Effects of continuous chelation on the instrumentation of curved canals with a martensitic NiTi file system: an ex vivo micro-CT evaluation.

This study aimed to evaluate the influence of continuous chelation on apical transportation and centrality in shaped curved canals prepared with a martensitic file system and evaluated by micro-CT. Twenty-four lower molar canals with a curvature of 25º-40º were scanned pre-operatively with micro-CT and divided into 2 groups according to two different irrigation regimens (n = 12). Group 1 was irrigated with NaOCl, group 2 with Dual Rinse. All canals were prepared with VDW.ROTATE system. The samples were scanned post-operatively and evaluated at 1, 3 and 5 mm from the apex to determine apical transportation and canal centrality using VG Studio software. Statistical analysis was performed with SPSS software using the non-parametric Mann-Whitney test. No statistically significant differences were found between the two groups for both apical transportation and canal centrality at any of the levels studied (p < 05). The use of continuous chelation during the instrumentation of the canals with martensitic alloy files does not produce greater transportation and does not generate changes in centralization compared to NaOCl-only irrigation. Combined chelation and disinfection while shaping with martensitic NiTi can simplify the irrigation regimen without inducing iatrogenic aberrations.

Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA.

AIM: To compare soft-tissue dissolution by sodium hypochlorite, with an EDTA intermediate rinse, with or without activation with passive ultrasonic activation (PUI) or sonic activation using the Endoactivator (EA) or Eddy tips (ED). METHODOLOGY: The root canals of eighty-three human maxillary central incisors were chemo-mechanically prepared and the teeth split. A standardized longitudinal intracanal groove was created in one of the root halves. Eighty-three porcine palatal mucosa samples were collected, adapted to fit into the grooves and weighed. The re-assembled specimens were randomly divided into four experimental groups (n = 20), based on the final rinse: no activation; EA; PUI; ED, using 2.5% sodium hypochlorite, with an EDTA intermediate rinse. A control group (n = 3) was irrigated with distilled water without activation. The solutions were delivered using a syringe and needle 2 mm from working length. Total irrigation time was 150 s, including 60 s of activation in the specific groups. The study was carried out at 36 ± 2 °C. The porcine palatal mucosa samples were weighed after completion of the assays. Student paired t-test and anova were used to assess the intra- and intergroup weight changes. The multiple comparisons were evaluated using Bonferroni correction (α = 0.05). RESULTS: Weight loss occurred in all experimental groups. Irrigant activation resulted in greater weight loss when compared to the nonactivated group [vs. EA (P = 0.001); vs. PUI (P < 0.001); vs. ED (P < 0.001)]. No significant differences were found amongst the different activation systems. CONCLUSIONS: Activation increased the tissue-dissolving activity of irrigants from artificial grooves in root canals of maxillary central incisors.

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.

Identification of SLC7A7, encoding y+LAT-1, as the lysinuric protein intolerance gene.

Lysinuric protein intolerance (LPI; OMIM 222700) is a rare, recessive disorder with a worldwide distribution, but with a high prevalence in the Finnish population; symptoms include failure to thrive, growth retardation, muscle hypotonia and hepatosplenomegaly. A defect in the plasma membrane transport of dibasic amino acids has been demonstrated at the baso-lateral membrane of epithelial cells in small intestine and in renal tubules and in plasma membrane of cultured skin fibroblasts from LPI patients. The gene causing LPI has been assigned by linkage analysis to 14q11-13. Here we report mutations in SLC7A7 cDNA (encoding y+L amino acid transporter-1, y+LAT-1), which expresses dibasic amino-acid transport activity and is located in the LPI region, in 31 Finnish LPI patients and 1 Spanish patient. The Finnish patients are homozygous for a founder missense mutation leading to a premature stop codon. The Spanish patient is a compound heterozygote with a missense mutation in one allele and a frameshift mutation in the other. The frameshift mutation generates a premature stop codon, eliminating the last one-third of the protein. The missense mutation abolishes y+LAT-1 amino-acid transport activity when co-expressed with the heavy chain of the cell-surface antigen 4F2 (4F2hc, also known as CD98) in Xenopus laevis oocytes. Our data establish that mutations in SLC7A7 cause LPI.

Non-type I cystinuria caused by mutations in SLC7A9, encoding a subunit (bo,+AT) of rBAT.

Cystinuria (MIM 220100) is a common recessive disorder of renal reabsorption of cystine and dibasic amino acids. Mutations in SLC3A1, encoding rBAT, cause cystinuria type I (ref. 1), but not other types of cystinuria (ref. 2). A gene whose mutation causes non-type I cystinuria has been mapped by linkage analysis to 19q12-13.1 (Refs 3,4). We have identified a new transcript, encoding a protein (bo, +AT, for bo,+ amino acid transporter) belonging to a family of light subunits of amino acid transporters, expressed in kidney, liver, small intestine and placenta, and localized its gene (SLC7A9) to the non-type I cystinuria 19q locus. Co-transfection of bo,+AT and rBAT brings the latter to the plasma membrane, and results in the uptake of L-arginine in COS cells. We have found SLC7A9 mutations in Libyan-Jews, North American, Italian and Spanish non-type I cystinuria patients. The Libyan Jewish patients are homozygous for a founder missense mutation (V170M) that abolishes b o,+AT amino-acid uptake activity when co-transfected with rBAT in COS cells. We identified four missense mutations (G105R, A182T, G195R and G295R) and two frameshift (520insT and 596delTG) mutations in other patients. Our data establish that mutations in SLC7A9 cause non-type I cystinuria, and suggest that bo,+AT is the light subunit of rBAT.

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.

Cystinuria calls for heteromultimeric amino acid transporters.

The proteins rBAT (related to bo,+ amino acid transporter) and 4F2hc (the heavy chain of the surface antigen 4F2) are homologous proteins that induce amino acid transport in Xenopus oocytes. The role of rBAT in amino acid transport is substantiated by the fact that mutations in the gene encoding it cause cystinuria, a heritable disease characterised by high concentrations of cystine in the urine. Structural and functional evidence supports the hypothesis that both rBAT and 4F2hc proteins form part of heterodimeric amino acid transporters. There is new evidence that the functional unit of system y+L amino acid transporter is a disulfide bridge-dependent complex of 4F2hc with a Xenopus oocyte plasma membrane protein.

Effect of dietary grape pomace and vitamin E on growth performance, nutrient digestibility, and susceptibility to meat lipid oxidation in chickens.

Grape pomace (GP) is a source of polyphenols with powerful antioxidant capacity. An experiment was conducted to investigate the effect of inclusion of GP at levels of 5, 15, and 30 g/kg and alpha-tocopheryl acetate (200 mg/kg) in a corn-soybean basal diet on growth performance, protein and amino acid digestibilities; antioxidant activity of diet, serum and excreta, lipid oxidation of breast and thigh meats during refrigerated storage, and liver vitamin E concentration. Growth performance and protein and amino acid digestibilities were not affected among the different treatments. Total intake and digestibility of extractable polyphenols in the birds fed the GP diet were increased compared with birds fed supplemented and unsupplemented vitamin E diets. Antioxidant activity in vitamin E and GP diets and excreta exhibited higher scavenging free radical capacity than the control diet using 3-ethylbenzthiazoline-6-sulfonic acid and ferric reducing antioxidant power methods. Lipid oxidation (malondialdehyde concentration) in breast and thigh meats was lower in the birds fed the supplemented vitamin E diet than the control diet after 1, 4, and 7 d of refrigerated storage. Results showed a linear reduction of lipid oxidation in breast and thigh meats at 4 and 7 d with increasing content of GP in the diet. Oxidative stability in breast and thigh meats at 1, 4, and 7 d of storage was equivalent or less effective in GP diets compared with the vitamin E diet. A linear increase was observed in liver alpha-tocopherol concentration with increasing content of GP in the diet, but it was inferior to the supplemented vitamin E diet. In conclusion, the results showed that a dietary inclusion rate up to 30 g/kg of GP did not impair chickens growth performance and protein and amino acids digestibilities and increased antioxidant activity in diet and excreta. Grape pomace and vitamin E diets reduced the lipid oxidation of meat during refrigerated storage and increased liver alpha-tocopherol concentration, although these effects were greater, in some cases, by adding vitamin E to the diet.

Neurophysiological monitoring of lumbosacral spinal roots during spinal surgery: continuous intraoperative electromyography (EMG).

INTRODUCTION: Neurophysiological monitoring during spinal surgery reduces the associated neurological complications. Continuous EMG recording has developed an useful technique for spinal root monitoring PATIENTS AND METHODS: Fifty four patients who underwent surgery for several lumbosacral spinal lesions (low and high degree spondylolisthesis, spinal stenosis, degenerated or herniated lumbar discs) were studied to evaluate the effectiveness of continuous EMG recording in monitoring spinal root function during surgery. Electrical root or screw stimulation was also performed in nine of them. To correlate surgical spinal root lesion with a precise EMG injury activity an animal study with 5 pigs was performed; lesion was produced by prolonged spinal root traction. RESULTS: In the porcine group EMG discharges lasting longer than one minute after cessation of root traction was noted in 74% of spinal root levels (neurotonic discharges or pseudo-rhythmic activity in 70% of the cases). Spinal root lesion was demonstrated through EMG three weeks after surgery. In the patient group pathological-significant EMG activity was not recorded in any case during monitoring. Mechanical or chemical root stimulation during surgery produced brief lasting EMG bursts of no pathological significance. Only a patient developed a mild acute L5-S1 radiculopathy after surgery (1 false negative) and post-operative deficit was not observed in the rest. Electrical stimulation of spinal roots and screws allowed to identify root level and prove the adequate placement of screws. CONCLUSION: Spontaneous and evoked EMG recordings are simple techniques that provide continuous information about lumbosacral spinal roots function throughout surgery.

In vitro activity of linezolid in combination with doxycycline, fosfomycin, levofloxacin, rifampicin and vancomycin against methicillin-susceptible Staphylococcus aureus.

The objective of this paper was to investigate the in vitro effects of linezolid combined with five antistaphylococcal antibiotics--doxycycline, fosfomycin, levofloxacin, rifampicin and vancomycin--upon methicillin-susceptible Staphylococcus aureus (MSSA). Five MSSA isolates from clinical specimens of human infections--hf008, hf095, hf295, hf602 and hf946--were used in this study. The checkerboard method was used to assess synergism between linezolid and the five antibiotics, and time-kill curves were carried out with the most active combinations. Indifference was the most common result achieved by the checkerboard method when linezolid was combined with rifampicin, vancomycin or doxycycline. The combination with levofloxacin yielded antagonism for two of the five isolates. However, four isolates showed synergy for the combination of linezolid plus fosfomycin with a fractional inhibitory concentration index (FICI) > or = 0.5. Neither linezolid nor fosfomycin alone inhibited growth at 1/4x minimum inhibitory concentration (MIC); but the combination of both drugs at 1/4 the respective MIC showed a synergistic bacteriostatic effect, a 2-3 log(10) decrease with respect to the most active antibiotic alone. In summary, the combination of subinhibitory.

Impact of delay to treatment upon survival in 1067 patients with breast-cancer.

The medical records of 1067 patients with breast cancer were reviewed to evaluate the influence of delay between first symptom and first treatment upon survival. Three delay intervals were considered: <3 months; 3-6 months and >6 months. At a follow-up of 120 months, survival analyses identified a statistically significant difference (p=0.029) favoring patients with <3 months delay in the whole cohort, and in the group of women aged 50 or older (p=0.001). No differences were found when survival according to delay was considered within each clinical stage. A Cox multivariate analysis revealed that performance status, stage, age and menopausal status were significant predictors of survival for the whole group of patients. However, delay was an independent prognostic factor in patients with age greater-than-or-equal-to 50. In summary, 38/1067 patients (3.1%) could have been adversely affected by a >3 months delay between first symptom and first treatment. Better survival rate for patients with a short delay would obey to a greater number of patients in favorable stages and a higher proportion of women aged 50 or older in this group.

Phase II trial of 4'-epi-doxorubicin in locally advanced or metastatic gastric cancer.

Patients with locally advanced or metastatic gastric adenocarcinoma received an i.v. bolus of 4'-epi-doxorubicin, 75/mg/m2/cycle, every 21 days. Partial responses were observed in 5 of 23 evaluable patients (21.7%). Treatment was generally well tolerated and toxicity was mild. The response rate to epirubicin appears to be very similar to that reported for doxorubicin. Larger doses of epirubicin could be safely used in future studies, and further evaluation of epirubicin in phase III trials is indicated.

La anestesia local con sedación como técnica de primera elección en la cirugía de hernia inguinal en régimen ambulatorio: rápida recuperación postoperatoria, alta seguridad y optimización de recursos / Local anesthesia with sedation as elective procedure in day ucise groin hernioplasty: quick postoperative recovery, high security and saving resources

Introducción: La anestesia local con sedación (ALS) se considera la técnica ‘gold estándar’ en la hernioplastia inguinal unilateral abierta, a pesar de que la anestesia raquídea (AR) sigue siendo la técnica más empleada en la práctica clínica diaria. La ALS parece aportar importantes ventajas con respecto a la AR, especialmente en el ámbito de la cirugía sin ingreso (CSI). El objetivo de este trabajo es demostrar los beneficios de ALS frente a AR en la hernioplastia inguinal en cuanto a los tiempos postoperatorios y las complicaciones postoperatorias en una unidad quirúrgica que realiza el 100 % de su actividad en régimen de Cirugía Mayor Ambulatoria (CMA). Material y método: 25 pacientes sometidos a hernioplastia inguinal con ALS y 25 con AR fueron incluidos en un estudio observacional retrospectivo comparativo. El estado clínico (ASA), el tipo de anestesia, los tiempos de recuperación en la Unidad de Recuperación Postanestésica (URPA), en la Unidad de Readaptación al Medio (URM) y durante su convalecencia en domicilio fueron comparados. Se registró cualquier complicación detectada en el periodo postoperatorio hasta el alta definitiva en ambos grupos. Resultados: Todos los pacientes fueron intervenidos según lo previsto. El tiempo de estancia media en URPA y URM, así como el tiempo transcurrido para recuperar la actividad normal tras la intervención, fueron significativamente inferiores en el grupo ALS. Las complicaciones fueron menos frecuentes y menos severas en el grupo ALS. Conclusión: Este trabajo afianza la ALS como técnica más adecuada que la AR para la intervención de hernia inguinal unilateral abierta en régimen de CMA (AU)

Introduction: Local anesthesia with sedation (LAS) is the ‘gold standar’ anesthetic technique in open groin hernioplasty, even if raquidea anesthesia (RA) is actually the most frequent anesthesia technique at the moment. LAS could contribute several advantages in this procedure especially in day case surgery. The main goal of this report is to show the benefits of LAS for groin hernioplasty regarding postoperative recovery times and outcomes in an only outpatient surgery unit. Material and methods: A 25 LAS group and a 25 RA group were enrolled in this observational retrospective comparative study. The clinical status (ASA), anesthetic technique, the Postanesthetic recovery Unit (PARU) recovery time, time before discharge, and time required to normal activity were compared. Any postoperative outcome was recorded. Results: All patients were operated as planned. Recovery times were shorter in the LAS group. Outcomes were more infrequent as well less severe in the LAS group. Conclusion: This report demonstrates that LAS is the most suitable anesthetic technique for unilateral open groin herniorraphy in Day case (AU)