DNA methylation profiles of genes associated with angiogenesis in the samples of placenta in pregnancies complicated by intrauterine growth restriction.

BACKGROUND: Impairment in placental angiogenesis is blamed for the etiopathogenesis of intrauterine growth restriction (IUGR). AIM: To assess the genes related to angiogenesis in placental biopsies of pregnancies complicated by IUGR that could be aberrantly methylated and adversely affect placental angiogenesis. METHODS: The methylation profiles of soluble fms-like tyrosine kinase-1 (sFLT-1), vascular endothelial growth factor (VEGF), and the placental growth factor (PIGF) were evaluated using Illumina MiSeq™ System in placental biopsies from term IUGR pregnancies without preeclampsia (n = 18) and healthy controls (n = 17). DNA was isolated from samples of tissue collected from the fetal side of the placenta. In the targeted regions, we have identified 30, 24, and 29 CpG islands (CpGi) within sFLT-1, VEGF and PIGF genes, respectively. CpGi which are most methylated in the promoter regions of three genes were selected for the study from the database http://www.ensembl.org. RESULT(S): IUGR fetuses had significantly lower placental and fetal birth weight than controls. The promoter of sFLT-1 at three CpGi and VEGF at six CpGi were the regions with significant methylation differences between IUGR and control placentas. sFLT-1 was hypermethylated at 265 and 352 CpGi; however, hypermethylation was lower in IUGR group compared to control group at this position. sFLT-1 was hypomethylated at 456 CpGi in IUGR group and hypermethylated at the same region in control group. VEGF was hypomethylated at 668, 703, and 710 CpGi in control and IUGR groups; however, hypomethylation at these positions was significantly higher in control group compared to IUGR. 776, 845, and 863 CpGi of VEGF promoter were significantly hypermethylated in IUGR group whereas hypomethylated in control group. The methylation profile of PIGF did not differ between the groups. After adjustment for the factors known to affect fetal birth weight, DNA methylation of VEGF 668 CpGi had a significant negative association with fetal birth weight in the control and the IUGR group and a positive association with IUGR pregnancies. CONCLUSION(S): Our results do not support the hypothesis that altered DNA methylation in the placental angiogenic genes is a major mechanism generally involved in IUGR. Only a specific region (at 668 CpGi) corresponding to the promoter of VEGF may serve as an epigenetic marker of IUGR and may be involved in the mechanism of IUGR. Large sample-sized studies are needed to understand the effects of DNA methylation on placental gene function and how they might influence fetal growth.

Management of vesicovaginal fistulas after gynecologic surgery.

OBJECTIVE: In developed nations, surgery, especially gynecologic procedures, is the major cause of vesicovaginal fistulas (VVFs). We retrospectively evaluated our treatment modalities for VVF repair caused by a gynecologic surgery, and discussed the reasons of selecting certain surgical techniques and their outcomes. MATERIALS AND METHODS: We compared the surgical procedure preferences of surgeons and their results with patient and surgeon characteristics for the management of VVFs after an inciting gynecologic surgery in Süleyman Demirel University Hospital, Isparta over a 10-year period. The surgical procedures were undertaken in departments of urology and obstetrics and gynecology. RESULTS: Abdominal repair was chosen for 65%, vaginal repair for 25%, and laparoscopic repair for 10% of patients. For the 75% of the patients that urologists operated, they chose the abdominal route. The mean parity number of patients who underwent abdominal repair was lower than that for vaginal repairs (p<0.05). For the patients managed with the vaginal route, 20% had a Martius flap, and 80% had a simple excision and repair. For patients operated via the abdominal route, 18% needed omental flap; no tissue interposition was used for the rest. The mean hospitalization time was less in patients managed with transvaginal repair (3.4 days) compared with transabdominal repair (9.2 days) (p<0.05). CONCLUSION: The choice of repair method depends on surgeon's training (gynecology vs. urology). The vaginal route should be the first choice because it does not compromise the success rate and the mean hospitalization time is less. For the transvaginal approach, access to the lesion is the most important factor for the success of the procedure. No flap is needed for tissues that appear well vascularized.

The effects of different restorative materials on the detection of approximal caries in cone-beam computed tomography scans with and without metal artifact reduction mode.

OBJECTIVES: The aim of this study was to investigate the influence of artifacts produced by different restorative materials on the detection of approximal caries in cone-beam computed tomography (CBCT) scans with and without the application of an artifact-reduction (AR) option. STUDY DESIGN: Ninety-eight noncavitated premolar and molar teeth were placed with approximal contacts consisting of 2 sound or carious teeth and 1 mesial-occlusal-distal restored tooth with resin-modified glass-ionomer cement (RMGIC), amalgam, composite, ceramic-based composite (CBC), or computer-aided design-computer-aided manufacturing (CAD-CAM) zirconia materials in between. The teeth were scanned with a CBCT system with and without the AR option. Images were evaluated by 2 observers. The teeth were histologically evaluated, and sensitivity, specificity, and areas under the receiver operating characteristic (ROC) curve were calculated according to the appropriate threshold. RESULTS: Specificity and sensitivity values for contact surfaces ranged from 0-48.39 and 82.93-98.40, respectively. The AR option affected (P < .05) approximal caries detection of the amalgam, composite, CAD-CAM, and CBC groups in contact surfaces and composite and RMGIC groups in noncontact surfaces. CONCLUSION: Artifacts produced by different restorative materials could affect approximal caries detection in CBCT scans. Use of the AR option with CBCT scans increases the accuracy of approximal caries detection.

Effect of Different Contact Materials on Approximal Caries Detection by Laser Fluorescence and Light-Emitting Diode Devices.

OBJECTIVE: The aim of this in vitro study was to investigate the influence of the adjacent tooth surface on pen type laser fluorescence (LFpen) and light-emitting diode (LED) device readings in detecting approximal caries lesions in permanent teeth. BACKGROUND DATA: Early detection of noncavitated dental caries is important, because disease progression can be easily halted at this stage with certain applications, such as fluoride therapy, antibacterial therapy, dietary changes, or low-intensity laser irradiation. MATERIALS AND METHODS: A total of 87 permanent molars with 156 approximal surfaces were assessed with LED- and LF-based devices in contact with sound tooth surfaces (the control group) as well as approximal amalgam, composite, zirconia, and full ceramic restorations. All teeth were assessed once by one trained examiner. After the LF and LED assessments, the teeth were histologically evaluated using stereomicroscopy as the gold standard. The sensitivity, specificity, accuracy, and area under the receiver operating characteristics (ROC) curve were calculated according to the appropriate thresholds (T1, sound surface or enamel caries; T2, dentin caries). RESULTS: For the LFpen device, higher sensitivity and accuracy was found when the adjacent surface was sound at the T1 threshold and no significant differences were found among accuracy at the T2 threshold. For the LED-based device, no significant differences were found among sensitivities at the T1 threshold. At the T2 threshold, specificity was higher when the adjacent tooth had a zirconia restoration. CONCLUSIONS: It was found that both devices could be used effectively for evaluating approximal surfaces with adjacent restored teeth, regardless of the different kinds of restorative materials.

Maternal serum copeptin concentrations in early- and late-onset pre-eclampsia.

OBJECTIVE: Early-onset pre-eclampsia is primarily associated with placental dysfunction, whereas late-onset pre-eclampsia is defined as a maternal constitutional disorder. As a protein cosynthesized with vasopressin, copeptin is a potential marker of metabolic syndrome and insulin resistance, which shares similar risk factors with pre-eclampsia. The aim of this study was to investigate the copeptin levels in patients with early-onset and late-onset pre-eclampsia. MATERIALS AND METHODS: A total of 80 pregnant women receiving antenatal and obstetric care were recruited. The patients were subdivided into four groups: Early-onset pre-eclampsia (n = 20), late-onset pre-eclampsia (n = 20), and two control groups of similar gestational ages for both pre-eclamptic groups (n = 20 in each group). The maternal serum copeptin levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The mean copeptin levels were 0.92 ± 0.57 ng/mL and 1.65 ± 0.95 ng/mL in the early-onset and late-onset pre-eclampsia groups, respectively. These values were higher compared with the control groups (0.54 ± 0.25 ng/mL and 1.15 ± 0.94 ng/mL, respectively). However, the difference was only statistically significant in the early-onset pre-eclampsia group (p = 0.011). Copeptin levels were associated only with gestational age and systolic-diastolic blood pressure. CONCLUSION: Our results suggest that copeptin levels might be useful in the evaluation of the severity of pre-eclampsia. However, copeptin might be involved in early- rather than late-onset pre-eclampsia.

Bond strengths of a self-etching adhesive to dentin surfaces treated with saliva, blood, and different hemostatic agents.

The aim of this study was to evaluate the microtensile bond strengths of a self-etching adhesive to dentin surfaces after treatment with 4 different hemostatic agents in the presence of saliva and blood. After testing, no significant differences were found between the mean bond strength of Clearfil SE (CSE) Bond resin adhesive to normal dentin and those of CSE to dentin treated with the hemostatic agents ViscoStat Clear, Astringedent, or Astringedent X (P > 0.05). However, the mean bond strength of CSE Bond to dentin treated with Ankaferd Blood Stopper (ABS) was significantly greater than those of the other groups (P < 0.05). Thus, while 3 of the tested hemostatic agents did not have significant effects on the bond strength of composite resin to dentin, ABS increased the bond strength of CSE Bond to dentin.

Evaluation of the bond strength between aged composite cores and luting agent.

PURPOSE: The aim of this study was to evaluate effect of different surface treatment methods on the bond strength between aged composite-resin core and luting agent. MATERIALS AND METHODS: Seventy-five resin composites and also seventy-five zirconia ceramic discs were prepared. 60 composite samples were exposed to thermal aging (10,000 cycles, 5 to 55℃) and different surface treatment. All specimens were separated into 5 groups (n=15): 1) Intact specimens 2) Thermal aging-air polishing 3) Thermal aging- Er:YAG laser irradiation 4) Thermal aging- acid etching 5) Thermal-aging. All specimens were bonded to the zirconia discs with resin cement and fixed to universal testing machine and bond strength testing loaded to failure with a crosshead speed of 0.5 mm/min. The fractured surface was classified as adhesive failure, cohesive failure and adhesive-cohesive failure. The bond strength data was statistically compared by the Kruskal-Wallis method complemented by the Bonferroni correction Mann-Whitney U test. The probability level for statistical significance was set at α=.05. RESULTS: Thermal aging and different surface treatment methods have significant effect on the bond strength between composite-resin cores and luting-agent (P<.05). The mean baseline bond strength values ranged between 7.07 ± 2.11 and 26.05 ± 6.53 N. The highest bond strength of 26.05 ± 6.53 N was obtained with Group 3. Group 5 showed the lowest value of bond strength. CONCLUSION: Appropriate surface treatment method should be applied to aged composite resin cores or aged-composites restorations should be replaced for the optimal bond strength and the clinical success.

Elution of monomer from different bulk fill dental composite resins.

OBJECTIVE: The purpose of this study was to evaluate the elution of Bis-GMA, TEGDMA, HEMA, and Bis-EMA monomers from six bulk fill composite resins over four different time periods, using HPLC. METHODS: Six different composite resin materials were used in the present study: Tetric Evo Ceram Bulk Fill (Ivoclar Vivadent, Amherst, NY), X-tra Fill (VOCO, Cuxhaven, Germany), Sonic Fill (Kerr, Orange, CA, USA), Filtek Bulk Fill (3M ESPE Dental Product, St. Paul, MN), SDR (Dentsply, Konstanz, Germany), EQUIA (GC America INC, Alsip, IL). The samples (4mm thickness, 5mm diameter) were prepared and polymerized for 20s with a light emitted diode unit. After fabrication, each sample was immediately immersed in 75wt% ethanol/water solution used as extraction fluid and stored in the amber colored bottles at room temperature. Ethanol/water samples were taken (0.5mL) at predefined time intervals:10m (T1), 1h (T2), 24h (T3) and 30 days (T4). These samples were analyzed by HPLC. The obtained data were analyzed with one-way ANOVA and Tukey HSD at significance level of p<0.05. RESULTS: Amount of eluted Bis-EMA and Bis-GMA from Tetric Evo Ceram Bulk Fill and amount of eluted TEGDMA and HEMA from X-tra Fill higher than others composites (p<0.05). SIGNIFICANCE: Residual monomers were eluted from bulk fill composite resins in all time periods and the amount of eluted monomers was increased with time.