Periaortitis Secondary to Evar: Case Report and Literature Review.

CLINICAL IMPACT: Even if periaortitis secondary to EVAR is a very rare complication, it is important for the surgeon to know this possible rare complication and its characteristics, in order to immediately recognize it and treat it adequately to avoid complications.

Microbiota of deciduous endodontic infections analysed by MDA and Checkerboard DNA-DNA hybridization.

AIMS: To evaluate the microbiota of endodontic infections in deciduous teeth by Checkerboard DNA-DNA hybridization after uniform amplification of DNA in samples by multiple displacement amplification (MDA). METHODOLOGY: Forty samples from the root canal system of deciduous teeth exhibiting pulp necrosis with or without radiographically detectable periradicular/interradicular bone resorption were collected and 32 were analysed, with three individuals contributing two samples; these were MDA-amplified and analysed by Checkerboard DNA-DNA hybridization for levels of 83 bacterial taxa. Two outcome measures were used: the percentage of teeth colonized by each species and the mean proportion of each bacterial taxon present across all samples. RESULTS: The mean amount of DNA in the samples prior to amplification was 5.2 (±4.7) ng and 6.1 (±2.3) µg after MDA. The mean number of species detected per sample was 19 (±4) (range: 3-66) to the nearest whole number. The most prevalent taxa were Prevotella intermedia (96.9%), Neisseria mucosa (65.6%), Prevotella nigrescens (56.2%) and Tannerella forsythia (56.2%). Aggregatibacter (Haemophilus) aphrophilus and Helicobacter pylori were not detected. P. intermedia (10%), Prevotella tannerae (7%) and Prevotella nigrescens (4.3%) presented the highest mean proportions of the target species averaged across the positive samples. CONCLUSION: Root canals of infected deciduous teeth had a diverse bacterial population. Prevotella sp. were commonly found with P. intermedia, Prevotella tannerae and Prevotella nigrescens amongst the most prominent species detected.

Mesenchymal stem cell transplantation in amyotrophic lateral sclerosis: A Phase I clinical trial.

Amyotrophic Lateral Sclerosis (ALS) is a devastating incurable disease. Stem-cell-based therapies represent a new possible strategy for ALS clinical research. The objectives of this Phase 1 clinical study were to assess the feasibility and toxicity of mesenchymal stem cell transplantation and to test the impact of a cell therapy in ALS patients. The trial was approved and monitored by the National Institute of Health and by the Ethics Committees of all participating Institutions. Autologous MSCs were isolated from bone marrow, expanded in vitro and analyzed according to GMP conditions. Expanded MSCs were suspended in the autologous cerebrospinal fluid (CSF) and directly transplanted into the spinal cord at a high thoracic level with a surgical procedure. Ten ALS patients were enrolled and regularly monitored before and after transplantation by clinical, psychological, neuroradiological and neurophysiological assessments. There was no immediate or delayed transplant-related toxicity. Clinical, laboratory, and radiographic evaluations of the patients showed no serious transplant-related adverse events. Magnetic resonance images (MRI) showed no structural changes (including tumor formation) in either the brain or the spinal cord. However the lack of post mortem material prevents any definitive conclusion about the vitality of the MSCs after transplantation. In conclusion, this study confirms that MSC transplantation into the spinal cord of ALS patients is safe and that MSCs might have a clinical use for future ALS cell based clinical trials.

Role of CA19.9 in predicting bevacizumab efficacy for metastatic colorectal cancer patients.

CEA and CA19.9 are biomarkers routinely measured for monitoring treatment response in metastatic colorectal cancer (MCRC) patients, yet their predictive value during therapies containing new antineoplastic drugs (i.e. FOLFIRI/OLFOX/Bevacizumab) has not yet been investigated. Consecutive chemotherapy-naive MCRC patients treated with either standard chemotherapy-alone (FOLFIRI/FOLFOX) or chemotherapy+bevacizumab (FOLFIRI+bevacizumab) were included in the analysis. Patients had to have serial biweekly measurement of CEA and CA19.9 available for at least three months of treatment. Primary study endpoint was Progression Free Survival (PFS). Biomarker levels and type of treatment as well as major demographic and clinical factors were analyzed for their impact on PFS. Out of 243 evaluated MCRC patients, 87 had biomarkers available as per inclusion criteria. Among all evaluated factors only type of treatment (chemotherapy-alone vs chemotherapy+bevacizumab) and baseline CA19.9 (> vs < normal) were independently associated with PFS, whilst neither baseline CEA nor biomarker reduction during therapy reached statistical significance. When patients with different baseline CA19.9 levels were analysed separately, only patients with abnormal CA19.9 benefited significantly from the administration of bevacizumab.The current study demonstrated a significant predictive value of CA19.9, but not of CEA and biomarker reduction, for MCRC patients treated with new antineoplastic drugs. Moreover, only patients with abnormal baseline CA19.9 levels benefited significantly from bevacizumab.

Preclinical studies on detection of circulating melanoma cells in patients: telomerase as a recognition marker of malignancy.

Preclinical studies based on a "simulation design", were performed with cultured melanoma cells prelabeled with 51Cr, added to normal blood and subjected to separation and recognition steps. Mononuclear cells (MNC) were isolated on ficollhypaque gradient, and melanoma cells were separated from lymphocytes using anti-CD45 immunomagnetic beads. Malignant cells were then recognized by measuring telomerase activity (TRAP and TRAP-ELISA assays). It was found that: (a)recovery of prelabeled cells present in MNC did not exceed 75%; (b) further recovery of prelabeled cells after separation from lymphocytes did not exceed 68%. Therefore, the overall recovery of prelabeled cells did not exceed 48%; (c) the entire procedure was able to reliably detect as few as 30 malignant cells added to normal blood, providing a telomerase signal significantly higher than that found in absence of melanoma cells. These results furnish the technical bases for developing a tumor detection assay in the blood of melanoma patients.

Atraumatic restorative treatment: clinical, ultrastructural and chemical analysis.

With the purpose of checking, in vivo, the effect of atraumatic restorative treatment (ART) on the remaining demineralized dentin, 12 primary molars with deep occlusal lesions from children with ages ranging from 3 to 7 were evaluated. After lesion excavation, and before glass ionomer cement placement, dentin samples were collected from the pulpal wall of the cavity. After 3 months, the restorations were removed and new samples were collected. Six microareas of each sample were analyzed by X-ray energy dispersion spectrometer. Samples obtained before treatment were infected and intertubular dentin had a loosely organized collagen matrix, with well-defined collagen fibers. Following treatment, in addition to a drastic reduction of the amount of bacteria, the intertubular dentin was denser, with more compact and closely packed collagen fibers. An increased calcium concentration was observed in dentin collected after treatment (p < 0.001), suggesting tissue remineralization, but fluoride was not detected. We conclude that ART allows a one-session approach, with the purpose of creating more favorable conditions for the healing process.

First permanent molar: first indicator of dental caries activity in initial mixed dentition.

The objective of the present study was to investigate among children in the initial mixed dentition phase the presence of clinical signs that might eventually function as more sensitive indicators of the development of caries disease, denoted here as caries activity. On this basis, we investigated the relationship between salivary levels of mutans streptococci (MS) and decayed, missing and filled permanent and deciduous tooth surfaces (DMFS and dmfs) using microbiological, clinical and radiographic examinations in 81 schoolchildren aged 7-8 years. Whereas dmfs did not present a positive correlation, DMFS was significantly correlated with salivary MS levels. The first permanent molars of the schoolchildren studied comprised 87.3% of the affected surfaces recorded in the DMFS, suggesting that the development of new lesions was preferentially located on the surfaces of the first permanent molars. These results permit us to conclude that the first permanent molars function as first indicators of dental caries activity in the schoolchildren examined.

Brainstem CMV encephalitis in AIDS: clinical case and MRI features.

We describe the clinical case and MRI findings of a patient with acquired immune deficiency syndrome and pathologically confirmed cytomegalovirus encephalitis. Prevalent brainstem and cerebellar signs together with almost exclusive involvement as seen on MRI of posterior fossa structures at the onset of the symptoms were the main features of our case.

Myopathy in long-term AZT therapy: clinical, electrophysiological and biopsy study in 67 HIV+ subjects.

The occurrence of muscular pathologies in AZT treated subjects has been evaluated in 67 HIV seropositive outpatients (56 AZT-treated and 11 untreated controls) in a neurological clinical and paraclinical follow-up study. Standard electromyographic and electrodiagnostic examinations, together with muscle enzyme determination, were performed in every subject, and periodically repeated at fixed intervals; in 11 patients a muscle biopsy sample was also obtained. An AZT-related myopathy was diagnosed in 8 biopsied cases; 9 more patients were considered to have AZT myopathy on clinical, EMG and ex juvantibus criteria. Statistical analysis showed that treatment duration was more relevant to the development of the myopathy than AZT dosage, though an individual predisposition could not be excluded, at least in a small number of cases. The risk of developing a toxic myopathy will therefore have to be considered when evaluating long-term effects of AZT therapy.