Dentin moisture conditions strongly influence its interactions with bioactive root canal sealers

Objectives@#It is known that bioactive materials interact with the dentin to undergo biomineralization. The exact role of moisture in this interaction is unknown. Here, we investigate the effects of dentin moisture conditions on the dislocation resistance of two bioactive root canal sealers (MTA Fillapex [Angelus Solucoes Odontologicas] and GuttaFlow BioSeal [Colténe/Whaledent AG]) at 3 weeks and 3 months after obturation. @*Materials and Methods@#Mandibular premolars (n = 120) were prepared and randomly divided into 3 groups based on the dentin condition: group 1, dry dentin; group 2, moist dentin; group 3, wet dentin. Each group was divided into 2 subgroups for root canal filling: MTA Fillapex and GuttaFlow BioSeal. Dislocation resistance was evaluated by measuring the push-out bond strength at 3 weeks and 3 months. Failure modes were examined under a stereomicroscope. Data were statistically analyzed by Kruskal-Wallis test with a significance level of 5%. @*Results@#Moist dentin resulted in higher bond strength values for both materials at both time points. This was significantly higher than wet and dry dentin for both the sealers at the 3 months (p < 0.05), while at 3 weeks it was significant only for GuttaFlow Bioseal. The different moisture conditions demonstrated similar trends in their effects on the dislocation resistance of the 2 root canal sealers. @*Conclusions@#The dentin moisture conditions had a significant impact on its interaction with the bioactive materials tested. Maintaining moist dentin, but not dry or wet dentin, may be advantageous before the filling root canals with bioactive sealers.

Percutaneous endovascular therapy for symptomatic chronic total occlusion of the left subclavian artery

<p><b>INTRODUCTION</b>Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery.</p><p><b>METHODS</b>Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included.</p><p><b>RESULTS</b>Overall, 16 patients (10 male, 6 female; mean age 56 ± 13 years) underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery. 6 (37.5%) had arm claudication, 8 (50.0%) had vertebrobasilar insufficiency and 2 (12.5%) had coronary steal. 18 balloon-expandable stents were implanted in 15 patients. Central luminal passage was not achieved in one patient because of the subintimal position of the guidewire (procedural success rate 93.8%). There were no procedure-related complications. Mean preprocedural and postprocedural systolic blood pressure differences between the upper extremities were 37 ± 13 (range 25-60) mmHg and 11 ± 9 (range 5-38) mmHg, respectively; the improvement was statistically significant. Outpatient follow-up revealed one asymptomatic restenosis at two years. The patency rate at two years was 93.3%.</p><p><b>CONCLUSION</b>Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results.</p>

Echocardiographic evaluation of biventricular function in patients with euthyroid hashimoto's thyroiditis

Objective: The aim of this study was to evaluate the left [LV] and right [RV] ventricular function in euthyroid Hashimoto's thyroiditis [eHT] patients

Subjects and Methods:Forty-five patients diagnosed with eHT and 45 age- and gendermatched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities [E, A, E', A'], isovolumic relaxation [IVRT] and contraction [IVCT] times, ejection time [ET], deceleration time [DT], Tei index, pulmonary acceleration time [PAcT] and tricuspid annular plane systolic excursion [TAPSE] of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signedrank test

Results:Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index [0.6 +/- 0.2 vs. 0.4 +/- 0.1, p < 0.001], higher DT [p < 0.001] and IVRT [p < 0.001] values, and higher E/E' ratios [p = 0.04]. In contrast, the peak E wave velocity [p = 0.02], E/A ratio [p = 0.01] and ET [p = 0.02] were significantly lower in the eHT group than amongst the controls. The RV, Tei index [0.40 +/- 0.11 vs. 0.28 +/- 0.07, p < 0.001], TAPSE [2.0 +/- 0.3 vs. 2.2 +/- 0.2 mm, p < 0.001], PAcT [124.3 +/- 22.6 vs. 149.4 +/- 18.3 ms, p < 0.001], A' [p = 0.007] and IVCT [p = 0.001] were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio [p = 0.01], E' [p = 0.03] and E'/A' ratio [p = 0.001] were significantly lower in the eHT patients than the control group

Conclusions:This study demonstrated that both RV and LV functions were impaired in patients with eHT

Relation between Left Atrial Remodeling in Young Patients with Cryptogenic Stroke and Normal Inter-atrial Anatomy / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: To investigate an association between left atrial (LA) structural and P wave dispersion (PWD) during sinus rhythm, and electrical remodeling in cryptogenic stroke (CS) patients. METHODS: Forty CS patients and 40 age- and sex-matched healthy controls were enrolled. P wave calculations were based on 12-lead electrocardiography (ECG) at a 50-mm/s-paper speed with an amplitude of 10 mm/mV. Difference between the maximum and minimum P wave duration was the P wave dispersion (PWD=Pmax-Pmin). LA deformation was evaluated by speckle tracking echocardiography within 3 days of the acute event. RESULTS: PWD was 30.1+/-7.0 ms and 27.4+/-3.5 ms in CS and control group (P=0.02), whereas LA maximum volume index [LAVImax] was 20.4+/-4.5 mL/m2 and 19.9+/-2.4 mL/m2 in CS and control group, respectively (P = 0.04). While global peak LA strain was [pLA-S] (LA reservoir function) 41.4 +/- 6.3% and 44.5 +/- 7.1% in CS and control group, (P = 0.04), global peak late diastolic strain rate values [pLA-SRa] (LA pump function) were 2.5 +/- 0.4% and 2.9 +/- 0.5% in CS and control group, respectively (P = 0.001). A mild and a strong negative correlation between global pLA-S and LAVImax (r=-0.49; P<0.01), and between PWD and global pLA-S (r = -0.52; P < 0.01), respectively, was observed in CS. CONCLUSIONS: Increased PWD is associated with impaired LA mechanical functions and enlargement, and involved in the pathophysiology of AF or an AF-like physiology in CS.

Evaluation of Cardiac Functions with Tissue Doppler Imaging in Prediabetic Subjects

BACKGROUND AND OBJECTIVES: The aim of the present study was to evaluate left ventricle systolic and diastolic function, using tissue Doppler echocardiography (TDE), in relation to blood glucose status in prediabetic patients who had no evidence of heart disease by conventional echocardiography (CE). SUBJECTS AND METHODS: We included 60 patients (30 female, 30 male) and 20 healthy controls (10 male, 10 female). All participants were randomised into four groups according to their oral glucose tolerance test. Group-I consisted of those patients who had only impaired fasting glucose (IFG). group-II consisted of patients who had only impaired glucose tolerance (IGT) and group-III consisted of patients who had both IFG and IGT, that is so-called combined glucose intolerance. Group-IV included the healthy controls. All subjects underwent both CE and TDE. RESULTS: No significant differences were found among the four groups in terms of CE. There was no significant difference between group-IV and group-I with respect to the early peak diastolic velocity (Ea) of medial mitral annulus (11.65+/-0.66 vs. 9.72+/-1.58, p>0.05), whereas a statistically significant difference was found between group-IV and group-II (11.65+/-0.66 vs. 9.06+/-1.07, p<0.001) and between group-IV and group-III (11.65+/-0.66 vs. 9.74+/-1.09, p<0.05). CONCLUSION: Diastolic myocardial dysfunction in prediabetic patients may be identified by quantitative TDE before the appearance of CE indices of myocardial dysfunction.

Two Cases of Multivessel Coronary Artery Ectasias Resulting in Acute Inferior Myocardial Infarction

The incidence of multivessel coronary artery ectasias (CAEs) among patients undergoing coronary artery angiography is very rare. All three coronary vessels can be affected by CAE, but most patients have an isolated arterial ectasia, commonly the right coronary artery. In this report we present two cases with inferior myocardial infarction that was likely caused by thrombotic occlusion of CAEs.

Prevalence of neuropathy and relationship with risk factors in diabetic patients: a single-center experience

To determine the rate of distal symmetrical polyneuropathy [DSP] in patients with type 2 diabetes mellitus, to evaluate the role of history, neurological examination and the electrodiagnostic methods in the diagnosis of DSP, and to determine the association between electromyography-supported neuropathy [ESN], neuropathic complaints [NCs] and risk factors. A total of 191 type 2 DM patients [109 female, 82 male; mean age 58.7 +/- 10 years] were recruited. The NCs were recorded. All patients had electromyographic [EMG] examinations. The relationship between ESN, NCs and risk factors were evaluated. Of the 191 patients, 83 [43.5%] had DSP on EMG examinations and 92 [48.2%] patients suffered from NCs. Among the ESN patients, a significant relationship existed with HbA1[c] level, illness duration, smoking, male gender or insulin usage [p < 0.05] but not with age, hypertension, hypercholesterolemia or hypertriglyceridemia. The frequency of NCs was higher in patients with ESN. There was also a significant association between NCs and ESN [p < 0.05]. The presence of NCs was not related to age, gender, smoking, hypertension, hypercholesterolemia and hypertriglyceridemia [p > 0.05] but NCs were correlated to HbA1[c] level, illness duration and insulin usage [p < 0.05]. Our data show that a strong association exists between the presence of DSP and illness duration, HbA1[c], smoking, thereby indicating that cessation of smoking and near normal glycemic control would be additional precautions to delay the beginning or progression of polyneuropathy

Three years of experience with a mobile angiograph in a center without on-site surgical back-up

The safety of percutaneous coronary interventions [PCI] performed in centers without surgical back-up is controversial, but data from several western countries indicates that this approach can be extended to a larger number of hospitals. We assessed the safety and efficacy of performing angiography and PCI with a mobile C-arm angiograph in a center without on-site surgical back-up, and compared our data with that reported in the literature. We retrospectively analyzed 1485 coronary angiograms and 172 PCI procedures performed in our center from January 2001 to May 2003 using a mobile angiograph. Half of the patients that have undergone PCI had refractory unstable angina and one-third had acute myocardial infarction [AMI]. The safety of PCI was assessed by the analysis of in-hospital complications [death, urgent need for repeated revascularization, AMI with or without ST elevation and stroke].The PCI procedures were considered effective when the post-PCI residual stenosis did not exceed 50% with distal Thrombolysis in Myocardial Infarction [TIMI] grade 3 flow. In patients who underwent diagnostic coronary angiography there were no deaths, anaphylatic shock, acute renal failure or major ischemic complications. In patients who underwent PCI, the mortality rate was 1.1% [2 deaths], two patients [1.1%] developed acute MI with ST segment elevation, one patient [0.5%] underwent repeated PCI and three patients [1.7%] were referred for urgent by-pass surgery. Conclusions: Diagnostic and PCI procedures can be safely performed using a mobile angiograph. The efficacy and safety requirements of PCI, performed in a center without an on-site surgical back-up facility using a mobile angiograph were similar to other data reported in the literature