Role of early short-term cardiac rehabilitation in patients undergoing pacemaker implantation

Exercise-based cardiac rehabilitation (CR) improves the clinical outcomes in patients with cardiovascular diseases. However, few data exist regarding the role of early short-term CR in patients undergoing pacemaker (PM) implantation. We assessed whether short-term CR following PM implantation was sufficient to improve both physical function and quality of life (QOL). A total of 27 patients with a 6-minute walking distance (6MWD) of less than 85% of the predicted value on the day following PM implantation were randomly assigned to either the CR group (n = 12, 44.4%) or the non-CR group (n = 15, 55.6%). The CR group involved individualized exercise-based training with moderate intensity for 4 weeks after PM implantation. Cardiopulmonary exercise test (CPET), 6MWD, muscle strength, and Short Form (SF)-36 were assessed at baseline and at the 4-week follow-up. After a mean follow-up period of 38.3 days, both groups showed significantly improved 6MWD. Peak oxygen uptake improved in both groups on CPET, but the difference was not statistically significant. Knee extension power and handgrip strength were similar in both groups. Regarding QOL, only the CR group showed improved SF-36 scores in the items of vitality and mental health. There was no difference in any subscale in the non-CR group. Neither lead dislodgement nor significant changes in PM parameters were observed in any patient. Early short-term CR following PM implantation was associated with improved psychological subscales and can be safely performed without increasing the risk of procedure-related complications.

Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)

OBJECTIVES

Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality.

DESIGN

Retrospective multinational study including SCN diagnosed between 1990 and 2014.

RESULTS

2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1).

CONCLUSIONS

After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN.

TRIAL REGISTRATION NUMBER

IRB 00006477.

Arteriovenous malformation of the pancreas in a patient with gastrointestinal bleeding: helical CT findings

Dynamic computed tomographic (CT) findings of arteriovenous malformation (AVM) of the pancreas include strong enhancement or conglomeration of small hypervascular spots in the pancreas and early contrast filling of the portal vein during the arterial phase. We describe a case with pancreatic AVM in which we identified enlarged arterial feeders and draining veins as supportive findings of the diagnosis and ulceration into the pancreatic duct as a possible cause of gastrointestinal bleeding at contrast-enhanced CT.

A novel splice acceptor mutation in the DSPP gene causing dentinogenesis imperfecta type II

The dentin sialophosphoprotein (DSPP) gene (4q21.3) encodes two major noncollagenous dentin matrix proteins: dentin sialoprotein (DSP) and dentin phosphoprotein (DPP). Defects in the human gene encoding DSPP cause inherited dentin defects, and these defects can be associated with bilateral progressive high-frequency sensorineural hearing loss. Clinically, five different patterns of inherited dentin defects are distinguished and are classified as dentinogenesis imperfecta (DGI) types I, II, and III, and dentin dysplasia types I and II. The genetic basis for this clinical heterogeneity is unknown. Among the 11 members recruited from the studied kindred, five were affected with autosomal dominant DGI type II. The mutation (g.1188C-->G, IVS2-3C-->G) lay in the third from the last nucleotide of intron 2 and changed its sequence from CAG to GAG. The mutation was correlated with the affection status and was absent in 104 unaffected individuals (208 alleles) with the same ethnic and geological background. The proband was in the primary dentition stage and presented with multiple pulp exposures. The occlusal surface of his dental enamel was generally abraded, and the dentin was heavily worn and uniformly shaded brown. The dental pulp chambers appeared originally to be within normal limits without any sign of obliteration, but over time (by age 4), the pulp chambers became partially or completely obliterated. The oldest affected member (age 59) showed mild hearing loss at high-frequency (8 kHz). Permanent dentition was severely affected in the adults, who had advanced dental attrition, premature loss of teeth, and extensive dental reconstruction.

Effect of eccentric load cycling on microleakage of Class V flowable and packable composite resin restorations

Class V composite restorations are subject to the stresses that induce non-carious cervical lesions. This study evaluated the effect of eccentric oblique load on microleakage of restorations. Class V cavities were randomly prepared on the buccal surfaces of 40 recently extracted premolars and restored with composite resin according to manufacturers' directions. Teeth were randomly assigned to one of four treatment groups with 10 teeth per group: (1) flowable resin (Revolution) without load cycling; (2) packable resin (Prodigy Condensable) without load cycling; (3) flowable resin with load cycling (200,000 cycles) and (4) packable resin with load cycling (200,000 cycles). All teeth were then immersed in 2% methylene blue solution for 24 hours after thermocycling (500 cycles). Dye penetration was measured (scores 0-3). The results indicated that adding load cycling significantly increased microleakage (p < 0.05). No significant differences in microleakage were observed for flowable resin vs packable resin. Gingival margins had significantly more microleakage (p < 0.05) than occlusal margins.

In vivo rehardening of enamel eroded by a cola drink

There are many concerns about the erosive effects of acidic beverages. In this study, the effects of Pepsi-Cola (pH 2.41) on bovine enamel and the rehardening effect resulting from intraoral exposure of the teeth were determined by microhardness testing (Vicker's Hardness Number). Bovine enamel specimens (VHN 380.00 +/- 12.74) were immersed in 100 ml of Pepsi-Cola for five minutes and subsequently exposed to human intraoral environment through the use of a removable resin plate. Microhardness testing was performed on specimens after one hour, twenty-four hours and forty-eight hours of exposure to an intraoral environment. The microhardness value was significantly (p < 0.05) reduced by the cola beverage (VHN 262.13 +/- 20.34), and significantly (p < 0.05) increased after intraoral exposure for one hour (VHN 299.75 +/- 26.86) and twenty-four hours (VHN 328.00 +/- 18.70). The difference in the microhardness between the twenty-four-hour group and the forty-eight-hour group (VHN 333.50 +/- 15.13) was not significant (p > 0.05). The microhardness value of the forty-eight-hour group was significantly less than the values recorded during the initial pre-study measurements p < 0.05).

Remineralizing effects of glass ionomer restorations on adjacent interproximal caries

The purpose of this study was to examine the in vitro remineralization of incipient caries lesions on teeth adjacent interproximally to teeth with Class II glass ionomer cement restorations. Sixty-four extracted molars were selected and 1 x 5 mm artificial caries lesions were created at the interproximal contact point. One hundred micrometer sections were obtained at the caries sites, and polarized-light photomicrographs were obtained. The sections were covered with varnish, leaving only the external section site exposed, and were placed back into the original tooth. In another sixty-four molars, Class II cavities were prepared. Equal numbers of preparations were filled with Fuji IX GP, Vitremer, Ketac-Molar, or Z 250. These sixty-four teeth were mounted to have interproximal contact with the adjacent teeth containing the artificial caries lesions. Specimens were placed in closed environments of artificial saliva for one month. After thirty days, the same sections were photographed again under polarized light, and areas of the lesions were quantitated. Decrease in the size of caries lesions indicated the glass ionomers had significantly greater remineralization effects on adjacent caries than the nonfluoridated composite resin (ANOVA p < 0.05). There were no significant differences among the three glass ionomers tested.

Dentin bond strength of packable composites using one-bottle adhesives

PURPOSE

To evaluate the shear bond strength to dentin of packable composites using their respective one-bottle adhesives.

MATERIALS AND METHODS

Human, noncarious extracted permanent molars stored in distilled water were used. Flat buccal and lingual dentin surfaces were ground wet on 600-grit silicon carbide paper. The teeth were then distributed at random into four groups of 8 teeth (16 surfaces) each: Group 1: Gluma Comfort Bond/Solitaire II; Group 2: Bond 1/Alert; Group 3: Prime & Bond NT/Surefil; Group 4: OptiBond Solo/Prodigy Condensable. Group 5: Single Bond/Z250 (control) Cylindrical samples of the materials were prepared in plastic molds and bonded to the dentin surface according to the manufacturers' instructions. All samples were placed in distilled water for 24 hrs, thermocycled for 500 cycles in distilled water at 6 degrees C and 60 degrees C and sheared with a universal testing machine at a crosshead speed of 0.5 mm/min.

RESULTS

In MPa: Group 1: 24.39 +/- 3.54; Group 2: 28.96 +/- 4.62; Group 3: 30.77 +/- 4.71; Group 4: 30.82 +/- 3.29; Group 5: 24.93 +/- 5.14. ANOVA revealed that Groups 1 and 2 were statistically significantly different from the other groups; there was no statistically significant difference between Groups 2, 3 and 4.

Bronchus-associated lymphoid tissue (BALT) lymphoma of the lung showing mosaic pattern of inhomogeneous attenuation on thin-section CT: a case report

The authors present a case of histologically proven bronchus-associated lymphoid tissue (BALT) lymphoma of the lung in a patient with primary Sjögren's syndrome that manifested on thin-section CT scan as a mosaic pattern of inhomogeneous attenuation due to mixed small airway and infiltrative abnormalities