Clinical evaluation of a new collagen matrix (Mucograft® prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial

Aim: The aim of this study was to test a new collagen matrix (CM) aimed to increase keratinized gingiva/mucosa when compared with the free connective tissue graft (CTG).
Material and Methods: This randomized longitudinal parallel controlled clinical trial studied 20 patients with at least one location with minimal keratinized tissue (1 mm).
Main Outcome Measure: The 6-month width of keratinized tissue. As secondary outcomes, the aesthetic outlook, the maintenance of periodontal health and the patient morbidity were assessed pre-operatively at 1, 3 and 6 months.
Results: At 6 months, the CTG attained a mean width of keratinized tissue of 2.6 (0.9) mm, while the CM was 2.5 (0.9) mm, these differences being insignificant. In both groups, there was a marked contraction (60% and 67%, respectively) although the periodontal parameters were not affected. The CM group had a significantly lower patient morbidity (pain and medication intake) as well as reduced surgery time.
Conclusions: These results prove that this new CM was as effective and predictable as the CTG for attaining a band of keratinized tissue, but its use was associated with a significantly lower patient morbidity.     

Sensitisation to aeroallergens among asthmatic and non-asthmatic adolescents living in a poor region in the Northeast of Brazil

ObjectivesTo assess the kind and frequency of sensitisation to aeroallergens (skin prick test - SPT) of asthmatic and non-asthmatic adolescents (13–14 years old) living in the city of Caruaru, Northeast of Brazil, and to analyse their exposure to some environmental factors.MethodA case-control study was conducted with asthmatic (50) and non-asthmatic (150) adolescents diagnosed by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. All were submitted to SPT with aeroallergens (house dust mites, cat and dog epithelium, cockroaches, moulds and grass) and completed a questionnaire to evaluate their environmental exposure.ResultsThere were no significant differences between groups regarding gender, age, number of siblings and environmental exposure. Asthmatic subjects exhibited a higher frequency of positive SPTs than non-asthmatic subjects (54.0% vs 33.3%, p=0.009) mainly due to Periplaneta americana (34.0% vs 12.7%, p=0.0007 respectively) and Canis familiaris (20.0% vs 8.7%, p=0.029).ConclusionAlthough sensitisation to aeroallergens was high among non-asthmatic adolescents, asthma was associated with parental history of atopic disease and sensitisation to P. americana and Canis familiaris but not to D. pteronyssinus showing that local studies are mandatory for the tailoring of appropriate management of allergic diseases.     

Evidence for a biphasic apoptotic pathway induced by melatonin in MCF-7 breast cancer cells

Abstract:  Previous investigations demonstrated that melatonin exerts an oncostatic action on estrogen-responsive breast cancer, both in vitro and in vivo. Nevertheless, the pro-apoptotic effect of melatonin is still a matter of debate. An experimental study was undertaken to focus on melatonin-related apoptosis and to identify the apoptotic pathways involved. Whole cell-count, flow-cytometry analysis and proteins involved in apoptotic pathways [p53, p73, murine double minute 2 (MDM2), caspases-9,-7,-6, cleaved-poly ADP ribose polymerase (PARP), Bcl-2, Bax and apoptotic inducing factor (AIF)] were investigated in human MCF-7 breast cancer cells treated with physiological (1 nM) concentration of melatonin. Melatonin exerts a significant growth-inhibitory effect on MCF-7 cells, becoming evident after 72 hr and thereafter increasing linearly up to 144 hr. In this model, the growth-inhibition is transforming growth factor beta 1 (TGFβ1)-dependent and it might be reversed by adding an anti-TGFβ1 antibody. Melatonin induces a significant rise in apoptotic rate, at both 24 and 96 hr. The anti-TGFβ1 antibody almost completely suppresses melatonin-related late apoptosis; however, early apoptosis is unaffected. Early programmed cell death is associated with a significant increase in the p53/MDM2 ratio and in AIF release, without modifications in caspase activity or cleaved-PARP levels. Activated caspases-9 and -7 and cleaved-PARP increased significantly at 96 hr, concomitantly with a down-regulation of the Bcl-2/Bax ratio. These data suggest that two distinct apoptotic processes are triggered by melatonin in MCF-7 cells: an early, TGFβ1 and caspase-independent response, and a late apoptotic TGFβ1-dependent process in which activated-caspase-7 is likely to be the terminal effector.     

Building evidence-based practice with staff nurses through mentoring

Evidence- based practice (EBP) is an effective way for nurses to improve patient outcomes. Although EBP has gained popularity, barriers to implementation exist. This study explored whether mentoring neonatal intensive care unit (NICU) nurses in EBP would increase their participation in EBP. A sample of 20 nurses were mentored in an EBP project. The EBP Beliefs Scale and EBP Implementation Scale measured scores upon initiation and completion of the project. Statistical analysis showed no significant changes in nurses' beliefs in EBP or implementation of EBP following mentoring. However, a moderate degree of correlation between changes in beliefs scores and implementation scores was seen with a borderline significance. Age and years of experience did significantly influence changes in EBP beliefs scores. Although the study results did not support that mentoring changed attitudes or utilization of EBP, changes in NICU were implemented as a result of the project activities.     

Developmental striatal critical period of activity-dependent plasticity is also a window of susceptibility for haloperidol induced adult motor alterations

Experience-dependent plasticity during critical periods of postnatal (PN) development shapes the adult brain anatomy and function. In rat motor system, there is a critical period of activity-dependent plasticity in the striatum (PN30-37). In this period, motor activity of running in a circular path induced in the Circling Training test (CT), elicits several plasticity changes on striatal synapses. It has been recently proposed that developmental critical periods might represent a unique pharmacological window of vulnerability to induce life-lasting behavioral modifications. In this paper we tested the hypothesis of existence of a pharmacological susceptibility to induce adult alterations on motor behavior during the striatal critical period. Due to its main action on the striatum and developmental motor behavioral effects, we applied the prototypical antipsychotic haloperidol to male rats (i.p. 0.7 or 2.5 mg/kg/day) before, during or after the period of plasticity (PN20-27, PN30-37 or PN40-47 respectively). Then, in the adulthood (PN80), we evaluated induced motor activity in the CT. The results showed that only rats exposed to the D2R blocker during the period PN30-37 increased the CT activity in comparison to control rats. Moreover, only these animals also showed an increase in the spontaneous locomotor activity at the open field test. These behavioral alterations were not accompanied by permanent striatal changes either on the number of D2R binding sites or on its mRNA expression levels. In conclusion, we have shown a pharmacological susceptibility of inducing adult motor behavior alterations by haloperidol during a natural critical period of activity-dependent plasticity (PN30-37) in rat striatum development. These results also emphasize the importance of behavioral screening for pharmacological agents to be used in developmental stages of maturation.     

In silico prediction and ex vivo evaluation of potential T-cell epitopes in glycoproteins 4 and 5 and nucleocapsid protein of genotype-I (European) of porcine reproductive and respiratory syndrome virus

T-cell epitopes of porcine reproductive and respiratory syndrome virus (PRRSV) glycoproteins 4 (GP4), 5 (GP5) and nucleocapsid (N) were predicted using bioinformatics and later tested by IFN-γ ELISPOT in pigs immunized with either a modified live vaccine (MLV) or DNA (open reading frames 4, 5 or 7). For MLV-vaccinated pigs, immunodominant epitopes were found in N but T-epitopes were also found in GP4 and GP5. For DNA-immunized pigs, some peptides were differently recognized. Using a large set of PRRSV sequences it was shown that N contains a conserved epitope and that for GP5, the genotype-I counterparts of previously reported epitopes of genotype-II strains were also immunogenic.     

Nefroureterectomía laparoscópica mediante laparoscopia asistida por la mano para el tratamiento del carcinoma transicional del tracto urinario superior

ObjectiveTo report our series of patients undergoing hand-assisted laparoscopic nephroureterectomy (HALNU) using the pluck-off procedure.Materials and methodsTwenty patient undergoing HALMU for upper urinary tract urothelial tumors from November 2002 to December 2007 were assessed. Demographic, clinical, surgical, and oncological data were assessed.ResultsMean patient age was 69 years. Mean operating time and mean intraoperative bleeding were 176 min and 381 mL respectively. Twenty percent of patients required transfusion of blood products. Conversion to open surgery was not required in any patient.Major and minor complications occurred in 25% and 30% of patients respectively.Mean time to oral intake was 48 hours, and mean hospital stay was 5 days.Pathological study revealed transitional cell carcinoma in all cases: grade I in 5%, grade II in 60%, and grade III in 35% of patients. Clinical stage was pTa in 5%, pT1 in 20%, pT2 in 25%, pT3 in 40%, and pT4 in 10% of patients.A bladder recurrence rate of 30% and a 49% overall survival were seen after a mean followup of 33 months (5-73). Six-year cancer-specific survival was 67%. No patient developed either peritoneal or surgical bed recurrence.ConclusionsHALMU using the pluck-off procedure is a feasible, safe, and effective surgery. Both surgical and oncological results are similar to those of open surgery and pure laparoscopy.     

Seguimiento del esfínter urinario artificial FlowSecure

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of cahnges in its design that resulted in a new prostheses, the FlowSecure artificial sphincter.The FlowSecure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure.A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the FlowSecure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence.