CARDIOGENIC SHOCK AND GLOBUS PALLIDUS INJURY AS A PRESENTATION OF CARBON MONOXIDE POISONING.

Carbon monoxide poisoning is one of the leading causes of mortality and morbidity by poisoning in the world. Signs and symptoms are nonspecific and related to impaired oxygen delivery to tissues, with the brain being the most affected organ due to its high oxygen demand. CO-Hb is a poor indicator of severity and long-term outcome, with clinicians relying more on clinical features such as level of consciousness and need for intubation, organ dysfunction and shock and also pH level. A 45-year-old female was found unconscious in her home with the fireplace lit and smoke all over the house. She was last seen well 18 hours before. She was brought to the emergency department and was admitted to the ICU in coma and cardiogenic shock, with a metabolic acidosis with hyperlactacidemia and a CO-Hb level of 15.5%. Laboratorial investigation revealed hepatic cytolysis, acute renal failure, rhabdomyolysis and a troponin I level of 338 ng/L. ECG showed no acute myocardial ischemia. Echocardiogram revealed diffuse hypokinesia with an ejection fraction of 25%. Head CT scan showed bilateral and symmetrical hypodensities of the globus pallidus. The patient underwent hyperbaric oxygen treatment with full neurological and cardiac recovery, allowing extubation 48 hours after admission. This rare severe case of coma due to carbon monoxide intoxication with globus pallidus injury and cardiogenic shock was successfully treated with hyperbaric oxygen, showing that it can be the right treatment choice in these cases, with an excellent impact on neurological and cardiac outcome.

L'intoxication au CO est une des causes principales de décès par empoisonnement dans le monde. Les signes, non spécifiques, sont dus à l'hypoxie cellulaire et le cerveau est le plus souvent atteint en raison de sa consommation d'oxygène élevée. Le taux d'HbCO est un indice peu fiable de la gravité initiale et du risque de séquelles si bien que l'on préfère se baser sur la clinique (conscience, nécessité d'intubation, dysfonctions d'organe, choc) et le pH sanguin. Une femme de 45 ans a été trouvée inconsciente à son domicile entièrement enfumé, cheminée allumée. Le dernier contact remontait à 18 heures. Elle a été hospitalisée en réanimation en coma et choc cardiogénique, avec une acidose lactique et une HbCO à 15,5%. La biologie retrouvait une cytolyse hépatique, une insuffisance rénale aiguë, une rhabdomyolyse et une troponine I à 338 ng/L. L'ECG ne trouvait pas d'ischémie, l'échocardiographie objectivait une hypokinésie globale et évaluait la fraction d'éjection à 25%. La TDM cérébrale montrait une hypodensité pallidale bilatérale. L'oxygénothérapie hyperbare (OHB) a permis une récupération neurologique et cardiaque complètes, permettant l'extubation à h48. Cette récupération complète après OHB confirme qu'il peut s'agir du traitement idoine des intoxications graves au CO, avec un excellent impact sur les devenirs cardiaque et neurologique.

Frequency of Application of AmF/NaF/SnCl2 Solution and Its Potential in Controlling Human Enamel Erosion Progression: An in situ Study.

Although several studies have demonstrated the efficacy of AmF/NaF/SnCl2 solution in inhibiting dental erosion progression, measures for further improvement in its effectiveness are paramount. Thus, this in situ study evaluated whether the protective effect promoted by the AmF/NaF/SnCl2 solution would be enhanced by increasing its frequency of use. The study was conducted with 12 volunteers, a 4-phase (5 days each) randomized, crossover model. Extraoral erosive challenges (0.5% citric acid, pH 2.6, 6 × 2 min/day) and rinsing protocol (1 or 2 × 2 min/day) were performed. Before the in situ phase, human enamel samples were subjected to an in vitro surface softening (1% citric acid, pH 4.0, for 3 min). Four treatment protocols were tested using samples in replicas (n = 12): group G1 - deionized water (negative control); G2 - NaF solution (positive control, 500 ppm F-, pH 4.5); G3 - AmF/NaF/SnCl2 solution (500 ppm F-, 800 ppm Sn2+, pH 4.5) once a day; G4 - AmF/NaF/SnCl2 solution twice a day. Tissue loss and morphological changes were determined by optical profilometry (n = 12) and scanning electron microscopy (n = 3) analysis, respectively. Data were statistically analyzed by ANOVA with subsequent pairwise comparison of treatments. Tissue loss means (±SD in µm) for each treatment protocol and statistical differences were found as follows: G1 4.55 ± 2.75, G2 4.59 ± 2.13, G3 2.64 ± 1.55, and G4 1.34 ± 1.16. Although there was no difference between the 2 AmF/NaF/SnCl2 solution application regimens (once or twice a day), application of the product twice a day was the only treatment that was able to control erosion progression, differing from the control groups.

Stability of treatments for recurrent temporomandibular joint luxation: a systematic review.

Temporomandibular joint luxation (TMJ) is the excessive anterior translation of the mandibular condyle out of its normal range of movement and away from the glenoid fossa. Once dislocation occurs, the abnormal condylar position generates reflex contractions of the masticatory muscles, which in turn hinder movement of the condyle back to its resting position. Frequent luxation episodes characterize a condition referred to as recurrent TMJ luxation. While there are several surgical and conservative therapeutic options available for recurrent TMJ luxation, a robust, evidence-based rationale for choosing one technique over another is missing. Thus, a systematic review based on the PRISMA statement was proposed in an attempt to determine which therapeutic option results in the longest time to relapse. There is no good quality evidence on which treatment options guarantee the long-term elimination of recurrent TMJ luxation. In cases of post-surgical relapse, eminectomy has often been used as a 'rescue procedure', which may mean that surgeons empirically consider this treatment to be the 'gold standard' for addressing recurrent TMJ luxation.

Antimutagenic action of the triterpene betulinic acid isolated from Scoparia dulcis (Scrophulariaceae).

The mutagenic and antimutagenic activities of triterpene betulinic acid {3b-3-hydroxy-lup-20(29)-en-28-oic} isolated from the roots of Scoparia dulcis (Scrophulariaceae) were analyzed using the somatic mutation and recombination test (SMART) in the wings of Drosophila melanogaster. The mutagenic potential of betulinic acid was evaluated at 3 different concentrations (1.64, 3.28, and 6.57 mM). Antimutagenic activity evaluation was performed by co-treatment trials in which the flies received betulinic acid at 3 different concentrations in addition to 10 mM pro-mutagenic urethane. The results demonstrated that betulinic acid was not capable of causing DNA damage. However, the frequency of small single spots, large spots, and twin spots was significantly reduced. In the high bioactivation cross, betulinic acid was significantly active and exerted enhanced antimutagenic activity, possibly as a desmutagen.

Dautrey's procedure: an alternative for the treatment of recurrent mandibular dislocation in patients with pneumatization of the articular eminence.

Temporomandibular joint (TMJ) dislocation is an involuntary forward movement of the mandible beyond the articular eminence with the condyle remaining stuck in the anterior-most position, leaving the patient unable to close their mouth. Conservative treatment for this condition includes the injection of sclerosing agents or the intramuscular administration of botulinum toxin type A, while surgical therapy requires either removal or augmentation of the articular eminence. Once the surgical treatment plan has been determined, pneumatization of the articular eminence may turn a relatively simple procedure into a great surgical challenge. We present herein the cases of two patients suffering from recurrent mandibular dislocation who happened to have pneumatization of the articular eminences. Both patients were treated with a down-fracture of the zygomatic arch, known as Dautrey's procedure, modified by the application of a miniplate connecting the displaced arch and the lateral portion of the articular eminence. Neither patient had suffered a new episode of dislocation at their most recent postsurgical visit.

Grip force control during simple manipulation tasks in non-neuropathic diabetic individuals.

OBJECTIVE: To assess hand function and grip force (GF) control in non-neuropathic diabetic individuals using traditional hand function tests and instrumented handles that provide information about the underlying neural mechanisms controlling simple manipulation tasks. METHODS: Twelve diabetic individuals (31-60 years-old) without neuropathy and 12 controls performed traditional functional tests (i.e., nine hole peg test, Jebsen-Taylor test, and maximum grip strength test) and were tested for GF control in two situations: holding a free moving instrumented handle and isometrically pulling fixed handles. Task performance in the tests and safety margin (SM - percentage of GF above the minimum needed to hold the handle) were the main dependent variables assessed. RESULTS: There was no difference between diabetics and controls in any functional test and in SM in isometric pulling task. However, diabetics presented around twice lower SM than controls in the free holding task. CONCLUSIONS: Diabetics showed no impairment in functional manipulation tasks. However, they presented a lower SM than healthy controls. SIGNIFICANCE: This lower SM suggests that diabetics may present sensory impairment that could put them at risk of losing objects during its manipulation. Also, it suggests that the applied experimental procedure is sensitive to detect mild sensory impairment in diabetics.

Evaluation of an innovative critical power model in intermittent vertical jump.

The aim of this study was to test if the critical power model can be used to determine the critical rest interval (CRI) between vertical jumps. Ten males performed intermittent countermovement jumps on a force platform with different resting periods (4.1+/-0.3 s, 5.0+/-0.4 s, 5.9+/-0.6 s). Jump trials were interrupted when participants could no longer maintain 95% of their maximal jump height. After interruption, number of jumps, total exercise duration and total external work were computed. Time to exhaustion (s) and total external work (J) were used to solve the equation Work=a+b x time. The CRI (corresponding to the shortest resting interval that allowed jump height to be maintained for a long time without fatigue) was determined dividing the average external work needed to jump at a fixed height (J) by b parameter (J/s). In the final session, participants jumped at their calculated CRI. A high coefficient of determination (0.995+/-0.007) and the CRI (7.5+/-1.6 s) were obtained. In addition, the longer the resting period, the greater the number of jumps (44+/-13, 71+/-28, 105+/-30, 169+/-53 jumps; p<0.0001), time to exhaustion (179+/-50, 351+/-120, 610+/-141, 1,282+/-417s; p<0.0001) and total external work (28.0+/-8.3, 45.0+/-16.6, 67.6+/-17.8, 111.9+/-34.6kJ; p<0.0001). Therefore, the critical power model may be an alternative approach to determine the CRI during intermittent vertical jumps.

Cartilage tissue engineering by expanded goat articular chondrocytes.

In this study we investigated whether expanded goat chondrocytes have the capacity to generate cartilaginous tissues with biochemical and biomechanical properties improving with time in culture. Goat chondrocytes were expanded in monolayer with or without combinations of FGF-2, TGF-beta1, and PDGFbb, and the postexpansion chondrogenic capacity assessed in pellet cultures. Expanded chondrocytes were also cultured for up to 6 weeks in HYAFF-M nonwoven meshes or Polyactive foams, and the resulting cartilaginous tissues were assessed histologically, biochemically, and biomechanically. Supplementation of the expansion medium with FGF-2 increased the proliferation rate of goat chondrocytes and enhanced their postexpansion chondrogenic capacity. FGF-2-expanded chondrocytes seeded in HYAFF-M or Polyactive scaffolds formed cartilaginous tissues with wet weight, glycosaminoglycan, and collagen content, increasing from 2 days to 6 weeks culture (up to respectively 2-, 8-, and 41-fold). Equilibrium and dynamic stiffness measured in HYAFF M-based constructs also increased with time, up to, respectively, 1.3- and 16-fold. This study demonstrates the feasibility to engineer goat cartilaginous tissues at different stages of development by varying culture time, and thus opens the possibility to test the effect of maturation stage of engineered cartilage on the outcome of cartilage repair in orthotopic goat models.

Pulsatile dynamic stiffness of cartilage-like materials and use of agarose gels to validate mechanical methods and models.

Stiffness is a fundamental indicator of the functional state of articular cartilage. Reported test modes include compressive incremental strain to determine the equilibrium modulus, and sinusoidal strain to determine the dynamic modulus and stress/strain loss angle. Here, initial development is described for a method recognizing that gait is pulsatile. Agarose gels have been used by others for validation or comparison of mechanical test methods and models for cartilage and proteoglycan aggregate. Accordingly, gels ranging from 0.5 to 20% agarose were prepared. Pulsatile stiffness in both indentation and unconfined compression were closely reproducible. Stiffness as a function of agarose concentration rose exponentially, as found using other methods. Indentation stiffness was higher than for unconfined compression and ranged from approximately 2.0 kPa for 0.5% gel to approximately 3,800 kPa for 20% gel. Pulsatile dynamic stiffness appears to be a useful method, although further development is needed. Agarose gel stiffness values obtained by other methods were reviewed for comparison. Unfortunately, reported values for a given agarose concentration ranged widely (e.g. fourfold) even when test methods were similar. Causes appear to include differences in molecular weight and gel preparation time-temperature regimens. Also, agarose is hygroscopic, leading to unintended variations in gel composition. Agarose gels are problematic materials for validation or comparison of cartilage mechanical test methods and models.

Effects of supplementation with ascorbic acid for a period of 120 days on the myosin-V and NADPHd positive myenteric neurons of the ileum of rats.

We investigated the effect of ascorbic acid (AA) supplementation on the NADPH-diaphorase (NADPHd) and myosin-V myenteric neurons in the ileum of rats, after 4 months of treatment. Two groups were compared, i.e. controls rats (C) and AA-treated rats (CA). Myosin-V immunohistochemistry and NADPHd histochemistry were employed. We investigated the areas of 500 cell bodies of myosin-V neurons and of 500 NADPHd stained neurons from all groups. The quantitative analysis was performed using an area of 8.96 mm2 from each ileum. There was an increase of 21.9% in the myosin-V immunoreactive myenteric neurons (P > 0.05) and of 22.5% in the NADPHd in group CA when compared with C (P < 0.05). There were no significant differences when we compared the area of myosin-V stained neurons between groups C and CA. However, we verified an area reduction of 7.5% in NADPHd neurons when comparing group C to group CA (P < 0.05).

Cytogenetic characterization of Brazilian Paspalum accessions.

Chromosome number, pairing relationship and meiotic behavior were evaluated in 24 Brazilian accessions of different Paspalum species as an initial screening to determine which of them might be useful in an interspecific hybridization program. The analysis showed that six were diploids, 16 tetraploids and two hexaploids. The pairing relationship was typical for the ploidy level and agreed with reported data. However, the meiotic behavior after diakinesis was much more abnormal than expected considering the pairing relationship. There was a high frequency of abnormal tetrads in the majority of accessions.

Linkage of the angiotensinogen gene locus to human essential hypertension in African Caribbeans.

The renin-angiotensin system regulates blood pressure and sodium balance. The angiotensinogen gene which encodes the key substrate within this system has been linked to essential hypertension in White Europeans. It has been suggested that people of West African ancestry may have a different genetic basis for hypertension. In this study we have tested whether there is linkage of the angiotensinogen gene to essential hypertension in African Caribbeans from St. Vincent and the Grenadines. DNA from 63 affected sibling pairs with hypertension was tested for linkage by analyzing whether there was excess allele sharing among siblings genotyped using an angiotensinogen dinucleotide repeat sequence. There was significant support for linkage (T = 3.07, P = 0.001) and association of this locus to hypertension (chi 2 = 50.2, 12 degrees of freedom, P << 0.001). A DNA polymorphism which alters methionine to threonine at position 235 (M235T) within the angiotensinogen peptide has been associated previously with hypertension. However, we found no association of this variant with hypertension in this study. These findings provide support for linkage and association of the angiotensinogen locus to hypertension in African Caribbeans and suggest some similarities in the genetic basis of essential hypertension in populations of different ethnicity.