Mechanical properties of calcium phosphate based dental filling and regeneration materials

The objective of this study was to compare the mechanical properties of calcium phosphate cements (CPC) for possible dental applications with varied liquid and powder compositions under the same testing condition. Cements studied in this experiment were divided into two groups of CPC not containing polymer and polymeric CPC (PCPC). Cement powder was formed by combining equimolar amounts of dicalcium phosphate anhydrous and tetracalcium phosphate, or acrylic resin polymer powder mixture. The CPC specimens for the compressive strength (CS) and diametral tensile strength (DTS) measurements were prepared by mixing powder and liquid for 30 s with a powder/liquid ratio of 3:1, and subsequently packing the paste into a brass mould. The specimens were kept at 37 degrees C and 100% relative humidity for 24 h before measurements were conducted on a Universal Testing Machine with a cross-head speed of 1 mm min-1. The CS of CPC was 0.14-10.29 MPa and that of PCPC was 0.26-117.58 MPa. The DTS of CPC was 0.10-4.56 MPa and that of PCPC was 0.07-22.54 MPa. The CS and DTS were very diverse depending on the composition of powder and liquid. Some compositions showed higher values than commercial liners. Thus compositions of 2% carboxymethyl cellulose + 35% citric acid in phosphate buffered saline (PBS), 20% gelatin in PBS, 2% sodium alginate in PBS, 20-40% aqueous acrylic-maleic copolymer solution, and some of the HPMC and PMVE-Ma solutions exhibited promising formulae for dentine regenerating materials. Acrylic resin-PCPC group showed generally higher CS and DTS values. Based on this study, further studies on the reaction with odontoblast and resultant dentine regeneration should be performed using promising compositions.     

Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study

BACKGROUND: Stroke is a rare but devastating complication after coronary artery bypass grafting (CABG) and its prevention remains elusive. We used a case control design to investigate the extent to which preoperative and perioperative factors were associated with occurrence of stroke in a cohort of consecutive patients undergoing myocardial revascularization. METHODS: From April 1996 to March 2001, data from 4,077 patients undergoing CABG were prospectively entered into a database. The association of preoperative and perioperative factors with stroke was investigated by univariate analyses. Factors observed to be significantly associated with stroke in these analyses were further investigated using multiple logistic regression to estimate the strength of the associations with the occurrence of stroke, after taking account of the other factors. RESULTS: During the study period, 4,077 patients underwent CABG and of these 923 (22.6%) had off-pump surgery. Forty-five patients suffered a perioperative stroke (1.1%). Overall there were 46 in-hospital deaths (1.1%), of whom 6 also suffered a stroke. Brain imaging of the stroke patients showed embolic lesions in 58%, watershed in 28%, and mixed in 14%. Multivariate regression analysis identified several preoperative factors as independent predictors of stroke, ie, age, unstable angina, serum creatinine greater than 150 mcg/ml, previous cerebrovascular accident (CVA), peripheral vascular disease (PVD), and salvage operation. When operative risk factors were added to the adjusted model, off-pump surgery was associated with a substantial, but not significant, protective effect against stroke (odds ratio = 0.56, 95% confidence interval 0.20 to 1.55). Survival for stroke patients was 93% and 78% at 1 and 5 years, respectively. CONCLUSIONS: Overall incidence of stroke is relatively low in our series. Age, unstable angina, previous CVA, PVD, serum creatinine greater than 150 mcg/ml, and salvage operation are independent predictors of stroke. These factors should be taken into account when informing each individual patient on the possible risk of stroke and in the decision-making process on the surgical strategy.     

Preoperative diagnosis of a paraesophageal bronchogenic cyst using endosonography

Preoperative diagnosis of paraesophageal bronchogenic cysts is difficult, and its management remains controversial. We describe the case of an incidental paraesophageal bronchogenic cyst, suspected preoperatively with endoscopic ultrasound and established intraoperatively by thoracoscopic inspection. Surgical treatment was achieved by cyst excision using a needlescopic technique. Endoscopic ultrasound seems to be the preoperative diagnostic test of choice for paraesophageal bronchogenic cysts.     

Off-pump coronary artery bypass with complete avoidance of aortic manipulation

BACKGROUND: Off-pump coronary artery bypass (OPCAB) with complete avoidance of aortic manipulation may further reduce perioperative morbidity in addition to the benefits achieved by avoiding cardiopulmonary bypass and cardioplegic arrest. METHODS: We prospectively analyzed 222 consecutive patients with multivessel disease who underwent OPCAB without aortic manipulation (group I), and compared them with 123 consecutive patients who underwent OPCAB using additional free arterial or saphenous vein grafts that were anastomosed on the ascending aorta (group II) and 76 consecutive patients who underwent on-pump conventional coronary artery bypass grafting (group III). RESULTS: No significant differences were noted in operative mortalities among the three groups (2/222, 3/123, and 2/76 in groups I, II, and III, respectively; p = NS). Fewer distal anastomoses were done in group I compared with groups II and III (3.2 +/- 0.9, 3.5 +/- 0.8, and 3.7 +/- 0.9 in groups I, II, and III, respectively; p < 0.001). No differences were noted in the incidences of postoperative morbidities such as mediastinitis, pulmonary complication, and reoperation for bleeding. The incidences of stroke, atrial fibrillation, and acute renal failure were significantly lower in group I than in group III (p < 0.05), although there were no significant differences between groups II and III. The incidence of perioperative myocardial infarction was significantly lower in group I than in groups II and III (p < 0.05), although there was no significant difference between groups II and III. CONCLUSIONS: Our results demonstrate that OPCAB with complete avoidance of aortic manipulation may further reduce the incidence of perioperative morbidities such as stroke, atrial fibrillation, acute renal failure, and perioperative myocardial infarction.     

Homocysteine and blood pressure in the Third National Health and Nutrition Examination Survey, 1988-1994

Studies suggest that homocysteine may elevate blood pressure and increase the risk of hypertension. The association of homocysteine with blood pressure and with the risk of hypertension was investigated using cross-sectional data from the Third National Health and Nutrition Examination Survey (1998-1994). Homocysteine had an independent positive association with blood pressure after adjusting for cardiovascular risk factors. A 1 standard deviation ( approximately 5 micro mol/liter) increase in homocysteine was associated with increases in diastolic and systolic blood pressure of 0.5 and 0.7 mmHg, respectively, in men and of 0.7 and 1.2 mmHg in women. Similarly, higher levels of homocysteine were associated with an increased risk of hypertension. In a comparison of the highest and lowest quintiles of homocysteine, women had a threefold increase in the risk of hypertension (95% confidence interval (CI): 1.7, 5.4), and men had a twofold increase (95% CI: 0.7, 5.1). In light of the homocysteine-blood pressure association, the association of homocysteine with prevalent cardiovascular disease was examined with and without adjusting for blood pressure. The results support a mediating role for blood pressure in women and suggest that the full effect of homocysteine on cardiovascular risk may be underestimated when blood pressure is adjusted.     

Food concentration affects the life history response of Ceriodaphnia cf. dubia to chemicals with different mechanisms of action

The effect of three chemicals with different mechanisms of action (3,4-dichloroaniline, fenoxycarb, and chlorpyrifos) on the life history response of the cladoceran Ceriodaphnia cf. dubia was examined under both limited (3 x 10(4) cells/mL) and abundant (15 x 10(4) cells/mL) food conditions. Toxicity tests were conducted at both food concentrations simultaneously for each chemical, and cladocerans were examined daily from less than 24 h old until their death. A range of life history parameters were calculated, including mean brood sizes, survival, net reproductive rate, and population growth rate. The toxicity of 3,4-dichloroaniline was not significantly affected by food concentration. However, limited food significantly decreased the toxicity of fenoxycarb, and significantly increased the toxicity of chlorpyrifos. The effect of food concentration on toxicity appears to depend on the mechanism by which the chemical exerts its toxicity and on food--chemical interactions. Possible mechanisms for the different effects of food concentration on toxicity are discussed.     

Intensity-modulated radiation therapy: First reported treatment in Australasia

Intensity-modulated radiation therapy (IMRT) is an exciting new advance in the practice of radiation oncology. It is the use of non-uniform radiation beams to achieve conformal dose distributions. As a result of the high initial capital costs and the time and complexity of planning, IMRT is not yet a widely available clinical treatment option. We describe the process involved in applying this new technology to a case of locally advanced nasopharyngeal cancer.     

Investigating the use of primary adult subventricular zone neural precursor cells for neuronal replacement therapies

With the relatively recent discovery that neurogenesis persists throughout life in restricted regions of the adult mammalian brain, including those of human beings, there has been great interest in the use of adult-derived neural stem cells for neuronal replacement. There are many great hurdles that must be overcome in order for such replacement strategies to succeed. In this review, we outline some of these hurdles and discuss recent experiments that investigate the potential of using neural precursor cells found in the subventricular zone of the adult brain for brain repair.