Search

Background: Quality of life (QoL) is a multifactorial concept that assesses physical and mental health. We prospectively studied the quality of life of patients undergoing coronary artery bypass graft (CABG) surgery using the Short-Form 36-item questionnaire (SF-36) up to 10 years after surgery., Methods: Between January 2000 and December 2002, all patients undergoing elective isolated CABG in the cardiac & thoracic surgery department of a large university hospital in Eastern France underwent initial QoL evaluation with the SF-36. The same questionnaire was mailed to every patient annually (± 2 weeks around the date of surgery) up to 10 years after their operation. We recorded socio-demographic and clinical variables at inclusion. Predictors of impaired QoL at 10 years were identified by logistic regression., Results: A total of 272 patients (213 men, 59 women) were enrolled; mean age at inclusion was 65 ± 10 years. At 10 years post-surgery, 81 patients had died (29.7%). The physical component summary (PCS) score was significantly higher at 5 years after surgery than at baseline (p < 0.01), and significantly lower at 10 years than at 5 years (p < 0.01), although there remained a significant difference between 10-year PCS and baseline score (p = 0.004). The mental component summary (MCS) score was significantly higher at 5 years than at the time of surgery (p < 0.001), and remained significantly higher compared to baseline at 10 years after surgery (p = 0.010). By multivariate analysis, diabetes and dypsnea were both associated with worse PCS at 10 years, while lower age was associated with better 10-year PCS. Only diabetes was associated with impaired MCS at 10 years., Conclusions: Cardiac surgery appears to durably and positively affect both physical and mental components of quality of life.

Objectives: This pilot study aimed to evaluate the relevance of endocan plasma levels for predicting pulmonary infection after cardiac surgery in patients with chronic kidney disease (CKD)., Methods: Serum collected in a previous prospective cohort study (from 166 patients with preoperative CKD who underwent cardiac surgery) was used. Five patients with postoperative pulmonary infection were compared with 15 randomly selected CKD patients with an uneventful outcome. Blood samples were tested at 4 time points (preoperatively and 6, 12, and 24 h after the end of surgery). Endocan, procalcitonin, and C-reactive protein plasma levels were compared between the two groups., Results: At 6 h, the patients with pulmonary infection had significantly higher levels of endocan than the patients without pulmonary infection (24.2 ± 15.6 vs. 6.4 ± 3.2 ng/mL; p = 0.03). A receiver operating characteristic curve analysis showed 80% sensitivity and 100% specificity for endocan to predict pulmonary infection (area under the curve 0.84), with a cutoff value of 15.9 ng/mL. The time saved by assessment of the endocan dosage compared to a clinical diagnosis of pulmonary infection was 47 h., Conclusion: This pilot study showed that a specific study to assess the link between endocan plasma levels and pulmonary infection after cardiac surgery in CKD patients is of potential utility.

Introduction  Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods  The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p  < 0.3 at univariate analysis. Results  Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3-9.9 and OR: 5.4, 95% CI: 1.3-21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control ( n  = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p  = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2-33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion  BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: The Gatti score is a weighted scoring system based on risk factors for deep sternal wound infection (DSWI) that was created in an Italian center to predict DSWI risk after bilateral internal thoracic artery (BITA) grafting. No external evaluation based on validation samples derived from other surgical centers has been performed. The aim of this study is to perform this validation., Patients and Methods: During 2015, BITA grafts were used as skeletonized conduits in all 255 consecutive patients with multi-vessel coronary disease who underwent isolated coronary bypass surgery at the Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. Baseline characteristics, operative data, and immediate outcomes of every patient were collected prospectively. A DSWI risk score was assigned to each patient pre-operatively. The discrimination power of both models, pre-operative and combined, of the Gatti score was assessed with the calculation of the area under the receiver operating characteristic curve., Results: Fourteen (5.5%) patients had DSWI. Major differences both as the baseline characteristics of patients and surgical techniques were found between this series and the original series from which the Gatti score was derived. The area under the receiver operating characteristic curve was 0.78 (95% confidence interval: 0.64-0.92) for the pre-operative model and 0.84 (95% confidence interval: 0.69-0.98) for the combined model., Conclusions: The Gatti score has proven to be effective even in a cohort of French patients despite major differences from the original Italian series. Multi-center validation studies must be performed before introducing the score into clinical practice.

Background: Commonly the frequency of international normalized ratio (INR) monitoring with a conventional laboratory test in stable patients is once a month. When using a dedicated personal device for INR assessment, the frequency may be increased to two or more times a month., Objective: To show that INR assessed by self-measurement at home is reliable and feasible in the mid-term and improves medical care., Patients and Methods: All patients in the study on INR self-measurement (clinical trial.gov: NCT00925197), conducted between 2004 and 2007, were re-contacted for mid-term follow-up. One hundred and seventy eight out of 192 patients who participated in the study answered a questionnaire. The average follow-up time was 4.2 years (±1) for the self-measurement group and 4.9 years (±1) for the laboratory-analyzed control group., Results: Only 26 patients (group A) continued to use INR self-measurement to monitor treatment with vitamin K antagonists (VKA). The main reasons to stop INR self-measurement were its high cost and difficulty in obtaining strips. There were significantly fewer bleeding complications (p=0.04) and complications related to VKA (p=0.01) in self-measured patients compared to the control group. Feelings of security and quality of life were also significantly better (p=0.002) for self-measured patients., Conclusion: Many patients with a mechanical heart valve, who self-measured INR, continue to use this method for their follow-up because of its positive effects on their health and quality of life., (© 2013 Elsevier Ltd. All rights reserved.)

Unlabelled: The 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) offers an excellent negative predictive value. Consequently, it is a reliable tool for excluding an infectious phenomenon in case of negativity. In case of persistent fever of unknown origin after cardiac surgery and in combination with other bacteriological examinations and medical imaging, we can rely on FDG-PET/CT to confirm or eliminate deep infections and prosthetic endocarditis. For this reason, FDG-PET/CT should be considered among the examinations to be performed in case of suspected infection after cardiac surgery. We have reported the case of a 76-year-old man who presented with a fever of unknown origin and recurrent septic shocks after a biological Bentall procedure combined with left anterior descending (LAD) coronary artery revascularization by the left internal thoracic artery. We performed a FDG-PET/CT which showed external iliac vein and right common femoral vein hyperfixation with infiltration of adjacent soft tissues, highly suspected to be an infectious process., Learning Objective: The aim of this case report is to show that FDG-PET/CT, in combination with other bacteriological examinations and medical imaging, can be extremely helpful in detecting deep infectious sources, even during the early postoperative period.

Background: Aortic valve stenosis is one of the most common heart diseases in older patients. Nowadays, surgical aortic valve replacement is the 'gold standard' treatment for this pathology and the most implanted prostheses are biological ones. The three most implanted bovine bioprostheses are the Trifecta valve (St. Jude Medical, Minneapolis, MN, USA), the Mitroflow valve (Sorin Group, Saluggia, Italy), and the Carpentier-Edwards Magna Ease valve (Edwards Lifesciences, Irvine, CA, USA). We propose a randomized trial to objectively assess the hemodynamic performances of these bioprostheses., Methods and Design: First, we will measure the aortic annulus diameter using CT-scan, echocardiography and by direct sizing in the operating room after native aortic valve resection. The accuracy of information, in terms of size and spatial dimensions of each bioprosthesis provided by manufacturers, will be checked. Their hemodynamic performances will be assessed postoperatively at the seventh day and the sixth month after surgery., Discussion: This prospective controlled randomized trial aims to verify and compare the hemodynamic performances and the sizing of these three bioprostheses. The data obtained may help surgeons to choose the best suitable bioprosthesis according to each patient's morphological characteristics., Trial Registration: ClinicalTrials.gov Identifier: NCT01522352.

Objective: To assess the results of tricuspid annuloplasty performed with the Edwards MC3 remodeling ring., Methods: From 2005 to 2007, 140 patients with tricuspid regurgitation (TR) secondary to left-sided valve disease (mean age 63.8 ± 11.6, permanent pacemaker in 7.8%, LVEF 56.4 ± 10.1%, LVEDD 54.1 ± 8 mm, SPAP 52.5 ± 14.4 mmHg) underwent tricuspid annuloplasty using the MC3 ring. Dilatation of the tricuspid annulus was present in all patients. Other concomitant mechanisms of TR (moderate leaflet prolapse, pacemaker wires, leaflets' retraction) were documented in 21 cases (15%). All patients underwent concomitant left-sided valve surgery. Ring size was between 28 and 32 in 84.3% of patients., Results: Hospital mortality was 3.5% and actuarial survival at 3 years 94.8 ± 2.1%. Mean follow-up of the 135 hospital survivors was 22 ± 9.5 months (median 23 months). Echocardiography at hospital discharge documented no or mild TR in 119 patients (87%), moderate TR (2+/4+) in 15 (11%) and moderate-to-severe (3+/4+) in 1 patient (0.7%). At echocardiographic follow-up moderate TR was present in 14 patients (10.3%) and moderate-to-severe TR in 2 (1.4%). At 3 years freedom from TR ≥ 2+ was 88.1 ± 2.78% and freedom from TR ≥ 3+ was 94.3 ± 4.89. Predictors of TR ≥ 2+ at hospital discharge and at follow-up were preoperative LVEF (OR:0.8; p = 0.001 at discharge; HR:0.9; p = 0.003 at follow-up) and the presence of other mechanisms of TR besides annular dilatation (OR:10.8; p = 0.007 at discharge; HR:6.1; p = 0.003 at follow-up)., Conclusion: Tricuspid annuloplasty with the MC3 ring provides satisfactory early results which remain stable at mid-term follow-up. The presence of other mechanisms besides annular dilatation leads to residual valve insufficiency after ring annuloplasty alone., (© 2012 Wiley Periodicals, Inc.)

The bioactivity of calcium silicate mineral trioxide aggregate (MTA) cements has been attributed to their ability to produce apatite in presence of phosphate-containing fluids. This study evaluated surface morphology and chemical transformations of an experimental accelerated calcium-silicate cement as a function of soaking time in different phosphate-containing solutions. Cement discs were immersed in Dulbecco's phosphate-buffered saline (DPBS) or Hank's balanced salt solution (HBSS) for different times (1-180 days) and analysed by scanning electron microscopy connected with an energy dispersive X-ray analysis (SEM-EDX) and micro-Raman spectroscopy. SEM-EDX revealed Ca and P peaks after 14 days in DPBS. A thin Ca- and P-rich crystalline coating layer was detected after 60 days. A thicker multilayered coating was observed after 180 days. Micro-Raman disclosed the 965-cm(-1) phosphate band at 7 days only on samples stored in DPBS and later the 590- and 435-cm(-1) phosphate bands. After 60-180 days, a layer approximately 200-900 μm thick formed displaying the bands of carbonated apatite (at 1,077, 965, 590, 435 cm(-1)) and calcite (at 1,088, 713, 280 cm(-1)). On HBSS-soaked, only calcite bands were observed until 90 days, and just after 180 days, a thin apatite-calcite layer appeared. Micro-Raman and SEM-EDX demonstrated the mineralization induction capacity of calcium-silicate cements (MTAs and Portland cements) with the formation of apatite after 7 days in DPBS. Longer time is necessary to observe bioactivity when cements are immersed in HBSS.

Objective: Dentinal MMPs have been claimed to contribute to the auto-degradation of collagen fibrils within incompletely resin-infiltrated hybrid layers and their inhibition may, therefore, slow the degradation of hybrid layer. This study aimed to determine the contribution of a synthetic MMPs inhibitor (galardin) to the proteolytic activity of dentinal MMPs and to the morphological and mechanical features of hybrid layers after aging., Methods: Dentin powder obtained from human molars was treated with galardin or chlorhexidine digluconate and zymographically analyzed. Microtensile bond strength was also evaluated in extracted human teeth. Exposed dentin was etched with 35% phosphoric acid and specimens were assigned to (1) pre-treatment with galardin as additional primer for 30s and (2) no pre-treatment. A two-step etch-and-rinse adhesive (Adper Scotchbond 1XT, 3M ESPE) was then applied in accordance with manufacturer's instructions and resin composite build-ups were created. Specimens were immediately tested for their microtensile bond strength or stored in artificial saliva for 12 months prior to being tested. Data were evaluated by two-way ANOVA and Tukey's tests (alpha=0.05). Additional specimens were prepared for interfacial nanoleakage analysis under light microscopy and TEM, quantified by two independent observers and statistically analyzed (chi(2) test, alpha=0.05)., Results: The inhibitory effect of galardin on dentinal MMPs was confirmed by zymographic analysis, as complete inhibition of both MMP-2 and -9 was observed. The use of galardin had no effect on immediate bond strength, while it significantly decreased bond degradation after 1 year (p<0.05). Interfacial nanoleakage expression after aging revealed reduced silver deposits in galardin-treated specimens compared to controls (p<0.05)., Conclusions: This study confirmed that the proteolytic activity of dentinal MMPs was inhibited by the use of galardin in a therapeutic primer. Galardin also partially preserved the mechanical integrity of the hybrid layer created by a two-step etch-and-rinse adhesive after artificial aging., (Copyright (c) 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objectives: To describe results from a novel percutaneous technique designed to minimize the risk of hemorrhage in the event of a major complication during transcatheter aortic valve implantation., Background: Vascular access management is a major challenge in transfemoral TAVI due to the large introducer sheathes required., Methods: Fifty-two pts underwent TAVI between November 2007 and March 2009. Of these, 37 received an Edwards-Sapien Valve (23 mm valve: 17/37; 26 mm valve: 20/37) whilst 15 patients received a CoreValve (26 mm valve: 6/15; 29 mm valve: 9/15). Using a crossover technique, the opposing femoral artery was cannulated with a 7Fr long sheath. This allowed contralateral passage of a balloon and inflation in the proximal iliac. The sheath was then removed and Prostar sutures tied in a dry field. Balloon optimization of the puncture site was performed as required., Results: In three subjects, elective surgical repair was undertaken due to excessive femoral arterial calcification. In the remaining 49, the crossover technique was employed and closed with two Prostar devices (Edwards-Sapien) or one (CoreValve). There were serious "on-table" complications in seven patients, six due to the large introducer sheathes used in the TAVI procedure-iliac avulsion, two iliac dissections, iliac perforation, common femoral perforation and scrotal hematoma. All were repaired safely by combined surgical and endovascular techniques, using the crossover technique to ensure patient stability. All made a good recovery and were independently ambulant at discharge., Conclusion: Using crossover balloon inflation as an adjunct to Prostar closure may be helpful for managing TAVI vascular access sites., ((c) 2009 Wiley-Liss, Inc.)

The degeneration of a previously surgically implanted aortic bioprosthesis is an increasing etiology of aortic stenosis in the elderly, but reoperative surgery may present prohibitive risks. The feasibility of transcatheter aortic valve implantation into a conventional bioprosthesis (valve-in-valve concept) has been evaluated to decrease the reoperative risk for patients with a failed bioprosthesis. There have been several reports of valve-in-valve procedures using the self-expandable prosthesis CoreValve (Medtronic Inc.), whereas the feasibility of this procedure with the Sapien balloon expandable valve (Edwards Lifesciences Inc.) is still not well established. Here we report the case of a patient submitted to balloon-expandable aortic valve-in-valve implantation in an emergency setting to treat a severe aortic stenosis due to the premature failure of a surgical bioprosthesis.

Suboptimally polymerized monomers may be responsible for the reduced material properties of simplified adhesives and their inherent bonded interface instability. This study was performed to determine the degree of cure within the hybrid layers produced by three one-step self-etch adhesives in situ using Raman microspectroscopy and to investigate nanoleakage expression. Dentin disks were bonded with AdheSE One, Adper Prompt L-Pop, or iBond. Composite layers of 2-mm thickness were built up in bulk on the polymerized adhesive surfaces and then the adhesive-dentin interfaces were exposed to a micro-Raman beam. Adhesive penetration was calculated using the relative intensities of bands associated with mineral and adhesive, and the degree of conversion (DC) was evaluated. Interfacial nanoleakage expression was evaluated on the same specimens. The DC values for the tested adhesives were found to increase in the following order: AdheSE One (48 +/- 16%) < Adper Prompt L-Pop (83 +/- 2%) = iBond (90 +/- 6%; P < 0.05). AdheSE One showed greater nanoleakage expression than iBond or Adper Prompt L-Pop. Increased nanoleakage expression was associated with AdheSE One that showed the lowest DC. This suggests that a low DC may affect the quality and the long-term stability of the adhesive interface owing to the elution of unreacted monomers forming a porous and highly permeable hybrid layer.

Purpose: Although it is deemed important, right atrial ablation is not considered feasible with bipolar radiofrequency alone. Normally, unipolar devices are used to complete the tricuspid connecting lines. We describe a simple technique to achieve a complete maze-like set of right ablations using a standard bipolar radiofrequency device., Description: Thirty-four patients underwent concomitant ablation with a right set of lines performed using bipolar radiofrequency only. The epicardium adjacent to the right atriotomy was entered and after separating the sulcus fat from the atrial wall, the deepest portion of the atrioventricular groove was developed bluntly with the scissors down to the tricuspid annulus. The tricuspid connecting lines were then performed with bipolar radiofrequency in an endo-epicardial fashion., Evaluation: No ablation-related complications occurred. No patient died. Three patients required pacemaker implantation. At a mean follow-up of 8 +/- 5, 85% of the patients were free from arrhythmias. At 6 months 20 of 24 patients (83%) were in stable sinus rhythm., Conclusions: All the maze III right atrial ablations can be performed using a bipolar radiofrequency device alone. The procedure is safe and easily reproducible on a regular basis.

Objectives: The purpose of this study was to measure the contraction stress development of three flowable resin-composite materials (Grandio Flow, VOCO GmbH, Cuxhaven, Germany; Tetric Flow, Ivoclar Vivadent, Schaan, Liechtenstein; Filtek Supreme XT Flowable Restorative, 3M ESPE, ST. Paul, MN, USA) and an universal micro-hybrid composite resin (Filtek Z250, 3M ESPE, St. Paul, MN, USA) during photopolymerization with a halogen curing light, using a novel stress-measuring gauge., Methods: Curing shrinkage stress was measured using a stress-analyzer. Composites were polymerized with a halogen curing unit (VIP, Bisco Inc., Schaumburg, IL, USA) for 40s. The contraction force (N) generated during polymerization was continuously recorded for 180s after photo-initiation. Contraction stress (MPa) was calculated at 20s, 40s, 60s, 120s and 180s. Data were statistically analyzed., Results: Filtek Supreme XT Flowable Restorative exhibited the highest stress values compared to other materials (p<0.05), while the lowest values were recorded with Tetric Flow (p<0.05). Tetric Flow was also the only flowable composite showing stress values lower than the conventional composite Filtek Z250 (p<0.05)., Significance: Flowable composites investigated with this experimental setup showed shrinkage stress comparable to conventional resin restorative materials, thus supporting the hypothesis that the use of flowable materials do not lead to marked stress reduction and the risk of debonding at the adhesive interface as a result of polymerization contraction is similar for both type of materials.

Purpose: The aim of this study was to investigate whether an electrical device for dental adhesive application (ElectroBond) influences bonding of two-step etch-and-rinse adhesives., Materials and Methods: Human teeth were selected and cut perpendicularly to their long axis to expose middle/ deep dentin. Specimens were then longitudinally sectioned into halves (experimental and control halves) to create two similar bonding substrates. Experimental halves were bonded using an ElectroBond-assisted application, while control halves were bonded with disposable sponges. The adhesives tested were Adper Scotchbond 1XT and XP-BOND. Bonded specimens were submitted to the microtensile bond strength test. Additional adhesive interfaces were prepared and processed for nanoleakage investigation involving TEM examination., Results: The microtensile bond test revealed higher values (p < 0.05) for both adhesives if ElectroBond was used during layering (55.5 +/- 7.9 MPa for Adper Scotchbond 1XT and 54.7 +/- 7.1 MPa for XP-BOND) compared to the conventional mechanical adhesive application technique (41.1 +/- 6.1 MPa for Adper Scotchbond 1XT and 38.0 +/- 7.8 MPa for XP-BOND). No difference between the two adhesives was found under the same application conditions. With electricity-assisted application, TEM micrographs revealed a significant decrease in nanoleakage expression compared to the controls., Conclusion: The use of an electric current produced by ElectroBond during the application of two-step etch-and-rinse adhesives may enhance resin impregnation, thus improving dentin hybridization. Further studies should be done to confirm that this device can similarly improve adhesive application in vivo.

Atrial fibrillation becomes a self-perpetuating arrhythmia as a consequence of electrophysiologic and structural remodeling involving the atrium. Oxidative stress may be a link between this rhythm disturbance and electrophysiologic remodeling. The aim of this study was to evaluate whether the heme oxygenase-1 (HO-1) marker of oxidative stress was more expressed in left atrial sites with stronger structural remodeling in patients affected by chronic atrial fibrillation (CAF) and mitral valve disease (MD). Myocardial samples were taken from the left atrial posterior wall (LAPW) and left atrial appendage (LAA) of 24 patients with CAF-MD in addition to 10 autopsy controls. The levels of HO-1 messenger RNA (mRNA) and HO-1 protein in each pathologic LAPW and LAA were quantified using reverse transcriptase polymerase chain reaction and enzyme-linked immunosorbent assay. Furthermore, light microscopy was used to morphometrically evaluate the differential myocyte and interstitial changes in the same CAF-MD LAPW and LAA samples. In controls, HO-1 protein was quantified using enzyme-linked immunosorbent assay. Unlike controls, patients with CAF-MD had higher levels of HO-1 mRNA and its protein product, expressed as LAPW/LAA ratios, in the LAPW (2.18 +/- 1.18, P < .0001, and 1.55 +/- 0.67, P < .005), and their LAPW also showed greater histologic changes in myocytolytic myocytes (15.1% +/- 3.1% versus 6.9% +/- 3.3%, P < .0001), interstitial fibrosis (8.2% +/- 2.2% versus 2.8% +/- 1.2%, P < .0001), and capillary density (816 +/- 120 number/mm(2) versus 1114 +/- 188 number/mm(2); P < .05). In addition, markers of oxidative stress were immunohistochemically studied with antinitrotyrosine and anti-iNOS antibodies. In patients with CAF-MD, the inducible enzyme HO-1 is more expressed in the left atrial areas that show greater structural remodeling. This finding strongly suggests a pathogenetic relationship between oxidative stress and the degree of histologic change.

Objective: Despite its efficacy and swiftness, bipolar radiofrequency is generally not used on the left isthmus for concern of injuring a coronary branch. Incomplete lesion sets or use of an additional unipolar device are often considered. We report a technique to perform a full left lesion set involving the mitral line using a standard bipolar radiofrequency device., Methods: An innovative complete left atrial lesion set was performed using only bipolar radiofrequency in 70 consecutive patients (study group). In 67/70 patients (96%) mitral valve disease was the main indication to surgery. Atrial fibrillation was permanent in 42 patients (60%), persistent in 25 (36%) and paroxysmal in three patients (4%). After beating-heart pulmonary vein isolation on-pump, the coronary-free area of the AV groove was marked epicardially by sticking a needle into the left atrial wall, behind the coronary sinus. The projection of the needle marker on the mitral annulus was then identified through the atriotomy and an endo-epicardial ablation was performed with the bipolar device involving the atrial wall, the coronary sinus, up to the annulus. The lesion set was then completed by connecting the encirclings and the left appendage, which was then sutured. Follow-up was 100% complete. Results were compared with those of a control group of 33 patients receiving bipolar radiofrequency left atrial ablations and a mitral connecting line with a second unipolar device., Results: All patients survived. No major complication occurred. Haematoma of the AV groove was observed during retrograde cardioplegia in one case. No myocardial ischaemia or re-exploration for bleeding (median 325 cc, interquartile range 250-442) occurred. Two out of 70 patients required a permanent pacemaker for AV block. Freedom from atrial fibrillation was 84% (95% CI: 75%, 93%) at 6 months and 81% (95% CI: 70%, 93%) at 1 year. One patient had left flutter. Comparison with the control group did not show any difference in clinical outcomes, but revealed bipolar ablation to the mitral annulus to abate the per patient cost of the ablation devices (1245+/-50 euro vs 2403+/-17 euro; p<0.0001)., Conclusions: Performing the mitral line with bipolar radiofrequency is safe and cost-effective. A complete left atrial ablation with a single bipolar radiofrequency device yields excellent clinical mid-term results.

Objective: Most of current dental adhesive systems show favorable immediate results in terms of retention and sealing of bonded interface, thereby counteracting polymerization shrinkage that affects resin-based restorative materials. Despite immediate efficacy, there are major concerns when dentin bonded interfaces are tested after aging even for short time period, i.e. 6 months., Methods: This study critically discusses the latest peer-reviewed reports related to formation, aging and stability of resin bonding, focusing on the micro and nano-phenomena related to adhesive interface degradation., Results: Most simplified one-step adhesives were shown to be the least durable, while three-step etch-and-rinse and two-step self-etch adhesives continue to show the highest performances, as reported in the overwhelming majority of studies. In other words, a simplification of clinical application procedures is done to the detriment of bonding efficacy. Among the different aging phenomena occurring at the dentin bonded interfaces, some are considered pivotal in degrading the hybrid layer, particularly if simplified adhesives are used. Insufficient resin impregnation of dentin, high permeability of the bonded interface, sub-optimal polymerization, phase separation and activation of endogenous collagenolytic enzymes are some of the recently reported factors that reduce the longevity of the bonded interface., Significance: In order to overcome these problems, recent studies indicated that (1) resin impregnation techniques should be improved, particularly for two-step etch-and-rinse adhesives; (2) the use of conventional multi-step adhesives is recommended, since they involve the use of a hydrophobic coating of nonsolvated resin; (3) extended curing time should be considered to reduce permeability and allow a better polymerization of the adhesive film; (4) proteases inhibitors as additional primer should be used to increase the stability of the collagens fibrils within the hybrid layer inhibiting the intrinsic collagenolytic activity of human dentin.

Aim: The surface roughness of 3 different resin restorative materials polymerized with a halogen and a plasma arc curing light, following finishing and polishing was evaluated in vitro., Methods: Using a metal mold, 10 block specimens were prepared from each material. A Mylar strip was placed on both sides of the mold. Five specimens from each material were cured with the halogen lamp, while the other 5 were polymerized with the plasma arc lamp. In both groups the surface exposed to curing light was finished and polished with the Enhance system (Dentsply). The opposite surface was not treated and served as a control. Both surfaces of each specimen were analyzed with a laser profilometer: the roughness average (R(a)) was evaluated. The Vickers microhardness of the polished surfaces was also calculated. All data were statistically analyzed with the Mann-Whitney test. A regression test was carried out to evaluate the possible correlation between roughness and microhardness., Results: The smoothest surfaces were obtained when composites were cured against a Mylar strip. Roughness was significantly increased in both groups in the treated surfaces. A significant correlation between roughness and microhardness could not be demonstrated., Conclusions: This study demonstrated that the surface polymerized against a Mylar strip was the smoothest surface produced, while the roughness of the Mylar-formed surface was significantly increased by finishing and polishing. Surface roughness following polishing is material-dependent.

It has been found that the pulmonary veins and adjacent left atrial posterior wall (LAPW) are deeply involved in both the initiation and maintenance of atrial fibrillation (AF), and the identification of these high-risk sites has aroused great interest in investigating their histopathologic substrate. We used light and conventional electron microscopy to evaluate the differential myocyte and interstitial changes in LAPW and left atrial appendage (LAA) samples from 28 patients with chronic AF undergoing mitral valve surgery and from 12 autoptic controls. There were always more myocytes with loss of sarcomeres in the LAPW than in the LAA (19.9% +/- 7.7% versus 8.2% +/- 5.0%; P < .0001), and the LAPW showed more marked immunohistochemical evidence of dedifferentiation, characterized by the reexpression of smooth muscle actin. In pathological left atria, myocyte diameter in the LAPW and LAA was comparable (19.0 +/- 1.5 versus 18.5 +/- 2.0 microm; not significant) but larger than in the controls (11.9 +/- 0.8 and 12.1 +/- 1.3 microm, respectively; P < .0001). A terminal deoxynucleotidyltransferase assay did not reveal any myocyte apoptosis. The LAPW also showed more interstitial fibrosis than the LAA (7.49% +/- 3.34% versus 2.80% +/- 1.35%; P < .0001). Ultrastructural examination confirmed the presence of myocyte myocytolysis in the perinuclear area and showed changes in mitochondrial shape. In conclusion, the LAPW in patients with chronic AF related to mitral valve disease seems to be a particular anatomical site in which major myocyte and interstitial changes are concentrated, whereas the LAA is more protected. This remodeling may increase the heterogeneity of LAPW electrical conduction, thus confirming this location as an elective target for the ablation treatment of AF.

All patients undergoing heart surgery experience a certain amount of nonspecific myocardial injury documented by the release of cardiac biomarkers and associated with poor outcome. We investigated the role of unipolar radiofrequency ablation of atrial fibrillation on the release of cardiac biomarkers in 71 patients undergoing mitral valve surgery and concomitant left atrial ablation case-matched with 71 patients undergoing isolated mitral surgery. The study was powered to detect a 3 ng/mL difference. There was no difference between the 2 groups in terms of cardiac troponin I (10 +/- 5.3 versus 12 + 10.4 ng/mL; P = 0.7) or creatine kinase-MB (50 +/- 21.8 versus 57 +/- 62.0 ng/mL; P = 0.5) release. Postoperative peak cardiac troponin I levels had univariate associations with the duration of cardiopulmonary bypass (P = 0.002) and aortic cross-clamping (P = 0.001) and with the surgical technique (15 +/- 12 ng/mL for mitral valve replacement versus 9 +/- 4.8 for mitral valve repair; P = 0.0007) at univariate analysis. Mitral valve replacement was the only independent predictor of postoperative peak release of cardiac troponin I identified with multivariate analysis (P = 0.005). Radiofrequency ablation of atrial fibrillation does not significantly increase cardiac biomarker release compared with isolated mitral surgery; mitral valve repair is associated with less release of cardiac biomarkers compared with mitral valve replacement.

Aim: The aim of the study was to evaluate the reaction exothermia of 2 relining resins for temporary crowns. The resins used were Duralay, a methacrylate-based resin, and Protemp II, a bisacrylic resin., Methods: The coronal parts of an adult molar and of an impacted one were used. Abutments were obtained from the crowns, while the radicular part was sectioned in order to insert a thermocouple into the pulpal chamber. During the experiment the tooth with the polymerising resin was put into an oral cavity simulator to keep a constant temperature. The thermal increase during polymerisation of the 2 resins was recorded for 6 minutes at 5 seconds intervals and with 1 and 2.5 mm dentin thickness (n = 10). Data were statistically analysed by variance analysis with Scheffe test., Results: The intrapulpal thermal increase was significantly higher in relation to the type of resin (Duralay p < 0.0001), thickness (1 mm p < 0.0001) and type of dentin (young dentin p < 00001)., Conclusions: In order to protect the pulp, during the direct relining of a temporary crown, it is recommendable to choose the best combination among resin, type of dentin and its residual thickness, besides adequate cooling techniques.

Aim: The aim of this study was to evaluate the influence of fiber post on all-ceramic prosthetic restorations, using the spectrophotometer Miniscan XE. Data were recorded according to the CIEL*a*b* system and the color difference (DE) was calculated., Methods: Carbon fiber Composipost (RTD) and quartz fiber Lightpost (RTD) posts were used. Square specimens (12x12 mm) were prepared using 9 #1 posts, covered with Z100 (3M) composite layers of different thickness (2, 3 and 4 mm) and color A3; 12x12 mm ceramic specimens (Finesse All Ceramic - 3M) of 2 and 3 mm thickness and color A3, were prepared using both opaque dentin and not., Results: With 2 and 3 mm thick ceramic layers, there was no color difference between carbon fiber specimens and quartz fiber specimens. Using the opaque dentin did not determine difference between groups., Conclusion: In this study, according to results, a 3 mm thick ceramic layer always produced a DE<1, independently from the endodontic post. However, 2 mm thick ceramic layers were able to cover every kind of endodontic posts, even if with a DE=+/-1.6, and therefore are clinically acceptable.

Medium-term results in the treatment of acetabular bone loss using bulk and/or morselized bone allografts supported by acetabular reinforcement rings are reported. A total of 164 hips in 157 patients were treated by means of this reconstruction technique. The devices employed were Müller ARRR in 24 cases and Burch-Schneider APC in 140. Mean follow-up was 67 months (minimum 12, maximum 123). A total of 4 patients developed deep infection that was treated by resection-arthroplasty. Aseptic loosening of acetabular implant following extensive resorption of bone graft was observed in 5 cases: 3 of the cases underwent acetabular revision. Clinical results were evaluated based on the Harris Hip Score: mean values of 35 and 78 were assessed preoperatively and at follow-up, respectively. X-ray signs of incorporation of bone graft were observed in all cases that progressed successfully.

Alveolar rhabdomyosarcoma (ARMS) is associated with the specific chromosomal translocation (2;13)(q35;q14) or its rarer variant t(1;13)(p36;q14), which produces the fusion gene PAX7-FKHR. Here we describe the human cell line RC2, derived from an ARMS, which harbors a cryptic t(1;13)(p36;q14) and concomitantly shows amplification of the PAX7-FKHR fusion gene and of the MYCN oncogene. The t(1;13) and MYCN oncogene were studied by standard cytogenetic analysis and molecular techniques. The reverse transcriptase polymerase chain reaction demonstrated the expression of PAX7-FKHR mRNA in RC2 cells, although karyotype analysis failed to demonstrate a t(1;13)(p36;q14) chromosomal translocation or a derivative 13 chromosome. Double minute chromosomes were detected in all the metaphases studied. Fluorescence in situ hybridization analysis revealed multiple copies of the PAX7-FKHR fusion gene localized exclusively on a subset of double minutes, whereas multiple copies of MYCN were identified on other double minute chromosomes. Southern-blot analysis demonstrated that RC2 cells contain approximately 20 copies of the MYCN oncogene. So far no continuous RMS cell line carrying the t(1;13)(p36;q14) has been described, and PAX7-FKHR and MYCN amplifications have always been reported to occur separately in rhabdomyosarcoma (RMS). The availability of an ARMS cell line that harbors the t(1;13)(p36;q14) constitutes a useful tool for further understanding the role of the PAX7-FKHR fusion gene in RMS oncogenesis and may improve knowledge of the possible relation between PAX7-FKHR and MYCN amplification.

Purpose: This study evaluated the marginal microleakage in bonded amalgam restorations in teeth extracted a month after restoration placement., Materials and Methods: Nine teeth in a patient scheduled for complete extraction were selected. In each tooth, a buccal prepared cavity was treated with Scotchbond Plus and filled with high copper amalgam. In four teeth, a lingual unlined restoration was also prepared as control. A month later, all the teeth were extracted; seven teeth were immersed for 48 hours in a 0.05% basic fucsine dye solution and then sectioned. Sections were observed with a stereomicroscope at 10X. Results were statistically evaluated using a nonparametric Mann-Whitney test for independent data. The remaining two teeth were sectioned and observed using a scanning electron microscope (SEM)., Results: Stereomicroscopic analysis revealed that 80% of bonded specimens did not exhibit dye infiltration at the enamel margin; the same percentage of bonded specimens showed partial infiltration at the cervical margin. In the unlined control specimens, there was a complete dye infiltration at both margins. SEM analysis revealed a good adaptation between resin and tooth and between resin and amalgam., Conclusion: Bonded amalgam restorations are effective in reducing marginal microleakage, particularly at the enamel margin.

Background: Cell-substratum interactions play a peculiar role in cell proliferation, differentiation and migration. They are regulated by various glycoproteins, among which fibronectin, and by receptors connecting cells to the extracellular matrix, i.e. integrins. Therefore, the aim of this study was to correlate the proliferation rates of the human fibroblast line WI-38 cultured in presence of titanium dental implants to cell adhesion capability to substrata., Methods: WI-38 fibroblasts were cultured in presence of four dental implants in titanium (one hydroxyapatite coated) for 48, 72 and 96 hours. Cell proliferation was evaluated by detecting 5-bromodeoxyuridine incorporation. Fibronectin organization and alpha5beta1 integrin expression were evidenced by indirect immunofluorescence., Results: A correlation between fibronectin organization and cell proliferation rates was demonstrated: cultures showing fibronectin mainly organized in fibrils presented the highest cell proliferation degrees. After 96 hours, the observed decrease of the number of proliferating cells corresponded to a different fibronectin organization. In presence of the hydroxyapatite coated implant, colocalization of fibronectin and alpha5beta1 integrin was represented in focal contacts in cultures exhibiting the highest proliferation rate, while cells with the lowest proliferation one expressed alpha5beta1 integrin in point contacts., Conclusions: Evidences obtained in this work showed that both the organization of fibronectin and the expression of alpha5beta1 integrin are strictly correlated to cell proliferation rates. Therefore, these parameters could be useful for evaluating the biocompatibility of dental materials in vitro.

A short-term (72-96 hours) biocompatibility evaluation in vitro of four single phase dental metal alloys was conducted by determining cell proliferation rates correlated to the organization of the extracellular matrix protein fibronectin in human fibroblast cultures. Immunocytochemical methods were performed to detect both cell proliferation rates by 5-bromodeoxyuridine (BrdU) incorporation, and fibronectin arrangement, i.e., diffuse in the extracellular matrix, organized in fibrils or in focal adhesions. We showed that cell proliferation rates were related to fibronectin expression. In particular, a higher percentage of cells in the S-phase were related to a predominance of fibronectin organized both in fibrils and in focal adhesions. The alloy with the highest Au content seemed the most biocompatible among those tested, since it behaved in a very similar manner to the controls. On the contrary, fibroblasts exposed to the alloy with the highest percentage of Ag had the most different behavior as compared to the controls. We can assume that a correlation exists between fibronectin organization and the percentage of BrdU-positive cells and that these parameters are varying with the different metal composition of the alloys. The observation of fibronectin arrangement together with cell proliferation rates could be considered a useful tool to determine the biocompatibility of these biomaterials.

The nature of the bone-implant interface has been much focused in investigating dental implant materials, whereas the relationship between implant and fibroblasts has received much less attention. To evaluate the biocompatibility degree of an implant material, both cell adhesion and cell growth must be tested in the presence of the implant. Four dental implant (A,B,C,D) made in titanium alloy and one of them (C) hydroxyapatite (HA)-coated in fibroblast cultures (48 and 72 h) were tested, by performing immunocytochemical techniques and then by observing fibronectin (FN) arrangement for cell adhesion and counting 5-bromodeoxyuridine (5-BrdU) to evaluate cell proliferation. Different FN arrangements were observed-i.e. organized in fibrils, or in focal adhesion plaques, as well as dispersed in the intercellular space-which varied for the different implants employed at the various culture stages. Equally, the per cent ratio of 5-BrdU positive cells was different, with a more significant increase (p < 0.001) between 48 and 72 h for implant C and the controls. It was observed that the higher percentages of 5-BrdU positive cells were in cultures where FN was organized mainly in focal adhesions, as well as 5-BrdU positive cells increased after 72 h in cultures, which after 48 h presented much FN dispersed in the intercellular space. It may be assumed that a correlation exists between FN arrangement and the percentage of 5-BrdU positive cells and that these two parameters vary in the presence of the different implants. Moreover, the HA-coated implant seems to be the most biocompatible in fibroblast cultures.

A mutation assay in cultured mammalian cells based on the direct analysis of minisatellite DNA was developed. Band pattern variations reflect DNA alterations ranging from single base changes to complex rearrangements. By DNA fingerprinting a large number of autosomal loci throughout the human genome can be simultaneously checked, therefore minimizing the size of the samples of cell colonies to be scored in the absence of phenotypic selection. For the mutation assay chinese hamster cells (V79) were treated with Nitrosoguanidine and 14 independent colonies were isolated and expanded. DNA fingerprints were obtained after digestion of the DNA extracted from each clone with bothHinfI andHae III, and hybridisation with both 33.15 and 33.6 probes. Twelve colonies from untreated cells were also analysed. Several differences in the band pattern of treated colonies were observed when compared with untreated cells; digestion withHae III and hybridisation with 33.15 probe allowed the detection of the highest frequency of induced variants. The results suggest that minisatellite sequences are hypermutable sites that can be used to monitor the mutagenic potential of chemical agents directly at the DNA level, without phenotypic selection. Moreover, with the method herein decribed, it is possible to distinguish between true mutations and epimutations, such as those caused by changes in DNA methylation.