Results of the trycort: Cohort study of add-on antihypertensives for treatment of resistant hypertension.

Although true treatment resistant hypertension is relatively rare (about 7.3% of all patients with hypertension), optimal control of blood pressure is not achieved in every other patient due to suboptimal treatment or nonadherence. The aim of this study was to compare effectiveness, safety and tolerability of various add-on treatment options in adult patients with treatment resistant hypertension The study was designed as multi-center, prospective observational cohort study, which compared effectiveness and safety of various add-on treatment options in adult patients with treatment resistant hypertension. Both office and home blood pressure measures were recorded at baseline and then every month for 6 visits. The study cohort was composed of 515 patients (268 females and 247 males), with average age of 64.7 ± 10.8 years. The patients were switched from initial add-on therapy to more effective ones at each study visit. The blood pressure measured both at office and home below 140/90 mm Hg was achieved in 80% of patients with add-on spironolactone, while 88% of patients taking this drug also achieved decrease of systolic blood pressure for more than 10 mm Hg from baseline, and diastolic blood pressure for more than 5 mm Hg from baseline. Effectiveness of centrally acting antihypertensives as add-on therapy was inferior, achieving the study endpoints in <70% of patients. Adverse drug reactions were reported in 9 patients (1.7%), none of them serious. Incidence rate of hyperkalemia with spironolactone was 0.44%, and gynecomastia was found in 1 patient (0.22%). In conclusion, the most effective and safe add-on therapy of resistant hypertension were spironolactone alone and combination of spironolactone and a centrally acting antihypertensive drug.

Multifactorial analysis of optical properties, sorption, and solubility of sculptable universal composites for enamel layering upon staining in colored beverages.

OBJECTIVE: To analyze the effects of factors 'composite,' 'medium,' and 'time' on color, translucency, and sorption/solubility of sculptable universal composites for enamel layering upon immersion in colored beverages. MATERIALS AND METHODS: Disk-shaped specimens, 10 mm in diameter and 2 mm thick (n = 5/group), of ultrafine, hybrid composite Essentia (GC), microhybrid Gaenial Anterior (GC), nanofilled Filtek Ultimate Enamel and Body ( 3M ESPE) were immersed in red wine, coffee, or distilled water for 15 days. CIELab color coordinates were measured and CIEDE2000 (∆E00 ) and Translucency Parameter differences (∆TP00 ) were calculated. Sorption and solubility were determined according to ISO 4049:2009. Data were analyzed using the analyses of variance and Tukey's post-hoc test (α = 0.05). RESULTS: Essentia and Gaenial exhibited the lowest and the highest staining-dependent color differences, with mean ∆E00 range of 1.7-6.1 and 5.1-11.3, respectively (p < 0.05). ∆TP00 was more pronounced in wine than in coffee (p < 0.05). Sorption and solubility varied between 9.8 and 15.3 µg/mm3 and -1.6 and -5.4 µg/mm3 , respectively, with positive correlation between ∆TP00 and sorption (p = 0.005). CONCLUSIONS: Total color and translucency differences of sculptable composites for enamel layering were material-, time- and medium-dependent. Translucency differences positively correlated with sorption. Overall, the ultrafine, hybrid composite exhibited the best results in terms of color stability, sorption and solubility. CLINICAL SIGNIFICANCE: Clinicians should be aware of differences in color stability of sculptable composites for enamel layering as these are directly exposed to discoloration in the oral environment and are directly related to patients' long-term satisfaction and restoration longevity. Ultrafine, hybrid composite may be preferred due to better color stability, lower sorption and solubility compared to nanofilled and microhybrid composites evaluated in this study.

Expression and role of p53 in oral lichen planus patients.

PURPOSE: Oral lichen planus (OLP) is an autoimmune skin and mucosal disorder. The range of malignant transformation in OLP varies between 0.1-3%. p53 is a tumor suppressor protein. Defective p53 could allow abnormal cells to proliferate, resulting in cancer. p53 plays an important role in cell cycle control and apoptosis and loss of p53 function has been demonstrated in about half of all human cancers. The purpose of the study was to investigate the malignant potential of OLP on the basis of p53 expression and to correlate p53 expression with clinical and histopathological features of OLP. METHODS: 40 patients with OLP underwent biopsy. All tissue samples were treated immunohistochemicaly using avidin-biotin peroxidase complex method. RESULTS: In 80% of OLP specimens the nuclei of basal and parabasal keratinocytes were p53-positive, but in low numbers. Low percentage of p53-positive cells in older and medium percentage of p53-positive cells in younger group of OLP patients were noted. Higher intensity of p53 stained keratinocytes, no matter their low number, could represent mutant and more stable form of p53 protein, and at the same time signal for monitoring of disease due to potential malignant transformation. Low percentage and weak intensity of p53-positive cells was detected mostly in OLP specimens with highly expressed civatte bodies (CB). Upregulation of apoptosis didn't correspond with the expression of CB. CONCLUSION: We believe that low percentage of p53-positive and well-marked keratinocytes in OLP represent the influence of mutant p53 protein, and that increasing expression of this protein could serve as a valuable diagnostic sign of early carcinogenesis. According to our results intensity of p53 coloration of keratinocytes could help assessing the malignant potential of OLP.

Expression of interleukin-33 and its receptor ST2 in periapical granulomas and radicular cysts.

BACKGROUND: Interleukin-33 (IL-33) is a recently identified cytokine belonging to the IL-1 family and ligand for the IL-1 receptor-related protein ST2. IL-33/ST2 signaling plays a critical role in allergy, autoimmunity, and chronic inflammatory disorders, but its role in the pathogenesis of periapical lesions is unknown. We aimed to investigate the expression patterns of IL-33 and ST2 in human periapical lesions. METHODS: Periapical lesions (n = 36) and healthy periapical tissues (n = 10) were evaluated by immunohistochemistry using antibodies specific for human IL-33 and ST2. Lesion samples were further analyzed by double immunofluorescence to assess IL-33/ST2 co-expression. RESULTS: The numbers of IL-33- and ST2-positive fibroblasts were significantly higher in periapical lesions compared to healthy periapical tissues (both P < 0.05), while the numbers of IL-33- and ST2-positive endothelial cells were similar (both P > 0.05). There were no significant differences in the numbers of IL-33- and ST2-positive fibroblasts and endothelial cells between periapical granulomas and radicular cysts (all P > 0.05). Similarly, numbers of ST2-positive mononuclear cells did not differ between periapical granulomas and radicular cysts (P > 0.05). The majority of epithelial cells in radicular cysts were IL-33 positive, while the small proportion of epithelial cells was ST2 positive. Double immunofluorescence analysis revealed IL-33/ST2 co-expression in fibroblasts and endothelial cells. CONCLUSIONS: IL-33 and ST2 are expressed in periapical granulomas and radicular cysts. Increased numbers of IL-33- and ST2-positive fibroblasts in periapical lesions when compared to healthy periapical tissues suggest that IL-33/ST2 signaling may be involved in periapical inflammation and tissue fibrosis.

Quality of analgesia after lower third molar surgery: A randomised, double-blind study of levobupivacaine, bupivacaine and lidocaine with epinephrine.

BACKGROUND/AIM: Surgical extraction of lower third molars is followed by mild or severe postoperative pain which peaks at maximal intensity in the first 12 hours and has a significant impact on a patient's postoperative quality of life. The use of long-acting local anaesthetics is a promising strategy to improve postoperative analgesia. The aim of the present study was to investigate analgesic parameters and patient satisfaction after using 0.5% levobupivacaine (Lbup), 0.5% bupivacaine (Bup) and 2% lidocaine with epinephrine 1:80,000 (Lid + Epi) for an inferior alveolar nerve block following lower third molar surgery. METHODS: A total of 102 patients (ASA I) were divided into three groups, each of which received either 3 mL of Lbup, Bup or Lid + Epi. The intensity of postoperative analgesia was measured using a verbal rating scale (VRS). The total amounts of rescue analgesics were recorded on the first and during seven postoperative days. Patients satisfaction was noted using a modified verbal scales. RESULTS: A significantly higher level of postoperative pain was recorded in Lid + Epi group compared to Bup and Lbup groups. No significant differences were seen between Bup and Lbup, but a significant reduction in the need for rescue analgesics was seen postoperatively in both Lbup and Bup (50%) in comparison with Lid + Epi (80%) in the first 24 hours. The same significant trend in rescue analgesic consumption was recorded for seven postoperative days. Patients' overall satisfaction was significantly lower for Lid + Epi (10%) than for Lbup (56%) and Bup (52%). CONCLUSION: The use of a new and long-acting local anaesthetic 0.5% levobupivacaine is clinically relevant and effective for an inferior alveolar nerve block and postoperative pain control after third molar surgery. In our study Lbup and Bup controled postoperative pain more efficiently after lower third molar surgery compared to Lid + Epi.

Experimental evaluation on the influence of autoclave sterilization on the cyclic fatigue of new nickel-titanium rotary instruments.

INTRODUCTION: The purpose of this study was to evaluate the effect of autoclave sterilization on cyclic fatigue resistance of rotary endodontic instruments made of traditional and new nickel-titanium (NiTi) alloys. METHODS: Four NiTi rotary endodontic instruments of the same size (tip diameter 0.40 mm and constant .04 taper) were selected: K3, Mtwo, Vortex, and K3 XF prototypes. Each group was then divided into 2 subgroups, unsterilized instruments and sterilized instruments. The sterilized instruments were subjected to 10 cycles of autoclave sterilization. Twelve files from each different subgroup were tested for cyclic fatigue resistance. Means and standard deviations of number of cycles to failure (NCF) and fragment length of the fractured tip were calculated for each group, and data were statistically analyzed (P < .05). RESULTS: Comparing the results between unsterilized and sterilized instruments for each type of file, differences were statistically significant (P < .05) only between sterilized and unsterilized K3XF files (762 versus 651 NCF). The other instruments did not show significant differences (P > .05) in the mean NCF as a result of sterilization cycles (K3, 424 versus 439 NCF; Mtwo, 409 versus 419 NCF; Vortex, 454 versus 480 NCF). Comparing the results among the different groups, K3 XF (either sterilized or not) showed a mean NCF significantly higher than all other files (P < .05). CONCLUSIONS: Repeated cycles of autoclave sterilization do not seem to influence the mechanical properties of NiTi endodontic instruments except for the K3 XF prototypes of rotary instruments that demonstrated a significant increase of cyclic fatigue resistance.

In vitro evaluation of microleakage of various types of dental cements.

INTRODUCTION: Microleakage is defined as the clinically undetectable seepage of oral fluids containing bacteria and debris between cement layer and tooth restoration. OBJECTIVE: This in vitro study investigated the effect of different dental cements (zinc-phosphate, polycarboxylate, glass-ionomer and resin cement) on microleakage in different ceramic crown systems (metal ceramic crown, metal ceramic crown with a porcelain margin, Empress 2 and in Ceram all-ceramic crowns) fixed on extracted human teeth. METHODS: One hundred and sixty intact human premolars were randomized to four groups of forty teeth each, according to the different ceramic crown systems. They were prepared in a standardized manner for metal-ceramic and all-ceramic crowns. Crowns were made following a standard laboratory technique, and each group of crowns were divided into four groups according to the different cement agents and cemented on their respective abutments. The specimens were subjected to thermocycling, placed in methylene blue solutions, embedded in resin blocks and vertically cut in the bucco-oral and meso-distal direction. The microleakage in the area of tooth-cement interface was defined as linear penetration of methylene blue and was determined with a microscope to assign microleakage scores using a five-point scale. RESULTS: A significant association was found between a cement type and degree of microleakage (p = 0.001). No statistically significant differences were found among the different ceramic crown systems luted with the same dental cement. The smallest degree of microleakage was observed in specimens luted with resin cement (X = 1.73), followed by glass-ionomer cement (X=2.45) and polycarboxylate cement (X = 3.20). The greatest degree of microleakage was detected in the crowns fixed with zincphosphate cement (X = 3.33). CONCLUSION: The investigated dental cements revealed different sealing abilities. The use of resin cement resulted in the percentage of 0 microleakage scores. Due to this feature, the resin cement is to be recommended in everyday clinical practice.

Influence of size and taper of artificial canals on the trajectory of NiTi rotary instruments in cyclic fatigue studies.

OBJECTIVE: The aim of this study was to investigate the influence of the shape of 3 different artificial canals on the trajectory followed by different nickel-titanium rotary instruments. STUDY DESIGN: Ten ProFile and Mtwo instruments, tip sizes 20 and 25, taper .06, were tested in 3 simulated root canals with an angle of curvature of 60 degrees and radius of curvature of 5 mm but with different shapes. Geometric analysis of the trajectory that each instrument followed inside the 3 different artificial canals was performed on digital images, determining 3 parameters: angle and radius of the curvature and the position of the center of the curvature. Mean values were then calculated for each instrument size in all of the artificial canals. Data were analysed using 1-way analysis of variance, Holm t test, and Student t test to determine any statistical difference (P < .05). RESULTS: In all instrument sizes, a statistically significant difference was noted among the artificial canals for the radius and angle of curvature. No statistically significant difference was noted between instruments of the same size for the radius and angle of curvature and the position of the center of the curve when measured in the canal constructed on the dimension of the instruments. CONCLUSIONS: Different instruments follow different trajectories in artificial canals constructed with the same parameters of curvature but different shapes, depending on their different bending properties. All of the instruments respected the established parameters of curvature only when the artificial canal is designed on the dimension of the instruments.

[Comparative immunohistochemical and quantitative analysis of inflammatory cells in symptomatic and asymptomatic chronic periapical lesions].

BACKGROUND/AIM: It has been demonstrated that lymphocytes, plasma cells, macrophages and neutrophil granulocytes represent the predominant cells of the inflammatory lesion of the dental granulomas. Other cells, such as mast cells, eosinophils, dendritic cells comprise minor, but functionally important cell populations. Most of the data considering cells that take part in these processes have been derived from immunohistological studies. This study was undertaken with the aim to determine the phenotype profile of inflammatory cells of dental granulomas using immunohistochemical method in order to study the differences of their quantitative properties and distribution between symptomatic and asymptomatic lesions. METHODS: The material for the analysis originated from 42 individuals with clinic and radiographic diagnosis of chronic periapical lesions. The tissue was take either during the periradicular surgery, or tooth extraction. Cryostat tissue sections were stained using the alkaline phosphatase-antialkaline phosphatase assay (APAAP). This method is highly valid and sensitive using a panel of specific monoclonal antibodies: CD3, CD4, CD8, CD19, CD38, CD14, CD1a, CD83, CD80, CD86, CD45 and CD123. RESULTS: The composition of the cell population revealed that there was no homogenous and site-specific pattern of the distribution of inflammatory cells. The results of our investigation revealed that the majority of inflammatory cells comprised lymphocytes and plasma cells, followed by subpopulations CD4+, CD8+ and CD14+ cells. Much lower in number were CD80+, CD86+ and CD83+ and CD1a+ cells. There were no statistically significant differences in mean values of inflammatory cells number between symtomatic and asymptomatic lesions, with the exception of CD86+ cells, the number of which was statistically higher in symptomatic lesions. CONCLUSION: Inflamatory infiltrate cells in dental granulomas are dominated by T- and B-lymphocytes. It points out the complexity of immunopathogenic events in imitiating and progressing of dental granulomas that involve mechanisms of both cellular and humoral immunity. Regarding the quantitative presence of immunocompetent cells in symptomatic and asymptomatic lesions no statistically significant difference was determined unless in mature dendritic cells present in symptomatic lesions.