Two-dimensional speckle tracking echocardiography is useful in early detection of left ventricular impairment in patients with Crohn's disease.

OBJECTIVE: Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect the entire gastrointestinal tract. Cardiac involvement is considered very rare. Pericarditis, myocarditis, endocarditis, cardiomyopathy and complete heart block are some of the cardiac extraintestinal manifestations of CD. The aim of this study was to explore the left ventricular (LV) functions with two-dimensional (2D) speckle tracking echocardiography (STE) in patients with CD with normal cardiac functions. PATIENTS AND METHODS: We enrolled 50 consecutive patients with CD and 50 age and sex matched healthy controls. All patients underwent a transthoracic echocardiogram with evaluation of LV functions with 2D STE. RESULTS: Baseline characteristics were similar between patients with CD (24 male, mean age: 41.0 ± 13.9 years) and controls (24 male, mean age: 40.1 ± 7.3 years). Although conventional echocardiographic parameters were similar between two groups, global longitudinal strain was significantly lower in patients with CD compared to controls (19.6 ± 3.3 versus 21.2 ± 2.9, p = 0.014). Correlation analysis revealed that Crohn's Disease Activity Index is inversely correlated with LV global longitudinal strain (r = -0.703, p < 0.001) in patients with CD. We also evaluated inflammatory parameters such as CRP, erythrocyte sedimentation rate, and complete blood counts in patients with CD. Correlation analysis revealed that only platelet value is weakly correlated with Crohn's Disease Activity Index (r = 0.311, p = 0.083). CONCLUSIONS: Crohn's disease is associated with impairment in LV global longitudinal myocardial function. Crohn's Disease Activity Index is also strongly correlated with LV global longitudinal strain. 2D-STE may be an useful method for early detection of LV impairment in patients with CD.

Survival in patients with hypoechoic muscularis propria lesions suggestive of gastrointestinal stromal tumors in gastric wall.

BACKGROUND: Subepithelial lesions (SEL) on upper gastrointestinal endoscopy are frequently encountered and referred to endoscopic ultrasound (EUS). Management of small gastric hypoechoic SELs of muscularis propria (MP) is controversial since EUS-assisted fine needle aspiration may be inconclusive, and surgical excision may be too invasive. We aimed to analyze our gastric MP-SELs in terms of survival and confounding factors. METHODS: Data from gastric hypoechoic MP-SELs suggestive of gastrointestinal stromal tumor (GIST) by EUS were retrospectively reviewed. Surgically resected GISTs were stratified according to the current pathological risk criteria. RESULTS: Sixty-one patients were identified. The mean age was 55.5 ± 13.2 years and 45.6% were male. Mean follow-up duration was 53.4 ± 26.7 (12-110) months. Twenty-eight (45.9%) patients were managed conservatively (diameter 15.3 ± 10.1 mm). There were no metastasis- or tumor-related deaths and no significant size changes (≥ 5 mm) in this group during follow-up. Thirty-three (54.1%) patients underwent complete resection (diameter 34.2 ± 14.1 mm) among which 25 (75.8%) had the final diagnosis of GIST; 2 (8.0%), 14 (56%) and 6 (24%) patients were classified in no-risk, very-low-risk, low-risk categories respectively, while 2 (8.0%) were in moderate-risk and only 1 (4.0%) was in high-risk category. CONCLUSIONS: The excellent survival of patients with small hypoechoic gastric MP-SELs with conservative management represents indolent course of those lesions. We suggest re- consideration of the recommendations in the current guidelines towards extending the follow-up intervals for small MP-SELs.

Microstructure and homogeneity of dental porcelain frits.

The microstructure and homogeneity of three commercial dentin and incisal unfired porcelain frits (one conventional and two ultra-low fusing types, fused-to metal were analyzed by X-ray diffractometry, scanning electron microspectroscopy, and wavelength- and energy dispersive X-ray microspectroscopy. The average contents of tetragonal and cubic leucite for the conventional and one of the ultra-low fusing type frits were 20.1-22.6 wt% and 0-2.6 wt%, respectively, whereas those of another of the ultra-low fusing type frits were about 11.5-11.6 wt% and 2.9-4.6 wt%, respectively. The conventional type frits seemed to be admixtures of three kinds of glass frits. One of the ultra-low fusing type frits seemed to be an admixture of four kinds of glass frits. Another ultra-low fusing frits seemed to be only one kind of glass frit dispersed with small size, less than 1 micron, leucite crystals. There were no remarkable differences in microstructure and homogeneity between dentin and incisal porcelain frits in each brand.

Structure of a new alkaline serine protease (M-protease) from Bacillus sp. KSM-K16.

An alkaline serine protease, M-protease, from Bacillus sp. KSM-K16 has been crystallized. Two morphologically different crystal forms were obtained. Crystal data of form 1: space group P2(1)2(1)2(1), a = 47.3, b = 62.5, c = 75.6 A, V = 2.23 x 10(5) A(3), Z = 4 and V(m) = 2.09 A(3) Da(-1). Crystal data of form 2: space group P2(1)2(1)2(1), a = 75.82 (2), b = 57.79 (2), c = 54.19 (1) A, V = 2.29 (2) x 10(5) A(3), Z = 4 and V(m) = 2.15 A(3) Da(-1). The crystal structure of M-protease in form 2 has been solved by molecular replacement using the atomic model of subtilisin Carlsberg (SBC) which is 60% homologous with M-protease, and refined to the crystallographic R-factor of 0.189 for 7004 reflections with F(o)/sigma(F) > 3 between 7 and 2.4 A resolution. The final model of M-protease contains 1882 protein atoms, two calcium ions and 44 water molecules. The three-dimensional structure of M-protease is essentially similar to other subtilisins of known structure. The 269 C(alpha) positions of M-protease have an r.m.s. difference of 1.06 A with the corresponding positions of SBC. The crystal data of form 2 are close to those of SBC, though the structure determination of form 2 made it clear that it is not isomorphous to the crystal structure of SBC. The deletions of amino acids occur at the residues 36' and 160'-163' compared with SBC (numerals with primes show the numbering for SBC). The deletion of the four residues (160'-163') may significantly affect the lack of isomorphism between M-protease and SBC.

[A cohort study on dental caries in infants].

A cohort study was performed to determine what techniques are effective in dental caries prevention in infants. Subjects were 878 children aged 18 months, who visited the Gifu-shi Central Public Health Center to receive the medical health check and who were found to be dental caries free. The subjects received both 18 months and 3 years old dental health examinations which included data on incidence of dental caries and oral hygiene conditions (plaque score). Information on the children's between-meals eating habits and mother aided daily tooth brushing habits were obtained from their mothers. Caries incidence was 31.5% and 43.3% in children with good and poor oral hygiene conditions, 30.9% and 38.5% in children with and without daily brushing habits, and 41.0% and 29.2% in children with and without between-meals eating habits, respectively. Logistic regression analysis indicated that oral hygiene conditions and eating habits between meals were more important than mother aided daily tooth brushing.

[The effect of ammonium fluoride solution at various concentrations on enamel].

The fluoride concentrations of ammonium fluoride solution (NH4F,pH 4.4), which has the same effect on enamel powder as conventional APF solution, were studied. Human enamel powder (200 mesh passed) was treated with solutions of NH4F (1,000 ppmF-, 3,000 ppmF-, 5,000 ppmF-, 7,000 ppmF-, 9,000 ppmF-, pH 4.4) and APF (9,000 ppmF-, pH 3.4) for 5 min. at 37 degrees C. Some of the specimen was washed with 1MKOH solution for 48 hours. Fluoride uptake by enamel powder was analyzed by means of chemical analysis and reaction products identified using X-ray diffractometry. The fluoride uptake of 5,000 ppmF- of NH4F-treated enamel was the same as that of APF-treated enamel. X-ray diffractometry showed that CaF2 was formed in the experimental groups. CaF2 with high crystallinity was formed in the NH4F-treated enamel, and the peak height of X-ray diffraction pattern of CaF2 in 3,000 ppmF- of NH4F-treated enamel was the same as that of APF-treated enamel. In conclusion, the ammonium fluoride solution of 3,000-5,000 ppmF- had a similar effect on enamel powder as conventional APF solution.

[Cohort study on cariostatic effect of 100ppmF- fluoride mouthrinsing].

The cariostatic effect of fluoride mouthrinsing with dilute fluoride solution in the school dental health programs was examined. The subjects were 138 children (75 of boys and 63 of girls) who carried out fluoride mouthrinsing with solution of 100 ppmF- for 6 years and 105 children (65 of boys and 40 of girls) who had no fluoride mouthrinsing were analysed by cohort study from 1983 to 1989. The cariostatic effect was evaluated by DMFT index and DMF rate for each tooth type in each erupted school grade. The increment of DMFT index was less than that of the control group. There was a clear cariostatic effect with the advance in the school grade. DMF rate for each tooth type of 1 in 2nd grade and 2 in 3rd grade students showed a statistically significant difference. Both that of upper and lower first molars in 1st and 2nd grade also showed the same result as that of upper incisors. In conclusion, a high cariostatic effect was obtained by introducing the use of fluoride mouthrinsing with a solution of 100ppmF- to the school dental health program, and the observation of DMF rate for each tooth type classified with each erupted school grade was a useful method to evaluate the cariostatic effect of fluoride mouthrinsing.

Microbeam x-ray diffraction analysis of dental calculus.

The crystalline components of human dental calculus were investigated using microbeam x-ray diffraction analysis. Hydroxyapatite and octacalcium phosphate were most frequently found in that portion having porous and zonal structure. In the portion of the homogeneous illustration showing high calcification, whitlockite is a main component. Brushite was unexpectedly rare, and no calcite was detected in any portion of human dental calculus. The mechanism of the formation of dental calculus being considered in this paper is that octacalcium phosphate or brushite is formed during the initial stage of calcification of dental plaque, and is gradually hydrolyzed and transformed into hydroxyapatite and/or whitlockite.