Inflammatory biomarkers in dentinal fluid as an approach to molecular diagnostics in pulpitis.

AIM: To explore a set of inflammatory biomarkers obtained from dentinal fluid (DF) from patients with symptomatic irreversible pulpitis (IP), reversible pulpitis (RP) and normal pulp (NP). METHODOLOGY: A cross-sectional exploratory study was performed, recruiting 64 patients on the basis of their respective pulp condition. DF samples were obtained from all patients (23, from IP patients; 20, from RP patients; and 21, from NP patients). Quantification of biomarkers was performed using a Luminex® MAGPIX platform system and multiplex assay kits. The Kruskal-Wallis test was used for comparisons with regard to pulp state. A simple logistic regression model and the odds ratio (OR) with a 95% level of confidence (P = 0.05) were used to evaluate associations between biomarker levels and pulpal diagnosis. The performance discrimination of the biomarkers was evaluated through the construction of a receiver operating characteristic (ROC) curve by calculating the area under the curve (AUC) for IP versus RP after logistic regression modelling. Youden criteria were used to establish cut-off points for biomarkers alone with AUC > 70 and P-value < 0.05, or estimated probabilities from the multivariable logistic model. RESULTS: The biomarkers that had significantly higher values in participants with IP versus RP were IL-1α, VEGF-α and FGF acid (P < 0.05). FGF acid (OR: 12.62; P = 0.0085; CI 95% 1.91-83.29) and VEGF-α (OR: 2.61; P = 0.0252; CI 95% 1.13-6.03) were associated with pulp diagnoses of IP versus RP. The AUC-ROC curve for FGF acid was 0.79. The model containing FGF acid, IL-1α, IL-6 and TIMP-1 had an AUC-ROC of 0.92 for IP versus RP with a significant difference from the FGF acid ROC curve (P = 0.0231). CONCLUSIONS: Dentinal fluid could be used to assay pulpal mediators in the molecular diagnosis of pulpitis. Despite the limitation of the clinical diagnostics used in the present study, it was possible to detect a difference between irreversible symptomatic pulpitis and reversible pulpitis associated with the following combined biomarkers: FGF acid + IL-6 + IL-1α, +TIMP-1.

Effect of perfluorodecanoic acid on pig oocyte viability, intracellular calcium levels and gap junction intercellular communication during oocyte maturation in vitro.

Perfluorodecanoic acid (PFDA) is a synthetic perfluorinated compound, which has been reported to exert adverse effects on somatic cells. However, its effects on germ cells have not been studied to date. The aim of the present study was to analyze the effects of PFDA on the viability, intracellular calcium levels and gap junction intercellular communication (GJIC) during porcine oocyte maturation in vitro. PFDA negatively impacted oocyte viability (medium lethal concentration, LC50 = 7.8 µM) and maturation (medium inhibition of maturation, IM50 = 3.8 µM). Oocytes exposed to 3.8 µM PFDA showed higher levels of intracellular calcium relative to control oocytes. In addition, GJIC among the cumulus cells and the oocyte was disrupted. The effects of PFDA on oocyte calcium homeostasis and intercellular communication seem to be responsible for the inhibition of oocyte maturation and oocyte death. In addition, since the deleterious effects of PFDA on oocyte viability, maturation and GJIC are significantly stronger than the previously reported effects of another widely used perfluorinated compound (Perfluorooctane sulfonate) in the same model, the use of PFDA in consumer products is questioned.

Experimental disturbances reveal group-level costs of social instability.

In group-living species, social stability is an important trait associated with the evolution of complex behaviours such as cooperation. While the drivers of stability in small groups are relatively well studied, little is known about the potential impacts of unstable states on animal societies. Temporary changes in group composition, such as a social group splitting and recombining (i.e. a disturbance event), can result in individuals having to re-establish their social relationships, thus taking time away from other tasks such as foraging or vigilance. Here, we experimentally split socially stable groups of captive zebra finches (Taeniopygia guttata), and quantified the effects of repeated disturbance events on (1) group foraging efficiency, and (2) co-feeding associations when subgroups were recombined. We found that the efficiency of groups to deplete a rich, but ephemeral, resource patch decreased after just a single short disturbance event. Automated tracking of individuals showed that repeated disturbances reduced efficiency by causing social relationships to become more differentiated and weaker, resulting in fewer individuals simultaneously accessing the patch. Our experiment highlights how short-term disturbances can severely disrupt social structure and group functionality, revealing potential costs associated with group instability that can have consequences for the evolution of animal societies.

Edad al momento del trasplante: ¿Quiénes tienen riesgo de mala evolución ? / Age at transplantation: who are at risk of a poor outcome ?

Introducción: Si bien la sobrevida de paciente e injerto en niños con trasplante renal (TxR) ha mejorado, algunos sugieren que la edad al TxR es predictora de malos resultados, y los mayores tendrían peor evolución. Objetivo: Definir sobrevida de paciente e injerto según edad al TxR, y factores pronósticos de fracaso en aquellos con peor evolución. Material y métodos: Cohorte retrospectivo de todos los pacientes con TxR en el Hospital Garrahan desde el 01-01-2002 hasta el 01-03-2016. Resultados: de 431 pacientes, 44, (10%) tenían < 6a, 179 (42%)> 6 y <12 y 208 (48%) ≥12 años. La sobrevida del paciente a 8 años fue 97%, 99% y 95% (p=0,2), y la del injerto de: 86%, 69% y 30% respectivamente (p=<0,001). En los ≥ de 12 años, con peor evolución, se incluyeron al análisis univariado como factores de riesgo de pérdida de injerto: GSFS como causa de IRC : HR: 9,4; (p<0,001), Rechazo Agudo (RA) temprano: HR: 8,1; (p<0,001), RA tardío: HR: 4,3; (p<0.001), DGF: HR: 4,1; (p<0,001), No adherencia: HR: 2,3; (p=0,02), Edad de DC > 35a: HR: 1,95 (p=0,1), Tiempo en diálisis: HR: 1,1 (p=0,1), Número de incompatibilidades HLAB y HLADR: HR: 0,8 (p=0,3), Tiempo de Isquemia : 0,9 (p=0,5), Sexo del receptor: HR:0,8 (p=0,6), Donante Cadavérico: HR: 1,2; (p=0,6), 2do TxR : HR: 1,2; (p=0,7). En análisis multivariado: RA tardío: HR: 12,9 (p<0,001), GSFS como causa de IRC: HR: 12,5 (p<0,001), RA temprano: HR: 9 (p<0,001), y DGF: HR: 4,9 (p<0,001). Conclusión: la sobrevida del injerto en adolescentes es inferior. Merecen atención, la prevención de la no adherencia asociada a rechazo, el paciente con GSFS y el retardo de la función pos TxR (AU)

Introduction: Although patient and graft survival of children with a kidney transplantation (KTx) has improved, it has been suggested that older age at KTx is a predictive factor of poor outcome. Aim: To evaluate patient and graft survival according to age at KTx and define predictive factors in those with a poor outcome. Material and methods: A retrospective cohort study was conducted in all patients who underwent KTx at Garrahan Hopital between 01-01-2002 and 01-03-2016. Results: Of 431 patients, 44 (10%) were <6yr, 179 (42%) >6yr, and <12yr, and 208 (48%) ≥12yr. Eight-year patient survival was 97%, 99%, and 95% (p=0.2) and graft survival was 86%, 69%, and 30% (p=<0.001), respectively. In children ≥12 yr, with a worse outcome, the following risk factors of graft loss were included in univariate analysis: FSGS-related CFR: HR: 9.4; (p<0.001), early acute rejection (AR): HR: 8.1; (p<0.001), late AR: HR: 4.3; (p<0.001), DGF: HR: 4.1; (p<0.001), non-adherence: HR: 2.3; (p=0.02), age of deceased donor >35yr: HR: 1.95 (p=0.1), time on dialysis: HR: 1.1 (p=0.1), number of HLA-B and HLA-DR mismatches: HR: 0.8 (p=0.3), cold ischemia time: 0.9 (p=0.5), recipient sex: HR:0.8 (p=0.6), deceased donor: HR: 1.2; (p=0.6), second KTx: HR: 1.2; (p=0.7; and in multivariate analysis: late AR: HR: 12.9 (p<0.001), FSGS-related CFR: HR: 12.5 (p<0.001), early AR: HR: 9 (p<0.001), and DGF: HR: 4.9 (p<0.001). Conclusion: Graft survival is lower in adolescents. Prevention of rejection associated with non-adherence, FSGS, and post-KTx DGF should be taken into account (AU)

Glomerulonefritis con semilunas / Glomerulonephritis with crescents

La glomerulonefritis rápidamente progresiva (GNRP) es una entidad caracterizada por una brusca y progresiva declinación de la función renal y por la presencia en la biopsia renal de proliferación celular extra capilar (semilunas) que ocupan el espacio de Bowmans. Nosotros analizamos en forma retrospectiva 37 niños con diagnóstico de GNRP (50% o más de los glomérulos con semilunas) asistidos en esta institución durante los últimos 20 años. El propósito fue evaluar la presentación clínica e histopatológica, etiología, evolución y factores de mal pronóstico. La edad media al diagnóstico fue de 11 ± 3,5 años. Los síntomas de presentación fueron: hematuria 100% de los casos (hematuria macroscópica 56%); hipertensión arterial 92%; proteinuria 88%; síndrome nefrótico 57%. Fue necesaria diálisis al ingreso en el 64,1% de los casos. Las biopsias renales fueron realizadas a 38 ± 26 días desde el comienzo de los síntomas. El porcentaje de glomérulos que presentaron semilunas fue del 81,4%; las mismas fueron epiteliales en el 28,3% de los casos; fibroepiteliales en el 21,8% y fibrosas en el 31,3%. En el 75,8% de las biopsias se encontró fibrosis intersticial y atrofia tubular moderada y/o severa. La inmunofluorescencia no mostro depósitos de complejos inmunes (GN pauci-inmune) en el 40,6% de las biopsias, mostró depósitos granulares de complejos inmunes en el 48,6% y depósitos lineales de anticuerpos anti membrana basal glomerular (Goodpasture´s) en el 10,8%. El tratamiento fue iniciado a 36 ± 32 días desde el comienzo de los síntomas. Todos los pacientes recibieron tratamiento de sostén; en 29 de ellos se indicaron además esteroides y ciclofosfamida, y en 5 solo esteroides. El tiempo medio de seguimiento fue de 4,6 ± 3,9 años. La sobrevida de los pacientes al final del seguimiento fue del 87% (IC95% 55-97%) y la sobrevida del órgano fue del 17% (IC95% 7-38%). Por análisis multivariado encontramos que la fibrosis intersticial y atrofia tubular moderada y/o severa fue el único factor que se relacionó con pérdida del órgano (OR: 14,6 IC95%2,6-80) p= 0,001. Nuestros resultados muestran que la GNRP en niños es una entidad con pobre pronóstico en relación a la función renal. El factor de peor pronóstico que puede llevar a la pérdida del órgano es el compromiso túbulo-intersticial (AU)

Rapidly progressive glomerulonephritis (RPGN) is characterized by a sudden and progressive decrease of kidney function and extra-capillary cell proliferation (crescents) occupying the Bowman's space on the biopsy. We retrospectively analysed 37 children with RPGN (50% or more of glomeruli with crescents) seen at our institution over the past 20 years. The purpose of the study was to evaluate clinical and histopathological presentation, etiology, outcome, and factors of poor prognosis. Mean age at diagnosis was 11 ± 3.5 years. Presenting symptoms were: hematuria in 100% of the cases (macroscopic hematuria 56%); arterial hypertension in 92%; proteinuria in 88%; and nephrotic syndrome in 57%. Dialysis was necessary on admission in 64.1% of the cases. Kidney biopsies were performed at 38 ± 26 days after symptom onset. The percentage of glomeruli that presented crescents was 81.4%; they were epithelial in 28.3% of the cases, fibroepithelial in 21.8%, and fibrous in 31.3%. In 75.8% of the biopsies interstitial fibrosis and moderate and/or severe tubular atrophy was found. Immunofluorescence techniques did not show immune complex deposits (pauci-immune GN) in 40.6% of the biopsies. Granular deposits of immune complexes were found in 48.6% and linear anti-glomerular basement membrane deposits (Goodpasture´s) in 10.8%. Treatment was started 36 ± 32 days after symptom onset. All patients received support treatment; in 29 steroids and cyclophosphamide were also indicated, and in 5 steroids only. Mean time of follow-up was 4.6 ± 3.9 years. Patient survival at the end of follow-up was 87% (95%CI 55-97%) and organ survival was 17% (95%CI 7-38%). On multivariate analysis we found that interstitial fibrosis and moderate and/or severe tubular atrophy was the only factor related to organ loss (OR: 14.6; 95%CI 2.6-80) p= 0.001). Our results show that RPGN in children has a poor prognosis regarding kidney function. Tubulo-interstitial involvement is the factor of poor prognosis that may lead to organ loss (AU)

Sobrevida de pacientes e injerto en niños con trasplante renal: experiencia del Hospital Garrahan en dos períodos / Patient and graft survival in children with a kidney transplant: The experience at Garrahan Hospital over two periods

En adultos y niños con trasplante renal (TxR) la sobrevida de paciente e injerto ha mejorado. En Argentina no existen datos de sobrevida en niños con TxR en diferentes décadas. El objeto de este trabajo fue valorar en niños con TxR sobrevida de paciente e injerto y analizar causas de muerte, perdida de injerto y factores de riesgo de pérdida. Dado que desde el año 2001 se unificaron prácticas de diagnóstico y tratamiento, se compararon dos periodos: 1988-2000 y 2001-2015. Se incluyeron 773 niños. A 1, 3, 5, 7 y 10 años, En TxR de DV (n=327), la sobrevida del paciente fue de 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% y 96% (p=0.74); la del injerto de 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81% y 76% (p=0.81). En TxR de DC (n=446) la sobrevida de paciente fue de 97%, 93%, 90%, 89% y 87% en el 1er. periodo vs. 100%, 99% y 98% 98% y 98% en el 2do (p<0.001); la del injerto de 83%, 75%, 68%, 64% y 52% vs. 95%, 87%, 83%, 76% y 61% respectivamente (p<0. 001). El Rechazo Crónico fue la 1er causa de perdida (61% vs 62%); la 2da la muerte del paciente con injerto funcionante. La sepsis bacteriana fue la 1era causa de muerte (56% vs 67%). Ningún niño falleció por neoplasia entre el 2001 y 2015. En DV, fueron predictores de perdida de injerto: DGF (HR: 4.8; p<0.001), edad al TxR > 12 años (HR: 2.7; p=0.002) y RA tardío (HR: 2.1; p=0.009). En DC la necesidad de diálisis en la 1er semana post TxR (DGF): (HR: 4.4; p<0.001), el rechazo agudo (RA) tardío (HR: 3.7; p<0.001), GSFS como causa de IRC (HR: 2.5; p=0.01), y RA temprano (HR: 2.2; p=0.02). Conclusión: En el 2do periodo la sobrevida de paciente e injerto los TxR con DC mejoro, y en los TxR con DV no tuvo cambios. El rechazo crónico continúa siendo la 1era causa de perdida. Ningún paciente tuvo neoplasia (AU)

Patient and graft survival in kidney transplantation (KTx) has improved. In Argentina there are no data comparing transplant outcomes in children over different eras. The aim of this study was to evaluate patient and graft survival in children with KTx and to analyze cause of death, graft loss, and risk factors of graft loss. As diagnostic and treatment practices were unified in 2001, two periods were compared: 1988-2000 and 2001-2015. Overall, 773 children were included. Survival at 1, 3, 5, 7, and 10 years after a living-related donor (LRD) KTx was 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% and 96% (p=0.74); graft survival was 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81%, and 76% (p=0.81). Patient survival after deceased donor (DD) KTx (n=446) was 97%, 93%, 90%, 89%, and 87% in the 1st period vs. 100%, 99% y 98% 98%, and 98% in the 2nd (p<0.001); graft survival was 83%, 75%, 68%, 64%, and 52% vs. 95%, 87%, 83%, 76%, and 61%, respectively (p<0. 001). Chronic rejection was the first cause of graft loss (61% vs 62%); the second was death of the patient with a functioning graft. Bacterial sepsis was the first cause of death (56% vs 67%). None of the patients died because of malignancies between 2001 and 2015. Among LRD transplants predicting factors of graft loss were: DGF (HR: 4.8; p<0.001), age at KTx >12 years (HR: 2.7; p=0.002), and late acute rejection (AR) (HR: 2.1; p=0.009). Among DD need for dialysis in the first week post-KTx (DGF): (HR: 4.4; p<0.001), late AR (HR: 3.7; p<0.001), FSGS-related CFR (HR: 2.5; p=0.01), and early AR (HR: 2.2; p=0.02). Conclusion: In the second period patient and graft survival after DD improved, while that of KTx with LRD remained unchanged. Chronic rejection continues being the first cause of graft loss. None of the patients developed malignancies.

IFPA meeting 2015 workshop report II: mechanistic role of the placenta in fetal programming; biomarkers of placental function and complications of pregnancy.

Workshops are an integral component of the annual International Federation of Placenta Association (IFPA) meeting, allowing for networking and focused discussion related to specialized topics on the placenta. At the 2015 IFPA meeting (Brisbane, Australia) twelve themed workshops were held, three of which are summarized in this report. These workshops focused on various aspects of placental function, particularly in cases of placenta-mediated disease. Collectively, these inter-connected workshops highlighted the role of the placenta in fetal programming, the use of various biomarkers to monitor placental function across pregnancy, and the clinical impact of novel diagnostic and surveillance modalities in instances of late onset fetal growth restriction (FGR).

Group structure predicts variation in proximity relationships between male-female and male-infant pairs of mountain gorillas (Gorilla beringei beringei).

Relationships between conspecifics are influenced by both ecological factors and the social organization they live in. Systematic variation of both--consistent with predictions derived from socioecology models--is well documented, but there is considerable variation within species and populations that is poorly understood. The mountain gorilla (Gorilla beringei) is unusual because, despite possessing morphology associated with male contest competition (e.g., extreme sexual dimorphism), they are regularly observed in both single-male and multimale groups. Both male-female and male-infant bonds are strong because males provide protection against infanticide and/or predation. Risk of these threats varies with social structure, which may influence the strength of social relationships among group members (including females and offspring, if females with lower infant mortality risk are less protective of infants). Here, we investigate the relationship between group structure and the strength of proximity relationships between males and females, males and infants, and females and offspring. Data come from 10 social groups containing 1-7 adult males, monitored by the Dian Fossey Gorilla Fund's Karisoke Research Center in Volcanoes National Park, Rwanda. After controlling for group size and infant age, association strength was similar for male-female pairs across group types with both dominant and nondominant males, but male-infant relationships were strongest in single-male groups where paternity certainty was high and animals had fewer social partners to choose from. The male:female and male:infant ratios better predicted both male-female and male-infant associations than the absolute number of males, females, or infants did. The fewer the number of males per female or infant, the more both pair types associated. Dominant males in groups containing fewer males had higher eigenvector centrality (a measure of importance in a social network) than dominant males in groups with more males. Results indicate that nondominant males are an important influence on relationships between dominant males and females/infants despite their peripheral social positions, and that relationships between males and infants must be considered an important foundation of gorilla social structure.

Texting while driving: is speech-based text entry less risky than handheld text entry?

Research indicates that using a cell phone to talk or text while maneuvering a vehicle impairs driving performance. However, few published studies directly compare the distracting effects of texting using a hands-free (i.e., speech-based interface) versus handheld cell phone, which is an important issue for legislation, automotive interface design and driving safety training. This study compared the effect of speech-based versus handheld text entries on simulated driving performance by asking participants to perform a car following task while controlling the duration of a secondary text-entry task. Results showed that both speech-based and handheld text entries impaired driving performance relative to the drive-only condition by causing more variation in speed and lane position. Handheld text entry also increased the brake response time and increased variation in headway distance. Text entry using a speech-based cell phone was less detrimental to driving performance than handheld text entry. Nevertheless, the speech-based text entry task still significantly impaired driving compared to the drive-only condition. These results suggest that speech-based text entry disrupts driving, but reduces the level of performance interference compared to text entry with a handheld device. In addition, the difference in the distraction effect caused by speech-based and handheld text entry is not simply due to the difference in task duration.

Expresión de citoquinas Th17 y su correlación con periodontopatógenos y el área periodontal inflamada en pacientes con periodontitis crónica / Th17 cytokines expression and its correlation with periodontopathogens and periodontal inflammed surface area (PISA) in patients with chronic periodontitis

Antecedentes: La periodontitis es una enfermedad inflamatoria infecciosa que involucra una respuesta inmune del hospedero y se caracteriza por destrucción del hueso alveolar, el objetivo del estudio es analizar la expresión de citoquinas Th17 y su correlación con periodontopatógenos y el área periodontal inflamada en pacientes con periodontitis crónica. Método: Se realizó un estudio descriptivo exploratorio en el que se reclutaron 23 pacientes con diagnóstico de periodontitis crónica y un grupo control de 10 individuos sano/gingivitis. A todos los sujetos se les realizó un examen periodontal completo. Además, se utilizó el método PISA (Periodontal Inflamed Surface Area) para cuantificar el tamaño de la herida periodontal. Se recolectaron muestras de FGC, plasma y placa bacteriana para su análisis mediante técnica de ELISA de IL-17 A, IL-6, IL-23 y IL-10 y PCR para la determinación de la presencia de: P. gingivalis, T. denticola, T. forsythensis, A. actinomycetemcomitans, F. nucleatum y P. intermedia. Los datos fueron analizados utilizando estadística descriptiva y la asociación entre variables se estimó a través de modelos de regresión logística. Resultados: Se observó una tendencia al aumento, no significativa, de los niveles de IL-17A, IL-6 y IL-23 a nivel de FGC en los sujetos con periodontitis crónica (p=0.716, 0.784, 0.421, respectivamente). Los pacientes con periodontitis crónica presentaron una disminución de la IL-10 (p=0.012) y los niveles de IL-17A se correlacionaron positivamente con el área periodontal inflamada (p=0.004). A nivel de los patógenos periodontales, se observó una asociación entre la presencia de: P. gingivalis, T. denticola, T. forsythensis y los niveles de IL-6 plasmática (p=0.017, 0.033, 0.024, respectivamente).

Objective: Periodontitis is an infectious and inflammatory disease that involves a host immune response and is characterized by alveolar bone destruction. Aim: Analyze the expression of Th17 cytokines and their correlation with periodontopathogens and periodontal inflamed area in patients with chronic periodontitis. Method: A case control study was performed. At the time of delivery, 23 cases of patients with periodontal diagnosis were enrolled in the study and 10 controls with gingivitis. The diagnosis involved a complete periodontal examination with periodontal Florida probe. Also we used the PISA (Periodontal Inflamed Surface Area) index to classify the groups. Plasma and GCF samples were collected and studied for protein expression by ELISA assays for IL17A, Il6, IL23 and IL10. Plaque was analyzed by PCR for the determination of the presence of: P. gingivalis, T. denticola, T. forsythensis, F. nucleatum, P. intermedia and A. actinomycetemcomitans. Data was analyzed using descriptive statistics and the association between variables was estimated through logistic regression models. Results: There is a trend of increased GCF levels of IL17A, IL6, and IL23 with no significance. However there was an association between gingivitis and IL10 plasma and GCF levels (p=0.012). In relation to the periodontal wound size, a correlation was observed between the levels of IL6 and IL10 in GCF. Analysis of periodontal pathogens, showed an association between the presence of: P. gingivalis, T. denticola, T. forsythensis and plasma levels of IL-6 (p=0.017, 0.033 and 0.024, respectively).

Porphyromonas gingivalis, Treponema denticola and toll-like receptor 2 are associated with hypertensive disorders in placental tissue: a case-control study.

AIM(S): To explore the associations between the presence of periodontal pathogens and the expression of toll-like receptors (TLR-2 and TLR-4) in the placental tissue of patients with hypertensive disorders compared to the placentas of healthy normotensive patients. MATERIAL AND METHODS: A case-control study was performed. From a cohort composed of 126 pregnant women, 33 normotensive healthy pregnant women were randomly selected, and 25 cases of patients with hypertensive disorders of pregnancy, including gestational hypertension and pre-eclampsia, were selected. Placental biopsy was obtained after aseptic placental collection at the time of delivery. All of the samples were processed and analysed for the detection of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Treponema denticola and Tannerella forsythia using the polymerase chain reaction (PCR) technique. Determination of the expressions of TLR-2 and TLR-4 was performed in samples of total purified protein isolated from placental tissues and analysed by ELISA. The data were assessed using descriptive statistics. The associations among variables were estimated through multiple logistic regression models and the Mann-Whitney test to evaluate the differences between the two groups. RESULTS: A significant increase was observed in the expression of TLR-2 in the placentas of patients with hypertensive disorders (p = 0.04). Additionally, the multiple logistic regression models demonstrated an association between the presence of T. denticola and P. gingivalis in placental tissues and hypertensive disorders (OR: 9.39, p = 0.001, CI 95% 2.39-36.88 and OR: 7.59, p = 0.019, CI 95% 1.39-41.51, respectively). CONCLUSIONS: In the present study, pregnant women with periodontal disease presented an association in the placental tissue between the presence of T. denticola and P. gingivalis and hypertensive disorders. Additionally, increased expression of TLR-2 was observed. However, further studies are required to determine the specific roles of periodontal pathogens and TLRs in the placental tissue of patients with pregnancy-related hypertensive disorders.

Increased inflammatory biomarkers in early pregnancy is associated with the development of pre-eclampsia in patients with periodontitis: a case control study.

AIM(S): To explore the relationship between biomarkers of systemic inflammation in plasma and gingival crevicular fluid in early pregnancy and the subsequent development of pre-eclampsia in patients with periodontitis. MATERIALS AND METHODS: A case-control study was performed. From a cohort composed of 126 pregnant women, 43 normotensive healthy pregnant women were randomly selected, and 11 cases of preeclampsia were identified. Plasmatic and gingival crevicular fluid (GCF) samples were collected in early pregnancy (11-14 wk gestation). The levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were measured in the plasma and GCF samples, whereas the level of C-reactive protein (CRP) was measured in plasma samples. Biomarkers were determined by ELISA assays. The data were analysed using descriptive statistics, and the association between variables was estimated through logistic regression models. RESULTS: There was observed an association between pre-eclampsia and plasmatic levels of CRP (OR: 1.07; p = 0.003). Additionally, pre-eclampsia also was associated with IL-6 levels in GCF samples in early pregnancy (OR: 1.05; p = 0.039). A multiple logistic regression model suggests that increased levels of IL-6 in GCF (OR = 1.06; p = 0.02; CI 95% 1.007-1.117) in early pregnancy increase the risk of developing pre-eclampsia. CONCLUSION(S): Pregnant women with periodontitis who later development pre-eclampsia, shows increased levels of IL-6 in GCF and CRP in plasma during early pregnancy. Periodontal disease could contribute to systemic inflammation in early pregnancy via a local increase of IL-6 and the systemic elevation of CRP. Therefore, both inflammatory markers could be involved in the relationship between periodontal disease and pre-eclampsia.

Asociación entre periodontitis crónica, interleuquina -6 (IL-6) e índice de masa corporal (IMC) en embarazadas / Association between chronic periodontitis, interleukin-6 (IL-6) and body mass index (BMI) in pregnant women

Objetivo: Determinar si la condición clínica periodontal materna, el índice de masa corporal (IMC) y su variación durante el embarazo, se asocian con marcadores de inflamación sistémica: interleuquina-6 (IL-6), factor de necrosis tumoral alfa (TNF-) y proteína C reactiva (PCR) a nivel plasmático. Material y Método: Estudio clínico que analizó una cohorte de 56 embarazadas entre 18 y 38 años de edad (promedio 27.9 +/- 7.04 años), derivadas de la unidad de medicina perinatal en el centro de salud docente asistencial (CESA) de la Universidad de los Andes. Todas ellas consintieron voluntariamente su participación en el estudio. En cada trimestre de embarazo, se les realizó un examen periodontal completo, consistente en la determinación de los niveles de inserción clínica, profundidad al sondaje, índice de higiene y sangrado en seis sitios por cada pieza dentaria, excluyendo terceros molares. Adicionalmente, en cada control se obtuvieron muestras de sangre periférica para la determinación de los mediadores proinflamatorios mediante técnica de ELISA. El diagnóstico periodontal y los niveles de mediadores inflamatorios fueron relacionados con la variación del IMC durante el embarazo. Resultados: Las embarazadas con periodontitis crónica presentaron una mayor variación y aumento del índice de masa corporal (p=0.039) y niveles de IL-6 (p=0.026) en comparación con las mujeres embarazadas con gingivitis. Conclusiones: En esta serie de pacientes, se demostró una asociación entre el diagnóstico clínico de periodontitis durante el embarazo con un aumento plasmático de IL-6, así como también una asociación entre un aumento del IMC con los niveles plasmáticos de PCR.

Objective: To determine if maternal periodontal clinical status, body mass index (BMI) and its variation during pregnancy are associated with increased levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-) and C-reactive protein (CRP) in plasma. Material and Methods: This clinical study included a total of 56 pregnant women between 18 and 38 years old (mean 27.9 +/- 7.04 years), referred from perinatal medicine unit at health care center Universidad de los Andes. All pregnant patients consented to voluntarily participate in the study. In each trimester of pregnancy, they underwent a complete periodontal examination, involving the determination of clinical attachment levels, probing depth, bleeding and hygiene index at six sites of each tooth, excluding third molars. Additionally, in each clinical check, peripheral blood samples were taken for determination of pro-inflammatory mediators with ELISA immunoassay. Periodontal diagnosis and inflammatory mediators were the variables analyzed in relation to changes in BMI during pregnancy. Results: Pregnant women with chronic periodontitis had an increase and more variation of BMI (p=0.039) and higher levels of IL-6 (p=0.026) in comparison with pregnant women with gingivitis. Conclusions: In this series of pregnant patients the clinical diagnosis of periodontitis, with an increase in BMI are associated with increased plasma levels of IL-6 and CRP.

Presencia de Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola y Aggregatibacter actinomycetemcomitans en el biofilm subgingival de pacientes diabéticos tipo 2: estudio transversal / Presence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans in the subgingival biofilm of diabetic mellitus 2 patients: a cross sectional study

Antecedentes: La investigación de la microflora subgingival en pacientes diabéticos tipo 2 con periodontitis ha presentado resultados contradictorios. Objetivo: Determinar la presencia de Porphyromonas gingivalis, Tannerella forshytia, Treponema denticola y Aggregatibacter actinomycetemcomitans, en el biofilm subgingival de pacientes diabéticos tipo 2 y relacionarlo con el grado de control metabólico. Método: Estudio descriptivo transversal, en el cual se analizaron 23 pacientes diabéticos derivados consecutivamente del Policlínico de Especialidades de la Universidad de los Andes. Previo consentimiento informado, se realizó un examen clínico periodontal que incluyó mediciones de profundidad al sondaje, nivel de inserción clínica y sangrado gingival. Fueron clasificados según severidad de periodontitis y control metabólico de la diabetes determinado por un promedio de 3 exámenes de hemoglobina glicosilada. La detección microbiológica se realizó mediante la técnica de reacción en cadena de la polimerasa. Resultados: En el grupo de pacientes estudiados, Treponema denticola y Tannerella forsythia fueron las bacterias más prevalentes (65.2 por ciento), seguida por Porphyromonas gingivalis (17.3 por ciento) y Aggregatibacter actinomycetemcomitans (13 por ciento). Los pacientes con peor control glicémico tuvieron una mayor presencia de Treponema denticola, Tannerella forsythia, Porphyromonas gingivalis y Agreggatibacter actinomycetemcomitans y un aumento en el índice de sangrado al sondaje. Conclusiones: En el grupo de pacientes diabéticos estudiado, las bacterias más prevalentes fueron Treponema denticola y Tannerella forsythia. Los pacientes diabéticos tipo 2 con moderado y mal control glicémico presentaron mayor presencia de los microorganismos estudiados, comparado con los grupos con mejores niveles de control glicémico.

Background: The investigation of subgingival microflora in type 2 diabetic patients with periodontitis presented conflicting results. Aim: To determine the presence of Porphyromonas gingivalis, Tannerella forshytia, Treponema denticola and Aggregatibacter actinomycetemcomitans in subgingival biofilm of patients with diabetes type 2 and to relate it to the degree of metabolic control. Method: A descriptive study, which analyzed 23 diabetic patients consecutively referred from the Internal Medicine Unit of Medicine Faculty at Universidad de los Andes was conducted. After obtaining an informed consent from the patients a clinical examination that included measurements of periodontal pocket depth, clinical attachment level and gingival bleeding was performed. The patients were classified according to the severity of periodontitis and metabolic control of diabetes as determined by an average of 3 of glycosylated haemoglobin tests. Microbial technique was performed by chain reaction of polymerase. Results: In the group of patients examined the most prevalent bacteria were, Treponema denticola and Tannerella forsythia (65.2 percent), followed by Porphyromonas gingivalis (17.3 percent) and Aggregatibacter actinomycetemcomitans (13 percent). Patients with poor glycemic control had a greater presence of Treponema denticola, Tannerella forsythia, Porphyromonas gingivalis and Agreggatibacter actinomycetemcomitans and an increase in the rate of bleeding on probing. Conclusions: In the group of diabetic patients studied, the most prevalent bacteria were Treponema denticola and Tannerella forsythia. Type 2 diabetic patients with moderate and poor glycemic control had a higher presence of these microorganisms, compared to groups with higher levels of glycemic control.

Efecto de la arginina 8 por ciento-carbonato de calcio y del fluoruro de sodio al 5 por ciento en la reducción de la hipersensibilidad dentinaria post terapia periodontal: ensayo clínico / Effect of 8 percent arginine, calcium carbonate and 5 percent sodium fluoride on the reduction of the dentine hipersensitivity post periodontal therapy: clinical trial

Objetivo: El objetivo de este estudio clínico fue evaluar y comparar la eficacia en la reducción de la hipersensibilidad dentinaria de la arginina al 8 por ciento-carbonato de calcio, monofluorfosfato (1.450 ppm) en comparación con un grupo control tratado en base a un barniz de flúor (22.600 ppm) y un dentífrico fluorado (1.450 ppm), 3 veces al día durante un minuto, en pacientes con hipersensibilidad radicular en forma inmediata a la terapia periodontal mecánica (medición basal) y a las 4 semanas respectivamente. Materiales y Método: Estudio clínico aleatorizado de grupos paralelos, con 4 semanas de seguimiento, en el cual se reclutaron 20 pacientes con diagnóstico de periodontitis crónica leve a moderada, en tratamiento periodontal mecánico con presencia de recesiones gingivales a nivel de incisivos, caninos o premolares. A todos ellos, previa firma de consentimiento informado y en forma inmediata a los pulidos radiculares, se les aplicó el test térmico de chorro de aire con la jeringa de aire de la unidad dental a nivel de las recesiones gingivales con hipersensibilidad. La molestia o dolor fue determinado mediante la utilización de una escala visual análoga, realizada en forma inmediata a los pulidos radiculares (medición basal). Los pacientes fueron aleatoriamente asignados a uno de los siguientes grupos: grupo control, se les aplicó barniz de flúor (22.600 ppm) en todas las recesiones gingivales y se les indicó un dentífrico fluorado (1.450 ppm); grupo experimental, a quienes se les aplicó pasta tópica de arginina y carbonato de calcio (8 por ciento) a nivel de las recesiones gingivales, complementado con el uso de un dentífrico cuyo componente activo es la arginina al 8 por ciento-carbonato de calcio. Todos los pacientes fueron evaluados 4 semanas posterior a la aplicación y utilización domestica de los agentes des-sensibilizantes por un único examinador. Resultados: Ambos grupos experimentaron una disminución en la sensibilidad dentinaria, sin...

Aim: The aim of this clinical study was to evaluate and to compare the efficacy in reducing the dentine hypersensitivity of an 8 percent arginine, calcium carbonate, 1.450 ppm sodium monofluorophosphate dentifrice with topical application and twice-daily brushing, with a negative control toothpaste containing calcium carbonate and 1.450 ppm fluoride as MFP, after periodontal treatment (baseline) and four weeks respectively. Methods: A four-week clinical study with 20 subjects with diagnosis of slight to moderate chronic periodontitis under mechanical periodontal treatment and presence of gingival recessions in incisors, canines or premolars, stratified based on baseline tooth sensitivity. Subjects brushed with either a 1.450 ppm fluoride dentifrice or a marketed 8 percent arginine calcium carbonate dentifrice twice daily for approximately one minute. At screening, baseline and weeks four, subjects' tooth sensitivity was determined through both evaporative (Schiff and Visual Analogue Scale [VAS]). The same examiner throughout the study performed subject assessments using each stimulus. Results: Both subject groups exhibited significant reductions from baseline to four weeks in dentine hypersensitivity. However, patients who received 8 percent arginine calcium carbonate therapy, exhibited a greater reduction, with a 60 percent of individuals lacking of pain and with a final median of 0 in comparison with the 5 percent fluoride varnish and fluoride toothpaste group in which a 100 percent of subjects felt some degree of pain, presenting a final medium VAS scale of 2.

Trasplante renal 1988 - 2008 / Kidney transplantation 1988 2008

Evaluación retrospectiva de 575 trasplantes (TX), 64,3 por ciento con donante cadavérico (DC), en 550 pacientes (311 varones) edad por x: 10.8 más menos 4.2 años, efectuados entre 1988 y 2008. edad por de donante: DC 22.5 más menos 14 años y DVR: 37.3 más menos 7.7 años. Principales causas de IRC: nefropatía por reflujo: 34,1 por ciento, hipo-displasia: 15.1 por ciento, SUH; 12.9 por ciento, GSF: 9.82 por ciento, glomerulonefritis varias: 16.4 por ciento. Inmunosupresion: en la mayoría de los pacientes, Cicloporina A; Azatioprina o micofenolato mofetil o ácido micofenólico y esteroides con linfo o timoglobulina secuencia en TXDC y profilaxis con gaciclovir en riesgo de infección por CMV. La sobrevida actuarial funcional renal (SA) a 1.3 a 5 años fue 96.5 por ciento, 94.4 por ciento y 86,2 por ciento TX DVR y 90,1 por ciento, 85,5 por ciento y 77.6 por ciento TX DC, p= 0.04, similar a resultados en EEUU (NAPRCTS 1999 - 2002). La GSF con 45.5 por ciento de recurrencia del síndrome nefrótico, tuvo inferior SA al 5to año, p= 0.001, comparado con otras etiologías de IRC. Los TX sin diálisis (D) previa, p= 0.003. Tuvieron trombosis 2.61 por ciento de los TX, más frecuentes con DPCA pre tx que con hemo D o sin diálisis, p= 0.01, con TXDC, p= 0.02 y con TX de donantes < de 6 años, p = 0.02. Los pacientes que requirieron diálisis post trasplante, tuvieron mayor creatinina al año D: 1.8 más menos 2.27 mg/dl.SD: 1.19 más menos 1.2, p < 0.01, e inferior SA al quinto año, p=0.001. Con tiempo de isquemia fria superior a 24 horas, 31,6 por ciento de los DC necesitaron diálisis. El rechazo celular agudo se dianosticó en el 14,8 por ciento de los pacientes. Las causas más frecuentes de fracaso del trasplante fueron: nefropatía crónica (69,8 por ciento) asociado a inadecuada adherencia en 54.7 por ciento, trombosis (12.6 por ciento), recurrencia (5.9 por ciento), ausencia de función (5 por ciento) rechazo severo (5 por ciento)Desarrollaron enfermedad. (AU)

Trasplante renal en pacientes pediátricos glomerulosclerosis focla y segmentaria / Kidney transplantation in pediatric patients with focal segmental glomerulosclerosis

La glomerulosclerosis focal y segmentaria (GSFS) es en Argentina la 3er cuasa de insuficiencia Renal Crónica (IRCT) en niños luego de las malformaciones y el SUH. Se ha señalado una peor sobrevida del injerto renal en pacientes con IRCT secundaria a GSFS post TX. El objeto primario de este trabajo fue evaluar la sobrevida alejada de injerto y paciente en niños con IRCT secundaria a GSFS trasplantad os y compararla con la de niños con IRCT de otras causas trnasplantados. También se evaluó el impacto de la recidiva del sindrome nefrótico, el tipo de donante y la necesidad hemodiálisis en la sobrevida del paciente de injerto. Se incluyeron los 534 trasplantes renales efectuados en el Hospital Juan P. Garrahan desde el 1/12/1988 hasta el 31/12/2007. Se definió como recurrencia del SN luego del TX a una proteinuria de 24 horas > a 50 mg/kg/día e hipoalbuminemia (< a 2.5 g/d). Para analizar la sobrevida de injerto y paciente se utilizó método de Kaplan Meier y test de log Rank para determinar significación estadística de causa una de las categorías evaluadas. Se estimó a Hazar Ratio (HR) de pérdida de injerto para: recurrencia GSFS, tipo de donante, necesidad de dialisis (dos primeras semanas post TX), y remisión de la proteinura. Se efectuaron 56 TX en 51 pacientes (48 por ciento mujeres) con GSFS, como causa de IRCT con una edad promedio TX de 10.97 más menos 4.28 años; 34 recibieron un injeto DC (64 por ciento). Se observó recurrencia del SN en 23/53 (43 por ciento). En el grupo con GSFS más la sobrevida del injerto a 1 ,3,5, y 10 años fue del 79 por ciento, 71 por ciento, 62 por ciento y 31 por ciento respectivamente, significativamente peor que la del grupo sin GSFS: 93 por ciento, 86 por ciento, 82 por ciento y 60 por ciento. En el grupo GSFS más se perdieron el 49 por ciento de los injertos comprado el 24.7 por ciento del grupo GSFS (p<0.05). Los pacientes con GSFS trasplantados con DC tuvieron peor sobrevida del injerto.(AU)