Synthesis and characterization of silica-chitosan hybrid materials as antibacterial coatings for titanium implants

To avoid dental implant-related infections and to promote the osseointegration of titanium implants, the application of silicon and chitosan containing coatings is proposed. Silicon is a well-known osteogenic element and chitosan was selected to confer the antibacterial properties. The synthesis of hybrid silica-chitosan coatings using the sol-gel process is presented and the characterization using ²⁹Si-NMR to verify the correct formation of the network is discussed. The ¹³C NMR spectroscopy was used to confirm the covalent union between chitosan and the silicon network. Hydrolytic degradation and silicon release studies showed the effective silicon release from the hybrids and, hence, the possibility to promote bone formation. The introduction of different amounts of chitosan and tetraethyl orthosilicate (TEOS) modulated the Si release. The analysis of cell cultures in vitro demonstrated that the hybrid coatings were not cytotoxic and promoted cell proliferation on their surfaces. The coatings containing 5%-10% chitosan had substantial antibacterial properties.

A resin composite material containing an eugenol derivative for intracanal post cementation and core build-up restoration

OBJECTIVES

To formulate and evaluate new dual cured resin composite based on the inclusion of eugenyl methacrylate monomer (EgMA) with Bis-GMA/TEGDMA resin systems for intracanal post cementation and core build-up restoration of endodontically treated teeth.

METHODS

EgMA was synthesized and incorporated at 5% (BTEg5) or 10% (BTEg10) into dual-cure formulations. Curing properties, viscosity, Tg, radiopacity, static and dynamic mechanical properties of the composites were determined and compared with Clearfil™DC Core-Plus, a commercial dual-cure, two-component composite. Statistical analysis of the data was performed with ANOVA and the Tukey's post-hoc test.

RESULTS

The experimental composites were successfully prepared, which exhibited excellent curing depths of 4.9, 4.7 and 4.2 mm for BTEg0, BTEg5 and BTEg10 respectively, which were significantly higher than Clearfil™DC. However, the inclusion of EgMA initially led to a lower degree of cure, which increased when measured at 24 h with values comparable to formulations without EgMA, indicating post-curing. The inclusion of EgMA also lowered the polymerization exotherm thereby reducing the potential of thermal damage to host tissue. Both thermal and viscoelastic analyses confirmed the ability of the monomer to reduce the stiffness of the composites by forming a branched network. The compressive strength of BTEg5 was significantly higher than the control whilst flexural strength increased significantly from 95.9 to 114.8 MPa (BTEg5) and 121.9 MPa (BTEg10). Radiopacity of the composites was equivalent to ∼3 mm Al allowing efficient diagnosis.

SIGNIFICANCE

The incorporation of EgMA within polymerizable formulations provides a novel approach to prepare reinforced resin composite material for intracanal post cementation and core build-up and the potential to impart antibacterial properties of eugenol to endodontic restorations.

The synthesis and characterisation of strontium and calcium folates with potential osteogenic activity

New strontium derivatives based on folic acid resulted in the formation of biocompatible SrFO compounds with osteogenic activity.

Evaluation of skeletal tissue repair, part 1: assessment of novel growth-factor-releasing hydrogels in an ex vivo chick femur defect model

Current clinical treatments for skeletal conditions resulting in large-scale bone loss include autograft or allograft, both of which have limited effectiveness. In seeking to address bone regeneration, several tissue engineering strategies have come to the fore, including the development of growth factor releasing technologies and appropriate animal models to evaluate repair. Ex vivo models represent a promising alternative to simple in vitro systems or complex, ethically challenging in vivo models. We have developed an ex vivo culture system of whole embryonic chick femora, adapted in this study as a critical size defect model to investigate the effects of novel bone extracellular matrix (bECM) hydrogel scaffolds containing spatio-temporal growth factor-releasing microparticles and skeletal stem cells on bone regeneration, to develop a viable alternative treatment for skeletal degeneration. Alginate/bECM hydrogels combined with poly (d,l-lactic-co-glycolic acid) (PDLLGA)/triblock copolymer (10-30% PDLLGA-PEG-PDLLGA) microparticles releasing VEGF, TGF-β3 or BMP-2 were placed, with human adult Stro-1+ bone marrow stromal cells, into 2mm central segmental defects in embryonic chick femurs. Alginate/bECM hydrogels loaded with HSA/VEGF or HSA/TGF-β3 demonstrated a cartilage-like phenotype, with minimal collagen I deposition, comparable to HSA-only control hydrogels. The addition of BMP-2 releasing microparticles resulted in enhanced structured bone matrix formation, evidenced by increased Sirius red-stained matrix and collagen expression within hydrogels. This study demonstrates delivery of bioactive growth factors from a novel alginate/bECM hydrogel to augment skeletal tissue formation and the use of an organotypic chick femur defect culture system as a high-throughput test model for scaffold/cell/growth factor therapies for regenerative medicine.

Evaluation of skeletal tissue repair, part 2: enhancement of skeletal tissue repair through dual-growth-factor-releasing hydrogels within an ex vivo chick femur defect model

There is an unmet need for improved, effective tissue engineering strategies to replace or repair bone damaged through disease or injury. Recent research has focused on developing biomaterial scaffolds capable of spatially and temporally releasing combinations of bioactive growth factors, rather than individual molecules, to recapitulate repair pathways present in vivo. We have developed an ex vivo embryonic chick femur critical size defect model and applied the model in the study of novel extracellular matrix (ECM) hydrogel scaffolds containing spatio-temporal combinatorial growth factor-releasing microparticles and skeletal stem cells for bone regeneration. Alginate/bovine bone ECM (bECM) hydrogels combined with poly(d,l-lactic-co-glycolic acid) (PDLLGA)/triblock copolymer (10-30% PDLLGA-PEG-PLDLGA) microparticles releasing dual combinations of vascular endothelial growth factor (VEGF), chondrogenic transforming growth factor beta 3 (TGF-β3) and the bone morphogenetic protein BMP2, with human adult Stro-1+bone marrow stromal cells (HBMSCs), were placed into 2mm central segmental defects in embryonic day 11 chick femurs and organotypically cultured. Hydrogels loaded with VEGF combinations induced host cell migration and type I collagen deposition. Combinations of TGF-β3/BMP2, particularly with Stro-1+HBMSCs, induced significant formation of structured bone matrix, evidenced by increased Sirius red-stained matrix together with collagen expression demonstrating birefringent alignment within hydrogels. This study demonstrates the successful use of the chick femur organotypic culture system as a high-throughput test model for scaffold/cell/growth factor therapies in regenerative medicine. Temporal release of dual growth factors, combined with enriched Stro-1+HBMSCs, improved the formation of a highly structured bone matrix compared to single release modalities. These studies highlight the potential of a unique alginate/bECM hydrogel dual growth factor release platform for bone repair.

[Hospitalization due to eating behavior disorders. Patient and family satisfaction]

OBJECTIVE

In this paper, we assess the quality of an inpatient unit for eating disorders from the patients' and their parents perspective in order to clarify some clinical questions concerning inpatient treatment.

METHOD

A satisfaction questionnaire was designed with open and closed questions separately for the patients and their relatives. The first type of items (53 for patients and 15 for relatives) were analyzed by the standard statistical methods. The second type (one question per questionnaire) was studied with the help of qualitative techniques. It was sent to all discharged patients (n = 299). We obtained the data from the answers (n = 174) and then looked for correlations with factors as compulsory admission at the hospital, age of patients and duration of the disorder.

RESULTS

A high level of general satisfaction was obtained by patients and parents answering the closed questions. The open one, discriminates among shades of meaning. coercive factors, such as compulsory admission, did not affect the level of satisfaction in our study. While most patients were concerned about excessive supervision and lack of privacy, many parents considered control measures as scarce and asked for support upon discharge.

CONCLUSION

Along general lines, hospitalization has been satisfactory for both the patients and their family. Forced admission did not significantly intervene in the subsequent satisfaction of the patient.

[The importance of loss in the genesis of depressive disorders]

BACKGROUND

The role of loss has been carefully examined in the investigation of depression since it constitutes a central aspect of most of the life events that lead to depression.

METHODS

In the present study, a review was made of the different studies on the role of loss, focusing on its different aspects and different types, the association between loss and some mental diseases, loss and prognosis, relationship between hopelessness and loss, variations of the events of loss based on different factors, also considering loss in the childhood.

RESULTS

Loss constitutes a central role in the appearance of many depressive disorders. It can act as a provoking agent, a vulnerability factor or an agent that can modify the form, severity and course of a depressive disorder. Different factors such as the genetic one, gender or moment of life when the loss takes place, can modulate the influence of loss events.

Prevalence of Metabolic Syndrome in Spanish Patients with Schizophrenia and Overweight

Aims:

The metabolic syndrome MS (visceral obesity, dyslipidaemia, hyperglycaemia, and hypertension), has become one of the major public-health challenges worldwide. Patients with schizophrenia are more likely to suffer from MS that the general population. We have analyzed the prevalence of MS in Spanish patients with schizophrenia and overweight.

Methods:

The CRESSOB study is a 12-month, prospective, naturalistic study including 110 community mental health clinics selected at random. Each site enrolled four consecutive patients with diagnosis of schizophrenia, according to DSM-IV TR criteria, and overweight (BMI > 25 Kg/m2). to assess the prevalence of MS we have analyzed the baseline results of the CRESSOB study. the National Cholesterol Educational Program (NCEP-ATPIII), the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definitions were used to established the presence of MS.

Results:

A total of 391 patients were enrolled on the study (mean age 40.5 years, 63.8% men). 75.9% of the patients did not meet criteria for remission, using the selected PANSS items. Mean GAF score was 52.7 (SD 15.4). Using the different criteria, 59.0% of males and 58.3% of females fulfilled the NCEP-ATPIII criteria, 71.1% of males and 65.8% of females fulfilled the IDF criteria and 70.1% of males and 65.1% of females fulfilled the AHA/NHLBI criteria.

Conclusions:

The MS is highly prevalent in Spanish patients with schizophrenia and overweight. Given the metabolic syndrome is an important risk factor for cardiovascular disease, these patients should receive appropriate clinical monitoring for this syndrome.

La artrodesis de las cuatro esquinas con placa circular

Objetivo: La artrodesis de las cuatro esquinas del carpo fue descrita inicialmente para el tratamiento del colapso avanzado del carpo e incluye la extirpación del escafoides y la fusión de los huesos semilunar, piramidal, hueso grande y ganchoso. Se ha utilizado la fijación con placas circulares con el objetivo de conseguir una fijación estable inmediata. El propósito de este estudio es evaluar la efectividad de estas placas en esta artrodesis mediocarpiana y valorar sus indicaciones así como ciertas consideraciones técnicas.

Material y métodos: En este estudio se ha incluido una serie de 20 pacientes intervenidos para practicar una artrodesis de las cuatro esquinas con placa SpiderÒ que presentaban un estadio II ó III de proceso degenerativo avanzado del carpo. También se ha utilizado esta técnica para otras indicaciones como las lesiones osteocondrales de la cabeza del hueso grande, necrosis avascular de la cabeza del hueso grande, artrosis mediocarpiana o inestabilidad mediocarpiana. El seguimiento medio ha sido de 18 meses (R= 8-25).

Resultados y conclusiones: Se ha conseguido el 100% de consolidaciones, y una importante disminución del dolor en todos los casos, manteniéndose una flexión palmar postquirúrgica de 34º (R= 12-45º); una flexión dorsal de 29º (R= 12-45º); una desviación radial postoperatoria de 12º (R= 0-16º) y una desviación cubital de 17º (R= 0-20º). Se apreció un aumento de la fuerza de agarre tras la cirugía y todos los pacientes volvieron a sus actividades previas.

Esta técnica quirúrgica ofrece una fijación estable inmediata que permite una movilización precoz tras la cirugía. Es importante el relleno de injerto de escafoides o cresta iliaca en los espacios entre los huesos a artrodesar.

[Chinese Polarity Inventory: its adaptation to our setting]

INTRODUCTION

The Chinese Polarity Inventory (CPI) is a self-report scale for bipolar disorder assessment, composed of two scales (mania and depression), with 20 items for each one.

OBJECTIVES

Translate, adapt and validate the CPI to our context.

MATERIAL AND METHODS

The questionnaire was applied to 123 patients: bipolar disorder in the manic phase (32), depressed (17), remission (30) and mixed state (3). We also established a control group with 30 patients without affective disorder. Internal consistency was assessed using Cronbach's alpha. On the other hand, validity was established using the Clinician Administered Rating Scale for Mania (CARS-M) in manic patients and the Hamilton scale in the depressed ones as a gold standard.

RESULTS

This scale has good psychometrics qualities. Internal consistence index (Cronbach's alpha) for the manic scale was 0.90 and for depression scale was 0.92. The correlation coefficient between the manic scale and the CARS-M was 0.82 and between the depression scale and the Hamilton scale was 0.67.

CONCLUSIONS

The CPI is an instrument of rapid and easy application that permits self-report of bipolar disorders. The best benefit for this scale is the possibility of application in the entire course of illness, for clinical and investigation activities and assessment of the treatment response.

[Results of a program of presymptomatic diagnosis of Huntington's disease: evaluation of a 6 year period]

OBJECTIVE

To know the uptake of predictive testing of Huntington's disease, the characteristics of the applicants, as well as the consequences for them.

METHODS

Prospective observational study between January of 1994 and December of 1999 of the predictive testing applicants who entered in the protocol consisted of: informative interview, psychiatric interview, blood extraction for molecular study, as well as outcome and follow-up interviews.

RESULTS

There were 87 applicants with a 50% risk. The mean age of the applicants was 28 years (SD = 7). Thirty one per cent already had children in the moment of predictive testing. The application rate according to the estimate population with 50% risk for the Comunidad Valenciana is 13,4%. The rate varies depending on the access to the information of the population in risk, being of 24,7% when they have direct access and of 8,3% when they do not have it (p < 0,01). Forty per cent did not come to the post-outcome visit, the positive or negative result for the mutation not influencing over it. Only 6,8% had some adverse event in the six years of follow-up all being slight.

CONCLUSIONS

The application rate is determined by the access to the information of the population in risk. The fulfilment of the protocol designed for presymptomatic diagnosis of Huntington's disease keeps the adverse events presentation to a minimum.

[Adaptation of the clinician-administered rating scale for mania]

INTRODUCTION

There is no mania rating scale properly adapted in Spain, and it's a true problem in research.

METHODS

The adaptation process has been the following one: The authors start from CARS-M of Altman et al. First the carry out the translation and back translation which was revised by the author of the scale. Then they fullfill some previous training with video filming and lastly they apply the scale to a group of 24 patients.

RESULTS

The Clinician-Administered Rating Scale for Mania (CARS-M) shows good psychometric proprieties among those its internal consistency of the scale, the interobservers reliability, and the item-total correlation. These results are lightly worse in the psychoticism sub-scale.

CONCLUSIONS

This rating scale for mania show itself as a useful instrument in clinic and research.

[Evaluation of two methods to avoid the nephropathy associated with radiologic contrast]

Our objective was to establish the efficacy of two methods to avoid contrast associated nephropathy (C.A.N). We studied in prospective and randomized form a sample of 75 patients of whom 25 were assigned to the

CONTROL GROUP

without interventions; 25 to the Saline group: 0.45% saline solution I.V., 1.5 cc/kg/min, 6 hours before and after the angiographic study and 25 to the Dopa group: equal procedure plus the aggregate of dopamine 2 micrograms/kg/min, 30 minutes before the study until the termination. The evaluation effected at patient's entry was considered T0, T1, 24 hs after the T2, 48 hs after. In T0 was registered: age, sex, pathological antecedents, drugs and plasmatic creatinine, and in T2 creatinine. An increase of 25% of the plasmatic creatinine in T2 was considered as C.A.N. The latter was present in 13/25 (OR: 1) CONTROL GROUP patients, 7/25 (OR 0.36), Salina group patients and in 5/25 (OR 0.23) Dopa group patients (p = 0.01). No significant difference was registered in the urinary output nor in the plasmatic creatinine levels. It is concluded that hydration during six hours before and after the study with 0.45% saline solution and the same plan with the aggregate of dopamine are effective to prevent a C.A.N.

The efficacy and tolerability of venlafaxine and paroxetine in outpatients with depressive disorder or dysthymia

A 24-week, double-blind, randomized trial was performed to compare the efficacy and tolerability of venlafaxine and paroxetine in patients with major depression or dysthymia. Outpatients aged 18-70 years with a baseline score of 17 on the 21-item Hamilton Depression Rating Scale (HAM-D) were eligible. Patients were randomly assigned to venlafaxine, 37.5 mg, in the morning and evening or paroxetine, 20 mg, in the morning and placebo in the evening, which could be increased to venlafaxine, 75 mg twice daily, or paroxetine, 20 mg twice daily, after 4 weeks. Efficacy was assessed with the 21-item HAM-D, the Montgomery-Asberg Rating Scale, the Hamilton Anxiety Rating Scale, and the Clinical Global Impressions Scale. Forty-one patients were randomized to venlafaxine and 43 to paroxetine. At week 6, a response was observed in 55% of patients on venlafaxine and 29% on paroxetine (P = 0.03). At week 12, significantly (P = 0.011) more patients in the venlafaxine group had a HAM-D remission score of 8 or less (59% versus 31%). Discontinuation for any reason occurred in 16 (39%) patients on venlafaxine and 11 (26%) on paroxetine. The most common adverse events were nausea (28%), headache (18%) and dry mouth (15%) with venlafaxine and headache (40%) and constipation (16%) with paroxetine. Venlafaxine was effective and well tolerated for the treatment of patients with mild to moderate depression or dysthymia. A consistently higher proportion of patients had a response or remission on venlafaxine than on paroxetine.

Habituation and sensitization processes in depressive disorders

The aim of the present study was to investigate further into habituation and sensitization processes in depressive disorders. The depressive subjects were 27 outpatients. All of them were diagnosed according to DSM-III-R criteria. Controls were 27 normal subjects. The amplitudes of electrodermal responses and the basal levels were recorded during a stimuli series of 15 80-dB tones and of 1 100-dB tone in the 11th trial. The depressive patients displayed lower basal conductance levels and lower conductance amplitudes in orienting responses to the first stimulus and to stimulus change. No differences were found in conductance response amplitudes of stimuli series, although a tendency towards smaller conductance amplitudes in depressive patients was observed before stimulus change. A trend towards habituation was detected in both groups, but no differences between them were present, neither the habituation velocity of depressives was found to be unlike normals. Our results display lower responsivity in depressive patients, which reflects alterations in the sensitization process.

Prevalence of psychopathology in burning mouth syndrome. A comparative study among patients with and without psychiatric disorders and controls

Forty-nine patients with burning mouth syndrome were simultaneously evaluated through a psychiatric interview and a psychopathologic questionnaire (SCL-90). The same protocol was applied to a control group (n = 47) free of oral complaints and with a similar age and sex distribution. The subgroup with burning mouth syndrome and associated psychiatric disorders differed from the subgroup of patients without psychiatric disorders in that the former exhibited significantly more symptoms of anxiety, depression, obsession, somatization, and hostility. This latter parameter appears to be present particularly among depressed persons. No significant psychopathologic differences were observed between the subgroup with BMS who exhibited no psychiatric disorders and the controls who were free of oral disorders.

Psychiatric morbidity in burning mouth syndrome. Psychiatric interview versus depression and anxiety scales

Seventy-four patients with burning mouth syndrome underwent a psychiatric interview; Hamilton's Depression and Anxiety Scales were applied independently. A psychiatric diagnosis was established in 38 cases (51.35%). Depression was the predominant disorder. The evaluation scales showed that when present, anxiety greatly influences the psychiatric condition of these patients. The differences in the results obtained with the two methods are discussed.