Analysis of the smear layer generated by different activation systems: an in vitro study.

OBJECTIVES: To evaluate via scanning electron microscopy the amount of smear layer generated during the use of sonic and ultrasonic activation systems with standardized short-term intentional contacts with the canal walls. METHODOLOGY: Seventy single-root human teeth were randomly assigned to 2 control (n = 5 each): NC (negative control), PC (positive control) and four experimental groups (n = 15 each): NC (negative control), PC (positive control), G1 (passive ultrasonic irrigation with Irrisafe), G2 (ultrasonic irrigation with EndoUltra), G3 (sonic irrigation with Endoactivator), G4 (sonic irrigation with Eddy). Samples were instrumented with ProTaper Next®. An irrigation protocol with sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) was followed for both PC and the experimental groups. Standardized intentional contacts were made in the mesial walls during 5 s at WL - 2 mm in all experimental groups. Two calibrated evaluators scored the smear layer generated with an ordinal scale by scanning electron microscopy. The weighted kappa coefficient (Kw) was calculated to determine the inter-observer agreement. Post-consensus ordinal data were analyzed using the ordinal (linear) chi-square test. RESULTS: When the agitation file is in contact with dentine walls, Irrisafe® significantly generated the least amount of smear layer in the coronal third (p < 0.05). Both in the middle and apical third, activation with Irrisafe® also showed statistically significant better results than Eddy™ and EndoUltra®. Endoactivator® showed significant better results than EndoUltra® and Eddy™ in the apical third (p < 0.05). CONCLUSIONS: Irrisafe generated the least amount of smear layer in the entire canal and similar to Endoactivator in the apical third when the agitation file is in contact with dentine walls. CLINICAL RELEVANCE: The smear layer is generated during activation. It is common to apply irrigation protocols where after the removal of the smear layer using chelants, a final rinse and activation is carried out but there are no previous studies analyzing the possible creation of a new smear layer with this final activation.

Double-Microcatheter Technique through Tortuous Anatomy for Coil Embolization of a Saccular $plenic Aneurysm: a Technical Report.

We report on a case of an asymptomatic splenic artery aneurysm (SAA) with a large neck in a 53-year-old female with an extreme vessel tortuosity which was treated with a Double Microcatheter Technique. This endovascular procedure consists of embolization of the aneurysm using detachable coils with no application of any glue, stent or balloon. At the end of procedure, no complications occurred. At the three-month follow-up an MRI showed the aneurysm's complete exclusion and patency of the splenic artery.

Adult ECG criteria for left ventricular hypertrophy in young competitive athletes.

Time-tested data indicate that ECG diagnosis of left ventricular hypertrophy in young athletes is challenging due to low sensitivity of the commonly used criteria. We sought to establish whether adult ECG criteria can be appropriate to make diagnosis of both common and uncommon patterns of left ventricular hypertrophy in young trained athletes. A total of 122 athletes, ages 16.2±3.8 years, training at least 5 h per week, were studied with Sokolow-Lyon voltage, Romhilt-Estes, Cornell voltage, Cornell Product, Perugia and Framingham scores. Garson Criteria were also investigated in athletes under 16. Participants were divided into 2 groups based on the presence (group-A, n=56) or absence (group-B, n=66) of at least one positive ECG score. Test performance was calculated with respect to accurate echocardiographic diagnosis of left ventricular hypertrophy. There were no inter-group differences regarding physical characteristics and training burden. 9 athletes from group-A (16%) and 2 from group-B (3%) were found to have left ventricular hypertrophy, likely to be pathological in 2 cases from group-A. Criteria gathering both QRS voltages and ST-T anomalies, like Perugia-score, best identified this subgroup and should be preferred to those based on QRS voltage analysis alone.

The effect of different taper preparations on the ability of sonic and passive ultrasonic irrigation to reach the working length in curved canals.

AIM: To evaluate the penetration of irrigants up to working length using two different activation systems in curved canals instrumented with 0.04 and 0.08 taper instruments. METHODOLOGY: Sixty-eight mesiobuccal canals from mandibular first molars with curvatures between 30° and 40° were used. The samples were divided into group 1, canals instrumented to size 30, 0.04 taper, and group 2, instrumented to size 30, 0.08 taper. Both groups were irrigated with a contrast solution and divided in 2 subgroups of 15 samples each: Groups 1A and 2A were activated with passive ultrasonic irrigation (PUI), whilst groups 1B and 2B were activated with sonic irrigation (SI). Radiographs were taken to evaluate the penetration of the contrast solution up to working length. This evaluation was performed using Adobe Photoshop CS5. Results were analysed with the chi-square test and a logistic regression model. RESULTS: Only groups with 0.04 taper demonstrated significant differences where the activation with PUI was superior at reaching working length than SI (P = 0.010). The logistic regression model showed that the only correlation in reaching working length was the activation system used (P = 0.005). CONCLUSION: The results suggest that variation of canal taper does not affect the ability of PUI to reach the working length in curved canals whilst SI obtained inferior results with 0.04 taper canal preparations.

Systemic hypertension counteracts potential benefits of growth hormone replacement therapy on left ventricular remodeling in adults with growth hormone deficiency.

BACKGROUND: Systemic Hypertension (SH) is the main cause of left ventricular (LV) hypertrophy in the general population, but only scanty data are available on LV geometric remodeling (LVGR) in hypertensive patients with GH deficiency (GHD). AIM: We investigated hypertensive LVGR in adult-onset GHD patients, before (T0) and after 55±16 months (T1) of individualized GH replacement therapy (GHRT). SUBJECTS: Fifty-one patients, aged 45±15 yr, 29 women, were enrolled. Fifteen patients met criteria for SH (group A) whereas 36 were normotensive (group B). METHODS: An echocardiogram was performed on all patients, at least twice (at T0 and T1). LV geometric remodeling as a relationship between LV mass (LVM) index and relative wall thickness (RWT), LV volumes, and ejection fraction were measured. RESULTS: At T0, group A showed higher LV mass and LVM index values than group B; LV hypertrophy was found in 40% and 22% of patients, respectively (p=0.06). At T1, IGF-I levels had increased significantly in both groups. LV hypertrophy rate consistently increased in group A (from 40 to 60%, p<0.05), whereas slightly decreased in group B (from 22 to 19%, ns). Body surface area (p<0.001), age (p<0.05), and systolic blood pressure (p<0.05) were main determinants of LVM at multivariate analysis. CONCLUSIONS: Along with body surface area and age, SH was significantly related to abnormal LVGR (LV hypertrophy) in GHD patients. As a result, blood pressure management and caloric intake restrictions are deemed necessary for this subset of patients.

Immuno-modulatory effects of vitamin D3 in human monocyte and macrophages.

Vitamin D3 [1α,25-(OH)(2)D(3)], involved in the regulation of body calcium homeostasis, promotes immature myeloid precursor cells differentiation into monocytes/macrophages. In this study we compared the regulatory interaction between 1α,25-(OH)(2)D(3) and tumor necrosis factor (TNF)-α or lipopolysaccharide (LPS) in the mRNA expression of interleukin (IL)-1ß, (IL)-6, TNF-α, toll like receptors (TLR)-2 and (TLR)-4 in freshly isolated human monocyte (MonoT0) and in macrophages cultured for seven days (MØT7). Additionally, we detected the effect of 1α,25-(OH)(2)D(3) on macrophages chemotaxis. The expression of IL-1ß, IL-6 and TNF-α, as well as TLR-2 and TLR-4 in MonoT0 and in MØT7 was examined by real time RT-PCR. Macrophages chemotaxis was analyzed by using horizontal chemotaxis agarose spot assay. We found that 1α,25-(OH)(2)D(3) influences macrophages chemotaxis and differently modulates the expression of IL-1ß, IL-6, TNF-α and TLRs in the two different stages of monocytes/macrophage maturation. In conclusion our data add new information about the role of 1α,25-(OH)(2)D(3) on the expression of inflammatory mediators in human monocyte/macrophages, underlying the complex function of these cells. Investigating the differences in the pattern of expression of immune-mediators produced by MonoT0 and MØT7 may provide a new way to examine their biochemical and molecular function and may constitute a model system with well-defined behavior with respect to early or tardive events in the innate immune response.

Efficacy of irrigation systems on penetration of sodium hypochlorite to working length and to simulated uninstrumented areas in oval shaped root canals.

AIM: To assess the ability of sodium hypochlorite (NaOCl) to penetrate simulated lateral canals and to reach working length (WL) when using the self-adjusting file (SAF). METHODOLOGY: Seventy single-rooted teeth with oval-shaped canals were used. Upon access, presence of a single canal was confirmed by direct visualization under a dental-operating microscope. Canal length and patency were obtained using a size 10 K-file and root length standardized to 18 mm. Pre-enlargement was restricted to the coronal one-third. The apical size of each canal was gauged at WL and samples larger than size 30 were excluded. Canals were instrumented for 5 min using the SAF system while delivering a total of 20 mL of 5.25% NaOCl and 5 mL of 17% EDTA. Then, the apical diameters were standardized to size 35 using hand files. Four hundred and twenty simulated lateral canals were then created during the clearing process and roots coated with wax to create a closed system. All samples were then cleared and randomly assigned to four experimental groups: 1 (n = 15) positive pressure; 2 (n = 15) SAF without pecking motion; 3 (n = 15) SAF with pecking motion; 4 (n = 15) apical negative pressure (ANP) irrigation and (n = 10) control groups. Samples were scored on the basis of the ability of the contrast solution to reach WL and permeate into the simulated lateral canals to at least 50% of the total length. The Kruskal-Wallis test was used to analyse irrigant penetration and the Tukey test to determine statistical differences between groups (P < 0.05). RESULTS: All samples irrigated with ANP were associated with irrigant penetration to WL (Table 1). The differences between group 4 (ANP) and all other groups were significant in penetration to WL (P < 0.05). The pecking motion allowed for further penetration of the irrigant when using the SAF system but failed to irrigate at WL. None of the experimental groups demonstrated predictable irrigation of simulated lateral canals. CONCLUSIONS: In this laboratory model, ANP was the only delivery system capable of irrigating consistently to full WL. None of the systems tested produced complete irrigation in artificial lateral canals.

Right ventricular obstructive hypertrophic cardiomyopathy in primary myo-adenylate deaminase deficiency.

MyoAdenylate Deaminase Deficiency (MADD) is a relatively common metabolic disorder of the skeletal muscle. Patients with MADD usually show an impaired bioenergetic production and a clinical spectrum with either exercise-induced muscle pain, fatigue and/or rhabdomyolysis. Left ventricular hypertrophy as well as other types of cardiac involvement have been reported in patients with primary MADD. We describe herein a case of a 61-year-old woman with biochemical and genetic evidence of Myo-Adenylate Deaminase deficiency, in whom we found a right ventricular hypertrophic cardiomyopathy leading to severe outflow tract dynamic obstruction.

High prevalence of coronary calcifications and increased risk for coronary heart disease in adults with growth hormone deficiency.

Assessment of coronary calcium deposits (CCD) by coronary computed tomography (CT) was recently introduced for evaluation of risk to develop events related to coronary heart disease (CHD). We investigated occurrence of CCD in 19 hypopituitary patients (patients), 34 healthy (H) subjects (H controls) and 36 patients with a similar rate of diabetes mellitus and hypertension (morbid, M), but without pituitary diseases (M controls). Patients were replaced with L-thyroxine, cortone acetate, sex hormones and/or desmopressin, but never with GH. Unenhanced coronary CT was performed by 16-row multislice scanner. Framingham score (FS) was calculated and CCD were measured by Agatston score (AS) in all subjects. AS>10 indicates increased CHD risk. CCD and AS >10 were detected in 50% and 33% of patients, respectively. Prevalence of CCD and mean AS were higher in patients than in H and M controls. In patients, AS was negatively dependent on IGF-I levels (p<0.01) and IGF-I SD (p<0.05), and AS >10 was associated with occurrence of hypertension (p<0.02) and hyperinsulinism (p<0.05). Men and women showed the same prevalence of AS >10 (25 vs 31%). FS and AS correlated significantly (rs=0.33, p<0.001), but CCD were detected also in 3/11 patients with low FS. In conclusion, 58% of patients were at CHD risk on the basis of increased FS and/or AS, above all if they were hypertensive and/or showed hyperinsulinism. CCD were detected also in patients with low FS. CHD risk is higher in women. Risk of CCD is increased in patients with low IGF-I levels.

Cardiovascular autonomic control in Becker muscular dystrophy.

Although autonomic symptoms are not prominent in dystrophinopathies, a reduced vagal activity and an enhanced sympathetic tone have been found in Duchenne muscular dystrophy. Twenty patients with Becker muscular dystrophy (BMD) were investigated by a battery of six cardiovascular autonomic tests (beat-to-beat variability during quiet breathing and deep breathing, heart rate responses to Valsalva maneuver and standing, blood pressure responses to standing and sustained handgrip) and power spectral analysis (PSA) of heart rate variability. Although 11 patients revealed abnormal findings at some cardiovascular tests, none of them had a definite autonomic damage, as indicated by two or more abnormal tests. The mean results of the single tests did not differ from normal controls, except for the beat-to-beat variability during quiet breathing, which was significantly higher in BMD (p<0.05). Such finding was confirmed by a significantly higher total variance (p<0.05), indicating an increased parasympathetic activity. Spectral components were not significantly different from normal controls. PSA values were not influenced by age, functional ability score or presence of heart abnormalities. Our data suggest that autonomic involvement does not represent a major finding in BMD.

[Reversal left diastolic ventriculo-atrial flow induced by asynchronism in a patient with dilated cardiopathy and VVI pacemaker]. / Reflusso diastolico ventricolo-atriale sinistro indotto dall'asincronismo atrio-ventricolare in paziente con cardiopatia dilatativa portatore di pacemaker VVI.

We studied a case of reversal atrioventricular diastolic flow in a 74-year-old patient suffering from chronic heart failure for six years, following double myocardial infarction on the inferior (in 1985) and the anterior wall (in 1992). During his last hospitalization, he had an arrhythmic complication (advanced atrioventricular block) that required a definitive implantation of a VVI-pacemaker. The patient, a working man in good hemodynamic condition over the past several years, acknowledged symptoms of progressive functional decline three to six months prior to coming to our observation for a medical check-up. The surface electrocardiogram showed normal electrical PM activity. Echo-Doppler examination beyond the improved systolic function of left ventricle showed a variable E/A velocity ratio of mitral valve flow, due to the casual relationship between spontaneous atrial electrical activity and ventricular stimulation. In addition, at the surface ECG we frequently observed a retrograde atrioventricular flow during mean phase of diastole each time the P wave occurred at the end of T wave. This event did not occur when the T-P interval was longer (a few more milliseconds) and was thus similar to a normal atrioventricular ECG sequence. To summarize, we can affirm that in patients with dilated cardiomyopathy and improved systolic function requiring pacemaker implantation, the sequential mode of ventricular stimulation must be preferred, especially if there is normal electrical activity in the right atrium.

Tsugicoline E, a new polyoxygenated protoilludane sesquiterpene from the fungus laurilia tsugicola1

Tsugicoline E (3) has been isolated from cultures of the Basidiomycetous fungus Laurilia tsugicola and its structure deduced from 1H and 13C NMR and single-crystal X-ray diffraction studies. The suggested absolute configuration is consistent with biogenetic considerations.

QSAR modeling with the electrotopological state indices: corticosteroids.

A structure-activity analysis of a series of steroids binding to corticosteroid-binding globulin was made using the electrotopological state index for each atom in the molecule. Two indices were found to correlate well with the binding affinity. The indices encode structural characteristics in the A and the D rings of the steroids in the study. One of the indices was formulated as the difference between two indices in the A ring. The two were not intercorrelated, suggesting that the composite index signals the influence of structure changes in or near the A ring that can be monitored by the composite index. This is a new observation using this structure-activity method. It is suggested that this model makes some contributions towards detection of the pharmacophore.

Subcutaneous ports in the radiology suite: an effective and safe procedure for care in cancer patients.

The purpose of the study is to present our experience and compare the results of the three types of ports used as a central venous access and performed in the radiology suite. Between March 1989 and November 1993 we performed 288 implantations (100 Implantofix Seldinger, 100 plastic Hickman port, and 88 stainless steel Port-a-cath) for chemotherapeutic treatment on the same number of patients diagnosed as having cancer. In all cases access was obtained via a subclavian vein (the left one in 185 cases and the right one in 103). All the system ports were implanted in the radiology suite. In all cases the procedure was successfully performed. Complications occurred in 26.3% of cases, most notably thrombosis in 13 cases (4.5%) and infection in 12 cases (4.1%). Duration of the port systems placement varied between 17 and 1467 days (a mean of 315 days). A total of 133 systems have been removed to date, 80 (60.%) due to termination of chemotherapy, and 53(40%) for treatment of complications. Significant differences (complications and port duration time) were not observed between the three types of reservoir used. Subcutaneous ports are safe, comfortable, and effective devices for central venous access.

[Cardiac involvement in familial amytrophic chorea with acantocytosis: description of two new clinical cases]. / Coinvolgimento cardiaco nella coreo-acantocitosi amiotrofica familiare: descrizione di due nuovi casi clinici.

Familial amyotrophic chorea and acanthocytosis, also known as the Levine-Critchley syndrome, is a rare inherited disease characterized primarily by central nervous system involvement with progressive demyelinization and autosomic or dominant transmission. Clinical symptoms include orofaciolingual dyskinesia and involuntary choreiform movements associated with skeletal muscle atrophy due to axonal demyelinization and erythrocyte acanthocytosis. A few patients have some cardiac abnormality, including an electrocardiographic pattern of left ventricular hypertrophy, left atrial wave abnormalities, non-specific ST-T wave changes, and a pseudonecrosis pattern with abnormal Q waves in the inferior leads. Two-dimensional echocardiography has disclosed concentric ventricular hypertrophy and the typical findings of congestive cardiomyopathy. We report the case of two brothers, 40 and 58 years old, who had asymmetric left ventricular hypertrophy (more marked in the younger brother), left ventricular mass index increase unrelated to a hypertensive state or the percent of circulating acanthocytes. Functional systolic parameters were normal. The younger brother had dilation of the aortic root and marked enlargement of the non-coronary Valsalva sinus, and both patients manifested mitral leaflet redundancy without evident prolapse. Our observations suggest the hypothesis that connective tissue and/or vessel muscle-elastic fiber pathology is associated with the well-known neurological disorders typical of the Levine-Critchley syndrome. It is thus advisable that these patients undergo thorough cardiovascular evaluation.

[Does aortic insufficiency influence Doppler-derived calculation of the valvular area in patients with mitral stenosis?]. / L'insufficienza aortica influenza il calcolo Doppler-derivato dell'area valvolare in pazienti con stenosi mitralica?

BACKGROUND: The evaluation of mitral valve area (MVA) in patients with mitral stenosis represents the main purpose of any diagnostic method, provided that MVA is a key parameter to indicate the need for valve surgery. The aim of this study was to assess whether the presence of aortic regurgitation associated with mitral stenosis affects the MVA measurement by left atrial pressure half time (PHT). METHODS: Eighty-nine patients with mitral valve stenosis (68 females and 21 males, mean age 53.6 +/- 12.1 years), were studied. Fourty-eight patients (36 females and 12 males) had a concomitant aortic regurgitation (AR group), whereas 41 patients (32 females and 9 males) did not reflect any aortic valve involvement (no-AR group). Aortic regurgitation was graded on the basis of color flow analysis. The majority of patients had a slight to moderate regurgitation. MVA determination was carried out using both Hatle formula (220/PHT) and planimetric measurement in parasternal short axis view. RESULTS: Statistical analysis demonstrated a good correlation between the 2 MVA measurement in both groups (IA group: r = 0.9, p < 0.0001, SSE = 0.21 cm2, y = 0.91x + 0.05; no-IA group r = 0.92, p < 0.0001, SSE = 0.22 cm2, y = 0.92x + 0.04). The concomitant aortic valve disease did not affect in any way the MVA measurement by means of the PHT method. CONCLUSIONS: The Doppler derived method appears to be reliable for estimating the mitral valve area in patients with mitral stenosis even in the presence of aortic regurgitation.

[Tricuspid insufficiency and pulmonary hypertension in mitral disease: an echocardiographic study]. / Insufficienza tricuspidalica e ipertensione polmonare nella malattia mitralica: studio ecocardiografico.

Tricuspid valve regurgitation and pulmonary hypertension have been evaluated with echo-color-Doppler technique in 100 patients (80 females and 20 males, mean age 54 years) affected by mitral valve stenosis. Pure mitral stenosis was present in 13 patients; 87 had an associated mitral regurgitation. The severity of mitral valve disease was based on the planimetric and functional (Doppler-derived) evaluation of valvular area. No relationship was found between extent of tricuspid regurgitation and severity of mitral valve disease, whereas pulmonary artery hypertension was significantly related to mitral valve involvement, above all Doppler mean gradient (r: 0.63, p < 0.005) and valvular area (r: -0.52, p < 0.01). The study suggests that in patients with mitral valve disease tricuspid regurgitation is independent of the degree of mitral valve involvement, whereas pulmonary hypertension is related to transvalvular gradient and to mitral valve area, but does not depend on the duration of the disease. This is evident only in patients who maintain the sinus rhythm.

[Acromegalic cardiopathy: a morphofunctional study with color-Doppler echocardiography]. / Cardiopatia acromegalica: studio morfo-funzionale con ecocardiografia color-Doppler.

We used color-Doppler echocardiography in an investigation of cardiac morphology and function to verify the cardiac anatomic and functional changes in acromegalic patients with or without hypertension and hyperlipemic states. Fifteen patients with growth hormone-secreting pituitary adenoma (mean age: 47.9 years) and 15 healthy control subjects were studied. We measured serum growth hormone (GH), somatomedin-C, cholesterol, triglyceride levels and carried out echocardiographic studies of the following cardiac morpho-functional parameters: left ventricular diameter, volume, mass and wall systolic stress. Serum GH and somatomedin-C levels were significantly higher in acromegalic patients than in controls (p < 0.001 and p < 0.001 respectively). Echocardiography evidenced increased left ventricular mass (60% of the acromegalic patients; p < 0.05) and increased wall systolic stress (53.3%; p < 0.05). Color-Doppler analysis evidenced abnormal diastolic function in 8 acromegalic patients (p < 0.001). We thus conclude that the most characteristic feature of acromegalic heart disease is left ventricular involvement, diastolic dysfunction, increased left ventricular mass or wall systolic stress. The pathogenesis is most probably multifactorial: essential hypertension, associated with slow and progressive evolution of heart disease, appears to be a determining factor.