Amniotic Allograft, A Possible Alternative to Free Gingival Graft in Improving Attached Gingiva Width: A Randomized Controlled Clinical Trial.

Background: Years of research have well demonstrated the pivotal role the attached gingiva plays in maintaining of periodontal health. Objective: This study aimed to compare the efficacy of two technics, amniotic allograft and free gingival graft (FGG), in improving the attached gingiva width (AGW) around the teeth. Methods: In this randomized controlled clinical trial study, 28 patients all in need of increased AGW were randomly halved and assigned to a test group receiving the amniotic allograft and a control group treated by a palatal FGG. Following the operation, the mean AGW, graft shrinkage, and color match were assessed and photographed at various intervals (1, 2, 6, and 12 weeks). The level of pain was also evaluated based on the visual analog scale (VAS). Results: The AGW was not significantly different between the two groups in 2, 6 and, 12 weeks postoperatively (P=0.17, 0.73, 0.76 respectively). The same applied to the amount of shrinkage between the two groups at the intervals (p=0.38, p=0.57 and p=0.52 respectively). The amniotic allograft group was superior (not significantly) in terms of the color match (p=0.59, p=0.31 and p=0.18 respectively). However, it was found to have significantly lower VAS pain scores than did the control group (p <0.05). Conclusion: Application of the amniotic allograft could decrease the postoperative pain as well as discomfort and effectively increase the AGW. Therefore, given the drawbacks of FGG, the amniotic allograft can be considered as a viable alternative.

Pancreatitis After Pancreatoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistula.

BACKGROUND: Morbidity after pancreas resection is still high with postoperative pancreatic fistulas (POPF) being the most frequent complication. However, exocrine insufficiency seems to protect from POPF. In clinical practice, patients showing increased postoperative systemic amylase concentrations appear to frequently develop POPF. We therefore retrospectively examined the occurrence of systemic amylase increase after pancreas resections and its association with the clinical course. PATIENTS AND METHODS: Perioperative data from 739 consecutive pancreas resections were assessed in a prospectively maintained SPSS database. Serum and drain amylase concentrations were determined by routine clinical chemistry. POPFs were graded into A-C according to ISGPF definitions. RESULTS: In patients with reduced serum amylase (n = 89) on day 1 after pancreatoduodenectomy, clinically relevant POPFs were not observed. In patients with normal serum amylase concentrations, clinically relevant POPFs occurred in 9 %, while in 39 % of the patients with more than three times elevated amylase concentrations, a clinically relevant postoperative fistula was observed (p < 0.001). Systemic hyperamylasemia detected on postoperative day 1 after pancreatoduodenectomy was further a good predictor for clinically relevant POPFs (AUROC = 0.797, p < 0.001). CONCLUSION: Patients with a high risk for developing clinically relevant POPFs can be identified on the first postoperative day by determining serum amylase.

Enhancement and in vitro evaluation of amifostine permeation through artificial membrane (PAMPA) via ion pairing approach and mechanistic selection of its optimal counter ion.

This study presents the results of in vitro evaluation of a series of organic counter ions that form ion pairs with amifostine. The selected counter ions have different lipophilicity, shape and flexibility. Intrinsic octanol buffer partition coefficient and binding constant of the ion pairs were calculated using quasi-equilibrium analysis. Permeation through hydrophobic PAMPA membranes of amifostine and its ion pairs with different counter ions was studied. Three counter ions, succinic acid, benzoic acid and phthalic acid demonstrated an increase in the apparent partition coefficient of amifostine in n-octanol. These counter ions were selected for permeability experiments in PAMPA membranes and an increase of the apparent permeability value Papp (cm/s) was also observed as a function of the counter ion concentration. Phthalic acid produced 1.6-fold increase of log PAB while for benzoic acid and succinic acid the values were 1.2 and 0.75-fold respectively. PAMPA permeability of amifostine significantly increased in the presence of phthalic acid (42-fold), benzoic acid (37-fold) and succinic acid (10.5-fold). This study showed that the permeability of amifostine across a lipophilic membrane was enhanced in the presence of counter-ions resulting ion pair formation.

Ion-pair strategy for enabling amifostine oral absorption: rat in situ and in vivo experiments.

This study shows the effect of ion pair formation on intestinal absorption and oral bioavailability of amifostine. Amifostine is a prodrug used as a highly potent and selective radiotherapy and chemotherapy protectant but due to its low lipophilicity and charge at physiological pH range, its trans epithelial transport and its potential for oral drug delivery is very low. Ion pair formation with negatively charged counter ions was evaluated by in situ rat perfusion studies as a possible strategy to enhance intestinal absorption of amifostine. Succinic acid, phthalic acid and benzoic acid were used as counter ions. Rat intestinal perfusion studies confirmed a statistically significant increase in amifostine permeability in the presence of the counter ions in the order of succinic>phthalic>benzoic. Rat pharmacokinetic studies in vivo were performed to calculate oral absolute bioavailability of amifostine alone and with ion pairs in order to confirm the in situ perfusion results and the applicability of the ion pair approach. Intravenous and intraduodenal administrations were done in rats using a permanent jugular vein cannulation technique and a duodenal cannulation method to avoid drug degradation in stomach. In vivo oral bioavailability studies demonstrated a 20-30-fold increase in amifostine bioavailability with succinic acid depending on counter ion ratio and 10-fold increase with phthalic acid as ion pair. In summary ion pair strategy with succinic acid could enable amifostine oral administration on enteric coated formulations.

Colour M-mode superiority in evaluation of improvement in myocardial performance indices following successful percutaneous coronary intervention (PCI).

AIM: This study aimed at evaluating the early effects of successful elective percutaneous coronary intervention (PCI) on systolic and diastolic function. METHODS: We consecutively studied the systolic and diastolic function in 21 patients with stable coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) > 40% before and 48 hours after successful elective PCI. RESULTS: Tei index and systolic indices (LVEF, regional wall motion abnormality score, tricuspid annular plane systolic excursion and peak systolic velocity of mitral and tricuspid annulus) did not change significantly. Among the diastolic indices, only velocity propagation (Vp) improved significantly (from 42.9 ± 10.8 to 51.8 ± 10.7, p-value = 0.008) following PCI. Diastolic velocities, E/A ratio, deceleration time (DT), early and late diastolic velocities of mitral annulus in TDI, pulmonary vein systolic (PVs) and diastolic flow velocity (PVd) did not show significant improvement. CONCLUSION: Propagation velocity of mitral inflow was the earliest index to recover following successful PCI in patients with stable CAD.