Effect of 2% chlorhexidine gel mixed with calcium hydroxide as an intracanal medication on sealing ability of permanent root canal filling: a 6-month follow-up

The present study was conducted to determine the influence of 2 intracanal medicaments (calcium hydroxide, chlorhexidine gel 2%) when used either alone or combined on the short- and long-term sealing ability of permanent root canal fillings. Ninety human upper central incisors were divided into 4 experimental groups (n=20). All root canals were instrumented in a step-back motion and then treated as follows: group I, root canal dressing with calcium hydroxide for 2 weeks and then obturation with laterally compacted gutta-percha and AH26 sealer; group II, chlorhexidine gel 2% for 2 weeks and obturation as in group I; group III, dressing with a new paste made by mixing calcium hydroxide plus chlorhexidine gel 2% for 2 weeks and obturation as described previously; group IV, immediately obturated with laterally compacted gutta-percha and AH26 sealer. Leakage along root canal fillings was measured using the transport fluid model. Short term measurements were carried out for 3 hours after 24 hours equilibrium establishment. Leakage was measured again at 6 months after the initial measurement. At 3 hours, no significant differences were found among the 4 experimental groups. Long-term measurements showed that also at 6 months no significant differences were observed between the group IV and the other 3 experimental groups. Under the conditions of the present study, it could be supported that none of the medications used seemed to affect negatively neither the short- nor the long-term sealing ability of the tested obturation technique. On the basis of these results and because of its increased antimicrobial action as it is supported in the literature, the new paste made of calcium hydroxide plus chlorhexidine gel 2% can be proposed for use in clinical practice without affecting the sealing ability of root canal obturation.     

Heart rate variability during recovery from a Wingate test in adolescent males

PURPOSE: To evaluate the effect of maturity status on the autonomic nervous system at rest and recovery after short-term, high-intensity exercise in adolescents. METHODS: A biological maturity age was estimated in 27 males by calculating the years from peak height velocity (PHV) using a multiple regression equation. Subjects were divided into two groups: pre-PHV (years from PHV < 0.49), N = 14, mean age = 12.29 +/- 0.91 yr; post-PHV (years from PHV > 0.5, N = 13, mean age = 15.12 +/-0.76 yr). HR variability was used to evaluate autonomic function. ECG tracings were collected during 5 min at rest and recovery after a Wingate test and were analyzed in the frequency domain (low-frequency (LF), high-frequency (HF), LF/HF, total power (TP)). Data are presented as natural logarithms (LN). RESULTS: Changes in HR from HR(peak) during exercise to HR measured at minute 4 after exercise ([DELTA]HR4) were significantly greater in the pre-PHV group (84.31 +/-17.58 bpm) compared with the post-PHV group (69.42 +/-17.63 bpm). There were no significant differences in resting HR variability between pre- and post-PHV groups (P > 0.05). Significant group x time interactions were found for LF(LN) (ms(2)) and TP(LN) (ms(2)) measured during recovery (P < 0.05). Post hoc tests showed that the pre-PHV group had significantly higher postexercise LF(LN) (5.02 +/- 0.97 vs 4.19 +/- 0.79) and TP(LN) (6.36 +/- 1.02 vs 5.62 +/- 0.65) compared with the post-PHV group. When postexercise LF(LN) (ms(2)) was normalized for TP(LN) (ms(2)), there were no significant differences between groups (P > 0.05). CONCLUSION: The pre-PHV group had higher total HR variability than the post-PHV group after a Wingate test, suggesting that maturity status significantly affects total HR variability during recovery after high-intensity exercise.     

Magnetization transfer ratio in the brain of preterm subjects: age-related changes during the first 2 years of life

To study the progress of myelination in preterm-born subjects by measuring the MT ratio (MTR) from birth, up to 24 months of corrected age. One hundred twenty-five preterm subjects (64 males and 61 females of gestational age 33+/-2.4 weeks with chronologic and corrected age of 9.3+/-5.1 and 7.7+/-5.1 months, respectively) with normal brain MR using classic sequences were further evaluated for MTR by using a three-dimensional gradient-echo sequence (TR=32/TE=8/flip angle=6 degrees 4 mm/2 mm overlapping sections) with and without magnetization transfer prepulse. The magnetization transfer ratio was calculated as: MTR=(SIo-SIm)/SIox100%, where SIm refers to signal intensity from an image acquired with a MT prepulse and SIo the signal intensity from the image acquired without a MT prepulse. MTR increased asymptotically in the genu (R2=0.85) and splenium (R2=0.85) of the corpus callosum, the white matter of the frontal lobe (R2=0.91) and occipital lobe (R2=0.82), thalamus (R2=0.86), caudate nucleus (R2=0.67) and putamen (R2=0.71), reaching the 95% of the final value at the corrected age 18.7, 17.7, 15.6, 12.9, 10.4, 9.2 and 6.4 months, respectively. This study shows age-related changes of the brain MTR and provides data that may be useful to assess disturbances in the progress of myelination.     

Heterologous Type I Collagen as an Add-on Therapy to Narrowband Ultraviolet B for the Treatment of Vitiligo: A Pilot Study

BackgroundThere is still an unsatisfied need for new treatments for vitiligo with more rapid onset and long-term sustainability of repigmentation.ObjectiveWe sought to evaluate the possible efficacy of heterologous type I collagen as an add-on therapy to narrowband ultraviolet B (NB-UVB) for the treatment of vitiligo.MethodsFive patients with non-segmental vitiligo older than 18 years with bilateral and approximately symmetrical vitiligo lesions that did not evolve in size for at least six months were included. All vitiligo lesions were treated with NB-UVB therapy according to the Vitiligo Working Group recommendations. Two selected nonfacial lesions of each patient were also treated with intradermal injections of heterologous type I collagen (HTIC) every two weeks. Repigmentation of HTIC plus NB-UVB-treated lesions and their symmetrical counterparts treated just with NB-UVB was evaluated at baseline and Week 12.ResultsRepigmentation of the HTIC-injected lesions started after the first treatment session in three cases and after the second session in two cases. After six sessions (Week 12), the mean repigmentation rate was 70.5 percent (95% confidence interval:0.569–0.841) in the NB-UVB plus HTIC treatment group versus 16.5 percent (95% confidence interval: 0.137–0.192) in NB-UVB treatment group (p=0.0006, paired t-test).ConclusionAlthough the number of patients treated with the combination treatment was limited in our study, our results suggest that the addition of HTIC to NB-UVB therapy might offer a more rapid onset of repigmentation in patients with vitiligo.     

Clinical outcome of norovirus infection in renal transplant patients

Transplant patients are at increased risk for developing severe norovirus (NoV) infections with secondary complications such as rejection episodes and acute transplant failure. This single‐center retrospective study included all kidney transplant patients tested positive for NoV RNA between January 2007 and December 2011. Data were compared to a control group of 528 kidney transplant patients without NoV infection. Sixty‐five kidney transplant patients were recorded NoV RNA positive. Of these, 26 patients (40%) presented with acute transplant failure (AKI). In 43 patients (66.2%), dose reduction in immunosuppression was performed, and of 22 patients receiving tacrolimus, four patients (18.2%) showed toxic trough levels above 15 ng/mL at time of diagnosis. In three patients (4.6%), indicated therapeutic procedures had to be postponed due to prolonged severe diarrhea. Ten patients (15.4%) developed chronic NoV infection. One‐year patient and graft survival in NoV patients and controls was 92.3% and 96.4%, respectively (n.s.). Compared to controls, eGFR was already significantly lower before NoV infection and loss of eGFR relative to baseline over 12 and 36 months was significantly higher in NoV‐infected patients. In particular, patients initially presenting with AKI experienced a long‐term loss of transplant function. Risk factors for NoV infection were immunosuppression containing steroids and antirejection therapy.     

Acute hepatitis in adult Still’s disease during corticosteroid treatment successfully treated with anakinra

Adult onset Still’s disease (AOSD) is a well-recognized clinical disorder characterized by involvement of various organs, including liver. However, acute hepatitis or hepatic failure is extremely rare, and most of the reported cases occurred during treatment with hepatotoxic drugs. Anakinra is an interleukin-1 receptor antagonist (IL-1Ra). Experimental and clinical data support a central role for IL-1Ra in fulminant hepatic failure. We report the case of a patient with AOSD complicated with acute hepatitis during treatment with corticosteroids, which was dramatically improved with anakinra.     

CB<Subscript>1</Subscript> cannabinoid receptor agonists increase intracranial self-stimulation thresholds in the rat

Rationale Addictive drugs have a number of commonalities in animal behavioral models. They lower intracranial self-stimulation (ICSS) thresholds, support self-administration, and produce conditioned place preference (CPP). However, cannabinoids appear atypical as drugs of abuse, since there are controversial data in the literature concerning their reinforcing properties.Objectives The aim of the present study was to examine the effects of cannabinoids on brain reward using the rate–frequency curve shift paradigm of ICSS.Methods Male Sprague–Dawley rats were implanted with electrodes into the medial forebrain bundle (MFB). Rate–frequency functions were determined by logarithmically decreasing the number of cathodal pulses in a stimulation train from a value that sustained maximal responding to one that did not sustain responding. After brain stimulation reward thresholds stabilized rats received intraperitoneal (IP) injections of the potent CB₁ receptor agonists WIN 55,212-2 (graded doses 0.1, 0.3, 1 and 3 mg/kg), CP 55,940 (graded doses 10, 30, 56 and 100 g/kg), or HU-210 (graded doses 10, 30, 100 g/kg).Results With the exception of the highest dose of all cannabinoid agonists tested, which significantly increased the threshold frequency required for MFB ICSS, all other doses of the tested drugs did not affect ICSS thresholds. The CB₁ receptor antagonist SR141716A reversed the actions of WIN 55,212-2 and CP 55,940, but not HU-210. However, the selective CB₁ cannabinoid receptor antagonist AM 251 counteracted the effect of HU-210. Both CB₁ receptor antagonists, at the doses used in the present study, did not affect reward thresholds by themselves.Conclusions The present results indicate that cannabinoid agonists do not exhibit reinforcing properties in the ICSS paradigm, but rather have an inhibitory influence on reward mechanisms. The results suggest that the anhedonic effects of cannabinoids are probably mediated by cannabinoid CB₁ receptors.     

Can steroids reverse the severe COVID-19 induced “cytokine storm”?

Severe coronavirus disease (COVID-19) is characterized by an excessive proinflammatory cytokine storm, resulting in acute lung injury and development of acute respiratory distress syndrome (ARDS). The role of corticosteroids is controversial in severe COVID-19 pneumonia and associated hyper-inflammatory syndrome. We reported a case series of six consecutive COVID-19 patients with severe pneumonia, ARDS and laboratory indices of hyper-inflammatory syndrome. All patients were treated early with a short course of corticosteroids, and clinical outcomes were compared before and after corticosteroids administration. All patients evaded intubation and intensive care admission, ARDS resolved within 11.8 days (median), viral clearance was achieved in four patients within 17.2 days (median), and all patients were discharged from the hospital in 16.8 days (median). Early administration of short course corticosteroids improves clinical outcome of patients with severe COVID-19 pneumonia and evidence of immune hyperreactivity.     

Enzalutamide and CXCR7 inhibitor combination treatment suppresses cell growth and angiogenic signaling in castration‐resistant prostate cancer models

Previous studies have shown that increased levels of chemokine receptor CXCR7 are associated with the increased invasiveness of prostate cancer cells. We now show that CXCR7 expression is upregulated in VCaP and C4‐2B cells after enzalutamide (ENZ) treatment. ENZ treatment induced apoptosis (sub‐G1) in VCaP and C4‐2B cells, and this effect was further increased after combination treatment with ENZ and CCX771, a specific CXCR7 inhibitor. The levels of p‐EGFR (Y1068), p‐AKT (T308) and VEGFR2 were reduced after ENZ and CCX771 combination treatment compared to single agent treatment. In addition, significantly greater reductions in migration were shown after combination treatment compared to those of single agents or vehicle controls, and importantly, similar reductions in the levels of secreted VEGF were also demonstrated. Orthotopic VCaP xenograft growth and subcutaneous MDA133‐4 patient‐derived xenograft (PDX) tumor growth was reduced by single agent treatment, but significantly greater suppression was observed in the combination treatment group. Although overall microvessel densities in the tumor tissues were not different among the different treatment groups, a significant reduction in large blood vessels (>100 μm²) was observed in tumors following combination treatment. Apoptotic indices in tumor tissues were significantly increased following combination treatment compared with vehicle control‐treated tumor tissues. Our results demonstrate that significant tumor suppression mediated by ENZ and CXCR7 combination treatment may be due, in part, to reductions in proangiogenic signaling and in the formation of large blood vessels in prostate cancer tumors.