION: perforation of the colon during colonoscopy is a rare complication with serious -even lethal- consequences. Conservative treatment can be provided for selected cases under strict clinical control. Type of surgery will depend on the lesion location and size, concomitant colon pathology, and degree of fecal contamination. Mortality seems to be related to general status rather than the surgical technique used.

Targeting canine mammary tumours via gold nanoparticles functionalized with promising Co(II) and Zn(II) compounds.

BACKGROUND: Despite continuous efforts, the treatment of canine cancer has still to deliver effective strategies. For example, traditional chemotherapy with doxorubicin and/or docetaxel does not significantly increase survival in dogs with canine mammary tumors (CMTs). AIMS: Evaluate the efficiency of two metal compounds [Zn(DION)2 ]Cl (TS262, DION = 1,10-phenanthroline-5,6-dione) and [CoCl(H2 O)(DION)2 ][BF4 ] (TS265) and novel nanovectorizations designed to improve the anti-cancer efficacy of these compounds in a new CMT derived cell line (FR37-CMT). MATERIALS AND METHODS: FR37-CMT cells were exposed to different concentrations of TS262 and TS265 and two new nanoparticle systems and cellular viability was determined. These nanosystems are composed of polyethylene-glycol, bovine-serum-albumin and TS262 or TS265 (NanoTS262 or NanoTS265, respectively). RESULTS: In FR37-CMT, TS262 and TS265 displayed IC50 values well below those displayed by doxorubicin and cisplatin. The nanovectorizations further decreased the IC50 values. DISCUSSION: TS262 and TS265 proved to be effective against FR37-CMT cells and more effective than of doxorubicin and cisplatin. The Nanosystems efficiently delivered the cytotoxic cargo inducing a significant reduction of cell viability in FR37-CMT cell line when compared to the free compounds. CONCLUSIONS: TS262 and TS265 are compounds with potential in the treatment of CMTs. NanoTS262 and NanoTS265 demonstrate that such simple nanovectorization via gold nanoparticles shows tremendous potential as anti-cancer formulations, which may easily be expanded to suit other cargo.

Immortalization and characterization of a new canine mammary tumour cell line FR37-CMT.

Here we describe the establishment of a new canine mammary tumour (CMT) cell line, FR37-CMT that does not show dependence on female hormonal signaling to induce tumour xenografts in NOD-SCID mice. FR37-CMT cell line has a stellate or fusiform shape, displays the ability to reorganize the collagen matrix, expresses vimentin, CD44 and shows the loss of E-cadherin which is considered a fundamental event in epithelial to mesenchymal transition (EMT). The up-regulation of ZEB1, the detection of phosphorylated ERK1/2 and the downregulation of DICER1 and miR-200c are also in accordance with the mesenchymal characteristics of FR37-CMT cell line. FR37-CMT shows a higher resistance to cisplatin (IC50 >50 µM) and to doxorubicin (IC50 >5.3 µM) compared with other CMT cell lines. These results support the use of FR37-CMT as a new CMT model that may assist the understanding of the molecular mechanisms underlying EMT, CMT drug resistance, fostering the development of novel therapies targeting CMT.

Hantavirus pulmonary syndrome in Anajatuba, Maranhão, Brazil.

The authors report a confirmed case of hantavirus pulmonary syndrome in the rural area of the municipality of Anajatuba, state of Maranhão. Two other suspected cases from the same region are also described. The confirmed case involved a previously healthy young woman who died with signs and symptoms of acute respiratory insufficiency 5 days after presenting fever, myalgia and a dry cough. The patient was a student who was helping her parents with work in the fields; it was a habit of the family to store rice inside the house. The suspected cases involved two first-degree relatives working as field hands who died of acute respiratory insufficiency 24 and 48 hours, respectively, after presenting fever, myalgia and a dry cough. Both stored rice and corn inside their home. People living in the region reported massive infestations with rats in the woods and fields.

5-Methyltetrahydrofolate-homocysteine methyltransferase gene polymorphism (MTR) and risk of head and neck cancer.

The functional effect of the A>G transition at position 2756 on the MTR gene (5-methyltetrahydrofolate-homocysteine methyltransferase), involved in folate metabolism, may be a risk factor for head and neck squamous cell carcinoma (HNSCC). The frequency of MTR A2756G (rs1805087) polymorphism was compared between HNSCC patients and individuals without history of neoplasias. The association of this polymorphism with clinical histopathological parameters was evaluated. A total of 705 individuals were included in the study. The polymerase chain reaction-restriction fragment length polymorphism technique was used to genotype the polymorphism. For statistical analysis, the chi-square test (univariate analysis) was used for comparisons between groups and multiple logistic regression (multivariate analysis) was used for interactions between the polymorphism and risk factors and clinical histopathological parameters. Using univariate analysis, the results did not show significant differences in allelic or genotypic distributions. Multivariable analysis showed that tobacco and alcohol consumption (P < 0.05), AG genotype (P = 0.019) and G allele (P = 0.028) may be predictors of the disease and a higher frequency of the G polymorphic allele was detected in men with HNSCC compared to male controls (P = 0.008). The analysis of polymorphism regarding clinical histopathological parameters did not show any association with the primary site, aggressiveness, lymph node involvement or extension of the tumor. In conclusion, our data provide evidence that supports an association between the polymorphism and the risk of HNSCC.

5-Methyltetrahydrofolate-homocysteine methyltransferase gene polymorphism (MTR) and risk of head and neck cancer

The functional effect of the A>G transition at position 2756 on the MTR gene (5-methyltetrahydrofolate-homocysteine methyltransferase), involved in folate metabolism, may be a risk factor for head and neck squamous cell carcinoma (HNSCC). The frequency of MTR A2756G (rs1805087) polymorphism was compared between HNSCC patients and individuals without history of neoplasias. The association of this polymorphism with clinical histopathological parameters was evaluated. A total of 705 individuals were included in the study. The polymerase chain reaction-restriction fragment length polymorphism technique was used to genotype the polymorphism. For statistical analysis, the chi-square test (univariate analysis) was used for comparisons between groups and multiple logistic regression (multivariate analysis) was used for interactions between the polymorphism and risk factors and clinical histopathological parameters. Using univariate analysis, the results did not show significant differences in allelic or genotypic distributions. Multivariable analysis showed that tobacco and alcohol consumption (P < 0.05), AG genotype (P = 0.019) and G allele (P = 0.028) may be predictors of the disease and a higher frequency of the G polymorphic allele was detected in men with HNSCC compared to male controls (P = 0.008). The analysis of polymorphism regarding clinical histopathological parameters did not show any association with the primary site, aggressiveness, lymph node involvement or extension of the tumor. In conclusion, our data provide evidence that supports an association between the polymorphism and the risk of HNSCC.

Cardiac involvement in Churg-Strauss syndrome shown by echocardiography.

To define the range of cardiac involvement in the Churg-Strauss syndrome, M mode, continuous wave Doppler, and cross sectional echocardiograms were recorded in twelve patients with the disorder. The M mode recordings were digitised and the cross sectional images were recorded with standardised gain settings to determine regional myocardial echo amplitude. Left ventricular end diastolic and end systolic dimensions were increased above the normal 95% confidence interval in four patients, three of whom showed a depressed shortening fraction. Mitral regurgitation was present in six patients; this was severe enough to need valve replacement in two. Mean echo amplitude in both the septum and the posterior wall was significantly increased above normal by a mean (SD) of 4.87 (2.57) dB, suggesting the presence of myocardial fibrosis. There was no evidence of subendocardial involvement as there is in other hypereosinophilic syndromes. Mitral regurgitation is common in the Churg-Strauss syndrome. This cannot be ascribed to involvement of the cusps or chordae and it occurs even when ventricular function is well preserved. It is suggested that mitral regurgitation is caused by diffuse myocardial fibrosis.

Functional importance of the long axis dynamics of the human left ventricle.

The role of longitudinally and circumferentially oriented fibres in left ventricular wall motion was examined by digitising echocardiograms of the mitral ring (whose motion reflects long axis change) and of the standard minor axis in 36 healthy individuals, 36 patients with coronary artery disease, 16 with left ventricular hypertrophy, 44 with mitral valve disease (24 of whom had undergone mitral valve replacement). In the controls long axis shortening significantly preceded minor axis shortening (mean (1 SD) difference 25 (40) ms) so that the minor axis increased more during isovolumic contraction (0.25 v 0.09 cm), indicating that the left ventricle became more spherical. Changes in the long and short axes were synchronous at end ejection and in early diastole in the controls. Epicardial excursion preceded endocardial excursion by 50 (20) ms at its peak. These time relations were consistently disturbed in all patient groups, irrespective of the extent of fractional shortening of the minor axis. The onset of long axis shortening was delayed, and this was often associated with premature shortening of the minor axis, the normal spherical shape change during isovolumic contraction was lost, and peak epicardial and endocardial changes became more synchronous. In patients with coronary disease these changes are the expected consequence of ischaemic injury to longitudinally orientated subendocardial fibres. In left ventricular hypertrophy their presence consistently showed systolic dysfunction when orthodox measures were still normal. They were more pronounced after mitral valve replacement when the papillary muscles had been sectioned; long axis shortening was reduced during systole and prolonged into early diastole, while normal shortening of the minor axis was maintained only by abnormal epicardial excursion. Relations between long and short axis motion in healthy individuals are characteristic, and their loss is an early index of systolic ventricular disease. These disturbances precede changes in orthodox measures such as fractional shortening or peak velocity of circumferential fibre shortening.

Restrictive cardiomyopathy and constrictive pericarditis: non-invasive distinction by digitised M mode echocardiography.

It is difficult to distinguish between restrictive cardiomyopathy and constrictive pericarditis on the basis of clinical findings and simple investigation. Cardiac catheterisation has been the reference standard for diagnosis but even this does not always permit an accurate distinction. A Summagraphics digitiser and Prime 750 computer system were used to digitise the echocardiograms of 15 patients with restrictive cardiomyopathy, 10 with constrictive pericarditis and a group of 20 age and sex matched normal subjects of similar age and sex distribution. Compared with controls, patients with restrictive cardiomyopathy showed a significant reduction in the following variables (a) decreased fractional shortening, (b) decreased peak left ventricular filling and emptying rates, (c) decreased percentage posterior wall thickening, and (d) decreased peak left ventricular posterior wall thickening and thinning rates. Whereas patients with constrictive pericarditis only had significantly reduced peak left ventricular filling and posterior wall thinning rates and significantly increased posterior wall thinning rate. When patients with restrictive cardiomyopathy were compared with those with constrictive pericarditis the significant differences were: (a) decreased peak left ventricular emptying rate, (b) decreased percentage posterior wall thickening, and (c) decreased peak left ventricular posterior wall thickening and thinning rates. Digitisation of M mode echocardiograms, with particular attention to posterior wall function, may be a useful adjunct to cardiac catheterisation in distinguishing restrictive cardiomyopathy from constrictive pericarditis.