Detection of Treponema denticola in root canal systems in primary and secondary endodontic infections. A correlation with clinical symptoms

AIM: The aim of the study was to investigate the presence of Treponema denticola in primary and secondary root-infected canal systems with periapical pathology and correlations with clinical signs and symptoms. METHODOLOGY: Endodontic samples were obtained from canals of 102 teeth: 79 had primary endodontic disease and 23 secondary endodontic disease. For each tooth, clinical data including symptoms and X-ray appearance were examined. The presence of T. denticola biological samples from the root canal space was detected by a PCR assay. RESULTS: T. denticola was detected in 24 out of the 79 teeth with primary infection and in 8 out of the 23 teeth with secondary infection. Teeth with specific clinical symptoms were frequently associated with T. denticola presence inside the root canal system. CONCLUSIONS: The presence of T. denticola in root canal system in association with specific clinical signs and symptoms of endodontic disease strongly suggests that this spirochete might play a critical role in the pathogenesis of the acute infection and rapid bone tissue alterations in both primary and secondary endodontic infections.     

Enumeration of viable Enterococcus faecalis, a predominant apical periodontitis pathogen, using propidium monoazide and quantitative real-time polymerase chain reaction

To discriminate between viable and non-viable Enterococcus faecalis, the predominant pathogen in apical periodontitis, a real-time PCR method combined with propidium monoazide (PMA) was developed and evaluated. PMA had no antimicrobial effect on E. faecalis cells and permitted enumeration of both viable and non-viable cells. Therefore, E. faecalis cells from the root canals of nine patients with apical periodontitis were analyzed to evaluate the diagnostic usefulness of this approach. Viable and non-viable E. faecalis cells were successfully discriminated in these clinical specimens. A real-time PCR assay combined with PMA will contribute to the precise diagnosis of apical periodontitis.     

三种根管充填材料对 乳牙根尖周炎常见细菌的抑菌性

目的评估和比较3种乳牙根管充填材料对乳牙根尖周炎常见细菌的抗菌功效。方法在体外实验中,采用纸片扩散法检测并观察3种乳牙根管充填材料及蒸馏水作用于粪肠球菌、牙龈卟啉单胞菌和具核梭杆菌后形成的抑菌环直径(mm),用SPSS 24.0软件进行统计分析。结果三重抗生素糊剂对乳牙根尖周炎根管中3种细菌均显示出最强的抗菌潜力,其次是Vitapex?、氢氧化钙糊剂,结果差异具有统计学意义(P0.05);蒸馏水对3种细菌是非抑制性的。粪肠球菌对3种药物反应最敏感,其次是牙龈卟啉单胞菌、具核梭杆菌,结果差异具有统计学意义(P0.05)。结论三重抗生素糊剂是最推荐用于治疗乳牙根尖周炎的根管充填材料。     

The enterococcal surface protein, Esp, is involved in Enterococcus faecalis biofilm formation

The enterococcal surface protein, Esp, is a high-molecular-weight surface protein of unknown function whose frequency is significantly increased among infection-derived Enterococcus faecalis isolates. In this work, a global structural similarity was found between Bap, a biofilm-associated protein of Staphylococcus aureus, and Esp. Analysis of the relationship between the presence of the Esp-encoding gene (esp) and the biofilm formation capacity in E. faecalis demonstrated that the presence of the esp gene is highly associated (P < 0.0001) with the capacity of E. faecalis to form a biofilm on a polystyrene surface, since 93.5% of the E. faecalis esp-positive isolates were capable of forming a biofilm. Moreover, none of the E. faecalis esp-deficient isolates were biofilm producers. Depending on the E. faecalis isolate, insertional mutagenesis of esp caused either a complete loss of the biofilm formation phenotype or no apparent phenotypic defect. Complementation studies revealed that Esp expression in an E. faecalis esp-deficient strain promoted primary attachment and biofilm formation on polystyrene and polyvinyl chloride plastic from urine collection bags. Together, these results demonstrate that (i) biofilm formation capacity is widespread among clinical E. faecalis isolates, (ii) the biofilm formation capacity is restricted to the E. faecalis strains harboring esp, and (iii) Esp promotes primary attachment and biofilm formation of E. faecalis on abiotic surfaces.     

Antibiotic resistance and virulence factors among clinical and food enterococci isolated in Slovakia

The resistance to antibiotics and the distribution of virulence factors in enterococci isolated from traditional Slovak sheep cheese bryndza was compared with strains from human infections. The occurrence of 4 enterococcal species was observed in 117 bryndza-cheese isolates. The majority of strains were identified as E. faecium (76 %) and E. faecalis (23 %). Several strains of E. durans and 1 strain of E. hirae were also present. More than 90 % of strains isolated from 109 clinical enterococci were E. faecalis, the rest belonged to E. faecium. The resistance to 6 antimicrobial substances (ampicillin, ciprofloxacin, higher concentration of gentamicin, nitrofurantoin, tetracycline and vancomycin) was tested in clinical and food enterococci. A higher level of resistance was found in clinical than in food strains and E. faecium had a higher resistance than E. faecalis; no resistance to vancomycin was detected. The occurrence of 3 virulence-associated genes, cylA (coding for hemolysin), gelE (coding for gelatinase) and esp (coding for surface protein) was monitored. Differences were found in the distribution of cylA gene between clinical and bryndza-cheese E. faecalis strains; in contrast to clinical strains (45 %), cylA gene was detected in 22 % of food isolates. The distribution of 2 other virulence factors, gelE and esp, was not significantly different in the two groups of E. faecalis strains. cylA and gelE genes were not detected in E. faecium but more than 70 % of clinical E. faecium were positive for esp, even thought none of the 79 E. faecium cheese isolates contained this gene.     

Study of dental caries and periapical lesions in a mediaeval population of the southwest France: Differences in visual and radiographic inspections

Dental caries and periapical lesions have often been studied in archaeological samples. The majority of these studies concern lesions detected clinically and, in some cases, radiography is used to improve the scoring results. The purpose of the present study was to compare and combine the two methods for recording caries and cysts. The studied dental material derived from a mediaeval sample from the south of France. The study included sixty mandibles (788 teeth). Each tooth was observed clinically and radiographically. Absence of teeth was noted and unerupted teeth, which could be viewed on radiographs were also noted. The location and degree of development of each lesion were recorded. Occlusal lesions of degree 1 were mostly detected clinically (5.1% vs.1.4% detected radiographically). Radiographic detection increased the score of approximal lesions of degree 2 (1.4% vs. 0.7%) and the detection of intraosseous lesions. This research has shown that the combination of radiographic and clinical examinations improves the caries detection and thus, increases the caries score in a studied dental sample.     

慢性根尖周炎应用氢氧化钙根管内封药的临床疗效观察

目的:观察慢性根尖周炎患牙用氢氧化钙根管内封药的临床疗效。方法:选择100例慢性根尖周病变患者随机分为实验组和对照组各50例;观察组用氢氧化钙做根管内封药;对照组用甲醛甲酚做根管内封药,观察术后1周的临床及X线片表现,并分析评定临床疗效。结果:术后1周有效率比较,观察组为96%,对照组为86%;两组间疗效差异具有统计学意义。结论:氢氧化钙是较理想的根管内消毒剂。     

两种根管冲洗液对狗牙根管内细菌抗菌作用的实验研究

目的观察2%洗必泰溶液和3%双氧水2种根管冲洗液对狗牙根管内粪肠球菌、溶血链球菌、微小消化链球菌、中间普氏菌及具核酸杆菌的影响,为临床根管治疗提供参考。方法选择成年健康杂种狗3只,共有24个实验牙,48个实验牙根。于狗牙根管内接种粪肠球菌、溶血链球菌、微小消化链球菌、中间普氏菌及具核酸杆菌。对狗牙完成根管治疗。于治疗后12个月拍摄根尖X线片,并记录牙齿和根尖周组织的临床表现。将患牙随机分为3组,每组7颗患牙,去除根管内充填物并进行根管预备,实验一组用2%洗必泰溶液冲洗根管,实验二组用3%双氧水冲洗根管,对照组用0.9%NaC l溶液冲洗根管。分别在根管预备前及根管预备冲洗后对根管内细菌取样,培养,鉴定并记录细菌菌落数量,测定根管内细菌变化情况。结果根管预备冲洗后3组根管内的细菌量均较根管预备前显著下降（P〈0.05）。2%洗必泰溶液和3%双氧水2种根管冲洗液的杀菌效果明显好于0.9%NaC l溶液（P〈0.05）,2%洗必泰溶液明显好于3%双氧水（P〈0.05）。结论2%洗必泰溶液是有效的根管冲洗药物,可明显减少狗牙根管内粪肠球菌、溶血链球菌、微小消化链球菌、中间普氏菌及具核酸杆菌的数量,但不能完全清除根管内的细菌。     

Prevalence of virulece-associated genes of Enterococcus faecalis clinical strains isolated from patients and volunteers

Enterococcus faecalis is an important cause of serious hospitals infections. Several E. faecalis putative virulence determinants have been identified. The aim of our study was to determine the prevalence of virulence factors among 180 strains of E. faecalis isolated from humans from different clinical sources in Poland. Tested strains were investigated for the presence of cylA, cylB, cylM, gelE, asal, esp, efaA and ace by using PCR method. Among all strains ace and efaA were most often detected. However, in opposite to strains obtained from faeces of volunteers, most of clinical strains carried esp (64,4% vs. 28,9%) and cylA (44,4% vs. 20%), cylB (41,5% vs. 20%), cylM (45,2% vs. 20%), respectively. Twenty different virulotype were represented by tested strains. Presence of all tested virulence determinants were the most frequently observed among clinical strains. There was no significant association between virulence factors and clinical source of isolation.     

Antibiotic resistance and virulence traits in clinical and environmental Enterococcus faecalis and Enterococcus faecium isolates

This study compared virulence and antibiotic resistance traits in clinical and environmental Enterococcus faecalis and Enterococcus faecium isolates. E. faecalis isolates harboured a broader spectrum of virulence determinants compared to E. faecium isolates. The virulence traits Cyl-A, Cyl-B, Cyl-M, gel-E, esp and acm were tested and environmental isolates predominantly harboured gel-E (80% of E. faecalis and 31.9% of E. faecium) whereas esp was more prevalent in clinical isolates (67.8% of E. faecalis and 70.4% of E. faecium). E. faecalis and E. faecium isolated from water had different antibiotic resistance patterns compared to those isolated from clinical samples. Linezolid resistance was not observed in any isolates tested and vancomycin resistance was observed only in clinical isolates. Resistance to other antibiotics (tetracycline, gentamicin, ciprofloxacin and ampicillin) was detected in both clinical and water isolates. Clinical isolates were more resistant to all the antibiotics tested compared to water isolates. Multi-drug resistance was more prevalent in clinical isolates (71.2% of E. faecalis and 70.3% of E. faecium) compared to water isolates (only 5.7% E. faecium). tet L and tet M genes were predominantly identified in tetracycline-resistant isolates. All water and clinical isolates resistant to ciprofloxacin and ampicillin contained mutations in the gyrA, parC and pbp5 genes. A significant correlation was found between the presence of virulence determinants and antibiotic resistance in all the isolates tested in this study (p<0.05). The presence of antibiotic resistant enterococci, together with associated virulence traits, in surface recreational water could be a public health risk.     

Clinical trials using dental stem cells: 2022 update

For nearly 20 years, dental stem cells(DSCs) have been successfully isolated from mature/immature teeth and surrounding tissue, including dental pulp of permanent teeth and exfoliated deciduous teeth, periodontal ligaments, dental follicles, and gingival and apical papilla. They have several properties(such as self-renewal, multidirectional differentiation, and immunomodulation) and exhibit enormous potential for clinical applications. To date, many clinical articles and clinical trials using DS...     

Dental wear and oral pathology: possible evidence and consequences of habitual use of teeth in a Swedish Neolithic sample

Atypical wear and oral lesions were studied in the dental remains from the Middle Neolithic Pitted Ware Culture site Ajvide on the island of Gotland in the Baltic Sea. Teeth (n = 764) from 17 males and 11 females were examined microscopically to document unusual wear, assess wear patterns and oral lesions as evidence of habitual behavior, and determine their effect on the oral health of this population. Five atypical wear types were observed: occlusal facets, occlusal excessive load, labial vertical striae, labial horizontal striae, and interproximal striae. Three oral lesions were recorded: chipping, periapical lesions, and dental tilting. Results indicate that teeth were used in a habitual manner at Ajvide, based on the morphology and regularity of the patterns of atypical wear. Differences were observed between the sexes, indicating gender-related differences in the habitual use of teeth. Some wear categories showed a significant correlation with age, signifying increased or accumulated wear with age. Statistically significant positive correlations were found in the molars between occlusal excessive load wear and periapical lesions as well as tilting. Other apparent links were also observed between chipping and vertical striae as well as excessive load, although these were not significant. This suggests a relationship between dental wear and dental pathologies at this site, suggesting that habitual use of teeth indirectly affected the general oral health at the site. Wear patterns, furthermore, seem to mirror both frequent activities as well as single events.     

全细菌SELEX法筛选粪肠球菌特异性适配体

肠球菌（Enterococcus）是内源性和外源性医院感染的第二大病原菌,检出率仅次于大肠杆菌,从分子水平上发展靶标的高亲和力分子探针对肠球菌的识别和检测具有非常重要的意义。本研究以粪肠球菌为靶标,运用全细菌指数富集的配体系统进化技术（whole-bacteria systematic evolution of ligands by exponential enrichment, whole-bacteria SELEX）,从全长为79个核苷酸包含35个随机碱基序列的单链DNA文库中筛选与靶标高亲和力、高特异性结合的适配体,利用荧光分析法监控筛选过程中不同轮次所得次级文库与粪肠球菌的结合力,经12轮筛选和克隆测序,获得了39条适配体序列。进一步对筛选得到的适配体进行序列比对、二级结构分析、流式细胞分析、解离常数（Kd）测定及特异性验证,最终获得一条与粪肠球菌能特异性结合的适配体Apt 21,其Kd值为549.2 ± 147.4 nmol/L。该适配体可作为粪肠球菌检测的识别元件,为建立基于适配体的新型粪肠球菌检测方法奠定了基础。     

Effect of banning vancomycin analogue avoparcin on vancomycin-resistant enterococci in chicken farms in Taiwan

Avoparcin, a vancomycin analogue, was banned as a feed additive in Taiwan in 2000. A nationwide surveillance was conducted to study the prevalence of vancomycin-resistant enterococci (VRE) on chicken farms between 2000 and 2003. Among the 1021 E. faecalis and 967 E. faecium isolates studied, resistance to tetracycline, erythromycin, high-level aminoglycosides, ciprofloxacin and chloramphenicol either increased or remained high except vancomycin. The proportion of VRE decreased, between 2000 and 2003, from 13.7% (22/161) to 3.7% (11/299) for E. faecalis, and 3.4% (4/119) to 0% (0/300) for E. faecium. Only 8.8% (7/80) of the chicken farms surveyed harboured VRE in 2003 compared with 25% (15/60) in 2000. All VRE were resistant to tetracycline and erythromycin. All VRE possess the vanA gene but nearly all (79 of 83 isolates) were susceptible to teicoplanin, indicating VanB phenotype. Some clones were detected from different farms in various regions over the years. We conclude that the frequency of VRE in chicken farms decreased in association with a ban on avoparcin; and the continued presence of VRE may be due to the ability of some strains to persist in the farms, transfer of vancomycin resistance determinants or co-selection by the continued use of other antibiotics.     

根管治疗失败病例根管内细菌对根尖周组织致病力的实验研究

目的观察根管治疗失败病例根管内分离的主要微生物对狗牙根尖周组织的影响。方法选择成年健康杂种狗5只,共有40个实验牙,80个实验牙根。实验一组于狗牙根管内接种溶血链球菌、微小消化链球菌、产黑色素类杆菌及具核梭杆菌;实验二组于狗牙根管内接种粪肠球菌及上述4种细菌;对照组不接种细菌。对狗牙完成根管治疗。分别于治疗后3、6、12个月拍摄根尖X线片,并记录牙齿和根尖周组织的临床表现;根管治疗后12个月处死动物,制备根尖周组织病理标本,观察根尖周骨组织破坏情况;动物处死前,根管内进行微生物的取样、培养和鉴定。结果实验组可见狗牙槽骨尖周骨质吸收,牙周膜纤维排列受到破坏,实验二组对根尖周破坏重于实验一组,对照组根尖周骨组织无破坏。结论从根管治疗失败病例根管内分离的主要微生物粪肠球菌、溶血链球菌、微小消化链球菌、产黑色素类杆菌及具核梭杆菌对狗牙根尖周组织有明显的破坏作用。     

粪肠球菌对泰利霉素药物敏感性与 耐药基因erm的分布

目的了解粪肠球菌对泰利霉素和其他常用抗菌药物的耐药性,以及泰利霉素耐药与红霉素耐药相关基因ermA、ermB、ermC之间的关系。方法对本院2010-2016年从各种临床标本收集鉴定的320株粪肠球菌,用微量肉汤稀释法测定这些菌株对泰利霉素及8种临床常用抗菌药物的最小抑菌浓度,并用PCR法检测耐药基因ermA、ermB、ermC的分布。结果320株粪肠球菌对泰利霉素中介耐药26株,耐药138株,耐药率达51.3%;对红霉素耐药率达95.6%,泰利霉素抗粪肠球菌效果优于红霉素。对利奈唑胺、万古霉素、呋喃妥因和氨苄西林耐药率分别为15.6%、0.6%、2.2%和0.6%。共10株(3.1%)携带ermA基因,207株(64.7%)携带ermB基因,对泰利霉素中介组中有23株ermB基因阳性,耐药组有131株ermB基因阳性,仅1株(0.3%)ermC基因阳性,该菌同时携带ermB基因。结论粪肠球菌对泰利霉素已有较高耐药率。粪肠球菌对泰利霉素MIC值改变与ermB基因密切相关,与ermA、ermC基因无明显相关性。     

Description of a 23.9-kilobase chromosomal deletion containing a region encoding fsr genes which mainly determines the gelatinase-negative phenotype of clinical isolates of Enterococcus faecalis in urine

Expression of virulence-related extracellular proteases, gelatinase, and serine protease of Enterococcus faecalis is regulated by a quorum-sensing system encoded by the fsr gene cluster. In this study, a 23.9-kb chromosomal deletion containing the fsr gene cluster region was found to be present in the majority (79%) of gelatinase-negative clinical isolates of E. faecalis from urine.     

Patterns of disease activity in multiple sclerosis: clinical and magnetic resonance imaging study.

OBJECTIVE--To compare the abnormalities shown by magnetic resonance imaging of the brain in three clinically distinct groups of patients with multiple sclerosis, and to correlate the extent of abnormality with the degree of clinical disability in the three groups. DESIGN--All patients underwent magnetic resonance imaging and full neurological examination, and their disability was scored according to the expanded Kurtzke disability state scale. SETTING--National Hospital for Nervous Diseases (Multiple Sclerosis NMR Research Group). PATIENTS--Three groups of patients with confirmed multiple sclerosis were studied: 12 patients with minimal disability despite a long (greater than 10 years) duration of illness (benign multiple sclerosis), 16 who had developed progressive disability after a relapsing and remitting course (secondary progressive multiple sclerosis), and 13 who had had progressive disability from the onset of the disease (primary progressive multiple sclerosis). MAIN OUTCOME MEASURES--Number and size of lesions in 17 anatomically defined sites; total lesion load, estimated with an arbitrary scoring system weighted for the size of lesions; and disability score. RESULTS--Magnetic resonance imaging showed that all 41 patients had abnormalities. These were extensive in the groups with secondary progressive and benign disease compared with the group with primary progressive disease. The lesions in the patients with secondary progressive disease were larger and more confluent than those in the two other groups (p = 0.007). Most lesions (85%) in the patients with primary progressive disease were under 5 mm in diameter; this percentage was higher than that in the two other groups (p = 0.032). Consequently the patients with primary progressive disease had the lowest mean lesion load (36.7); that in the patients with benign disease was 52.7 and that in the patients with secondary progressive disease 64.6 (p = 0.05). No correlation existed between disability and total lesion load. The distribution of brain lesions and of detectable lesions of the spinal cord, and the frequency of cortical atrophy, were similar in all groups. CONCLUSIONS--No relation was found between the degree of clinical disability and the extent of abnormality shown by magnetic resonance imaging: patients with clinically benign disease often had extensive abnormalities and those with primary progressive disease had surprisingly few lesions. Though magnetic resonance imaging increases knowledge of the disease process in multiple sclerosis and is invaluable in diagnosis, it is not helpful in predicting disability in individual patients.     

吞咽困难对食管早期肿瘤及癌前病变患者食管动力、心理状态和临床相关症状的影响

摘要 目的：探讨吞咽困难对食管早期肿瘤及癌前病变患者食管动力、心理状态和临床相关症状的影响。方法：纳入2020年3月-2021年9月在南京医科大学第一附属医院消化内科住院确诊为食管早期肿瘤及癌前病变拟行内镜治疗的60例患者，根据有无合并吞咽困难将患者分为吞咽困难组和无吞咽困难组，分别比较两组患者在临床特征、高分辨率食管测压（HRM）参数以及焦虑自评量表（SAS）、抑郁自评量表（SDS）、胃食管反流病自评量表（GERDQ）评分的差异，分析HRM异常参数与原发病灶参数的相关性。结果：吞咽困难组患者的食管下括约肌（LES）中心点位置低于无吞咽困难组患者，LES静息压、LES残余压、无效吞咽百分比显著高于无吞咽困难组患者（P<0.05），HRM异常参数与原发病灶参数之间未见明显相关性（P>0.05），吞咽困难组患者的SAS、SDS评分高于无吞咽困难组（P<0.05），而两组患者GERDQ评分比较差异无统计学意义（P>0.05）。结论：食管早期肿瘤及癌前病变患者出现的吞咽困难症状与合并的异常食管动力有关，同时在一定程度上影响了患者的心理状态，对患者的临床相关症状无明显影响。     

Association of Allergic Symptoms with Dengue Infection and Severity: A Systematic Review and Meta-analysis

The relationship between the severity of dengue infection and allergy is still obscure. We conducted an electronic search across 12 databases for relevant articles reporting allergic symptoms, dengue infection, and dengue classification. These studies were categorized according to dengue severity and allergy symptoms, and a meta-analysis was performed by pooling the studies in each category. Among the included 57 articles, pruritus was the most common allergic sign followed by non-specified allergy and asthma(28.6%, 13%, and 6.5%, respectively). Despite the reported significant association of dengue with pruritus and total Ig E level(P \ 0.05), in comparison with non-dengue cases and healthy controls, there was no association between the different severe dengue group with pruritus, skin allergy, food allergy or asthma. However,removing the largest study revealed a significant association between asthma with dengue hemorrhagic fever(DHF) rather than dengue fever(DF). In comparison with DF, DHF was associated with Ig E positivity. Furthermore, specific-Ig E level was higher in secondary DF rather than primary DF. There was a possible association between allergy symptoms and dengue severity progression. Further studies are needed to clarify this association.