Regenerative endodontics: a comprehensive review Kim, S. G.; Malek, M.; Sigurdsson, A. ...
International endodontic journal,
December 2018, 2018-Dec, 2018-12-00, 20181201, Letnik:
51, Številka:
12
Journal Article
Recenzirano
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing ...literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet‐rich fibrin have been utilized in regenerative endodontics. This approach has been described as a ‘paradigm shift’ and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient‐centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.
Although the therapeutic benefit of proteasome inhibition in multiple myeloma remains unchallenged, drug resistance inevitably emerges through mechanisms that remain elusive. Bortezomib provokes ...unwanted protein accumulation and the endoplasmic reticulum stress to activate the unfolded protein response (UPR) and autophagy as compensatory mechanisms that restore protein homeostasis. High-throughput screens to detect pharmacologics that modulated autophagy to enhance the anti-myeloma effect of bortezomib revealed metformin, a widely used antidiabetic agent with proven efficacy and limited adverse effects. Metformin co-treatment with bortezomib suppressed induction of the critical UPR effector glucose-regulated protein 78 (GRP78) to impair autophagosome formation and enhance apoptosis. Gene expression profiling of newly diagnosed myeloma patient tumors further correlated the hyperexpression of GRP78-encoding HSPA5 with reduced clinical response to bortezomib. The effect of bortezomib was enhanced with metformin co-treatment using myeloma patient tumor cells and the chemoresistant, stem cell-like side population that may contribute to disease recurrence. The relevance of the findings was confirmed in vivo as shown by metformin co-treatment with bortezomib that delayed the growth of myeloma xenotransplants. Taken together, our results suggest that metformin suppresses GRP78, a key driver of bortezomib-induced autophagy, and support the pharmacologic repositioning of metformin to enhance the anti-myeloma benefit of bortezomib.
Atherosclerosis, the leading cause of death in the developed world and nearly the leading cause in the developing world, is associated with systemic risk factors including hypertension, smoking, ...hyperlipidemia, and diabetes mellitus, among others. Nonetheless, atherosclerosis remains a geometrically focal disease, preferentially affecting the outer edges of vessel bifurcations. In these predisposed areas, hemodynamic shear stress, the frictional force acting on the endothelial cell surface as a result of blood flow, is weaker than in protected regions. Studies have identified hemodynamic shear stress as an important determinant of endothelial function and phenotype. Arterial-level shear stress (>15 dyne/cm2) induces endothelial quiescence and an atheroprotective gene expression profile, while low shear stress (<4 dyne/cm2), which is prevalent at atherosclerosis-prone sites, stimulates an atherogenic phenotype. The functional regulation of the endothelium by local hemodynamic shear stress provides a model for understanding the focal propensity of atherosclerosis in the setting of systemic factors and may help guide future therapeutic strategies.
Reference evapotranspiration (ET0) plays a fundamental role in irrigated agriculture. The objective of this study is to simulate monthly ET0 at a meteorological station in India using a new method, ...an improved support vector machine (SVM) based on the cuckoo algorithm (CA), which is known as SVM-CA. Maximum temperature, minimum temperature, relative humidity, wind speed and sunshine hours were selected as inputs for the models used in the simulation. The results of the simulation using SVM-CA were compared with those from experimental models, genetic programming (GP), model tree (M5T) and the adaptive neuro-fuzzy inference system (ANFIS). The achieved results demonstrate that the proposed SVM-CA model is able to simulate ET0 more accurately than the GP, M5T and ANFIS models. Two major indicators, namely, root mean square error (RMSE) and mean absolute error (MAE), indicated that the SVM-CA outperformed the other methods with respective reductions of 5-15% and 5-17% compared with the GP model, 12-21% and 10-22% compared with the M5T model, and 7-15% and 5-18% compared with the ANFIS model, respectively. Therefore, the proposed SVM-CA model has high potential for accurate simulation of monthly ET0 values compared with the other models.
The efficient utilization of hydropower resources play an important role in the economic sector of power systems, where the hydroelectric plants constitute a significant portion of the installed ...capacity. Determination of daily optimal hydroelectric generation scheduling is a crucial task in water resource management. By utilizing the limited water resource, the purpose of hydroelectric generation scheduling is to specify the amount of water releases from a reservoir in order to produce maximum power, while the various physical and operational constraints are satisfied. Hence, new forms of release policies namely, BSOPHP, CSOPHP, and SHPHP are proposed and tested in this research. These policies could only use in hydropower reservoir systems. Meanwhile, to determine the optimal operation of each policy, real coded genetic algorithm is applied as an optimization technique and maximizing the total power generation over the operational periods is chosen as an objective function. The developed models have been applied to the Cameron Highland hydropower system, Malaysia. The results declared that by using optimal release policies, the output of power generation is increased, while these policies also increase the stability of reservoir system. In order to compare the efficiency of these policies, some reservoir performance indices such as reliability, resilience, vulnerability, and sustainability are used. The results demonstrated that SHPHP policy had the highest performance among the tested release policies.
Aims
Alzheimer's disease (AD) is characterized by degeneration of cholinergic basal forebrain (CBF) neurons in the nucleus basalis of Meynert (nbM), which provides the major cholinergic input to the ...cortical mantle and is related to cognitive decline in patients with AD. Cortical histone deacetylase (HDAC) dysregulation has been associated with neuronal degeneration during AD progression. However, whether HDAC alterations play a role in CBF degeneration during AD onset is unknown. We investigated global HDAC protein levels and nuclear HDAC2 immunoreactivity in tissue containing the nbM, changes and their association with neurofibrillary tangles (NFTs) during the progression of AD.
Methods
We used semi‐quantitative western blotting and immunohistochemistry to evaluate HDAC and sirtuin (SIRT) levels in individuals that died with a premortem clinical diagnosis of no cognitive impairment (NCI), mild cognitive impairment (MCI), mild/moderate AD (mAD) or severe AD (sAD). Quantitative immunohistochemistry was used to identify HDAC2 protein levels in individual cholinergic nbM nuclei and their colocalization with the early phosphorylated tau marker AT8, the late‐stage apoptotic tau marker TauC3 and Thioflavin‐S, a marker of β‐pleated sheet structures in NFTs.
Results
In AD patients, HDAC2 protein levels were dysregulated in the basal forebrain region containing cholinergic neurons of the nbM. HDAC2 nuclear immunoreactivity was reduced in individual cholinergic nbM neurons across disease stages. HDAC2 nuclear reactivity correlated with multiple cognitive domains and with NFT formation.
Conclusions
These findings suggest that HDAC2 dysregulation contributes to cholinergic nbM neuronal dysfunction, NFT pathology, and cognitive decline during clinical progression of AD.
Wide-neck bifurcating aneurysms are increasingly treated with intracranial stent-assisted coiling by using shape-memory alloy microstents. We sought to investigate the short- and long-term effects of ...intracranial stent implantation on the geometry and angular conformation of the stent-coiled vascular bifurcation.
Thirty patients underwent stent-mediated coiling for 31 bifurcation aneurysms by using 31 self-expanding Neuroform (n = 14) and Enterprise (n = 17) stents (17 women; mean age, 56 years). The angle (δ) between the stented mother and daughter vessels at the bifurcation was measured by using multiplanar imaging of reconstructed rotational conventional angiography volumes and was compared by using matched-pair statistics. Neuroform and Enterprise longitudinal stent stiffness was measured in vitro at an increasing bending angle θ (θ = 180°-δ).
Stent deployment increased the bifurcation angle δ from 101.5° to 119.8° postprocedurally and to 137.3° (P < .0001) at latest follow-up, resulting in effective straightening; the angular remodeling was greater in distal-versus-proximal arteries (anterior cerebral > MCA > BA > ICA), inversely proportional to mother-vessel diameter and proportional to pretreatment bending angle θ. At follow-up, angle δ continued to significantly expand, with remodeling being greater in the early period (1-6 versus >7 months) and more pronounced with the longitudinally stiffer closed-cell Enterprise compared with the open-cell Neuroform stent.
Stent placement across bifurcation aneurysms leads to a significant biphasic angular remodeling related to stent type and vessel caliber, altering morphology to mimic sidewall lesions, a phenomenon needing consideration during procedural planning. Future work is needed to uncover the hemodynamic implications of this structural change and any possible effect on aneurysm-recurrence rates.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Relentless cyst growth substantially enlarges both kidneys and culminates in renal failure. Patients ...with ADPKD also have vascular abnormalities; intracranial aneurysms (IAs) are found in ∼10% of asymptomatic patients during screening and in up to 25% of those with a family history of IA or subarachnoid haemorrhage. As the genes responsible for ADPKD—PKD1 and PKD2—have complex integrative roles in mechanotransduction and intracellular calcium signalling, the molecular basis of IA formation might involve focal haemodynamic conditions exacerbated by hypertension and altered flow sensing. IA rupture results in substantial mortality, morbidity and poor long-term outcomes. In this Review, we focus mainly on strategies for screening, diagnosis and treatment of IAs in patients with ADPKD. Other vascular aneurysms and anomalies—including aneurysms of the aorta and coronary arteries, cervicocephalic and thoracic aortic dissections, aortic root dilatation and cerebral dolichoectasia—are less common in this population, and the available data are insufficient to recommend screening strategies. Treatment decisions should be made with expert consultation and be based on a risk-benefit analysis that takes into account aneurysm location and morphology as well as patient age and comorbidities.
Increasingly tourism destinations worldwide have to face the threats associated with climate change. Because of these threats, there is a growing need to develop and reinforce the adaptive capacity ...of tourism systems to cope with current and future challenges. In tourism studies, resilience assessments are a relatively new approach used to ascertain stakeholders' opinions regarding the human and natural conditions that are likely to increase the capacity of the tourism system to successfully cope with disturbances. This study examined local communities in and around Dana Biosphere Reserve (Jordan), specifically perspectives regarding the social, environmental, governance and economic dimensions of resilience that theoretically support the capacity of the ecotourism system to withstand or adapt to climate change. The results indicated perceived moderate resilience to climate-change-related threats in the environment dimensions of the study, and scope for further development of resilience in the social, economic and governance dimensions. Ultimately, further adaptation planning and policies appear necessary, to ensure robust and proactive measures are in place to respond to climate change threats and to protect the ecotourism socio-ecological system in Dana Biosphere Reserve.
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