HPLC analysis of eluted monomers from two composite resins cured with LED and halogen curing lights

This study investigated the leaching of monomers (Bis-GMA and TEGDMA) from nano-hybrid (Filtek Supreme) and flowable (Filtek Flow) dental composite resins cured with LED or conventional halogen curing lights, and immersed in saliva or water for 24 h. Nine disc specimens were made for each experimental group. After the polymerization process, the specimens were immersed in either water or saliva and incubated at 37 degrees C for 24 h. Eluted Bis-GMA and TEGDMA monomers were detected using high performance liquid chromatography (HPLC). The data were analyzed using three-way ANOVA (p = 0.05) and the independent samples t test. TEGDMA (53.15-1 microg/L) was leached from the resins at a higher level than Bis-GMA (28-0.5 microg/L) (p < 0.01), regardless of the affecting factors: composite type, solvent (media) and type of curing light. In general, Filtek Flow resin released more TEGDMA than Filtek Supreme (p < 0.05), but the Supreme resin released more Bis-GMA than TEGDMA (p < 0.05). Halogen light induced greater monomer elution than LED light immersion in water. Saliva released more TEGDMA than water (p < 0.05). We conclude that (1) total leached TEGDMA was higher than total Bis-GMA, (2) saliva and halogen light (lower intensity than LED) leached more monomers from the resins, and (3) the flowable composite resin leached more TEGDMA than the nano-hybrid.     

Physiological changes in the critically ill patient with sepsis

Intensive care medicine deals with the critically ill; these patients usually have multiple organ failure, and complex medical conditions. The mortality in Australia and New Zealand among this population is approximately 16.1%, with approximately 24.2% having existing co-morbidities, and 23.4% of these patients experiencing sepsis or septic shock. Sepsis is a clinical syndrome that traditionally was regarded as a physiological maladaptive response to a foreign pathogen and ranges in disease severity from simple sepsis to septic shock, a life threatening condition, associated with multiple organ failure. Sepsis has profound effects on all systems of the body, and most notably the cardiovascular, renal and hepatic systems. There has been much research into the septic critically ill patient and recent developments in basic pharmacology and physiology has yielded results applicable to clinical practice. Sepsis may induce a state of increased cardiac output, which has significant effects on drug pharmacokinetics and pharmacodynamics. This increased cardiac output increases both renal and hepatic blood flow, and alters rates of antibiotic metabolism, and excretion. There are also alterations in the fluid compartments of the septic critically ill, that results in an altered volume of distribution, and ultimately decreased antibiotic concentrations at their site of action. This article will examine and review in detail the septic critically ill patient, and the effects that sepsis has on physiology and the resulting altered antibiotic pharmacokinetics and pharmacodynamics. Current knowledge suggests that the medical prescriber should be weary of antibiotic dosing in the septic critically ill, and consider alternative dosing regimes that are individualized to the patient in order to maximize efficacy.     

Radiopharmaceuticals: when and how to use them to treat metastatic bone pain

Bone pain due to skeletal metastases constitutes the most common type of cancer-related pain. The management of bone pain remains challenging and is not standardized. In patients with multifocal osteoblastic metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. The lack of general knowledge about radiopharmaceuticals, their clinical utility and safety profiles, constitutes the major cause for their underutilization. Our goal is to review the indications, selection criteria, efficacy, and toxicities of two approved radiopharmaceuticals for bone pain palliation: strontium-89 and samarium-153. Finally, a brief review of the data on combination therapy with bisphosphonates or chemotherapy is included.     

Pathways of renal injury in systemic gram-negative sepsis

Acute renal failure is a grave complication of systemic gram-negative sepsis. The pathophysiological mechanisms of sepsis leading to kidney injury result in part from systemic inflammatory and haemodynamic alterations. These are triggered by the interaction of endotoxin with Toll-like receptor 4 (TLR4) on cells of the immune system. Recently, TLR4 and other co-effector molecules were identified on renal tubular and vascular cells. Furthermore, it was demonstrated that systemic endotoxin has direct access to renal sites where these receptors are expressed. Therefore, we review data in support of this novel pathway of renal injury in sepsis, whereby systemic endotoxin causes direct injury through interactions with local epithelial and endothelial TLR4.     

Role of nitric oxide and prostaglandin systems in lithium modulation of acetylcholine vasodilation

The mechanism of lithium action, an effective treatment for bipolar disease, is still unknown. The present study examined the role of nitric oxide (NO) and prostaglandin systems in lithium modulation of acetylcholine in mesenteric vascular bed of rats by cannulating superior mesenteric artery. Acetylcholine (ACh) or sodium nitroprusside was injected under constant controlled flow induced by phenylephrine; therefore, changes in perfusion pressure reflect changes in resistance. Although 0.5 mM or 1 mM lithium-pretreatment of vascular bed causes reduction in ACh-response, 1.5 mM lithium induced no changes and 2 and 2.5 mM lithium potentiated ACh-induced mesenteric vascular bed relaxation compared to control group. Pretreatment of vascular bed with L-NAME or indomethacin decreased ACh-induced relaxation in 2 concentrations of 0.5 and 2 mM of lithium. The vasorelaxation response to sodium nitroprusside, the NO donor, was not different among lithium groups (0.5 and 2 mM) and controls. In conclusion, there is a dual modulation of endothelium-dependent relaxation, including an inhibitory effect at lower dose and a stimulating effect at higher dose of lithium in rat mesenteric vascular bed. NO synthesis or cyclooxygenase inhibition decreased vasorelaxation in both lower and higher doses of lithium, suggesting a role for NO and prostaglandin in this effect.     

Cinnarizine in refractory migraine prophylaxis: efficacy and tolerability. A comparison with sodium valproate

This was a double-blind clinical trial designed to assess the efficacy and safety of the cinnarizine (CIN) in patients with migraine who were refractory to propranolol and tricyclic antidepressants in comparison with sodium valproate (SV) to investigate whether CIN could be at least as effective as SV. A total of 125 patients were treated in a treatment period of 12 weeks. All patients had at least one intake of trial medication and 2-week post baseline efficacy observation which all were included in the ITT analysis. Of the 125 subjects treated, 46 discontinued prematurely: 25 from the CIN and 21 from the SV group. The main reasons for premature discontinuation were: lost to follow up (25/46, 63.2%), insufficient response (16/46, 20%), and adverse events (5/46, 12.8%). No statistically significant inter-group differences in the number of discontinuation was observed (p > 0.05). In both groups, number of attacks, intensity, and duration of attacks significantly decreased (p < 0.05). No statistically significant inter-group differences were observed regarding the mean number of attacks, duration, and intensity of migraine attacks for any of the time intervals analysed, except for the mean reduction of third and fourth visits intensity from baseline which were significantly different in two groups (p < 0.05), with the CIN group showing more reduction. Analysis of the number of responders showed that in the CIN group 61.2% subjects were responders, and 63.8% in the SV group. No statistically significant differences between the treatment groups were found for any of the secondary parameters. Overall 26 subjects reported one or more adverse events during the study period: 13 subjects in each group. Five subjects discontinued prematurely due to adverse events; two in the CIN group with significant weight gain, and 3 in the SV group with significant weight gain and severe tremor. These results suggest that CIN is an effective and safe prophylactic agent even in severe migraine headache. An erratum to this article can be found at     

Evaluation of the Outcome of Complete Sinus Excision with Reconstruction of the Umbilicus in Patients with Umbilical Pilonidal Sinus

Umbilical pilonidal sinus is a cause of umbilical discharge. In this study, the outcome of complete excision of the umbilical sinus with umbilical reconstruction is considered. Adult patients with umbilical pilonidal sinus who had not undergone any previous surgeries were operated on using a technique that involves complete excision of the sinus after eversion of the umbilicus followed by reconstruction of the umbilicus. Patients were then followed; and wound complications, recurrence, and patient satisfaction were evaluated at postoperative visits. A total of 45 patients underwent the operation; 39 (86.5%) were male, and 6 (13.5%) were female. The mean age was 22.6 years (18-27 years). Six male patients had synchronous sacrococcygeal pilonidal disease. The mean follow-up period was 34 months (3-62 months). Only four patients had wound drainage after operation, and all required drainage of the wound. No recurrence was observed during the follow-up period, and all patients were satisfied with the appearance of their umbilicus. The technique of complete sinus excision and umbilical reconstruction is an effective and acceptable method for treating umbilical pilonidal sinus and may be recommended for primary treatment of this disease.     

Glutathione peroxidase activity and serum selenium concentration in intrinsic asthmatic patients.

Serum glutathione peroxidase (GSH-Px) activity and selenium concentration were compared in intrinsic asthmatic patients and non-asthmatic control subjects. Serum GSH-Px activity and selenium concentration were assessed in 46 asthmatic patients and 75 age- and sex-matched non-asthmatic subjects by spectrophotometric assay. Mean serum GSH-Px activity was lower in intrinsic asthmatic subjects (9.4 +/- 2.6 pmol NADPH oxidized/min/g of protein) than in non-asthmatic subjects (16.3 +/- 2.9 pmol NADPH oxidized/min/g of protein). Mean serum selenium was lower in intrinsic asthmatic subjects (1.15 +/- 0.23 microM) than in non-asthmatic subjects (1.98 +/- 0.27 microM). Asthmatic patients have significantly lower concentration of selenium and GSH-Px activity measured in serum.