Effects of thrice weekly nocturnal hemodialysis on arterial stiffness

ObjectiveIn this study, we compared the changes in arterial stiffness in chronic hemodialysis patients treated with 8-h vs. 4-h thrice weekly in-center hemodialysis.MethodsSixty prevalent chronic hemodialysis patients assigned to 8-h nocturnal in-center thrice weekly HD (NHD) and 60 control cases assigned to 4-h thrice weekly conventional HD (CHD) were followed for one year. Radial–carotid pulse wave velocity, augmentation index and echocardiography were performed at baseline and 12^th month.ResultsMean age of the patients was 49 ± 11 years, 30.8% were female, 27.5% had diabetes mellitus and mean dialysis vintage was 57 ± 47 months. Baseline demographical, clinical and laboratory parameters were similar between groups. During a mean follow-up of 15.0 ± 0.1 months, blood pressure remained similar in both groups while the number of mean daily anti-hypertensive substances decreased in the NHD group. In the NHD group, time-averaged serum phosphorus and calcium–phosphorus product were lower than the CHD group. Pulse wave velocity and augmentation index decreased in the NHD group (from 11.02 ± 2.51 m/s to 9.61 ± 2.39 m/s and from 28.8 ± 10.3% to 26.2 ± 12.1%; p = 0.008 and p = 0.04, respectively). While augmentation index increased in the CHD group (28.0 ± 9.4 to 31.0 ± 10.7%, p = 0.02), pulse wave velocity did not change. Subendocardial viability ratio and ejection duration improved in the NHD group (from 135 ± 28 to 143 ± 25%, p = 0.01 and from 294 ± 34 ms to 281 ± 34 ms, p = 0.003, respectively), accompanied by regression of left ventricular mass index. In multiple stepwise linear regression analyses, NHD was associated with improvements in augmentation index, ejection duration and subendocardial viability ratio.ConclusionsThese data indicate that arterial stiffness is ameliorated by implementation of longer hemodialysis sessions.     

Prognostic value of uric acid in patients with ST-elevated myocardial infarction undergoing primary coronary intervention

Elevated uric acid (UA) levels have been associated with cardiovascular disease in epidemiologic studies. The relation between UA levels and long-term outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention is not known. Data from 2,249 consecutive patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were evaluated. Patients were divided into 2 groups with high or low UA using upper limits of normal of 6 mg/dl for women and 7 mg/dl for men. There were 1,643 patients in the low-UA group (mean age 55.9 ± 11.6 years, 85% men) and 606 patients in the high-UA group (mean age 60.5 ± 12.6 years, 76% men). Serum UA levels were 8.0 ± 1.5 mg/dl in the high-UA group and 5.2 ± 1.0 mg/dl in the low-UA group (p <0.001). The in-hospital mortality rate was significantly higher in patients with high UA levels (9% vs 2%, p <0.001), as was the rate of adverse outcomes in patients with high UA. The mean follow-up time was 24.3 months. Cardiovascular mortality, reinfarction, target vessel revascularization, heart failure, and major adverse cardiac events were all significantly higher in the high-UA group. In a multivariate analyses, high plasma UA levels were an independent predictor of major adverse cardiac events in the hospital (odds ratio 2.03, 95% confidence interval 1.25 to 3.75, p = 0.006) and during long-term follow-up (odds ratio 1.64, 95% confidence interval 1.05 to 2.56, p = 0.03). In conclusion, high UA levels on admission are independently associated with in-hospital and long-term adverse outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention.     

Increased carotid intima-media thickness is associated with higher SYNTAX score

The main purpose of this study was to investigate the relation between carotid intima-media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 ± 0.12 mm and 15 ± 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT (r = .42, P < .001), age (r = .23, P < .001), hypertension (r = .27, P = 0.001), diabetes (r = 0.11, P = 0.02), smoking (r = .24, P = .01), dyslipidemia (r = .2, P = 0.03), and β-blocker use (r = .19, P < .001). In multivariate analysis, CIMT (β = .34, P < .001) and age (β = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect complex coronary artery lesions.     

Clinical and magnetic resonance imaging findings of the temporomandibular joint and masticatory muscles in patients with rheumatoid arthritis

The aim of this study was to investigate the clinical, radiographic, and magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) and masticatory muscles in rheumatoid arthritis (RA) patients. Twenty-eight RA patients and 29 healthy subjects were participated in the study. The patient underwent clinical and laboratory investigation. DAS28 scores were calculated. Lateral panoramic radiography was performed to evaluate condylar erosion and condylar movement. Craniofacial MRI was performed to evaluate TMJ and masseter, medial and lateral pterygoid muscles’ thickness, and cross-sectional area. It was found that the mean maximal interincisal distance, range of lateral, retrusive (P < 0.05) and protrusive motion were all lesser in RA group. Lateral panoramic radiography revealed a distinct erosion in 10.7% (3/28) and restricted condylar movement in 53.6% (15/28) of RA patients. Two RA patients demonstrating marked condylar erosion in lateral panoramic radiographs were RF negative and had DAS28 scores 3.41 and 4.61. MRI findings revealed condylar erosion and effusion in one RA patient and atrophic changes of masticatory muscles in another patient. There was no statistical significance between RA and healthy groups for the thickness and cross-sectional areas of the masticatory muscles. RA group revealed a strong linear relationship for the right and left muscle thickness and cross-sectional areas in regression analysis. TMJ symptoms are frequent findings and thought to be affected from mean disease duration in RA. Laboratory findings should be considered for disease activity–related TMJ involvement. RA patients did not present muscular atrophy or hypertrophy.     

Nonsense β-thalassemia mutation at codon 37 (TGG>TGA), detected for the first time in three Turkish cases

Thalassemias are genetically heterogeneous group of disorders with reduced or absent production of globin. β-Thalassemia major can be caused by homozygosity or compound heterozygosity for β-globin gene mutation. Here we report, for the first time in Turkey, three cases who carry the nonsense β-thalassemia (β-thal) mutation at codon 37 (TGG>TGA; Trp→Stop) causing premature stop codon.     

Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction

OBJECTIVES:

Acute ST-elevation myocardial infarction is associated with ventricular dysfunction due to ischemia-induced progressive myocardial damage. The decrease in ventricular compliance causes left atrial dilatation and stretching of the atrial myocardium, which are the main stimuli for the secretion of atrial natriuretic peptide. The aim of this study was to evaluate left atrial dimensions and atrial natriuretic peptide levels in patients early after their first acute ST-elevation myocardial infarction and assess the probable interaction between coronary lesions and these measurements.

METHODS:

A total of 110 patients with acute myocardial infarction and 50 controls were studied. Plasma atrial natriuretic peptide was measured at admission. Left ventricular function, diameter, and volume index were evaluated using transthoracic echocardiography. Gensini and vessel scores of the patients who underwent coronary angiography were calculated.

RESULTS:

Plasma atrial natriuretic peptide in the patients with myocardial infarction was increased compared with that in controls (3.90±3.75 vs. 1.35±0.72 nmol/L, p<0.001). Although the left atrial diameter was comparable in patients and controls, the left atrial volume index was increased in patients with acute myocardial infarction (26.5±7.1 vs. 21.3±4.9 mL/m², p<0.01). Multivariate regression analysis showed a strong independent correlation between the left atrial volume index and the plasma atrial natriuretic peptide level (β = 0.23, p = 0.03).

CONCLUSIONS:

The left atrial volume index and plasma atrial natriuretic peptide level were correlated in patients with acute myocardial infarction.     

Effect of Photoactivated Disinfection on Bond Strength of Root Canal Filling

IntroductionThe aim of this in vitro study was to assess and compare the effect of photoactivated disinfection (PAD) on the bond strength of root canal sealers to human root canal dentin using the push-out test.MethodsFifteen extracted human mandibular premolar teeth with single and straight roots were used. After the clinical crowns were removed from the cementoenamel junction, root canals were prepared with the ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) rotary system to the size of the F3 file. The smear layer of the roots was removed using 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl) and distillate water. The roots were then randomly divided into 3 groups (n = 5) according to the final irrigation regimen. In group 1, PAD (FotoSan; CMS Dental, Copenhagen, Denmark) was applied to the root canals and light cured for 20 seconds. Group 2 was finally irrigated with a 2% solution of chlorhexidine gluconate, and group 3 served as the control group (NaOCl + EDTA). All the canals were then obturated with the lateral condensation technique using gutta-percha and AH Plus sealer (Dentsply Maillefer) sealer. One-millimeter-thick horizontal sections from the coronal and midthirds of each root (n: 5 × 4 = 20) were sliced for the push-out bond strength measurement. The data were converted to megapascals and statistically analyzed using 1-way analysis of variance and the post hoc Tukey test.ResultsThere was no significant difference among the bond strength of PAD, chlorhexidine gluconate, and NaOCl (P > .05).ConclusionsWe conclude that PAD does not adversely affect the bond strength of the AH Plus sealer to root canal dentin and that it can be used for the final disinfection of root canals.     

Effects of different bleaching methods on shear bond strengths of orthodontic brackets

Objective:To evaluate the effects of different bleaching methods on the shear bond strength (SBS) of orthodontic brackets.Materials and Methods:Forty-five freshly extracted premolars were randomly divided into three groups (n  =  15 per group). In group I, bleaching was performed with the office bleaching method. In group II, bleaching was performed with the home bleaching method. Group III served as the control. Orthodontic brackets were bonded with a light cure composite resin and cured with an LED light. After bonding, the SBS of the brackets were tested with a Universal testing machine.Results:Analysis of variance indicated a significant difference between groups (P < .001). The highest values for SBS were measured in group III (20.99 ± 2.32 MPa). The SBS was significantly lower in groups I and II than in group III (P < .001). The lowest values for SBS were measured in group II (6.42 ± 0.81 MPa). SBS was significantly higher in group I than in group II (P < .001).Conclusions:Both of the bleaching methods significantly affected the SBS of orthodontic brackets on human enamel. Bleaching with the home bleaching method affected SBS more adversely than did bleaching with the office bleaching method.     

In Vitro Fracture Resistance of Endodontically Treated Roots Filled with a Bonded Filling Material or Different Types of Posts

AimThis study aimed to compare the fracture resistance of roots filled with a bonded material, fiber posts, or titanium post systems.MethodsCanals in the first group were filled with AH Plus and gutta-percha cones, and roots in the second group were filled with Epiphany sealer and Resilon cones. The root fillings (60 roots) were removed up to 4 mm from the canal apex to obtain 10-mm-deep post spaces, and posts were cemented. The groups were as follows: AH Plus control group, Epiphany control group, AH Plus fiber post group, AH Plus titanium post group, Epiphany fiber post group, and Epiphany titanium post group. Fracture tests were performed by using an Instron testing machine. The force was applied at a 45° axial angle with a constant speed of 1 mm/min. For each sample, the force at which fracture occurred was recorded in units of newtons. Statistical analysis was carried out by using analysis of variance test.ResultsThere was no statistically significant difference between all groups (P > .05).ConclusionsTitanium posts, fiber posts, and Epiphany root canal filling systems were found to have no reinforcing effect on endodontically treated roots.