Evaluation of smear layer and debris removal by stepwise intraoperative activation (SIA) of sodium hypochlorite

Objectives: To evaluate the efficacy of a stepwise intraoperative activation (SIA) of irrigants during and after the instrumentation compared with that of a conventional activation (CA) performed only after the instrumentation to remove smear layer and debris using different activation devices. Materials and methods: A total of 70 single-rooted teeth were divided into a control group (no activation, n = 10) and two different experimental groups according to the irrigant activation protocol used: group 1 (CA), in which sodium hypochlorite was activated only after the use of the last mechanical file, and group 2 (SIA), in which activation was performed during and after the instrumentation. The two groups were divided into 3 subgroups according to the activation device used (n = 10): passive ultrasonic irrigation (PUI, subgroup a), EndoActivator (EA, subgroup b), and EDDY (subgroup c). The roots were split longitudinally and observed using scanning electron microscopy (SEM) to evaluate the presence of debris and smear layer, and the results were statistically analyzed. Results: All activation protocols and devices were more effective than control group in removing smear layer and debris from all root canal thirds (P < 0.05), except for CA-EA (group 1b) in the apical third. In the apical third, SIA was found to be more effective than CA (P < 0.05) to remove smear layer and residual debris when PUI was used, to remove the smear layer when EA was used (P < 0.05), and to remove residual debris when EDDY was used (P < 0.05). PUI and EDDY removed statistically more smear layer and debris than EA in the apical third (P < 0.05). Conclusions: The SIA technique improved the smear layer and debris removal from the apical third and debris removal from the coronal third, and PUI and EDDY were more effective than EA in the apical third. Clinical relevance: The stepwise intraoperative activation (SIA) technique may increase smear layer and debris removal

Staging Parkinson's disease according to the MNCD classification correlates with caregiver burden

Abstract Background and objective Recently, we demonstrated that staging Parkinson's disease (PD) with a novel simple classification called MNCD, based on four axes (motor, non‐motor, cognition, and dependency) and five stages, correlated with disease severity and patients’ quality of life. Here, we analyzed the correlation of MNCD staging with PD caregiver's status. Patients and methods Data from the baseline visit of PD patients and their principal caregiver recruited from 35 centers in Spain from the COPPADIS cohort from January 2016 to November 2017 were used to apply the MNCD total score (from 0 to 12) and MNCD stages (from 1 to 5) in this cross‐sectional analysis. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory‐II (BDI‐II), PQ‐10, and EUROHIS‐QOL 8‐item index (EUROHIS‐QOL8). Results Two hundred and twenty‐four PD patients (63 ± 9.6 years old; 61.2% males) and their caregivers (58.5 ± 12.1 years old; 67.9% females) were included. The frequency of MNCD stages was 1, 7.6%; 2, 58.9%; 3, 31.3%; and 4–5, 2.2%. A more advanced MNCD stage was associated with a higher score on the ZCBI (p < .0001) and CSI (p < .0001), and a lower score on the PQ‐10 (p = .001), but no significant differences were observed in the BDI‐II (p = .310) and EUROHIS‐QOL8 (p = .133). Moderate correlations were observed between the MNCD total score and the ZCBI (r = .496; p < .0001), CSI (r = .433; p < .0001), and BDI‐II (r = .306; p < .0001) in caregivers. Conclusion Staging PD according to the MNCD classification is correlated with caregivers’ strain and burden