Improvement of the efficacy of endodontic solvents by ultrasonic agitation

[Excerpt] The success rates of endodontic treatment can reach levels from 86% to 98% (Abitbol et al., 2003). However, apical periodontitis may still persist or develop after treatment due to various factors, namely coronal leakage, caries or fractures, thus enabling reinfection by microorganisms of the oral cavity or proliferation of microorganisms in persisting endodontic infections (Siqueira, 2001, Correia-Sousa et al., 2015, Melo et al., 2017). Endodontic retreatment aims to reduce the bacterial load to a level that enables periapical healing. Nevertheless, its outcome is poor – about 70.9–83% (Torabinejad et al., 2009, Ng et al., 2011). The cleanliness of root canals cannot be accurately assessed through conventional periapical radiography or magnifying devices, but residual gutta-percha is systematically found in micro-CT scans after retreatment (Oltra et al., 2017). Chloroform and xylene have been widely used as endodontic solvents but concerns about their toxicity and potential carcinogenic effect led to seeking alternatives (Tamse et al., 1986, Metzger et al., 2000, Vajrabhaya et al., 2004, Magalhaes et al., 2007). Essential oils, like eucalyptol or orange oil, are one of the most common alternative groups of solvents used to enhance the dissolution or softening of gutta-percha. However, although they are considered less toxic, they are also reported as less powerful (Zaccaro Scelza et al., 2006, Faria-Junior et al., 2011, Martos et al., 2011). Studies show that, despite all the currently available technology, it is still not possible to achieve the complete removal of the potentially infected filling materials, which prevents total debridement and effective bacteria control (Alves et al., 2016, Keles et al., 2016, Rossi-Fedele and Ahmed, 2017). Although solvents have been indicated to prevent complications, such as ledges or perforations, in retreatment procedures, the literature reports that their use may hinder the cleaning of the root canal (Horvath et al., 2009). Retreatment can be carried out with or without solvents, but professionals often prefer to remove gutta-percha mainly with instrumentation, even though this may be a longer and less predictable procedure (Sae-Lim et al., 2000, Khalilak et al., 2013). Thus, endodontic solvents have almost fallen out of use. A new insight on endodontic retreatment seems to be necessary. [...]- (undefined

The C242T polymorphism of the p22-phox gene (CYBA) is associated with higher left ventricular mass in Brazilian hypertensive patients

<p>Abstract</p> <p>Background</p> <p>Reactive oxygen species have been implicated in the physiopathogenesis of hypertensive end-organ damage. This study investigated the impact of the C242T polymorphism of the p22-phox gene (CYBA) on left ventricular structure in Brazilian hypertensive subjects.</p> <p>Methods</p> <p>We cross-sectionally evaluated 561 patients from 2 independent centers [Campinas (n = 441) and Vitória (n = 120)] by clinical history, physical examination, anthropometry, analysis of metabolic and echocardiography parameters as well as p22-phox C242T polymorphism genotyping. In addition, NADPH-oxidase activity was quantified in peripheral mononuclear cells from a subgroup of Campinas sample.</p> <p>Results</p> <p>Genotype frequencies in both samples were consistent with the Hardy- Weinberg equilibrium. Subjects with the T allele presented higher left ventricular mass/height^2.7than those carrying the CC genotype in Campinas (76.8 ± 1.6 vs 70.9 ± 1.4 g/m^2.7; p = 0.009), and in Vitória (45.6 ± 1.9 vs 39.9 ± 1.4 g/m^2.7; p = 0.023) samples. These results were confirmed by stepwise regression analyses adjusted for age, gender, blood pressure, metabolic variables and use of anti-hypertensive medications. In addition, increased NADPH-oxidase activity was detected in peripheral mononuclear cells from T allele carriers compared with CC genotype carriers (p = 0.03).</p> <p>Conclusions</p> <p>The T allele of the p22-phox C242T polymorphism is associated with higher left ventricular mass/height^2.7and increased NADPH-oxidase activity in Brazilian hypertensive patients. These data suggest that genetic variation within NADPH-oxidase components may modulate left ventricular remodeling in subjects with systemic hypertension.</p

Verification of the HDM-4 fuel consumption model using a Big data approach: a UK case study

This paper presents an assessment of the accuracy of the HDM-4 fuel consumption model calibrated for the United Kingdom and evaluates the need for further calibration of the model. The study focuses on HGVs and compares estimates made by HDM-4 to measurements from a large fleet of vehicles driving on motorways in England. The data was obtained from the telematic database of truck fleet managers (SAE J1939) and includes three types of HGVs: light, medium and heavy trucks. Some 19,991 records from 1,645 trucks are available in total. These represent records of trucks driving at constant speed along part of the M1 and the M18, two motorways in England

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Sodium intake and its association with structural and hemodynamic alterations in carotid arteries of hypertensive subjects

Orientadores: Wilson Nadruz Junior, Maria Cecilia Jayme Bueno GallaniTese (doutorado) - Universidade Estadual de Campinas. Faculdade de Ciencias MedicasResumo: O consumo elevado de sódio vem sendo amplamente estudado ao longo dos anos com o intuito de avaliar sua contribuição para o desenvolvimento de hipertensão arterial e aumento do risco cardiovascular. No entanto, pouco se sabe sobre o impacto do consumo de sódio sobre a estrutura e hemodinâmica das artérias carótidas. Desta forma, este estudo buscou investigar os efeitos do consumo de sódio sobre parâmetros estruturais e hemodinâmicos nas artérias carótidas de indivíduos hipertensos. A amostra foi composta por cento e trinta e quatro pacientes (n=134), selecionados aleatoriamente, atendidos no ambulatório de Hipertensão Arterial do Hospital de Clínicas da Universidade Estadual de Campinas - UNICAMP. O consumo diário de sódio (CDS) foi estimado pelos métodos de auto-relato: recordatório de 24 horas; consumo de sódio per capita e um questionário de freqüência alimentar - QFASó. Foram ainda obtidos dados clínicos e laboratoriais e realizado o exame ultra-sonográfico de carótidas. Os sujeitos tiveram um CDS de 5520 ± 286mg/dia. A análise univariada mostrou que o consumo diário de sódio se correlacionou com o diâmetro sistólico e diastólico da artéria carótida comum (r=0.36 e r=0.34, ambos p <0.001), tensão circunferencial de pico e média (r=0.44 e r=0.39, ambos p <0.001), Modelo de elasticidade de Young (r=0.40, p <0.001), espessura de íntima-média (r=0.19, p <0.05) e com o índice de resistência da artéria carótida interna (r=0.20, p <0.05). A análise multivariada mostrou que o consumo diário de sódio foi associado com o diâmetro da artéria carótida comum, a tensão circunferencial da parede e o modelo de elasticidade de Young. Estes dados sugerem que o consumo de sódio é um preditor independente de menor elasticidade, aumento do diâmetro da artéria e maior carga hemodinâmica local nas artérias carótidas de hipertensosAbstract:High sodium consumption and its effect on hypertension has been widely studied over the years in an attempt to more clearly assesses its contribution for high blood pressure levels and progression of cardiovascular disease. However, little is known about the impact of dietary sodium on the structure and hemodynamics of carotid arteries. We investigated the effects of sodium intake on carotid structural and hemodynamic parameters of hypertensive subjects. The study sample was compound by one hundred third four subjects (n=134) who attended a hypertensive outpatient clinic in State University of Campinas teaching hospital, were randomly selected. Daily sodium intake was estimated by 24 hour recall, discretionary sodium and a food frequency questionnaire. Clinical history, carotid ultrasound and hemodynamic, inflammatory and metabolic parameters were also obtained. The studied sample had a daily sodium intake of 5520±286mg/day. Univariate analysis showed that daily sodium intake correlated with common carotid artery systolic and diastolic diameter (r=0.36 and r=0.34; both p<0.001), peak and mean circumferential tension (r=0.44 and r=39; both p<0.001), Young's Elastic Modulus (r=0.40, p<0.001), intima-media thickness (r=0.19, p<0.05) and with internal carotid artery resistive index (r=0.20; p<0.05). Multivariate analyses showed that daily sodium intake was associated with common carotid artery diameter, circumferential wall tension and Young's Elastic Modulus. These data suggest that sodium intake is an independent predictor of reduced elasticity, increased luminal diameter and higher local hemodynamic load in carotid arteries of hypertensive subjectsDoutoradoCiencias BasicasDoutor em Clínica Médic

Sodium consumption : characterization and relation between alimentary behavior, clinical and genetic factors of hypertensive subjects

Orientadores: Maria Cecilia Jayme Bueno Gallani, Wilson Nadruz JuniorDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Este estudo teve como objetivo geral caracterizar e o comportamento em saúde de pacientes hipertensos em seguimento ambulatorial em relação ao consumo de sódio e a sua relação com variáveis clínicas, hipertrofia ventricular esquerda (HVE), crenças sobre dieta hipossódica e com o polimorfismo da subunidade p22phox do sistema NADPH oxidase, recentemente relacionado à sensibilidade ao sódio e HVE. O estudo foi dividido em duas etapas com objetivos distintos: Estudo I) Desenvolver e validar métodos de auto-relato para mensuração de consumo dietético de sódio entre pacientes hipertensos de baixa renda; e Estudo li) Caracterizar e avaliar a relação entre variáveis clínicas, consumo de sódio na dieta habitual, crenças sobre adesão à dieta hipossódica e genótipo,de sujeitos hipertensos. No Estudo I, foi desenvolvido e validado um Questionário de Freqüência Alimentar - QFASó e validados os métodos recordatório de 24 h e inventário de 72 h. O QFASó foi aplicado a 132 sujeitos e submetido à analise de conteúdo (avaliação por juízes e pré-teste), de confiabilidade, li pelo critério da estabilidade (teste re-teste) e finalmente à validade convergente, por meio da correlação com marcador biológico (sódio urinário). O recordatório de 24h e inventário de 72h foram submetidos à análise da validade convergente, por meio da correlação entre os métodos de auto-relato e com o sódio urinário. Concluiu-se que o QFASÓ é uma medida estável (K=0,79 a 0,98 IC=95%), e válida demonstrando correlação convergente com o sódio urinário"(r=0,25 p=0,03) e com o segundo dia do inventário de 72h (r=0,20 p=0,03). Também foi confirmada a validade convergente!do recordatório de 24h e do inventário de 72h, que apresentaram correlação entre si (r=O,39 p<0,001) e com o sódio urinário (r=0,28 p=0,01; r=0,28 p=0,01). Destaca-se que a correlação dos métodos de auto-relato necessitam da correção pelo sal per capita (sal adicionado durante ou após o preparo dos alimentos) para a estimativa mais próxima do real consumo de sódio. No estudo li, realizado com os mesmos 132 sujeitos hipertensos, foi realizada a caracterização do consumo de sódio obtida pelos métodos de auto-relato e sódio urinário; caracterização do perfil lipídico, glicêmico e de marcador de risco cardiovascular (proteína C reativa), ecocardiograma para caracterização da HVE e caracterização das crenças sobre adesão à dieta ! hipossódica (versão brasileira [Ferreira, Gallani, 2005] da BDCS-Beliefs about diet compliance scale) [Bennett et aI. 1997]) e caracterização genética relacionada ao polimorfismo 930A/G da sub-unidade p22phox da enzima NADPH-oxidase. Foi observado elevado consumo de sódio na população estudada - pelo menos três vezes maior do que o consumo de sódio recomendado para sujeitos hipertensos, tanto para mulheres (13,9 g/dia) como para homens (17,9 g/dia), dado prioritariamente pelo sal adicionado aos alimentos. Embora não tenha sido observada correlação significativa entre consumo de sódio e os níveis pressóricos, houve correlação positiva entre consumo e massa ventricular esquerda (r=O,20 p=O,03). Observou-se que quanto maior a percepção de benefícios da adesão à dieta hipossódica, menor a massa ventricular esquerda (r=-O,22 p=O,01) e que quanto maior a percepção de barreiras, maior o consumo de sódio (recordatório de 24 h) (r=O,17 p=O,05). Em relação ao polimorfismo houve diferença entre o consumo de sódio dado pelo QFASó corrigido com o sódio per capita entre os genótipos AAIAG e AG, sendo que o os indivíduos AA/AG consomem mais sódio (p=O,02). Não houve diferenças entre genótipos quanto a: HVE, variáveis clínicas e crenças. Nossos dados sugerem que os fatores cognitivos permeiam a evolução clinica da hipertensão, por meio de sua influência sobre os comportamentos em saúde. Sujeitos com crenças mais negativas sobre adesão à dieta hipossódica tendem a consumir dieta mais salgada e apresentam marcadores de maior gravidade da HAS. Intervenções terapêuticas para pacientes hipertensos devem incluir não somente abordagem clínica e medicamentosa, mas também intervenções educativas voltadas à modificação dos fatores subjacentes a adoção de comportamentos saudáveisAbstract: The aim of this study was to identify among hypertensive subjects the health behavior related to sodium consumption and its relation with, clinical variables, left ventricular hypertrophy (L VH), beliefs about low sodium diet compliance and to the NADPH system 930 A/G polymorphism, recently associated to sodium sensitivity and LVH. Therefore this study was split in two steps with distinct objectives: Study I) to develop and validate methods for measuring dietary sodium consumption among hypertensive low income patients; Study 11) to verify the relation between sodium consumption, clinical variables, L VH, beliefs about dietary compliance, and genotype. In the first study it was developed and validated a food frequency questionnaire - QFASó, and other two methods: the 24 hour recall and 72 hour inventory were validated to measure sodium consumption. Content validity of the QFASó was confirmed trough judges evaluation and the pre-test; its reliability was confirmed trough the test-retest (K=0,79 - 0,98 IC=95%) and finally its convergent~valid was confirmed within urinary sodium (r=0,25 p=0,03) and second day of the 72 hour inventory (r=0,20 p=0,03). The 24h recall and the 72h inventory were also considered valid by the correlation with each other (r=0,39 p<0,001) and by the urinary sodium correlation (r=0,28 p=O,01; r=O,28 p=O,02). It is important to highlight that the discretionary salt was added to the results of the methods in order to better ~stimate the sodium consumption. In the second study, carried out with the same 132 subjects, sodium consumption was evaluated with the self-report methods and urinary sodium; echocardiogram data were used to characterize L VH; beliefs about a low sodium diet compliance scale (Brazilian version [Blacksmith, Gallani, 2005] of the BDCS-Beliefs about diet compliance scale) [Bennett et aI. 1997]), cholesterol, triglyc~rides, LDL-col and HDL-col, fasting glucose, reative C protein and genetic characterization related to the p22phox 930A/G polymorphism were also evaluated. The average of sodium consumption observed was three times higher than recommended for hypertensive subjects, either for women (13,9 g/day) and men (17,9 g/day), given mostly frem the discretionary salt. Although no significant correlation have been observed between sodium consumption and blood pressure, sodium consumption was positively correlated with left ventricular mass (r=O,20 p=0,03). The beliefs scale evidenced that the highest the perceived benefits of a low sodium diet, lower the values of !eft ventricular mass (r=-0,22 p=O,01); the highest perceived barriers, higher the sodium consumption according to the 24-hour recaI! (r=O, 17 p=0,05) among the subjects. AA/AG genotype presented higher sodium consumption according to the QFASó than the GG genotype (p=O,02). There was no difference between the subgroups genotypes in relation to clinical variables, L VH and the beliefs scale. The results suggest that cognitive factors can affect clinical variables and hypertension trough the influence of the beliefs on the behavior of sodium consumption. Hypertensive subjects with more negative beliefs about the low sodium diet compliance tend to consume saltier diet and have a more severe type of hypertension. Therapeutic interventions for hypertensive subjects should not only include clínical and drug therapy approaches, but also educative interventions directed to the modification of the underlying factors regarding the adoption of health behaviorsMestradoEnfermagem e TrabalhoMestre em Enfermage