Evaluation of microleakage of root canal fillings irradiated with different output powers of erbium,chromium:yttrium‐scandium‐gallium‐garnet laser

This study evaluated the root canal seal achieved by irradiation with an erbium, chromium:yttrium‐scandium‐gallium‐garnet laser, and the optimal output power to remove debris and the smear layer were determined. One hundred mandibular premolar teeth were prepared and divided into four groups. Group 1 was not lased but was irrigated with 5 mL of 5.25% NaOCl and 5 mL of 17% ethylenediaminetetraacetic acid. Group 2 was irradiated at a panel setting of 1 W, group 3 at 2 W and group 4 at 2.5 W, with a 50% water level and 48% air‐cooling level. Root canals were obturated by cold lateral compaction, and apical microleakage was measured using a fluid filtration model. The remaining debris and smear layer were evaluated via scanning electron microscopy. Statistically significant differences were detected between groups. Irradiation at 1 and 2 W using an erbium, chromium:yttrium‐scandium‐gallium‐garnet laser produced a seal superior to that of the other treatments.     

Inflammatory activation: cardiac, renal, and cardio-renal interactions in patients with the cardiorenal syndrome

Although inflammation is a physiologic response designed to protect us from infection, when unchecked and ongoing it may cause substantial harm. Both chronic heart failure (CHF) and chronic kidney disease (CKD) are known to cause elaboration of several pro-inflammatory mediators that can be detected at high concentrations in the tissues and blood stream. The biologic sources driving this chronic inflammatory state in CHF and CKD are not fully established. Traditional sources of inflammation include the heart and the kidneys which produce a wide range of pro-inflammatory cytokines in response to neurohormones and sympathetic activation. However, growing evidence suggests that non-traditional biomechanical mechanisms such as venous and tissue congestion due to volume overload are also important as they stimulate endotoxin absorption from the bowel and peripheral synthesis and release of pro-inflammatory mediators. Both during the chronic phase and, more rapidly, during acute exacerbations of CHF and CKD, inflammation and congestion appear to amplify each other resulting in a downward spiral of worsening cardiac, vascular, and renal functions that may negatively impact patients’ outcome. Anti-inflammatory treatment strategies aimed at attenuating end organ damage and improving clinical prognosis in the cardiorenal syndrome have been disappointing to date. A new therapeutic paradigm may be needed, which involves different anti-inflammatory strategies for individual etiologies and stages of CHF and CKD. It may also include specific (short-term) anti-inflammatory treatments that counteract inflammation during the unsettled phases of clinical decompensation. Finally, it will require greater focus on volume overload as an increasingly significant source of systemic inflammation in the cardiorenal syndrome.     

Tularemia and the oculoglandular syndrome of Parinaud

An 18-year-old female came to our clinic with complaints of a tender lump just under her jaw on the left side and another lump in front of her left ear, ecchymosis around the eye and some redness in the eye at the same side. After administering antibiotic therapy for two days we suspected of tularemia and referred the patient to the Infectious Diseases Department. A serum sample was taken and a fine needle aspiration biopsy was performed. The patient was diagnosed with tularemia, the oculoglandular syndrome of Parinaud. Tularemia should also be kept in mind for differential diagnosis in patients with both ocular and glandular symptoms in endemic regions like Turkey and the appropriate therapy should be initiated immediately.     

Evaluation of choroidal thickness and choroidal vascularity index during pregnancy

ObjectiveTo assess the choroidal structural characteristics in the first and third trimesters in pregnant women using enhanced depth imaging optical coherence tomography and binarization method.DesignProspective study.ParticipantsTwenty-five eyes of 25 pregnant women in the first trimester (group 1) and 25 eyes of 25 pregnant women in the third trimester (group 2) were examined. Healthy age-matched 25 participants were enrolled as a control group (group 3).MethodsThe choroidal thickness (CT) was measured at 3 points; subfoveal, 1500 μm nasal to the fovea, and 1500 μm temporal to the fovea. Total choroidal area, luminal area, stromal area, stroma/lumen ratio, and choroidal vascularity index (CVI) were measured by Image-J software.ResultsThe mean subfoveal and nasal CT were statistically significantly increased in group 1 compared with controls (p = 0.005 and p = 0.004, respectively). The mean temporal CT was statistically significantly increased in group 1 compared with groups 2 and 3 (group 1 vs group 2, p = 0.043; group 1 vs group 3, p = 0.011). The mean total choroidal area, stromal area, and luminal area were significantly increased in groups 1 and 2 compared with control group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, p = 0.002, p = 0.002, respectively). There were no statistically significant differences among groups in terms of mean stroma/lumen ratio and CVI (p = 0.148 and p = 0.312, respectively).ConclusionsThere was a significant increase in subfoveal, temporal, and nasal CT in the first trimester. Total choroidal, stromal, and luminal areas were significantly increased in the first and third trimesters.     

The presence of oxidized low-density lipoprotein and inducible nitric oxide synthase expression in renal damage after intestinal ischemia reperfusion

Intestinal ischemia/reperfusion (I/R) is a complex phenomenon that causes destruction of both local and remote tissues. The objective of this study was to investigate the possible participation of oxidized low-density lipoproteins (oxLDLs) and inducible nitric oxide synthase (iNOS) expression in renal tissue damage after intestinal I/R. The superior mesenteric artery was blocked for 30 minutes, followed by 24 hours of reperfusion. At the end of the reperfusion period, renal tissues were removed; the presence of oxLDL, superoxide dismutase enzyme activity, malondialdehyde levels, and iNOS expression were evaluated. I/R resulted in positive oxLDL staining in renal tissue. Compared with control rats, tissue from the I/R group showed significantly higher malondialdehyde levels and lower superoxide dismutase enzyme activity. Strong and diffuse iNOS expression was present in the I/R group. Our findings support the hypothesis that I/R of intestinal tissue results in oxidative and nitrosative stress and enhances lipid peroxidation in the end organ. These data show that oxLDL accumulates in rat renal tissue after intestinal I/R. Antioxidant strategies may provide organ protection in patients with reperfusion injury, at least by affecting interactions with free radicals, nitric oxide, and oxLDL. This study demonstrates for the first time that oxLDL may play a role in renal tissue damage after intestinal I/R. Antioxidant strategies may be beneficial for protection from reperfusion injury.     

Neonatal onset atypical hemolytic uremic syndrome successfully treated with eculizumab

Background

Atypical hemolytic uremic syndrome (aHUS) is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment. Neonatal cases are extremely uncommon. Plasma therapy is the first choice therapy in patients with aHUS based on the belief of an underlying complement dysregulation. Alternatively, eculizumab, which targets complement 5, is used to block complement activation.

Case-diagnosis/treatment

Sudden onset macroscopic hematuria, hypertension, and bruises over the entire body were noted in a 5 day-old newborn. Investigations revealed hemolytic anemia, thrombocytopenia, renal impairment, and a low serum C3, leading to the diagnosis of aHUS. Fresh frozen plasma (FFP) infusions and peritoneal dialysis for acute kidney injury were initiated. This approach yielded full renal and hematological remission. The patient was discharged with FFP infusions, but subsequently developed three life-threatening disease recurrences at 1, 3, and 6 months of age. The last relapse presented with uncontrolled hypertension and impaired renal function while the patient was receiving FFP infusions. After the first dose of eculizumab, his renal and hematological parameters returned to normal and his blood pressure normalized. Genetic screening of the CFH gene revealed a novel homozygous p. Tyr1177Cys mutation.

Conclusion

Eculizumab can be considered as an alternative to plasma therapy in the treatment of specific patients with aHUS, even in infants.     

β-Glucan treatment prevents progressive burn ischaemia in the zone of stasis and improves burn healing: An experimental study in rats

Saving the zone of stasis is one of the major goals of burn specialists. Increasing the tissue tolerance to ischaemia and inhibiting inflammation have been proposed to enable salvage of this zone. After a burn, excessive inflammation, including increased vascular permeability, local tissue oedema and neutrophil activation, causes local tissue damage by triggering vascular thrombosis and blocking capillaries, resulting in tissue ischaemia and necrosis. Oxygen radicals also contribute to tissue damage after a burn. However, macrophages play a pivotal role in the response to burn. We studied β-glucan because of its many positive systemic effects that are beneficial to burn healing, including immunomodulatory effects, antioxidant effects (free-radical scavenging activity) and effects associated with the reduction of the inflammatory response.     

nNOS expression in the brain of rats after burn and the effect of the ACE inhibitor captopril

Objective

To investigate the role of endogenous neuronal nitric oxide synthase (nNOS) on brain injury after burn and the effects of the captopril.

Methods

Wistar albino rats (200–250 g) were exposed on the dorsal surface to 90 °C (burn) or 25 °C (sham) water for 10 s. The ACE group was treated with intraperitoneal 10 mg/kg captopril immediately after burn and this treatment was repeated twice daily. At the end of the 24 h brain samples were taken. nNOS was studied in brain areas by immunohistochemistry.

Results

There was no difference between the cerebellar and hypothalamic areas the nNOS expression of all groups. nNOS expression increased in the frontal cortex, striatum and midbrain in the burn group compared to the control group. In the frontal cortex, nNOS expression significantly decreased after ACE inhibitor treatment (p < 0.05). The striatal nNOS of the ACE group significantly increased when compared to the control group (p = 0.001). In the midbrain of the animals, nNOS decreased in the ACE group. Hippocampal nNOS expression did not change after burn and significantly increased after ACE inhibitor therapy (p < 0.05).

Conclusions

Our data showed that the pathophysiological events following burn appear to be related to an acute inflammatory reaction which is associated with nNOS in the frontal cortex, striatum and midbrain, and captopril treatment abrogates the nNOS response in the frontal cortex and midbrain.