Effectiveness of Three Bleaching Techniques for Endodontically Treated Teeth: A Randomized Clinical Trial.

BACKGROUND: Various techniques, products, and protocols are used for the bleaching of non-vital teeth. The walking bleach technique involves sealing the bleaching agent in the pulp chamber. In the inside/outside technique, a low-concentration bleaching agent is applied at home using a custom tray. In the in-office technique, a high-concentration bleaching agent is applied by a dental professional. Limited research has compared the effectiveness of these techniques. OBJECTIVE: This clinical trial aimed to evaluate the effectiveness of the walking bleach, the inside/outside, and the in-office bleaching techniques. METHODS AND MATERIALS: Fifty-four discolored teeth were selected according to eligibility criteria, randomized, and assigned to three treatment groups (n=18): walking bleach (sodium perborate - SP), inside/outside bleaching (7.5% hydrogen peroxide -HP7.5), and in-office bleaching (35% hydrogen peroxide - HP35). A cervical seal was placed in all the teeth, and nonvital bleaching was performed according to each technique. The CIELab color coordinates were measured using a clinical spectrophotometer at baseline, weekly, and at the 1-week follow-up. ΔE00 and ΔWID were calculated between the baseline and each evaluation time point. The ANOVA, Fisher exact, and Kruskal-Wallis tests were used to compare the quantitative variables, and the Fisher exact test, to determine the association among categorical variables. Bleaching effectiveness was interpreted by 50:50% perceptibility and acceptability thresholds. RESULTS: As the treatment progressed, all techniques presented a significant increase in L* and WID (p<0.001), and a significant decrease in a* and b* (p<0.001). HP7.5 and HP35 presented greater increases in WID mean values, in comparison with SP (p=0.006). No significant differences were observed among the techniques for ΔE00 after treatment completion (p=0.383). There were no statistical differences in bleaching effectiveness among the techniques after treatment completion (p=0.098). CONCLUSION: All techniques presented excellent effectiveness after treatment completion. However, HP7.5 and HP35 techniques provided a more rapid whitening response.

Antimicrobial effects of a borate-based bioactive glass wound matrix on wound-relevant pathogens.

OBJECTIVE: The antimicrobial effects of a borate-based bioactive glass matrix (BBBGM) on clinically relevant microorganisms was investigated for up to seven days in vitro. METHOD: A total of 19 wound-relevant pathogens were studied using the in vitro AATCC 100 test method. RESULTS: The reduction of viable Gram-negative and Gram-positive bacteria and yeasts at days 4 and 7 post-culture on the BBBGM was significant (> 4log10) in most cases. Mould counts were reduced (<2log10) during the seven-day assessment, indicating that mould viability and reproduction was inhibited. The cell count of each organism was reduced at seven days indicating that the BBBGM not only reduced the viable cell count, but that the cell count did not recover during the seven-day period, indicating a sustained reduction in pathogenic activity. CONCLUSION: Based on the present results, the use of a BBBGM as a pathogenic barrier should be considered as a tool for combating pathogenic colonisation and infection in acute and hard-to-heal (chronic) wounds.

Integrated transcriptome and in vitro analysis revealed anti-proliferative effect of sodium perborate on hepatocellular carcinoma cells.

BACKGROUND: Hepatocelular carcinoma is one of the leading cancer types with no effective cure as poor prognosis is still a challenging aspect. Thus, alternative therapeutics are necessary to control hepatocelular carcinoma. Boron derivatives such as boric acid (BA), sodium perborate tetrahydrate (SPT) and sodium pentaborate pentahydrate (NaB) have been discovered to have anti-cancer effect. This study investigated the anti-proliferative effects of SPT against hepatocelular carcinoma (HCC) using in vitro and transcriptome approaches. METHODS: Cytotoxic level of SPT on cell survival were detected using MTS assay. The apoptotic cell death and cell cycle arrest was determined using Annexin V/PI and cell cycle assay, respectively. Transcriptome analysis was performed using RNA-seq, followed by functional and KEGG pathway enrichment analysis. qPCR was used to validate the different genes. RESULTS: SPT treated HepG2 and Hep3B cells induced cytotoxicity having IC50 values of 1.13 mM and 0.91 mM, respectively. SPT caused mitotic arrest in G0/G1 phase at 48 h and subsequent apoptotic cell death. RNA-seq revealed a total number of 822 and 1075 differentially expressed genes (DEGs) which after SPT treatment in HepG2 and Hep3B cells, respectively. Functional and KEGG pathway enrichment results suggested that there are several genes involved to induce apoptosis related pathways. The DEGs in p53 signaling pathway may have closely relationships to the cells apoptosis caused by SPT treatment. qPCR results validated dynamic changes in p53 signaling pathway, DNA replication and cell cycle related genes, such as CDKN1A, SERPINE1, PMAIP1, MCM3, MCM5 and MCM6. CONCLUSION: In vitro experiments and RNA-seq analysis show anti-proliferative and apoptotic effect of SPT in HCC cells. Further studies might help in understanding the molecular mechanisms of SPT.

Promising potential of boron compounds against Glioblastoma: In Vitro antioxidant, anti-inflammatory and anticancer studies.

Glioblastoma (GB) is the most common and aggressive primary malignant astrocytoma correlated with poor patient survival. There are no curative treatments for GB, and it becomes resistant to chemotherapy, radiation therapy, and immunotherapy. Resistance in GB cells is closely related to their states of redox imbalance, and the role of reactive oxygen species and its impact on cancer cell survival is still far from elucidation. Boron-containing compounds, especially boric acid (BA) and borax (BX) exhibited interesting biological effects involving antibacterial, antiviral, anti-cancerogenic, anti-mutagenic, anti-inflammatory as well as anti-oxidative features. Recent studies indicated that certain boron compounds could be cytotoxic on human GB. Nevertheless, there is gap of knowledge in the literature on exploring the underlying mechanisms of anti-GB action by boron compounds. Here, we identified and compared the potential anti-GB effect of both BA and BX, and revealed their underlying anti-GB mechanism. We performed cell viability, oxidative alterations, oxidative DNA damage potential assays, and explored the inflammatory responses and gene expression changes by real-time PCR using U-87MG cells. We found that BA and BX led to a remarkable reduction in U-87MG cell viability in a concentration-dependent manner. We also found that boron compounds increased the total oxidative status and MDA levels along with the SOD and CAT enzyme activities and decreased total antioxidant capacity and GSH levels in U-87MG cells without inducing DNA damage. The cytokine levels of cancer cells were also altered. We verified the selectivity of the compounds using a normal cell line, HaCaT and found an exact opposite condition after treating HaCaT cells with BA and BX. BA applications were more effective than BX on U-87MG cell line in terms of increasing MDA levels, SOD and CAT enzyme activities, and decreasing Interleukin-1α, Interleukin-6 and Tumor necrosis factor- α (TNF- α) levels. We finally observed that anticancer effect of BA and BX were associated with the BRAF/MAPK, PTEN and PI3K/AKT signaling pathways in respect of downregulatory manner. Especially, BA application was found more favorable because of its inhibitory effect on PIK3CA, PIK3R1, PTEN and RAF1 genes. In conclusion, our analysis indicated that boron compounds may be safe and promising for effective treatment of GB.

Innovative Bioactive Glass Fiber Technology Accelerates Wound Healing and Minimizes Costs: A Case Series.

OBJECTIVE: To evaluate the efficacy and value of a novel borate-based bioactive glass fiber (BBGF) advanced wound matrix in the treatment of chronic wounds. METHODS: Four patients with chronic wounds that had failed multiple prior treatments were identified and treated with the BBGF technology. Patient demographics, wound characteristics, and prior treatment history were obtained. Costs associated with prior treatments were estimated and recorded using available cost data. RESULTS: The average wound duration prior to initiation of BBGF treatment was 391 days. All of the patients had a history of multiple failed interventions, including operative procedures, negative-pressure wound therapy, cellular and/or tissue-based products, dermal grafts, and synthetic wound matrices. Prior interventions resulted in an average estimated cost of $87,750 per patient. All of the patients achieved complete wound closure in an average of 55 days using BBGF treatment. Patients were treated with 3.3 applications of the BBGF product on average, with an average cost of $3,564. The use of the BBGF advanced wound matrix on initial presentation could have saved the healthcare system an average of $84,186 per patient and reduced wound duration by an average of 336 days. CONCLUSIONS: The BBGF advanced wound matrix resulted in the healing of chronic wounds that had failed multiple prior interventions. In this series of challenging cases, BBGF accelerated healing while minimizing costs and improving patient outcomes. By offering an effective therapy at a low cost, BBGF has the potential to add significant value for both the healthcare system and the patient.

Dependence of laser-induced tissue ablation on optical fiber movements for laser prostatectomy.

PURPOSE: The aim of the current study was to identify the efficient fiber movements for 532-nm laser prostatectomy. MATERIALS AND METHODS: 532-nm Lithium triborate (LBO) laser light was tested on 120 kidney tissues at three different translational speeds (TS 1, 2, and 4 mm/s) and four different rotational speeds (RS 0.5, 1.0, 1.6, and 2.1 rad/s). The applied power was 120 W at a 2-mm working distance and 60° sweeping angle. Ablation rate and dimensions of resulting ablation craters were measured. RESULTS: Slower TSs and RSs created deeper and wider ablation craters with thinner coagulation, leading to more efficient ablation performance. Maximal ablation rate was achieved at a TS of 2 mm/s and RSs of 0.5 and 1.0 rad/s. An RS of 0.5 rad/s accompanied surface carbonization for all the TSs. Irrespective of TS, ablation rate became saturated at faster RSs than 1.0 rad/s. Faster TSs or RSs reduced tissue ablation, but increased thermal coagulation due to a shorter interaction time. CONCLUSIONS: Optimal ablation efficiency occurred at a TS of 2 mm/s and a RS of 1.0 rad/s with a thin coagulation of around 1.0 mm and no or minimal carbonization. Further studies will validate the current findings with prostate tissue and high-power levels for laser prostatectomy.

Borax Alleviates Copper-Induced Renal Injury via Inhibiting the DNA Damage and Apoptosis in Rainbow Trout.

The aim of this study was to determine the therapeutic potential of borax against copper in the kidney tissue of the rainbow trout fed with added borax (BX) (1.25, 2.5, and 5 mg/kg) and/or copper (Cu) (500,1000 mg/kg) contents. For this purpose, two treatment groups had designed, and glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) enzyme activities were determined. Besides, oxidative DNA damage (8-hydroxy-2'-deoxyguanosine, 8-OHdG), caspase-3, and malondialdehyde (MDA) levels were assessed in kidneys of all treatment groups. In molecular pathway, hsp70, CYP1A, and antioxidant gene expression levels were determined. In the results of the analysis, antioxidant enzyme activity and gene expression were increased; 8-OHdG, caspase-3, and MDA levels were decreased in groups fed with borax supplemented feeds compared to the copper-treated group. The alterations among the groups were found as significant (p < 0.05). CYP1A and hsp70 gene expressions were upregulated in copper and copper combined groups (p < 0.05). The findings of present research showed that borax had alleviative effect on copper-induced toxicity and could be used as an antidote in fish nutrition.

Safety and Efficacy of a Novel Vaginal Anti-infective, TOL-463, in the Treatment of Bacterial Vaginosis and Vulvovaginal Candidiasis: A Randomized, Single-blind, Phase 2, Controlled Trial.

BACKGROUND: Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) present serious reproductive health risks and management challenges, with poor control attributed to survival of treatment-resistant biofilm communities. Boric acid is used in various regimens for non-albicans VVC and recurrent BV. We investigated safety and efficacy of a novel boric acid-based vaginal anti-infective with enhanced antibiofilm activity (TOL-463) in treating BV and VVC. METHODS: In this phase 2 randomized, investigator-blinded trial conducted at 2 sexual health clinics, women with BV or VVC were randomly assigned (1:1) to 7 nights of TOL-463 vaginal gel or insert. The primary test of cure (TOC) was clinical cure at day 9-12; safety was assessed at TOC and day 21-30. RESULTS: One hundred six participants (53 with BV, 36 VVC, 17 both) were enrolled; most were African American (69%). Clinical cure rate of BV at TOC was 59% (95% confidence interval [CI], 41%-75%) for TOL-463 insert and 50% (95% CI, 31%-69%) for TOL-463 gel, and for VVC, 92% (95% CI, 67%-99%) for TOL-463 insert and 81% (95% CI, 57%-93%) for TOL-463 gel. Both products were safe and well tolerated with no secondary cases of VVC; vulvovaginal burning was the most common adverse event (9.6%). CONCLUSIONS: TOL-463, especially in vaginal insert form, is effective and safe in treating BV and VVC. Future studies should assess the potential role of TOL-463 as a biofilm disrupter in enhancing likelihood of cure relative to approved therapies, reducing recurrence rates, and combined with traditional antimicrobials. CLINICAL TRIALS REGISTRATION: NCT02866227.

The Effect of Boric Acid and Borax on Oxidative Stress, Inflammation, ER Stress and Apoptosis in Cisplatin Toxication and Nephrotoxicity Developing as a Result of Toxication.

The development of treatment protocols that can reduce side effects in chemotherapy applications is extremely important in terms of cancer treatment. In this context, it was aimed to investigate the effects of boric acid and borax on cisplatin toxicity (nephrotoxicity) in rats. In the experimental phase, eight groups were formed from rats. Boric acid and borax were given to the treatment groups with three different doses using gavage. On the fifth day of the study, cisplatin (10 mg/kg) was administered to all rats except the control group. At the end of the study, oxidative stress-related (GSH, MDA, PCO, GPx, 8-OHdG), inflammation-related (TNF-α, IL-1ß, IL-18, MCP-1, ICAM, TGF-ß), apoptosis-related (p53, caspase 1, 3, 8, 12, bcl-2, bcl-xL, NFkB), and ER stress-related (GRP78, ATF-6, PERK) basic parameters were analyzed in serum, erythrocyte, and kidney tissues. Kidney tissues were also examined by histopathological and immunohistochemical methods. Borax and boric acid at different doses decreased inflammation and oxidative stress caused by cisplatin toxicity and increased ER stress. As a result of the treatments applied to experimental animals, it was determined that boric acid and borax reduced apoptotic damage in kidney tissue, but the decrease was statistically significant only in 200 mg/kg boric acid-administered group. In the study, low anti-apoptotic effects of borate doses with the anti-inflammatory and antioxidant effect may be due to increased ER stress at the relevant doses. Further studies on the effects of boron compounds on ER stress and apoptotic mechanisms may clarify this issue. Thus, possible side effects or if there are new usage areas of borone compounds which have many usage areas in clinics can be detected.

Comparison of intracoronal bleaching methods on teeth discolored by different antibiotic pastes.

AIM: To compare the bleaching efficacy of sodium perborate with different activation methods on crowns discolored by two different antibiotic pastes. MATERIALS AND METHODS: Eighty-five extracted human incisors were prepared to size #30 using ProTaper rotary instruments. After chemomechanical preparation and irrigation procedures, the specimens received triple antibiotic paste (TAP, n = 40), minocycline paste (MP, n = 40), or calcium hydroxide (n = 5, control group) and coronally sealed with temporary filling material. Spectrophotometric readings were obtained on day 0-week 4. Data were analyzed with the Mann-Whitney U-test and Wilcoxon sign test (P < 0.05). Sodium perborate was then inserted into the pulp chambers of discolored teeth (four subgroups, n = 10) and activated by heat or ultrasonically using two different frequencies and times. Spectrophotometric readings were obtained on days 3-7. Data were analyzed by the Mann-Whitney U-test and Kruskal-Wallis test (P > 0.05). RESULTS: Both groups showed statistically significant coronal discoloration at each time interval (P < 0.01), but their final shades did not significantly differ between the groups (P > 0.05). Although the MP subgroups exhibited more bleaching than the TAP subgroups on days 3 and 7, the difference was not significant (P > 0.05). The bleaching results for the sodium perborate activation techniques did not significantly differ among groups (P > 0.05). CONCLUSIONS: Both antibiotic pastes induced crown discoloration that was reversible using all sodium perborate bleaching techniques.

Evaluation of processed borax as antidote for aconite poisoning.

ETHNOPHARMACOLOGICAL RELEVANCE: Aconite root is very poisonous; causes cardiac arrhythmias, ventricular fibrillation and ventricular tachycardia. There is no specific antidote for aconite poisoning. In Ayurveda, dehydrated borax is mentioned for management of aconite poisoning. AIM OF THE STUDY: The investigation evaluated antidotal effect of processed borax against acute and sub-acute toxicity, cardiac toxicity and neuro-muscular toxicity caused by raw aconite. MATERIALS AND METHODS: For acute protection Study, single dose of toxicant (35mg/kg) and test drug (22.5mg/kg and 112.5mg/kg) was administered orally, and then 24h survival of animals was observed. The schedule was continued for 30 days in sub-acute protection Study with daily doses of toxicant (6.25mg/kg), test drug (22.5mg/kg and 112.5mg/kg) and vehicle. Hematological and biochemical tests of blood and serum, histopathology of vital organs were carried out. The cardiac activity Study was continued for 30 days with daily doses of toxicant (6.25mg/kg), test drug (22.5mg/kg), processed borax solution (22.5mg/kg) and vehicle; ECG was taken after 1h of drug administration on 1TB, 15th and on 30th day. For neuro-muscular activity Study, the leech dorsal muscle response to 2.5µg of acetylcholine followed by response of toxicant at 25µg and 50µg doses and then response of test drug at 25µg dose were recorded. RESULTS: Protection index indicates that treated borax gave protection to 50% rats exposed to the lethal dose of toxicant in acute protection Study. Most of the changes in hematological, biochemical parameters and histopathological Study induced by the toxicant in sub-acute protection Study were reversed significantly by the test drug treatment. The ventricular premature beat and ventricular tachyarrhythmia caused by the toxicant were reversed by the test drug indicate reversal of toxicant induced cardio-toxicity. The acetylcholine induced contractions in leech muscle were inhibited by toxicant and it was reversed by test drug treatment. CONCLUSION: The processed borax solution is found as an effective protective agent to acute and sub-acute aconite poisoning, and aconite induced cardiac and neuro-muscular toxicity. Processed borax at therapeutic dose (22.5mg/kg) has shown better antidotal activity profile than five times more than therapeutic dose (112.5mg/kg).

Photoselective Vaporesection of the Prostate with an End-firing Lithium Triborate Crystal Laser.

BACKGROUND: Photoselective vaporization of the prostate is a technique that is widely used for the treatment of benign prostatic hyperplasia (BPH) and has pronounced advantages compared to the traditional transurethral resection of the prostate. Following the recent introduction of end-firing lithium triborate lasers, we have created a new technique called photoselective vaporesection of the prostate (PVRP). This study described our initial experience using the PVRP technique for the treatment of BPH. METHODS: This prospective study included a total of 35 patients with BPH who underwent PVRP from August 2013 to July 2014. The chief clinical parameters were obtained and evaluated during the perioperative period and follow-up, including the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate, and prostate volume. All variables were evaluated for statistically significant differences compared to baseline values using the analysis of variance. RESULTS: The mean subgroup IPSS and QoL scores significantly improved during follow-up; the respective decreases in IPSS storage score, IPSS voiding score, IPSS nocturia score, and QoL score were 75.3%, 83.6%, 51.4%, and 71.7%, respectively (all P < 0.001 compared with baseline). Three patients were diagnosed with prostate cancer based on postoperative pathological examinations. There were no serious perioperative complications. CONCLUSION: The PVRP technique demonstrates satisfactory short-term clinical outcomes and perioperative safety in the treatment of BPH.

Effectiveness of various interventions on maintenance of gingival health during 1 year - a randomized clinical trial.

BACKGROUND: Rinsing with the combined use of an oxygenating-agent (OA) and chlorhexidine (CHX) in addition to mechanical oral hygiene could improve and/or maintain good gingival health over a long period. METHODS: This study had an examiner-blinded, randomized, six-group parallel design consisting of two-phases: a 3-week treatment phase and a subsequent 12-month experimental phase. A total of 267 subjects in good general health (≥18 years), without periodontitis, with at least five teeth per quadrant, and with moderate to advanced gingivitis were enrolled. A 3-week treatment phase was initiated to improve gingival health. Subjects were assigned to one of the six groups: two basic oral hygiene groups (Control I & II), one professional oral hygiene instruction group (OHI), one professional prophylaxis group (PP), an OA&CHX rinse group and a group receiving a combination of all regimens (COMBI group), being OHI + PP + OA&CHX. Dental plaque, gingival bleeding and staining assessments were performed at the start of the treatment phase, at baseline and at 4, 7, 10, and 12 months. RESULTS: There was a significant reduction in dental plaque-scores for the OA&CHX and COMBI-group (0.51 [SD = 0.37], 0.38 [SD = 0.33] respectively) and a significant reduction in gingivitis scores for the OA&CHX and COMBI group (6.9% [SD = 14.0], 13.4% [SD = 13.4] respectively) from the start of the treatment phase to baseline. No clinically relevant changes were observed for the other four groups. After baseline, bleeding and plaque-scores increased back to a non-significant level between groups, and this level remained throughout the study. CONCLUSION: OA&CHX and COMBI-group showed a clinically relevant improvement after the treatment phase in terms of dental plaque and gingival bleeding levels. At the 4-month clinical assessment, there was no longer a significant difference between groups.

Polymeric Membrane Dressings for Topical Wound Management of Patients With Infected Wounds in a Challenging Environment: A Protocol With 3 Case Examples.

Patients with acute wounds often delay seeking medical assistance until an incapacitating infection has developed. When such patients come for help at a remote Christian clinic in northern Ghana, West Africa, the goals of care are to resolve and prevent a return of infection, decrease pain, enable an immediate return to normal activities, and facilitate healing. Because the local protocol of care, Edinburgh University Solution of Lime (EUSOL)-soaked gauze, did not meet these goals, the author tried using a variety of donated wound dressing regimens. Ultimately, polymeric membrane dressings (PMDs) were observed to meet patient care needs while also reducing clinic staff time and resources, and a PMD protocol of care was developed. Three (3) representative patients who presented with acute wounds and infection are described: a 20-year-old man with a hand abscess, a 16-year-old boy with a malleolus wound, and an approximately 20-year-old woman with an injection abscess, all otherwise relatively healthy, albeit undernourished. All 3 patients re- ceived oral antibiotics, their wounds were initially cleansed and debrided, and an appropriate configuration of either regular or silver-containing PMDs was applied to all exposed wound surfaces. Dressing changes were scheduled based upon the personalized plan of care. In all 3 patients, the pain-relieving properties of PMDs allowed resumption of activi- ties within 1 day of initiating treatment, the dressings' continuous wound cleansing system kept the wounds clean and free of infection despite the challenging environment, and the wounds healed steadily. Managing infected acute wounds with PMDs through complete wound closure was time efficient for clinic staff and met all 4 major patient goals of care. Randomized, controlled studies to compare wound and quality of life outcomes in patients whose infected wounds are managed with PMDs compared with those whose wounds are managed with other advanced dressings are warranted.

Effectiveness of chemical disinfection on biofilms of relined dentures: A randomized clinical trial.

PURPOSE: To evaluate the effect of disinfection with sodium perborate or chlorhexidine (when combined with brushing) on the removal of biofilm in relined dentures. METHODS: Swabs were collected 48 hours after the relining procedure and at the follow-up time intervals of 7, 15, 30, 90, and 180 days. The dentures' surface roughness was measured at the same times. 45 subjects were randomly divided into three groups of 15 subjects each. The control group brushed with coconut soap and a soft toothbrush. The sodium perborate group followed the same procedure and also disinfected with sodium perborate solution for 5 minutes per day. The chlorhexidine group followed the control group procedure and disinfected with 2% chlorhexidine digluconate solution for 5 minutes per day. The number of colony forming units and the surface roughness were evaluated statistically by 2-way repeated-measure ANOVA (α = 0.05). RESULTS: The control group dentures exhibited similar levels of microbial cells throughout the experiment. However, after 15 days, no microbial growth was observed on the dentures for which either disinfection agent was used. There were no statistically significant differences in superficial roughness between the groups (P = 0.298). The disinfection agents used, combined with brushing, were able to remove the relined dentures' biofilm after 15 days of disinfection. Roughness was not a predominant factor in CFU reduction.

Debridement for venous leg ulcers.

BACKGROUND: Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice documents and expert opinion suggests that the removal of devitalised tissue from venous ulcers (debridement) by any one of six methods helps to promote healing. However, to date there has been no review of the evidence from randomised controlled trials (RCTs) to support this. OBJECTIVES: To determine the effects of different debriding methods or debridement versus no debridement, on the rate of debridement and wound healing in venous leg ulcers. SEARCH METHODS: In February 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. In addition we handsearched conference proceedings, journals not cited in MEDLINE, and the bibliographies of all retrieved publications to identify potential studies. We made contact with the pharmaceutical industry to enquire about any completed studies. SELECTION CRITERIA: We included RCTs, either published or unpublished, which compared two methods of debridement or compared debridement with no debridement. We presented study results in a narrative form, as meta-analysis was not possible. DATA COLLECTION AND ANALYSIS: Independently, two review authors completed all study selection, data extraction and assessment of trial quality; resolution of disagreements was completed by a third review author. MAIN RESULTS: We identified 10 RCTs involving 715 participants. Eight RCTs evaluated autolytic debridement and included the following agents or dressings: biocellulose wound dressing (BWD), non-adherent dressing, honey gel, hydrogel (gel formula), hydrofibre dressing, hydrocolloid dressings, dextranomer beads, Edinburgh University Solution of Lime (EUSOL) and paraffin gauze. Two RCTs evaluated enzymatic preparations and one evaluated biosurgical debridement. No RCTs evaluated surgical, sharp or mechanical methods of debridement, or debridement versus no debridement. Most trials were at a high risk of bias.Three RCTs assessed the number of wounds completely debrided. All three of these trials compared two different methods of autolytic debridement (234 participants), with two studies reporting statistically significant results: one study (100 participants) reported that 40/50 (80%) ulcers treated with dextranomer beads and 7/50 (14%) treated with EUSOL achieved complete debridement (RR 5.71, 95% CI 2.84 to 11.52); while the other trial (86 participants) reported the number of ulcers completely debrided as 31/46 (76%) for hydrogel versus 18/40 (45%) for paraffin gauze (RR 0.67, 95% CI 0.45 to 0.99). One study (48 participants) reported that by 12 weeks, 15/18 (84%) ulcers treated with BWD had achieved a 75% to 100% clean, granulating wound bed versus 4/15 (26%) treated with non-adherent petrolatum emulsion-impregnated gauze.Four trials assessed the mean time to achieve debridement: one (86 participants) compared two autolytic debridement methods, two compared autolytic methods with enzymatic debridement (71 participants), and the last (12 participants) compared autolytic with biosurgical debridement; none of the results achieved statistical significance.Two trials that assessed autolytic debridement methods reported the number of wounds healed at 12 weeks. One trial (108 participants) reported that 24/54 (44%) ulcers treated with honey healed versus 18/54 (33%) treated with hydrogel (RR (adjusted for baseline wound diameter) 1.38, 95% CI 1.02 to 1.88; P value 0.037). The second trial (48 participants) reported that 7/25 (28%) ulcers treated with BWD healed versus 7/23 (30%) treated with non-adherent dressing.Reduction in wound size was assessed in five trials (444 participants) in which two autolytic methods were compared. Results were statistically significant in one three-armed trial (153 participants) when cadexomer iodine was compared to paraffin gauze (mean difference 24.9 cm², 95% CI 7.27 to 42.53, P value 0.006) and hydrocolloid compared to paraffin gauze (mean difference 23.8 cm², 95% CI 5.48 to 42.12, P value 0.01). A second trial that assessed reduction in wound size based its results on median differences and, at four weeks, produced a statistically significantly result that favoured honey over hydrogel (P value < 0.001). The other three trials reported no statistically significant results for reduction in wound size, although one trial reported that the mean percentage reduction in wound area was greater at six and 12 weeks for BWD versus a non-adherent dressing (44% versus 24% week 6; 74% versus 54% week 12).Pain was assessed in six trials (544 participants) that compared two autolytic debridement methods, but the results were not statistically significant. No serious adverse events were reported in any trial. AUTHORS' CONCLUSIONS: There is limited evidence to suggest that actively debriding a venous leg ulcer has a clinically significant impact on healing. The overall small number of participants, low number of studies and lack of meta-analysis in this review precludes any strong conclusions of benefit. Comparisons of different autolytic agents (hydrogel versus paraffin gauze; Dextranomer beads versus EUSOL and BWD versus non-adherent dressings) and Larvae versus hydrogel all showed statistically significant results for numbers of wounds debrided. Larger trials with follow up to healing are required.

Borax partially prevents neurologic disability and oxidative stress in experimental spinal cord ischemia/reperfusion injury.

OBJECTIVES: The aim of this study is to investigate the potential effects of borax on ischemia/reperfusion injury of the rat spinal cord. METHODS: Twenty-one Wistar albino rats were divided into 3 groups: sham (no ischemia/reperfusion), ischemia/reperfusion, and borax (ischemia/reperfusion + borax); each group was consist of 7 animals. Infrarenal aortic cross clamp was applied for 30 minutes to generate spinal cord ischemia. Animals were evaluated functionally with the Basso, Beattie, and Bresnahan scoring system and inclined-plane test. The spinal cord tissue samples were harvested to analyze tissue concentrations of nitric oxide, nitric oxide synthase activity, xanthine oxidase activity, total antioxidant capacity, and total oxidant status and to perform histopathological examination. RESULTS: At the 72nd hour after ischemia, the borax group had significantly higher Basso, Beattie, and Bresnahan and inclined-plane scores than those of ischemia/reperfusion group. Histopathological examination of spinal cord tissues in borax group showed that treatment with borax significantly reduced the degree of spinal cord edema, inflammation, and tissue injury disclosed by light microscopy. Xanthine oxidase activity and total oxidant status levels of the ischemia/reperfusion group were significantly higher than those of the sham and borax groups (P < .05), and total antioxidant capacity levels of borax group were significantly higher than those of the ischemia/reperfusion group (P < .05). There was not a significantly difference between the sham and borax groups in terms of total antioxidant capacity levels (P > .05). The nitric oxide levels and nitric oxide synthase activity of all groups were similar (P > .05). CONCLUSIONS: Borax treatment seems to protect the spinal cord against injury in a rat ischemia/reperfusion model and improve neurological outcome.

Effect of daily use of an enzymatic denture cleanser on Candida albicans biofilms formed on polyamide and poly(methyl methacrylate) resins: an in vitro study.

STATEMENT OF PROBLEM: Candida biofilms on denture surfaces are substantially reduced after a single immersion in denture cleanser. However, whether this effect is maintained when dentures are immersed in cleanser daily is unclear. PURPOSE: The purpose of this study was to evaluate the effect of the daily use of enzymatic cleanser on Candida albicans biofilms on denture base materials. MATERIAL AND METHODS: The surfaces of polyamide and poly(methyl methacrylate) resin specimens (n=54) were standardized and divided into 12 groups (n=9 per group), according to study factors (material type, treatment type, and periods of treatment). Candida albicans biofilms were allowed to form over 72 hours, after which the specimens were treated with enzymatic cleanser once daily for 1, 4, or 7 days. Thereafter, residual biofilm was ultrasonically removed and analyzed for viable cells (colony forming units/mm(2)) and enzymatic activity (phospholipase, aspartyl-protease, and hemolysin). Factors that interfered with the response variables were analyzed by 3-way ANOVA with the Holm-Sidak multiple comparison method (α=.05). RESULTS: Polyamide resin presented more viable cells of Candida albicans (P<.001) for both the evaluated treatment types and periods. Although enzymatic cleansing significantly (P<.001) reduced viable cells, daily use did not maintain this reduction (P<.001). Phospholipase activity significantly increased with time (P<.001) for both materials and treatments. However, poly(methyl methacrylate) based resin (P<.001) and enzymatic cleansing treatment (P<.001) contributed to lower phospholipase activity. Aspartyl-protease and hemolysin activities were not influenced by study factors (P>.05). CONCLUSIONS: Although daily use of an enzymatic cleanser reduced the number of viable cells and phospholipase activity, this treatment was not effective against residual biofilm over time.

Fracture resistance of teeth submitted to several internal bleaching protocols.

AIM: The aim of this study was to evaluate the fracture resistance of teeth submitted to several internal bleaching protocols using 35% hydrogen peroxide (35HP), 37% carbamide peroxide (37CP), 15% hydrogen peroxide with titanium dioxide nanoparticles (15HPTiO2) photoactivated by LED-laser or sodium perborate (SP). MATERIALS AND METHODS: After endodontic treatment, fifty bovine extracted teeth were divided into five groups (n = 10): G1-unbleached; G2-35HP; G3-37CP; G4-15HPTiO2 photoactivated by LED-laser and G5-SP. In the G2 and G4, the bleaching protocol was applied in 4 sessions, with 7 days intervals between each session. In the G3 and G5, the materials were kept in the pulp teeth for 21 days, but replaced every 7 days. After 21 days, the teeth were subjected to compressive load at a cross head speed of 0.5 mm/min, applied at 135° to the long axis of the root using an eletromechanical testing machine, until teeth fracture. The data were submitted to ANOVA and Tukey tests (α = 5%). RESULTS: The 35HP, 37CP, 15HPTiO2 and SP showed similar fracture resistance teeth reduction (p > 0.05). All bleaching treatments reduced the fracture resistance compared to unbleached teeth (p < 0.05). CONCLUSION: All bleaching protocols reduced the fracture resistance of endodontically-treated teeth, but there were no differences between each other. CLINICAL SIGNIFICANCE: There are several internal bleaching protocols using hydrogen peroxide in different concentrations and activation methods. This study evaluated its effects on fracture resistance in endodontically-treated teeth.

Detrusor overactivity does not predict bothersome storage symptoms after photoselective vaporization of the prostate with lithium triborate laser.

OBJECTIVE: To find out if detrusor overactivity (DO) is a predictor of moderate or severe storage lower urinary tract symptoms (LUTS) persisting 6 months after photoselective vaporization of the prostate (PVP). MATERIALS AND METHODS: Patients with bladder outlet obstruction proved by urodynamics who underwent PVP with the lithium triborate laser were followed for 6 months with the International Prostate Symptom Score (IPSS) questionnaire. Moderate-to-severe storage LUTS were defined as IPSS storage domain score >8 and/or a score for an IPSS question on urgency >3. Predictive values of DO, IPSS domains, urgency, prostate volume, bladder outlet obstruction grade, and energy used were tested by logistic regression analysis. RESULTS: Seventy-six men at the age of 66.4 ± 6.8 years underwent PVP, including 36 (47.4%) with DO. Incidence of moderate or severe storage LUTS was decreasing from 60.5% to 48.7% at week 6 and 11.8% at month 6 postoperatively. At a univariate analysis, urgency score and storage domain score were significantly associated with bothersome storage LUTS at month 6. Multivariate analysis confirmed predictive value of preoperative urgency having an odds ratio of 5.7 (95% confidence interval, 1.41-23.16; P = .014). DO was not associated with the defined outcome. CONCLUSION: In our group, DO was not useful in predicting persistent storage symptoms after PVP. Patients with severe preoperative urgency should be informed about a risk of such outcome.