Does Calcium Hydroxide Reduce Endotoxins in Infected Root Canals? Systematic Review and Meta-analysis

IntroductionThe purpose of this study was to evaluate the potential of endotoxin reduction by comparing the number of lipopolysaccharides (LPSs) before and after the use of calcium hydroxide (Ca[OH]₂) as intracanal medication (ICM).MethodsSearches were performed up to June 2020. Clinical and experimental studies comparing the amount of LPSs before and after the use of Ca(OH)₂ as ICM in infected root canals were included. Risks of bias assessment and data extraction were performed. Meta-analysis was conducted by subgrouping according to Ca(OH)₂, the presence of an antimicrobial substance (AS), irrigant solution during chemomechanical preparation (CMP), and the incidence of LPS reduction. The certainty of evidence was determined by the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsNine studies were included in the qualitative synthesis and 7 in the meta-analysis. Three articles had low risk of bias (RB), 1 had moderate RB, 2 had high RB, and 3 “some concerns.” Overall, Ca(OH)₂, with or without AS, reduced mean LPSs before CMP (standardized mean difference [SMD] = −1.087 [confidence interval {CI}, −1.453 to −0.721], P < .001, I² = 58.7%) and after CMP (SMD = −0.919 [CI, −1.156 to −0.682], P < .001, I² = 24.7%). Considering the irrigant solutions, the overall results showed a reduction before (SMD = −1.053 [CI, −1.311 to −0.795], P < .001, I² = 58.7%) and after CMP (SMD = −0.938 [CI, −1.147 to −0.729], P < .001, I² = 24,6%). Analyses presented very low certainty of evidence. The incidence of LPS reduction was 98.9% and 61.7% for Ca(OH)₂ with and without AS, respectively.ConclusionsCa(OH)₂ reduces endotoxin levels when used as ICM but is unable to eliminate LPSs completely independent of the irrigating solution used with very low certainty of evidence.     

A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest

ObjectiveDuring cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac output generated by chest compression decreases gradually with the prolongation of cardiac arrest and resuscitation. Early studies have demonstrated that myocardial blood flow during CPR is largely dependent on peripheral vascular resistance. In this study, we investigated the effects of chest compression in combination with physical control of peripheral vascular resistance assisted by tourniquets on myocardial blood flow during CPR.MethodsVentricular fibrillation was induced and untreated for 7 min in ten male domestic pigs weighing between 33 and 37 kg. The animals were then randomized to receive CPR alone or a tourniquet assisted CPR (T-CPR). In the CPR alone group, chest compression was performed by a miniaturized mechanical chest compressor. In the T-CPR group, coincident with the start of resuscitation, the thin elastic tourniquets were wrapped around the four limbs from the distal end to the proximal part. After 2 min of CPR, epinephrine (20 μg/kg) was administered via the femoral vein. After 5 min of CPR, defibrillation was attempted by a single 150 J shock. If resuscitation was not successful, CPR was resumed for 2 min before the next defibrillation. The protocol was continued until successful resuscitation or for a total of 15 min. Five minutes after resuscitation, the elastic tourniquets were removed. The resuscitated animals were observed for 2 h.ResultsT-CPR generated significantly greater coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow. There was no difference in both intrathoracic positive and negative pressures between the two groups. All animals were successfully resuscitated with a single shock in both groups. There were no significant changes in hemodynamics observed in the animals treated in the T-CPR group before-and-after the release of tourniquets at post-resuscitation 5 min.ConclusionsT-CPR improves myocardial and cerebral perfusion during CPR. It may provide a new and convenient method for augmenting myocardial and cerebral blood flow during CPR.     

The epigenetically active small chemical N-methyl pyrrolidone (NMP) prevents estrogen depletion induced osteoporosis

Currently, there are several treatments for osteoporosis however; they all display some sort of limitation and/or side effects making the need for new treatments imperative. We have previously demonstrated that NMP is a bioactive drug which enhances bone regeneration in vivo and acts as an enhancer of bone morphogenetic protein (BMP) in vitro. NMP also inhibits osteoclast differentiation and attenuates bone resorption.In the present study, we tested NMP as a bromodomain inhibitor and for osteoporosis prevention on ovariectomized (OVX) induced rats while treated systemically with NMP. Female Sprague–Dawley rats were ovariectomized and weekly NMP treatment was administrated 1 week after surgery for 15 weeks. Bone parameters and related serum biomarkers were analyzed. 15 weeks of NMP treatment decreased ovariectomy-induced gained weight in average by 43% and improved bone mineral density (BMD) and bone volume over total volume (BV/TV) in rat femur on average by 25% and 41% respectively. Moreover, mineral apposition rate and bone biomarkers of bone turnover in the treatment group were at similar levels with those of the Sham group.Due to the function of NMP as a low affinity bromodomain inhibitor and its mechanism of action involving osteoblasts/osteoclasts balance and inhibitory effect on inflammatory cytokines, NMP is a promising therapeutic compound for the prevention of osteoporosis.     

Aβ amyloid,cognition, and APOE genotype in healthy older adults

BackgroundOnly one study has investigated the relationship between cerebral β-amyloid (Aβ), apolipoprotein E (APOE) ɛ4 genotype, and cognition. Although significant relationships between cerebral Aβ and cognition were observed in ɛ4 carriers but not noncarriers, the magnitude of this relationship was not reported. Further, when demographic variables were controlled, the influence of APOE ɛ4 on the relationship between cerebral Aβ and cognition dissipated.MethodsIn 144 healthy older adults who had undergone amyloid scanning and APOE ɛ4 genotyping in the Australian Imaging, Biomarkers, and Lifestyle (AIBL) Flagship Study of Ageing, correlations were conducted to determine the magnitude of relationship between cerebral Aβ and cognition in ɛ4 carriers and noncarriers. Fisher’s Z was used to compare these correlations and Cohen’s q determined the magnitude of difference between correlations.ResultsCerebral Aβ was significantly associated with tasks of visual and verbal episodic memory in APOE ɛ4 carriers. This association was not observed in ɛ4 noncarriers. The relationship between cerebral Aβ and episodic memory in ɛ4 carriers was significantly different from that in ɛ4 noncarriers, and the magnitude of this difference was small to moderate.ConclusionsIn APOE ɛ4 carriers, there is a moderate negative relationship between cerebral Aβ and episodic memory. This suggests that increased cerebral Aβ may signify the onset of preclinical AD, especially in healthy older adults who are genetically at risk for AD.     

Maternal immunization with a DNA vaccine candidate elicits specific passive protection against post-natal Zika virus infection in immunocompetent BALB/c mice

Zika virus (ZIKV) infection is closely associated in the fetus with microcephaly and in the adults with Guillain-Barré syndrome and even male infertility. It is an urgent international priority to develop a safe and effective vaccine that offers protection to both women of childbearing age and their children. In this study, female immunocompetent BALB/c mice were immunized with a DNA-based vaccine candidate, pVAX1-ZME, expressing the prM/E protein of ZIKV, and the immunogenicity for maternal mice and the post-natal protection for suckling mice were evaluated. It was found that administration with three doses of 50 μg pVAX1-ZME via in vivo electroporation induced robust ZIKV-specific cellular and long-term humoral immune responses with high and sustained neutralizing activity in adult mice. Moreover, using a maternal immunization protocol, neutralizing antibodies provided specific passive protection against ZIKV infection in neonatal mice and effectively inhibited the growth delay. This vaccine candidate is expected to be further evaluated in higher animals, and maternal vaccination shows great promise for protecting both women of childbearing age and their offspring against post-natal ZIKV infection. The vaccinated mothers and ZIKV-challenged pups provide key insight into Zika vaccine evaluation in an available fully immunocompetent animal model.     

Body Surface Area (BSA) is a Better Osteoporosis Associated Anthropometric Parameter Than Other Anthropometric Parameters in Elderly Population

Body surface area (BSA) is widely used for adjusting drug dose, while few studies have yet systematically evaluated its association with osteoporosis and compared its advantage with other anthropometric parameters in osteoporotic risk prediction. A total of 10,021 Chinese individuals aged over 65 years were enrolled in our study. Bone mineral density (BMD) was measured, and demographic information was also collected. Pearson correlation analysis, receiver operating characteristic (ROC) curves and predictive analysis were performed to assess the clinical practice of BSA for osteoporosis. BSA had the strongest correlation with BMD (0.544, p < 0.001) compared with conventional anthropometric indices. Besides, BSA had the highest power in osteoporosis prediction, with an area under the curve (AUC) reaching 0.81. After incorporating BSA into the osteoporosis risk prediction model, the AUC improved from 0.82 to 0.83 (p < 0.01). We found BSA provided additional diagnostic value beyond conventional anthropometric information with continuous and category NRIs were 30.40% (p < 0.01) and 3.29% (p < 0.01), respectively, and the IDI was 1.85% (p < 0.01). BSA was positively associated with osteoporosis and showed superior discriminative ability for osteoporosis risk prediction compared with other anthropometric parameters in the Chinese elderly population.     

Food environment,walkability, and public open spaces are associated with incident development of cardio-metabolic risk factors in a biomedical cohort

We investigated whether residential environment characteristics related to food (unhealthful/healthful food sources ratio), walkability and public open spaces (POS; number, median size, greenness and type) were associated with incidence of four cardio-metabolic risk factors (pre-diabetes/diabetes, hypertension, dyslipidaemia, abdominal obesity) in a biomedical cohort (n=3205). Results revealed that the risk of developing pre-diabetes/diabetes was lower for participants in areas with larger POS and greater walkability. Incident abdominal obesity was positively associated with the unhealthful food environment index. No associations were found with hypertension or dyslipidaemia. Results provide new evidence for specific, prospective associations between the built environment and cardio-metabolic risk factors.     

The associations between traffic-related air pollution and noise with blood pressure in children: Results from the GINIplus and LISAplus studies

Although traffic emits both air pollution and noise, studies jointly examining the effects of both of these exposures on blood pressure (BP) in children are scarce. We investigated associations between land-use regression modeled long-term traffic-related air pollution and BP in 2368 children aged 10 years from Germany (1454 from Munich and 914 from Wesel). We also studied this association with adjustment of long-term noise exposure (defined as day–evening–night noise indicator “Lden” and night noise indicator “Lnight”) in a subgroup of 605 children from Munich inner city. In the overall analysis including 2368 children, NO₂, PM_2.5 mass (particles with aerodynamic diameters below 2.5 μm), PM₁₀ mass (particles with aerodynamic diameters below 10 μm) and PM_2.5 absorbance were not associated with BP. When restricting the analysis to the subgroup of children with noise information (N = 605), a significant association between NO₂ and diastolic BP was observed (−0.88 (95% confidence interval: −1.67, −0.08)). However, upon adjusting the models for noise exposure, only noise remained independently and significantly positively associated with diastolic BP. Diastolic BP increased by 0.50 (−0.03, 1.02), 0.59 (0.05, 1.13), 0.55 (0.03, 1.07), and 0.58 (0.05, 1.11) mmHg for every five decibel increase in Lden and by 0.59 (−0.05, 1.22), 0.69 (0.04, 1.33), 0.64 (0.02, 1.27), and 0.68 (0.05, 1.32) mmHg for every five decibel increase in Lnight, in different models of NO₂, PM_2.5 mass, PM₁₀ mass and PM_2.5 absorbance as the main exposure, respectively. In conclusion, air pollution was not consistently associated with BP with adjustment for noise, noise was independently and positively associated with BP in children.     

Validation of the Sleep Disturbance Scale for Children and prevalence of parent-reported sleep disorder symptoms in Chinese children

ObjectiveTo translate and validate the Sleep Disturbance Scale for Children (SDSC), a promising questionnaire for use among children in epidemiological studies, in Chinese children.MethodsIn total, 3525 children aged 5–16 years were randomly selected from five primary schools in Shenyang. Internal consistency, reliability and factor analyses were undertaken to assess the construct validity of the SDSC.ResultsInternal consistency indicated adequate reliability (Cronbach’s α = 0.81). Factor analytic results indicated a six-factor solution (ie, six types of sleep disorder) based on parent-reported sleep disorder symptoms. The mean total score of the SDSC was 39.28 ± 7.83 and 156 (4.43%) children were identified as suffering from parent-reported sleep disorder. The prevalence for each sleep type disorder ranged from 3.46% to 6.30% with the highest for sleep hyperhidrosis (SHY) and the lowest for disorders of initiating and maintaining sleep. Significant differences were found between boys and girls in the prevalence of sleep breathing disorders (6.51% vs 3.72%), SHY (8.62% vs 4.00%) and parent-reported sleep disorders (5.19% vs 3.67%).ConclusionsThe SDSC is reliable and useful in screening for parent-reported sleep disorders in Chinese children. Compared with other countries, parent-reported sleep disorders among Chinese elementary school children were at a relatively low level of prevalence.