Human immunodeficiency virus-associated Kaposi sarcoma as an immune reconstitution inflammatory syndrome: a literature review and case report

BACKGROUND: Kaposi sarcoma (KS) is the most common human immunodeficiency virus (HIV)-associated neoplasm (HIV-KS). Highly active antiretroviral therapy (HAART) results in a decrease in the incidence and prevalence of HIV-KS as well as in clinical improvement. However, in a subset of subjects who are HIV seropositive, KS may recrudesce early following the introduction of HAART as an immune reconstitution inflammatory syndrome (IRIS). METHODS: The management of a patient who is HIV seropositive with rapid clinical worsening of oral KS lesions shortly after the initiation of HAART was documented. Repeated serologic testing for CD4(+) T-cell count and microscopic examination of two biopsy specimens of the oral lesion, one taken before and the other taken after cytotoxic chemotherapy, followed by surgical excision was the treatment modality used. RESULTS: Microscopic examination of the incisional biopsy specimen taken from the oral lesion at the time of the initial consultation confirmed the clinical diagnosis of KS. The sequential serological tests showed a progressive increase in CD4(+) T-cell counts that paralleled the rapid clinical worsening of the KS disease. This was consistent with the diagnosis of IRIS-associated HIV-KS. Subsequent cytotoxic chemotherapy brought about resolution of the IRIS and regression of the HIV-KS lesions. Microscopic examination of a biopsy specimen obtained after cytotoxic chemotherapy did not show any of the original KS. The residual palatal exophytic mass was excised. CONCLUSIONS: IRIS-associated HIV-KS is not a disease, but rather a temporary paradoxical immunoinflammatory reaction brought about by improvement in immune status following HAART. IRIS-associated HIV-KS can be controlled effectively by limited systemic cytotoxic chemotherapy in the setting of HAART.     

Shear bond strength of AH-26 and Epiphany to composite resin and Resilon

The aim of this study was to evaluate the relative bond strengths of AH-26 and Epiphany sealers to both Resilon and composite resin. Four groups of substrate/bonded sealer combinations were tested: group A, composite resin substrate + Epiphany sealer; group B, composite resin substrate + AH-26 sealer; group C, Resilon substrate + Epiphany sealer; and group D, Resilon substrate + AH-26 sealer. Bond strength was evaluated in shear mode by using a universal testing machine at a crosshead speed of 0.5 mm/min. Statistical analysis (Kruskall-Wallis and Dunn tests) showed that the bond strength of AH-26 to both substrates was significantly greater than the bond strength of Epiphany. Therefore, the monoblock in the root canal might be more effectively achieved by combining Resilon core material with the epoxy resin-based sealer (AH-26) rather than Epiphany sealer.     

Polymerization eficiency of dual-polymerized resin cements light-irradiated through ceramics and laboratory-processed resin composite

The purpose of the study was to determine the influence of light-irradiation through two ceramic and one resin composite materials on the degree of remaining double carbon bonds in 3 dual-polymerized resin cements. After mixing, the cement was inserted into a 0.5 mm deep recess in a silicon mold, covered with one ceramic or resin composite rectangular block and exposed through the block with the light from a halogen polymerization unit for 40 s. Infrared spectroscopic analysis was used to record the degree of remaining double carbon bonds. Light irradiation through 2 mm-thick ceramic and resin composite materials increased the degree of remaining double carbon bonds relative to the direct photopolymerization analogues.     

Molecular characterization of one-step self-etching adhesives placed on dentin and inert substrate

PURPOSE: To evaluate the phase separation, extent of dentin demineralization, and curing efficiency of one-step self-etching adhesives placed on dentin and on inert substrate. MATERIALS AND METHODS: The adhesives tested were G-Bond (GB), iBond (IB) and Clearfil S3 Bond (SB). Two groups (2 x 3) of dentin and inert (gold) specimens were prepared for each product. The films formed on inert surfaces were subjected to mild (1st group) or strong air drying (2nd group) and examined with near- and mid-FTIR microspectroscopy. On dentin (1st group), the extent of demineralization (% DM) was evaluated before and after adhesive treatment plus rinsing with water and acetone by mid-FTIR microspectroscopy. The films formed after strong air drying (2nd group) and 20 s of light curing were rinsed with acetone, and the degree of cure (% DC) was measured by micro-multiple internal reflection FTIR spectroscopy. ANOVA was used to assess the statistically significant differences in % DM and % DC (alpha = 0.05). RESULTS: In GB and IB, mild air drying produced more water droplets and monomer separation than strong air drying. SB demonstrated the least separation. IB induced the highest % DM. All the adhesives demonstrated the greatest % DC on dentin. On both substrates SB showed the highest % DC values. CONCLUSION: Phase separation including water and/or monomers was found in all the adhesives. The extent of dentin demineralization and degree of cure varied among the products tested. The degree of cure was higher on dentin than on the inert substrate.     

Occupational health legislation and practices related to seafarers on passenger ships focused on communicable diseases: results from a European cross-sectional study (EU SHIPSAN PROJECT)

Background  

Seafarers play an important role in the transmission of communicable diseases. The aim of the present study is to draw information and identify possible gaps on occupational health practices related to seafarers sailing on ships within the European Union Member States (EU MS) with focus on communicable diseases.     

PAHs sources contribution to the air quality of an office environment: experimental results and receptor model (PMF) application

The objectives of this study were to measure the concentrations of PAHs (polycyclic aromatic hydrocarbons) in three particle fractions [particulate matter (PM) <1 μm in diameter (PM1), PM <2.5 μm in diameter (PM2.5) and the respirable fraction (<4 μm in diameter)] in the air of offices in which smoking was allowed and forbidden, respectively, and to identify the potential sources by applying the Positive Matrix Factorization (PMF) model. We sampled the indoor air of both environments during 24-h periods for PM1 and PM2.5 and conducted personal exposure measurements for the respirable PM fraction during working hours. The measurements indicated a clear difference in the levels of carcinogenic PAHs (PAHcancer) in the two office environments. In the smokers’ office, PAHcancer levels fell by >70% during the weekend relative to working days, implying the importance of smoking and dust resuspension sources. The PMF model identified four contributory factors–sources: smoking, dust resuspension and two different vehicle-related sources. For 15 PAHs, the same factor made the largest contribution to both the PM1 and PM2.5 fractions, implying a common origin and further supporting the validity of the proposed approach. For the majority of the carcinogenic PAHs, smoking and dust resuspension made the strongest contribution (>90%) to both the PM1 and PM2.5 fractions. Although our PMF analysis confirmed the well-known contribution of smoking and traffic-related sources to levels of PAHs, the identification of dust resuspension as a separate source of PAHs is of great interest and requires further study.     

Thirty-Day Outcome Following Carotid Artery Stenting: A 10-Year Experience from a Single Center

We aimed to present our experience with carotid angioplasty and stenting (CAS) and to document how the technique evolved over the last decade (1997–2007). A retrospective study of 333 patients (259 men; median age, 69 years) who underwent 336 CAS procedures. Of these, 118 (35%) patients were symptomatic and 164 (49%) lesions involved the left carotid bifurcation. The first 163 patients received a balloon-expandable stent, whereas the remaining 173 received a self-expandable one. Cerebral protection devices were used in the last 84 (25%) procedures. Access was via the femoral artery in all but six cases, in which direct puncture of the common carotid was necessary. The left common carotid originated from the innominate artery in 18 cases (5%). Conversion to open endarterectomy was necessary in two patients due to inability to remove the filter. Perioperative neurological events included stroke in 6 patients (1.8%), transient ischemic attack in 15 (4.5%), and hyperperfusion syndrome in 10 (3.0%). Three patients died during the first 30 days. As a result, the mortality and the combined stroke/death rate were 0.9 and 2.4%, respectively, with no differences between symptomatic and asymptomatic patients. Bradycardia was noted in 48 patients (14%), and hypotension in 45 (13%). Univariate analysis identified hypertension (P = 0.03), hyperlipidemia (P = 0.02), and current or ex-smoking (P = 0.02) as significant risk factors for death/stroke. On multivariate analysis using logistic regression, only hyperlipidemia [odds ratio (OR), 53.90; 95% confidence interval (CI), 4.19–693.47; P = 0.002] and current or ex-smoking (OR, 63.84; 95% CI,: 4.80–848.68; P = 0.001) remained statistically significant. In conclusion, CAS can be performed safely and effectively, with acceptable mortality, stroke/death, and cardiovascular complication rates. Although technological advances (stent design, cerebral protection devices), perioperative pharmacological management, and increasing experience are all clinically significant factors influencing the short-term results, none appeared to be statistically significant in this patient sample.