Dentinal tubule penetration of AH Plus,BC Sealer and a novel tricalcium silicate sealer: a confocal laser scanning microscopy study

Objectives

The aim of this in vitro study was to assess the dentinal tubule penetration of three different sealers, AH Plus, BC Sealer and a novel tricalcium silicate sealer (NTS).

Materials and methods

Ninety-six human maxillary central incisors were divided into three experimental groups (n = 32) and were filled with gutta-percha using a single-cone technique in conjunction with one of the three sealers: AH Plus, BC Sealer or NTS. The roots in each group were cross-sectioned at 1 and 5 mm from the root apex, and the surfaces were examined under confocal laser scanning microscopy (CLSM). The sealer penetration depths were measured at their maximum depths and at four circumferential depths (12, 3, 6 and 9 o’clock) and were evaluated using ImageJ software (ImageJ, NIH).

Results

The maximum and mean penetration depths were significantly higher at 5 mm compared to 1 mm from the apex in the AH Plus (p < 0.001), BC Sealer (p < 0.001) and NTS groups (p < 0.001). No significant difference was observed between the groups at 1 mm for both parameters. The maximum and mean penetration depths were significantly lower at 5 mm for AH Plus compared with the other two groups (p = 0.012).

Conclusions

Within the study limitations, the BC Sealer and NTS demonstrated better tubule penetration results than the AH Plus sealer.

Clinical relevance

Although no study has confirmed a relationship between the penetration depth of root canal sealers and the prevention of apical periodontitis, dentinal tubule sealer penetration may improve obturation quality.

     

Risk of Venous Thromboembolism in Patients with Large Hemispheric Infarction Undergoing Decompressive Hemicraniectomy

Background

Deep-venous thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute ischemic stroke. This study is the first to examine the risk of venous thromboembolism in patients with large hemispheric infarction undergoing decompressive hemicraniectomy.

Methods

The study population included 95 consecutive patients with a large hemispheric infarction who underwent decompressive hemicraniectomy between 2006 and 2014 at our institution. All patients received prophylactic unfractionated heparin and intermittent compression devices (SCD). Patients were systematically screened for DVT at 5-day interval using Duplex ultrasound. PE was diagnosed on chest CT angiography.

Results

Mean age was 57 ± 12 years; mean BMI was 28.3 ± 7.4 kg/m². 30.5 % of patients had infarction in the dominant hemisphere and 69.5 % in the non-dominant hemisphere. The mean NIHSS score was 16.0 ± 5 at admission. The mean length of stay was 22 ± 17 days. 35 % of patients developed a DVT including 27 % who developed above-knee DVT and required placement of an inferior vena cava filter. In multivariable analysis, predictors of DVT were an NIHSS ≥ 17 (p = 0.007), seizures (p = 0.003), hypertension (p = 0.03), and increasing length of stay (p = 0.01). The proportion of patients who developed PE was 13 %. In multivariate analysis, BMI ≥ 30 predicted PE (p = 0.05).

Conclusions

The rate of DVT and PE is remarkably high in patients with large hemispheric infarction undergoing decompressive hemicraniectomy despite prophylactic measures. We recommend routine screening for DVT in this population. Interventions beyond the standard prophylactic measures may be necessary in this high-risk group.

     

Absence of cardiac siderosis by MRI T2* despite transfusion burden,hepatic and serum iron overload in Lebanese patients with sickle cell disease

Background: The use of magnetic resonance imaging (MRI) to detect organ‐specific iron overload is becoming increasingly common. Although hepatic iron overload has been recognized in patients with sickle cell disease (SCD), cardiac iron deposition has only been examined in a few reports. Methods: This was a cross‐sectional study of 23 patients with SCD. Patient charts were reviewed and data collected for drug use, total lifetime transfusions (TLT), transfusion rate (TR), status of the spleen, and comorbid illnesses or infections. Blood samples were obtained for assessment of hemoglobin, serum ferritin, non‐transferrin‐bound iron (NTBI), and liver enzyme levels. Doppler echocardiography was performed to detect pulmonary hypertension (PHT) and assess left ventricular ejection fraction. Cardiac iron levels were measured by MRI T2*. Direct determination of liver iron concentration (LIC) was performed using R2 MRI. In this study, cardiac T2* >20 ms was considered normal. Results: The mean age was 24.4 ± 9.7 yr, with a male to female ratio of 15:8. A total of 9 (49.9%) patients were splenectomized. The mean TR was 14.1 ± 13.2 Units/yr, and the mean hemoglobin level was 9.0 g/dL. PHT was detected in 6 (27.3%) patients, but none had evidence of heart failure. The mean serum ferritin, LIC, and NTBI levels were 997.7 ng/mL, 4.6 mg Fe/g dw, and 1.1 ± 2.2, respectively. TR was a much better predictor of iron burden (LIC, ferritin, NTBI) than TLT. In fact, TR less than 10 Units/yr did not produce significant iron overload reflecting spontaneous losses as high as 0.11 mg/kg/d. None of the patients had evidence of cardiac iron overload (mean cardiac T2* = 37.3 ± 6.2 ms; range: 21.9–46.8 ms). There was also no statistically significant correlation between cardiac T2* values and any of the study variables. Conclusion: Our study demonstrates that TR is a stronger predictor of iron overload than TLT. It also confirms cardiac sparing in patients with SCD, even in subjects with significant transfusion burden, systemic and hepatic iron overload.     

A newly recognized skeletal dysplasia with rhizomelic limbs and retinitis pigmentosa

A girl with severe pre- and post-natal short stature, low-pitched voice, retinitis pigmentosa, photophobia, short neck, broad thorax, platyspondyly, rhizomelic shortening of the long bones, bilateral subluxation of the hips, advanced maturation of the epiphyses, and apparently normal intellectual development is described. The girl's parents are first cousins. Two subsequent pregnancies had ended in spontaneous abortion with polyhydramnios and severe growth retardation. To the best of our knowledge, this association had not been previously reported, and may be considered a newly recognized syndrome.     

Basic principles for evaluation of less deformable erythrocyte subpopulations with the Microfiltrometer

The Microfiltrometer consists of a filtration system for diluted erythrocyte suspensions, through a filter containing 30 cylindrical micropores, 5 microm in diameter, under the influence of a driving pressure. A feeding sinusoidal alternating current of 40 kHz, 300 microA is delivered to the filter. The change in impedance is collected for each temporary flow of erythrocytes through a given micropore. Two main parameters are measured for individually explored erythrocytes: the entry time tau in the micropore and the maximal variation of impedance deltaZ occurring for the transitory flow. The slope deltaZ/tau defines the velocity of pore blockage. A "Microfiltrometer Deformability Index" (MDI) is established by using this slope. When MDI > or = 1, the erythrocyte is considered to be deformable and, conversely, when MDI < 1, the erythrocyte is considered to be undeformable. Using this procedure, less than 2% undeformable erythrocytes in healthy blood samples are identified, with a specificity of 99% and a sensitivity of 97.5%.     

Predictors of psychological distress in Lebanese hostages of war

A cross-sectional study addressed the experience of Lebanese hostages of war in Lebanon. It specifically assessed the prevalence of general distress and its relationship to captivity-related factors and selected psychosocial variables. Trained field researchers using standard measurements interviewed 118 Lebanese hostages released from Khiam prison, an Israeli detention center in Lebanon. Questionnaires administered included the GHQ-12 and the Harvard Trauma Questionnaire. Individuals were detained for 3.4 years on average, and 86% were tortured. Psychological distress was present in 42.1% of the sample compared to 27.8% among the control group. In the multivariate analysis, the significant predictors for distress were: years of education and increase in religiosity after release. In conclusion, even after 2 years of release, more than one-third of the Lebanese hostages released from Khiam prison were found to have psychological distress. Caregivers need to pay special attention to the mental health of hostages of war. The paper discusses the meaning and implications of the factors predicting resilience and vulnerability in this particular population.