Influence of antioxidants on stress of bonding agents in recently whitened teeth

The aim of this study was to evaluate the influence of time of application of antioxidant agents on the bond strength to bovine enamel after bleaching by light emitting diode. Twenty two bovine incisors were used, on which the vestibular surfaces were flattened and divided into four experimental groups (n = 15) according to each antioxidant agent, with two groups each, varying the application time of 1 or 10 minutes, all submitted to the same whitening agent (Lase Peroxide) and the control group was only restored. The other groups were treated with antioxidant agents before the restorative procedure using the adhesive system All Bond 3 and resin Filtek Z-350. To obtain the dental fragments, teeth were placed in a precision cutter (Elquip), obtaining 0.8 mm 2 with sticks that were submitted to micro tensile testing at a test speed of 0.5 mm/min. The results, statistically analyzed by ANOVA and Tukey test (p < 0.05), indicated an increase in the value of bond strength of bleached groups treated with ascorbic acid, and a reduction when combined with sodium thiosulfate. No improvement in bond strength was found in the others.     

The pattern of irreversible brain changes after cardiac arrest in humans

Irreversible brain damage resulting in sustained post-arrest coma is a most serious complication of CA in resuscitated patients. In this study we present the neuropathological examination performed on 17 brains of patients who had remained unconscious for variable post-resuscitation periods and died after survival time ranging from 1 day to 36 days following cardiac arrest. Two main types of irreversible brain lesions were observed. The first one consisted of primary ischaemic selective disseminated neuronal death appearing in the form of acidophilic neurones with consecutive neuronal loss and reactive astroglial activation in the brain regions vulnerable to ischaemia or in more widespread distribution. The second included microinfarcts or confluent areas of pancellular necrosis associated with perivascular and diffuse tissue sponginess and was considered as secondary to post-resuscitation systemic and regional circulatory disturbances. These lesions showed multifocal, perivascular and laminar distribution with apparent predilection to the cortical border zones of arterial supply territories and were associated with disintegration and loss of GFAP-reactive astrocytes. Continuity between the areas of selective neuronal loss and focal tissue pannecrosis with corresponding patchy disappearance of GFAP- and VIM-positive astrocytes indicates the contribution of astroglia in the progression of postischaemic brain lesions. Both types of changes, evaluated in the neocortex and hippocampus, were more intensive and heterogeneous in the patients dying after prolonged coma duration than in those with recovery of consciousness within the first days after resuscitation.     

Smooth Muscle Operator: Robotic-Assisted Enucleation of an Esophageal Leiomyoma

Digestive Diseases and Sciences -     

Pulmonary Perfusion Asymmetry in Patients after Repair of Tetralogy of Fallot: A 4D Flow MRI-Based Study

Background: Repaired Tetralogy of Fallot (rTOF) patients may have residual lesions such as main (MPA) and branch pulmonary artery stenosis (BPAS). While MPA stenosis is well studied, few data are available on BPAS in rTOF. We aimed to describe pulmonary perfusion in a large paediatric cohort of rTOF and its impact on right ventricular and outflow-tract hemodynamics using 4D flow CMR. Methods: 130 consecutive patients (mean age at CMR 14.3 ± 4.6 years) were retrospectively reviewed. 96 patients had transannular patch without valve preservation while 34 patients had conserved annulus or valved conduit. A pulmonary blood flow ratio (right pulmonary artery (RPA)/left pulmonary artery (LPA)) between 0.75 and 1.56 was considered normal. Results: Asymmetric pulmonary perfusion was present in 59/130 patients (45%), with 54/59 (91%) having left lung hypoperfusion (blood flow ratio >1.56). RPA/LPA perfusion ratio in the whole cohort was independently associated with the LPA Z-score (−0.053, p = 0.007), the RPA regurgitant fraction (RF) (0.013, p = 0.011) and previous LPA stenting (0.648, p = 0.004). Decreasing LPA % perfusion (and conversely increasing RPA % perfusion) was significantly associated with higher MPA diameter Z-score (−0.06, p = 0.007). On multivariate analysis, MPA Z-score was independently associated with pulmonary RF (0.48, p < 0.001) and with right ventricular indexed volumes (coefficient 3.6, p = 0.023). In patients with transannular patch repair, asymmetric pulmonary flow was an independent predictor of right ventricular ejection fraction (RVEF) (−3.66, p = 0.04). Conclusions: Pulmonary perfusion asymmetry is frequent in rTOF and is associated with abnormal right ventricular and outflow-tract hemodynamics, including MPA dilatation and decreased RVEF in patients after transannular patch.     

Health care and medication costs and use among older adults with heart failure

BACKGROUND: Heart failure disproportionately affects older adults for whom multiple medications are prescribed to prevent exacerbations and hospitalization. To target interventions effectively, it is important to understand the association of medication acquisition with health care utilization and costs. METHODS: We used electronic medical records from an urban public health care system to identify patients aged >/=50 years who had a diagnosis of heart failure. We assessed the association between inappropriate or appropriate medication supplies and hospitalization and costs using multivariable analyses that adjusted for demographic characteristics, prior health care use, health status, and insurance status. RESULTS: Total health care costs for treating 1554 patients with heart failure from 1996 to 2000 were 36.6 million dollars (in 2000 dollars). Less than a third of patients received appropriate medication supplies (between 90% and 110% of the supplies needed) annually. Compared with patients with appropriate supplies, the odds of hospitalization were greater among those with undersupplies (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 2.3 to 4.2; P <0.0001) or oversupplies (OR = 2.0; 95% CI: 1.7 to 2.4; P <0.0001). Total costs were 25% higher for patients with undersupplies (95% CI: 8% to 46%; P = 0.004) and 18% higher for those with oversupplies (95% CI: 7% to 30%; P = 0.0009) than for those with appropriate supplies. CONCLUSION: Among adults with heart failure, inappropriate medication supplies were associated with increased hospitalization and higher costs. Monitoring medication supplies from electronic medical records may be a useful component of programs aiming to improve care while managing costs.     

Research in patients with heart failure: challenges in recruitment.

BACKGROUND: Published studies of patients with heart failure may not include details about the challenges in the recruitment process. OBJECTIVES: To describe the recruitment process during the first 18 months of a study being conducted to evaluate cognitive deficits in patients with chronic heart failure. METHODS: Details of the recruitment process are described for 2 clinic sites. RESULTS: A total of 4,027 echocardiograms were screened at site 1 to evaluate eligibility. Of the 161 patients eligible, 61 (38%) were invited to participate, and 29 of the 61 (48%) completed the study. At site 2, four hundred thirty-seven medical records of patients were screened, resulting in 163 eligible patients (37%). The staff invited 70 of the 163 patients (43%) to participate, and 52 of the 70 (74%) completed the study. The refusal rate was 23% at site 1 and 21% at site 2. CONCLUSIONS: Successful recruitment in studies involving patients with heart failure often requires screening of a large group of patients.     

Molecular and Clinical Diagnosis of Group A Streptococcal Pharyngitis in Children

Group A Streptococcus (GAS) pharyngitis is a very common condition causing significant morbidity in children. Accurate diagnosis followed by appropriate antimicrobial therapy is recommended to prevent postinfectious sequelae. Diagnosis of GAS pharyngitis by a rapid antigen detection test (RADT) or culture in the absence of discriminating clinical findings remains challenging. Validation of new sensitive rapid diagnostic tests is therefore a priority. The performance of a loop-mediated isothermal amplification (LAMP) assay (illumigene assay) for the diagnosis of GAS pharyngitis was compared with that of a RADT and standard culture in 361 pediatric throat swab samples. Discrepant results were resolved using an alternate molecular assay. Test results were correlated with clinical presentations in patients positive by either method. The closest estimate of the true prevalence of GAS pharyngitis was 19.7% (71/361 samples). The illumigene assay alone detected 70/71 GAS-positive samples; RADT and culture detected 35/71 and 55/71 samples, respectively. RADT followed by culture confirmation of RADT-negative specimens detected 58/71 cases. The illumigene assay increased identification among children eligible for testing by American College of Physicians (ACP)/American Academy of Family Physicians (AAFP) criteria from 31 to 39 positive cases, five of which were false positives. Analysis of clinical data in GAS-positive patients indicated that a significantly greater proportion of children with McIsaac scores of ≥4 tested positive by the illumigene assay versus RADT and culture. Overall, the illumigene assay was much more sensitive and was similarly specific for GAS detection, compared to culture alone, RADT alone, or the ACP/AAFP RADT/culture algorithm. Combining high sensitivity with rapidly available results, the illumigene GAS assay is an appropriate alternative to culture for the laboratory diagnosis of GAS pharyngitis in patients for whom testing is clinically indicated.     

Peptides stimulating synthesis of extracellular matrix used in anti-ageing cosmetics: Are they clinically tested? A systematic review of the literature

Peptides stimulating synthesis of extracellular matrix are now commonly used in the production of anti-ageing cosmetics. However, much uncertainty still exists about the methodology of their clinical assessment. The aim of the study was to review the literature for clinical study designs assessing the efficacy of these peptides. The authors searched systematically publications indexed in PubMed, Scope and Web of Science, according to the PRISMA protocol. Altogether 12 scientific papers, reporting results of 15 independent studies were identified. Out of these 15 studies, only six used a placebo control. Double-blinding was applied in five out of 15 studies. Nine studies were based on female-only populations. For the product performance evaluation, most of the studies (10 out of the 15) used image-based methods. The literature on the topic is sparse. The studies carried out so far have many methodological limitations. Most of the clinical experiments hitherto conducted were non-double-blind and used no placebo control. There is a need for better planned and controlled clinical trials in this area.     

Pityriasis Alba—Common Disease,Enigmatic Entity: Up‐to‐Date Review of the Literature

Pityriasis alba (PA) is a skin disorder that affects children and adolescents. Although it is common worldwide, its incidence is markedly higher in darker skin phototypes. Its characteristic features include an extended, multistage course and spontaneous remissions and recurrences. Preceded by erythematous changes, patches of hypopigmented skin of up to a few centimeters in diameter appear on the upper body. Pruritus may accompany it. Even though its etiology is unknown, possible reported triggering factors include sunlight, beauty treatments, and microorganisms, among others. Calcineurin inhibitors play the most crucial role in PA pharmacotherapy. PA often coexists with atopic dermatitis and is considered one of its milder forms.