A laboratory evaluation of cell viability, radiopacity and tooth discoloration induced by regenerative endodontic materials.

AIM: To analyse the cytotoxicity, colour change and radiopacity of MTA Flow (MTA), UltraCal XS (UC) and Bio-C Temp (BT). METHODOLOGY: Human dental pulp cells (hDPCs) stimulated with lipopolysaccharide (LPS) were placed in contact with several dilutions of culture media previously exposed to the experimental materials and tested for cell viability using MTT. Bovine teeth were prepared to simulate an open apex and to mimic extensive crown fracture. The roots were filled with a mixture of agar and blood, and the materials placed over this mixture. The control group consisted of teeth filled only with agar and blood. Colour assessment analyses were performed before and immediately after material insertion and repeated at 30, 45 and 60 days using a spectrophotometer. The total colour change (ΔEab , ΔE00 and whiteness index (WI)) was calculated based on the CIELAB colour space. Digital radiographs were acquired for radiopacity analysis. Cell viability was analysed by one-way anova, whilst differences in colour parameters (ΔEab , ΔE00 and WI) were assessed by two-way repeated measures anova (α = 0.05). Tukey's test was used to compare the experimental groups, and Dunnett's test was used to compare the experimental groups with the control group. RESULTS: MTA, UC and BT had similar cell viability to that of the control group (DMEM) (P > 0.05), except for the BT group at the 1 : 1 and 1 : 2 dilutions, which had significantly lower viability (P < 0.001). All materials were associated with discoloration values greater than what is considered to be the acceptable threshold, and BT resulted in less or similar tooth colour change than MTA and UC, respectively. Decreasing radiopacity over time was observed only in the MTA group (P = 0.007). Lower values of radiopacity were found in the BT group compared with the UC and MTA groups (P < 0.001). CONCLUSIONS: The new bioceramic material (BT) had acceptable cell viability, similar to that of MTA and UC at the highest dilutions, and BT resulted in less tooth colour change than MTA and UC. Despite its lower radiopacity, BT was identified radiographically.

Study of correlation between forced vital capacity and demand for healthcare services in severe asthmatics.

BACKGROUND: Involvement of the small airways may be related to increased severity and increased demand for health care services and incurring in high costs, private or for the healthcare system. The hyperinflation consequent to this involvement reduces lung volumes, such as FVC, FEV1 and SVC. The aim of this study was to evaluate the correlation between the predicted values of FVC, FEV1 and SVC with the demand for healthcare services by severe asthmatics. METHODS: We retrospectively evaluated in order of arrival, the medical records of 98 patients with severe asthma, in step 4 treatment in the intercritical period of the disease, correlating the number of times each patient sought health care services represented by admissions to the ER, ICU and hospital wards due to asthma, in the year before the last spirometry and the predicted values of FVC, FEV1 and SVC. RESULTS: Our sample showed a clear and significant negative correlation between the predicted values of FVC, FEV1 and SVC and demand for healthcare services. CONCLUSION: For this sample we conclude, that reduced forced vital capacity correlated with asthma severity, defined by greater demand for care in the ER, ICU and hospital ward and was more evident in women.

[Analysis of fatigue associated to periodic limb movement during sleep in former poliomyelitis patients]. / Análisis de la fatiga asociada al movimiento periódico de las extremidades durante el sueño en pacientes con antecedente de poliomielitis.

INTRODUCTION: Following poliomyelitis, patients may experience sleep disorders stemming from periodic limb movement, leading to fatigue and compromised muscle function the following day. AIM: To establish the presence or absence of muscle fatigue in these patients using electromyography and relating the data to polysomnographic findings. PATIENTS AND METHODS: An analytical cross-sectional study was carried out involving 19 individuals with motor sequelae in the lower limbs stemming from poliomyelitis. Quantitative tests for the assessment of neurophysiological aspects (knee-jerk/Achilles reflexes and peripheral muscle strength of rectus femoris) and a sleep study (standard, level I polysomnography) were administered. RESULTS: A statistically significant difference was detected (p < 0.01) in muscle strength, demonstrating muscle fatigue associated to sleep disorder. CONCLUSION: Individuals with sequelae from poliomyelitis exhibit sleep disorders that may lead to muscle fatigue. Periodic limb movement may contribute to this phenomenon.

Uso del aparato bucal "PMpositioner" en el tratamiento del ronquido y la apnea obstructiva del sueño / Use of PMpositioner oral appliance in the treatment of snoring and mild obstructive sleep apnea

La elección de un aparato bucal apropiado para lograr los mejores resultados en el tratamiento de la apnea obstructiva del sueño es importante. El objetivo de este estudio fue evaluar el efecto de un aparato bucal específico, el PMPositioner, para el tratamiento del ronquido y la apnea obstructiva del sueño leve, a través de polisomnografía y la Escala de Epworth del sueño, después de seis meses de uso del mencionado aparato. Se incluyeron en el estudio 17 pacientes divididos en dos grupos: un grupo de roncadores (n=7) y otro grupo (n=10) con apnea obstructiva leve. Los resultados fueron significativos para el segundo grupo, revelando una disminución en el índice de apnea-hipoapnea de 7,4 +- 5,0 a 3,0 +- 2,5 (p<0.05), aumento del sueño REM de 16,0+-4,0 a 19+-6,0 y una mejora de la somnolencia en la Escala Epworth de 12,5+-5,4 a 7,4+-2,4. Se constató una disminución en los ronquidos y los síntomas subjetivos. PMPositioner, fue efectivo en el tratamiento de los ronquidos y la apnea obstructiva leve, la reducción de la somnolencia y de otros síntomas.

The choice of an adequate oral appliance is very important in the treatment of obstructive sleep apnea. The present study evaluated the effect of PMPositioner for the treatment of snoring and mild obstructive sleep apneathrough polysomnography and Epworth Sleep Scale prior to treatment and after six months. Seventeen patients, divided into 2 groups, snoring (n=7) and 10 with mild obstructive sleep apnea were enrolled. The results were significant for obstructive sleep apnea group reveling a decrease in the apnea/hypopnea index from 7.4±5.0 to 3.0±2.5 (p<0.05), anincrease in oxigen saturation from 88.0±6.0 to 90.0±2.8 (p<0.05), an increase in REM sleep from 16.0±6.0 to 19±4.0 and a sleepiness improved in from 12.5±5.4 to 7.4±2.4. Furthermore, it was noticed an improvement in snoring and subjective symptoms. The PM Positioner is efficient in the treatment of snoring and mild obstructive sleep apnea and in reduction of sleepness and others symptoms.

Correlation of the in vitro antifungal drug susceptibility with the in vivo activity of fluconazole in a murine model of cerebral infection caused by Cryptococcus gattii.

Forty Cryptococcus gattii strains were submitted to antifungal susceptibility testing with fluconazole, itraconazole, amphotericin B and terbinafine. The minimum inhibitory concentration (MIC) ranges were 0.5-64.0 for fluconazole, <0.015-0.25 for itraconazole, 0.015-0.5 for amphotericin B and 0.062-2.0 for terbinafine. A bioassay for the quantitation of fluconazole in murine brain tissue was developed. Swiss mice received daily injections of the antifungal, and their brains were withdrawn at different times over the 14-day study period. The drug concentrations varied from 12.98 to 44.60 µg/mL. This assay was used to evaluate the therapy with fluconazole in a model of infection caused by C. gattii. Swiss mice were infected intracranially and treated with fluconazole for 7, 10 or 14 days. The treatment reduced the fungal burden, but an increase in fungal growth was observed on day 14. The MIC for fluconazole against sequential isolates was 16 µg/mL, except for the isolates obtained from animals treated for 14 days (MIC = 64 µg/mL). The quantitation of cytokines revealed a predominance of IFN-γ and IL-12 in the non-treated group and elevation of IL-4 and IL-10 in the treated group. Our data revealed the possibility of acquired resistance during the antifungal drug therapy.

The effects of low-level laser on muscle damage caused by Bothrops neuwiedi venom

The present study aimed to assess the effects of low-level laser (660 nm) on myonecrosis caused by the insertion of Bothrops neuwiedi venom in the gastrocnemius muscle of rats. Male Wistar rats were divided into three groups (n equal 24 each): Group S (0.9 percent saline solution); Group V (venom) and Group VLLL (venom plus low-level laser). These categories were subdivided into four additional groups (n equal 6) based on the euthanasia timing (3 hours, 24 hours, 3 days and 7 days). The groups V and VLLL were inoculated with 100 miL of concentrated venom (40 mig/mL) in the gastrocnemius muscle. The muscle was irradiated using a gallium-aluminum-arsenide laser (GaAlAs) at 35 mW power and 4 J/cm² energy density for 3 hours, 24 hours, 3 days or 7 days after venom inoculation. To evaluate the myotoxic activity of the venom, CK activity was measured and the muscle was histologically analyzed. The low-level laser reduced venom-induced CK activity in the groups euthanized at 3 hours, 24 hours and 3 days (p smaller that 0.0001). Histological analysis revealed that low-level laser reduced neutrophilic inflammation as well as myofibrillar edema, hemorrhage and myonecrosis following B. neuwiedi envenomation. These results suggest that low-level laser can be useful as an adjunct therapy following B. neuwiedi envenomation.

Photoacoustic monitoring of the absorption of isotonic saline solution by human mucus.

Viscosity and elasticity are the fundamental rheologic properties of respiratory mucus, and are important determinants of transportability of mucus in the mucociliary system. One technique that permits to monitor indirectly the rheologic properties of any sample is the photoacoustic technique. Using that technique, the absorption of isotonic saline solution by human mucus was monitored. The mucus was obtained from 11 volunteers, divided into two groups: five volunteers presenting pneumology symptoms (group I) and six healthy volunteers (group II). The photoacoustic signal of the mucus absorbing the saline solution was monitored as function of time, with measurements being performed each 10 min, up to 120 min. The resulting curves were fitted to sigmoidal curves to simulate the evolution on time of the photoacoustic signal. A characteristic time for the half saturation of the absorption process was obtained. For group I the time obtained was 23.3+/-5.3 min and for group II the time obtained was 55.0+/-7.7 min, both means being significantly different (Student t-test, p<0.05). This result supports the empirical practice of treating individuals presenting symptoms of airway obstruction with about 30 min of inhalations of isotonic saline solution vapor for the clearance of the airways.

Sleep-related breathing disorders in amyotrophic lateral sclerosis.

Sleep-related breathing events in patients with amyotrophic lateral sclerosis (ALS) have been reported in small case series, but the association with the clinical presentation--with (B) or without (nonB) bulbar symptoms--or the relevance for prognosis have not been investigated. We retrospectively analyzed sleep studies of 114 (46 nonB) ALS patients, aged 54 +/- 11 years. Respiratory function was better in nonB patients: forced vital capacity was 76 +/- 20% vs 55 +/- 23% in the bulbar group (p < 0.001); PaCO2 41 +/- 5 vs 44 +/- 6 mm Hg p < 0.05. The mean apnea/hypopnea index (AHI) was higher in nonB patients (22 +/- 12 vs 15 +/- 16 events per hour- p < 0.05); in this group 21 out of 46 patients (46%) had more than 20 events/hour versus 14 out of 68 (21%) in the nonB group (p < 0.005). On the contrary the oxygen desaturation index (ODI) was similar (10 +/- 11 vs 9 +/- 12 events per hour, p = NS). Most events had a central genesis and obstructive events were usually erratic, except in 7 patients (6 in group B) who had more than 10 obstructive events/hour. Data were stratified in three groups: with a disease duration below 1 year (< 1 yr), between 1 and 2 years (1-2 yr), and more than 2 years (> 2 yr). The occurrence of sleep-related respiratory disorders decreased with the increase of disease duration (23 +/- 15; 18 +/- 14; and 16 +/- 15 events per hour respectively), the decrease being significantly lower in the > 2 yr group than in the < 1 yr (p < 0.05). Again ODI was similar in the three groups. In conclusion the present study shows that sleep-related breathing events are more common than previously described in ALS patients, particularly in the first year following onset of the disease. Obstructive events occur rarely, although the prevalence of obstructive sleep apnea is higher than predicted, particularly when bulbar symptoms are present. Patients without bulbar signs show a higher prevalence of central events. The progressive decrease of events with the increase of disease duration could be due to a progressive weakness of respiratory muscles, but it could also suggest an independent role for nocturnal events which could be linked to a worse prognosis or to a more rapid decay of clinical status.

Comparison of uteroplacental glycosylation in the camel (Camelus dromedarius) and alpaca (Lama pacos).

The recent birth of a camel-llama hybrid, after numerous failed attempts, has prompted an investigation into the glycosylation of apposing fetal and maternal tissues of pregnant camels and alpacas. This study was undertaken to determine whether interspecies differences in glycans are factors that may account in part for the difficulty in producing a viable hybrid. Specimens of camel placentae from day 60 to day 375 of gestation and alpaca placentae from day 22 to term (approximately 345 days) were fixed and embedded in resin, and sections were stained with a panel of 19 biotinylated lectins and an avidin--peroxidase revealing system. Several qualitative interspecies differences in tissue glycosylation were found, mainly in the trophoblast, and especially with respect to bi/tri-antennary bisected N-glycan, fucosylated structures, beta-galactosyl residues and sialyl termini. In the maternal uterine epithelium, differences were found mainly in bi/tri-antennary bisected complex N-glycan and beta-galactosyl residues, indicating that there is more conservation of glycosylation in maternal tissues compared with trophoblast. There were also many quantitative differences in the distribution of glycans. It is possible that a failure to effect the normal glycan--glycan complementation that occurs at the cell surface between maternal and fetal tissues during the implantation processes of apposition and adhesion may account in part for the difficulty in establishing a viable pregnancy between these two species.

Quality of Life Evaluation and Survival Study: a 3-yr prospective multinational study on patients with chronic respiratory failure.

Therapy of patients with chronic respiratory failure is mainly directed at minimizing symptoms in order to improve, or at least to prevent a deterioration of, patients' well-being. Under such circumstances, the perceived effect of therapies on patients' well-being and daily life represents the most important subjective outcome of treatment. Therefore, there is a need to provide a global estimate of health in patients on long term oxygen therapy or overnight home mechanical ventilation. The Maugeri Foundation Respiratory Failure Questionnaire (MRF28) is the first health status ("quality of life") questionnaire specifically developed for use in CRF and its items were selected to be applicable to patients with both obstructive and restrictive diseases. The Quality of Life Evaluation and Survival Study (QuESS) is a multinational study with the aim of re-evaluating the natural history of chronic respiratory failure in about 300 patients. To the authors knowledge, the Quality of Life Evaluation and Survival Study is the first study to evaluate the natural history of chronic respiratory failure in such a large number of subjects and with a complete set of data. In fact, both pathophysiologic and health status assessments will be made. Moreover, by collecting data on mortality, disease exacerbations and hospitalization, it will also be possible to verify the predictive ability of health status versus pathophysiology in terms of mortality and healthcare utilization.