Basic Laboratory Studies Research Articles

2539 Case of a Young Man With Small Bowel Obstruction After Trauma

INTRODUCTION: In few reports, trauma has been associated with small bowel obstruction. These cases typically happen in children; however, in adults this is a rare phenomenon. We present a case in a young male with a history of MVA 5 years prior, who presented for small bowel obstruction related to his prior trauma. CASE DESCRIPTION/METHODS: A 27 yo male presented with recurrent abdominal pain for six months. He had intermittent diarrhea, abdominal bloating, and a 15 lb weight loss over that time. Physical examination was normal. Basic laboratory studies were significant for T bili of 1.4 mg/dl (normal 0.1 - 1.0). Diagnostic EGD, colonoscopy, and CT scan of the abdomen/pelvis were normal. Due to concern for a potential diagnosis of small bowel Crohn's disease, a video capsule study was performed, which showed a hold-up in the mid small bowel for over 2 hours, without any other abnormalities. Due to this, an upper double balloon enteroscopy was performed, which was revealing for a stenosis in the distal jejunum. The stenosis was marked with submucosal india ink injection. Biopsies of the stenosis were unrevealing. Previous medical history was negative with the exception of a motor vehicle accident complicated by intra-peritoneal bleeding five years ago, which was managed conservatively without surgery. Review of this patient's medications was negative for any NSAID use. He had no history of radiation exposure or abdominal surgery. He had never experienced any symptoms of abdominal pain or bloating prior to the onset of symptoms 6 months ago. Family history is negative for celiac disease or inflammatory bowel disease. Surgical resection of the stenotic segment was performed. The patient recovered from surgery without complication. Histopathology from the resected segment was consistent with benign small bowel without inflammation or other pathologic features. The conclusion of the medical providers was that this patient developed a symptomatic stricture as the result of previous MVA with hematoma. DISCUSSION: Small bowel obstruction from trauma has been highlighted in few cases in children; however, trauma-causing small bowel obstruction (SBO) in adults is more rare. Throughout the cases we reviewed, the timeline of this trauma causing SBO ranged from thirteen weeks to eight years after the initial event.2,3,4 In this case, the man presented five years after his MVA with symptoms of bowel obstruction, with a prior hematoma being the cause of this obstruction. This case highlights MVA as a cause of SBO in adults.

Cell therapy in orthopaedics: where are we in 2019?

Stem cells are defined by their potential for self-renewal and the ability to differentiate into numerous cell types, including cartilage and bone cells. Although basic laboratory studies demonstrate that cell therapies have strong potential for improvement in tissue healing and regeneration, there is little evidence in the scientific literature for many of the available cell formulations that are currently offered to patients. Numerous commercial entities and 'regenerative medicine centres' have aggressively marketed unproven cell therapies for a wide range of medical conditions, leading to sometimes indiscriminate use of these treatments, which has added to the confusion and unpredictable outcomes. The significant variability and heterogeneity in cell formulations between different individuals makes it difficult to draw conclusions about efficacy. The 'minimally manipulated' preparations derived from bone marrow and adipose tissue that are currently used differ substantially from cells that are processed and prepared under defined laboratory protocols. The term 'stem cells' should be reserved for laboratory-purified, culture-expanded cells. The number of cells in uncultured preparations that meet these defined criteria is estimated to be approximately one in 10 000 to 20 000 (0.005% to 0.01%) in native bone marrow and 1 in 2000 in adipose tissue. It is clear that more refined definitions of stem cells are required, as the lumping together of widely diverse progenitor cell types under the umbrella term 'mesenchymal stem cells' has created confusion among scientists, clinicians, regulators, and our patients. Validated methods need to be developed to measure and characterize the 'critical quality attributes' and biological activity of a specific cell formulation. It is certain that 'one size does not fit all' - different cell formulations, dosing schedules, and culturing parameters will likely be required based on the tissue being treated and the desired biological target. As an alternative to the use of exogenous cells, in the future we may be able to stimulate the intrinsic vascular stem cell niche that is known to exist in many tissues. The tremendous potential of cell therapy will only be realized with further basic, translational, and clinical research. Cite this article: Bone Joint J 2019;101-B:361-364.

Pluripotent stem cell differentiation reveals distinct developmental pathways regulating lung- versus thyroid-lineage specification

The in vitro-directed differentiation of pluripotent stem cells (PSCs) through stimulation of developmental signaling pathways can generate mature somatic cell types for basic laboratory studies or regenerative therapies. However, there has been significant uncertainty regarding a method to separately derive lung versus thyroid epithelial lineages, as these two cell types each originate from Nkx2-1+ foregut progenitors and the minimal pathways claimed to regulate their distinct lineage specification in vivo or in vitro have varied in previous reports. Here, we employ PSCs to identify the key minimal signaling pathways (Wnt+BMP versus BMP+FGF) that regulate distinct lung- versus thyroid-lineage specification, respectively, from foregut endoderm. In contrast to most previous reports, these minimal pathways appear to be evolutionarily conserved between mice and humans, and FGF signaling, although required for thyroid specification, unexpectedly appears to be dispensable for lung specification. Once specified, distinct Nkx2-1+ lung or thyroid progenitor pools can now be independently derived for functional 3D culture maturation, basic developmental studies or future regenerative therapies.

PRIMARY ALDOSTERONISM IN YOUNG PATIENT WITH RECURRENT RESISTANT HYPERTENSION AFTER SOLITARY ADRENAL ADENOMA SURGICAL RESECTION

Objective: the diagnostic workup of resistant hypertension in young patients the therapeutic approach of patients with primary aldosteronism due to adrenal adenoma and contra-lateral adrenal hyperplasia the diagnostic workup and reevaluation of aldosteronism recurrence after initial surgical treatment the correlation between recurrent resistant hypertension and primary aldosteronism recurrence. Design and method: A 34-year-old male was referred to our specialized department for second-degree arterial hypertension (mean readings 170/110 mmHg). The physical examination was normal, except his 31 kg/m2 Body Mass Index. The ECG and cardiac ultrasound had normal findings. Basic laboratory studies were in physiological range. Secondary hypertension diagnostic workup was decided and initial treatment with two neutral antihypertensive agents. Specific hormonal profile revealed a plasma aldosterone(PA) level of 237.9 pg/ml and a plasma renin activity(PRA) of 0,23ng/ml/h, resulting in a pathological plasma aldosterone/plasma renin activity(PA/PRA) ratio. The saline suppression test revealed a plasma renin activity of 0.02 ng/ml/h and a high plasma aldosterone level of 20,29 pg/ml. The serum levels of dehydroepiandrosterone sulfate, adrenocorticotropin, and cortisol were normal. The suprarenal magnetic resonance imaging illustrated a 46,3 × 31 mm left adrenal adenoma and contralateral adrenal hyperplasia. A surgical intervention was performed with adrenal adenoma enucleation.Results: Postoperatively, the patient remained normotensive for about 14 months. He presented thereafter with a recurrence of resistant hypertension. New basic and hormonal laboratory studies revealed plasma renin activity levels of 0,4 ng/ml/h and plasma aldosterone levels of 381 pg/ml. After saline suppression test, plasma aldosterone levels remained high (163pg/ml). The magnetic resonance imaging illustrated a small left adrenal adenoma of 11 mm and constant right adrenal hyperplasia. The patient was initially treated with 200 mg eplerenone/ day with subsequently dose adjustment to 100 mg/day resulting in mean blood pressure readings of 135/90mmHg and no concurrent hyperkalemia. Conclusions: Primary hyperaldosteronism remains a challenging diagnosis. Unilateral adrenal hyperplasia is statistically rare, as well as the coexistence of contralateral big size adrenal adenoma. In young patients presenting with adrenal adenomas (especially big sized) and concurrent pathological hormonal profile, the surgical treatment is probably required, without however excluding new hormonal control for secondary hypertension in case of hypertension recurrence.

Preparation and characterization of dummy-template molecularly imprinted polymers as potential sorbents for the recognition of selected polybrominated diphenyl ethers

The main aim of this work was to conduct the preliminary/basic research concerning the preparation process of a new dummy molecularly imprinted polymer (DMIP) materials. Developed DMIPs were proposed as a sorption material in solid-phase extraction (SPE) technique for recognition of selected low mass polybrominated diphenyl ethers (PBDEs) – PBDE-47 and PBDE-99. Four new DMIPs were synthesized employing bulky polymerization technique by application of structural analogue of low mass PBDEs - 4,4′-Dihydroxydiphenyl ether, as a dummy template. The DMIPs and corresponding non-imprinted polymers were prepared using different functional monomers: methacrylic acid; methyl methacrylate and different porogen agents: acetonitrile and tetrahydrofuran. The polymerization reaction was thermally initiated with 1,1′-azobis (cyclohexanecarbonitryle). Ethylene glycol dimethacrylate was applied as a cross-linker. To optimize geometries and to calculate energies of the respective template-monomer complexes, the computational molecular modeling method was employed. The particles morphology and physicochemical characteristics of developed DMIPs and their equivalent NIPs were performed using nitrogen sorption porosimetry, scanning electron microscopy, and Fourier transform infrared spectroscopy. The sorption capacities of prepared DMIPs and corresponding NIPs were studied using standard binding test. The adsorption capability studies give a possibility to assess the imprinting factor (IF) values, which were in the range from 1.1 to 4.0, depending on the DMIP type. The recovery values of PBDE-47 and PBDE-99 from prepared organic solutions were in the range from 43 to 92%, depending on the studied DMIP. Performed basic laboratory studies give a possibility to select the optimal DMIP material which might be applied in the environmental samples preparation process as a potential sorbent for the recognition of low mass PBDEs.

Emergency Physician Risk Estimates and Admission Decisions for Chest Pain: A Web-Based Scenario Study

We conducted this study to better understand how emergency physicians estimate risk and make admission decisions for patients with low-risk chest pain. We created a Web-based survey consisting of 5 chest pain scenarios that included history, physical examination, ECG findings, and basic laboratory studies, including a negative initial troponin-level result. We administered the scenarios in random order to emergency medicine residents and faculty at 11 US emergency medicine residency programs. We randomized respondents to receive questions about 1 of 2 endpoints, acute coronary syndrome or serious complication (death, dysrhythmia, or congestive heart failure within 30 days). For each scenario, the respondent provided a quantitative estimate of the probability of the endpoint, a qualitative estimate of the risk of the endpoint (very low, low, moderate, high, or very high), and an admission decision. Respondents also provided demographic information and completed a 3-item Fear of Malpractice scale. Two hundred eight (65%) of 320 eligible physicians completed the survey, 73% of whom were residents. Ninety-five percent of respondents were wholly consistent (no admitted patient was assigned a lower probability than a discharged patient). For individual scenarios, probability estimates covered at least 4 orders of magnitude; admission rates for scenarios varied from 16% to 99%. The majority of respondents (>72%) had admission thresholds at or below a 1% probability of acute coronary syndrome. Respondents did not fully differentiate the probability of acute coronary syndrome and serious outcome; for each scenario, estimates for the two were quite similar despite a serious outcome being far less likely. Raters used the terms "very low risk" and "low risk" only when their probability estimates were less than 1%. The majority of respondents considered any probability greater than 1% for acute coronary syndrome or serious outcome to be at least moderate risk and warranting admission. Physicians used qualitative terms in ways fundamentally different from how they are used in ordinary conversation, which may lead to miscommunication during shared decisionmaking processes. These data suggest that probability or utility models are inadequate to describe physician decisionmaking for patients with chest pain.

The Intersection of HPV Epidemiology, Genomics and Mechanistic Studies of HPV-Mediated Carcinogenesis.

Of the ~60 human papillomavirus (HPV) genotypes that infect the cervicovaginal epithelium, only 12–13 “high-risk” types are well-established as causing cervical cancer, with HPV16 accounting for over half of all cases worldwide. While HPV16 is the most important carcinogenic type, variants of HPV16 can differ in their carcinogenicity by 10-fold or more in epidemiologic studies. Strong genotype-phenotype associations embedded in the small 8-kb HPV16 genome motivate molecular studies to understand the underlying molecular mechanisms. Understanding the mechanisms of HPV genomic findings is complicated by the linkage of HPV genome variants. A panel of experts in various disciplines gathered on 21 November 2016 to discuss the interdisciplinary science of HPV oncogenesis. Here, we summarize the discussion of the complexity of the viral–host interaction and highlight important next steps for selected applied basic laboratory studies guided by epidemiological genomic findings.

Biomarkers of early kidney cells dysfunction in patients with membranous nephropathy

Introduction/Objective. An unfavorable prognosis of membranous nephropathy (MN) is determined by the presence of persistent proteinuria and extensive tubulointerstitial lesions at initial biopsy. Our study investigated the value of markers of renal cell dysfunction (glomerular filtration rate, urinary excretion of protein, ectoenzyme proximal tubular epithelial cells, and oxidative stress) in patients with MN, and points to the use of these markers in a possible therapeutic modification. Methods. The study included 28 patients with MN and 30 healthy individuals as control. In addition to the basic laboratory studies, enzyme [aminopeptidase N (APN), plasma cell glycoprotein-1 (PC-1), N-acetyl- ?-D-glucosaminidase (NAGA), and dipeptidyl peptidase-4] activity was determined in serum and urine, as well as parameters of oxidative damage [thiobarbituric acid concentration of substance-responders (TBARS), malondialdehyde, and the concentration of the total sulfhydryl (SH) group]. Results. In patients with MN, serum activity of PC-1 and APN and urinary excretion of NAGA were significantly higher than in the control group. Also, significant correlation between daily proteinuria and serum PC-1 activity and urinary excretion of NAGA was found in patients with MN. Serum and urine levels of TBARS as well as total SH group levels were significantly lower in patients with MN than in healthy controls. Conclusion. Kidney damage in MN is accompanied by the release of several tubular enzymes, with potential diagnostic and prognostic significance. The study suggests a possible role of oxidative stress in pathogenesis of MN and the use of antioxidants in preventing impairment as part of future therapy.

A Perforated Peptic Ulcer Contained by the Liver

Perforated peptic ulcers (PPU) are an uncommon, life-threatening disease with a mortality as high as 40%. Patients typically present acutely with chest pain, abdominal pain, and/or peritonitis, however they can also present with complications such as fistulas, abscess formation, or sepsis. We present a case of an elderly woman with an atypical presentation of a perforated gastric ulcer. An 88 year old woman was admitted with increasing fatigue, non-bloody emesis, and melena for 3 days. She denied abdominal pain, weight loss, dysphagia, odynophagia, NSAID or alcohol use. Her medical history was significant for well-controlled hyperparathyroidism and osteoporosis; her only medications included alendronate and cinacalcet. On initial evaluation, her blood pressure was 110/70 mmHg and her heart rate was 75 bpm. Physical examination revealed tarry black stool on rectal exam and a non-tender epigastrium. Basic laboratory studies exposed a Hgb of 6.4g/dl from her baseline of 10 g/dl. Blood chemistries, liver function tests, and coagulation studies were unremarkable. A chest X-ray revealed no free air under the diaphragm. Given for concern of blood loss from a GI source, an upper esophagogastroduodenoscopy (EGD) was performed, which showed one giant non-bleeding 6cm x 5cm, cratered, gastric ulcer with view of the liver through a 1 cm perforation (Image 1 & 2). Biopsies were negative for H. pylori and malignancy. She urgently underwent an emergent laparoscopic partial gastrectomy with gastrojejunostomy without complications. Post-operatively, she was successfully managed with antibiotics and pantoprazole with noted improvement on follow up 2 weeks later. Peptic ulcer disease (PUD) usually presents with iron-deficiency anemia and/or with upper gastrointestinal symptoms. This patient's presentation was most likely consistent with a slow upper gastrointestinal bleed; the absence of peritoneal signs and abdominal free-air made a perforated viscus less likely. However, the area of perforation in the gastric antrum was contained by a dynamic ascending and prolapsing liver, leading to this patient's delayed and atypical presentation. Modern PUD therapy via EGD and medications has rendered PPU an uncommon clinical scenario; PPU was once a more common surgical emergency. This case illustrates the variability in presentation of the already rare entity of PPU.Figure: Endoscopic image of a 5cm x 6cm non-bleeding, cratered ulcer with 1 cm perforation and view of extraluminal organ thought to be liver (marked by the yellow arrow) seen prolapsing in and out of the perforation.Figure: Wider view of large cratered ulcer on upper endoscopy. Base of the intact ulcer had adherent clots and adherent material without active bleeding.

Panel 4: Report of the Microbiology Panel.

Objective To perform a comprehensive review of the literature from July 2011 until June 2015 on the virology and bacteriology of otitis media in children. Data Sources PubMed database of the National Library of Medicine. Review Methods Two subpanels comprising experts in the virology and bacteriology of otitis media were created. Each panel reviewed the relevant literature in the fields of virology and bacteriology and generated draft reviews. These initial reviews were distributed to all panel members prior to meeting together at the Post-symposium Research Conference of the 18th International Symposium on Recent Advances in Otitis Media, National Harbor, Maryland, in June 2015. A final draft was created, circulated, and approved by all panel members. Conclusions Excellent progress has been made in the past 4 years in advancing our understanding of the microbiology of otitis media. Numerous advances were made in basic laboratory studies, in animal models of otitis media, in better understanding the epidemiology of disease, and in clinical practice. Implications for Practice (1) Many viruses cause acute otitis media without bacterial coinfection, and such cases do not require antibiotic treatment. (2) When respiratory syncytial virus, metapneumovirus, and influenza virus peak in the community, practitioners can expect to see an increase in clinical otitis media cases. (3) Biomarkers that predict which children with upper respiratory tract infections will develop otitis media may be available in the future. (4) Compounds that target newly identified bacterial virulence determinants may be available as future treatment options for children with otitis media.

Annals for Educators - 21 February 2017

Annals for Educators - 21 February 2017

IN VITRO PHYTOREMEDIATION OF PERSISTENT ORGANIC POLLUTANTS BY Helianthus annuus L. PLANTS

Plant model systems are needed to properly conduct basic laboratory studies prior to field applications of phytoremediation. In vitro plant cultures are a useful tool for such research. This study focuses on the removal and/or degradation of 24 persistent organic pollutants under in vitro conditions by Helianthus annuus L (sunflower). The main purpose of exploiting this plant for phytoremediation process is due to its strong adaptability to adverse environments conditions such as resistance to pests, disease, and others. The study of bioremediation effects of all chemical molecules under in vitro conditions showed promising results. Sixteen out of twenty-four compounds evaluated reached up to 87% for remediation. The highest accumulation of pollutants was observed in the roots, showing that these results are consistent with the current literature. Through the study, it was observed effective absorption of POPs with logKow ranging from 4.50 to 6.91. Sunflower phytoremediation process efficiently detected heptachlor, aldrin, heptachlor epoxide, trans-chlordane, chlordane, dieldrin, DDE, DDT, methoxychlor, mirex and decachlorobiphenyl.

Pluripotent stem cell differentiation reveals distinct developmental pathways regulating lung- versus thyroid-lineage specification.

The in vitro-directed differentiation of pluripotent stem cells (PSCs) through stimulation of developmental signaling pathways can generate mature somatic cell types for basic laboratory studies or regenerative therapies. However, there has been significant uncertainty regarding a method to separately derive lung versus thyroid epithelial lineages, as these two cell types each originate from Nkx2-1+ foregut progenitors and the minimal pathways claimed to regulate their distinct lineage specification in vivo or in vitro have varied in previous reports. Here, we employ PSCs to identify the key minimal signaling pathways (Wnt+BMP versus BMP+FGF) that regulate distinct lung- versus thyroid-lineage specification, respectively, from foregut endoderm. In contrast to most previous reports, these minimal pathways appear to be evolutionarily conserved between mice and humans, and FGF signaling, although required for thyroid specification, unexpectedly appears to be dispensable for lung specification. Once specified, distinct Nkx2-1+ lung or thyroid progenitor pools can now be independently derived for functional 3D culture maturation, basic developmental studies or future regenerative therapies.

Síndrome anémico

DefinitionAnemia is a reduction of the red cell mass below the normal range resulting in a reduction in the ability of the blood to deliver oxygen to tissues. According to severity and duration of hypoxia, distinctive signs and symptoms as well as compensatory cardiovascular responses are developed. PathogenesisAnemia is the result of one or more combinations of the following mechanisms: blood loss, decreased red blood cell production or increased destruction of erythrocytes (hemolysis). DiagnosisAnemia is diagnosed when hemoglobin levels are “lower limit of normal” offered by the WHO committee. However, because its clinical relevance, this lower limit must be individualized in the clinical context of each patient. General diagnostic algorithms can be used in order to reach a differential diagnosis. Full clinical history and thorough physical examination, along with basic laboratory studies including, among others, complete blood count (blood smear, reticulocytes, Coombs test and iron levels) allow reaching initial differential diagnosis among: microcytic, normocytic or macrocytic anemia (morphological criteria) and regenerative or central anemia (etiopathogenesis).

PP.LB03.01] RENOVASCULAR HYPERTENSION AS INITIAL MANIFESTATION OF SOLITARY RENAL ARTERY ANEURYSM IN A YOUNG GREEK MALE

Objective: To present a rare case of branch renal artery aneurysm focusing on: -the diagnostic work-up of hypertension in a young patient -the cause-effect relationship between renal artery aneurysm and hypertension -the mechanism underlying renovascular hypertension -the therapeutic approach of hypertension and renal aneurysm -the 5-year follow-up and prognosis Design and method: A 35 year old Greek male with no past medical history presents with de novo stage 3 hypertension with average readings of 220/130mmHg. Basic laboratory studies revealed dyslipidaimia, normal renal function and normal albumin excretion levels. Plain kidney-ureter-bladder radiographic imaging showed renal calcification. The diagnostic workup for secondary hypertension included a computed tomography angiography of renal blood vessels and suprarenal glands which has shown a renal artery aneurysm. Despite normal perfusion was observed, the renogram showed a 8% reduction of the left kidney function. A thoracic computed tomography idetified no other abnormal vessels. The magnetic angyography illustrated a 5 cm branch renal artery aneurysm with a wall thrombus, anterior to the left kidney.Immediate surgical repair was performed with ligation of the vessel and resection of the aneurysm. Results: Postoperatively the patient presented clinical improvement (blood pressure around 120/80mmHg) with two antihypertensive agents, including an inhibitor of the renin-angiotensin-aldosterone system. The dyslipidaimia was treated with statin and ezetimibe. A renogram performed 3 months after the surgical procedure showed a 22% decline on the left kidney function. This further reduction might be attributed to the aneurysmectomy and angioplastic renal artery branch closure. Left renal function remained stable for the next five years. During that time frame the patient did not present with any major cardiovascular complications. Conclusions: Our results are compatible with the Coral Trial and with other studies as the Renal Artery Aneurysms-A 35 year Clinical Experience. In the last one, the surgical benefit was a decline in blood pressure while taking fewer antihypertensive agents and the maintenance of the renal function in selected cases. Our patient had an excellent long-term clinical outcome associated with renal function maintenance and normalization of blood pressure.

Outpatient removal of tunneled dialysis catheters by nephrology fellows in training at a Veterans Affairs Medical Center.

Removal of tunneled dialysis catheters (TDC) usually occurs in dedicated procedure suites and is performed relatively rarely at the bedside. Scarce evidence exists in the literature to assess the safety and success of this procedure when performed during supervised academic training. We conducted a retrospective chart review of all TDC removals performed on an outpatient basis by nephrology fellows under faculty supervision during a 5-year period at an academic Veterans Affairs Medical Center. Data were collected regarding patient demographics, basic laboratory studies, pertinent clinical information and procedure-related variables. We evaluated the safety, success and complication rate of this procedure. We identified 72 TDC removals that met the above criteria. Mean age was 63 ± 10 years. All patients were male and hypertensive, 68% were diabetic and 69% were African-American. Overall, 88% of procedures were performed in end-stage renal disease (ESRD) patients, while the rest had needed temporary dialysis for acute kidney injury. Notably, 49 patients (68%) were taking one or more of aspirin, clopidogrel or warfarin at the time of TDC removal. Overall complication rate was low (<2%). There was no increase in risk of bleeding, even in subjects receiving anti-platelet therapy; only one of the 49 patients (2%) had a minor bleeding complication. Outpatient TDC removal by trainees was successful and safe in the vast majority of cases (99%). We propose that TDC removal skills should be actively pursued and acquired by all nephrology fellows. This would expand the scope of practice for future general nephrologists and facilitate timely patient care.

Assessment of postoperative pain after reciprocating or rotary NiTi instrumentation of root canals: a randomized, controlled clinical trial.

The aim of this study was to assess postoperative pain in a prospective randomized clinical trial comparing two groups, using the Reciproc® system in one group and the ProTaper® rotary system in the other. The study included 78 male patients, aged 18-64years (mean age of 26years), with asymptomatic pulp necrosis in mandibular molar teeth (n = 78). The single-session endodontic treatment was performed by a single operator specialized in Endodontics. Mechanical preparation of the root canals was performed using the ProTaper® and Reciproc® instrumentation techniques. Postoperative pain was recorded using a verbal rating scale (VRS) and verbal description with well-defined categories at the three following time intervals: 24h, 72h, and 7days after the endodontic procedure. The assessment of postoperative pain was recorded as no pain, mild pain, moderate pain, and severe pain or flare-up. Data were analyzed using the nonparametric Mann-Whitney test with the aid of the STATA® software. The incidence of postoperative pain in the ProTaper group (PT) 24h after the endodontic procedure was 17.9 and 5.1% after 72h. In the Reciproc group (RP), the incidence after 24h was 15.3 and 2.5% after 72h. No patients presented severe pain at the time intervals assessed. No significant difference (p > 0.05) in postoperative pain was found between the ProTaper® and Reciproc® instrumentation technique during endodontic treatment in this study. According to our findings and the results of the clinical trial, the occurrence of postoperative pain was low and similar between the reciprocating and rotary techniques during the time intervals assessed. These results are different from basic laboratory studies that affirm that the reciprocating techniques tend to promote more postoperative pain since extrusion of debris is greater.

Antiretroviral Therapy – Changes of Basic Laboratory Parameters in Hiv-Infected Bulgarian Patients

Summary HIV-1 infection keeps on being a global problem because of its pandemic character and the impossibility for eradication. The combined antiretroviral therapy (АRТ) remains the only treatment which has proven its effectiveness for maintaining the life of HIV positive patients. Because of long term (life time) duration of this therapy, it is necessary to monitor patients for possible drug toxicity. The aim of our research is to evaluate the changes of basic laboratory examinations while conducting a long-term АRТ. We analyzed basic laboratory studies of 145 HIV-infected Bulgarian patients in the current research. The patients were separated into four groups according to their treatment regimen. They were on dispensary monitoring and were being treated in the Department for Patients with Acquired Immune Deficiency in the Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov” - Sofia. Our results showed that combined ART led to changes in blood count, alanin-aminotransferase (ALT), glucose and total cholesterol. Some of these changes are significant for some of the drugs administered. The current ART does not lead to severe toxicity and life-threatening conditions such as those which were observed in the first few years of ART introduction.

The Discrimination of Printed Words by Prereading Children

In addition to the discrimination of individual printed letters, beginning readers must learn to perceive individual letters within complex, whole-word stimuli. The present study shows that the discrimination of letters presented individually does not automatically entail the discrimination of 3-letter printed words that differ only in the first letter (e.g., sat, mat). Thirty-two children ranging in age from 3½ to 5½ years participated in two studies. All showed highly accurate discrimination of individual letters in identity matching-to-sample procedures before being exposed to the word-matching task. On the word-matching task, 21 of the 32 children showed accuracy of less than 85%, and 11 of these showed accuracy of 65% or less. Word-discrimination accuracy did not improve in retests of a subset of children after periods ranging from 3 weeks to 3 months. In Study 2, six children who initially showed relatively low word-matching accuracy were taught using fading procedures. Moreover, generalization to untaught words was shown. These results extend basic laboratory studies that have shown difficulties discriminating multi-element stimuli despite the discrimination of the individual component elements.

Sepsis in old age: review of human and animal studies.

Sepsis is a serious problem among the geriatric population as its incidence and mortality rates dramatically increase with advanced age. Despite a large number of ongoing clinical and basic research studies, there is currently no effective therapeutic strategy that rescues elderly patients with severe sepsis. Recognition of this problem is relatively low as compared to other age-associated diseases. The disparity between clinical and basic studies is a problem, and this is likely due, in part, to the fact that most laboratory animals used for sepsis research are not old while the majority of sepsis cases occur in the geriatric population. The objective of this article is to review recent epidemiological studies and clinical observations, and compare these with findings from basic laboratory studies which have used aged animals in experimental sepsis.