Evaluation of the diagnostic validity of noninvasive tests for predicting liver fibrosis stage in chronic hepatitis B patients.

BACKGROUND AND STUDY AIM: The aim of this study was to evaluate the effectiveness of noninvasive tests in predicting liver fibrosis levels in chronic hepatitis B (CHB) patients. PATIENTS AND METHODS: A total of 539 treatment naive patients aged 18 years and older with CHB who underwent liver biopsy were included. Patients with coinfections and comorbidities were excluded. Data were obtained retrospectively from patient' follow- up files. Liver biopsy was evaluated according to the Ishak scoring system. SPSS 22.0 program was used for statistical analysis. Diagnostic sensitivity of APRI, FIB-4, NLR, GPR, AAR, RPR, API, King's score, Fibro Q and MPV was determined for predicting ≥F2, ≥F3, ≥F4, ≥F5 groups. RESULTS: The median age of the CHB patients was 41 ±11.57 / year and 49.2% of the patients were female. The distribution of fibrosis stages was : F0, 16.5% ; F1, 26.4% ; F2, 39.7% ; F3, 10.4% ; F4, 4.1% ; F5, 2.4% ; F6 0.4%. Age, AST, ALT, GGT, ALP, RDW, HBV DNA levels were significantly higher, platelet and albumin levels were significantly lower in the ≥F3 group. All noninvasive tests except NLR and AAR predicted ≥F3 adequately (AUROC >0.5). King's score for predicting ≥F2, ≥F5, and GPR for predicting ≥F3 had the highest diagnostic power. The tests predicted the fibrosis stage better, as the fibrosis stage progressed. CONCLUSION: As a result, most of the noninvasive tests we evaluated could predict significant fibrosis and cirrhosis with significant accuracy. The rate of unnecessary biopsies can be reduced with the help of these noninvasive tests.

Cytogenetic findings in patients diagnosed with breast cancer having undergone adjuvant chemotherapy regimens.

The aim of the present study was to investigate DNA damage in peripheral blood lymphocytes of breast cancer (BC) patients before and after administration of chemotherapy. We analyzed the frequency of sister chromatid exchange (SCE), occurrence of micronuclei (MN), and lymphocyte proliferation rate index (PRI) as cytogenetic markers in 28 female BC patients before and after chemotherapy, and in 20 age-matched healthy female volunteers. Prior to treatment, BC patients showed significantly increased background levels of SCE and MN, and lowered PRIs compared to healthy women. In comparison with pre-treatment levels, SCE and MN frequencies were significantly elevated and PRI reduced in blood samples collected after chemotherapy. Our findings indicate that SCE, MN, and PRI may serve as sensitive biomarkers for routine detection of the genetic abnormalities that may occur following administration of antineoplastic drugs in the clinical setting, as well as for the monitoring of high-risk patients receiving chemotherapy for BC.

Comparison of ProTaper, RaCe and Safesider instruments in the induction of dentinal microcracks: a micro-CT study.

AIM: To evaluate ex vivo the incidence of microcracks in root dentine after canal preparation with ProTaper Universal (PTU), RaCe or Safesider instrumentation systems using microcomputed tomography (micro-CT). METHODOLOGY: Thirty freshly extracted mandibular molars with two separate mesial canals and foramina were used. The roots were allocated into three similar groups according to curvature angles and radii of the canals and lengths of the roots. Distal roots were removed and mesial roots were embedded in acrylic resin and instrumented with the PTU, RaCe or Safesider systems up to size 30 (F3 for PTU, size 30, 0.04 taper for RaCe and Safesider) for all instrumentation groups. Dentinal microcracks were evaluated on micro-CT images of the apical 10 mm of the roots with 1-mm intervals. Two experienced observers evaluated the images twice in a blinded fashion. The presence of dentinal microcracks (complete/incomplete cracks and craze lines) was noted and analysed statistically using McNemar and chi-square tests (P = 0.05). RESULTS: There were microcracks on uninstrumented root sections. All instrumentation systems significantly increased the number of dentinal microcracks when compared to preoperative specimens (P < 0.05). There were new microcracks on the postoperative samples. The PTU system (42%) led to greater number of post-instrumentation microcracks than Safesider (35%) and RaCe (25%) systems, respectively. The difference between PTU and RaCe system was significant (P < 0.05). CONCLUSIONS: All instrumentation systems significantly increased the number of microcracks compared with preoperative specimens. The PTU system generated more post-instrumentation dentinal microcracks than the RaCe system.

Shaping ability of two M-wire and two traditional nickel-titanium instrumentation systems in S-shaped resin canals.

AIMS: The aim of this study was to evaluate the shaping effects of two M-wire and two traditional nickel-titanium (NiTi) rotary systems in simulated S-shaped resin canals. SUBJECTS AND METHODS: Forty simulated S-shaped canals in resin blocks were instrumented with two traditional (ProTaper, Sendoline S5) and two M-wire (WaveOne, GT series X) NiTi systems according to the manufacturers' instructions. Ten resin blocks were used for each system. Pre- and post-instrumentation images were captured using a stereomicroscope and superimposed with an image program. Canal transportation, material removal, and aberrations were evaluated and recorded as numeric parameters. STATISTICAL ANALYSIS USED: Data were analyzed using one-way ANOVA and post-hoc Tukey tests with a 95% confidence interval. RESULTS: There were significant differences between systems in terms of transportation and material removal (P<0.05). Coronal danger zone was the most common aberration. CONCLUSIONS: Within the limits of this ex vivo study, it was found that the manufacturing methods (M-wire or traditional NiTi) and kinematics (rotary or reciprocating motion) did not affect the shaping abilities of the systems. The extended file designs of highly tapered NiTi systems (ProTaper, WaveOne) resulted in greater deviations from the original root canal trace and more material removal when compared to less tapered systems (Sendoline S5, GT series X).

The risk of polyomavirus-associated graft nephropathy is increased by a combined suppression of CD8 and CD4 cell-dependent immune effects.

Polyomavirus-associated graft nephropathy (PAN) has emerged as a significant risk factor for kidney graft loss. We analyzed intracellular cytokine responses for possible protective versus permissive immunologic effects on BK-virus replication. One hundred five renal transplant patients included in a prospective single-center study were randomized to receive cyclosporine mycophenolate mofetil (MMF) (CM: n = 31), tacrolimus (Tac)/MMF (TM: n = 32) or Tac/MMF with conversion to everolimus (TErl; n = 32). Ten patients were not randomized (NR) due to contraindications to MMF. The immunosuppressive therapy was monitored pre- and posttransplantation at 4, 12, and 24 months using triple fluorescence flow cytometry for intracellular interleukin (Il)-2 Il-4 and interferon (IFN)-γ production in phorbol myristate acetate- and lipopolysaccharide- stimulated lymphocyte cultures. BK viremia screening was performed by reverse-transcriptase polymerase chain reaction testing on days 0, 14, 30, 60, 90, 120, 180, 270, 360, and 720. Seven of 105 (6.7%) patients developed biopsy-proven PAN (CM: n = 1, TM: n = 3, TErl: n = 2, NR: n = 1), among whom 4 lost their grafts (TM: n = 1, TErl: n = 2, NR: n = 1). Twenty-one of 105 (20.0%) patients had documented BK viremia. BK viremia which preceded PAN in all cases, was significantly associated with TM immunosuppression: 4/31 (12.9%) CM: 11/32 (34.4%) TM; 5/32 (15.6%) TErl, and 1/10 (10.0%) NR patients (P = .034). BK-viremic patients showed significantly diminished CD8(+) T-cell Il-2 production at 120 days (P = .011) and 1 year posttransplantation (P = .014) compared with non-BK-viremic patients. Patients with PAN displayed significantly lower CD4(+) T-cell Il-4 responses at 1 and 2 years after transplantation (1 year: P = .007; 2 years: P = .001) with diminished IFN-γ responses at 1 year after transplantation (P = .011). Our analysis showed the incidence of BK viremia to be increased among patients with defective cytotoxic CD8(+) T-cell -dependent immune reactivity. Recipients who progressed from BK viremia to overt PAN showed an additional immunologic defect in CD4(+) T-cell function. Patients on a Tac- plus MMF-based immunosuppression were at higher risk to develop BK viremia.

SU-E-T-208: The Secondary Malignancy Risk Estimation Due to the Neutron Contamination in 3D-CRT and IMRT Treatment Techniques by Using Bubble Detectors.

PURPOSE: In this study, the neutron measurements were performed in free in air and RW3 solid water phantom to estimate the secondary malignancy risk for three dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) techniques in prostate cancer treatment. METHODS: Neutron dose were measured in 18 MV Elekta Synergy Platform and Varian Clinac linear accelerators by using bubble detector for personal neutron dosimetry (BD-PND). To determine the neutron equivalent dose in different depths and different distance from the edge of treatment field RW3 solid water phantom was used and organs location was defined in Alderson Rando phantom with respect to target (prostate) position in the treatment field. By using these data, we determined the neutron equivalent dose and effective dose for the standard prostate cancer patient treated with 3D-CRT and IMRT with 18 MV photon energy. The total dose was 70 Gy in 3D-CRT and 76 Gy in IMRT treatment in the current study. For both of these treatment techniques, we estimated the risk of secondary malignancies due to the neutron contamination by using the International Commission on Radiological Protection (ICRP) report 103. RESULTS: The equivalent dose and effective dose due the neutron contamination were considerably high in 18 MV IMRT technique. The secondary malignancy risk estimation for 3D-CRT and IMRT were found to be 0.44% and 1.15% for Elekta Synergy Platform linear accelerator, 0.92% and 2.38% for the Varian Clinac DHX High Performance linear accelerator, respectively. CONCLUSIONS: Therefore, one should take care of the secondary malignancy risk in case of using 18 MV in IMRT applications.

Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals.

AIM: To compare the efficacy of several techniques for the removal of calcium hydroxide (Ca(OH)(2)) from root canals. METHODOLOGY: The root canals of 24 freshly extracted human mandibular premolars were prepared with ProTaper rotary instruments. The teeth were sectioned longitudinally along the length of the instrumented canals. The roots were subsequently reassembled with wires. After Ca(OH)(2) was placed into the canals, four techniques were used for its removal. In Group I, the teeth were irrigated with 5 mL of 2.5% NaOCl. Group II was treated in the same manner as Group I, but 5 mL of 17% EDTA was used in addition to NaOCl. In Group III, the teeth were irrigated with 5 mL of 2.5% NaOCl and agitated by an ultrasonic unit. In Group IV, the teeth were irrigated with 5 mL of 2.5% NaOCl and a CanalBrush was used to remove the Ca(OH)(2) . The roots were disassembled and digital photographs were taken. Measurements of residual Ca(OH)(2) were performed as percentages of the overall canal surface area. The data was analysed with one-way ANOVA with post hoc Tukey test. RESULTS: Significantly less residual material was obtained with a CanalBrush and passive ultrasonic agitation of NaOCl than the other groups (P < 0.05). There was no significant difference between syringe delivery of NaOCl and NaOCl+EDTA (P > 0.05). CONCLUSIONS: None of the techniques removed the Ca(OH)(2) dressing completely. CanalBrush and ultrasonic agitation of NaOCl were significantly more effective than irrigant-only techniques.

Efficacy of three rotary NiTi instruments in removing gutta-percha from root canals.

AIM: To investigate the ability of three rotary nickel-titanium instruments and hand instrumentation to remove gutta-percha and sealer. METHODOLOGY: Sixty freshly extracted human single-rooted teeth, each with one root canal, were instrumented with K-files and filled using cold lateral compaction of gutta-percha and AH Plus (Dentsply Detrey, Konstanz, Germany) sealer. The teeth were randomly divided into four groups of 15 specimens each. Removal of gutta-percha was performed with the following devices and techniques: ProTaper, R-Endo, Mtwo and Hedström files. The specimens were rendered transparent and the area of remaining filling material on the root canal wall was measured using a computer image analysis program. Statistical analysis was accomplished by Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni correction for the analysis of residual root filling material and working time. RESULTS: The ProTaper group had less filling material inside the root canals than the other groups, but a significant difference was found between only the ProTaper and Mtwo groups (P < 0.05). The retreatment time for Mtwo and ProTaper was significantly shorter compared with R-Endo and manual instrumentation with Hedström files (P < 0.001). R-Endo was significantly faster than manual instrumentation (P < 0.001). CONCLUSIONS: Under the experimental conditions, ProTaper left significantly less gutta-percha and sealer than Mtwo instruments. Complete removal of materials did not occur with any of the instrument systems investigated.