Severe pulmonary hypertension and circulatory failure associated with Congenital syphilis. Case report.

BACKGROUND: Congenital syphilis is a vertical infection caused by Treponema pallidum. Despite the implementation of preventive strategies during pregnancy, its incidence is increasing, and it constitutes an important public health problem. Most patients with congenital syphilis are asymptomatic; however, a small group may develop severe disease at birth with the need of advanced resuscitation in the delivery room, acute hypoxemic respiratory failure, and hemodynamic instability. Therefore, awareness is needed. METHODS AND RESULTS: This series describes the clinical course of two late preterm infants with congenital syphilis who developed acute hypoxemic respiratory failure, pulmonary hypertension, and circulatory collapse early after birth. Integrated hemodynamic evaluation with neonatologist-performed echocardiography (NPE) and therapeutic management is provided. CONCLUSIONS: A comprehensive hemodynamic evaluation including early and serial functional echocardiography in these patients is needed to address the underlying complex pathophysiology and to help to establish accurate treatment.

Infraclavicular anterior thoracic approach for access to the upper thoracic vertebrae: case report and description of a new surgical technique.

Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA "C" spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4.

Paciente con espondilodiscitis que presentó deformidad cifótica con compromiso neurológico a nivel torácico superior, quien fue tratado con un nuevo abordaje torácico anterior infraclavicular derecho, como nueva técnica quirúrgica alternativa. Varón de 72 años con deformidad en cifosis secundaria a espondilodiscitis T2-T3 ASIA "C", tratado con instrumentación cervicotorácica posterior C5 a T6 y abordaje anterior transtorácico infraclavicular derecho con colocación de cilindro expandible. Dentro de la revisión bibliográfica realizada en los buscadores no se encontraron técnicas similares a la descrita en este artículo. Dada la complejidad del abordaje quirúrgico, esta nueva técnica se describe como una nueva forma de acceder a la columna torácica superior, demostrando que el abordaje torácico anterior infraclavicular derecho es una nueva alternativa para acceder a la columna torácica superior desde T1 a T4.

Combining grazing incidence X-rays and micro-diffraction for qualitative phase identification in forensic powdered micro-samples.

Capillary diffraction or microdiffraction are standard techniques for characterizing small samples when only a few milligrams are available. On the other hand, we have typical grazing incidence diffraction or different variations of grazing incidence (GI) diffraction used, such as in-plane grazing incidence (IP-GI) or GI using a micro focusing source, to study thin films. However, when few powder micrograms are available, the characterization task is complicated. In the present work, few micrograms of typical forensic samples are analyzed using standard Bragg-Brentano, X-ray powder diffraction geometry, and grazing incidence X-ray micro-diffraction (GIµXRD). Samples include soils, cosmetic eyeshadows, two different pyrotechnic materials, and a highly explosive mixture contained at primer cup of ammunition. The analysis was carried out from 1 to 5 degrees of the incident parallel beam with a shaking sample. Depending on the fixed incident angle, different small regions of the diffraction patterns showed an improvement in the intensity of the peaks with respect to the conventional Bragg-Brentano configuration. However, 3-5 degrees of the fixed incident beam showed the best results. This new data acquisition technique, based on the combination of two known diffraction methods, could be a powerful tool for studying samples outside of forensic sciences such as nanomaterials, medicine, or any other field where the sample quantity is extremely small, also, without the need to transport evidence and travel to external facilities with higher analytical performance such as synchrotron radiation installations or other large experimental facilities.

Effectiveness and Adverse Events of Use of Natalizumab in a Brazilian Cohort of Patients With Multiple Sclerosis.

PURPOSE: Natalizumab (NTZ) is a monoclonal antibody with confirmed efficacy in white populations with recurrent-remitting multiple sclerosis (RRMS); there are few studies, however, in mixed-race populations. Real-world studies of NTZ are needed to better understand the drug's effectiveness. This study evaluated the effectiveness and adverse events of NTZ in a cohort of Brazilian patients with MS, as well as the impact of clinical and demographic factors on patient response to treatment. METHODS: This multicenter, Brazilian observational study was conducted from January 2011 until December 2016 and included patients with RRMS (McDonald criteria 2005 and 2010) aged ≥18 years treated with NTZ for at least 3 months. Demographic, clinical, and radiologic data were obtained from medical records and during follow-up visits. The primary outcomes investigated were the absolute number of relapses and annualized rate of relapses, change in Expanded Disability Status Scale value, and presence of new lesions on magnetic resonance imaging after starting NTZ treatment; the occurrence and type of adverse events were also analyzed. In addition, the impact of demographic and clinical prognostic factors and radiologic activity on the effectiveness of NTZ was measured. Descriptive and univariate statistical analyses used a significance level of P < 0.05. RESULTS: The study enrolled 56 patients; 64% were women, and 36% were of African descent. There was a significant reduction in the mean absolute number (P = 0.001) and in the annualized rate (P = 0.001) of relapses and in the radiologic activity of the disease (P = 0.001). Furthermore, 71% of patients showed no increase in Expanded Disability Status Scale score after 1 year of treatment. The effectiveness of NTZ was not associated with the presence of clinical and demographic prognostic factors, and the most frequent adverse events during the use of NTZ were gastrointestinal symptoms; there were no cases of progressive multifocal leukoencephalopathy. IMPLICATIONS: According to patients' reports and clinicians' observations regarding clinical and radiologic benefits and tolerability to adverse events, the use of NTZ was favorable in this Brazilian MS cohort, regardless of the presence of unfavorable prognostic factors.

Nano-Indentation Response of Ultrahigh Molecular Weight Polyethylene (UHMWPE): A Detailed Analysis.

Nano-indentation, a depth sensing technique, is a useful and exciting tool to investigate the surface mechanical properties of a wide range of materials, particularly polymers. Knowledge of the influence of experimental conditions employed during nano-indentation on the resultant nano-mechanical response is very important for the successful design of engineering components with appropriate surface properties. In this work, nano-indentation experiments were carried out by selecting various values of frequency, amplitude, contact depth, strain rate, holding time, and peak load. The results showed a significant effect of amplitude, frequency, and strain rate on the hardness and modulus of the considered polymer, ultrahigh molecular weight polyethylene (UHMWPE). Load-displacement curves showed a shift towards the lower indentation depths along with an increase in peak load by increasing the indentation amplitude or strain rate. The results also revealed the strong dependence of hardness and modulus on the holding time. The experimental data of creep depth as a function of holding time was successfully fitted with a logarithmic creep model (R2 ≥ 0.98). In order to remove the creeping effect and the nose problem, recommended holding times were proposed for the investigated polymer as a function of different applied loads.

Vitrification of equine expanded blastocysts following puncture with or without aspiration of the blastocoele fluid.

BACKGROUND: Historically, cryopreservation of equine embryos >300 µm gave poor pregnancy rates until researchers collapsed the blastocoele cavity and aspirated the blastocoele fluid prior to vitrification. OBJECTIVE: To determine if aspiration of the blastocoele fluid prior to vitrification is essential for post warming survival. STUDY DESIGN: In vivo experiments. METHODS: Fifty embryos were recovered on day 7-8 and washed in holding medium (HM; M-199HEPES + 20% FBS + antibiotics). Embryos were punctured using a micromanipulator mounted 30 µm biopsy needle; following this 28 had >90% of their blastocoelic fluid actively aspirated while the remaining 22 were not-aspirated. Embryos were then vitrified using a two-step process with increasing concentrations of DMSO and ethylene glycol (7.5-15% v:v), and 0.5 mol/L sucrose in the final solution before being loaded onto a Cryolock device and plunged into liquid nitrogen. The embryos were warmed by plunging the Cryolock tip into HM with 1 mol/L sucrose at 37°C. After 1 min, the embryos were transferred to HM + 0.5 mol/L sucrose at RT for 4 min before transfer into HM for a further 4 min prior to transfer to a recipient mare. RESULTS: Mean (±s.e.) embryo diameter was not significantly different between the punctured and punctured plus aspirated group (646.4 ± 61.7 vs. 754.8 ± 59.1 µm, respectively; P = 0.215). Nonaspirated and aspirated embryos gave pregnancy rates of 10/22 (45%) and 21/28 (75%) respectively (P = 0.061). Sub-dividing embryos on the basis of size showed that vitrification of larger embryos (>550 µm) yielded a significantly higher pregnancy rate when they were aspirated vs. not-aspirated (13/18 [72%] vs. 1/10 [10%], respectively; P = 0.006), whereas there was no difference for smaller embryos (8/10 [80%] vs. 9/12 [75%], respectively; P = 0.8). MAIN LIMITATIONS: Group sizes are limited. CONCLUSION: Aspiration of blastocoele fluid from embryos ≤550 µm is not a pre-requisite for successful vitrification. The Summary is available in Spanish - see Supporting Information.

Intestinal IMINO transporter SIT1 is not expressed in human newborns.

The expression of amino acid transporters in small intestine epithelia of human newborns has not been studied yet. It is further not known whether the maturation of imino acid (proline) transport is delayed as in the kidney proximal tubule. The possibility to obtain small intestinal tissue from patients undergoing surgery for jejunal or ileal atresia during their first days after birth was used to address these questions. As control, adult terminal ileum tissue was sampled during routine endoscopies. Gene expression of luminal imino and amino acid transporter SIT1 (SLC6A20) was approximately threefold lower in newborns versus adults. mRNA levels of all other luminal and basolateral amino acid transporters and accessory proteins tested were similar in newborn mucosa compared with adults. At the protein level, the major luminal neutral amino acid transporter B0AT1 (SLC6A19) and its accessory protein angiotensin-converting enzyme 2 were shown by immunofluorescence to be expressed similarly in newborns and in adults. SIT1 protein was not detectable in the small intestine of human newborns, in contrast to adults. The morphology of newborn intestinal mucosa proximal and distal to the obstruction was generally normal, but a decreased proliferation rate was visualized distally of the atresia by lower levels of the mitosis marker Ki-67. The mRNA level of the 13 tested amino acid transporters and accessory proteins was nonetheless similar, suggesting that the intestinal obstruction and interruption of amniotic fluid passage through the small intestinal lumen did not affect amino acid transporter expression. NEW & NOTEWORTHY System IMINO transporter SIT1 is not expressed in the small intestine of human newborns. This new finding resembles the situation in the proximal kidney tubule leading to iminoglycinuria. Lack of amniotic fluid passage in small intestinal atresia does not affect amino acid transporter expression distal to intestinal occlusion.

Exocrine pancreas glutamate secretion help to sustain enterocyte nutritional needs under protein restriction.

Glutamine (Gln) is the most concentrated amino acid in blood and considered conditionally essential. Its requirement is increased during physiological stress, such as malnutrition or illness, despite its production by muscle and other organs. In the malnourished state, Gln has been suggested to have a trophic effect on the exocrine pancreas and small intestine. However, the Gln transport capacity, the functional relationship of these two organs, and the potential role of the Gln-glutamate (Glu) cycle are unknown. We observed that pancreatic acinar cells express lower levels of Glu than Gln transporters. Consistent with this expression pattern, the rate of Glu influx into acinar cells was approximately sixfold lower than that of Gln. During protein restriction, acinar cell glutaminase expression was increased and Gln accumulation was maintained. Moreover, Glu secretion by acinar cells into pancreatic juice and thus into the lumen of the small intestine was maintained. In the intestinal lumen, Glu absorption was preserved and Glu dehydrogenase expression was augmented, potentially providing the substrates for increasing energy production via the TCA cycle. Our findings suggest that one mechanism by which Gln exerts a positive effect on exocrine pancreas and small intestine involves the Gln metabolism in acinar cells and the secretion of Glu into the small intestine lumen. The exocrine pancreas acinar cells not only avidly accumulate Gln but metabolize Gln to generate energy and to synthesize Glu for secretion in the pancreatic juice. Secreted Glu is suggested to play an important role during malnourishment in sustaining small intestinal homeostasis. NEW & NOTEWORTHY Glutamine (Gln) has been suggested to have a trophic effect on exocrine pancreas and small intestine in malnourished states, but the mechanism is unknown. In this study, we suggest that this trophic effect derives from an interorgan relationship between exocrine pancreas and small intestine for Gln-glutamate (Glu) utilization involving the uptake and metabolism of Gln in acinar cells and secretion of Glu into the lumen of the small intestine.

Comparison of cytotoxicity, genotoxicity and immunological inflammatory biomarker activity of several endodontic sealers against immortalized human pulp cells.

AIM: To establish an SV40 T-Ag-transfected cell line of human pulp-derived cells in order to compare the cytotoxicity, genotoxicity and to investigate the activities of immunological biomarkers of several endodontic sealers. METHODOLOGY: Primary human pulp cells and transfected cells were cultured. Cell morphology and proliferation were analysed, and the expression of cell-specific gene transcripts and proteins was detected by RT-PCR and immunohistochemistry. Transfection of human pulp-derived cells resulted in an immortalized cell line retaining phenotypic characteristics from the primarily cells tested. The SV40 T-Ag-transfected cells were cultured and stimulated by sealers (Apexit Plus, Real Seal, AH Plus, and EndoREZ) to evaluate the cytotoxicity and genotoxicity by MTT and MTN assays, respectively. Immunological inflammatory biomarkers (IL6, IL8 and TNF-α) were determined by ELISA assay. The differences between median values were statistically analysed using Kruskal-Wallis and Dunn's tests at 5% significance level. RESULTS: The cytotoxicity assay revealed that multimethacrylate (Real Seal) was the most cytotoxic sealer (P < 0.05) and exhibited the highest inflammatory potential against the SV40 T-Ag-transfected cells (P < 0.05). All root canal sealers tested were able to stimulate the immortalized pulp cells to produce IL-6, IL-8 and TNF-α, with differences in relation to the control group (P < 0.05). Higher levels of IL-6, IL-8 and TNF-α were found in cell supernatant after stimulation with multimethacrylate (Real Seal) compared to all other sealers tested (P < 0.05). No differences were found comparing epoxy resin-based sealer (AHPlus), single-methacrylate sealer (EndoREZ) and calcium hydroxide-based sealer (Apexit Plus), regardless of the cytokine investigated (all P > 0.05). CONCLUSIONS: A SV40 T-Ag-transfected cell line of human pulp-derived cells was established. The methacrylate resin-based sealer (Real Seal) exhibited the greatest cytoxicity and inflammatory potential against immortalized pulp cells compared to an epoxy resin-based sealer (AH Plus), a methacrylate-based sealer (EndoRez) and a calcium hydroxide-based sealer (Apexit).

Caracterização físico-química de amostras de mel de abelha africanizada dos municípios de Santa Helena e Terra Roxa (PR) / Physicochemical parameters of honey from samples from africanized honeybees in Santa Helena and terra roxa counties (PR)

O presente estudo teve como objetivo a caracterização físico-química de amostras de mel de Apis mellifera coletadas nos municípios de Santa Helena e Terra Roxa, localizados na região oeste do Estado do Paraná, Brasil. Foram coletadas 40 amostras de mel, sendo 20 do município de Santa Helena e 20 de Terra Roxa (PR), coletadas diretamente com os apicultores, as quais foram submetidas a análises físico-químicas de umidade, acidez, pH, cinzas, condutividade elétrica e cor, a fim de verificar se as mesmas apresentavam-se em conformidade com a legislação nacional vigente (Instrução Normativa nº 11), além de conhecer o perfil físico-químico do mel das diferentes localidades, na safra 2008/2009. Os dados encontrados foram submetidos à análise de variância e teste F a 5% de significância. Os resultados apresentaram diferença significativa (P<0,05) apenas entre os valores de acidez, tendo o mel oriundo de Terra Roxa apresentado valor mais alto (33,45±7,7meq.kg-1) que o de Santa Helena (24,53±6,3meq.kg-1). Em sua maioria, as amostras analisadas encontraram-se dentro das especificações determinadas pela legislação para as características físico-químicas, com exceção do parâmetro de umidade, que, apesar de não ter apresentado diferença significativa entre os valores encontrados para os dois municípios, estavam acima do limite estabelecido pela legislação (20 por cento) em 8 amostras do município de Santa Helena e em 7 de Terra Roxa, totalizando 37,5 por cento) das amostras. Essa característica pode ter deixado o produto mais susceptível à fermentação e pode ter sido ocasionada pela colheita imatura do mel...

This study aimed to physicochemically characterize the honey samples of Apis mellifera collected in Santa Helena and Terra Roxa counties, located in the western region of Paraná State, Brazil. Forty honey samples were collected, 20 in Santa Helena and 20 in Terra Roxa (PR) counties, directly from beekeepers, and were subjected to physico-chemical analyzes of moisture, acidity, pH, ashes, electrical conductivity and color, to verify whether they were in accordance with the existing national legislation (Instruction No. 11), in addition to knowing the physicochemical profile of different sites during the 2008/2009 season. The data were submitted to analysis of variance and F test at 5 percent significance level. The results showed significant differences (P<0.05) between values of acidity, and the honey samples from Terra Roxa presented a higher value (33.45±7.7 meq.kg-1) than Santa Helena (24 = 53±6.3 meq.kg-1). Most of the analyzed samples were within the specifications prescribed in the legislation for the physico-chemical parameters except for moisture, which despite having presented a significant difference between values obtained from two counties, were above the limits established by the legislation (20 percent) in eight samples in Santa Helena and seven in Terra Roxa counties, totaling 37.5 percent. This characteristic may have made the product more susceptible to fermentation, and may have been caused by harvesting immature honey...

L-lysine dose dependently delays gastric emptying and increases intestinal fluid volume in humans and rats.

BACKGROUND: Novel sensory inputs for the control of food intake and gastrointestinal (GI) function are of increasing interest due to the rapid increase in nutrition-related diseases. The essential amino acid L-lysine was demonstrated to have a selective impact on food intake, gastric emptying, and intestinal transit in rats, thus indicating a potential novel direct sensory input to assess dietary protein content and quality. The aim of this study was to assess translational aspects of this finding and to investigate the dose-dependent effect of L-lysine on human and rat GI function. METHODS: L-lysine doses from 0-800 mg in rats and 0.5-7.5 g in humans were analyzed for their effect on gastric emptying and GI secretion. Human GI function was assessed non-invasively using magnetic resonance imaging (MRI), rat data were acquired using standard lethal measurement methods. L-lysine dose dependently delayed gastric emptying and stimulated GI secretion in rats as reflected by residual phenol red content and increased gastric wet weight. KEY RESULTS: The dose-dependent delay in gastric emptying observed in rats was confirmed in humans with an increase in halftime of gastric emptying of 4 min/g L-lysine, p < 0.01. Moreover, a dose-dependent increase in intestinal fluid accumulation was observed (0.4 mL/min/g L-lysine, p < 0.0001). No effect on alkaline tide, glucose concentration, hematocrit, or visceral sensations was detected. CONCLUSIONS & INFERENCES: This translational study demonstrates comparable dose-dependent effects of intragastric L-lysine on GI function in humans and rats and suggests a broader role for individual amino acids in the control of GI motility and secretion in vivo.

Nonparametric segmentation of nonstationary time series.

The nonstationary evolution of observable quantities in complex systems can frequently be described as a juxtaposition of quasistationary spells. Given that standard theoretical and data analysis approaches usually rely on the assumption of stationarity, it is important to detect in real time series intervals holding that property. With that aim, we introduce a segmentation algorithm based on a fully nonparametric approach. We illustrate its applicability through the analysis of real time series presenting diverse degrees of nonstationarity, thus showing that this segmentation procedure generalizes and allows one to uncover features unresolved by previous proposals based on the discrepancy of low order statistical moments only.

Cosmovisión ancestral y comprensión de los conceptos salud, cuidado y enfermería en habitantes del resguardo muisca de Chía, 2010 / Ancestral worldview and understanding of the concepts of health, care and nursing in the population of a muisca reservation in Chía, 2010

El reconocimiento, fortalecimiento y recuperación de prácticas de cuidado en culturas diversas favorece la calidad de las acciones de enfermería; el Enfoque Biopsicosocial, cultural y espiritual y la teoría Transcultural aportan a este objetivo y sirven de soporte al diseño de estrategias orientadas a preservar, adaptar y reestructurar los cuidados culturales; acciones que desde la comprensión de la salud en este grupo, se propone sean lideradas por el profesional de enfermería. La investigación descriptiva cualitativa contó con la participación voluntaria de familias y líderes muiscas reconocidos como cuidadores por la comunidad; se presenta como abordaje metodológico que posibilita reconocer la comprensión actual de los conceptos salud, cuidado y enfermería. La información recolectada mediante la observación, encuestas y entrevistas, en las categorías enunciadas, se analizó por triangulación de fuentes y de investigadores. Se identificó un marcado proceso de aculturación en las tres categorías analizadas: el concepto “cuidado” guarda mayor proximidad con la cosmovisión ancestral; la comprensión de la salud no incorpora dimensiones reconocidas ancestralmente; y, la enfermería se identifica como un “quehacer” propio del género femenino que articula las dimensiones comunicacional, afectiva y de protección próximas a lo descrito como cuidado por los líderes en salud ancestrales.

Recommendations for the use of extended criteria donors in lung transplantation.

Selection criteria for lung donation were based on initial experiences with lung transplantation without further studies to improve them, thereby guaranteeing the best use of donated organs. A definition of an extended criteria donor is therefore required to obtain more lungs to meet the demands of patients awaiting transplantation. Studies have been reviewed for the impact on survival and morbidity of age ranges, oxygen fraction, cause of death, smoking habits, x-ray findings, infection, hepatitis serology and non-heart-beating status, seeking to support physicians to make decisions regarding the use of marginal organs.

Lung transplantation for patients older than 65 years: is it a feasible option?

BACKGROUND: Advanced age has been a relative contraindication to lung transplantation. However, the exact age limit for this procedure has not yet been established. The aim of this work is to present our experience with this particular group. METHODS: This retrospective review included medical charts of patients who underwent lung transplantation at our institution from January 2004 to February 2009: namely, 112 cadaveric lung transplants with 12 patients (10.7%) >65 years old. RESULTS: There were 9 male patients and the overall mean age was 68 years (range 66-72). The indications were pulmonary fibrosis in 8 and emphysema in 4 cases. Four patients had mild coronary artery disease and 4 systemic hypertension. All of the procedures were unilateral and only 2 required extracorporeal circulation. Only 5 patients received blood product transfusions intraoperatively; the mean ischemic time was 222 minutes. Four patients developed primary graft dysfunction, the mean requirement for mechanical ventilation was 30 hours, and the mean intensive care unit stay, 11 days. Postoperative complications were respiratory infections (n = 8), catheter-related infection (n = 1), atrial fibrillation (n = 2). The mean hospital stay was 28 days and the 1-year survival was 75%. CONCLUSION: Lung transplantation is a feasible option for well-selected patients with end-stage pulmonary disease who are >65 years old. Our study reinforces the modern trend for unilateral procedures in this situation.

Lung transplantation for lymphangioleiomyomatosis: single-center Brazilian experience with no chylothorax.

BACKGROUND: Lymphangioleiomyomatosis (LAM), a rare cystic disease characterized by proliferation of smooth muscle cells in the lung interstitium, almost exclusively affects females in their reproductive years. Lung transplantation has been established as effective therapy for end-stage pulmonary LAM. METHODS: This retrospective study includes lung transplantation patients with LAM at a single institution between 1989 and 2009. RESULTS: During the study period we performed 300 lung transplantations, and in 10 cases the recipients had LAM. All patients were females with a mean age of 43.8 years. The mean time from the diagnosis to lung transplantation was 5 years. Seven patients had experienced previous pneumothoraces, five of whom were treated with pleurodesis. In all patients we performed a single-lung transplantation (left-sided = 9 and right-sided = 1). In three cases, the pleurodesis was on the same side as the transplantation, with great intraoperative bleeding in one subject (left pleurectomy). There was one early death due to infective endocarditis at posttransplant day 19. The median length of mechanical ventilation was 13 hours, while the mean hospital stay was 16.75 days. There was no case of chylothorax. Late complications included one case of native lung pneumothorax, one diaphragmatic hernia, one posttransplant lymphoproliferative disease, one respiratory sepsis, and one mycobacterial infection. The 1- and 3-year survival rates were 90% and 80%, respectively. CONCLUSION: Lung transplantation is a feasible therapeutic option for patients with LAM, despite previous ipsilateral pleurodesis. The left-sided predilection for our procedures may have been responsible for the absence of chylothorax in this series.

Antimicrobial analysis of chlorhexidine gel and intracanal medicaments against microorganisms inoculated in root canals.

AIM: The aim of this paper was to evaluate the antimicrobial activity of 2% chlorhexidine gel (CLX) associated with various intracanal medicaments against Candida albicans and Enterococcus faecalis inoculated in root canals. METHODS: Thirty six human single-rooted teeth were contaminated with C.albicans and E.faecalis. The canals were instrumented using 2% CLX gel and were divided into three groups according to the intracanal medicaments (ICM) used. Group 1: calcium hydroxide paste [Ca(OH)2], Group 2: 2% chlorhexidine gel (CLX) and Group 3: 2% CLX gel + Ca(OH)2. The root canal collections were performed after 21 days of contamination (control collection), after instrumentation (1st collection), after 14 days of intracanal medicament (2nd collection) and 7 days after medicament removal (3rd collection). The microbiological samples were plated in culture media and incubated for 48 hours. The results were submitted to Kruskal-Wallis test (P ≤ 0.05). RESULTS: It was verified that the instrumentation with CLX reduced the number of CFU/ml significantly when compared with the confirmation collection (control). However, the use of the ICM was only capable to eliminate completely the microorganisms in the root canals without difference statistics between them. CONCLUSION: Although the use of 2% chlorherixidine gel reduces the number of microorganisms significantly, only the ICM calcium hydroxide and calcium hydroxide associated with chlorhexidine are able to eliminate these microorganisms completely.

Cytotoxicity and genotoxicity of pulp capping materials in two cell lines.

AIM: The aim of this study was to evaluate the cytotoxicity and genotoxicity of the new castor oil bean cement (COB) material in comparison to commonly used pulp capping materials. METHODOLOGY: Specimens of COB, calcium hydroxide (Hydro C), and mineral trioxide aggregate (white and gray MTA) were extracted in culture medium (91.6 mm(2) sample surface mL(-1)). Transfected human pulp cells (tHPCs) were exposed to dilutions of the extracts for 1 h, and the generation of reactive oxygen species (ROS) was determined by flow cytometry (FACS) using H(2)DCF-DA as a dye. Survival of tHPCs was measured photometrically using a crystal violet assay after a 24-h exposure period. Genotoxicity as indicated by the formation of micronuclei in V79 cells, and the modification of the normal cell cycle by extracts of the materials was analysed by FACS. RESULTS: Clear cytotoxic effects were detected only with extracts of Hydro C under the current experimental conditions. The two MTA preparations induced an insignificant reduction in the number of cells. In contrast, the extracts of COB slightly induced cell proliferation. Extracts of Hydro C caused a twofold increase in ROS production, whilst the other tested materials were ineffective. An increase in the number of micronuclei was not detected with any material tested; Hydro C slightly increased the number of cells in G1 and G2. CONCLUSIONS: The COB and the two MTA preparations did not negatively influence cell survival or ROS production and may thus be further considered for pulp capping studies.

Multiple synchronous bronchial carcinoid tumors: report of a case.

Peripheral bronchial carcinoids are uncommon. Their presentation as synchronous tumors is rare and limited to anecdotal cases.We report the case of a 62-year-old female with the radiological finding of multiple bilateral nodular lesions. Bilateral sequential thoracotomies were performed and all three nodules were treated by sublobar resections. Pathological examination revealed all specimens to be carcinoid tumors and subsequent investigation confirmed the lung as the primary site. A review of previous cases of multiple carcinoids is presented and the particularities of their management are discussed.