Influence of needle design and irrigation depth in the presence of vapor lock: A computational fluid dynamics analysis in human oval roots with apical ramification

This paper aims to study the removal of a vapor lock located in the apical ramification of an oval distal root of a human mandibular molar, simulating different needles and irrigation depths with computational fluid dynamic. A geometric reconstruction of the micro-CT of the molar shaped up to a WaveOne Gold Medium instrument was used. A vapor lock located in the apical 2 mm was incorporated. Geometries with positive pressure needles (side-vented [SV], flat or front-vented [FV] and notched [N]) and the EndoVac microcannula (MiC) were created to run the simulations. Irrigation key parameters (flow pattern, irrigant velocity, apical pressure, wall shear stress) and vapor lock removal were compared among the different simulations. Each needle behaved differently that is, FV removed the vapor lock from one ramification and had the highest apical pressure and shear stress values; SV removed the vapor lock in the main root canal but not in the ramification and reached the lowest apical pressure from the positive pressure needles; N was not able to completely remove the vapor lock and showed low apical pressure and shear stress; MiC removed the vapor lock from one ramification, had negative apical pressure and the lowest maximum shear stress. The main conclusion is that none of the needles showed complete removal of vapor lock. MiC, N, and FV were able to partially remove the vapor lock from one out of the three ramifications. However, SV needle was the only simulation that showed high shear stress with low apical pressure.

Single nucleotide polymorphisms in ADAM17, IL23R and SLCO1C1 genes protect against infliximab failure in adults with Crohn's disease

BACKGROUND

To predict primary failure of infliximab (IFX) therapy in Crohn's disease (CD) and to identify patients who maintain long-term effectiveness to IFX is currently not feasible. Some genetic variations are proposed as potential biomarkers.

AIM

We assessed a set of single nucleotide polymorphisms (SNPs) in genes related to the IFX mechanism of action and the presence of HLA-DQA1 * 05 allele on the primary response and long-term durability in CD patients.

METHODS

A multi-centre cross-sectional study of IFX-exposed adult patients with CD was undertaken. Treatment persistence and time to failure were co-primary endpoints. DNA from the 131 patients was genotyped. Association between SNPs and clinical variables with IFX persistence was assessed.

RESULTS

Failure to IFX was documented in 65 (49.6%) out of 131 patients. IFX persistence was associated either with carrying the TT genotype in ADAM17 rs10929587 (ORa=0.2; 95%CI=0.1-0.8; p = 0.021), or the CC genotype in SLCO1C1 rs3794271 (ORa=0.2; 95%CI=0.1-0.7; p = 0.008), according to multivariate logistic regression. In contrast, previous bowel resection increased the risk of IFX failure (ORa=2.8; 95%CI=1.1-7.3; p = 0.025). Cox regression analysis confirmed these findings and also identified IL23R rs10489629-TT (HRa 0.41; 95%CI=0.22-0.75; p = 0.004) and concomitant immunosuppressants (HRa 0.46; 95%CI=0.27-0.77; p = 0.003) as protection from IFX failure. However, no association between HLA-DQA1 * 05 allele and persistence of IFX therapy was found, with similar failure rates among carriers and non-carriers (52.8% vs. 47.4%, respectively; p = 0.544).

CONCLUSIONS

SNPs rs10929587-TT in ADAM17, rs10489629-TT in IL23R and rs3794271-CC in SLCO1C1, together with no previous bowel surgery and concomitant immunosuppression, were identified as protection from failure to IFX.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Reporte de caso: Tumor de células en forma de huso en un canino (fibrosarcoma)

Este trabajo presenta y documenta el caso clínico de un canino y los hallazgos histopatológicos de un tumor de células en forma de huso, subcutáneo, en región cervical con metástasis a región faringo–laringo–traqueal. El paciente fue un canino macho, raza caniche, de 5 años, llevado a la clínica veterinaria de la Universidad de los Llanos. Al examen físico se evidenció en porción dorsal del cuello una masa subcutánea, indolora, firme, de 18 x 11cm, mucosas pálidas, ganglios retrofaríngeos aumentados de tamaño y epifora bilateral. Se realiza eutanasia y necropsia, se toman muestras de tejidos fijados en formalina buffer al 10% que se envía al laboratorio de histopatología animal. Las muestras se procesaron mediante métodos rutinarios para microscopía óptica. Cortes histológicos de 3-4 μm de grosor fueron coloreados con hematoxilina–eosina (H&E) y coloración tricrómica de Masson. En la necropsia se encontró una masa cervical dorsal aparentemente encapsulada, de 18 x 11 cm, firme, anclada al ligamento nucal, zonas de consistencia blanda, puntos rojos y superficie rugosa. Adicionalmente, se encontró nódulo tumoral, firme, fibroso de 6x4 cm en región faringo–laringo–traqueal izquierda. En el examen microscópico se observaron zonas de bastante celularidad arregladas en forma de fascículos, núcleos pleomórficos hipercromáticos con forma de huso, con 1 a 2 nucleolos y otras zonas con menor celularidad en un estroma fibromixoide. Con la coloración de tricrómico de Masson, el 50% de las células adquiere una coloración azul, positiva para fibras colágenas. Se diagnosticó un tumor de células en forma de huso maligno, clasificado como fibrosarcoma.

Present Status and Future Directions - Canal Shaping

This narrative review will focus on the evolution, present and future of engine‐driven root canal preparation. Root canal preparation changed drastically when Walia in 1988 introduced the use of nickel‐titanium (NiTi) alloys in Endodontics. In 2013, five generations of NiTi endodontic instruments had been established based on their metallurgical, mechanical properties and design features. Since then, manufacturers have been introducing further major changes in instrument design and characteristics that have not been translated in new recognized generations of instruments. In general, those changes have demonstrated enhanced instrument properties, but it is not clear yet if all those improvements are directly translated to an improvement in clinical success. This narrative review attempts to address the present status of engine‐driven instruments in terms of both evidence from laboratory‐based studies and clinical data, to identify potential further generations of instruments, and last to anticipate future directions for research and development.

Mycoplasma genitalium and sexually transmitted infections: evidences and figures in a tertiary hospital

Introduction

Mycoplasma genitalium is an emerging cause of sexually transmitted infections (STIs) and has been implicated in non-gonococcal urethritis in men and cervicitis in woman. The aim of this study is determinate the incidence and pathogenicity of M. genitalium within the diagnosis of STIs detected from clinical samples in a third level hospital.

Material and methods

A total of 8,473 samples from endocervix, urethra, vagina, rectum and others were processed applying Allpex STI Essential Assay. More than 190 records were reviewed to determinate M. genitalium pathogenicity.

Results

M. genitalium was detected in a rate 2.8%. Co-infections were detected in 20% of the patients.

Conclusions

M. genitalium is considered a STI emerging pathogen thanks to the renewal of multiplex-PCR tests although with a low incidence in our approach. Emerging from our experience and the institutional recommendations both detection of acid nucleic techniques (NAATs) and gonococcal culture might be implemented accurately and coexist to adequate prescriptions.

Dexamethasone-induced intrauterine growth restriction modulates expression of placental vascular growth factors and fetal and placental growth

Prenatal exposure to glucocorticoids (GC) is a central topic of interest in medicine since GCs are essential for the maturation of fetal organs and intrauterine growth. Synthetic glucocorticoids, which are used in obstetric practice, exert beneficial effects on the fetus, but have also been reported to lead to intrauterine growth retardation (IUGR). In this study, a model of growth restriction in mice was established through maternal administration of dexamethasone during late gestation. We hypothesised that GC overexposure may adversely affect placental angiogenesis and fetal and placental growth. Female BALB/c mice were randomly assigned to control or dexamethasone treatment, either left to give birth or euthanised on days 15, 16, 17 and 18 of gestation followed by collection of maternal and fetal tissue. The IUGR rate increased to 100% in the dexamethasone group (8 mg/kg body weight on gestational days 14 and 15) and pups had clinical features of symmetrical IUGR at birth. Dexamethasone administration significantly decreased maternal body weight gain and serum corticosterone levels. Moreover, prenatal dexamethasone treatment not only induced fetal growth retardation but also decreased placental weight. In IUGR placentas, VEGFA protein levels and mRNA expression of VEGF receptors were reduced and NOS activity was lower. Maternal dexamethasone administration also reduced placental expression of the GC receptor, αGR. We demonstrated that maternal dexamethasone administration causes fetal and placental growth restriction. Furthermore, we propose that the growth retardation induced by prenatal GC overexposure may be caused, at least partially, by an altered placental angiogenic profile.

Benchmarking environmental and economic indicators of sludge management alternatives aimed at enhanced energy efficiency and nutrient recovery

Wastewater treatment plants (WWTPs) have been developed as multifunctional systems that aim to eliminate pollutants present in wastewater, manage the sludge produced and improve energy efficiency. Specifically, sludge management accounts for the largest share in operational costs. Considering the relevant role of sludge treatment within the overall management scheme, this study aims to evaluate different alternatives and strategies for sludge management and treatment from the perspective of life cycle analysis, with special emphasis on those options that reduce environmental impacts and economic costs. Two pre-treatments (chemical or thermal) and two post-treatments (composting unit followed by land application or incineration) were evaluated to improve the eco-balance of the anaerobic digestion (AD) process in terms of operational (biogas production and digested sludge), environmental and economic indicators. According to the results obtained, both sludge pre-treatment alternatives proved to be an adequate alternative to improve biogas production without negatively affecting environmental and economic impacts. Finally, if the final disposal of the digestate is analysed, its application to the soil as a biofertiliser is recommended, since it presents a better environmental profile than incineration.

Circulating MicroRNA Profile Associated with Obstructive Sleep Apnea in Alzheimer's Disease

The diagnosis of obstructive sleep apnea (OSA) in Alzheimer's disease (AD) by polysomnography (PSG) is challenging due to the required collaboration of the patients. In addition, screening questionnaires have demonstrated limited usefulness with this subpopulation. Considering this, we investigated the circulating microRNA (miRNA) profile associated with OSA in AD patients. This study included a carefully selected cohort of females with mild-moderate AD confirmed by biological evaluation (n = 29). The individuals were submitted to one-night PSG to diagnose OSA (apnea-hypopnea index ≥ 15/h) and the blood was collected in the following morning. The plasma miRNA profile was evaluated using RT-qPCR. The patients had a mean (SD) age of 75.8 (5.99) years old with a body mass index of 28.6 (3.83) kg m^-2. We observed a subset of 15 miRNAs differentially expressed between OSA and non-OSA patients, of which 10 were significantly correlated with the severity of OSA. Based on this, we built a prediction model that generated an AUC (95% CI) of 0.95 (0.88-1.00) including 5 of the differentially expressed miRNAs that correlated with OSA severity: miR-26a-5p, miR-30a-3p, miR-374a-5p, miR-377-3p, and miR-545-3p. Our preliminary results suggest a plasma miRNA signature associated with the presence of OSA in AD patients. Further studies will be necessary to validate these findings.

Analysis of the smear layer generated by different activation systems: an in vitro study

OBJECTIVES

To evaluate via scanning electron microscopy the amount of smear layer generated during the use of sonic and ultrasonic activation systems with standardized short-term intentional contacts with the canal walls.

METHODOLOGY

Seventy single-root human teeth were randomly assigned to 2 control (n = 5 each): NC (negative control), PC (positive control) and four experimental groups (n = 15 each): NC (negative control), PC (positive control), G1 (passive ultrasonic irrigation with Irrisafe), G2 (ultrasonic irrigation with EndoUltra), G3 (sonic irrigation with Endoactivator), G4 (sonic irrigation with Eddy). Samples were instrumented with ProTaper Next®. An irrigation protocol with sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) was followed for both PC and the experimental groups. Standardized intentional contacts were made in the mesial walls during 5 s at WL - 2 mm in all experimental groups. Two calibrated evaluators scored the smear layer generated with an ordinal scale by scanning electron microscopy. The weighted kappa coefficient (K_w) was calculated to determine the inter-observer agreement. Post-consensus ordinal data were analyzed using the ordinal (linear) chi-square test.

RESULTS

When the agitation file is in contact with dentine walls, Irrisafe® significantly generated the least amount of smear layer in the coronal third (p < 0.05). Both in the middle and apical third, activation with Irrisafe® also showed statistically significant better results than Eddy™ and EndoUltra®. Endoactivator® showed significant better results than EndoUltra® and Eddy™ in the apical third (p < 0.05).

CONCLUSIONS

Irrisafe generated the least amount of smear layer in the entire canal and similar to Endoactivator in the apical third when the agitation file is in contact with dentine walls.

CLINICAL RELEVANCE

The smear layer is generated during activation. It is common to apply irrigation protocols where after the removal of the smear layer using chelants, a final rinse and activation is carried out but there are no previous studies analyzing the possible creation of a new smear layer with this final activation.

Level of understanding of Alzheimer disease among caregivers and the general population

INTRODUCTION

Understanding of Alzheimer disease (AD) is fundamental for early diagnosis and to reduce caregiver burden. The objective of this study is to evaluate the degree of understanding of AD among informal caregivers and different segments of the general population through the Alzheimer's Disease Knowledge Scale (ADKS).

PATIENTS AND METHODS

We assessed the knowledge of caregivers in different follow-up periods (less than one year, between 1 and 5 years, and over 5 years since diagnosis) and individuals from the general population. ADKS scores were grouped into different items: life impact, risk factors, symptoms, diagnosis, treatment, disease progression, and caregiving.

RESULTS

A total of 419 people (215 caregivers and 204 individuals from the general population) were included in the study. No significant differences were found between groups for overall ADKS score (19.1 vs 18.8, P = .9). There is a scarce knowledge of disease risk factors (49.3%) or the care needed (51.2%), while symptoms (78.6%) and course of the disease (77.2%) were the best understood aspects. Older caregiver age was correlated with worse ADKS scores overall and for life impact, symptoms, treatment, and disease progression (P < .05). Time since diagnosis improved caregivers' knowledge of AD symptoms (P = .00) and diagnosis (P = .05).

CONCLUSION

Assessing the degree of understanding of AD is essential to the development of health education strategies both in the general population and among caregivers.

Suitability of different tooth replicas for endodontic training: perceptions and detection of common errors in the performance of postgraduate students

AIM

To compare the perceptions of students when using five different tooth replicas and to detect common errors in the performance of students that might be attributed to a specific type of tooth replica.

METHODOLOGY

Five groups (n = 10 each) of artificial first maxillary molars (DEPT, DRSK, Nissin, DENTALIKE and TrueTooth) were used. All 50 teeth were mounted individually in opaque containers, distributed in 10 packages containing a sample from each with an assigned random order for students to perform root canal treatments. Ten postgraduate students each performed a root canal treatment on the five replicas, in the assigned order, and completed a satisfaction questionnaire. Three trained and calibrated endodontic educators, each with more than 15 years of experience, evaluated their performance using a grading rubric and completed a questionnaire to detect common errors attributed to a specific tooth replica. Inter-rater reliability was calculated with the interclass correlation coefficient for both consistency and absolute agreement. A two-way related measures anova was used to assess the interaction amongst evaluators and tooth groups on the average scores of students. Post hoc T3 Dunnet was used to compare groups. The perceptions of students amongst groups were compared with chi-square and linear-by-linear association tests.

RESULTS

Inter-rater reliability was very high for both consistency (ICCC = 0.939; 95% confidence interval (CI) 0.902-0.964) and absolute agreement (ICCA = 0.940; 95% CI 0.904-0.965). No significant differences were found amongst the ratings of evaluators; however, students performed differently when using the various tooth replicas (P < 0.05). Overall, 60% of students preferred the DRSK replica for root canal treatment training purposes, followed by DENTALIKE (30%). The least preferred was TrueTooth (70% responses) due to its complex anatomy and poor resistance to instruments and heat pluggers. Evaluators detected several common errors in specific tooth replicas and preferred tooth replicas manufactured based on microCT scans of natural teeth.

CONCLUSIONS

Tooth replicas manufactured based on microCT scans of natural teeth (TrueTooth and DENTALIKE) had much better acceptance amongst evaluators, although students rated and performed less well in TrueTooth replicas due to their greater level of difficulty.

Relationship between unintentional canal overfilling and the long-term outcome of primary root canal treatments and nonsurgical retreatments: a retrospective radiographic assessment

AIM

To determine retrospectively the long-term radiographic outcome of root canal treatments and root canal retreatments with unintentional root canal overfilling.

METHODOLOGY

A total of 220 root canal treatments (143 primary/77 retreatments) with postoperative unintentional canal overfilling and performed by two endodontists during their 45 years of private practice were included in the study. Lateral condensation techniques and nine different sealers were used. Overfilling was confirmed with a postoperative periapical radiograph and patients were scheduled regularly for recall visits. Average recall time was 4.86 years (maximum = 30 years). Two calibrated observers evaluated the radiographs and determined the long-term outcome using the PAI score pooled in a 3-category scale. The persistence or resorption of the extruded material was registered. The Kappa coefficient (K) was calculated and a logistic regression was used for further analysis. Odds ratios and their 95% CI were estimated.

RESULTS

The level of inter-observer agreement was 66.1%. Primary root canal treatments had a significantly (P = 0.015) greater rate of success (91.6%) than retreatments (81.8%). Tooth location (P = 0.019) was the only other factor that significantly affected the outcome. The type of extruded material, and its resorption or persistence did not relate to the outcome. Persistence of extruded material was significantly affected by tooth location and recall time after treatment.

CONCLUSION

The outcome of root canal treatment with unintentional canal overfilling was not associated with the type of extruded material or its resorption or persistence. The persistence of extruded material did not relate to a favourable or unfavourable outcome.

Realization of a Rydberg-Dressed Ramsey Interferometer and Electrometer

We present the experimental realization and characterization of a Ramsey interferometer based on optically trapped ultracold potassium atoms, where one state is continuously coupled by an off-resonant laser field to a highly excited Rydberg state. We show that the observed interference signals can be used to precisely measure the Rydberg atom-light coupling strength as well as the population and coherence decay rates of the Rydberg-dressed states with subkilohertz accuracy and for Rydberg state fractions as small as one part in 10^{6}. We also demonstrate an application for measuring small, static electric fields with high sensitivity. This provides the means to combine the outstanding coherence properties of Ramsey interferometers based on atomic ground states with a controllable coupling to strongly interacting states, thus expanding the number of systems suitable for metrological applications and many-body physics studies.

An innovative wastewater treatment technology based on UASB and IFAS for cost-efficient macro and micropollutant removal

An innovative process based on the combination of a UASB reactor and an IFAS system is proposed in order to combine different redox conditions and biomass conformations to promote a high microbial diversity. The objective of this configuration is to enhance the biological removal of organic micropollutants (OMPs) as well as to achieve the abatement of nitrogen by using the dissolved methane as an inexpensive electron donor. Results showed high removals of COD (93%) and dissolved methane present in the UASB effluent (up to 85%) was biodegraded by a consortium of aerobic methanotrophs and heterotrophic denitrifiers. Total nitrogen removal decreased slightly along the operation (from 44 to 33%), depending on the availability of electron donor, biomass concentration, and configuration (floccules and biofilm). A high removal was achieved in the hybrid system (>80%) for 6 of the studied OMPs. Sulfamethoxazole, trimethoprim, naproxen, and estradiol were readily biotransformed under anaerobic conditions, whereas ibuprofen or bisphenol A were removed in the anoxic-aerobic compartment. Evidence of the cometabolic biotransformation of OMPs has been found, such as the influence of nitrification activity on the removal of bisphenol A, and of the denitrification activity on ethinylestradiol removal.

Morphological variations of the mandibular canal in digital panoramic radiographs: a retrospective study in a Chilean population

BACKGROUND

Morphological variations of the mandibular canal (MC) have been described in literature, so the clinician must be able to recognise them and adapt their treatment accordingly. The aim of this study was to determine the prevalence of morphological variations of the MC using digital panoramic radiographs (DPR) of Chilean patients.

MATERIALS AND METHODS

A retrospective study in which 1400 DPR were analysed to identify cases of bifid, trifid and retromolar MC. The radiographs were analysed independently by two examiners who had previously been trained by a specialist in oral and maxillofacial radiology. Inclusion and exclusion criteria were applied to reach a final sample.

RESULTS

Nine hundred and twenty-five radiographs were included (599 female, 326 male; mean age 36.1 ± 15.54 years). The prevalence of bifid MC was 11% (n = 102), with no significant differences by sex (p = 0.069). Proportion of bifid MC was higher among younger patients (p = 0.038). Prevalence of morphologi- cal variations of type 1 bifid MC was 7.4% (n = 69), type 2 was 2.3% (n = 23), type 3 was 0% (n = 0) and type 4 was 1.1% (n = 10). Prevalence of retromolar canal was 0.9% (n = 8), with no significant differences by sex (p = 0.893) or age (p = 0.371); of these, 2 (0.2%) cases were forward type and 6 (0.6%) cases were retromolar type. No cases of trifid MC were found.

CONCLUSIONS

Digital panoramic radiographs are useful for detecting morphological variations of the MC; we were able to identify three types of bifid MC as well as retromolar canals. Proper identification of these variations by an easily accessible examination is important for avoiding possible complications in clinical-surgical practice.

Persistently altered liver test results in hepatitis C patients after sustained virological response with direct-acting antivirals

Guidelines recommend evaluating persistent alteration of liver tests in HCV-infected patients after sustained virological response (SVR) and its influence on liver disease progression. We studied the prevalence, etiology, associated factors and evolutionary implications of persistent alteration of liver tests in HCV patients after direct-acting antivirals (DAA)-induced SVR. This was a prospective study of HCV-infected patients and SVR after DAA. Those with another previously diagnosed liver disease were excluded. Persistent alteration of liver tests was defined as any increase in ALT, AST or GGT at SVR12 and SVR24. Causes were determined according to standard clinical practice, including liver biopsy and follow-up transient elastography. A total of 1112 patients were included (70.8% males, median age 53 years, 38.8% cirrhosis, 34.9% interferon-experienced, 56.8% HIV-coinfected). Persistent alteration of liver tests was detected in 130/1112 patients (11.7% [95%CI: 9.7-13.6]). Its frequency differed between HCV-monoinfected (45/480: 9.4% [95%CI: 6.7-12.1]) and HIV-coinfected (85/632: 13.5% [95%CI: 10.7-16.2]) (P = .046). In multivariable analysis, cirrhosis (OR 2.12; 95%CI: 1.28-3.53; P = .004) and baseline transient elastography values (OR 1.03; 95%CI: 1.01-1.04; P = .000) were associated with persistent alteration of liver tests. The main etiologies were clinical diagnosis suggestive of nonalcoholic fatty liver disease in 47 (36.2%), alcohol in 30 (23.1%) and drug consumption in 19 (14.6%). Baseline and follow-up transient elastography was performed in 594 patients and showed a significantly different decrease in patients who did or did not have a persistent alteration of liver tests (-21.1% vs -30%, respectively; P = .003), independently of sex, HIV status or baseline TE value. In conclusion, persistent alteration of liver tests is not infrequent after SVR. It is associated with cirrhosis and baseline transient elastography, and the main cause is fatty liver. According to transient elastography changes, persistent alteration of liver tests seems to affect the course of liver disease.

An antisense oligonucleotide targeting TGF-β2 inhibits lung metastasis and induces CD86 expression in tumor-associated macrophages

Background

The transforming growth factor (TGF)-β pathway is a well-described inducer of immunosuppression and can act as an oncogenic factor in advanced tumors. Several preclinical and clinical studies show that the TGF-β pathway can be considered a promising molecular target for cancer therapy. The human genome has three TGF-β isoforms and not much is known about the oncogenic response to each of the isoforms. Here, we studied the antitumor response to ISTH0047, a recently developed locked nucleic acid-modified antisense oligonucleotide targeting TGF-β2.

Materials and methods

We have studied the anticancer response to ISTH0047 using gymnotic delivery in tumor cell cultures and in in vivo preclinical orthotopic mouse models for primary tumors (breast and kidney tumors) and lung metastasis.

Results

We observed that ISTH0047 is able to significantly reduce TGF-β2 mRNA and protein levels without altering the levels of TGF-β1 and TGF-β3. ISTH0047 prevented lung metastasis in syngeneic orthotopic renal cell carcinoma (RENCA) and breast cancer (4T1) tumor models. In addition, using an orthotopic xenograft model of a lung cancer cell line (CRL5807) that mainly expresses TGF-β2, we observed that ISTH0047 had an important effect on the lung microenvironment inhibiting the growth of lung lesions. ISTH0047 treatment re-educated macrophages in the lung parenchyma to express the tumor-suppressive factor, CD86.

Conclusion

Overall, our data point to TGF-β2 as a therapeutic target and ISTH0047 as a novel anticancer drug to prevent lung metastasis by impacting on the tumor niche, in part, through the induction of CD86 in tumor-associated macrophages.

Bilateral bifid mandibular canal: a case report using cone beam computed tomography

The mandibular canal (MC) originates in the mandibular foramen and runs bilaterally through the mandibular ramus and body, ending in the mental foramen. One of the most common anatomical variations is bifid MC, the configurations of which have been classified into four categories and sub-categories. The prevalence of these variations depends on the imaging method used. Studies carried out in panoramic X-rays and cone beam computed tomography (CBCT) show prevalences varying between 1% and 20%. In this case report we present the finding of a bilateral bifid MC by CBCT examination; we describe its location and morphological characteristics. The variation found was a type 1 bilateral bifid MC, which consists in an accessory canal originating from a single mandibular foramen and extending to the third molar or its immediate surroundings. In this report we discuss the importance of detecting these anatomical variations, as well as their implications in clinical practice.

A Clinical Comparison of Two Formulations of Tobramycin 0.3% Eyedrops in the Treatment of Acute Bacterial Conjunctivitis

Purpose

To compare the safety and efficacy of a new enhanced viscosity ophthalmic formulation of tobramycin, given twice daily (BID), with the existing four times daily (QID) treatment regimen in patients with acute bacterial conjunctivitis.

Methods

This was a 12-day, multicenter, observer-masked, randomized, parallel group study. Patients received one drop of tobramycin 0.3% (3 mg/mL) enhanced viscosity ophthalmic solution BID or tobramycin 0.3% (3 mg/mL) ophthalmic solution QID in the affected eyes for 7 days. The primary efficacy variable was the percentage of patients with sustained cure/presumed bacterial eradication based on clinical judgment at the test-of-cure visit (Day 12). Pretherapy bacterial isolates were obtained and tested for susceptibility to tobramycin by determination of minimum inhibitory concentrations (MIC).

Results

A total of 276 patients were enrolled in the study and 203 of these were culture positive and attended all follow-up examinations. In this group, 98% of those treated with tobramycin enhanced viscosity ophthalmic solution and 99% of those treated with tobramycin 0.3% ophthalmic solution were categorized as having sustained cure/presumed eradication at the test-of-cure visit (p=0.6037). Reported adverse events were not serious, mild to moderate in severity, and generally did not prevent continuation in the study. Several pretreatment pathogens demonstrated tobramycin resistance (MIC > 4 mg/mL). However, therapy with both treatments was effective in the majority of the cases.

Conclusions

Tobramycin enhanced viscosity ophthalmic solution is well tolerated and has equivalent efficacy to the established treatment regimen with a simplified posology. The formulation provides an alternative therapy for acute bacterial conjunctivitis that should improve patient compliance and satisfaction.

Prevalence and morphometric analysis of idiopathic osteosclerosis in a Chilean population

BACKGROUND

The aim of this study was to analyse the prevalence and morpho-metric parameters of idiopathic osteosclerosis (IO) in a Chilean population. IO is an intraosseous growth of compact, benign, unilocular, non-expandable bone that is referred to as an anatomical variation.

MATERIALS AND METHODS

A cross-sectional study was performed using 1000 digital panoramic radiographs of adults in which data on the location (maxillary/ mandibular, right/left hemiarcades), shape, position to the dental apex, and the prevalence of IOs were observed in relation to gender and age. The morphometric parameters evaluated were area, height, width, and the linear distances of the IO up to the midline and at the base of the mandible.

RESULTS

The overall prevalence was 2.8% (27 individuals), with the majority of cases in women (66.7%) in the second, third, and fifth decades of life, but without significant differences. All cases were present in the mandible (100%), usually in the left hemiarcade (59.3%), molar (48.2%) and premolar (44.4%) regions; at the height of the dental apices (65.5%), with an irregular shape (40.7%) and round (37%). The area of the IOs was 33.9 ± 20.1 mm2, with a height of 7.7 ± ± 3.1 mm, width of 6.6 ± 3.1 mm, and the distance from the IO to the mandible median line was 26.6 ± 10.7 mm and 9.7 ± 3.7 mm to the mandibular base.

CONCLUSIONS

All the data observed corroborate with previous studies; the IO does not present a large difference in the Chilean population evaluated compared to pre-vious studies carried out in other populations. (Folia Morphol 2018; 77, 2: 272-278).

Injection in temporomandibular joint of rats. Description of technical protocol

The development of animal models for research has been very diffused. Osteoarthritis is a joint degenerative pathology that induces cartilage erosion, chondrocyte proliferation and osteophyte formation. The aim of this paper is to present a technical procedure to perform the injection of monosodium iodine acetate in the temporomandibular joints of rats to generate osteoarthritis and to contribute to future research analysis related to pathology progression and proper treatment performance. The use of rat models may be a complex process because of their size, but they can be compared to the human temporomandibular joint due to the similar characteristics and the possibility of performing diagnosis and treatment protocols in order to detect this pathology.

New curricular design in biostatistics to prepare residents for an evidence-based practice and lifelong learning education: a pilot approach

AIM

To develop, implement and evaluate an innovative curriculum in biostatistics in response to the need to foster critical thinking in graduate healthcare education for evidence-based practice and lifelong learning education.

METHODOLOGY

The curriculum was designed for first-year residents in a postgraduate endodontic programme using a six-step approach to curriculum development to provide sufficient understanding to critically evaluate biomedical publications, to design the best research strategy to address a specific problem and to analyse data by appropriate statistical test selection. Multiple learner-centred instructional methods and formative and summative assessments (written tasks, simulation exercises, portfolios and pre-post knowledge tests) were used to accomplish the learning outcomes. The analysis of the achievement of the group of students and a satisfaction survey for further feedback provided to the residents at the end of the curriculum were used for curriculum evaluation.

RESULTS

All residents demonstrated competency at the end of the curriculum. The correct answer rate changed from 36.9% in the pre-test to 79.8% in the post-test. No common errors were detected in the rest of the assessment activities. All participants completed the questionnaire demonstrating high satisfaction for each independent category and with the overall educational programme, instruction and course in general.

CONCLUSIONS

The curriculum was validated by the assessment of students' performance and a satisfaction survey, offering an example of a practical approach to the teaching of statistics to prepare students for a successful evidence-based endodontic practice and lifelong learning education as practicing clinicians.

Barcodes of marine invertebrates from north Iberian ports: Native diversity and resistance to biological invasions

Ports are gateways for many marine organisms transported by ships worldwide, especially non-indigenous species (NIS). In this study carried out in North Iberian ports (Cantabrian Sea, Bay of Biscay) we have observed 38% of exotic macroinvertebrates. Four species, namely the barnacle Austrominius modestus, the tubeworm Ficopomatus enigmaticus, the Pacific oyster Crassostrea gigas and the pygmy mussel Xenostrobus securis, exhibited clear signs of invasiveness. A total of 671 barcode (cytochrome oxidase subunit I or 18S rRNA) genes were obtained and confirmed the species status of some cryptic NIS. Negative and significant correlation between diversity estimators of native biota and proportion of NIS suggests biotic resistance in ports. This could be applied to management of port biota for contributing to prevent the settlement of biopollutants in these areas which are very sensitive to biological invasions.

Drug-Induced Lung Injury in a Liver Transplant Patient Treated With Sofosbuvir

New direct-acting antivirals (DAAs) have dramatically improved sustained virologic response (SVR) rates in patients treated for chronic hepatitis C. Although the safety of these agents has been very good in registration trials, unexpected side effects have been reported after much broader use of DAAs on marketing. We retrospectively examined all liver transplant recipients with chronic hepatitis C that received sofosbuvir-based regimens at our clinic. A total of 24 liver transplant recipients with recurrent chronic hepatitis C had received sofosbuvir up to April 2015. Regimens were as follows: sofosbuvir+simeprevir (8), SOF+ledipasvir (6), sofosbuvir+daclatasvir (5) and sofosbuvir+ribavirin (5). Overall, treatment was very well tolerated with only mild adverse events in 42% of patients. However, a 52-year-old woman developed severe respiratory failure within 10 days after beginning sofosbuvir+daclatasvir. High-resolution computerized tomography showed areas of diffused ground-glass opacities in both lungs, suggesting drug-induced lung injury. The bronchoalveolar lavage showed marked signs of acute inflammation without recovering any infectious agent. The patient was treated with high-dose corticosteroids and steadily recovered. DAA therapy was not discontinued, but sofosbuvir was replaced by simeprevir. She reached sustained virologic response after completing 24 weeks of DAA therapy. Given the close temporal association, radiologic and bronchoalveolar lavage findings, and negative work-up for infectious agents, we postulated that sofosbuvir was the most likely explanation for drug-induced lung injury in our patient.

Phase-sensitive correlation optical time-domain reflectometer using quantum phase noise of laser light

We propose and experimentally demonstrate a simple approach to realize a phase-sensitive correlation optical time-domain reflectometer (OTDR) suitable for detection and localization of dynamic perturbations along a single-mode optical fiber. It is based on the quantum phase fluctuations of a coherent light emitted by a telecom DFB diode laser. Truly random probe signals are generated by an interferometer with the optical path difference exceeding the coherence length of the laser light. Speckle-like OTDR traces were obtained by calculating cross-correlation functions between the probe light and the light intensity signals returned back from the sensing fiber. Perturbations are detected and localized by monitoring time variations of correlation amplitude along the fiber length. Results of proof-of-concept experimental testing are presented using an array of ultra-low-reflectivity fiber Bragg gratings as weak reflectors.

Nutritive and xenobiotic compounds in the alien algae Undaria pinnatifida from Argentine Patagonia

Seaweeds have been used as food since ancient times. The edible brown algae Undaria pinnatifida is native to northeast Asia; however, in 1992, the first specimens in Patagonian environments were found and, since then, have rapidly expanded. The main object of this study was to determine, for the first time in Argentina, the nutritive composition and concentrations of trace elements and hydrocarbons in these alien algae and evaluate their usefulness as food. Sexually mature U. pinnatifida samples were collected at 10-m depth in the Nuevo and San José gulfs. The first site is influenced by activities from Puerto Madryn city, and the latter place was considered as the control. Protein, dietary fiber, and mineral concentrations were similar in both gulfs and in the same order as in eastern countries. Crude protein, indigestible fiber, and calcium and magnesium concentrations were greatest in blade; lipid concentration was greatest in sporophyll; and sodium and potassium concentrations were greatest in midrib. Amino acids showed the greatest concentrations in blades, and these were greater than those reported in kelp from Japan. Cadmium (Cd), arsenic, mercury, and hydrocarbons were detected, but only Cd showed concentrations that could be a risk for consumption. In Argentina, maximum acceptable levels of these contaminants in seaweeds are not established.

Cross-species transferability of eastern white pine (Pinus strobus) nuclear microsatellite markers to five Mexican white pines

We examined cross-species transferability and usefulness of six nuclear microsatellite markers developed in consubgeneric eastern white pine (Pinus strobus) with regard to ecologically and commercially important Mexican white pine species of conservation genetics concern: Pinus chiapensis (Mart.) Andresen, P. flexilis James, P. strobiformis Engelm., P. ayacahuite Ehrenb. Ex Schltdl, and P. ayacahuite var. veitchii (Roezl) G.R. Shaw. Four to six microsatellite loci were found to be polymorphic in different species, with moderate to high informativeness in a relatively small number of samples (PIC/HE=0.25-0.93). This successful transfer sidesteps the time- and resource-consuming development of species-specific microsatellite markers, and will facilitate population and conservation genetic studies and genetic resource management of the less studied Mexican white pines.

Validated finite element analyses of WaveOne Endodontic Instruments: a comparison between M-Wire and NiTi alloys

AIM

To validate torsional analysis, based on finite elements, of WaveOne instruments against in vitro tests and to model the effects of different nickel-titanium (NiTi) materials.

METHODOLOGY

WaveOne reciprocating instruments (Small, Primary and Large, n = 8 each, M-Wire) were tested under torsion according to standard ISO 3630-1. Torsional profiles including torque and angle at fracture were determined. Test conditions were reproduced through Finite Element Analysis (FEA) simulations based on micro-CT scans at 10-μm resolution; results were compared to experimental data using analysis of variance and two-sided one sample t-tests. The same simulation was performed on virtual instruments with identical geometry and load condition, based on M-Wire or conventional NiTi alloy.

RESULTS

Torsional profiles from FEA simulations were in significant agreement with the in vitro results. Therefore, the models developed in this study were accurate and able to provide reliable simulation of the torsional performance. Stock NiTi files under torsional tests had up to 44.9%, 44.9% and 44.1% less flexibility than virtual M-Wire files at small deflections for Small, Primary and Large instruments, respectively. As deflection levels increased, the differences in flexibility between the two sets of simulated instruments decreased until fracture. Stock NiTi instruments had a torsional fracture resistance up to 10.3%, 8.0% and 7.4% lower than the M-Wire instruments, for the Small, Primary and Large file, respectively.

CONCLUSION

M-Wire instruments benefitted primarily through higher material flexibility while still at low deflection levels, compared with conventional NiTi alloy. At fracture, the instruments did not take complete advantage of the enhanced fractural resistance of the M-Wire material, which determines only limited improvements of the torsional performance.

Observation of Efimov resonances in a mixture with extreme mass imbalance

We observe two consecutive heteronuclear Efimov resonances in an ultracold Li-Cs mixture by measuring three-body loss coefficients as a function of magnetic field near a Feshbach resonance. The first resonance is detected at a scattering length of a_((0))=-320(10)a_((0)), corresponding to ∼7(∼3) times the Li-Cs (Cs-Cs) van der Waals range. The second resonance appears at 5.8(1.0)a_((0)), close to the unitarity-limited regime at the sample temperature of 450 nK. Indication of a third resonance is found in the atom loss spectra. The scaling of the resonance positions is close to the predicted universal scaling value of 4.9 for zero temperature. Deviations from universality might be caused by finite-range and temperature effects, as well as magnetic field-dependent Cs-Cs interactions.

Propofol administration is safe in adult eosinophilic esophagitis patients sensitized to egg, soy, or peanut

BACKGROUND

Sedation might improve tolerability and adherence to endoscopic procedures in patients with eosinophilic esophagitis (EoE). Propofol administration is often contraindicated in patients with hypersensitivity to egg, soy, or peanut.

OBJECTIVE

To investigate the safety of propofol administration for procedural sedation in EoE patients sensitized/allergic to egg, soy, peanut.

METHODS

A retrospective observational study in adult EoE patients undergoing esophagogastroduodenoscopy with propofol sedation was conducted between January 2009 and March 2013. Food-specific serum IgE and skin prick tests for egg, soy, peanut, and cross-reactant foods were performed in all patients.

RESULTS

Sixty EoE adult patients, mostly on food elimination diets (91%), were evaluated (age: 28 years (14-56), male gender (90%)). Atopy was present in 88% of patients, being the most prevalent comorbidities rhinoconjunctivitis (78%) and asthma (67%). Fifty-two patients (86%) were sensitized to either egg, soy, or peanut. Eighteen patients (28%) had a history of allergic reactions to egg, legumes, and nuts and strictly avoided these foods. A total of 404 upper endoscopies were performed under propofol sedation. No allergic adverse events were reported, except a transient bronchospasm after orotracheal intubation in an asthmatic adolescent receiving multiple drugs for anesthesia, in whom no sensitization to either propofol or its lipid vehicle was confirmed.

CONCLUSIONS

Propofol was safely administered for procedural sedation in a large series of adult EoE patients multisensitized to egg, soy, peanut, showing one-third clinical allergy to these foods.