Endodontic complications after plastic restorations in general practice

AIM: To test the hypothesis that dentine and pulp protection by conditioning-and-sealing is no less effective than using a conventional calcium hydroxide lining. METHODOLOGY: A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long-term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning-and-sealing with a smear-removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05). RESULTS: A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post-restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning-and-sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92). CONCLUSIONS: Considered within the context of routine primary dental care: Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning-and-sealing with adhesive resins. Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment. In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams.     

The interrelationship between bolus breakdown, mandibular first molar displacement and jaw movement during mastication

The purpose of this study was to clarify the interrelationship between food bolus breakdown, mandibular first molar displacement and jaw movement during mastication. Finite element models were constructed of the maxillary first molar crown, the mandibular first molar consisting of crown, root, periodontal ligament and alveolar bone, as well as the food bolus were constructed. Based on the actual measurement of the jaw movement pattern and the characteristics of food bolus, the patterns of mandibular first molar displacement and bolus breakdown on time course in the progress of mastication were simulated, to investigate the biomechanical significance of tooth displacement and jaw movement during mastication, using finite element non-linear dynamic analysis. The results showed that the patterns of tooth displacement and jaw movement and characteristics of food bolus changed with an interrelationship to each other as mastication progressed. Particularly at the initial phase, it was suggested that the patterns of mandibular first molar displacement and jaw movement worked inter-dependently to accomplish an efficient hard-bolus breakdown.     

钴对小鼠卵母细胞成熟和体外受精的影响

[目的]研究钴的生殖毒性.[方法]采用卵母细胞体外培养和体外受精的方法.[结果]氯化钴降低体内(0 h)第一极体释放率和卵母细胞存活率(P＜0.01),降低卵母细胞(24 h)的体外受精率(P＜0.01),且有剂量依赖性增加,随着体外培养时间的延长,2个剂量组的第一极体释放率与各自0 h相比有显著提高,除了6.0 mg·kg-1组外,48 h后3.0 mg·kg-1剂量组的IVF率与24 h时相比显著提高,3.0 mg·kg-1和6.0 mg·kg-1两组的IVF率在48 h和72 h时与对照组比差异均有显著性(P＜0.05,P＜0.01).[结论]实验结果提示,氯化钴能够抑制卵母细胞的体内成熟,降低卵母细胞的体外受精能力,具有明显的生殖毒性.     

浅述脉动真空压力蒸汽灭菌器维修及保养

目的：加强脉动真空压力蒸汽灭菌器的维修及维护保养,保证医疗仪器装备始终处于良好的工作状态.方法：严格认真执行国家卫生部颁布〈医疗设备技术管理规范〉为标准,对脉动真空压力蒸汽灭菌器的维修、保养、及常见故障原因进行分析.结果：脉动真空压力蒸汽灭菌器的维护保养和维修保证了灭菌物品的质量和提高了脉动真空压力蒸汽灭菌器的使用寿命.     

The action of TH17 cells on blood brain barrier in multiple sclerosis and experimental autoimmune encephalomyelitis

Th17 cells, known as a highly pro-inflammatory subtype of Th cells, are involved very early in numerous aspects of multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE) neuropathology. A crucial event for the formation and accumulation of MS lesions is represented by the disruption of the blood brain barrier (BBB) in relapsing-remitting MS. Th17 cells also contribute to the progression of MS/EAE. These events will allow for the passage of inflammatory cells into the brain. Secondary to this, increased recruitment of neutrophils occurs, followed by increased protease activity that will continue to attract macrophages and monocytes, leading to brain inflammation with sustained myelin and axon damage.This review focuses mainly on the role of Th17 cells in penetrating the BBB and on their important effects on BBB disruption via their main secretion products, IL-17 and IL-22. We present the morphological aspects of Th17 cells that allow for intercellular contacts with BBB endothelial cells and the functional/secretory particularities of Th17 cells that allow for intercellular communications that enhance Th17 entry into the CNS. The cytokines and chemokines involved in these processes are described. In conclusion, Th17 cells can efficiently cross the BBB using pathways distinct from those used by Th1 cells, leading to BBB disruption, the activation of other inflammatory cells and neurodegeneration in MS patients.     

Bleeding/plaque ratio

The purpose of the present study was to investigate the clinical differences between individuals highly susceptible and individuals insusceptible to periodontal breakdown. The susceptible group consisted of 7 patients with a diagnosis of juvenile periodontitis. The insusceptible group consisted of 7 individuals selected on the basis of age (52 years or older), presence of at least 18 teeth, no evidence of extractions due to periodontal breakdown, no loss of attachment, shallow pockets, gross amounts of plaque and no history of interdental cleaning. Results showed that the susceptible group had more bleeding, less plaque and deeper pockets than the insusceptible group. Since the 2 groups seem to behave differently with regard to bleeding upon probing and amount of plaque, bleeding/plaque ratios were calculated. Testing showed a highly significant difference between the 2 groups. The same results were obtained if only sites with shallow pockets were included in the analysis. On the basis of these results, it is hypothesized that a high value of the ratio between bleeding and plaque may act as a prognostic indicator for periodontal breakdown.     

Exercise-induced changes in protein metabolism

Exercise has a profound acute effect on protein metabolism. Whereas reports on whole body responses to exercise have varied results, it is generally agreed leucine oxidation is increased during exercise, thus indicating increased net protein breakdown. Following endurance exercise, whole body protein breakdown is generally reduced from resting levels, while following eccentric exercise, both whole body protein breakdown and leucine oxidation are increased. Whole body protein synthesis, on the other hand, is either increased or unchanged. Much of the disagreement in the results of studies on the response of whole body protein metabolism to exercise may be attributed to the limitations of the available methods. Even if the methodology accurately reflects whole body metabolism, this may not reflect changes in the protein metabolism of muscle. Although endurance exercise has not been studied, muscle protein breakdown is increased following resistance exercise. There is a concomitant, and qualitatively greater, increase in muscle protein synthesis following resistance exercise, which may last for as long as 48 h. Increased muscle protein synthesis is linked to increased intramuscular availability of amino acids, and thus, to increased blood flow and increased amino acid delivery to the muscle, as well as increased amino acid transport. Administration of exogenous amino acids after exercise increases protein synthesis while ameliorating protein breakdown, thus improving net muscle protein balance. While it is clear that muscle protein synthesis and protein breakdown increase in a qualitatively similar manner following exercise, the mechanisms of stimulation have yet to be determined. However, we propose that the intracellular availability of amino acids is the link between these processes.     

Population analysis of the non linear red blood cell partitioning and the concentration-effect relationship of draflazine following various infusion rates

Aims To investigate the impact of the specific red blood cell binding on the pharmacokinetics and pharmacodynamics of the nucleoside transport inhibitor draflazine after i.v. administration at various infusion rates. It was also aimed to relate the red blood cell (RBC) occupancy of draflazine to the ex vivo measured adenosine breakdown inhibition (ABI). Methods Draflazine was administered to healthy volunteers as a 15-min i.v. infusion of 0.25, 0.5, 1, 1.5 and 2.5 mg immediately followed by an infusion of the same dose over 1 h. Plasma and whole blood concentrations were measured up to 120 h post dose, and were related to the ex vivo measured ABI, serving as a pharmacodynamic endpoint. The capacity-limited specific binding of draflazine to the nucleoside transporter located on the erythrocytes was evaluated by a population approach. Results The estimate of the population parameter typical value (%CV) of the binding constant K_d and the maximal specific binding capacity (B_max ) was 0.385 (3.5) ng ml⁻¹ plasma and 158 (2.1) ng ml⁻¹ RBC, respectively. The non-specific binding was low. The specific binding to the erythrocytes was a source of non-linearity in the pharmacokinetics of draflazine. The total plasma clearance of draflazine slightly decreased with increasing doses, whereas the total clearance in whole blood increased with increasing doses. The sigmoidal E_max equation was used to relate the plasma and whole blood concentration of draflazine to the ex vivo determined ABI. In plasma, typical values (%CV) of E_max, IC₅₀ and Hill factor were 81.4 (1.9)%, 3.76 (9.3) ng ml⁻¹ and 1.06 (3.4), respectively. The relationship in whole blood was much steeper with population parameter typical values (%CV) of E_max, IC₅₀ and Hill factor of 88.2 (2.0)%, 65.7 (2.8) ng ml⁻¹ and 4.47 (5.5), respectively. The RBC occupancy of draflazine did not coincide with the ex vivo measured ABI. The observed relationship between RBC occupancy and ABI was not directly proportional but similar for all studied infusion schemes. Conclusions The findings of this study show that the occupancy of the nucleoside transporter by draflazine should be at least 90% in order to inhibit substantially adenosine breakdown in vivo. On the basis of these findings it is suggested that a 15 min infusion of 1 mg draflazine followed by an infusion of 1 mg h⁻¹ could be appropriate in patients undergoing a coronary artery bypass grafting.     

Intraocular microsurgery with a picosecond Nd:YAG laser

We investigated the use of picosecond Nd:YAG laser pulses for intraocular microsurgery. With a pulse duration of 100 picoseconds, only 70 μJ of pulse energy is required to consistently produce optical breakdown in the deep vitreous. This pulse energy is nearly two orders of magnitude less than the typical pulse energies used in conventional (nanosecond) photodisruptors. The reduced pulse energy results in a smaller zone of tissue damage, an important consideration when operating close to the retina or other sensitive ocular structures. Efficient cutting action is achieved by applying multiple pulses at a moderately high repetition rate of 50–200 Hz. An in vitro model was developed to assess axial confinement of picosecond photodisruption. In vivo vitreous membrane surgery was performed in experimental rabbit eyes to demonstrate a potential clinical application of picosecond laser—induced optical breakdown. © 1994 Wiley-Liss, inc.     

Revisional Surgery for Failed Gastric Restrictive Procedures for Morbid Obesity

As part of the Adelaide Obesity Surgery Study, we have reviewed all patients who have undergone revisional surgery. Of the 310 trial patients, 63 (20%) had revisions 1-69 (median 32) months following their original surgery--30% of all 105 gastrogastrostomy (GG) operations, 22% of 106 gastroplasty (GP) procedures, and 9% of 99 gastric bypasses (GB). Failure was due to stomal dilatation, 11% of all trial patients (71% of GG revisions), stomal stenosis, 6% (52% of GP revisions) and staple dehiscence, 4%. There was no mortality and a low hospital morbidity. Long-term success was only 23% (follow-up at least 3 years) and was achieved at considerable expense (3 reversals, 10 further revisions, 44 endoscopic procedures). Revisional surgery was successful in 45% of patients with stomal dilatation or dehiscence but in only 17% with stenosis. Overall, the most successful operation was revision of, or conversion to, gastric bypass (58% success rate), compared with gastroplasty (24%) and gastrogastrostomy (25%). Our long-term results following revisional surgery were disappointing, particularly for stenosis, and most failures followed revision to GG or GP. Roux-en-Y gastric bypass is the procedure of choice when considering revision.