Implications of gluten exposure period,CD clinical forms,and HLA typing in the association between celiac disease and dental enamel defects in children. A case–control study

International Journal of Paediatric Dentistry 2010; 20: 119–124 Background. The association between coeliac disease (CD) and dental enamel defects (DED) is well known. Aim. The aim of this study was to investigate the prevalence of DED in children with CD and to specifically find the association of DED and gluten exposure period, CD clinical forms, HLA class II haplotype. Design. This study was designed as a matched case–control study: 250 children were enrolled (125 coeliac children – 79 female and 46 male, 7.2 ± 2.8 years and 125 healthy children). Data about age at CD diagnosis, CD clinical form, and HLA haplotype were recorded. Results. Dental enamel defects were detected in 58 coeliac subjects (46.4%) against seven (5.6%) controls (P < 0.005). We found an association between DED and gluten exposure period, as among CD subjects the mean age at CD diagnosis was significantly (P = 0.0004) higher in the group with DED (3.41 ± 1.27) than without DED (1.26 ± 0.7). DED resulted more frequent (100%) in atypical and silent CD forms than in the typical one (30.93%). The presence of HLA DR 52‐53 and DQ7antigens significantly increased the risk of DED (P = 0.0017) in coeliac children. Conclusions. Our results confirmed a possible correlation between HLA antigens and DED.     

Long-Term Survival in Patients Treated with Cardiac Resynchronization Therapy: A 3-Year Follow-Up Study from the InSync/InSync ICD Italian Registry

Background: Studies reporting the long-term survival of patients treated with cardiac resynchronization therapy (CRT) outside the realm of randomized controlled trials are still lacking. The aim of this study was to quantify the survival of patients treated with CRT in clinical practice and to investigate the long-term effects of CRT on clinical status and echocardiographic parameters.
Methods: The study population consisted of 317 consecutive patients with implanted CRT devices from eight Italian University/Teaching Hospitals. The patients were enrolled in a national observational registry and had a minimum follow-up of 2 years. A visit was performed in surviving patients and mortality data were obtained by hospital file review or direct telephone contact.
Results: During the study period, 83 (26%) patients died. The rate of all-cause mortality was significantly higher in ischemic than nonischemic patients (14% vs 8%, P = 0.002). Multivariate analysis showed that ischemic etiology (HR 1.72, CI 1.06–2.79; P = 0.028) and New York Heart Association (NYHA) class IV (HR 2.87, CI 1.24–6.64; P = 0.014) were the strongest predictors of all-cause mortality. The effects of CRT persisted at long-term follow-up (for at least 2 years) in terms of NYHA class improvement, increase of left ventricular ejection fraction, decrease of QRS duration (all P = 0.0001), and reduction of left ventricular end-diastolic and end-systolic diameters (P = 0.024 and P = 0.011, respectively).
Conclusions: During long-term (3 years) follow-up after CRT, total mortality rate was 10%/year. The outcome of ischemic patients was worse mainly due to a higher rate of death from progressive heart failure. Ischemic etiology along with NYHA class IV was identified as predictors of death. Benefits of CRT in terms of clinical function and echocardiographic parameters persisted at the time of long-term follow-up.     

Pre- and Postjunctional Effects of Diadenosine Polyphosphates in the Guinea-pig Vas Deferens

The pre- and postjunctional activities of a number of diadenosine polyphosphates were examined in the guinea-pig isolated vas deferens at the level of the membrane-potential, using a modified sucrose-gap technique. P¹,P³-Di(adenosine 5′)triphosphate (Ap₃A), P¹,P⁴-di(adenosine 5′)tetraphosphate (Ap₄A) and P¹,P⁵-di(adenosine 5′)pentaphosphate (Ap₅ A) all caused concentration-dependent depolarization of the smooth muscle membrane. The potency order was: Ap₅A > Ap₄A. Ap₃A. P¹, P²-Di(adenosine 5′)pyrophosphate (Ap₂A) did not evoke depolarization even at the highest concentration tested (1 mM). All the dinucleotides caused a reduction in the amplitude of evoked excitatory junction potentials (e.j.ps). The potency order was: Ap₅A = Ap₄A > Ap₃A > Ap₂A. The depolarizations evoked by the dinucleotides were markedly reduced by the selective P_2X-purinoceptor antagonist, pyridoxalphosphate-6-azophenyl-2′,4′-disulphonic acid (PPADS, 10 μM), as was the amplitude of the fully facilitated e.j.p. The inhibition of the e.j.p. evoked by Ap₃A and Ap₂A was reduced by the P₁-purinoceptor antagonist, 8-p-sulphophenyltheophylline (8-pSPT, 50 μM), but that evoked by Ap₅A and Ap₄A was not. Thus, Ap₃A, Ap₄A and Ap₅ A evoke depolarization of the guinea-pig vas deferens via P_2X-purinoceptors, and additionally Ap₂A and Ap₃A exert a prejunctional effect via P₁-purinoceptors. The prejunctional activity of Ap₄A and Ap₅A is mediated via an undefined purinoceptor, which is neither P₁ nor P_2X.     

Liposomes as In-vivo Carriers for Citicoline: Effects on Rat Cerebral Post-ischaemic Reperfusion#

Abstract— Citicoline is a therapeutic agent widely used in the treatment of brain injury, for example in cerebrovascular disease or traumatic accidents. Unfortunately, the strong polar nature of this drug prevents it crossing the blood-brain barrier. In this paper, the possibility of efficiently trapping citicoline in liposomes to improve its therapeutic effects is reported. The citicoline-encapsulation efficiency, drug leakage and size analysis of various liposome systems were studied. The real therapeutic effectiveness of these citicoline liposome formulations was evaluated by biological assay. The effects of free and liposome encapsulated citicoline on survival rate of ischaemic reperfused male Wistar rats (80–100 g) were investigated. Of the phospholipid mixtures used in citicoline liposome formulation the best in terms of delivery and therapeutic effects was 1,2-dipalmitoyl-sn-glycero-phosphocholine:dipalmitoyl-dl -α-phosphatidyl-l -serine: cholesterol (7:4:7 molar ratio). This phospholipid mixture was also assayed for brain conjugated diene levels in rats, since this parameter is an index of lipid peroxidation in rat cerebral cortex during post-ischaemic reperfusion. A citicoline-loaded phospholipid mixture has produced an increase in rat survival rate of about 24% and a reduction in diene levels of 60%, compared to the free drug.     

Re-anatomization of Anterior Eroded Teeth by Stratification with Direct Composite Resin

Gastroesophageal reflux disease (GERD) is a condition where stomach acids are chronically regurgitated into the esophagus and oral cavity, resulting in the irreversible erosion of tooth structure. The dentist often is the first health care professional to identify the affected dentition. Restorative treatment should be accomplished after management of the systemic condition. Dental treatment improves the patient's oral hygiene, reduces thermal sensitivity, prevents pulpal involvement and further abrasion, and esthetics are improved. This article presents a case report where dental erosion was present because of GERD. Conservative dental treatment of the eroded dentition is described, including diagnosis, treatment planning, bleaching, and restorative reconstruction with direct composite layering techniques without any preparation of the tooth structure. After 1 year of clinical service, the restored teeth present an excellent clinical appearance and require no repair or polishing.

CLINICAL SIGNIFICANCE

The treatment of eroded teeth, caused by gastroesophageal reflux disease (GERD), with direct composite resin appears to be a conservative and esthetic procedure that is well accepted by patients. However, this treatment can be carried out only after complete management of the causes of the GERD.