bluuebunny/crossref_metadata_2025 huggingface dataset:
The complement system at the feto‐maternal interface: friend or foe?
Authors: Tedesco Francesco , Bulla Roberta , Bossi Fleur , Macor Paolo. , Radillo Oriano , De Seta Francesco
Published: March 2003

The complement system is an essential component of the innate immune system and functions as a double‐edged weapon providing on the one hand an effective means of defence and yet causing cell and tissue damage. The liver represents the major source of complement components present in the blood that circulates in decidua and in intervillous space. We have examined macrophages, endothelial and stromal cells and trophoblast as the most likely candidates for local production of complement components. All these cells produce primarily C4 and C3 and various other components under the control of locally available cytokines. We have recently examined the distribution and the role of C1q and of the related proteins, MBL and emilin, a component of the elastic fibers. While emilin is evenly distributed in the decidual stroma, both C1q and MBL appear to be present preferentially on the wall of blood vessels. The results of in vitro experiments have shown that extravillous trophoblast use C1q and emilin to adhere and to migrate in decidua. Deposits of complement components are seen particularly on the wall of spiral arteries. C1q can be detected on the endothelium and also in the subendothelium, where we detect deposition also of the terminal complex. Placental cells are protected from the undesired effect of complement activation products by acquiring complement regulators from the fluid phase or by expressing regulators on the cell surface including DAF, MCP and CD59.
The role of activin a in the maternal systemic inflammatory response in preeclampsia
Authors: Sargent Ian L. , Tannetta Dionne S. , Muttukrishna Shanti , Redman Chris W.G.
Published: March 2003

BACKGROUND:  The maternal syndrome of preeclampsia is associated with a systemic inflammatory response. Circulating levels of activin A are significantly elevated in preeclampsia. The aims of this study were to determine whether activation of trophoblast, peripheral blood mononuclear cells (PBMC) and endothelial cells by pro‐inflammatory cytokines is the cause of these high levels of activin A and to investigate its role in leucocyte activation and endothelial cell function.

RESULTS:  Term villous cytotrophoblast and endothelial cells (HUVECS) secreted increased levels of activin A in response to TNF‐α and IL‐1. PBMC from nonpregnant, normal pregnant and preeclamptic women did not spontaneously release activin A, but LPS and TNF‐stimulated production, with higher levels in preeclampsia. Activin A had no effect on the expression of leucocyte activation markers but significantly reduced the secretion of TNF‐α by activated PBMC although this effect was less marked in pregnancy. Activin A significantly inhibited HUVEC proliferation in a dose dependent manner.

CONCLUSIONS:  The high circulating levels of activin A in preeclampsia may result from the effects of the inflammatory response on trophoblast, PBMC and endothelial cells. Although activin A has anti‐inflammatory properties on nonpregnant cells, this effect is reduced in pregnancy. The raised levels of activin A may also cause endothelial cell dysfunction, thus exacerbating the maternal syndrome.
T and B Lymphocyte Subsets in Patients with Unexplained Recurrent Spontaneous Abortion: IVIG versus Placebo Treatment
Authors: Jablonowska Barbara , Palfi Miodrag , Matthiesen Leif , Selbing Anders , Kjellberg Svante , Ernerudh Jan
Published: March 2003

Jablonowska B, Palfi M, Matthiesen L, Selbing A, Kjellberg S, Ernerudh J. T and B Lymphocyte subsets in patients with unexplained recurrent spontaneous abortion: IVIG versus placebo treatment. AJRI 2002; 48:312–318 © Blackwell Munksgaard, 2002

PROBLEM: To investigate circulating lymphocyte subsets in women with recurrent spontaneous abortion (RSA) in relation to pregnancy outcome and to treatment with intravenous immunoglobulin (IVIG).

METHOD OF STUDY: Forty‐one women with a history of unexplained RSA were examined during first trimester of pregnancy before IVIG or placebo treatment and after pregnancy. The results were compared with five healthy, non‐pregnant women and five women in the first trimester of normal pregnancy. Circulating lymphocyte subsets with focus on T‐cell subpopulations were determined by flow cytometry.

RESULTS: The proportions of human leukocyte antigen (HLA)‐DR positive T cells (CD3+ HLA‐DR+), T‐killer/effector cells (CD8+ S6F1+) and B cells (CD19+) were increased, whereas the proportion of T‐suppressor/inducer cells (CD4+ CD45RA+) was decreased during first trimester pregnancy of RSA women compared with pregnant normal controls. T and B lymphocyte subsets did not correlate with pregnancy outcome on either IVIG or placebo group.

CONCLUSIONS: In RSA patients, the immune system seems to be activated in contrast to the suppression noted in normal pregnancy.
The Administration of Cortisone to Female B6A Mice During their Immune Adaptive Period Causes Anovulation and the Formation of Ovarian Cysts
Authors: Chapman John C. , Min Soohong , Kunaporn Saichol , Tung Keith , Shah Saureen , Michael Sandra D.
Published: March 2003

PROBLEM: Female mice that are injected with estradiol‐17β (E2) and testosterone during the 7‐day immune adaptive period are infertile at adulthood. To determine whether the resultant infertility can be caused by steroids other than estrogens/androgens, this study examined the effect of injecting cortisone, alone, and in combination with E2 and testosterone, on reproductive function.

METHOD OF STUDY: Neonatal (C57BL/6J × A/J)F1 B6A female mice were injected from 3 to 6 days of age with sesame oil:ethanol (9:1; v:v), alone, or containing 20 μg cortisone acetate, 20 μg E2, or 20 μg testosterone. Two additional groups were given 20 μg cortisone acetate in combination with 20 μg E2 or 20 μg testosterone. At adulthood the animals were killed, the stage of vaginal estrus determined, the ovaries examined for the presence of corpora lutea and follicular cysts, and circulating levels of progesterone, E2, and testosterone were measured by radioimmunoassay (RIA).

RESULTS: It was found that injections of cortisone seriously compromise reproductive development. For example, 11% of cortisone‐injected animals had ovaries that lacked corpora lutea. In addition, 39% of cortisone‐injected females had ovaries with follicular cysts. Cortisone‐injected females also had low levels of circulating progesterone (18 ng/mL versus 30 ng/mL for the sesame oil‐injected females).

CONCLUSION: It is concluded that the deleterious effect of steroids on reproductive function, when administered during the immune adaptive period, is not restricted to estrogens and androgens. It is proposed that injections of cortisone alter T‐lymphocyte subsets, which contributes to anovulation and the production of follicular cysts.
Fetal Survival in the Rat as Affected by Intrauterine Injection of Serum Containing Antiphospholipid Antibodies
Authors: Halperin Reuvit , Hadas Eran , Shinnar Nili , Bukovsky Ian , Schneider David
Published: March 2003

PROBLEM:  We wanted to study and examine whether the detrimental effect of antiphospholipid antibodies on gestation is locally derived. Therefore, we established an experimental rat model, enabling to study the intrauterine effect of serum, containing antiphospholipid antibodies, in vivo.

METHODS:  Sera were obtained from five women, having anticardiolipin antibody and lupus anticoagulant, and presenting with antiphospholipid antibody syndrome. Pooled serum of 150 μL was injected into unilateral uterine horn of each rat on days L2–L7 of rat pregnancy. The contralateral uterine horn was used for injection of 150 μL normal serum or physiologic saline as a control. The rats were sacrificed on day L14, and the uterus of each rat was inspected for the presence of live and resorbed fetuses.

RESULTS:  A significant effect on fetal resorption and viability was observed following the intrauterine injection of antiphospholipid positive serum (APL positive serum), as compared with the intrauterine injection of normal serum or saline. A significant increase in fetal resorption rate and decrease in fetal viability was noted following the injection of APL positive serum on day L6 (P = 0.005 and 0.004, respectively) and day L7 (P = 0.003 and 0.003, respectively) as compared with normal serum. A comparison with the contralateral injection of saline demonstrated a significant effect of the APL positive serum also following the intrauterine injection on days L3 and L5.

CONCLUSIONS:  The current study provides an experimental rat model, which can be employed to study the local intrauterine effect of APL positive serum on pregnancy outcome and to further assess the efficacy of various treatment modalities.
Influence of Carrier Protein Conjugation Site and Terminal Modification of a GnRH‐I Peptide Sequence in the Development of a Highly Specific Anti‐fertility Vaccine. Part I
Authors: Ferro Valerie A. , Khan Mohammad A. H. , Earl Elizabeth R. , Harvey Michael J. A. , Colston Angela , Stimson William H.
Published: March 2003

PROBLEM: We previously immunoneutralized gonadotrophin releasing hormone (GnRH), using an analogue of GnRH (des‐1 GnRH‐I), conjugated to tetanus toxoid via a carbodiimide reaction. The castration effect on the reproductive system was not consistent in all the treated animals. Therefore, we examined the possibility that conjugation to the carrier protein via the N‐ or C‐terminal could have an effect on efficacy.

METHOD OF STUDY: GnRH analogue sequences were synthesized consisting of an additional cysteine at either terminal and specific conjugation was carried out using a bifunctional linker agent.

RESULTS: Conjugation of the monomer through the N‐terminal proved to be a highly effective means of causing immunocastration in terms of decreased gonadotrophin and testosterone concentrations and testicular size, whereas conjugation through the C‐terminal proved to be ineffective. This was reflected in the ability of the antibodies to bind native GnRH, but not the levels of the anti‐GnRH antibodies.

CONCLUSION: Immunoneutralization efficacy was attributed to the importance of preserving the GnRH C‐terminal.
Effect of Ovaric Hyper‐stimulation on Blood Lymphocyte Subpopulations, Cytokines, Leptin and Nitrite Among Patients with Unexplained Infertility
Authors: Fornari M. C. , Sarto A. , Berardi V. E. , Martínez M. A. , Rocha M. G. , Pasqualini S. , Diez R. A.
Published: March 2003

Fornari MC, Sarto A, Berardi VE, Martínez MA, Rocha MG, Pasqualini S, Diez RA. Effect of ovaric hyper‐stimulation on blood lymphocyte subpopulations, cytokines, leptin and nitrite among patients with unexplained infertility. AJRI 2002; 48:394–403 © Blackwell Munksgaard, 2002

PROBLEM: To determine the effect of ovarian stimulation on TH1, TH2 and natural killer (NK) lymphocytes, plasma cytokines, leptin and nitrite levels.

METHODS: Women with reproductive failure were studied during the implantation window, at baseline (n=18) and under ovarian stimulation (gonadotropins + progesterone, n=6). Controls: eight fertile women. Lymphocyte subpopulations and NK function were determined by flow cytometry. Interleukin‐2 (IL‐2), IL‐4, IL‐10, IFN‐γ, TNF‐α, TGF‐β1 and leptin were measured by enzyme immunoassay (EIA); nitrite by the Griess reaction.

RESULTS: At baseline, patients had higher values of NK effectors, NK activity and plasma IFN‐γ and IL‐2 than controls. Conversely, TGF‐β1 values were lower. Hormones induced leukocytosis. Under stimulation, TH1 CD4+ cells, NK effectors and function and plasma IFN‐γ and IL‐2 decreased, while transforming growth factor (TGF)‐β1 increased. Other variables did not change.

CONCLUSION: The abnormal distribution of leukocytes, high TH1 cytokines and a low TGF‐β1 associated with reproductive failure, respond to ovarian stimulation, achieving total or partial normalization.
Progesterone Induced Blocking Factor (PIBF) Mediates Progesterone Induced Suppression of Decidual Lymphocyte Cytotoxicity
Authors: LAŠKARIN GORDANA , TOKMADŽIĆ VLATKA S. , ŠTRBO NATAŠA , BOGOVIĆ TATJANA , SZEKERES‐BARTHO JULIA , RANDIĆ LJILJANA , PODACK ECKHARD R. , RUKAVINA DANIEL
Published: March 2003

Laškarin G, Tokmadžić VS, Štrbo N, Bogović T, Szekeres‐Bartho J, Randić L, Podack ER, Rukavina D. Progesterone induced blocking factor (PIBF) mediates progesterone induced suppression of decidual lymphocyte cytotoxicity. AJRI 2002; 48:201–209 © Blackwell Munksgaard, 2002

PROBLEM:  Progesterone induced blocking factor (PIBF) is a mediator of progesterone that blocks peripheral blood lytic natural killer (NK) activity. Progesterone or PIBF stimulated decidual macrophages block up‐regulation of perforin expression in decidual lymphocytes (DL). Therefore, we investigated whether progesterone regulates cytotoxicity of DL.

METHOD OD STUDY:  Decidual mononuclear cells were cultured with progesterone, PIBF, progesterone and anti‐PIBF antibody or in the medium only. Cytolytic activity of non‐adherent DL was measured by PKH‐26 (red) 2 hr cytolytic assay and flow cytometry. Perforin positive DL were detected by immunofluorescency and PIBF‐positive cells by immunohistology.

RESULTS:  Progesterone and PIBF, in a dose‐dependent manner decreased cytotoxicity of DL against K‐562 targets, and perforin egzocytosys was blocked. Anti‐PIBF antibodies reversed the progesterone mediated reduction in cytolytic activity of DL. PIBF positive cells were found in first trimester pregnancy decidua.

CONCLUSION:  The results indicate possible role for PIBF, as a mediator of progesterone in regulation of DL cytolytic activity at the maternal–foetal (M–F) interface.
Changes in the Number of Polymorphonuclear Leukocytes and Concentrations of IL‐8 and Granulocyte Elastase in the Vaginas of Normal Pregnant Women
Authors: YAMADA TETSUO , MINAKAMI HISANORI , MATSUBARA SHIGEKI , KOHMURA YASUHIRO , AOYA TOSHIO , SATO IKUO
Published: March 2003

PROBLEM: It is unknown whether the number of vaginal polymorphonuclear leukocytes (vPMNs) of healthy pregnant women changes during pregnancy.

METHOD OF STUDY: We studied 23 women after 14.7 ± 3.6 weeks, 37 women after 25.2 ± 3.1 weeks, and 26 women after 32.9 ± 2.0 weeks of gestation. Numbers of total vPMNs, viable vPMNs, dead vPMNs, percentage viability of vPMNs, and concentrations of IL‐8 and elastase activity were determined in vaginal washings.

RESULTS: The vPMNs, including viable and dead vPMNs, significantly increased with advancing gestation from 9.9 ± 8.6 × 105 to 13.1 ± 13.4 × 105, and to 27.1 ± 26.6 × 105 (r=0.315, P < 0.01). Vaginal IL‐8 significantly increased with advancing gestation. However, increases in vaginal elastase activity did not occur.

CONCLUSIONS: These results suggested that an increase in vPMNs is an early event, and that the increase in vaginal elastase activity is a late event in relation to the ripening of the uterine cervix.
Expression of Pro‐inflammatory Cytokines in Mouse Blastocysts During Implantation: Modulation by Steroid Hormones
Authors: BASAK SAYANTANI , DUBANCHET SYLVIE , ZOURBAS SANDRINE , CHAOUAT GÉRARD , DAS CHANDANA
Published: March 2003

PROBLEM: Expression and hormonal regulation of pro‐inflammatory cytokines and their role in blastocyst activation and implantation is poorly known. The present study is aimed at analysing the expression and hormonal modulation of two pro‐inflammatory cytokines [interleukin‐1α (IL‐1α) and IL‐6] in mouse blastocysts during implantation.

METHOD OF STUDY: Blastocyst–uterine interactions are inhibited by progesterone during implantation and subsequent treatment with oestrogen triggers events that allow implantation to begin. Using this delayed implantation mouse model, dormant and activated blastocysts were recovered from mice treated with progesterone alone and progesterone plus oestrogen therapy, respectively. Expression of IL‐1α and IL‐6 messenger RNA (mRNA) was analysed in normal, dormant and activated blastocysts by in situ hybridization using specific labelled sense and antisense RNA probes, and the protein expression of the same was analysed by immunocytochemistry.

RESULTS: In situ hybridization revealed IL‐1α and IL‐6 mRNA localization in normal, dormant and activated blastocysts and a differential expression was observed in relation to the exposure to progesterone and oestrogen. There was less expression in the dormant blastocysts as compared with the normal and activated ones, and the pattern was similar for both cytokines. Immunocytochemistry also revealed a similar pattern of protein expression to that of the mRNA expression for both the cytokines.

CONCLUSIONS: Using a delayed implantation model, we show that mouse blastocysts express both IL‐1α and IL‐6 mRNA as well as their respective proteins. Both mRNA and the protein levels of IL‐1α and IL‐6 seem to be hormonally modulated in mouse blastocysts during implantation.
Demonstration of the Presence of IL‐16, IL‐17 and IL‐18 at the Murine Fetomaternal Interface during Murine Pregnancy
Authors: Ostojic S. , Dubanchet S. , Chaouat G. , Abdelkarim M. , Truyens C. , Capron F.
Published: March 2003

PROBLEM:  To determine if interleukin‐16 (IL‐16), IL‐17, and IL‐18 are present at the murine fetomaternal interface during pregnancy as a first step towards investigating their roles in fetomaternal relationship.

METHODS:  Expression of IL‐16, IL‐17, and IL‐18, was assessed by immunohistochemistry (IHC) in the BALB/c × BALB/k (H2d × H2k), and the CBA/J × BALB/c non‐abortion prone, and CBA/J × DBA/2 abortion prone matings. Enzyme‐linked immunosorbent assay (ELISA) were performed for the two latter cytokines to compare local production in the abortion prone CBA/J × DBA/2 versus the non‐abortion prone CBA/J × BALB/c matings.

RESULTS:  Expression of IL‐17 was borderline. The anti‐IL‐16 staining specifically localized in the uterine stroma and glandular epithelium and was rather low in the placenta. IL‐18 staining started in the peri‐implantation uterus in the basal proliferative stroma, and was also traced, although weaker, in the glandular epithelium. In the immediate post‐implantation period, a weak stromal staining persisted but there was a strong labeling of the ectoplacental cone. Interestingly, when the ectoplacental cone differentiates into placenta having a major histocompatibility complex (MHC) class I+ spongiotrophoblast and a (MHC class I–) labyrinth, a very strong transient labeling of uterine natural killer (u‐NK) cells was found. Later in gestation, IL‐18 was also produced by giant cell and spongiotrophoblast. Finally, we compared by ELISA the production of IL‐17/‐18 in CBA/J × DBA/2 and CBA/J × BALB/c matings. We detected significantly more IL‐18 in the non‐abortion prone combination decidua or placenta.

CONCLUSION:  The three cytokines IL‐16, IL‐17, and IL‐18 were detected at the fetomaternal interface with a tissue specific, stage‐dependent distribution. The predominance of IL‐18 secretion in the non‐resorption prone matings lead us to question the general validity of the classical T‐helper (Th)1/2 paradigm.
Increased Pregnancy‐Associated Plasma Protein‐A (PAPP‐A) Concentrations in Peritoneal Fluid of Women with Endometriosis
Authors: Arici Aydin , Matalliotakis Ioannis , Goumenou Anastasia , Koumantakis Georgios , Fragouli Yvoni , Mahutte Neal G.
Published: March 2003

PROBLEM:  Pregnancy‐associated plasma protein‐A (PAPP‐A) belongs to a group of glycoproteins isolated from extracts of human placenta. Healthy ovarian and uterine tissues are also known to express PAPP‐A. We hypothesized that PAPP‐A levels might also be elevated in the peritoneal fluid (PF) of women with endometriosis, and examined variations in PF PAPP‐A during the menstrual cycle and with the severity of the disease.

METHOD OF STUDY:  PF PAPP‐A were measured in 60 women with endometriosis and 38 women without endometriosis using a high‐sensitivity immunofluorometric assay.

RESULTS:  We found that the mean level of PAPP‐A was higher in PF from patients with endometriosis than controls (p = 0.003). Furthermore, significant correlation was found between the stages of endometriosis and the levels of PAPP‐A in these patients (r = 0.39, p = 0.009). The concentrations of PAPP‐A in PF were significantly higher in the secretory phase than the proliferative phase of the menstrual cycle in both women with and without endometriosis (p = 0.009 and P = 0.002, respectively). Finally, among the controls, women undergoing tubal ligation had significantly lower mean PF levels of PAPP‐A than women with infertility or pelvic pain (p = 0.001).

CONCLUSION:  We conclude that PF levels of PAPP‐A vary during the menstrual cycle, and are highest in the secretory phase. We also find that PF PAPP‐A levels are significantly increased in women with endometriosis, and that the degree of elevation corresponds to the extent of disease.
Leakage along warm gutta‐percha fillings in the apical canals of curved roots
Authors: Fan B. , Wu M‐K. , Wesselink P. R.
Published: March 2003

Abstract – The aim of this study was to investigate the leakage along the apical portion of warm gutta‐percha obturated curved canals. Human mandibular premolars with single, curved (21°–40°) canals were prepared using the Lightspeed technique. Two groups of prepared canals, matched according to curvature and prevalence of apical transportation, were obturated by two techniques. Coronal gutta‐percha was removed immediately after root obturation was completed to simulate the procedure for post space preparation. Leakage along the apical 3 mm of root filling was measured with a fluid transport device. Vertical condensation of warm gutta‐percha and Pulp Canal Sealer provided less leakage than Thermafil plastic obturators and AH26 sealer (P=0.002).
A multidisciplinary treatment approach to a complicated maxillary dental trauma: a case report
Authors: Leroy R. L. R. G. , Aps J. K. M. , Raes F. M. , Martens L. C. , De Boever J. A.
Published: March 2003

Abstract – This case report describes the treatment of an 18‐year‐old male who lost two central maxillary incisors due to dental trauma. Because of a deep overbite and serious occlusal instability, the lost teeth 11 and 21 could not be replaced by a conventional fixed prosthesis. The vertical dimension of occlusion was increased using a Hawley‐type appliance over a period of 1 year. When sufficient intermaxillary space was gained the alveolar ridge was augmented with a mandibular symphysis graft. Nine months later two one‐stage non‐submerged implants (ITI, Straumann, Waldenburg, Switzerland) were inserted. After further soft tissue adaptation to two temporary acrylic crowns, porcelain veneers were placed on the two implants and the lateral incisors.
The influence of interfacial forces and duration of filing on root canal shaping
Authors: Gulabivala K. , Abdo S. , Sherriff M. , Regan J. D.
Published: March 2003

Abstract – The aim of this study was to investigate the possible relationship between interfacial forces, duration of instrumentation and effectiveness of root canal shaping by filing. All factors were standardised except the manner of manipulation of the files and the dependent variables (interfacial force and duration of filing). The outcome measured was the final prepared canal shape. The study tested the hypothesis that if interfacial forces and duration of filing had predictive value for effective canal shaping, a relationship between them should be apparent. If it was not, it could be inferred that the remaining uncontrollable variable, “manner of file manipulation” had a dominating influence. 18 operators used a standard filing technique to instrument a root canal each in single rooted teeth matched for anatomy. The teeth were mounted in a custom‐made transducer designed to measure laterally applied interfacial forces between file and dentine. The length of time taken with each instrument in the series was measured giving a total duration of instrumentation. The final canal shape measured by standardised “before” and “after” radiographic images of the roots was judged against an “ideal” canal shape calculated from the size of instruments used and based on the preliminary canal shape. Although some trends were revealed, no obvious relationship was demonstrated between interfacial force, duration of filing and final canal shape. Operators clearly used a range of interfacial forces characteristic for each individual and for the different file sizes. Both light and heavy forces could produce a satisfactory canal shape. Use of light or heavy forces did not obviously affect speed of preparation. Tactile discrimination was not dependent on use of light or heavy forces. It was inferred that the “manner of file manipulation” remained undefined and was probably the dominant factor influencing outcome of canal shaping.
Calcium hydroxide retention in wide root canals with flaring apices
Authors: Metzger Z. , Solomonov M. , Mass E.
Published: March 2003

Abstract – Calcium hydroxide (CH) is used to induce apexification in immature, pulpless teeth with wide root canals and flaring apices. Three placement methods of CH were compared in vitro, for their ability to enhance CH retention in the canal. Barium sulfate (BS), added as radiopacifier, was studied for its effects on the radiographic follow up of CH retention, as well as on the ability to detect voids in the CH. Calcium hydroxide filled teeth were kept in phosphate buffered saline‐containing tubes in a shaker water bath. Radiographs were taken weekly to follow the retention or loss of the material; they were scanned and stored as digitized images. Quantitative evaluations were done on these images, using a computerized gray scale. Condensed CH was better retained in root canals than either lentulo‐placed paste or commercial injected paste. Barium sulfate in the CH paste enabled better detection of voids in the paste filling the canal, however, it obscured the disappearance of CH from the canal, due to a residual radiopacity effect. The results supported (a) condensation of calcium hydroxide as a preferred method that improves its retention in wide root canals, and (b) discontinuing the use of barium sulfate as a radiopacifier in apexification procedures.
A retrospective study of dento‐alveolar injuries of children in Ankara, Turkey
Authors: Altay Nil , Güngör H. Cem
Published: March 2003

Abstract – Information concerning age and sex distribution, etiology, types, place and extent of trauma as well as seasonal variations, time difference between traumatic injury and seeking of dental care and number of traumatic injuries was recorded retrospectively from 150 patients. The study comprised 91 boys and 59 girls representing 246 dental injuries and 332 injured teeth (72 primary and 260 permanent teeth). The most common injuries were uncomplicated crown fracture (23.57%), subluxation (15.85%), avulsion (10.16%), lateral luxation (9.75%), complicated crown fracture and intrusion (8.4% and 8.94%, respectively). The occurrence of uncomplicated crown fractures was significantly higher (P<0.05) in the 10–12 years age group than other age groups. Lateral luxation and intrusion were significantly higher in the 1–6 and 7–9 years age groups (P<0.05, respectively).
Oral trauma in Brazilian patients aged 0–3 years
Authors: Cunha Robson Frederico , Pugliesi Daniela Maria Carvalho , De Mello Vieira Ana Elisa
Published: March 2003

Abstract – The aim of the present investigation was to gather data pertaining to dental trauma in 1654 patients aged 0–3 years, attended at the Baby Clinic of the School of Dentistry at Araçatuba – UNESP, Brazil. The prevalence of traumatic injuries was 16.3%. There was greater involvement of boys (62.6%), of children aged 1–2 years (39.9%) and of the maxillary central incisors (86%). Falls were more often the etiology for dental injuries (58.3%). There was a predominance of uncomplicated crown fractures (48.4%).
A case report of reattachment of fractured root fragment and resin‐composite reinforcement in a compromised endodontically treated root
Authors: Lui Joo Loon
Published: March 2003

Abstract – The composite reinforcement technique has been used clinically to salvage damaged root‐filled teeth compromised by caries, trauma, developmental abnormalities, internal resorption and iatrogenic causes. This clinical case report describes the use of the technique to reattach a fractured fragment in a compromised endodontically treated root besides reinforcing it for continued function in the mouth. Factors of clinical importance related to this additional application; including reattachment of tooth fragments, post crown retention, coronal microleakage and fracture resistance and strength, are also briefly discussed.
Traumatized Primary Teeth in Children Assisted at the Federal University of Santa Catarina, Brazil
Authors: Cardoso Mariane , De Carvalho Rocha Maria José
Published: March 2003

Abstract  – The goal of the present study was to identify the factors related to the occurrence of dental trauma in deciduous teeth. Over a period of 25 months, 85 children between 10 months and 6 years of age were assisted by the staff of the Pediatric Dentistry Clinic of the Federal University of Santa Catarina (UFSC) Florianópolis, Brazil. The children, all assisted by only one professional, a dentist working as a trainee in the Pediatric Dentistry Clinic, had 157 traumatized teeth treated. The occurrence of trauma was higher in male patients (51.8%) and in children between 1 and 3 years old. The average age was about

 = 2.7 years. The 54.1% of the assisted children had more than one traumatized tooth and the repeat trauma occurred 16.7% of the time. Anterior teeth represented 98.7% of the cases and 76.4% of the trauma were on the maxillary central incisor teeth. Both sides of the mouth had approximately the same number of traumatic injuries. Luxations were more frequent (85.4%) than fractures (14.6%). Subluxations represented 38.8% of the luxated teeth. Falls were the main cause of trauma (78%). A percentage of 41.9 children were assisted by a dental professional during the first 24 h after the incident. The study concluded that the deciduous dentition is mostly affected by luxations (subluxations) that occur specially on the maxillary central incisor teeth, in patients between 1 and 3 years of age. Falls are the most common etiological factor and more than one traumatized tooth is common. Some of the cases were repeat traumatic injuries.
Treatment of replacement resorption with Emdogain® − a prospective clinical study
Authors: Filippi Andreas , Pohl Yango , Von Arx Thomas
Published: March 2003

Abstract –

The present clinical study investigated the outcome of intentional replantation using Emdogain for periodontal healing following trauma‐related ankylosis. Sixteen ankylosed teeth affected by replacement resorption were treated as follows: After tooth extraction, the root canal was obturated with a retrograde titanium post. Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. The mean follow‐up period was 15 months (range 4–24 months). Eleven teeth showed no signs of recurrence of ankylosis: they were in full function and exhibited no pathological clinical findings. Four severely traumatized teeth demonstrated a recurrence of ankylosis after a mean period of 6 months, one tooth was lost in a second accident after 7 months. The estimated probability of 1 year without recurrence of ankylosis was P = 0.66 (95% confidence interval [0.40; 0.94]). The mean survival time was 10.2 months (SD 1.1). The results indicate that treatment of replacement resorption following light to moderate trauma with replantation and Emdogain appears to prevent or delay recurrence of ankylosis in many cases.
Reinforcing effect of a resin glass ionomer in the restoration of immature roots in vitro
Authors: Goldberg Fernando , Kaplan Andrea , Roitman Marcela , Manfré Susana , Picca Mariana
Published: March 2003

Abstract  – Fifty‐six extracted maxillary central incisors were used for this study. The crown of each tooth was removed in order to obtain a standard length of 13 mm. Root canals were enlarged to simulate immature teeth after apexification. The apical 2 mm of the root canal was obturated with gutta‐percha and AH26 sealer. The specimens were divided into two groups. Group A was unrestored and served as positive control. In group B, the canal walls were reinforced with a resin modified glass ionomer using a translucent curing post. All teeth were subjected to compressive force using an Instron testing machine until fracture occurred. Group B showed an increased resistance to fracture (456.02 ± 172.47 N) compared with group A (263.46 ± 98.00 N). The difference between groups was statistically significant (P < 0.005).
Clinical response to experimental forces and non‐surgical therapy of teeth with various alveolar bone loss
Authors: Canakci Varol , Orbak Recep , Tezel Adnan , Canakci Cenk Fatib
Published: March 2003

Abstract –  Firm lateral force is necessary for the thorough removal of calculus during scaling and root planning (SRP) with hand instruments. However, this firm lateral force should be applied to root surfaces without considering the tooth's loss of supporting tissues. The purpose of the present study was two‐fold: firstly, to evaluate the initial pain response of periodontally diseased non‐molar teeth with two different levels of alveolar bone loss (ABL) to experimental lateral and vertical pull forces; and secondly, to examine the clinical response of these teeth to non‐surgical therapy. Twenty patients with chronic periodontitis were specifically selected in two groups according to the level of ABL at non‐molar teeth. Group I consisted of 10 patients who have 141 non‐molar teeth with a radiographic evidence of 40–65% ABL. Group II consisted of 10 patients who have 132 non‐molar teeth with a radiographic evidence of ≥70% ABL. All patients were systemically healthy, free of pain, and reported no current medication usage. Starting from 0 and gradually increasing an experimental lateral force with digital force gauge, and also an experimental vertical pull force with mechanical force gauge were applied to each tooth and measured. As a result of a single experimental force applied to each non‐molar tooth, the initial pain response emerged in the patients was determined by means of electronic bell system used by patients themselves. Each patient was treated with SRP using specific hand instruments under local anesthesia. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and periotest values (PV scores) were compared in both groups at initial and at month 3. A mean experimental lateral force of 24.6 N and a mean experimental vertical pull force of 48.3 N caused initial pain response in group I. Initial pain response occurred with a mean experimental lateral force of 5.3 N and a mean experimental vertical pull force of 19.4 N in group II. Only group I showed statistically significant decrease in PI, GI, PD and a significant attachment gain at month 3 (P < 0.05). There was a decrease of 6 PV in group I at month 3 (P < 0.05), whereas an increase of 4 PV was observed in group II (P > 0.05). This study showed that lateral and vertical forces required for effective SRP do not cause any problem in the group with 40–65% ABL. However, they may cause trauma in the group with ∼70% ABL. Thus, the results suggest that the degree of healing would be different in the group with ≥70% ABL and in the group with 40–65% ABL.
Long‐term results of the application of solvent‐dehydrated bone xenograft and duramater xenograft for the healing of oroantral osseous defects: a pilot experimental study
Authors: Çetiner Sedat , Esen Emin , Üstün Yakup , Öztunç Haluk , Tuncer İlhan
Published: March 2003

Abstract –  The aim of this study was to investigate the long‐term effects of the use of human cadaveric solvent‐dehydrated bone graft and duramater as a barrier membrane for the treatment of oroantral communication. Standard oroantral osseous defects were created in five minipigs. Subjects received cancellous bone graft in the form of block or microchips, duramater or a combination of bone and membrane. Uneventful healing was achieved in all of the subjects, clinically including the control site which did not receive any material. The operated bone segments were evaluated both by radiological and histological examinations after 6 months. Radiological evaluation was carried out using bone density analysis software and histological evaluation made by light microscopy. Radiological and histological results revealed that bone grafting of oroantral osseous defects improved the bone quality. However, application of duramater did not change this activity, both alone or combined with bone grafts. Within the limits of this experimental study, although solvent‐dehydrated bone grafts were found superior and could be applied for the healing of osseous oroantral defects, resorbable membranes did not contribute to this process.
Methods for detecting coronary disease: epidemiology and clinical management
Authors: Faergeman O.
Published: March 2003

The epidemic of atherosclerotic disease in wealthy countries had probably begun by 1900. Although a few physicians understood how atherosclerosis/thrombosis of the coronary arteries caused angina pectoris and myocardial infarction, the medical community did not accept that relationship until the 1920s. In wealthy countries, the epidemic peaked in mid‐century, and it is now advancing in poor countries and in countries becoming affluent. Two recent developments in methods for disease detection, however, will profoundly affect not only our understanding of the epidemic of atherosclerotic disease, but also our management of patients. A redefinition of the clinical diagnosis of myocardial infarction, a well‐used but imperfect measure of the epidemic, was published in September 2000. Criteria employed for about 50 years have now been replaced by criteria based on sensitive biochemical markers of necrosis of as little as 1 g of myocardium, accompanied by chest discomfort or electrocardiographic (ECG) changes, or following coronary artery intervention. The new criteria, adopted by the major societies of cardiology in Europe and the United States, is likely to increase the apparent incidence and prevalence of coronary heart disease (CHD). In the beginning of the twentieth century, diagnosis of CHD required an autopsy. In the end it was carried out by angiography as well, but it could not be applied to large proportions of the population. That has now been changed by new, non‐invasive methods of computer tomography (CT) and magnetic resonance imaging (MRI), and patients, however, asymptomatic, will expect treatment for a disease that physicians have detected. Coronary artery disease (CAD) will be to CHD what occult cancer is to cancer.
Efficacy of ropivacaine compared with ropivacaine  plus sufentanil for postoperative analgesia after  major knee surgery
Authors: Lorenzini C. , Moreira L. B. , Ferreira M. B. C.
Published: March 2003

SummaryThis study compared the analgesic efficacy of an epidural infusion of ropivacaine and ropivacaine with sufentanil following major knee surgery. In a double‐blind clinical trial, 115 adult patients received either epidural ropivacaine (R group, 2 mg.ml−1), or ropivacaine (2 mg.ml−1) with sufentanil (RS group, 1 µg.ml−1), using a patient‐controlled epidural analgesia technique. Pain scores (visual analogue scale, VAS, and the simple descriptive scale, SDS), side‐effects, motor block and treatment quality were recorded at 6, 12 and 24 h after the insertion of the epidural catheter. In the RS group, analgesic efficacy was significantly greater than in the R group between 12 and 24 h following insertion of the epidural catheter (VAS: 92.9% vs. 72.9%, p = 0.009). There was no significant difference during the other periods. Pruritus, nausea and vomiting were significantly more frequent in the RS group. Good postoperative analgesia was obtained with an epidural infusion of ropivacaine (2 mg.ml−1). When this local anaesthetic was administered with sufentanil, there was an improvement in the analgesic effect but a significant increase in the number of patients who reported adverse effects. The differences were more pronounced 12 h after the beginning of the analgesic schedule. This study failed to demonstrate any worthwhile clinical benefit from the addition of sufentanil.
Surface immunoglobulin on B lymphocytes as a potential target for specific peptide ligands in chronic lymphocytic leukaemia
Authors: Buhl L. , Szecsi P. B. , Gisselø G. G. , Schafer‐Nielsen C.
Published: March 2003

Summary.  With the aim of producing unique targets for malignant cells we have identified peptide ligands for the clonal surface immunoglobulin isolated from the B cells of a chronic lymphocytic leukaemia (CLL) patient. The peptides were identified from random‐peptide phage‐display libraries. The obtained ligands bound specifically to the surface of the target lymphocytes as well as to clonal immunoglobulin in lysate from the same cells. Peptide‐based antigen mimotopes may have a future use in targeted therapy of CLL and other B‐cell‐derived malignancies displaying surface immunoglobulin.
P‐glycoprotein, lung resistance‐related protein and multidrug resistance‐associated protein in de novo adult acute lymphoblastic leukaemia
Authors: Damiani Daniela , Michelutti Angela , Michieli Mariagrazia , Masolini Paola , Stocchi Raffaella , Geromin Antonella , Ermacora Anna , Russo Domenico , Fanin Renato , Baccarani Michele
Published: March 2003

Summary.  P‐glycoprotein (P‐gp), lung resistance‐related protein (LRP) and multidrug resistance‐associated protein (MRP) expression, and blast cell intracellular daunorubicin accumulation (IDA) were evaluated in 95 previously untreated cases of adult acute lymphoblastic leukaemia (ALL) using flow cytometry. Forty‐five out of 95 (47%) patients were P‐gp positive (+), 12/66 (18%) were LRP+ and 11/66 (17%) were MRP+. Eighteen out of 66 (28%) patients showed a simultaneous multidrug resistance (MDR)‐related protein expression higher than controls for more than one protein, while 24/66 (36%) cases did not overexpress any protein. Twenty‐one out of 24 (87%) cases overexpressing at least one MDR‐related protein had a defect in accumulating daunorubicin into their blast cells, while only 4/24 (16%) cases who did not overexpress any protein had similar features. The complete remission rates were similar in MDR‐positive and ‐negative (–) patients but relapses within 6 months were more frequent in P‐gp+ cases, and therefore the disease‐free survival duration was shorter in P‐gp+ than in P‐gp– patients (P = 0·01). The number of MRP+ and/or LRP+ cases was too small to be able to draw any conclusion on their role in affecting or predicting therapy outcome. In conclusion, P‐gp overexpression associated with a defect in daunorubicin accumulation is a frequent feature in adult ALL at onset and seems to be related to poorer therapy outcome and, consequently, a shorter disease‐free survival. LRP and MRP overexpression seems to be a rare event and no conclusion can be drawn on its prognostic role.
Interleukin 10 abolishes the growth inhibitory effects of all‐trans retinoic acid on human myeloma cells
Authors: Otsuki Takemi , Yata Kenichiro , Sakaguchi Haruko , Kurebayashi Junichi , Matsuo Yoshinobu , Uno Masako , Fujii Tomohiro , Eda Sakura , Isozaki Yumika , Yawata Yoshihito , Yamada Osamu , Wada Hideho , Sugihara Takashi , Ueki Ayako
Published: March 2003

Summary. Recently, it was disclosed that all‐trans retinoic acid (ATRA) inhibits myeloma cell growth by downregulating the interleukin 6 (IL‐6)/IL‐6 receptor (IL‐6R) auto/paracrine loop, and upregulating p21/Cip1 cyclin‐dependent kinase inhibitor (CDK‐I), thereby inducing apoptosis with a decrease in Bcl‐2 protein expression. To elucidate and generalize the effects of ATRA on the proliferation and cellular biology of myeloma cells, 12 human myeloma cell lines established in our laboratory were utilized. Two out of the 12 lines showed enhanced growth on supplementation of ATRA and were characterized by IL‐10 production, downregulation of membrane Fas and reduced upregulation of p21/Cip1 CDK‐I message. These characteristics may prove important for the clinical use of ATRA and should be considered before starting ATRA therapy for myeloma.
Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice
Authors: Nordin P , Bartelmess P , Jansson C , Svensson C , Edlund G
Published: March 2003

Background

The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres.

Methods

Three hundred patients with primary inguinal hernia were randomized to either a Shouldice repair or to a tension-free Lichtenstein repair. In a pretrial training programme the five participating general surgeons were taught to perform the two techniques in a standard manner. Follow-up was performed after 8 weeks, 1 year and 3 years. The last examination was performed by an independent blinded assessor.

Results

There was a significant difference in operating time in favour of the Lichtenstein technique. After a follow-up of 36–77 months seven recurrences were found in the Shouldice group (95 per cent confidence interval (c.i.) 1·3 to 8·1) and one in the mesh group (95 per cent c.i. 0·0 to 2·0). Chronic groin pain was reported by 4·2 and 5·6 per cent in the Shouldice and Lichtenstein groups respectively. It was characterized as mild or moderate in all except two patients who had the Shouldice operation.

Conclusion

Lichtenstein hernia repair was easier to learn, took less time and resulted in fewer recurrences. It was possible to achieve excellent results with this technique in a general surgical unit.
Liver fibrosis increases the risk of intrahepatic recurrence after hepatectomy for hepatocellular carcinoma
Authors: Ko S , Kanehiro H , Hisanaga M , Nagao M , Ikeda N , Nakajima Y
Published: March 2003

Background

Hepatocellular carcinoma (HCC) commonly develops in patients with chronic hepatitis. Intrahepatic recurrence after hepatectomy often includes nodules of new tumour in the liver remnant. The aim of this study was to examine hepatitis-related factors that might predict this type of recurrence.

Methods

The influence of various hepatitis-related factors on intrahepatic recurrence of HCC was studied by multivariate analysis in 138 patients who underwent curative resection and were followed for more than 2 years.

Results

The Cox proportional hazard model showed that histological evidence of fibrosis of the underlying liver was the most significant predictive factor for intrahepatic recurrence (P = 0·001). Serum albumin level was also significantly associated with recurrence (P = 0·038). The relative risks of histological fibrosis and low serum albumin levels were 8·9 and 1·7 respectively. Among tumour-related factors, only tumour size was significantly associated with recurrence (P = 0·017). Major hepatectomy was also an independent risk factor for intrahepatic recurrence (P = 0·004).

Conclusion

Histological evidence of fibrosis and low serum albumin levels are useful predictors of intrahepatic recurrence after hepatectomy, presumably owing to metachronous multifocal tumour in the liver remnant.