Comprehensive association study of genetic variants in the IL-1 gene family in systemic juvenile idiopathic arthritis.

Patients with systemic juvenile idiopathic arthritis (sJIA) have a characteristic daily spiking fever and elevated levels of inflammatory cytokines. Members of the interleukin-1 (IL-1) gene family have been implicated in various inflammatory and autoimmune diseases, and treatment with the IL-1 receptor antagonist, Anakinra, shows remarkable improvement in some patients. This work describes the most comprehensive investigation to date of the involvement of the IL-1 gene family in sJIA. A two-stage case-control association study was performed to investigate the two clusters of IL-1 family genes using a tagging single nucleotide polymorphism (SNP) approach. Genotyping data of 130 sJIA patients and 151 controls from stage 1 highlighted eight SNPs in the IL1 ligand cluster region and two SNPs in the IL1 receptor cluster region as showing a significant frequency difference between the populations. These 10 SNPs were typed in an additional 105 sJIA patients and 184 controls in stage 2. Meta-analysis of the genotypes from both stages showed that three IL1 ligand cluster SNPs (rs6712572, rs2071374 and rs1688075) and one IL1 receptor cluster SNP (rs12712122) show evidence of significant association with sJIA. These results indicate that there may be aberrant control of the activity of the IL-1 family in sJIA patients causing the increased susceptibility to the disease.

ADAMTS-1 and -4 are up-regulated following transient middle cerebral artery occlusion in the rat and their expression is modulated by TNF in cultured astrocytes.

ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) enzymes are a recently described group of metalloproteinases. The substrates degraded by ADAMTS-1, -4 and -5 suggest that they play a role in turnover of extracellular matrix in the central nervous system (CNS). ADAMTS-1 is also known to exhibit anti-angiogenic activity. Their main endogenous inhibitor is tissue inhibitor of metalloproteinases (TIMP)-3. The present study was designed to investigate ADAMTS-1, -4 and -5 and TIMP-3 expression after experimental cerebral ischaemia and to examine whether cytokines known to be up-regulated in stroke could alter their expression by astrocytes in vitro. Focal cerebral ischaemia was induced by transient middle cerebral artery occlusion in the rat using the filament method. Our results demonstrate a significant increase in expression of ADAMTS-1 and -4 in the occluded hemisphere but no significant change in TIMP-3. This was accompanied by an increase in mRNA levels for interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra) and tumour necrosis factor (TNF). ADAMTS-4 mRNA and protein were up-regulated by TNF in primary human astrocyte cultures. The increased ADAMTS-1 and -4 in experimental stroke, together with no change in TIMP-3, may promote ECM breakdown after stroke, enabling infiltration of inflammatory cells and contributing to brain injury. In vitro studies suggest that the in vivo modulation of ADAMTS-1 and -4 may be controlled in part by TNF.

Effectiveness of electrochemically activated water as an irrigant in an infected tooth model.

AIM: To test the effectiveness of electrochemically activated aqueous solutions in the debridement of Enterococcus faecalis biofilms in root canals of extracted teeth. METHODOLOGY: Extracted, human, single-rooted teeth (198) assembled into 11 sets (n = 18) with matching anatomical characteristics were randomly assigned to eight experimental groups. After decoronation, the root canals were prepared to a standard size. Enterococcus faecalis biofilms were grown in the root canals of autoclaved, individually mounted teeth over 48 h. Electrolysed saline collected as anolyte at the anode and catholyte at the cathode were the test agents. The four ultrasonication and four without ultrasonication irrigant groups included: neutral anolyte (NA) (pH 6.5), acidic anolyte (AA) (pH 3.0), catholyte (C) (pH 11.5) and C alternated with neutral anolyte (C/NA). Phosphate-buffered saline (PBS) with and without ultrasonication formed negative and NaOCl (3%) positive control groups. After irrigation, root canal samples were serially diluted, cultured and enumerated. The data were analysed as ratios of residual colony-forming units (CFUs) in PBS versus the test irrigants and using multivariate regression. RESULTS: The NA and NA (ultrasonicated, U), C/NA and AA (U) groups had significantly (alpha = 0.05) less and C (U) and C/NA (U) significantly (alpha = 0.05) more bacteria (CFUs mL(-1)) compared with their respective PBS controls. Ultrasonicated C/NA had significantly (alpha = 0.05) higher CFU counts than the nonultrasonicated solution. Other comparisons between ultrasonic and nonultrasonic groups were not significant. Of the nonultrasonicated groups, C/NA and NA were most effective, whilst of the ultrasonicated groups, AA and NA were most effective. None of these was as effective as 3% NaOCl. CONCLUSIONS: All but two groups (AA and C) were significantly different from their PBS controls. There was a significant difference between the C/NA groups with and without ultrasonication but not between other combinations. NA (U) and AA (U) were the most effective test solutions but NaOCl (3%) gave by far the highest bacterial kills.

In vitro cleaning ability of root canal irrigants with and without endosonics.

A variety of methods have been used to evaluate the cleanliness of root canals after endodontic preparation and irrigation. Few irrigation agents other than sodium hypochlorite (NaOCl) have been tested in conjunction with endosonics. The purpose of this study was to examine the cleaning ability of water, NaOCl, Hibiscrub and a biological washing liquid when used as intracanal irrigants, with and without endosonics. Two methods of evaluation were employed to assess the root canal cleanliness after endodontic preparation. A total of 56 teeth, divided into eight groups, were prepared manually using the step-down technique. Each irrigating agent was used in two experimental groups, with and without endosonics. Two additional teeth which received neither instrumentation nor irrigation served as the controls. The teeth were split longitudinally and the state of cleanliness of the root canal was assessed by scoring the amount of stained organic debris and smear layer. It was demonstrated that the results of debris and smear layer scoring were significantly influenced by the type of irrigant and whether endosonics had been used. All agents exhibited similar cleaning ability when introduced manually. With endosonics, NaOCl yielded significantly less stainable debris (P < 0.05) than the other groups which showed no significant difference. The ability to remove the smear layer was enhanced, but at some distance short of the working length, by endosonics for all irrigants tested. None of the solutions tested was able to produce a canal wall that was free of smear layer.

A comparison in vitro of two ultrasonic root canal preparation techniques.

Two ultrasonic techniques were compared for their ability to clean and shape root canals in extracted human teeth. One technique was recommended by the manufacturer (Cavi-Endo, Dentsply), while the other was a modification by the authors of the stepdown technique. Mesiobuccal root canals of molars were instrumented using these techniques, after which a silicone impression material was injected into the prepared canals. The roots were then split longitudinally and one half was stained for debris scoring while the silicone impressions were assessed for shape. The results showed that the modified technique produced significantly cleaner canals than the recommended technique. The shaping ability of both techniques was difficult to evaluate because of the complex morphology of molar root canals. The final shape of the prepared canal depended more on the initial shape than on the instrumentation technique.

Endodontics in the UK 1990: an overview.

The first workshop on endodontics, in 1978, pointed out that the standard of endodontics in the United Kingdom was poor. The British Endodontic Society has subsequently attempted to improve the remuneration in the NHS by conducting and publishing a survey, and also establishing guidelines for minimum acceptable standards. Despite this, in the author's opinion, there has been no improvement. However, four ways of raising the standards of endodontics are proposed.

Organizing a postgraduate course.

The running of a section 63 hands-on course on endodontics requires prior planning. Suggestions on how to plan such course include the design of the programme, the number of course members and instructors, requirements from the postgraduate centre, equipment and materials needed, travel and accommodation, and finally reimbursement.

Current status of the use of ultrasound in endodontics.

Although endosonics has received much attention in the literature, it is not clear whether it is recommended. This review discusses the types of endosonic unit available, ultrasonic phenomena such as cavitation and acoustic streaming, irrigation, cutting dentine, and clinical techniques for cleaning and shaping. The more recent evidence suggests that endosonics provides an efficient method of debridement providing sodium hypochlorite is used, but is less efficient at shaping the walls of the canals. New methods of filing have been introduced by the manufacturers but they have not taken into account the most recent research; for this reason an alternative approach is described.

Safe use of codeine in the recovering alcoholic or addict.

The effect that codeine has on the process of addiction and recovery is unclear. Confusion about definitions, study endpoints, and a lack of well-controlled clinical studies has led to this uncertainty. Codeine addiction is uncommon in people who do not have existing vulnerability to addiction, including alcoholism. Codeine use can sustain addiction or increase the risk of relapse in patients afflicted with addiction. The risk of relapse must be considered when treating conditions such as pain or cough in a person recovering from addiction. Codeine use may be circumvented with the appropriate use of alternative treatments for pain or cough. If codeine use becomes necessary, cautious prescribing and reliance on the patient's recovery support network become imperative.

Dentine-removing characteristics of an ultrasonically energized K-file.

This in vitro study evaluated the pattern of dentine removal when an ultrasonically energized file (Cavi-Endo-size 25 file) was applied to flat surfaces of dentine under standardized conditions. The influences of power setting, interfacial force between file and dentine, direction of file oscillation and operator-assisted movement were examined. Impressions of the instrumented surfaces revealed characteristic patterns consisting of a series of oblique crests, each one parallel to the next and separated by a constant distance along the line of contact with the file. Determination of height, width and separation of these crests with a Reflex microscope aided objective assessment. The simplest pattern was formed when the energized file was held against the dentine (power setting = 1; interfacial force = 30 g). Increasing the power setting to 8 caused deeper troughs over the apical 5 mm. The width of the crests corresponded to the taper of the file except at the apical tip where the crests were relatively wider. However, increasing the interfacial force to 60 g reduced the efficiency of the apical part of the file. The superimposition of operator-induced movement greatly increased the extent of dentine removal, resulting in a tapering groove with a persistent crestal pattern. Oscillation of the file perpendicular to the dentine surface had a significantly greater influence on dentine removal, producing a deeper groove than was obtained with oscillation parallel to the surface. These findings may be of relevance in aiding controlled root canal preparation when using the Cavi-Endo instrument.

An in vitro comparison of ultrasonic and conventional methods of irrigant replacement.

The effectiveness of irrigant replacement in fine canals was compared using three sizes of irrigating needle and an ultrasonic method. The results showed that irrigant replacement became progressively less effective towards the apex regardless of the method of irrigation or needle size. With conventional methods, irrigation performance varied with the size of needle and volume of irrigant. With the ultrasonic method results depended on irrigation time, but was independent of irrigant flow rate through the handpiece, the size of the canal or the file size.

An in vitro method for comparing the effects of different root canal preparation techniques on the shape of curved root canals.

This study introduced an in vitro model which was designed to observe the effects of instrumentation on the shape of curved root canals. The model may be accurately rotated through 90 degrees allowing reproducible radiographs to be taken from two different angles. The root canals were filled with a radiopaque contrast medium before radiographs were taken. Two-dimensional evaluation of the shape of the root canals, before and after preparation was made on enlarged photographic prints obtained from the radiographs. A custom-made grid was used as a guide for measurement and accurate transfer from the pre- to postpreparation prints. Reproducibility of measurement was within 4 per cent. This method is feasible for quantitative comparison of the effect of instrumentation on the shape of root canals.

The effect of hand, sonic and ultrasonic instrumentation on the shape of curved root canals.

This study compared the effects of hand, sonic and ultrasonic instrumentation on the shape of curved root canals in 60 extracted human lateral incisors and premolars. Each root of moderate or severe canal curvature was mounted onto a simulated crown and filled with a radiocontrast medium. Enlarged photographic prints obtained from radiographs taken before and after root canal preparation were measured. The results indicated a lower incidence of apical zip and elbow formation in the ultrasonic preparations when compared with those prepared by hand and sonic, irrespective of the canal curvature. A more prominent hour-glass shape was prepared by hand and sonic instruments particularly in severely curved root canals. A distinctive taper was produced by each method of preparation. All three instrumentation techniques showed preferential dentine removal from the convex aspect of the canal in the apical portion and the concave aspect in the middle portion of the root canal.