Effects of Combined Endurance and Resistance Eccentric Training on Muscle Function and Functional Performance in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial.

OBJECTIVE: To evaluate the adherence to treatment and efficacy of an eccentric-based training (ECC) program on peripheral muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Prospective, assessor-blinded, randomized controlled trial. SETTING: The cardiopulmonary rehabilitation unit of a tertiary subacute referral center. PARTICIPANTS: Thirty (N=30) stable inpatients (mean age 68±8 years; FEV1 44±18% of predicted) with COPD were included in the study. INTERVENTIONS: Inpatients were randomly assigned to 4 weeks of a combined endurance and resistance ECC (n=15) or conventional training (CON; n=15). MAIN OUTCOME MEASURES: Quadriceps peak torque (PT) was the primary outcome measure for muscle function. Rate of force development (RFD), muscle activation and quality (quadriceps PT/leg lean mass), 6-min walk distance (6MWD), 4-meter gait speed (4mGS), 10-meter gait speed, 5-repetition sit-to-stand (5STS), dyspnea rate, and mortality risk were the secondary outcomes. Evaluations were performed at baseline and repeated after 4 weeks and 3 months of follow-up. RESULTS: Quadriceps PT, RFD, and muscle quality improved by 17±23% (P<.001), 19±24%, and 16±20% (both P<.05) within the ECC group. Besides, a significant between-group difference for RFD (56±94 Nm/s, P=.038) was found after training. Both groups showed clinically relevant improvements in 6MWD, 4mGS, dyspnea rate, and mortality risk, with no significant differences between groups. CONCLUSION: Combined endurance and resistance ECC improved lower limbs muscle function compared with CON in inpatients with COPD. In contrast, ECC did not further improve functional performance, dyspnea, and mortality risk. ECC may be of particular benefit to effect on skeletal muscle function in patients with COPD.

Prevalencia de cristales de colesterol en granulomas perirradiculares de origen endodóntico / Prevalence of cholesterol crystals in periradicular granulomas of endodontic origin

Resumen Objetivo Comparar dos procedimientos de soldadura convencionales empleando una aleación de Cr-Co, para conectar barras coladas seccionadas a ser fijadas sobre implantes. Materiales y métodos A partir de un modelo maestro que representa un maxilar desdentado con cuatro implantes, se confeccionaron veinte (n=20) probetas seccionadas en tres partes. Se conformaron dos grupos, cada uno con diez (n=10) ejemplares. Una vez acondicionadas, fueron atornilladas al modelo maestro. Su desajuste inicial se analizó utilizando una lupa estereoscópica, con una cámara incorporada y un software. Las partes fueron soldadas empleando un procedimiento diferente para cada grupo. Las correspondientes al Grupo I se invistieron en un block refractario a base de sílico-fosfato. Las del Grupo II se montaron en una estructura metálica Clever Spider. El desajuste fue mensurado y los resultados procesados estadísticamente. El nivel de significación fue establecido en p<0,05. Resultados El Grupo I tuvo un desajuste inicial de 97,30±13,81μm y el Grupo II de 98,53±11,24μm. Luego de la soldadura, el Grupo I registró 98,53±17,17μm, 1,23μm mayor respecto al inicial. En el Grupo II se observó 103,13±17,61μm, 4,60μm por encima del original. Se analizaron mediante prueba t de Student; en ambos casos el resultado fue de p>0,05. Al comparar entre sí los grupos I y II, por medio de la prueba t y de comprobación no paramétrica de Mann-Whitney, se observaron diferencias no significativas, p=0,41 y p=0,38 respectivamente. Conclusiones Bajo las condiciones de este estudio, se observó que los dos métodos de soldadura analizados fueron confiables para unir supraestructurasos metálicas sin que se afecte su ajuste final.

Abstract Aim Compare two conventional welding procedures using a Cr-Co alloy, to connect sectioned cast bars to be fixed on implants. Materials and methods From a master model representing a toothless jaw with four implants, twenty (n=20) specimens sectioned into three parts were made. Two groups were formed, each with ten (n=10) specimens. Once conditioned, they were screwed to the master model. Its initial mismatch was analyzed using a stereoscopic magnifier, with a built-in camera and a software. The parts were welded using a different procedure for each group. Those corresponding to Group I were invested in a refractory block based on silyl-phosphate. Those of Group II were mounted on a Clever Spider metal structure. The mismatch was measured, and the results processed statistically. The level of significance was established at p<0.05. Results Group I had an initial mismatch of 97.30 ±13.81μm, and Group II of 98.53±11.24μm. After welding, Group I registered 98.53±17.17μm, 1.23μm higher than the initial one. In Group II, 103.13±17.61μm was observed, 4.60μm above the original. They were analyzed using Student's t test; in both cases the result was p>0.05. When comparing groups I and II, using the t-test and the Mann-Whitney nonparametric verification, non-significant differences were observed, p=0.41 and p=0.38 respectively. Conclusions Under the conditions of this study, it was observed that the two welding methods analyzed were reliable for joining metallic superstructures without affecting their final fit.

Prevalencia de cristales de colesterol en granulomas perirradiculares de origen endodóntico / Prevalence of cholesterol crystals in periradicular granulomas of endodontic origin

Objetivos: Identificar y determinar la prevalencia de cristales de colesterol (CRCo) en granulomas perirradiculares de origen endodóntico y el tipo de reacción que provocan en los tejidos circundantes. Material y métodos: Se estudiaron con microscopía óptica 75 preparados histológicos de archivo pertenecientes a lesiones perirradiculares humanas correspondientes a piezas dentarias que habían recibido un tratamiento endodóntico pre- vio y que, según los informes que acompañaban las muestras, habían sido obtenidas mediante una apicectomía. Del total, 68 muestras fueron diagnosticadas como granulomas, mientras que los 7 restantes se diagnosticaron como quistes inflamato- rios y fueron descartadas. Resultados: 39 granulomas pertenecían a pacientes de sexo femenino con presencia de CRCo en el 58,97% de los ca- sos. Los 29 granulomas restantes pertenecían al sexo mascu- lino y presentaron CRCo en un 41,37%. La mayor proporción de CRCo fue hallada en granulomas pertenecientes a pacien- tes mayores de 62 años. Los CRCo se observaron rodeados de macrófagos y células gigantes multinucleadas, provocando una reacción a cuerpo extraño. También se observaron células espumosas en áreas circundantes. Conclusiones: La presencia de CRCo en granulomas perirradiculares de origen endodóntico provoca una reacción a cuerpo extraño que puede interferir con el proceso de re- paración posendodóntico especialmente en pacientes de edad avanzada (AU)

Aim: Identify and determine the prevalence of cholester- ol crystals (CRCo) in periradicular granulomas of endodontic origin and the type of reaction they produce in the surround- ing tissues. Material and methods: 75 archival histological preparations were studied with optical microscopy. They be- longed to human periradicular lesions corresponding to teeth that had received a previous endodontic treatment and that, according to the reports accompanying the samples, had been obtained by an apicoectomy. Of the total, 68 samples were diagnosed as granulomas, while the remaining 7 were diag- nosed as inflammatory cysts and were discarded. Results: 39 granulomas corresponded to female patients in which the presence of CRCo was observed in 58.97% of the cases. The remaining 29 granulomas were from male patients and showed CRCo in 41.37% of the cases. The highest pro- portion of CRCo was found in patients over 62 years of age. The CRCo were surrounded by macrophages and multinucle- ated giant cells causing a foreign body reaction. Foam cells were also observed in the surrounding areas. Conclusions: The presence of CRCo in periradicular granulomas of endodontic origin could be a factor interfering with periapical healing after conventional endodontic thera- py, especially in elderly patients (AU)

Dysbiosis and leaky gut in hyper-inflated COPD patients: Have smoking and exercise training any role?

BACKGROUND: To characterize the leaky gut syndrome in a cohort of COPD patients with lung hyperinflation according to their clinical history (i.e. hyperinflation severity, chronic respiratory failure [CRF] presence, GOLD stage, prescribed therapy, smoking history) and with or without recent exercise training activity. METHODS: At the ambulatory visit, we evaluated selected COPD patients with lung hyperinflation [residual volume (RV)≥110% pred, TLC≤120% pred)] in clinical stability, identifying them as those who have attended a recent program of exercise training and those who were waiting for it. Clinical and respiratory characteristics (forced expiratory volume at the first second, forced vital capacity, and arterial blood gasses) were collected. Microbiota composition (CFU/ml), and intestinal permeability (i.e., Zonulin ng/ml) were measured in the stool and normalized to the normality cutoff value. RESULTS: All patients [n = 32, median age: 67 years, median RV: 185.0% pred (IQR: 162.0-206.0) and TLC 125.0% pred (IQR: 113.0-138.0)] showed depletion of Lactobacilli, Bacteroides and a great increase in E. Coli, KES (2 and 6.4 times) and Saccharomyces concentrations (2.5 times) other than normality. All evaluations on gut microbiota composition in the whole population were independent of BMI, CRF, GOLD stage or hyperinflation severity, and inhaled steroid therapy. Smoking habits (smokers vs ex-smokers) influenced only Bacteroides species (p<0.05) and no systemic inflammation was present in these patients. On the contrary, Zonulin concentration, a marker of intestinal permeability, was significantly higher than normal (2.8 times) and was correlated with Saccharomyces (p = 0.013). Zonulin (p = 0.001) and Saccharomyces (p<0.0001) were also significantly different in patients undergoing exercise training with respect to those on the waiting list for training. These findings were not influenced by smoking habits. CONCLUSIONS: A marked dysbiosis and leaky gut alteration characterize all COPD hyper-inflated patients, being worse in patients waiting for exercise training. A pre-to-post study is necessary to confirm these preliminary findings.

Muscle function and functional performance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a prospective observational study.

This study aimed to measure changes in different properties of skeletal muscles and evaluate their contribution and relationship to changes in functional performance after pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). COPD outpatients attending 5 weeks of conventional PR were recruited. Functional performance [5-repetitions sit-to-stand (5STS), and 4-m gait speed (4mGS)], and muscle function (maximal isometric strength, power, force control, and relative concentric and eccentric activation during 5STS) were assessed after PR and 3 months of follow-up. Twenty patients (71 years; 52% of predicted FEV1) completed the study. 4mGS and relative concentric activation during 5STS decreased respectively by 7.7% and 26% between the beginning of PR and follow-up. Quadriceps strength, power, and force control improved by 10.4%, 27.3%, and 15.2%, respectively, from the beginning of PR to follow-up the relative eccentric activation during 5STS explained 31% of the variance in 4mGS changes. In conclusion, functional performance appeared to decline after conventional PR, whereas several properties of skeletal muscles were maintained at follow-up in COPD outpatients. Of note, eccentric contractions might play a role in the improvement of functional performance. Therefore, future studies with interventional design should include eccentric training in PR programs during clinical COPD practice.

Ability of two reciprocating Nickel-Titanium instruments for guttapercha/ sealer removal in simulated curved root canals.

The aim of this study was to compare the capacity of two reciprocating NiTi instruments in removing gutta-percha/sealer material from simulated curved root canals (SCRC). The time required for filling material removal was also recorded. Twenty SCRCs were divided into two groups of 10 (n=10) samples each. In Group 1, the SCRC were prepared to a R25 Reciproc Blue instrument (RCPB; VDW, Munich, Germany). In Group 2 the SCRC were prepared to a Primary WaveOne Gold instrument (PWOG; Dentsply, Ballaigues, Switzerland). In both groups, the canals were filled with matched-taper single gutta-percha cones and AH Plus sealer. Filling materials were removed with R25 RCPB (Group 1) and PWOG (Group 2). The amount of remaining gutta-percha/sealer was calculated at three predetermined levels of evaluation located at 2, 6 and 10 mm from the WL and expressed in percentages. Canals re-treated with RCPB contained significantly less remaining gutta-percha/sealer compared tocanalspreparedwith PWOG (P=0.02). The RCPB instruments required significantly less time to complete the retreatment procedures (P<0.01). No unwinding or instrument separation was noted. RCPB instruments removed significantly more gutta-percha/sealer from simulated curved root canals than PWOG. However, neither of the tested instruments completely removed all filling materials.

El propósito del presente estudio fue comparar la capacidad de dos instrumentos de NiTi de movimiento reciproco para remover la obturación de gutapercha/sellador durante el retratamiento de conductos curvos simulados (SCRC). El tiempo requerido para la remoción del material fue también registrado. Se utilizaron veinte (n=20) SCRC divididos en dos grupos de diez especimenes (n=10) cada uno. En el Grupo 1 los SCRC se prepararon hasta un instrumento Reciproc Blue R25 (RCPB; VDW, Munich, Germany). En el Grupo 2, los SCRC se prepararon hasta un instrumento WaveOne Gold Primary (PWOG; Dentsply, Ballaigues, Switzerland). En ambos grupos los conductos se obturaron con cono único de gutapercha de conicidad creciente y el sellador AH Plus. La remoción de los materiales de obturación se realizó mediante los instrumentos RCPB R25 (Grupo 1) o PWOG (Grupo 2). La cantidad de gutapercha/sellador remanente se calculó en tres niveles de evaluaciónpredeterminadosubicados a 2, 6 y 10mm de la LT, y finalmente fue expresada en porcentajes. La cantidad de gutapercha/ sellador remanente en los SCRC retratados con RCPB fue significativamente menor en comparación con los que fueron retratados con PWOG (P=0.02). Los instrumentos RCPB requirieron un tiempo significativamente menor para completar el retratamiento (P<0.01). No se observaron deformaciones o separación de los instrumentos. Los instrumentos RCPB removieron una cantidad significativamente mayor de gutapercha/sellador que los instrumentos PWOG en conductos curvos simulados. Sin embargo, ninguno de los instrumentos ensayados removió completamente los materiales de obturación.

Ability of two reciprocating Nickel-Titanium instruments for guttapercha/ sealer removal in simulated curved root canals / Análisis de la capacidad de dos instrumentos reciprocantes de Niquel-Titanio para la remoción de gutapercha/sellador en conductos curvos simulados

ABSTRACT The aim of this study was to compare the capacity of two reciprocating NiTi instruments in removing gutta-percha/sealer material from simulated curved root canals (SCRC). The time required for filling material removal was also recorded. Twenty SCRCs were divided into two groups of 10 (n=10) samples each. In Group 1, the SCRC were prepared to a R25 Reciproc Blue instrument (RCPB; VDW, Munich, Germany). In Group 2 the SCRC were prepared to a Primary WaveOne Gold instrument (PWOG; Dentsply, Ballaigues, Switzerland). In both groups, the canals were filled with matched-taper single gutta-percha cones and AH Plus sealer. Filling materials were removed with R25 RCPB (Group 1) and PWOG (Group 2). The amount of remaining gutta-percha/sealer was calculated at three predetermined levels of evaluation located at 2, 6 and 10 mm from the WL and expressed in percentages. Canals re-treated with RCPB contained significantly less remaining gutta-percha/sealer compared to canals prepared with PWOG (P=0.02). The RCPB instruments required significantly less time to complete the retreatment procedures (P<0.01). No unwinding or instrument separation was noted. RCPB instruments removed significantly more gutta-percha/sealer from simulated curved root canals than PWOG. However, neither of the tested instruments completely removed all filling materials.

RESUMEN El propósito del presente estudio fue comparar la capacidad de dos instrumentos de NiTi de movimiento reciproco para remover la obturación de gutapercha/sellador durante el retratamiento de conductos curvos simulados (SCRC). El tiempo requerido para la remoción del material fue también registrado. Se utilizaron veinte (n=20) SCRC divididos en dos grupos de diez especimenes (n=10) cada uno. En el Grupo 1 los SCRC se prepararon hasta un instrumento Reciproc Blue R25 (RCPB; VDW, Munich, Germany). En el Grupo 2, los SCRC se prepararon hasta un instrumento WaveOne Gold Primary (PWOG; Dentsply, Ballaigues, Switzerland). En ambos grupos los conductos se obturaron con cono único de gutapercha de conicidad creciente y el sellador AH Plus. La remoción de los materiales de obturación se realizó mediante los instrumentos RCPB R25 (Grupo 1) o PWOG (Grupo 2). La cantidad de gutapercha/sellador remanente se calculó en tres niveles de evaluación predeterminados ubicados a 2, 6 y 10 mm de la LT, y finalmente fue expresada en porcentajes. La cantidad de gutapercha/ sellador remanente en los SCRC retratados con RCPB fue significativamente menor en comparación con los que fueron retratados con PWOG (P=0.02). Los instrumentos RCPB requirieron un tiempo significativamente menor para completar el retratamiento (P<0.01). No se observaron deformaciones o separación de los instrumentos. Los instrumentos RCPB removieron una cantidad significativamente mayor de gutapercha/sellador que los instrumentos PWOG en conductos curvos simulados. Sin embargo, ninguno de los instrumentos ensayados removió completamente los materiales de obturación.

Microdureza de dos materiales endodónticos a base de silicato de calcio. Un ensayo ex vivo / Surface microhardness of two calcium silicate-based endodontic materials. An ex vivo assay

esumen Objetivo: Comparar la microdureza de dos materiales endodónticos a base de silicato de calcio: MTA Densell Endo Sealer y TotalFill BC Sealer. Materiales y métodos: Se evaluó la microdureza de los selladores MTA Densell Endo Sealer (Grupo 1, n=5) y To- talFill BC Sealer (Grupo 2, n=5) contenidos en cilindros de dentina de vacuno a los 14 días posteriores a su fraguado. La medición se realizó a temperatura ambiente mediante la prue- ba de indentación Vickers. Se realizaron cinco indentaciones por probeta con una carga de 100 g durante 10 s cada una. Las mediciones se convirtieron a valores de dureza Vickers (HV) y los promedios de los valores HV de cada grupo se compararon por medio de la prueba t de Student con un nivel de significación de P <0,05. Resultados: A los 14 días, luego del fraguado, la mi- crodureza de MTA Densell Endo Sealer fue significativamen- te mayor (P=0,001) que la de TotalFill BC Sealer. Conclusiones: Los resultados sugieren que a causa de su dureza la remoción de MTA Densell Endo Sealer puede resultar dificultosa cuando está indicado un retratamiento (AU)

Aim: To compare the microhardness of two silicate-based endodontic materials: MTA Densell Endo Sealer and Total Fill BC Sealer. Materials and methods: Samples of MTA Densell Endo Sealer (Group 1, n=5) and Total Fill BC Sealer (Group 2, n=5) contained into cow dentine cylinders were subjected to the Vickers Microhardness Indentation test at room temper- ature and 14 days after setting. Five indentations per sample were performed under a load of 100 g for 10 s. The indenta- tion measurements were converted into hardness values (HV). Mean HV values of each group were compared using the Stu- dent t test at a significance level of P <0,05. Results: 14 days after setting, the microhardness of MTA Densell Endo Sealer was significantly greater (P=0,001) than that of Total Fill BC Sealer. Conclusions: The results of this study suggest that due to its hardness the removal of MTA Densell Endo Sealer could be difficult to perform when a root canal retreatment is indicated (AU)

Endodoncia y ortodoncia. Parte 2: casos clínicos / Endodontics and orthodontics. Part 2: clinical cases

Objetivo: Describir el tratamiento endodóncico de cuatro casos clínicos de reabsorción radicular desarrollada durante o tras un tratamiento ortodóncico. Casos clínicos: Después de la preparación y la desinfección de los conductos radiculares, estos fueron obturados por un tiempo prudencial con una medicación intraconducto de hidróxido de calcio, que luego fue reemplazada por MTA. Luego de un período de entre uno y cuatro años, según el caso, los tratamientos fueron evaluados clínica y radiográficamente. Los dientes que debieron ser extraídos fueron analizados histológicamente. Según la evolución clínica y radiográfica de los casos presentados, el uso inicial de hidróxido de calcio y su posterior reemplazo por MTA parecería ser un protocolo adecuado para completar el proceso de reparación de los tejidos apicales y perirradiculares en casos de reabsorciones radiculares provocadas por fuerzas ortodóncicas excesivas. Las enfermedades sistémicas deben ser tenidas en cuenta para la elección de la terapéutica (AU)

Aim: To describe the endodontic treatment of four clinical cases of permanent teeth suffering root resorption during or after orthodontic treatment. Clinical cases: Four clinical cases of permanent teeth with root resorption were endodontically treated. After the root canals were prepared and disinfected, they were medicated with calcium hydroxide. After an appropriate observation period, the canals were finally filled with MTA. The treatment outcomes were clinically and radiographically assessed at an interval between one to four years according to the clinical case. The histological findings of teeth that required extraction was also described. Our clinical and radiographic observations suggest that a temporary filling with calcium hydroxide and further obturation with MTA can provide a favorable intracanal environment for apical and periradicular tissue reparation. The clinician needs a full medical history to be aware of the systemic diseases in patients with root resorption that will be of importance for the proper selection of treatment (AU)

Effectiveness of Continuous Chest Wall Vibration With Concurrent Aerobic Training on Dyspnea and Functional Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of continuous chest wall vibration with concurrent aerobic training in addition to a 4-week pulmonary rehabilitation program on dyspnea and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Randomized, single-blind, placebo-controlled trial. SETTING: The Cardiopulmonary Rehabilitation Unit of a tertiary referral subacute rehabilitation center. PARTICIPANTS: A sample of 146 consecutive patients with COPD (Global Initiative for Chronic Obstructive Lung Disease II-III-IV) were assessed for eligibility. The final sample of 40 patients (N=40) was randomized into 3 groups (intervention, sham intervention, control). INTERVENTIONS: All groups carried out 5 sessions per week for 4 weeks of standard pulmonary rehabilitation treatment. The 2 daily 30-minute sessions included aerobic training and resistance training or airway clearance techniques. The intervention group performed the aerobic training with the addition of continuous chest wall vibration applied during cycling, whereas the sham intervention group received continuous chest wall vibration as a placebo during cycling. MAIN OUTCOME MEASURES: Six-minute walk distance (6MWD) and Barthel Index based on dyspnea (BID). RESULTS: A total of 36 participants completed the study (69±7 years; forced expiratory volume in 1 second percentage of predicted, 40.15%±15.97%). Intention to treat analysis showed no significant differences between groups for 6MWD and BID. However, the increase in 6MWD was a clinically important difference in the intervention group (42.57±43.87m, P=.003), with a moderate effect size (d=0.58). CONCLUSIONS: Continuous chest wall vibration with concurrent aerobic training in addition to a standard pulmonary rehabilitation program might improve functional exercise capacity compared with usual care, but there were no effects on dyspnea, respiratory muscle function, or quality of life in patients with COPD.

Feasibility of subacute rehabilitation for mechanically ventilated patients with COVID-19 disease: a retrospective case series.

In this case series study, we aimed to evaluate the feasibility of a subacute rehabilitation program for mechanically ventilated patients with severe consequences of COVID-19 infection. Data were retrospectively collected from seven males (age 37-61 years) who were referred for inpatient rehabilitation following the stay in the ICU (14-22 days). On admission, six patients were still supported by mechanical ventilation. All patients were first placed in isolation in a special COVID unit for 6-22 days. Patients attended 11-24 treatment sessions for the duration of rehabilitation stay (13-27 days), including 6-20 sessions in the COVID unit. The treatment included pulmonary and physical rehabilitation. The initially nonventilated patient was discharged prematurely due to gallbladder problems, whereas all six mechanically ventilated patients were successfully weaned off before transfer to a COVID-free unit where they stayed for 7-19 days. At discharge, all patients increased limb muscle strength and thigh circumference, reduced activity-related dyspnea, regained functional independence and reported better quality of life. Rehabilitation plays a vital role in the recovery of seriously ill post-COVID-19 patients. Facilities should develop and implement plans for providing multidisciplinary rehabilitation treatments in various settings to recover functioning and prevent the development of long-term consequences of the COVID-19 disease.

Comportamiento biológico de dos selladores endodónticos biocerámicos en el tejido óseo de la rata. Un ensayo in vivo / Biological behavior of two bioceramic endodontic sealers in the bone tissue of the rat. In vivo study

Objetivo: Analizar cualitativamente la biocompatibilidad y la capacidad osteogénica de dos selladores endodónticos a base de silicato de calcio: el biocerámico Bio-C Sealer (BIOc) y MTA Densell Sealer (MTAd). Materiales y métodos: En la tibia izquierda de 30 ratas Wistar macho se implantó un tubo de silicona obturado con BIOc. De igual forma, en la tibia derecha de cada una se implantó un tubo de silicona obturado con MTAd. Los animales fueron eutanasiados en grupos de 10 a los 7, 30 y 90 días. Las tibias fueron procesadas para su análisis histológico y analizadas con microscopía óptica. Según lo observado, fueron clasificadas en tres categorías: 1: Presencia de cápsula fibrosa sana y neoformación ósea, sin células inflamatorias; 2: Cápsula fibrosa con o sin células inflamatorias, formación inicial de trabéculas óseas y presencia de células inflamatorias en los tejidos circundantes; 3: Ausencia de cápsula y/o tejido óseo y presencia de numerosas células inflamatorias. Los resultados fueron analizados con las pruebas de McNemar y de Kruskal-Wallis (P<0,05). Resultados: A los 7 días, los tejidos en contacto con BIOc y MTAd reaccionaron según la categoría 3. A los 30 días, todos los casos correspondieron a la categoría 2. A los 90 días, los 10 implantes de BIOc fueron clasificados según la categoría 1. MTAd presentó nueve casos de categoría 1 y un caso de categoría 2. No hubo diferencias significativas entre ambos selladores dentro de cada uno de los períodos de observación (P>0,05), pero sí las hubo cuando se compararon los resultados obtenidos entre períodos de observación (P<0,05). Conclusión: Al finalizar el ensayo, Bio-C Sealer y MTA Densell Sealer se comportaron como materiales biocompatibles y osteogénicos en tibias de rata (AU)

Aim: To analyze the biocompatibility and osteogenic capacity of two silicate-based endodontic sealers, the bioceramic Bio C-Sealer (BIOc) and the MTA-based sealer MTA Densell (MTAd). Materials and methods: Silicone tubes filled with BIOc were implanted in the left tibias of 30 white male Wistar rats (one per tibia). In similar fashion, tubes filled with MTAd were implanted in the right tibias. The animals were euthanized in groups of 10 at 7, 30 and 90 days postoperatively. The tibias were removed, processed for histology and analysed under optical microscopy. The observations were classified in three categories: 1: Presence of a healthy fibrous capsule and newly formed bone trabeculae without inflammatory cells. 2: Fibrous capsule with or without inflammatory cells, initial formation of bone trabeculae and presence of inflammatory cells in the surrounding tissues. 3: Absence of a fibrous capsule and/or bone formation with the presence of numerous inflammatory cells. Data was analyzed by the McNemar and the Kruskal-Wallis test (P<0.05). Results: At 7 days: The tissues in contact with BIOc and MTAd reacted as category 3. At 30 days: All cases were classified as category 2. At 90 days: All BIOc cases were in category 1 while MTAd presented nine cases of category 1 and one case of category 2. There were no significant differences (P>0.05) between both sealants BIOc and MTAd in each period group. However, there were significant differences (P<0.05) when the results between periods were compared. Conclusion: At the end of the experiment both, BIOc and MTAd behaved as biocompatible and osteogenic materials in the rats' tibias (AU)

Endodoncia y ortodoncia: parte 1 / Endodontics and orthodontics: part 1

Las fuerzas ejercidas durante el tratamiento ortodóncico son consideradas un tipo particular de traumatismo dental. El movimiento ortodóncico de una pieza dentaria puede producir inflamación o necrosis pulpar y reabsorción radicular. Estos efectos colaterales indeseables son difíciles de tratar, especialmente cuando las fuerzas aplicadas son excesivas y no controladas. Diferentes estudios han evaluado el impacto de las fuerzas excesivas durante el movimiento dentario. Sin embargo, los resultados son confusos y contradictorios. La predisposición genética y la variabilidad biológica individual de los pacientes son factores importantes que deben ser tenidos en cuenta. Por eso es necesario contar con una historia clínica completa, utilizar imágenes 3D y realizar diferentes pruebas clínicoradiográficas con el fin de obtener información precisa acerca del diagnóstico, la indicación de tratamiento y el posible pronóstico a distancia. El objetivo de este artículo es realizar una revisión de la patología pulpar y la reabsorción radicular en relación con el tratamiento ortodóncico (AU)

Orthodontic forces are recognised as a particular type of dental trauma. During orthodontic tooth movement, the occurrence of pulp inflammation or necrosis and subsequent root resorption are undesirable side effects that are difficult to treat, especially when uncontrolled excessive forces are applied. Several studies have evaluated the impact of excessive forces during teeth movement. However their results are confused and contradictory. Genetic disposition and individual biological variability are important factors that must be always considered. Therefore, a complete clinical history, the use of 3D images along with different clinical and radiographic diagnostic methods are necessary to provide accurate diagnosis and prognosis of the treatment. The objective of this article is to review the possibility of pulp pathology and root resorption related to orthodontic treatment (AU)

Effect of nocturnal EPAP titration to abolish tidal expiratory flow limitation in COPD patients with chronic hypercapnia: a randomized, cross-over pilot study.

BACKGROUND: Tidal expiratory flow limitation (EFLT) promotes intrinsic PEEP (PEEPi) in patients with chronic obstructive pulmonary disease (COPD). Applying non-invasive ventilation (NIV) with an expiratory positive airway pressure (EPAP) matching PEEPi improves gas exchange, reduces work of breathing and ineffective efforts. We aimed to evaluate the effects of a novel NIV mode that continuously adjusts EPAP to the minimum level that abolishes EFLT. METHODS: This prospective, cross-over, open-label study randomized patients to one night of fixed-EPAP and one night of EFLT-abolishing-EPAP. The primary outcome was transcutaneous carbon dioxide pressure (PtcCO2). Secondary outcomes were: peripheral oxygen saturation (SpO2), frequency of ineffective efforts, breathing patterns and oscillatory mechanics. RESULTS: We screened 36 patients and included 12 in the analysis (age 72 ± 8 years, FEV1 38 ± 14%Pred). The median EPAP did not differ between the EFLT-abolishing-EPAP and the fixed-EPAP night (median (IQR) = 7.0 (6.0, 8.8) cmH2O during night vs 7.5 (6.5, 10.5) cmH2O, p = 0.365). We found no differences in mean PtcCO2 (44.9 (41.6, 57.2) mmHg vs 54.5 (51.1, 59.0), p = 0.365), the percentage of night time with PtcCO2 > 45 mm Hg was lower (62(8,100)% vs 98(94,100)%, p = 0.031) and ineffective efforts were fewer (126(93,205) vs 261(205,351) events/hour, p = 0.003) during the EFLT-abolishing-EPAP than during the fixed-EPAP night. We found no differences in oxygen saturation and lung mechanics between nights. CONCLUSION: An adaptive ventilation mode targeted to abolish EFLT has the potential to reduce hypercapnia and ineffective efforts in stable COPD patients receiving nocturnal NIV. TRIAL REGISTRATION: ClicalTrials.gov, NCT04497090. Registered 29 July 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04497090 .

Eficacia del instrumento XP-endo Finisher y del sistema EndoActivator en la reducción/eliminación del biofilm bacteriano: un ensayo ex vivo / Ability of the XP-endo Finisher instrument and the EndoActivator system to reduce/eliminate of the bacterial biofilm: an ex vivo assay

Objetivos: Comparar ex vivo la eficacia del instrumento XP-endo Finisher y del sistema EndoActivator en la reducción/eliminación del biofilm microbiano en conductos radiculares infectados. Materiales y métodos: Se utilizaron 23 premolares inferiores humanos extraídos cuya longitud fue estandarizada en 17 mm. Todos los conductos se prepararon con el sistema WaveOne Gold Medium (#35.06). Los dientes se esterilizaron, se inocularon con Enterococcus faecalis y se separaron en dos grupos experimentales de 10 piezas cada uno. De los 3 dientes remanentes, 1 fue utilizado como control positivo y 2, como controles negativos. En el grupo 1, las soluciones irrigantes se agitaron con XP-endo Finisher. En el grupo 2, se utilizó EndoActivator. Se tomaron muestras antes de la contaminación, luego de esta y después de la agitación de los irrigantes mediante conos de papel estériles. La carga microbiana fue sembrada en agar sangre y los conos se cultivaron en caldo tripteína de soja. La remoción de la carga microbiana se determinó por la presencia o ausencia de turbiedad del medio. Las unidades formadoras de colonias (UFC) remanentes se cuantificaron y los resultados se categorizaron como R1 (≤10 UFC) o R2 (>10 UFC). Los datos fueron analizados mediante la prueba de Fisher. Resultados: No hubo diferencias significativas entre XP-endo Finisher y EndoActivator (P>0,05). El número de usos no influyó sobre la capacidad operativa de ambos instrumentos (AU)

Aim: To compare ex vivo the effectiveness of the XP-endo Finisher and the EndoActivator in biofilm reduction/ removal from infected root canals. Materials and methods: Twenty three extracted human single-rooted lower premolars were selected and standardised to 17 mm in length. All the canals were prepared with WaveOne Gold Medium reciprocating files (#35.06). The teeth were autoclaved and inoculated with Enterococcus faecalis. The infected teeth were then assigned to 2 experimental groups of 10 teeth each according to the final irrigation/agitation protocol. Of the three remaining teeth, one was used as a positive control, and the other two were used as negative controls. In Group 1 the irrigating solutions were agitated with XP-endo Finisher while in Group 2 the EndoActivator was used. All root canals were sampled before and after contamination, and again after irrigant agitation with sterile paper points. The microbial load was spread on blood agar plates and the paper points were cultured in sterile trypticase soy broth. The removal of the microbial load was determined by visual observation of the turbidity of the media and by quantification of the number of colony-forming units (UFC). The results were categorized as R1 (≤10 UFC) or R2 (>10 UFC). Data were analysed by the Fisher's exact test at P<0.05. Results: No significant differences was found between XP-endo Finisher and EndoActivator (P>0.05) regarding their effectiveness in the reduction/removal of the microbial biofilm. The number of uses of both instruments did not affect their operative performance (AU) Conclusion: XPF and EA were both equally effective for microbial biofilm reduction/removal from ex vivo infected root canals (AU)

Feasibility and Efficacy of the Pulmonary Rehabilitation Program in a Rehabilitation Center: CASE REPORT OF A YOUNG PATIENT DEVELOPING SEVERE COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME.

DETAILS OF THE CLINICAL CASE: A 51-yr-old man underwent a respiratory rehabilitation program (RRP), after being tracheostomized and ventilated due to acute respiratory distress syndrome (ARDS) from coronavirus disease-2019 (COVID-19) infection. Respiratory care, early mobilization, and neuromuscular electrical stimulation were started in the ad hoc isolation ward of our rehabilitation center. At baseline, muscle function was consistent with intensive care unit-acquired weakness and the patient still needed mechanical ventilation (MV) and oxygen support. During the first week of RRP in isolation, the patient was successfully weaned from MV, the tracheal cannula was removed, and the walking capacity was recovered. At the end of the RRP, continued in a standard department, respiratory muscles strength increased by 7% and muscle function improved as indicated by the quadriceps size enlargement of 13% and the change of the Medical Research Council sum score from 48/60 to 58/60. DISCUSSION: Providing RRP in patients with severe COVID-19 ARDS involves risks for operators and organizational difficulties, especially in rehabilitation centers; nevertheless, its continuity is important to prevent the development of permanent disabilities in previously healthy subjects. Limited to the experience of only one patient, we were able to carry out a safe RRP during the COVID-19 pandemic, promoting the complete functional recovery of a COVID-19 young patient. SUMMARY: Most patients who develop serious consequences of COVID-19 infection risk a reduction in their quality of life. However, by organizing and directing specialized resources, subacute rehabilitation facilities could ensure the continuity of the RRPs even during the COVID-19 pandemic.

Nocturnal Hypoxemia Impacts Right Ventricle Diastolic Function in Obstructive Sleep Apnea: A Retrospective Observational Study.

Obstructive sleep apnea (OSA), although a growing healthcare problem and documented risk factor for cardiovascular diseases, is still under-diagnosed in cardiac patients. To investigate the correlation between OSA and echocardiographic parameters of right ventricle diastolic (RVD) dysfunction, in particular trans-tricuspid E-wave deceleration time (EDT), we retrospectively analyzed data of 103 pure (comorbidity-free) OSA patients with comprehensive echocardiographic examination (ETT). Apnea/hypopnea index (AHI), oxygen desaturation index (ODI), mean nighttime oxyhemoglobin saturation (SpO2), time elapsed with SpO2 < 90% (T90) and mean peak desaturation of nocturnal events (Mdes, graded as mild, medium or severe) were compared with echocardiographic parameters. We found RVD dysfunction present in 58.3% of patients. Altered EDT correlated significantly with mean SpO2, T90, and Mdes (p < 0.01, all). Nocturnal desaturators had a significantly worse EDT than non-desaturators (p = 0.027) and a higher risk of prolonged EDT (odds ratio, OR = 2.86). EDT differed significantly according to Mdes severity (p = 0.005) with a higher risk of prolonged EDT in medium/severe vs. mild Mdes (OR = 3.44). EDT detected the presence of RVD dysfunction in 58.3% of our pure OSA patients. It correlated poorly with AHI severity but strongly with nocturnal desaturation severity, independently of age. This ETT marker may be useful for deciding appropriate diagnostic and therapeutic strategies.

Automatic tailoring of the lowest PEEP to abolish tidal expiratory flow limitation in seated and supine COPD patients.

RATIONALE: In COPD patients, the development of tidal expiratory flow limitation (EFLT) results in intrinsic positive end-expiratory pressure (PEEPi), leading to increased work of breathing and worsening patient-ventilator interaction. An external PEEP can mitigate these consequences, but how to optimize its value it is still unknown. OBJECTIVE: To measure the minimum PEEP able to abolish EFLT by a new automatic non-invasive ventilation (NIV) mode in stable hypercapnic COPD patients in the seated and supine positions. METHODS: Twenty-six hypercapnic COPD patients (mean±SD: FEV1%pred = 39.2 ±â€¯16.1, FEV1/FVC%pred = 46.3 ±â€¯16.3%) were studied while receiving NIV during two consecutive 15-min periods, with patients studied seated in the first and supine in the second. A ventilator able to identify EFLT breath-by-breath by using the forced oscillation technique optimized in real-time PEEP to the lowest pressure able to abolish EFLT (PEEPO). RESULTS: The ventilator was always able to identify a PEEPO. Its values were highly variable among patients and increased from median(iqr) 4.0 (0.03) (range: 4.0-8.3cmH2O) to 6 (6.1) cmH2O (range: 4.0-15.7 cmH2O) when patients moved from the seated to the supine position, respectively. PEEPO in supine position did not correlate to any spirometric or anthropometric variable. CONCLUSIONS: PEEPO in COPD patients is highly variable and increases in supine position. It is not predicted by spirometric nor anthropometric variables, but had a considerable variability among the patients. We suggest that PEEPo may be used as a phenotyping variable in COPD patients.

Endodoncia y operatoria dental 4. Hipersensibilidad dentinaria: ensayo preliminar ex vivo de un modelo experimental para su tratamiento / Endodontics and operative dentistry 4. Dentine hypersensitivity: an ex vivo preliminary assay of an experimental model

Objetivo: Determinar el grado de confiabilidad de un modelo de dentina humana para evaluar la calidad de oclusión de los túbulos dentinarios luego del uso de dos agentes desestabilizantes que contienen oxalato de potasio. Materiales y métodos: Se obtuvieron dos secciones horizontales en forma de discos de dentina de 0,8 mm de espesor de cada uno de 21 terceros molares sanos extraídos por razones periodontales, ortodóncicas o quirúrgicas. El barro dentinario de las superficies coronaria y pulpar de los discos se eliminó con ácido fosfórico al 35% y posterior lavado con suero fisiológico y secado. De cada molar se separó un disco para el grupo 1 (n=20). Los segundos discos de cada molar se destinaron al grupo 2 (n=20). Y los dos discos del molar restante no recibieron tratamiento (controles negativos). El ensayo se realizó en dos etapas. En la primera, las superficies coronarias de los discos del grupo 1 se trataron con Klepp Desensitizer, mientras que en el grupo 2 se empleó BisBlock Desensitizer. Posteriormente, se metalizaron con oro-paladio y se observaron en un microscopio electrónico de barrido. En la segunda etapa, los discos se retiraron del microscopio, se invirtieron de posición, y la superficie pulpal ubicada en posición superior se lavó con suero, se secó, se metalizó y se observó nuevamente con el microscopio. Con el objeto de realizar el análisis químico de los agentes desestabilizantes, se obtuvieron otros dos discos a partir de un molar adicional y se prepararon ambos siguiendo el mismo protocolo que en los discos experimentales. Uno de ellos se trató con Klepp Desensitizer, y el otro, con BisBlock Desensitizer. Finalmente, las superficies pulpares de ambos discos adicionales se metalizaron con carbón y se examinaron mediante un análisis de energía dispersiva de rayos X. Resultados: En la primera etapa del ensayo, la superficie coronaria de los 20 discos de cada grupo se encontraba cubierta por una capa uniforme de cristales precipitados a partir de ambos agentes desestabilizantes. En la segunda etapa, la superficie pulpar de los 20 discos del grupo 1 reveló que todos los túbulos dentinarios estaban totalmente ocluidos por los cristales en nueve (n=9) casos. Lo mismo ocurrió en ocho (n=8) discos del grupo 2. En ambos casos los cristales ocluyeron totalmente los túbulos hasta una profundidad de 0,8 mm. En 11 (n=11) y 12 (n=12) discos de los grupos 1 y 2 respectivamente se observaron túbulos parcialmente ocluidos o bien una combinación de estos con túbulos vacíos. Las diferencias entre grupos no fueron significativas (P>0,05). En los controles negativos todos los túbulos se encontraban vacíos. El análisis de energía dispersiva de rayos X reveló que los cristales precipitados a partir de ambos agentes desestabilizantes dentro de los túbulos contenían importantes concentraciones de calcio y trazas de potasio. Conclusiones: El modelo ensayado parecería ser adecuado para comparar ex vivo la calidad de protección de la superficie dentinaria producida por los agentes desestabilizantes a base de oxalato de potasio (AU)