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.

Production of 129mXe and 131mXe via neutron activation of 128Xe and 130Xe at ILL-RHF and NCBJ-MARIA high-flux reactors.

The long-lived xenon isomers 129mXe and 131mXe are of interest for the GAMMA-MRI project, which aims at developing a novel imaging modality based on magnetic resonance of polarized unstable tracers. Here, we present the steps leading to and following the production of these two isomers via neutron irradiation of highly-enriched 128Xe and 130Xe gas samples at two high-flux reactors, the High-Flux Reactor (Réacteur à haut flux, RHF) at the Institut Laue-Langevin (ILL) and the MARIA reactor at the National Centre for Nuclear Research (NCBJ). We describe the experimental setups and procedures used to prepare the stable xenon samples, to open the irradiated samples, and to transfer xenon isomers into reusable transport vials. The activity of 129mXe and 131mXe was measured to be in the range of tens of MBq per sample of 0.8(1)mg, and was proportional to thermal neutron flux density. A small activity of unstable contaminants was also visible in the samples, but their level is not limiting for the GAMMA-MRI project's objectives. In addition, the minimum thermal neutron flux density required to produce 129mXe and 131mXe sufficient for the project could be also determined.

[Cross-cultural adaptation to Spanish of the Signs of Depression Scale (SODS) to the early assessment of mood in patients admitted to a Stroke Unit]. / Adaptación transcultural al español de la Signs of Depression Scale (SODS) para la evaluación precoz del estado de ánimo en pacientes ingresados en una unidad de ictus.

INTRODUCTION: Stroke hospitalization negatively affects mood. Clinical guidelines recommend early evaluation of mood disorders. However, there is no consensus on the most appropriate scale in Spanish language. AIM: The objective of the study is the cross-cultural adaptation of the Signs of Depression Scale (SODS) in patients admitted to the stroke unit of the Hospital del Mar. MATERIALS AND METHODS: The work scheme for transcultural adaptation into Spanish was: a) direct translation; b) reconciliation and synthesis of translations; c) reverse translation into English; d) consensus of the back-translated version with original author; e) cognitive interrogation; f) revision and consensus version in Spanish; g) reading test, spelling, and grammar check; h) final version. Analysis and descriptive summary of the adaptation process was performed. RESULTS: There were no differences between direct translation versions. The back-translation version was accepted by the author of the original questionnaire. A convenience sample of patients with/without aphasia (n = 22) was included for cognitive interview from which no major problems were identified in the implementation of the questionnaire. Inclusive language was used in the final version. CONCLUSION: The transcultural adaptation of the scale allows in a simple and early way the evaluation mood in patients admitted to the stroke unit. The Spanish version is equivalent to the original instrument. This adaptation can be incorporated into care in the Stroke Unit and is extrapolated to other Spanish-speaking centres.

TITLE: Adaptación transcultural al español de la Signs of Depression Scale (SODS) para la evaluación precoz del estado de ánimo en pacientes ingresados en una unidad de ictus.Introducción. La hospitalización por ictus afecta negativamente al estado de ánimo. Las guías clínicas recomiendan evaluar precozmente el estado de ánimo. Sin embargo, no existe consenso sobre la escala más apropiada en idioma español. Objetivo. El objetivo del estudio es realizar una adaptación transcultural de la Signs of Depression Scale en pacientes ingresados en la unidad de ictus. Materiales y métodos. El esquema de trabajo de la adaptación transcultural al español fue: a) traducción directa; b) conciliación y síntesis de las traducciones; c) traducción inversa al inglés; d) consenso de la versión retrotraducida; e) interrogatorio cognitivo; f) revisión y versión consensuada en español; g) prueba de lectura, revisión ortográfica y gramatical, y h) versión final. Se realizó un análisis y un resumen descriptivo del proceso de adaptación transcultural. Resultados. Las versiones de traducción directa no presentaron diferencias. La versión de la traducción inversa fue aceptada por la autora del cuestionario original. Para el interrogatorio cognitivo se incluyó una muestra por conveniencia de 22 pacientes con/sin afasia a partir de la cual no se identificaron problemas en la aplicación del cuestionario. Se utilizó un lenguaje inclusivo en la versión final. Conclusiones. La versión española es equivalente al instrumento original. La adaptación transcultural de la escala permite, de forma sencilla y precoz, la evaluación del estado de ánimo en pacientes con ictus. Esta adaptación se puede incorporar en los cuidados en la unidad de ictus y es extrapolable a otros centros de habla hispana.

Change in triggered EMG thresholds for thoracic pedicle screws caused by pneumothorax during surgery for adolescent idiopathic scoliosis. Report of two cases. / Alteración en los umbrales de estimulación de tornillos pediculares torácicos secundaria a neumotórax en cirugía por escoliosis idiopática del adolescente. A propósito de dos casos.

Posterior spinal instrumentation and fusion with pedicle screws inserted by free-hand technique and controlled by multimodal intraoperative monitoring is the most common technique in adolescent idiopathic scoliosis surgery. Pneumothorax is a described complication of this kind of procedure. Triggered electromyography is used to identify pedicle wall breakthrough and prevent neurological injuries. We report 2 clinical cases in which unilateral decrease in triggered electromyography values associate with ipsilateral pneumothorax. Postoperative chest radiographs need to be done in order to diagnose a pneumothorax. However, routinely performing a chest radiograph has been questioned because of the low incidence of this surgical complication. As a result of the association described in this article, we consider that when a unilateral decrease in triggered electromyography values is detected, a hidden pneumothorax should be suspected and ruled out.

Plasma membrane-bound carbonic anhydrase activity in the regenerating rat liver.

Part of the carbonic anhydrase activity of hepatocytes has been reported to be located in the plasma membrane. This strategic location suggests a physiological role other than that located within the cell and probably related to the specific secretory function of these cells. Furthermore, after two-thirds hepatectomy an enzymatic retrodifferentiation has been reported. We reasoned that liver regeneration probably affects the carbonic anhydrase activity in different ways depending upon its location and hence presumably physiological role. We measured, therefore, carbonic anhydrase activity in a soluble fraction or in a plasma membrane-enriched fraction obtained from liver homogenate from rats undergoing hepatectomy (two-thirds) one, three or seven days before liver resection and homogenation. No changes in carbonic anhydrase activity were found as far as soluble fraction was concerned. However, the carbonic anhydrase activity in plasma membrane was reduced (by 55%) soon after hepatectomy, there after it increased, returning to near control value at seven days. Lactate dehydrogenase activities in soluble and plasma membrane fractions were not modified by the regenerative process. Neither was 5'-nucleotidase activity determined in plasma membrane affected by liver regeneration. In summary, these results indicate a higher sensitivity of plasma membrane carbonic anhydrase activity to the regenerative process than soluble carbonic anhydrase activity. This suggests a different control of the turnover of these isoenzymes during rat liver regeneration. The phenomenon is consistent with a different physiological role for these activities; i.e., one (plasma membrane-bound carbonic anhydrase activity) may be involved in specific functions of differentiated hepatocytes, and another (soluble carbonic anhydrase activity) may be involved in general functions shared by both differentiated and undifferentiated cells.

Evidence for dual effect of bile acids on thymidine anabolism and catabolism by the regenerating rat liver.

Bile acids have been reported to modify DNA synthesis by rodent livers in regeneration, which may be due in part to their ability to interact with the machinery responsible for deoxyribonucleotide synthesis. The aim of this work was to gain information on the effect of taurocholate (TC) on both anabolic and catabolic pathways accounting for the fate of [methyl-14C]thymidine in the liver of two-third hepatectomized rats. Using high-pressure liquid chromatography, the soluble fraction of liver homogenate was used to measure the ability of TC to modify both the rate of thymidine monophosphate formation from thymidine - i.e., thymidine kinase (TK) activity - and the rate of thymidine release from thymidine, which is the result of at least three different reactions catalyzed by thymidine phosphorylase, nucleosidase and nucleoside deoxyribosyl transferase. TC was found to induce a dose-dependent inhibition of both processes. The nature of this inhibition seems to be in part competitive. Apparent Ki values were 1.5 mM for TK and 4 mM for thymidine release. These inhibitory effects were mimicked by glycocholate but not by taurine. To investigate the relevance of the TC-induced modification of anabolism and catabolism in the whole organ, experiments on regenerating perfused rat livers were carried out. The donors underwent two-third hepatectomy 24 h before liver isolation. They were either fasted during this period (F) or allowed free access to food (NF). DNA synthesis, as measured by [methyl-14C]thymidine incorporation into DNA, was significantly increased in both groups, as compared with control non-hepatectomized animals. However, enhancement in DNA synthesis in group F was only 50% of the value found in the NF group. Intravenous TC administration before and/or during liver perfusions induced a dose-dependent recovery of DNA synthesis in the F group. This effect was accompanied by opposed modifications in the amount of radiolabelled metabolites contained in the non-DNA fraction of liver homogenate, consistent with a marked inhibition of thymidine catabolism. These results suggest that, in addition to the previously reported effects of TC on thymidine anabolism, bile acids are also able to affect the thymidine catabolism. The overall results of this dual effect on the fate of thymidine in the regenerating rat liver depend on the metabolic situation. Under circumstances of no nutrient restriction, the effect of TC is characterized by inhibition of thymidine incorporation into DNA. By contrast, under depressed DNA synthesis due to fasting, the overall effect of TC is a partial recovery of this process.

Epistaxis in children under the age of two: possible marker of abuse/neglect? A retrospective study in North-Eastern Piedmont hospitals.

AIM: Epistaxis is an extremely common event at all ages; however, under two years of age epistaxis is a very rare event and recent studies carried out in Great Britain concern this event as related to possible non-accidental trauma. To date, no other studies carried out in Italy are available on this topic. METHODS: A file review of all cases of epistaxis occurred in children under the age of 2 who were admitted into the ED in our area over a period of two years was carried out. RESULTS: We have collected data concerning 10 cases of epistaxis occurred in children under 2 years of age with an incidence of 10.4 cases per 10000 accessions to the ED of children under the age of 2. Four of the cases had attendances for head injury or facial trauma. CONCLUSION: The results obtained are higher than the results of the British studies adopting the same methodology, but comparable to their surveillance data on the general population. Through the analysis of the collected data, two correlated assumptions have been made: a possible relationship between epistaxis and neglect, and a relation between epistaxis and domestic accidents.

[Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle]. / Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis.

OBJECTIVES: To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. MATERIAL AND METHOD: A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). RESULTS: The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. DISCUSSION: When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. CONCLUSIONS: The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS.

[Basic techniques of root canal instrumentation]. / Técnicas básicas de instrumentación de conductos radiculares.

Many of the techniques for root canal instrumentation in endodontic treatment have been subject of great sophistication, relegating a second place the basic endodontic techniques which in our opinion can solve most of the cases that are treated by the general dental practitioner. We described each of this techniques the steps that have to be followed and the pros and cons. Finally a comparison of them is made, emphasizing the most relevant characteristics.

[Urethral lesion caused by a condom: description of a case]. / Lesione uretrale da "condom": descrizione di un caso.

We report a case of severe urethral lesion in a male patient with a vascular cerebral stroke. The wrong application of condom catheter without pain or other symptoms developed the urethral lesion.