Evaluation of sex differences in patients with ST-elevated myocardial infarction: an observational cohort study in Amsterdam and surrounding region.

INTRODUCTION: Women with ST-elevation myocardial infarction (STEMI) present with different symptoms compared to men. This can result in delays in diagnosis and in the timely treatment of women. The aim of this study is to examine these differences, including the short- and long-term mortality in women and men. METHODS: This quality registry study included all patients with STEMI who received primary percutaneous coronary intervention in 2015 or 2016 in Amsterdam and the surrounding region. RESULTS: Three PCI centres and the Emergency Medical Service in Amsterdam participated. In total, 558 men (71%) and 229 women (29%) were included. Women were on average 7 years older than men (68 vs 61 years, p < 0.001), and suffered more often from hypertension (46% vs 34%, p = 0.002) and monovascular disease (69% vs 57%, p = 0.002). A higher percentage of men were current smokers (41% vs 49%, p = 0.043). Patient delay, system delay and overall ischaemic times were similar in both women and men (medians: 51, 94 and 157 min, respectively). Initiation of treatment was achieved within 90 min after STEMI diagnosis in 85% of patients (87% in women, 85% in men). Thirty-day and 1­year mortality adjusted hazard ratio for women versus men was 1.60 (95% CI 0.9-3.0) and 1.24 (95% CI 0.8-2.0), respectively. DISCUSSION: Recognition of cardiac complaints remains challenging for patients. In the Amsterdam region, time delays and mortality were not significantly different between men and women presenting with STEMI. These results are in contrast to findings in similar registries. This suggests that implementation of current knowledge and national campaigns are effective in increasing awareness of the signs and symptoms suggestive of myocardial infarction.

A novel multimodular methodology to investigate external cervical tooth resorption.

AIM: To introduce a multimodular combination of techniques as a novel minimal invasive approach to investigate efficiently and accurately external cervical resorption (ECR). METHODOLOGY: One case of a central incisor with extensive external cervical resorption was selected to demonstrate the potential of a comparative novel study methodology. ECR diagnosis was based on clinical inspection, digital radiography and cone-beam computed tomography (CBCT). After extraction, the tooth was investigated using microfocus computed tomography (micro-CT), nano-CT and hard tissue histology. These techniques were compared for their accuracy and applicability to highlight their advantages and disadvantages. RESULTS: Nano-CT was more effective than micro-CT and CBCT for detailed ex vivo exploration of ECR. The reparative tissue, pericanalar resorption resistant sheet (PRRS), pulp tissue reactions, resorption channels and their interconnection with the periodontal ligament space were accurately visualized by detailed processing and analysis of the nano-CT data set with Dataviewer and CTAn software. Nano-CT analysis provided better insight in the true extent of the resorption, based on quantitative measurements and 3D visualization of the tooth structure. Nano-CT imaging results were similar to hard tissue histology at the mineralized tissue level. To clarify the dynamic phenomenon of reparative tissue formation and substitution of the resorbed tissues, nano-CT needed to be associated with hard tissue histology. CONCLUSION: Nano-CT is a fast and minimal invasive technique for the ex vivo analysis and understanding of ECR and is complementary with hard tissue histology. A combined approach of clinical and CBCT examination, with nano-CT and histological mapping measurements, can provide an ideal platform for future ECR imaging and exploration studies.

Fast and sensitive LC-MS/MS method measuring human mycotoxin exposure using biomarkers in urine.

A direct, fast and sensitive LC-MS/MS method was developed to measure biomarkers for mycotoxin exposure in human urine. In total, 32 biomarkers were quantitatively or semi-quantitatively measured in 32 urine samples of Belgian volunteers using two injections. All urine samples contained deoxynivalenol-15-glucuronide, the major detoxification metabolite of deoxynivalenol, in the ng/mL range. Also deoxynivalenol-3-glucuronide and de-epoxy-deoxynivalenol-glucuronide were present in, respectively, 90 and 25% of the samples, while deoxynivalenol was detected in 60% of the samples, in lower concentrations. Deoxynivalenol glucuronides were the major biomarkers for deoxynivalenol exposure. Ochratoxin A was detected in 70% of the samples in pg/mL. Citrinin and/or dihydrocitrinone were detected in 90% of the samples, also in concentrations of pg/mL. The presence of ochratoxin A and citrinin was confirmed by a second method using sample cleanup by immunoaffinity columns, followed by LC-MS/MS. Our data show that humans are much more exposed to citrinin than realized before and suggest further work on citrinin exposure in relation with ochratoxin A exposure, as both mycotoxins are nephrotoxic.

External cervical resorption: an analysis using cone beam and microfocus computed tomography and scanning electron microscopy.

AIM: To provide a three-dimensional representation of external cervical resorption (ECR) with microscopy, stereo microscopy, cone beam computed tomography (CT), microfocus CT and scanning electron microscopy (SEM). SUMMARY: External cervical resorption is an aggressive form of root resorption, leading to a loss of dental hard tissues. This is due to clastic action, activated by a damage of the covering cementum and stimulated probably by infection. Clinically, it is a challenging situation as it is characterized by a late symptomatology. This is due to the pericanalar protection from a resorption-resistant sheet, composed of pre-dentine and surrounding dentine. The clastic activity is often associated with an attempt to repair, seen by the formation of osteoid tissue. KEY LEARNING POINTS: Cone beam CT is extremely useful in the diagnoses and treatment planning of ECR. SEM analyses provide a better insight into the activity of osteoclasts. The root canal is surrounded by a layer of dentine that is resistant to resorption.

Playing wind instruments as a potential aetiologic cofactor in external cervical resorption: two case reports.

AIM: To present two cases of external cervical resorption (ECR) on maxillary incisors, in which the primary aetiologic factor is suggested to be pressure trauma by frequently playing wind instruments. SUMMARY: The exact aetiological spectrum of ECR is still poorly understood. For resorption to occur, a defect in the cementum layer (trigger) is a likely prerequisite. Whilst the mechanism for continuation (stimulus) is still unclear, knowledge of potential predisposing factors is important in assessing patients at risk. Pressure generated by playing wind instruments could present an aetiological factor in ECR because it affects the cervical region of the root surface. The cases that are presented may confirm this hypothesis and the extent of resorption defects is shown by cone-beam computer tomography (CT) and micro-focus CT imaging techniques.

Void detection in root fillings using intraoral analogue, intraoral digital and cone beam CT images.

AIM: To compare void detection in root fillings using different radiographic imaging techniques: intraoral analogue, intraoral digital and cone beam CT (CBCT) images and to assess factors influencing small void detection. METHODOLOGY: Two straight root canals in canine teeth were prepared. Calibrated steel wires of five different diameters (200, 300, 350, 500, 800 microm) were inserted respectively in the canal after the injection of a sealer. To simulate filling voids of known dimensions, the wires were removed after the sealer had set. Each sample was imaged, using a Minray X-ray tube (Soredex, Helsinki, Finland) at optimal clinical settings combined with Vistascan PSP (Dürr Dental, Bietigheim-Bissingen, Germany), Digora Optime PSP (Soredex), Sigma CCD (Instrumentarium, Tuusula, Finland) and E-speed films (Agfa-Gevaert, Mortsel, Belgium). The teeth were also imaged using CBCT (3D Accuitomo, Morita, Japan). A generalized mixed model and ANOVA analysis were used on the acquired data (Tukey-Kramer correction). RESULTS: There was no evidence that the factor 'root level' affected void detection in root fillings. 'Void size' was a main determining factor as all voids larger than 300 microm were determined with all techniques. For the smaller voids, there were significant differences between the 5 imaging techniques at different void sizes and different root levels. CONCLUSIONS: Void size and imaging technique were main determining factors. Voids larger than 300 mum were determined with all imaging techniques. For small void detection, all digital intraoral techniques performed better than intraoral analogue and CBCT images.

Towards the development of innovative multi-mycotoxin reference materials as promising metrological tool for emerging and regulated mycotoxin analyses.

The interest in LC-MS/MS multi-mycotoxin methods unveiled an urgent need for multi-mycotoxin reference material. A multi-fusariotoxin, including deoxynivalenol (DON); zearalenone (ZEN); T-2 toxin (T-2); HT-2 toxin (HT-2); enniatin A, A1, B, and B1 (ENNs); and beauvericin (BEA), contaminated wheat flour was obtained by inoculation Fusarium spp. strains. The candidate material has successfully passed the homogeneity test and submitted to an international interlaboratory study achieved by 19 laboratories from 11 countries using their routine analytical method. The dispersion of the results for ZEN and BEA did not allow the derivation of reliable consensus values, while the assignment was only possible for DON, HT-2, T-2, and ENN A. No link was found between the methods used by the participants and the results. Significant changes in dry matter contents (≥±1.4 % of the initial dry matter) and significant changes in ergosterol contents (≥±10 %) did not occur. Using the mycotoxin contents in wheat flour stored at -80 °C as reference values, statistically significant decreases were observed only for T-2 contents at +24 °C, in contrast to the storage at -20 and +4 °C. For the other involved toxins, the candidate material was found to be stable at -20, +4, or +24 °C. Based on the T-2 decreases, a shelf life of 6 years was derived from isochronous study when the material is kept at -20 °C. At room temperature (e.g., +24 °C) or higher, this time validity drastically decreases down to 6 months. The development of this metrological tool is an important step towards food and feed quality control using multi-mycotoxin analyses. In vivo animal experiments using multi-mycotoxin-contaminated feeds dealing with the carryover or mitigation could further benefit from the methodology of this work.

Screening survey of co-production of fusaric acid, fusarin C, and fumonisins B1, B2 and B3 by Fusarium strains grown in maize grains.

Fusarium species isolated from Belgian maize were screened for their ability to produce fusarin C, fusaric acid, fumonisins B1 (FB1), FB2 and FB3 in maize grains. First, cultivation of Fusarium species in Myro liquid medium allowed overcoming the shortage of the standard of fusarin C on the market. All Fusarium verticillioides produced much higher contents of mycotoxins in Myro compared to Fusarium graminearum or Fusarium venenatum. The optimization of the LC-MS/MS method resulted in low limits of detection and quantification for fusarin C, fusaric acid, FB1, FB2 and FB3 determination in maize grains. Its application for screening the potential toxin production ability evidenced that the concentrations of the analytes were significantly increased at various levels when F. verticillioides strains were cultivated in maize grains and reached 441 mg kg(-1) for fusaric acid, 74 mg kg(-1) for fusarin C, 1,301 mg kg(-1) for FB1, 367 mg kg(-1) for FB2 and 753 mg kg(-1) for FB3.

Effect of photo-activated disinfection on endodontic pathogens ex vivo.

AIM: To test the hypothesis that photo-activated disinfection (PAD) has a bactericidal effect on pathogens inoculated in root canals, with emphasis on biofilm formation/destruction. METHODOLOGY: Root canals of extracted teeth (n = 38) were prepared (size 30, 0.10 taper), autoclaved, divided into three groups and two negative controls inoculated (Streptococcus anginosus, Enterococcus faecalis or Fusobacterium nucleatum) and treated (PAD, laser, dye or positive control) according to a cross-sectional design. Resultant colony-forming unit counts were associated with observations of cell structural changes using environmental scanning electron microscopy (ESEM) on inoculated dentinal surfaces (n = 22, two controls) before (1, 2 and 6 days of incubation) and after treatment with PAD. RESULTS: Treatment of root canals with PAD (15 J) caused a significant reduction of the bacterial load, resulting in a 93.8% kill of S. anginosus (P < 0.0001), a 88.4% kill of E. faecalis (P < 0.05) and a 98.5% kill of F. nucleatum (P < 0.0001), but no sterilization. Laser alone had no significant effect on the load nor did the dye without laser. The ESEM experiment showed that individual cells or monolayers were easily eliminated with PAD. But when biofilms were present (2 and 6 days for E. faecalis, 6 days for S. anginosus), bacterial eradication was substantially reduced in deep layers. CONCLUSIONS: Photo-activated disinfection is not an alternative but a possible supplement to the existing protocols for root canal disinfection as the interaction between light (diode laser) and associated dye (TBO) provides a broad-spectrum effect. Some endodontic pathogens that grow as single-species biofilms, however, are difficult to eradicate.