Glutamate control of pulpal blood flow in the incisor dental pulp of the rat

Glutamate is present in primary sensory afferents innervating the dental pulp and is known to exert vasoactive effects. The aims of this study were (i) to assess pulpal blood flow (PBF) after glutamate infusion in the dental pulp and (ii) to observe the distribution of glutamatergic nerve fibers expressing the vesicular transporters of glutamate (VGluT). The PBF was monitored with laser Doppler flowmetry before and after glutamate (0.5 M) infusion in the dental pulp vs. saline infusion. Immunochemistry for VGluT1, 2, and 3 was performed in addition to immunochemistry for the vascular and neuronal markers smooth‐muscle actin (SMA), isolectin B4 (IB4), and calcitonin gene‐related peptide (CGRP). Glutamate infusion resulted in a PBF increase that lasted for 60 s. Positive immunolabeling was observed for the three glutamate transporters, but was more pronounced for VGluT3. Moreover, VGluT3 immunoreactivity was observed within nerve fibers entering the dental pulp and terminating at the periphery and at the vicinity of odontoblasts. Also, VGluT3 was colocalized with the vascular marker SMA, and in some nerve fibers with IB4, but not with CGRP. This study provides support for a control of dental pulp microcirculation by neurons expressing VGluT3.     

Imagerie des tumeurs urologiques dans une zone d’endémie bilharzienne au Mali

Established as a major cause of urogenital tumors in some countries, bilharziasis has not been studied significantly in Mali in this respect. To determine the characteristics of urologic tumors in an area where urinary schistosomiasis is endemic, we carried out a cross sectional survey in a rural area with crop irrigation. The survey consisted in the examination of subjects living in the endemic area for parasitological, clinical, ultrasonographical and biological data. Microscopic hematuria was present in 46% of subjects (295/639) and macroscopic hematuria in 19% (141/719). Fifteen cases of bladder tumor were observed in adult men and women aged 35 to 62 years. An anatomopathological examination of the excised tumors carried out in 11 such cases revealed that the cancer was primarily epidermoid cancer. In the upper urinary tract, 24 cases of moderate hydronephrosis (3.3%) and 17 cases of major hydronephrosis (2.3%) were observed. A score from 6 to 24 according to Niamey’s protocol was observed in 31 patients (4.2%). This prevalence is fairly significant if one considers the proportion of malignant tumors found in this area of endemic bilharziasis. Although other investigations are necessary to better describe such tumors, these observations emphasize the public health problem constituted by malignant lesions caused by chronic Schistosoma haematobium (S. haematobium) infection in areas of Mali where crop irrigation is used.     

Diagnostic accuracy of serum hyaluronic acid, FIBROSpect II, and YKL-40 for discriminating fibrosis stages in chronic hepatitis C

OBJECTIVES:  Noninvasive serum markers of liver fibrosis are being used as an alternative to liver biopsy. Currently available tests distinguish, with accuracy, only absent/minimal fibrosis (Ishak stages 0–1) and advanced fibrosis/cirrhosis (Ishak stages 4–6), but not intermediate fibrosis (Ishak stages 2–3). Our aim was to evaluate the diagnostic accuracy of hyaluronic acid (HA), FIBRO Spect II (FS-II), and YKL-40 (chondrex, human cartilage glycoprotein-39) in various clinically important categories of fibrosis, and further correlate these serum markers with digital quantification of fibrosis (DQF) and Ishak stages.
METHODS:  Serum HA, YKL-40, and FS-II were retrospectively assessed and correlated with Ishak stages and DQF scores in 75 patients with chronic hepatitis C (HCV). Spearman's rho statistics assessed relationships among all parameters, and receiver operator characteristic curves evaluated accuracy of each parameter when compared to the Ishak stages.
RESULTS:  All three serum markers and DQF correlated highly with one another ( P ≤ 0.01) and with Ishak stages of fibrosis. Among the serum markers, HA was effective in discriminating between Ishak stages 0–1 and Ishak stages 2–3 compared with FS-II, with an area under the curve of 0.76 versus 0.66 and a false-positive rate of 0.33 versus 0.67, respectively. All three serum markers predicted advanced fibrosis and cirrhosis. YKL-40 had the highest false-positive rates in all categories of fibrosis.
CONCLUSIONS:  HA can be utilized as a reliable surrogate marker in distinguishing three clinically relevant stages of fibrosis: absent/minimal, intermediate, and advanced/cirrhosis. HA should be considered as a cost-effective alternative to other serum markers for staging fibrosis and for determining the timing and selection of HCV treatment.     

Aneurysms in Takayasu disease

Takayashu's inflammatory panarteritis essentially results in stenotic lesions of the supra aortic axes and the collateral vessels of the abdominal aorta. Fusiform, segmental post-stenotic dilatation is commonly observed. Three particular types of aneurysms are described, each illustrated by a case report: --aneurysm of the ascending aorta causing severe aortic regurgitation by dilatation of the aortic ring: the diagnosis of Takayashu's disease was made in a young West Indian female on the evidence of associated aortic lesions and calcification of the descending thoracic aorta. The patient underwent replacement of the ascending aorta and aortic valve replacement. This form is very rare, although mild aortic regurgitation in Takayashu's disease has been reported in about ten cases by different workers; --large saccular aortic aneurysm. This lesion of the descending thoracic aorta with parietal calcification and without intrasaccular thrombosis was associated with a long, irregular stenosis of the paroxismal segment of the aorta, giving rise to signs of coarctation, and with multiple stenoses of the supra-aortic axes in a 31 year old Algerian. Surgical cure was realised by occluding the orifice in order to avoid replacing the aorta at the origin of the main medullary arteries. An ascending aorta-abdominal aorta bypass was performed at the same time, together with correction of the stenoses of the supra-aortic vessels. A few similar cases of large succular aneurysms of the thoracic or abdominal aorta or of the large collateral vessels have previously been described; --pseudo-aneurysm due to arterial rupture and formation of a large hematoma. A 20 year old Algerian presented with a polylobulated saccular aneurysm of the superficial femoral artery in the femoral triangle. Several stenotic lesions typical of Takayashu's disease (including a particularly rare stenosis of the contra lateral superficial femoral artery) were associated. At surgery, the lesion was found to be a pseudo-aneurysm with no true arterial wall on histological examination. The role of an infective endarteritis is discussed and excluded. This type of lesion does not appear to have been previously reported. These three varieties of aneurysm were the presenting signs of Takayashu's disease in the cases reported.     

Inferior vena caval return to the left atrium with intact interauricular septum. Apropos of 2 cases surgically treated with success

Two cases of abnormal inferior vena caval return to the left atrium are reported in a 9 year old boy and 13 year old girl. The diagnosis was suspected on the finding of severe cyanosis alone, and the anomalous systemic venous return was correctly identified by angiography of the inferior vena cava. There were three angiographic points of interest in these two cases: the normal position of the inferior vena cava, the absence of a left-to-right interatrial shunt and the presence of a vertical intra-left atrial "membrane" inserted behind the orifice of the inferior vena cava. Surgical correction consisted in resecting the inferior part of the interatrial septum and reconstructing a new septum behind the orifice of the inferior vena cava with a dacron patch in one case and by direct suture in the other. The good surgical result was controlled by angiography in both cases. In the second case, an intrapulmonary shunt due to multiple arteriovenous fistulae demonstrated by contrast echocardiography was responsible for persistent mild cyanosis for a few months after surgery. The long-term clinical results were excellent in both cases. The authors review the literature of this rare malformation due to persistence of part of the right valve of the sinus venosus.     

Clinical and histological responses of human dental pulp to MTA and combined MTA/treated dentin matrix in partial pulpotomy

The aim of this study was to compare the responses of mineral trioxide aggregate (MTA) and combined MTA/treated dentin matrix (TDM) as direct pulp capping material. In this clinical trial study, 33 intact third molars in 11 healthy volunteers (three molars in each) were included. Partial pulpotomies were performed in a split mouth manner in two of the third molars in each patient randomly and the third tooth had used as TDM source. The coronal dentin was chopped to dentine chips and transformed to TDM using different concentrations of ethylene diamine tetraacetic acid (EDTA) solution. Pulps were directly capped by MTA alone or using a combination layering of MTA/TDM. Following 6‐week clinical and radiological evaluations, each tooth was extracted and prepared for histological evaluation. There were no significant differences in the clinical and radiographic responses or in the quality of dentin bridges (P > 0.05). However, the dentin bridge was significantly thicker in MTA/TDM group than MTA group (P = 0.003). Using the combination of MTA/TDM as a pulp‐dressing agent may form a thicker dentin bridge compared to MTA alone.     

Relationship between carotid artery atherosclerosis and bulb geometry

The carotid bifurcation is a common site of atherosclerotic plaque. Plaque development is thought to occur preferentially at geometrically predisposed areas such as arterial branch points. The aim of this study was to investigate the geometric and anatomical variables that contribute to the development of carotid plaque using three-dimensional (3D) ultrasound. Sixty-seven consecutive outpatients referred for elective coronary angiography underwent 3D carotid ultrasound scans for the purpose of carotid plaque quantification. Geometric quantification of the left and right carotid bulbs were performed retrospectively on this study population. Geometric values such as angle, area and length of the carotid bulb and the bifurcation were determined using QLAB software (Philips Healthcare). Plaque volume within the carotid bulb and artery branches was quantified using the stacked contour method. Pearson’s correlation and linear regression analysis were used to determine the relationship between anatomical variables and plaque volume. The mean age for the total patient population was 65.9?±?11.5 years. Carotid bulb inflow area (BIA) (r?=?0.28, p?=?0.001), bulb volume (BV) (r?=?0.21, p?=?0.01) and bifurcation angle (BifA) (r?=?0.18, p?=?0.04) showed a positive linear relationship with plaque volume. In contrast, internal carotid artery angle (ICAA) (r?=???0.18, p?=?0.04) and bulb flare (r?=???0.20, p?=?0.02) displayed a negative linear relationship with plaque volume. When adjusting for age and sex, only the BIA remained significant (β?=?0.18, p?=?0.04). Geometric variables were identified as potential risk factors associated with plaque volume in the carotid bulb. Further analysis of the evolution of the BIA as well as the relationship to other geometric variables could create a stronger predictive model of atherosclerosis as well as assist in preoperative planning.