Development Related Termination of the Root Apical Meristem Activity Abstract Root system architecture is modulated through growth and branching of individual roots, while the growth is strictly regulated via long term apical meristem (RAM) maintenance and cell elongation. RAM activity is not consistent during root on- togeny, which was shown in several dicotyledonous species as change in root meristem structure and decline in root growth rate during individual root development. This thesis is focused on changes in extent and arrangement of meristematic tissues and their derivatives within adventitious roots of Acorus calamus and Oryza sativa during long term cultivation. Changes in meristem and elongation zone length, the root cap length, radial tissue complexity, as well as the changes in root hair emergence, etc., are put into relation with quantified expression level of selected important regulatory elements taking part in RAM maintenance (WOX and SCR family transcription factors). Methodology and approach for future research in this field are outlined. Keywords: Root, Apical Meristem, Root System Architecture, RAM Termination

A dificuldade de realizar a patência apical, tendo em vista que os canais radiculares apresentam algum grau de curvatura, exigiu o desenvolvimento de instrumentos rotatórios para agilizar o tempo operatório e facilitar sua execução. O objetivo deste estudo foi avaliar a influência de diferentes instrumentos de patência, utilizados 1 mm além do forame apical, no tempo de ação, transporte e centralização do canal radicular de canais radiculares curvos. Trinta e três raízes mesiais de molares superiores com curvatura entre 20 e 40 graus e raio menor que 10 mm foram selecionadas e divididas em 3 grupos (n = 11): R-Pilot #12.5 taper 0.04 (VDW, Munich, Alemanha), ProDesign Logic #25 taper 0.01 (Easy Equipamentos Odontologicos, Belo Horizonte, Brasil) e ProGlider #16 e taper variável de 0.02 a 0.08 (Dentsply Maillefer, Ballaigues, Suiça). Através de imagens pré e pós-operatórias de microtomografia computadorizada foram feitas as análises de transporte e centralização do canal radicular. Ainda, o tempo de ação de cada um dos instrumentos foi cronometrado. Para avaliar o transporte, foi utilizado o teste ANOVA. Para avaliar a centralização foi utilizado o teste Kruskal-Wallis. O tempo de ação foi avaliado pelo teste de Kruskal-Wallis e Post hoc de Dunn. O nível de significância foi de 5% para todos os testes aplicados. Não houve diferença estatística entre os grupos nas análises de transporte e centralização. Já na análise de tempo, o instrumento ProGlider se mostrou significativamente mais rápido se comparado com o ProDesign Logic 25.01 (P<0,05), o instrumento R-Pilot não foi diferente do ProGlider e Logic (p>0,05). Os instrumentos de patência utilizados neste estudo, e trabalhados 1 mm além do forame apical, permaneceram relativamente centralizadas dentro do canal radicular e promoveram transporte apical mínimo, sendo clinicamente irrelevante. / The difficulty of performing the apical patency, considering that the root canals present some degree of curvature, required the development of rotary instruments to speed up the operative time and facilitate its execution. The aim of this study was to evaluate the influence of different glide path files, used 1 mm beyond the apical foramen, on the preparation time, apical transportation and centering of the root canal of curved roots. Thirty three mesiobuccal roots from maxillary molars, with 20 to 40 degrees of curvature and presenting radio curvature lower than 10 mm were selected and divided in 3 groups (n = 11): R-Pilot #12.5 taper 0.04 (VDW, Munich, Germany), ProDesign Logic #25 taper 0.01 (Easy Equipamentos Odontologicos, Belo Horizonte, Brazil) ProGlider #16 e taper variable of 0.02 to 0.08 (Dentsply Maillefer, Ballaigues, Switzerland). Analysis of transportation and centration of root canal was performed using pre and postoperative computerized microtomography images and the work time of each file was measured. To evaluate the apical transportation, ANOVA test was used, while a Kruskal-Wallis test was used to assess centering ability. As for action time, Kruskal-Wallis and Dunn tests were performed. The level of significance was 5 % in all tests. No statistical difference was found amongst the groups for the variables apical transportation and centralization. When evaluated the action time, the ProGlider file has been significantly faster when compared to ProDesign Logic 25.1 (P<0.05).while R-pilot has not differed from ProGlider and Logic (P>0.05). The glide path files used – 1 mm beyond the apical foramen – remained relatively centralized inside the root canal and promoted minimal apical transportation, expressing no clinical relevance.

Introdução: Os objetivos deste estudo foram comparar a extrusão apical de debris durante a desobturação com WaveOne Gold, ProTaper retratamento, D-RaCe ou limas manuais; descrever as falhas e/ou fraturas ocorridas nos instrumentos de NiTi; e comparar o WaveOne Gold com os sistemas ProTaper e RaCe em relação à quantidade de material obturador remanescente, transporte apical (TA) e tempo de trabalho após a desobturação e após o repreparo de canais radiculares curvos. Materiais e Métodos: Quarenta canais mésiovestibulares de molares superiores foram preparados, obturados e divididos em 4 grupos (n=10): WOG) WaveOne Gold Primary e Medium; PTG) ProTaper Retreatmento e ProTaper Next; RCG) D-RaCe e RaCe; e LM) Limas manuais. A extrusão de debris foi determinada subtraindo-se o peso final do peso inicial dos Eppendorfs. Os instrumentos de NiTi (n=18) foram analisados em MEV antes e após a desobturação. A quantidade de material obturador remanescente e o TA foram avaliados em micro-TC. O tempo de trabalho foi anotado e comparado. Os dados foram estatisticamente analisados (α=.05). Resultados: WOG extruiu menos debris do que LM e RCG (P<.05), e foi similar ao PTG (P>.05). Não houve diferença entre LM, PTG e RCG (P>.05). A análise em MEV mostrou, dos 18 instrumentos avaliados, 3 fraturas e 10 deformações. Nas duas etapas avaliadas, WOG apresentou similar (P>.05) e menor (P<.05) quantidade de material obturador remanescente do que PTG e RCG, respectivamente. A quantidade de material no WOG e RCG foi menor após o repreparo (P<.05). Na desobturação, WOG teve maior TA em 4mm do que em 2mm (P<.05). Em 2mm, o TA do WOG foi menor do que RCG (P<.05), e em 4mm foi igual ao PTG e RCG (P>.05). Na desobturação, o tempo de trabalho no grupo LM foi maior que nos demais (P<.05). No repreparo, WOG foi mais rápido do que PTG e RCG (P<.05). Conclusões: Todos os instrumentos causaram extrusão de debris, sendo que o WOG apresentou os menores valores. Nenhum sistema removeu completamente o material obturador de raízes mésiovestibulares de molares superiores. Considerando os baixos valores de TA obtidos, os instrumentos avaliados foram considerados seguros para desobturação e repreparo de canais curvos. A desobturação com LM foi mais lenta do que com os instrumentos de NiTi. O sistema reciprocante foi mais rápido do que os rotatórios no reprepro. / Introduction: The aims of this study were to assess the amount of apically extruded debris during filling removal with WaveOne Gold, ProTaper Retreatment, D-RaCe or hand files; to describe failures of NiTi instruments; and to compare WaveOne Gold with ProTaper and RaCe systems regarding remaining filling material, apical transportation (AT) and working time after filling removal and after shaping of curved root canals. Methods: Forty mesiobuccal canals of maxillary molars were prepared, filled, and assigned into 4 groups (n=10): WOG) WaveOne Gold Primary and Medium; PTG) ProTaper Retreatment and ProTaper Next; RCG) D-RaCe and RaCe; HF) Hand files. The amount of extruded debris was determined by subtracting the final from the initial Eppendorfs weight. The NiTi instruments (n=18) used for filling removal were analyzed pre and post-operatively by SEM. Micro-CT analysis assessed the residual filling material and AT. Working time was recorded and compared. Data were statistically analyzed (α=.05). Results: WOG produced less debris compared with HF and RCG (P<.05), and similar to PTG (P>.05). HF, PTG and RCG showed no difference (P>.05). SEM analyses after filling removal showed, from the 18 instruments evaluated, 3 fractures and 10 deformations. In both evaluated steps, WOG had similar (P>.05) and less (P<.05) amount of filling material as PTG and RCG, respectively. The remaining material in WOG and RCG was lower after shaping (P<.05). In filling removal, WOG had higher AT at 4mm than at 2mm (P<.05). At 2mm, AT of WOG was lower than RCG (P<.05), and at 4mm, was equal to PTG and RCG (P>.05). In filling removal, working time in HF group was significantly higher than others (P<.05). In shaping step WOG was faster than PTG and RCG (P<.05). Conclusions: All instruments tested caused debris extrusion, with WOG presenting the lowest values. Neither system could completely remove the filling material of mesiobuccal canals of maxillary molars. Considering the low AT values obtained, the instruments evaluated were safe for filling removal and shaping of curved canals. Filling removal with HF was slower than with the NiTi files. The reciprocating system was faster than the rotary in shaping the root canals.

Objective: Compare in vitro the weight of extruded apical debris using a manual technique, a Protaper® rotary systems and Reciproc® reciprocating in single rooted premolars. Materials and methods: An experimental type of research have been done in vitro, for wish sixty human single rooted premolar with similar characteristics, divided on three groups. Depending on the type of instrumentation the groups were divided on (n=20) manual step back, Protaper® y Reciproc® respect. Instrumentation have been done on each group agreed with the instructions of the fabricant. Independent on every technique, each one of them were irrigated with 1 ml of distillated water. The weight of collected debris was extruded using the method modified by Myers and Montgomery in 1991. Subsequently the sample is placed into the incubator (Gravity Convection Incubator, Model Economy 2EG) at 37° C for seven days. After the debris was weighed using an electronic balance (Balance Electronics Denver Instrument M-220D) with an accuracy of <0.0001 g. Results: Reciproc® produced less debris 0.0010 compared with other systems. No statistically significant difference was observed between the manual techniques and the Protaper® (p=0.1939). At the time to compare the three manual systems Step back, Protaper® and Reciproc®, statistically differences were found (p=0.0001) respect from the quantity of debris extruded. Conclusions: Every technique of instrumentation produces extrusion of the debris. This extrusion to the periapical region can cause inflammation and flare up after the treatment and can cause sings, however it depends of the quantity of debris extruded. In the present study the Protaper® extruded significantly more quantity of apical debris that the one in the instrumentation with Reciproc® and manual. / Objetivo: comparar in vitro el peso del debris apical extruido, utilizando una técnica manual step back, un sistema rotatorio Protaper® y un reciprocante Reciproc® en premolares de un solo conducto. Materiales y métodos: se realizó un estudio tipo experimental in vitro, para lo cual se necesitó 60 piezas humanas premolares de un solo conducto y similares características, divididas en tres grupos. Según el tipo de instrumentación, los grupo fueron divididos en (n=20) manual Step Back, Protaper® y Reciproc®, respectivamente. Se procedió a instrumentar cada grupo de acuerdo a las instrucciones del fabricante. Independientemente de cada técnica, todos se irrigaron con 1 ml de agua destilada. El peso del debris extruido fue recolectado usando el método de Myers and Montgomery, en 1991. Seguidamente, las muestras se colocaron en la incubadora a 37°C por siete días. Después, el debris fue pesado usando una balanza electrónica con una precisión de < 0.0001 g. Resultados: el Reciproc® produjo menor debris 0.0010 comparado con los otros sistemas. No hubo diferencias estadísticamente significativas al comparar la técnica manual con el Protaper® (p= 0.1939). Al comparar los tres sistemas manual Step Back, Protaper® y Reciproc® se encontraron diferencias estadísticamente significativas (p=0.0001) con respecto a la cantidad de debris extruido. Conclusiones: todas las técnicas de instrumentación producen extrusión del debris. Esta extrusión hacia la región periapical puede causar inflamación y flare up, después del tratamiento de endodoncia, y causar sintomatologías. Sin embargo, dependerá de la cantidad de debris extruida. En el presente estudio el Protaper® extruyó significativamente mayor cantidad de debris apical que la instrumentación con Reciproc® y manual. / Tesis

Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is a transient left ventricular dysfunction associated with stress (usually emotional) induced myocardial injury and stunning. It often presents as myocardial infarction on surface electrocardiogram (EKG). Diagnosis is made by coronary angiography, which rules out coronary artery disease and shows pathognomonic apical ballooning. In this article, we present a case of a 72-year-old woman who initially presented with an ST segment elevation myocardial infarction on EKG. Coronary angiography showed severe left anterior descending artery and diagonal lesions requiring percutaneous coronary intervention. Post–percutaneous coronary intervention, EKG changes resolved. The next day, the patient developed recurrent chest pain and her EKG showed diffuse T-wave inversion in precordial leads with reemerging ST segment elevations concerning for stent thrombosis. The patient underwent repeat emergent coronary angiography, which showed patent stents and findings consistent with takotsubo cardiomyopathy.

An 82-year-old woman presented to the emergency department with chest pain after sustaining a transient ischemic attack 1 week prior to presentation. Electrocardiography revealed ST-segment elevation in leads I, II, aVF, and V3 through V6. Coronary angiography demonstrated nearly normal coronaries but left ventriculography showed apical akinesis and basal hyperkinesis. One month later her follow-up echocardiography showed no wall motion abnormalities. Several reports of tako-tsubo syndrome or transient left ventricular apical ballooning have been described, especially in Japan. We present a case with the typical features of the syndrome after a cerebrovascular accident.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19624号 / 医博第4131号 / 新制||医||1015(附属図書館) / 32660 / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 今中 雄一, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医科学) / 甲第24533号 / 医科博第147号 / 新制||医科||10(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 篠原 隆司, 教授 松田 道行, 教授 伊藤 貴浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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