Chemokines and interleukin-18 are up-regulated in bronchoalveolar lavage fluid but not in serum of septic surgical ICU patients.

Our objective was to investigate the levels of chemokines (MIP1-alpha, MCP-1, and Gro-alpha), Interleukin-18 (IL-18), and Interleukin (IL-6) in bronchoalveolar lavage (BAL) fluid and serum at the onset and ongoing states of sepsis as defined by the American College of Chest Physicians/Society of Critical Care Medicine in septic surgical ICU patients. Our summary background data was to understand the significance of compartmentalized inflammatory mediator production in an immunologically active organ (lung) in comparison with levels in the systemic circulation. The study group consisted of 20 septic patients and 10 non-septic patients on surgical ICU. At the onset of sepsis, both BAL fluid and serum samples were taken and levels of MIP-1alpha, MCP-1, GRO-alpha, IL-18, and IL-6 were measured by ELISA. Furthermore, over a subsequent 8-day period, levels of these mediators were determined in serum. In some experiments, IL-18 mRNA levels were determined in peripheral blood lymphocytes (PBL) of septic and non-septic patients. At the onset of sepsis, MIP-1alpha, MCP-1, GRO-alpha, IL-18, and IL-6 levels were significantly up-regulated in BAL fluid as compared with non-septic controls. In marked contrast, with the exception of IL-18 mRNA and IL-6 peptide, there was no increase in serum levels of inflammatory mediators determined both at the onset and during the ongoing states of sepsis. Based on the present data, monitoring levels of serum chemokines and IL-18 protein as markers of sepsis might be misleading since despite their non-detection in serum, they were highly up-regulated in the lung tissue compartment. These data might underscore the role of MIP-1alpha, MCP-1, GRO-alpha, and IL-18 in the mediation of local tissue damage. Furthermore, these findings raise the notion that mediator measurement in immunologically active organs might serve as pivotal indicators of sepsis prior to the actual fulfillment of specific clinical criteria that defines the patient as being septic.

Root canal treatment of primary molars with infected pulps using calcium hydroxide as a root canal filling.

In the two case reports, pulpectomy is described as the treatment of choice for a necrotic pulp. A calcium hydroxide paste was used as root canal filling. Its simple application and subsequent good resorption during by the eruption of the permanent tooth strengthened that choice.

Clinical and microbiological caries-risk parameters at different stages of dental development.

Caries incidence and activity in general are not linear functions, but show several intensity peaks at different stages of life. The purpose of this study was to evaluate, whether the transition from the primary to the permanent dentition is accompanied by any significant changes in several clinical and microbiological parameters commonly used as predictors of caries activity. Sixty children and adolescents, aged 3 to 16, participated in the study and according to age were assigned to 4 different dentition groups (primary, early mixed, late mixed, permanent). The results indicate, that there is a significant decrease in salivary Streptococcus mutans and Lactobacillus spp. counts in the late mixed dentition group compared to the primary and the early mixed dentition group. Furthermore, in the permanent dentition group the stimulated salivary flow rate was significantly higher than in all other groups. Differences regarding plaque score and salivary buffering capacity were not significant for all groups examined. It is concluded, that the transition from the primary to the permanent dentition in general is accompanied by significant, yet temporary decline in the numbers of caries-associated microorganisms, reflecting marked differences in caries incidence and activity, previously reported by other authors.

Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesions.

AIM: This prospective clinical study explored the influence of calcium hydroxide as an interappointment dressing on the healing of periapical lesions associated with pulpless teeth that had not been endodontically treated previously. This was achieved by comparing the prognosis after a two-visit root canal treatment with that following a one-visit treatment. METHODOLOGY: Seventy-three patients were recruited having one tooth with an endodontically induced lesion. Of these patients, 67 could be re-examined. Calcium hydroxide was placed in the instrumented root canals of 31 teeth for at least one week and the treatment finished at the second visit. Thirty-six teeth were root canal treated at one visit. The criteria for success were the absence of signs and symptoms indicating an acute phase of periapical periodontitis and radiographically a periodontal ligament space of normal width. Methods for event time analysis were used to evaluate and compare the prognosis of both treatment approaches. RESULTS: The probability that complete periapical healing will take place increased continuously with the length of the observation period. In both treatment groups the likelihood that the root canal treatment yields a success within an observation time of five years exceeded 90%. A statistically significant difference between the two treatment groups could not be detected. CONCLUSIONS: From a microbiological perspective, one-visit root canal treatment created favourable environmental conditions for periapical repair similar to the two-visit therapy when calcium hydroxide was used as antimicrobial dressing. One-visit root canal treatment is an acceptable alternative to two-visit treatment for pulpless teeth associated with an endodontically induced lesion.

[Comparison of clinical and microbiological parameters for determination of actual caries risk]. / Vergleich klinischer und mikrobiologischer Parameter zur Bestimmung des aktuellen Kariesrisikos.

In 28 children and adolescents, age 4-17, the numbers of decayed tooth surfaces, filled surfaces and the extent of plaque coverage measured with a plaque scoring index were recorded as clinically assessible caries risk factors. Subsequently paraffin stimulated saliva samples were taken from the same subjects and evaluated microbiologically for their content of caries related microorganisms (S. mutans, lactobacilli). Statistical analysis of correlation revealed only weak, mostly not significant correlations between clinical and microbiological findings. The results are discussed.

Nuclear export of the DEAD box An3 protein by CRM1 is coupled to An3 helicase activity.

We have recently identified the Xenopus laevis An3 protein as a bona fide substrate for the nuclear export receptor CRM1 (Exportin 1). An3 binds directly to CRM1 with high affinity via a leucine-rich nuclear export signal located in the extreme N terminus. An3 is a member of the DEAD box family of RNA helicases, which unwind RNA duplexes. RNA unwinding is coupled to hydrolysis of nucleoside triphosphates by the helicase, and the ATPase activity of several helicases is greatly stimulated by various polynucleotides. Here we report that dATP hydrolysis by An3 is stimulated approximately 6-fold by total RNA from X. laevis oocytes, whereas poly(U) RNA fails to enhance hydrolysis, suggesting the existence of a specific RNA activator for An3. Kinetic analysis reveals that a mutation within the conserved DEAD box motif reduces the rate of dATP hydrolysis by approximately 6-fold. In accordance with this, the DEAD box mutant is unable to unwind double-stranded RNA. Microinjection of the An3 DEAD box mutant into X. laevis oocytes nuclei reveals a significantly lower export rate as compared with wild-type An3 protein. This is not because the mutant has lower affinity toward CRM1, nor is it due to altered RNA binding capacity. This suggests that nuclear export of An3 protein by CRM1 is coupled to An3 helicase activity.

Caries risk analysis: considering caries as an individual time-dependent process.

AIM: To estimate the probability that a tooth does not develop a cavitated lesion (= end-stage caries) within time periods of interest. Additionally it was of interest to assess the heterogeneity between patients, in relation to the time periods required for their teeth to develop a cavitated lesion. DESIGN: A prospective study using patient data of a clinical pedodontic course. SAMPLE AND METHODS: Forty-one patients who had been followed for at least 3 years were selected. Before initiation of therapy, affiliation to a specific risk group was checked. Nine individuals who had belonged to a high-risk group on test were excluded. Of 1968 teeth, 1378 were eligible for data evaluation. The statistical techniques applied originate from time-to-event analysis methods, including a parametric frailty approach providing estimates of the relative caries risk for each individual to develop a cavitated lesion. RESULTS: In the selected group of patients the probability that a tooth remained free of a cavitated lesion within five years ranged from 0.89 to 0.95 applying a 95% confidence interval. In the present sample the true caries risk of the patients to develop a cavitated lesion varied considerably although such variation was not expected from the individual examinations at baseline. CONCLUSION: The frailty model accounts sufficiently for the heterogeneity of each patient. The applied time-to-event methods facilitated reliable estimation of both the probability that a tooth remains free of a cavitated lesion within a certain time and the relative caries risk of an individual to develop a cavitated lesion.

Transient carpal tunnel syndrome accompanying rubella infection.

Four children are presented with otherwise uncomplicated rubella infection suffering from transient carpal tunnel syndrome. The diagnosis was confirmed by repeated measurements of sensory conduction velocity and sensory action potential amplitude. The symptoms were only nocturnal. They disappeared rapidly but the neurophysiological changes normalized slowly. The possibility of a carpal tunnel syndrome should be considered in a child with rubella complaining of numbing or tingling fingers during the night.

[Composite filling materials in animal experiments]. / Komposit-Füllungsmaterialien im Tierversuch

The pulp tolerance of the composites "Estic" (Kulzer) and "Compocap" (Vivadent) and the polyacrylatecement "Bondal" (Vivadent) was tested in a total of 97 cervical cavities in rhesus monkeys. "Bondal" was well tolerated by the pulp. Both composites when used without cement base provoked slight to moderate reactions. This could be avoided by using "Bondal" cement bases.