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Background/Aim. The studies of hydroxyapatite (HAp) and growth factors as the materials used for direct pulp capping have produced conflicting results for both the issue of the inflammatory response and the issue of calcified bridge formation. Hap/poly (lactide-co-glycolide) (HAp/PLGA) is a bioresorbable polymer with demonstrated good characteristics as the carrier for the bone morphogenetic protein necessary in bone tissue regeneration. The role of growth factors in dental tissue reparation (in both reactionary and reparative dentinogenesis) represents the new foundation and provides a different approach to dental pulp treatment. Growth factors – transforming growth factor beta-1 (TGF-β-1) – directly induce morphological and functional differentiation of neo-odontoblasts. The aim of this study was to investigate the effect of calcium HAp/PLGA and growth factors (TGF β-1) in the formation of a calcified tissue – dentine bridge – on the teeth of our experimental model. Methods. In this experimental study, rodent (rabbit) teeth were used as the animal model. After the trepanation of pulp space with sterile steel drills, the pulp was capped with calcium HAp/PLGA (experimental group I; n = 60); calcium HAp/PLGA combined with TGF β-1 growth factor (experimental group II; n = 60), and there was a control group of intact teeth (n = 20). The experiment was performed in general anesthesia. The animals were kept alive for 1, 3, and 6 months. The extracted teeth were adequately prepared for scanning electron microscopy. Results. Scanning electron microscopy demonstrated that the number of teeth with calcified tissue in the form of dental bridges in the HAp/PLGA+TGF β-1 group, 6 months after the treatment, was statistically significantly greater (66.67%) than after 3 months (26.67%), at the statistical significance level of p < 0.05. Conclusion. Direct pulp capping covers the artificially exposed dental pulp and makes possible the formation of a dentine bridge (a tubular structure composed of reparative dentine) in the period of 3 months.

Background/Aim. Although apicoectomy is performed routinely and yields excellent results, a close patient observation during the postoperative course is desirable in order to avoid possible complications. The aim of this study was to investigate the adequacy of postoperative control visits a day after surgery using the store-and-forward telemedicine method compared to the clinical in-person controls. Methods. A total of 122 apicoectomies were performed during 115 dental surgery interventions. The follow-up dental ex-amination a day after apicoectomy consisted of reviewing extraoral and intraoral photographs on the internet and re-viewing responses to the questionnaire. After that, patients were examined in-person. Cohen’s kappa („store-and-forward” method) coefficient, diagnostic sensitivity (SE), sensitivity (SP), and efficiency (EFF) were determined. Statistical comparisons were performed using the Z-test, and nonparametric characteristics were tested using McNemar’s χ2-test at the statistical significance cut-off value of p = 0.05. Results. There were 106 (92%) patients seen at the control dental examination. The agreement between in-person and store-and-forward telemedicine method was found in 104 (98%) cases. The obtained agreement values (K = 0.85, S = 0.99, SP = 0.86, EFF = 0.98) indicated an almost complete diagnostic agreement. Conclusion. Based on the internet transmission of patients’ digital photographs and ac-companying patient medical history records, the study showed that the in-person control dental examinations a day after surgery can be successfully replaced with the remote store-and-forward method of telemedicine.

Background/Aim. Hydroxyapatite (HAp) is one of the most commonly used calcium phosphate bioceramics with osteoconductive properties. Growth factors are capable of directly inducing morphological and functional differentiation of neodontoblasts. The aim of this study was to investigate the effectiveness of HAp-based biomaterial in combination with transforming growth factor-β1 (TGF-β1) in the creation of new dentine and obturation of the root canal apex in the teeth of an experimental animal model. Methods. Rodent (rabbit) teeth were used as the experimental animal model. After pulp removal with a pulp extirpator in vital pulpectomy, the biomaterial was applied using a Lentulo spiral in the apex portion at the level of the physiological foramen apicale. The experiment was performed in general anesthesia. Animals were kept alive for 3, 6, and 12 months after the treatment. The extracted teeth were analyzed by scanning electron microscopy (SEM). Results. Using SEM, it was found that the number of teeth with newly created dentine and apex canal obturation was greater 12 months after the treatment. Conclusion. Apex obturation of the dental root canal with newly created dentine took place in our experimental groups treated by biomaterial with or without TGF-β1.

Background/Aim. Identification of caries risk indicators involved in the disease development is of great importance. The aim of this study was to assess the association between distinctive risk indicators and different stages of caries disease process in children. Methods. The cross-sectional study was conducted on a sample (n = 327) of school children ages 7–11. A questionnaire submitted to parents was used to record the data regarding demographic characteristics, children's dietary habits, oral hygiene habits and oral health behaviors. Caries was assessed using the International Caries Detection and Assessment System (ICDAS) II and subjects were stratified according to the highest and most prevalent caries lesion stage. The data obtained were analyzed using the χ2 or Fisher`s exact test and multinomial logistic regression. Results. Caries lesions were detected in 56.6% of examinees observed in the study. Compared to caries-free subjects, appearance of initial caries lesions was statistically significantly influenced by maternal education level (p = 0.021), paternal occupational status (p = 0.023), toothbrushing frequency (p < 0.001), and caries status of deciduous teeth (p = 0.027). Maternal educational level (p = 0.026), paternal occupational status (p = 0.003), sweets and snacks taking frequency (p = 0.005), toothbrushing frequency (p < 0.001), and fluoridate dentifrice usage (p = 0.027) were associated with moderate caries lesions. Maternal educational level (p < 0.001), sweets and snacks taking frequency (p = 0.022) and toothbrushing frequen-cy (p < 0.001) were associated with extensive caries lesions. Maternal educational level (p = 0.02) and brushing frequency (p < 0.001) were statistically significantly associated with the highest prevalence of initial caries lesions. Maternal educational level (p = 0.025), toothbrushing frequency (p < 0.001) and frequency of dental check-ups (p = 0.016) were statistically significantly associated with the highest prevalence of moderate caries lesions. Conclusion. Parental socioeconomic indicators and children's behavior related to oral health were involved in the changes from caries-free status to different caries stages.

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Introduction: Direct and indirect pulp capping is a therapeutic procedure to preserve the tooth's vitality. The aim was to scan electron and polarization microscopy: analyze changes in cellular and extracellular components of dental pulp after direct and indirect overlay with glass-ionomer cement (GIC), determine the appearance of the dentine surface after direct and indirect pulping overlap with GIC and forms a proposal for a clinical application of preparations if it provides good and effective dentingenesis. Methods: The experiment was performed on experimental animals (domestic swine). For this research, alkaline cement was used ALFAGAL* bejz. On the teeth of the experimental group, preparations of the V class were made from the vestibular side. Twenty-two teeth were made indirectly, and twenty -two teeth directly covered with pulp. After completion of the preparation, dentin is directly covered with glass-ionomer cement (GIC) Alfagal* bejz. Through the ALFAGAL material for definitively closing cavities ( amalgam) is l aid. On the teeth where the perforation of the pulp chamber was made, ALFAGAL bejz was loaded directly into the pulp chamber, and through this the cavity was definitely sealed with GIC FUJI IX (GC Japan). Suitably prepared teeth and pulp were observed by SEM and a polarization microscope. Results: By observing and analyzing the obtained results, on a polarization and scanning electron microscope compared to the control group, results were obtained which can have a significant clinical implication in the biological treatment of the pulp. Alfagalbejz is directly applied in the pulp chamber: the boundary between newly developed reparative dentine is detected in the normal dentine structure, amorphous dentine, reproduction of connective tissue cells without pro inflammatory reactions and initial dedifferentiation in odontoblast, young blood vessels and cells (fibrocytes, histiocytes and fibroblasts) are observed. Indirectly applied Alfagal* bejz indicates the presence of different maturation stages of dentin, dentinal canals are clearly visible with a normal dentin structure, zero amorphous dentine and immature dentine structure are observed as well. The presence of an amorphous calcite of the dentine structure indicates the initial creation of a solid tissue barrier, which is the goal of the experiment. Conclusion: The results obtained by experimental research suggest ALFAGAL bejz as a good material for the direct and indirect overlap of the pulp.

Correlation of fillings on the tooth and changes in the tissues having direct contact with the tooth aroused keen interest amongst many professionals. Irregularly shaped fillings can damage the periodontal tissues. The primary indicator of the validity of the dental work is its ability to ensure the preservation of normal physiological status of the tissue, primarily gingival, alveolus and periodontum. The main purpose of this paper is to make histological assessments of the tissue of the interdental region before and after correction of irregular filling in experimental animals. The research was conseived as a histological study with experimental animals ( rabbits). The tested teeth were divided into two groups: a) the experimental group consisted of teeth with irregular fills, and b)the control group consisted of teeth with regular fillings and healthy teeth. The experiment carried out under general anesthesia. The experiment was being monitored over 12-month period. Having been expired the first part of the experiment , after 6-month period, in experimental animals, it was carried out the second part of the one consisting of the correction of irregular fillings. The second part of the experiment was closely monitored a month, three and six months after the correction of irregular filings. After sacrificing the animals, tissue was prepared for histological analysis. Histological analysis showed changes in the periodontal tissues prior to correction of irregular fillings and significant improvement of the tissue of the interdental region after correction of the same ones. The pathological changes occuring in the periodontal tissues are not irreversible since after correction of irregular filligs are being lost mainly.

When pulp tissue gets exposed, therapy procedures are supposed to promote healing and to ease forming of reparative dentin in order to preserve vitality and health of the pulp. Vital pulp therapy (VPT) procedure includes removal of the local irritants as well as application of protective materials directly or indirectly on tooth pulp. Vital pulp therapy may be used for the treatment of the reversible pulp diseases in order to promote root development and to form apical region which will ensure correct endodontic tooth treatment in later stages. There are numerous controversies concerning vital pulp therapy but mostly related to the choice of the materials, correct technique and evaluation of the final therapy results. The goal of the experimental research is to use scanning electron and polarized microscopy to analyze modifications on cellular and extracellular components of the tooth pulp after direct and indirect overlaying with materials on the calcium hydroxide basis (Calcimol VOCO USA). We will also determine the appearance of dental surface after direct and indirect overlaying and if Calcimol proves good and effective in dentinogenesis, we will propose it for clinical usage. Research has been conducted on experimental animals (pig). Materials used in this research were on calcium hydroxide - base, Calcimol. V class preparation has been applied on the teeth of the experimental group. Eleven teeth have been overlaids directly and the same number of teeth has been overlaid indirectly. After the preparation, materials based on calcium hydroxide have been applied and cavity has been closed with materials from the glass ionomer cement group (FUJI IX GC Japan). Teeth that were treated with pulp perforation had their chambers filled with materials on calcium hydroxide-base and their cavities were closed with glass ionomer cement (FUJI IX GC Japan). Correctly prepared teeth have been observed with SEM and polarization microscopes. Observing and analyzing of the results with polarization and scanning electron microscope in comparison with control group showed that gained results may have significant clinical implication in biological pulp treatment. Directly applied Calcimol observed through polarization microscope points to intensive changes in blood vessels and beginnings of erythrocyte disintegration, distinct extravasation, and appearance of the small necrotic spots. SEM analyzes shows contact of the amalgam-Calcimol without new amorphous dentinal structures. Indirectly applied Calcimol observed through polarization microscope points to newly formed dentinal structures, calcification cores surrounded by huge cells and blood vessels presence. SEM analyzes shows clear border between newly formed dentinal tubules and ordinary dentinal structure. Gained results suggest application of the Calcimol as a material for indirect pulp overlay while its application in indirect overlay isn't indicated.

Introduction. The optimal revascularization strategy for unprotected left main coronary disease (ULMCD) is the subject of ongoing debate and patients with ULMCD still represent a challenge for interventionalist, especially in the setting of an acute coronary syndome (ACS). Case report. We presented two cases of percutaneous treatment of ULMCD in the settings of ACS (ST Segment Myocardial Infarction and Non ST Segment Myocardial Infarction - STEMI and NSTEMI) in a catheterization laboratory without back-up of cardiosurgical department. Both patients were hemodynamically unstable with clinical signs of cardiogenic shock. Coronary angiography revealed left main thromobosis and using intra-aortic balloon pump as hemodynamic support primary angioplasty procedures were performed. Immediately after the procedures the patients hemodynamically improved and remained stable till discharge from hospital. Conclusion. Percutaneous coronary intervention (PCI) has become the most common strategy of revascularization in ACS patients with ULMCD and is generally preferred in patients with multiple comorbidities and/or in very unstable patients. In cases with no cardiosurgical departments PCI is an inevitable, bail-out, life saving procedure.

Introduction. Research of effects that irregular interproximal dental restoration have on supporting structures of the teeth and examination of evolution and course of changes in tissue structure is quite a poorly studied topic. Aim of this study is to examine and assess clinical and radiological changes in periodontal tissue caused by irregular interproximal dental restoration in particular group of patients with different age and sex. Methods. Irregularities which were assesed in this study are divided into two groups: a) gap (cracks) occurring between dental restorations and the gingival walls in Class II cavities, b) prominence of dental fillings out of the teeth anatomical sphere, resulting with the positive step in gum third of tooth in Class II cavities. The study was based on whether in the particular forms of irregularities of the dental restorations are differences in the degree of change in the periodontal tissue, depending on the material from which the restoration is made, and the materials used were composite fillings and amalgams. Results of this study show that irregular dental fillings significantly affect the inflammatory response in periodontal tissue. Irregularities in the form of unfilled space cause major changes in periodontal tissue. Composite fillings cause a higher degree of inflammation in relation to amalgam fillings. Conclusion. Improper tooth fillings cause periodontal tissue damages.

Bacground/Aim. Chronic heart failure (CHF) is highly prevalent and constitutes an important public health problem around the world. In spite of a large number of pharmacological agents that successfully decrease mortality in CHF, the effects on exercise tolerance and quality of life are modest. Renal dysfunction is extremely common in patients with CHF and it is strongly related not only to increased mortality and morbidity but to a significant decrease in exercise tolerance, as well. The aim of our study was to investigate the prevalence and influence of the renal dysfunction on functional capacity in the elderly CHF patients. Methods. We included 127 patients aged over 65 years in a stable phase of CHF. The diagnosis of heart failure was based on the latest diagnostic principles of the European Society of Cardiology. The estimated glomerular filtration rate (eGRF) was determined by the abbreviated Modification of Diet in Renal Disease (MDRD2) formula, and patients were categorized using the Kidney Disease Outcomes Quality Initiative (K/DOQI) classification system. Functional capacity was determined by the 6 minute walking test (6MWT). Results. Among 127 patients, 90 were men. The average age was 72.5 ± 4.99 years and left ventricular ejection fraction (LVEF) was 40.22 ± 9.89%. The average duration of CHF was 3.79 ± 4.84 years. Ninty three (73.2%) patients were in New York Heart Association (NYHA) class II and 34 (26.8%) in NYHA class III. Normal renal function (eGFR ≥ 90 mL/min) had 8.9% of participants, 57.8% had eGFR between 60-89 mL/min (stage 2 or mild reduction in GFR according to K/DOQI classification), 32.2% had eGFR between 30-59 mL/min (stage 3 or moderate reduction in GFR) and 1.1% had eGFR between 15-29 mL/min (stage 4 or severe reduction in GFR). We found statistically significant correlation between eGFR and 6 minute walking distance (6MWD) (r = 0.390, p < 0.001), LVEF (r = 0.268, p < 0.05), NYHA class (ς = -0.269, p < 0.05) and age (r = - 0.214, p < 0.05). In multiple regression analysis only patients’ age was a predictor of decreased 6MWD < 300 m (OR = 0.8736, CI = 0.7804 - 0.9781, p < 0.05). Conclusion. Renal dysfunction is highly prevalent in the elderly CHF patients. It is associated with decreased functional capacity and therefore with poor prognosis. This study corroborates the use of eGFR not only as a powerful predictor of mortality in CHF, but also as an indicator of the functional capacity of cardiopulmonary system. However, clinicians underestimate a serial measurement of eGFR while it should be the part of a routine evaluation performed in every patient with CHF, particularly in the elderly population.

Introduction. Dislodgement and embolization of the new generation of coronary stents before their deployment are rare but could constitute a very serious complication. Case Outline. We report a case of a stent dislodgement into the left main coronary artery during the primary coronary intervention of infarct related left circumflex artery in a patient with acute myocardial infarction. The dislodged and unexpanded bare-metal stent FlexMaster 3.0x19 mm (Abbot Vascular) was stranded and bended in the left main coronary artery (LMCA), probably by the tip of the guiding catheter, but stayed over the guidewire. It was successfully retrieved using a low-profile Ryujin 1.25x15 balloon catheter (Terumo) that was passed through the stent, inflated and then pulled back into the guiding catheter. After that, the whole system was withdrawn through the 6 F arterial sheath via the transfemoral approach. After repeated cannulation via the 6F arterial sheath, additional BMW and ATW guidewires were introduced into the posterolateral and obtuse marginal branches and a bare-metal stent Driver (Medtronic Cardiovascular Inc) 3.0x18 mm was implanted in the target lesion. Conclusion. Stent dislodgement is a rare but potentially life-threatening complication of the percutaneous coronary intervention. This incident occurring in the LMCA in particular during an acute myocardial infarction requires to be urgently resolved. The avoidance of rough manipulation with the guiding catheter and delivery system may help in preventing this kind of complications.

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Introduction. Ectopic cervical thymus (ECT) occurs as a result of incomplete migration of the thymic primordia during embryogenesis. In the majority of cases, ECT is asymptomatic; however, in 10% of patients, there are different kinds of symptoms. Case report. A four-month-old baby boy was referred to our clinic for an evaluation of a growing large mass on the right side of the neck, present since birth. Physical examination revealed a solid, painless, soft, moderately mobile mass of irregular round shape localized on the right side of the neck, in front of the sternocleidomastoid muscle, below the parotid gland, and above the carotid lodge. The skin above the mass was unchanged. The dimensions of the mass were 40 × 32 × 15 mm. Based on the clinical and ultrasonographic findings, as well as the findings of the magnetic resonance imaging, it was suspected that the mass was an ECT. The mass was removed by surgical excision. The pathohistology report confirmed the presence of an ECT, with Hassall’s corpuscles in the medulla. The postoperative course went smoothly, and the wound healed well. During the regular clinical, immunological, and ultrasound follow-ups over a period of six months, normal findings were registered. Conclusion. Congenital ECT is a rare congenital anomaly that must be, however, taken into account when considering the differential diagnosis of cervical tumor masses.

Introduction. Microtia presents a congenital ear deformity ranging from a minor and barely visible defect to a complete absence of the ear. Currently, there are three options for ear reconstruction: autologous costal cartilage, silicon prothesis, and prosthetic ear. Ear reconstruction with autologous costal cartilage is usually performed in two stages. During the first stage, the cartilaginous framework is fabricated and placed under the skin, in the anatomical position of the ear. In the second stage, the elevation of the frame is performed. During these procedures, complications such as vascular compromise of the skin envelope can occur. Cartilage exposure can lead to its resorption and distortion, leading to an unsatisfactory anatomical result, and this should be resolved as soon as possible. Cartilage exposure at the convex part of the frame is especially problematic. The goal of this paper is to show that fascial turnover flap is a safe method to deal with cartilage exposure as a complication. Outlines of cases. We present two patients with anotia and hemifacial microsomia. Both underwent autologous cartilage microtia repair. In both patients, the cartilage exposure at the convex part of the ear was revealed as a complication. Fascial turnover flap has been used to resolve this complication in both patients. Conclusion. Fascial turnover flap is a safe method to deal with cartilage exposure after microtia reconstruction with autologous cartilage.

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Copyright of Acta Medica Medianae is the property of Acta Medica Medianae and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The paper deals with the nature of totalitarian societies in Anthony Burgess' A Clockwork Orange and Margaret Atwood's The Handmaid's Tale. Apart from the fundamental characteristics and values of these societies, as well as the particular views of both a male and a female writer on this subject, the paper analyzes the relationship between dystopian and real modern societies through various authors' observations. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Medianae is the property of Acta Medica Medianae and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)