Novel case of combination antibiotic therapy for treatment of a complicated polymicrobial urinary tract infection with one organism harboring a metallo-ß-lactamase (MBL) in a pregnant patient.

Carbapenem resistance due to metallo-beta-lactamases (MBLs) is a global phenomenon and an important challenge for antibiotic therapy (Boyd et al., 2020 [1]). While previous reports have demonstrated both in vitro and in vivo synergy using the combination of ceftazidime-avibactam and aztreonam against Stenotrophomonas maltophilia, an MBL-harboring organism, this treatment strategy has not been reported during pregnancy (Mojic et al., 2017 [2], [3], Mojica et al., 2016 [4], Alexander et al., 2020 [5]). We describe a 33-year-old pregnant female with polymicrobial, bilateral pyelonephritis caused by Stenotrophomonas maltophilia and other gram-negative bacteria. The organisms were eradicated with the combination of ceftazidime-avibactam and aztreonam followed by successful delivery with no observed adverse effects in either mother or child post-partum.

Mechanical property evaluation of pressable restorative ceramics.

OBJECTIVE: The aim of this study was to evaluate the flexure strength under static and cyclic loading and the fracture toughness under static loading of six restorative ceramic materials. Specifically the intent was to compare four leucite (K2O.Al2O(3).4SiO2) strengthened feldspathic (pressable) porcelains (OA, OI, E, and FP) to a low fusing feldspathic porcelain (F) and an experimental (EC) lithium disilicate containing ceramic. METHODS: All materials were tested as a control in air and distilled water (without aging) and after three months aging in air or distilled water to determine flexure strength and fracture toughness. A staircase approach was used to determine the cyclic flexure strength. EDS and SEM analysis were conducted on the polished and fracture surfaces. RESULTS: The mean flexure strength for the controls in air and water (without aging or cyclic loading) ranged from 67 to 99 MPa, except the experimental ceramic that was twice as strong with a mean flexure strength of 191-205 MPa. For the mean fracture toughness, the range was 1.1-1.9 MPa/m0.5 with the experimental ceramic being 2.7 MPa/m0.5. The effect of testing in water and aging for three months caused a moderate reduction in the mean flexure strength (6-17%), and a moderate to severe reduction in the mean fracture toughness (5-39%). The largest decrease (15-60%) in mean flexure strength was observed when the samples were subjected to cyclic loading. SIGNIFICANCE: The lithium disilicate containing ceramic had a significantly higher flexure strength and fracture toughness when compared to the four pressable leucite strengthened ceramics and the low fusing conventional porcelain. All of the leucite containing pressable ceramics did provide an increase in mean flexure strength (17-19%) and mean fracture toughness (3-64%) over the conventional feldspathic porcelain. Further, the influence of testing environment and loading conditions implies that these ceramic materials in the oral cavity might be susceptible to cyclic fatigue, resulting in a significant decrease in the survival time of all-ceramic restorations.

Relative solubilities of hybrid ionomers and compomers by acid impingement.

The purpose of this investigation was to determine the relative erosion/solubility for hybrid glass-ionomers and a compomer using the jet-impingement technique with lactic acid of various molarities. The materials studied included Dyract, Duet, Vitremer, Advance, Fuji-II LC, and Fuji-I, Ketac Cem and Modern Tenacin as the control. Data were analysed using ANOVA and Tukey's comparison test. Results indicated that depth of erosion/solubility with hybrid glass-ionomers and compomers was not measurable by the normal procedure. Similarly, weight changes were not detectable at 0.002, 0.02 and 0.05 M (except for Advance at 0. 05 M). All glass-ionomers materials and the compomer revealed weight changes at 0.1 M after 24 h, in the following increasing order: Dyract < Fuji-II LC=Duet < Advance < Vitremer. It was concluded that weight loss is a better parameter to characterize these new hybrids glass-ionomers and compomers for erosion/solubility by jet-impingement. In addition, a lactic acid of minimum 0.1 M as a test solution is required to generate 24 h-data that can be measured in most laboratories and thus used for statistical comparison.

Study of devitrification of Dicor glass.

The nucleation and crystallization of tetrasilicic fluormica crystals in the Dicor group of glass ceramics is not as well understood as the crystallization sequence of trisilicic mica in the Macor group of glass ceramics. The main aim of this investigation was to obtain kinetic data of crystallization and to examine the devitrification process at different stages of heat treatment during non-isothermal heating. The kinetic parameters, such as the activation energy, Ec, the reaction order, n, and the frequency factor, v, for the devitrification reaction were computed using the Johnson-Mehl-Avrami (JMA) equation and the data from differential thermal analysis (DTA). The crystallization at different stages of devitrification was evaluated by scanning electron microscopy (SEM) observations, and Fourier transform infrared (FTIR) spectroscopy with KBr-reflectance technique. All DTA curves at different heating rates showed a single exothermic crystallization peak, just above the glass transition temperature in the temperature range of 745-850 degrees C. Linear relationships between the logarithm of heating rate and the reciprocal of temperature, and the logarithm of temperature rise and the reciprocal of temperature were observed. The computation of kinetic parameters gave the values for activation energy, Ec = 203 kJ mol-1, the reaction order n = 3.4 +/- 0.20 and the frequency factor v = 2.88 x 10(11) s-1. SEM observation showed precipitation of crystals in the DTA run which were considerably finer (approximately 0.1 micron) than the block shaped mica plates (approximately 4 microns) observed in the sample subjected to recommended non-isothermal-isothermal heating cycle. The FTIR spectra of beyond the exothermic peak DTA run samples, and the completely cerammed samples showed two additional peaks at wave numbers of 705 and 671 cm-1 compared with the ascast glass and the samples heated before the onset of the exothermic peak. Similar peaks in FTIR spectra also appeared from MgF2- powder at the same wave numbers. Based upon these results, it is proposed that during non-isothermal heating a spinodal decomposition of glass matrix occurs, which is followed by the exothermal precipitation of round tetrasilicic fluormica crystals by a cellular precipitation mechanism.

Phenotypic and functional properties of murine gamma delta T cell clones derived from malaria immunized, alpha beta T cell-deficient mice.

Six murine T cell clones expressing gamma delta TCR were generated from malaria immunized, alpha beta T cell-deficient mice. Phenotypic characterization of these clones has revealed that, in contrast to conventional alpha beta T cells, there is a considerable degree of heterogeneity among these gamma delta clones with regard to their surface markers and their lymphokine profile. One clone was found to display significant anti-parasite activity in vivo upon adoptive transfer. We attempted to determine whether the protective clone differs in one or more key characteristics from the non-protective clones. Although no obvious pattern peculiar to the protective gamma delta clone was observed, it appears that more than one parameter may, in combination, define a distinct protective phenotype, and thus explain the functional difference between the protective and non-protective gamma delta clones.

Heats of reactions between dentine bonding agents and tooth components.

The heat of reaction of dentine bonding agents alone and dentine bonding agents with dentine, hydroxyapatite and collagen were measured using a differential scanning calorimeter (DSC) in the isothermal mode. The bonding agents were Scotchbond and Panavia Ex adhesives, and GC Fuji-II glass ionomer cement. The heat of reaction for Scotchbond and Panavia Ex bonding adhesives were 44.3 and 6.9 mcal/mg, respectively. Furthermore, results support the view that the glass ionomer cements adhere to tooth structure by chemical bonding.

Leaching from glass ionomer cements.

This study compared the electrical conductivities, pH and leached ion (F-, Ca, Al, Si) concentrations in supernatant liquids obtained from four glassionomer cements, a buffered ionomer cement, a polycarboxylate cement and a zinc phosphate cement, at three different levels of settings. The result indicated that the measured parameters are highest for the unset condition of cements and decreases as the set condition is approached, except for pH, which shows the opposite trend. Two pulp sensitive glassionomer cements, Chem Bond and Ketac Cem showed high Ca:F ratios as well as high Ca and F concentrations. Further, it is suggested that the cytotoxicity of leached F-, Si, Al and Zn at high concentration and at low pH may induce sensitivity in tooth structure.

Effects of endurance exercise on bone mass and mechanical properties in intact and ovariectomized rats.

Exercise may play a role in the prevention of bone fractures in postmenopausal osteoporosis. The effects of endurance exercise on bone properties were assessed in 9-month-old sham-operated (SH) and ovariectomized (OVX) rats. The rats were either kept sedentary (SED) or were exercised (EX) on a rodent treadmill at 21 m/minute, 7% grade, 40 minutes/day, 4 days/week for 3 months. Bone mineral (by ash weight), morphometry, and biomechanical properties (by three-point bending) were evaluated after excision of bones at sacrifice. Ovariectomy resulted in a loss of bone mineral in femur, tibia, and fourth lumbar vertebra (L4), but biomechanical (force, deformation, stress, strain, and modulus of elasticity) and morphometric (length, cortical and medullary area, and moment of inertia) properties of femur were maintained. The ash weight of femur and tibia, but not L4, as well as femur yield and maximum force and moment of inertia, were improved in OVX-EX rats compared to OVX-SED animals. In SH rats exercise had no influence on ash weight of any of the three bones or femur morphometric properties, yet femur maximum force and plastic deformation were significantly enhanced compared to SH-SED rats. The results of the present study suggest that endurance exercise has beneficial effects on the bone mineral as well as biomechanical properties (femur yield and maximum force) during early stages after ovariectomy and improves the bending strength of the intact femur without an effect on bone mineral in sham-operated rats.

Effects of two non-endurance exercise protocols on established bone loss in ovariectomized adult rats.

The effects of non-endurance exercise on bone properties were evaluated in 9-month-old sham-operated (SH) and ovariectomized (OVX) rats. The studies were started 3 months postsurgery, after bone mass was decreased in OVX rats. The sham and OVX rats were either kept sedentary (SED) or were trained to run with one of two protocols: 12 m/minute, 50 minutes/day, 4 days/week (low intensity, frequent, EX-1); or 21 m/minute, 40 minutes/day, 1 day/week (moderate intensity, infrequent, EX-2). A group of seven rats evaluated at the beginning of the study served as baseline control. The bone mineral was assessed by the ash weight of the left femur, tibia, and 4th lumbar vertebra. Biomechanical (strength, deformation, stress, strain, and stiffness) and morphometric (length, cortical and medullary area, moment of inertia) properties were evaluated for the right femur. There was a significantly lower bone mineral and mechanical properties in OVX-SED (n = 7) than in SH-SED (n = 10) rats. The OVX-EX-1 (n = 6) rats had higher ash content of femur and tibia than OVX-SED rats, but the change was significant only for tibia. The EX-2 had no effect on the ash content, but femur stress was higher in OVX-EX-2 (n = 8) than in OVX-SED rats. The femur yield force and deformation were improved in OVX rats with both exercise protocols, whereas the vertebra ash weight, femur strain, modulus of elasticity, length, cortical area, and moment of inertia were not changed.(ABSTRACT TRUNCATED AT 250 WORDS)

Fracture toughness, diametrical strength, and fractography of amalgam and of amalgam to amalgam bonds.

Chevron-notch fracture toughness, diametrical tensile strength and fractography were evaluated for bulk amalgams and for bonds formed between new and 1-day-old amalgams of the same type. Three types of bonded specimens were prepared: 1) by mechanically roughening the 1-day-old amalgam with 600-grit paper; 2) using a new mercury-rich amalgam; and 3) using a bonding resin, either 4-META or a phosphate ester monomer. Similar values in bond properties were obtained with all bonding techniques for two commercial dispersed-phase bonded amalgams, one of which contained palladium; however, bulk fracture toughness of the palladium-containing amalgam was significantly less than for the palladium-free amalgam. This result reveals that the bonding of amalgam to amalgam, at least for these two amalgams, is a surface-related phenomenon, and thus, the traditional reporting of bonding properties as a percentage of bulk properties loses meaning. Short-rod geometry was more representative of the interfacial bond properties since these samples fractured within the interfacial bonds, while diametrical strength samples often fractured slightly away from the interface. The use of bonding resins did not improve bond fracture toughness for either amalgam, while the diametrical strength improved for one of the amalgams. The use of mercury-rich amalgam significantly improved the fracture toughness over all other techniques for one amalgam while proving to be similar to a 600-grit preparation for the second amalgam.(ABSTRACT TRUNCATED AT 250 WORDS)

The antimicrobial effect of an iron-binding agent on Streptococcus mutans.

The antimicrobial activity of 2,2'-bipyridine, an iron-binding agent, was investigated by incorporating this agent into Scotchbond dental adhesive resin. The growth of Streptococcus mutans on the surface of resin, media and culture vessel was determined by optical density measurements. It was observed that 2,2'-bipyridine exhibited excellent antimicrobial properties.

Fibrin glue improves the healing of irradiated bowel anastomoses.

Many surgeons are reluctant to construct a bowel anastomosis with irradiated intestine. Previous studies have demonstrated diminished tensile strength of rat small bowel anastomoses that have been irradiated intraoperatively. To determine whether fibrin glue, a known tissue adhesive, improves the healing of these anastomoses, 69 male Sprague-Dawley rats were randomized into three anastomotic groups: Group 1, sutured ileal anastomosis without radiation or fibrin glue; Group 2, irradiated sutured ileal anastomosis without fibrin glue; and Group 3, irradiated ileal anastomosis with fibrin glue added to the suture line. Groups 2 and 3 received a single dose of 2,000 R intraoperatively. At seven days, the rats were sacrificed and the anastomotic segment was tested for breaking (tensile) strength. Anastomotic collagen content was evaluated using a hydroxyproline assay. Tensile strength results demonstrated that Group 2 was significantly weaker than Groups 1 and 3 (P = 0.001) and that the hydroxyproline content of Group 3 was significantly greater than that of Group 2 (P = 0.015). These results show that the addition of fibrin glue to an intraoperatively irradiated small bowel anastomosis improves healing, as demonstrated by both tensile strength and hydroxyproline content studies.

Effect of intraoperative radiation on the tensile strength of small bowel anastomoses.

Increasing interest in the use of preoperative or intraoperative radiation therapy for cancer has led to concerns regarding tissue healing and integrity subsequent to treatment. This is especially so for intestinal anastomoses incorporating irradiated bowel, where poor healing may lead to anastomotic disruption and sepsis. One hundred thirty Sprague-Dawley rats were randomized into five groups as follows: both limbs, one limb, or neither limb of an anastomosis received 2,000 R of radiation intraoperatively. A fourth group had a segment of small bowel irradiated, with no anastomosis; a fifth group had the gut exposed by celiotomy. The control groups and all anastomoses underwent tensile strength measurements on the seventh postoperative day, with findings as follows: no anastomosis, no irradiation, 143.75 g; no anastomosis, irradiated, 114.50 g; anastomosis, no irradiation, 85.273 g; anastomosis, one limb irradiated, 78.100 g; anastomosis, both limbs irradiated, 59.00 g. There was no statistical difference in tensile strength of the anastomosis between when neither limb and when just one limb was irradiated. However, when both limbs were irradiated, the loss of strength was statistically significant (P = 0.002). Irradiation damage scores were assigned using Black et al.'s histologic scoring system. These scores were not significantly different between the irradiated segments. Inflammation and fibrosis scores for the anastomoses were also not significantly different. These results indicate that, in rats, anastomotic healing is impaired only when both limbs of the anastomosed intestine are irradiated. The normal strength of the anastomosis with only one limb irradiated cannot be explained by differences in inflammation, fibrosis, or radiation damage and is caused by an undetermined factor.

Copper-, indium-, tin-, and calcium-fluoride admixed amalgams: release rates and selected properties.

A conventional (Minimax), two single-particle high-Cu (Summalloy and Aristaloy CR), and two dispersed-phase (Cluster and Phasealloy) amalgam alloys were each admixed with 0.5 wt% of CuF2, InF3, SnF2, and CaF2, and evaluated for F-, Cu, and Sn release, as well as for corrosion resistance, microstructure, and compressive strength. Over a 43-week interval, only Cluster revealed somewhat of a sustained F- release in artificial saliva. A ranking for F- release was Cluster (highest), Summalloy, Phasealloy, Minimax, and Aristaloy CR. The effectiveness of the F- compounds in releasing F- followed CuF2 (highest), SnF2, InF3 (1.0%), InF3, and CaF2. Amalgams with admixed CuF2 released both the most Cu and increased Sn. For three amalgams, CaF2 admixtures also increased the Cu release. Constant-potential coulometry distinguished among the different fluoride amalgams. Only Minimax revealed a significant reduction in compressive strength with two admixtures. Microstructural analysis revealed an increased pore distribution around the Ag-Cu dispersed particles, and it was assumed that the F- particles were contained within the pores, since SEM, EDS with a low element detector, and ESCA were all unable to detect the F- particles.

Effect of helium-neon and infrared laser irradiation on wound healing in rabbits.

We examined the biostimulating effects of helium-neon laser radiation (HeNe; 632.8 nm), pulsed infrared laser radiation (IR; 904 nm), and the two combined on skin wound healing in New Zealand white rabbits. Seventy-two rabbits received either 1) no exposure, 2) 1.65 J/cm2 HeNe, 3) 8.25 J/cm2 pulsed IR, or 4) both HeNe and IR together to one of two dorsal full-thickness skin wounds, daily, for 21 days. Wound areas were measured photographically at periodic intervals. Tissue samples were analyzed for tensile strength, and histology was done to measure epidermal thickness and cross-sectional collagen area. Significant differences were found in the tensile strength of all laser-treated groups (both the irradiated and nonirradiated lesion) compared to group 1. No differences were found in the rate of wound healing or collagen area. Epidermal growth was greater in the HeNe-lased area compared to unexposed tissue, but the difference was not significant. Thus, laser irradiation at 632.8 nm and 904 nm alone or in combination increased tensile strength during wound healing and may have released tissue factors into the systemic circulation that increased tensile strength on the opposite side as well.

Inhibition of bacterial colonization by antimicrobial agents incorporated into dental resins.

The antimicrobial activity of several chemical agents was determined by incorporating these agents into dentine adhesive resin and following the colonization of Streptococcus mutans on the surfaces of the resin and culture vessel, as well as in the surrounding medium, by optical density measurements. It was found that sodium fluoride and dodecylamine, an organic amine, exhibited excellent antimicrobial properties. These chemicals not only inhibited bacterial growth completely but also seemed to reduce the adhesion of the bacteria to the resin surface. A silver compound, protargin, was mildly effective in inhibiting growth of S. mutans. Copper oxide and chelating acids such as vanillic acid, syringic acid, and ethylenediamine-n, n' diacetic acid (EDDA) were not effective as antimicrobial agents against S. mutans.

Surface analysis of tarnished dental alloys.

Six crown and bridge alloys ranging in nobility between 25-63 wt % (18-45 at %) were analyzed by optical microscopy, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and secondary ion mass spectroscopy (SIMS), as well as by L*a*b* colorimetry before and after in vitro tarnishing in artificial saliva with and without additions of 0.00016, 0.016, and 1.6 % Na2S with a rotating wheel apparatus. All alloys except the lowest of 18 at % changed colors to about the same degree after 72 h of tarnishing. All alloys decreased in L*, while increased in both a* and b*, thus appearing darker and with increased redness and yellowness. This was due to localized darkening and to other products. For all alloys except one, saliva without sulfide promoted color changes more severe than for saliva with 0.016 % Na2S. For the most part, analysis by EDS was unable to detect differences between the tarnished films and the as-polished surfaces. SIMS analysis, however, showed changes in the substrate ion (Cu, Ag, Pd, and In) peak intensities. In most cases the intensities decreased and with the decrease greater with the sulfide-free saliva than with sulfide-containing. This indicated that sulfide promoted insoluble deposition of products. Changes in the Ag, Pd, and In peak intensities followed much the same pattern as with Cu. The as-polished surfaces, even though carefully prepared, showed much contamination in the form of organics, namely C, CH, N, NH, O, CHN, CN, as well as from Na, K, Ca, Si, S, Cl, and others. Most tarnished surfaces showed large increases in Na, K, and Ca, and with the sulfide-free saliva being more severe in this regard. The mass spectrum also showed peaks with atomic mass units in the range 55-58 related to only some of the tarnished surfaces.

Corrosion of dental burs in sterilizing and disinfecting solutions.

Potentiodynamic anodic polarization, SEM, and energy dispersive microanalysis techniques were used to determine electrochemical aggressiveness of disinfecting and sterilizing solutions on carbide and stainless steel burs. The importance of galvanic cell formation in carbide burs caused by mixed metal coupling was examined. The following conclusions were reached. 1. Anodic polarization methods are an effective means for discriminating among the relative corrosiveness of sterilizing and disinfecting agents on dental instruments, particularly dental burs. 2. The relative degree of corrosiveness on stainless steel burs shows Omni II and Omnicide solutions the best, Sterall and Sporicidin solutions the poorest, and Glutarex solution intermediate. Omnicide and Glutarex solutions show the least degree of corrosiveness on the carbide burs. 3. SEM analysis of ground, polished, and treated surfaces shows corrosion deposition over the soldered joint of the carbide burs. The stainless steel shank is a cathodic component of a three-way galvanic cell, whereas the silver soldered joint is an anodic component.