Healing of a tooth with an overinstrumented apex, extensive transportation and periapical lesion using a 5 mm calcium hydroxide apical plug: an 8-year follow-up report

Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.

Microbial Translocation Is Associated with Extensive Immune Activation in Dengue Virus Infected Patients with Severe Disease

Background: Severe dengue virus (DENV) disease is associated with extensive immune activation, characterized by a cytokine storm. Previously, elevated lipopolysaccharide (LPS) levels in dengue were found to correlate with clinical disease severity. In the present cross-sectional study we identified markers of microbial translocation and immune activation, which are associated with severe manifestations of DENV infection. Methods: Serum samples from DENV-infected patients were collected during the outbreak in 2010 in the State of Sa˜o Paulo, Brazil. Levels of LPS, lipopolysaccharide binding protein (LBP), soluble CD14 (sCD14) and IgM and IgG endotoxin core antibodies were determined by ELISA. Thirty cytokines were quantified using a multiplex luminex system. Patients were classified according to the 2009 WHO classification and the occurrence of plasma leakage/shock and hemorrhage. Moreover, a (non-supervised) cluster analysis based on the expression of the quantified cytokines was applied to identify groups of patients with similar cytokine profiles. Markers of microbial translocation were linked to groups with similar clinical disease severity and clusters with similar cytokine profiles. Results: Cluster analysis indicated that LPS levels were significantly increased in patients with a profound pro-inflammatory cytokine profile. LBP and sCD14 showed significantly increased levels in patients with severe disease in the clinical classification and in patients with severe inflammation in the cluster analysis. With both the clinical classification and the cluster analysis, levels of IL-6, IL-8, sIL-2R, MCP-1, RANTES, HGF, G-CSF and EGF were associated with severe disease. Conclusions: The present study provides evidence that both microbial translocation and extensive immune activation occur during severe DENV infection and may play an important role in the pathogenesis.

Interpretation of the depths of maximum of extensive air showers measured by the Pierre Auger Observatory

To interpret the mean depth of cosmic ray air shower maximum and its dispersion, we parametrize those two observables as functions of the rst two moments of the lnA distribution. We examine the goodness of this simple method through simulations of test mass distributions. The application of the parameterization to Pierre Auger Observatory data allows one to study the energy dependence of the mean lnA and of its variance under the assumption of selected hadronic interaction models. We discuss possible implications of these dependences in term of interaction models and astrophysical cosmic ray sources.

Cyanobacteria in biological soil crusts, Earth´s Most Extensive Biofilms: adaptation and sensitivity to global warming

School of Life Sciences, Arizona State University, Tempe AZ, USA

L'effetto della pressione sulle perdite in condotte con fessure longitudinali - The effect of pressure on leakage in longitudinally crecked pressurized pipes.

La crescente attenzione verso un utilizzo attento, sostenibile ed economicamente efficiente della risorsa idrica rende di primaria importanza il tema delle perdite idriche e della gestione efficiente dei sistemi idrici. La richiesta di controlli dell’uso dell’acqua è stata avanzata a livello mondiale. Il problema delle perdite idriche nei Paesi industrializzati è stato così affrontato con specifiche normative e procedure di best practice gestionale per avanzare una valutazione delle perdite idriche e una limitazione degli sprechi e degli usi impropri. In quest’ambito, la pressione gioca un ruolo fondamentale nella regolazione delle perdite reali. La regolazione delle pressioni nelle diverse ore del giorno consente, infatti, di poter agire su queste ultime perdite, che aumentano all’aumentare della pressione secondo una cosiddetta legge di potenza. La motivazione della presente tesi è originata dalla necessità di quantificare il livello di perdita idrica in un sistema acquedottistico in relazione alla pressione all’interno del sistema stesso. Per avere una stima realistica che vada al di là della legge della foronomia, si vuole valutare l’influenza della deformabilità della condotta in pressione fessurata sull’entità delle perdite idriche, con particolare attenzione alle fessurazioni di tipo longitudinale. Tale studio è condotto tramite l’introduzione di un semplice modello di trave alla Winkler grazie al quale, attraverso un’analisi elastica, si descrive il comportamento di una generica condotta fessurata longitudinalmente e si valuta la quantità d’acqua perduta. I risultati ottenuti in condizioni specifiche della condotta (tipo di materiale, caratteristiche geometriche dei tubi e delle fessure, etc.) e mediante l’inserimento di opportuni parametri nel modello, calibrati sui risultati forniti da una raffinata modellazione tridimensionale agli elementi finiti delle medesime condotte, verranno poi confrontati con i risultati di alcune campagne sperimentali. Gli obiettivi del presente lavoro sono, quindi, la descrizione e la valutazione del modello di trave introdotto, per stabilire se esso, nonostante la sua semplicità, sia effettivamente in grado di riprodurre, in maniera realistica, la situazione che si potrebbe verificare nel caso di tubo fessurato longitudinalmente e di fornire risultati attendibili per lo studio delle perdite idriche. Nella prima parte verrà approfondito il problema della perdite idriche. Nella seconda parte si illustrerà il semplice modello di trave su suolo elastico adottato per l’analisi delle condotte in pressione fessurate, dopo alcuni cenni teorici ai quali si è fatto riferimento per la realizzazione del modello stesso. Successivamente, nella terza parte, si procederà alla calibrazione del modello, tramite il confronto con i risultati forniti da un’analisi tridimensionale agli elementi finiti. Infine nella quarta parte verrà ricavata la relazione flusso-pressione con particolare attenzione all’esponente di perdita, il cui valore risulterà superiore a quello predetto dalla teoria della foronomia, e verrà verificata l’effettiva validità del modello tramite un confronto con i risultati sperimentali di cui è stata fatta menzione in precedenza.

Acute transverse myelitis in Lyme neuroborreliosis

Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18 years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations.

Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures

To evaluate the use of computer-assisted designed and manufactured (CAD/CAM) orbital wall and floor implants for late reconstruction of extensive orbital fractures.

Extensive extranodal metastases of basal-like breast cancer with predominant myoepithelial spindle cell differentiation

A differentiation towards myoepithelial cells has been demonstrated in several types of lesions in the breast. These include multifocal myoepitheliomatosis, the rare mixed tumor or pleomorphic adenoma, adenoid cystic carcinoma, adenomyoepithelioma and myoepithelial carcinoma (malignant myoepithelioma). Myoepithelial carcinoma is the only lesion purely composed of myoepithelial cells. All these tumors are benign and/or of low-grade malignancy, with the exception of malignant myoepithelioma. In contrast to the statement of the current World Health Organization (WHO), recent studies have reported that regional and distant metastases may occur in about 50% of pure myoepithelial carcinomas. The presented case of a breast carcinoma with dominant myoepithelial/spindle cell differentiation in a 58-year-old woman is an excellent example to document the highly aggressive biological behavior of this tumor phenotype. Despite an extensive chemotherapy and radiotherapy, the tumor was rapidly progressive, forming a finally exulcerating local tumor relapse and widespread metastases to the myocardium, lungs, liver, kidneys and skin. Similarities in morphology and biological behavior compared to patients with "triple-negative" (hormone receptor and Her2) monophasic sarcomatoid carcinomas and pure spindle cell sarcomas are discussed.

Extensive clonal spread and extreme longevity in saw palmetto, a foundation clonal plant

The lack of effective tools have hampered our ability to assess the size, growth and ages of clonal plants. With Serenoa repens (saw palmetto) as a model, we introduce a novel analytical framework that integrates DNA fingerprinting and mathematical modelling to simulate growth and estimate ages of clonal plants. We also demonstrate the application of such life-history information of clonal plants to provide insight into management plans. Serenoa is an ecologically important foundation species in many Southeastern United States ecosystems; yet, many land managers consider Serenoa a troublesome invasive plant. Accordingly, management plans have been developed to reduce or eliminate Serenoa with little understanding of its life history. Using Amplified Fragment Length Polymorphisms, we genotyped 263 Serenoa and 134 Sabal etonia (a sympatric non-clonal palmetto) samples collected from a 20 X 20 m study plot in Florida scrub. Sabal samples were used to assign small field-unidentifiable palmettos to Serenoa or Sabal and also as a negative control for clone detection. We then mathematically modelled clonal networks to estimate genet ages. Our results suggest that Serenoa predominantly propagate via vegetative sprouts and 10000-year-old genets may be common, while showing no evidence of clone formation by Sabal. The results of this and our previous studies suggest that: (i) Serenoa has been part of scrub associations for thousands of years, (ii) Serenoa invasion are unlikely and (ii) once Serenoa is eliminated from local communities, its restoration will be difficult. Reevaluation of the current management tools and plans is an urgent task.

Extensive clonal spread and extreme longevity in saw palmetto, a foundation clonal plant

The lack of effective tools has hampered our ability to assess the size, growth and ages of clonal plants. With Serenoa repens (saw palmetto) as a model, we introduce a novel analytical frame work that integrates DNA fingerprinting and mathematical modelling to simulate growth and estimate ages of clonal plants. We also demonstrate the application of such life-history information of clonal plants to provide insight into management plans. Serenoa is an ecologically important foundation species in many Southeastern United States ecosystems; yet, many land managers consider Serenoa a troublesome invasive plant. Accordingly, management plans have been developed to reduce or eliminate Serenoa with little understanding of its life history. Using Amplified Fragment Length Polymorphisms, we genotyped 263 Serenoa and 134 Sabal etonia (a sympatric non-clonal palmetto) samples collected from a 20 x 20 m study plot in Florida scrub. Sabal samples were used to assign small field-unidentifiable palmettos to Serenoa or Sabal and also as a negative control for clone detection. We then mathematically modelled clonal networks to estimate genet ages. Our results suggest that Serenoa predominantly propagate via vegetative sprouts and 10000-year-old genets maybe common, while showing no evidence of clone formation by Sabal. The results of this and our previous studies suggest that: (i) Serenoa has been part of scrub associations for thousands of years, (ii) Serenoa invasions are unlikely and (ii) once Serenoa is eliminated from local communities, its restoration will be difficult. Reevaluation of the current management tools and plans is an urgent task.

Formation of Phosphatidylethanol and Its Subsequent Elimination During an Extensive Drinking Experiment Over 5 Days

BACKGROUND: For almost 30 years, phosphatidylethanol (PEth) has been known as a direct marker of alcohol consumption. This marker stands for consumption in high amounts and for a longer time period, but it has been also detected after 1 high single intake of ethanol (EtOH). The aim of this study was to obtain further information about the formation and elimination of PEth 16:0/18:1 by simulating extensive drinking. METHODS: After 3 weeks of alcohol abstinence, 11 test persons drank an amount of EtOH leading to an estimated blood ethanol concentration of 1 g/kg on each of 5 successive days. After the drinking episode, they stayed abstinent for 16 days with regular blood sampling. PEth 16:0/18:1 analysis was performed using liquid chromatography-tandem mass spectrometry (high-performance liquid chromatography 1100 system and QTrap 2000 triple quadrupole linear ion trap mass spectrometer. Values of blood alcohol were obtained using a standardized method with headspace gas chromatography flame ionization detector. RESULTS: Maximum measured concentrations of EtOH were 0.99 to 1.83 g/kg (mean 1.32 g/kg). These values were reached 1 to 3 hours after the start of drinking (mean 1.9 hours). For comparison, 10 of 11 volunteers had detectable PEth 16:0/18:1 values 1 hour after the start of drinking, ranging from 45 to 138 ng/ml PEth 16:0/18:1. Over the following days, concentrations of PEth 16:0/18:1 increased continuously and reached the maximum concentrations of 74 to 237 ng/ml between days 3 and 6. CONCLUSIONS: This drinking experiment led to measurable PEth concentrations. However, PEth 16:0/18:1 concentrations stayed rather low compared with those of alcohol abusers from previous studies.