Is Periodontal and Peri- Implant Disease Associated with Fixed Partial Denture Use? A 25-year Prospective Case Series.

INTRODUCTION: The association of the periodontium with the fixed prosthesis is the basis of prosthetic rehabilitation. This prospective case series aimed to evaluate periodontal health through the relation between periodontal/peri-implant disease progression and the use of fixed partial dentures (FPDs). METHODS: Probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI) on either teeth or implants were evaluated at up to 25-year follow-up and compared with the baseline. Statistical analysis was performed using the Kaplan-Meier test (p⟨0.05). RESULTS: The prospective evaluation showed that the patients maintained adequate periodontal health. Failure (severe periodontal stages) occurred in 12.5% of patients. The survival rate for 107 teeth/implants was 80.48%. The comparisons for clinical parameters revealed no statistically significant difference (p⟩ 0.05). At T1, the measurements for anterior and posterior regions, respectively, were PD =2.7mm and 3.1mm; CAL= 3.3mm and 3.6mm; GI=0.5 (both regions); and PI=0.79 and 0.62. Periodontal/peri-implant disease progression did not relate to the use of prostheses. CONCLUSIONS: Patients with more frequent follow-up appointments and lower GI and PI showed periodontal health for longer periods. Patients with different oral hygiene levels present different periodontal disease progression. Periodic hygiene control and motivation are vital factors for extensive oral rehabilitation success.

Electronic device or regulated tobacco product? Learning from the diffusion of heated tobacco products in Spain.

OBJECTIVES: Tobacco companies have introduced heated tobacco product (HTP) in many countries and marketed it on the grounds that it is a less harmful alternative to health. However, tobacco companies have been widely criticized for taking advantage of a loophole that allows electronic devices to circumvent regulations limiting tobacco advertising. This work aims to determine whether HTPs respected the rules that regulate tobacco advertising when it was introduced in Spain. STUDY DESIGN: This is an observational epidemiological study. METHODS: Using monthly time series data from September 2016 to June 2020, we analyzed whether the adoption of HTPs has followed the same behavior patterns as other brands that were introduced under the same conditions of use. The Bass model is used to analyze the diffusion of HTPs, and 30 other traditional cigarette brands introduced under the same conditions as this HTPs. RESULTS: The adoption of HTPs in Spain has been like that of brands of slim cigarettes that are mistakenly considered to be healthier than traditional cigarettes. The results indicate that the use of HTPs has spread in the same way as additive-free and ultra-slim cigarette brands. CONCLUSIONS: Policymakers should keep in mind that laws should restrict any marketing of tobacco products that promotes positive connotations between tobacco use and being healthy. If manufacturers are allowed to classify a category and/or brand of tobacco products as less harmful to health, the imitation effect is very high, leading to the proliferation of smoking.

Geochemical behavior of rare earth elements (REE) in urban reservoirs: the case of Funil Reservoir, Rio de Janeiro State, Brazil.

Rare earth elements (REE) have unique chemical properties, which allow their use as geochemical tracers. In this context, the present study aims to assess the role of Funil Reservoir on REE biogeochemical behavior. We collected water samples upstream of the reservoir (P-01) in the city of Queluz, inside the reservoir (P-02), and downstream of Funil Reservoir (P-03) in the city of Itatiaia, RJ. In the field, physicochemical parameters were measured using a probe (pH, temperature, electrical conductivity, and dissolved oxygen). In the laboratory, water samples were filtered (0.45 µm) and properly packed until chemical analysis. Chlorophyll a concentrations were determined by a spectrophotometric method and suspended particulate matter (SPM) by a gravimetric method. Ionic concentrations were determined by ion chromatography technique and REE concentrations were determined by ICP-MS. Chlorophyll a concentrations were higher in Funil Reservoir. Ionic concentrations in Queluz (P-01) suggest anthropic contamination. The sum of REE in the dissolved fraction ranged from 2.12 to 12.22 µg L-1. A positive anomaly of La in Queluz indicates anthropic contamination. The observed patterns indicate that Funil Reservoir acts as a biogeochemical barrier, modifying the fluvial transport of REE. Nonetheless, another factor that probably influences REE behavior is the algal bloom that occurs in reservoirs during the rainy season. The seasonal behavior of algae can influence REE biogeochemistry through the incorporation and release of trace metals.

Noncompliance to iodine supplementation recommendation is a risk factor for iodine insufficiency in Portuguese pregnant women: results from the IoMum cohort.

PURPOSE: After a recommendation for iodine supplementation in pregnancy has been issued in 2013 in Portugal, there were no studies covering iodine status in pregnancy in the country. The aim of this study was to assess iodine status in pregnant women in Porto region and its association with iodine supplementation. METHODS: A cross-sectional study was conducted at Centro Hospitalar Universitário São João, Porto, from April 2018 to April 2019. Pregnant women attending the 1st trimester ultrasound scan were invited to participate. Exclusion criteria were levothyroxine use, gestational age < 10 and ≥ 14 weeks, non-evolutive pregnancy at recruitment and non-signing of informed consent. Urinary iodine concentration (UIC) was measured in random spot urine by inductively coupled plasma-mass spectrometry. RESULTS: Median UIC was 104 µg/L (IQR 62-189) in the overall population (n = 481) of which 19% had UIC < 50 µg/L. Forty three percent (n = 206) were not taking an iodine-containing supplement (ICS) and median UIC values were 146 µg/L (IQR 81-260) and 74 µg/L (IQR 42-113) in ICS users and non-users, respectively (p < 0.001). Not using an ICS was an independent risk factor for iodine insufficiency [adjusted OR (95% CI) = 6.00 (2.74, 13.16); p < 0.001]. Iodised salt use was associated with increased median iodine-to-creatinine ratio (p < 0.014). CONCLUSIONS: A low compliance to iodine supplementation recommendation in pregnancy accounted for a mild-to-moderately iodine deficiency. Our results evidence the need to support iodine supplementation among pregnant women in countries with low household coverage of iodised salt. Trial registration number NCT04010708, registered on the 8th July 2019.

Influence of sperm post-thaw subpopulations of angus and nelore bulls on pregnancy rates by fixed-time artificial insemination.

BACKGROUND: The heterogeneity of ejaculate indicates that fertility is still variable among bulls and that more stringent evaluation methods are needed to identify the ejaculates suitable for AI. OBJECTIVE: To identify and characterize the sperm subpopulations (SP) in thawed semen doses of Nelore and Angus bulls and to evaluate the influence of these sperm subpopulations on pregnancy rate in cows submitted to fixed-time AI (FTAI). MATERIALS AND METHODS: A dose of post-thawed semen from each bull (n=18; consisting of Angus n = 9 and Nelore n = 9) was analyzed for: sperm kinetics; morphology and plasma membrane integrity; and the determination of the sperm subpopulations. Differences between the groups were estimated with the t-test considering a significance level of <5%. RESULTS: There was no influence between breeding bulls for sperm morphology, plasma membrane integrity, and pregnancy rate (P > 0.05). Regarding the kinetic parameters evaluated by the CASA system, Nelore had greater values, for cells with slow velocity (Angus: 16.4 %; Nelore: 21.7%; P = 0.028). In contrast, ANGUS bulls had more static cells (Angus: 27.2%; Nelore: 9.3%; P = 0.048). Based on CASA system data and clustering procedures, four sperm subpopulations were statistically established. In Angus bulls, a higher level of fast and nonlinear spermatozoa were found in SP3 (33.3%), followed by SP1 (32.7%%) with fast and progressive spermatozoa. Whereas, SP1 of Nelore bulls had 33.8% fast and progressive spermatozoa, followed by 32.2% of SP3 with fast and nonlinear spermatozoa. CONCLUSION: Both breeds of bulls presented similar proportions of sperm SP. Consequently, no influence on the pregnancy rates was shown in cows submitted to the IATF programs on a large scale. doi.org/10.54680/fr22310110312.

Growth performance of South African Windsnyer pigs to the dietary inclusion of Amarula oil cake.

Dietary inclusion of Amarula oil cake (AOC) in pig diets can ease pressure of relying on non-native feed sources and benefit the swine industry. The study was conducted to determine the growth performance of Windsnyer pigs fed increasing levels of AOC. Twenty-five clinically growing male boars with an initial body weight of 19.92 ± 8.74 kg were used in the study that lasted 6 weeks. All pigs were allocated to diets in a completely randomised design. Five experimental diets were formulated to contain 0, 50, 100, 150 and 200 g/kg DM of AOC. Average daily feed intake (ADFI), average daily gain (ADG), feed conversion ratio (FCR), scaled average daily feed intake (SADFI), scaled average daily gain (SADG) and body weight (BW) were calculated weekly. The diet affected ADFI, ADG, FCR and SADG (P < 0.05). Scaled average daily feed intake was not affected by the diet (P > 0.05). There was a significant interaction between AOC inclusion and weeks of feeding on ADFI, ADG and FCR (P < 0.05). Age of pigs decreased FCR quadratically (P < 0.001). A quadratic relationship between ADFI and increasing levels of AOC was observed (P < 0.05). Average daily gain, FCR and SADG decreased linearly with increasing AOC levels (P < 0.05). Using the broken stick analyses, the maximum inclusion of AOC was 102.17 g/kg DM. Amarula oil cake can be incorporated in diets of Windsnyer pigs up to 100 g/kg DM without constraining growth performance.

In vitro digestibility of four high moisture grains used in liquid pig feeding.

One of the main challenges in the livestock sector is the need to increase sustainability and production efficiency. In pig production, feed is the main production cost. High moisture grains (HMGs) have recently emerged as an interesting alternative to conventional feedstuffs. In this study, the nutritional value for pigs of eight HMGs was determined considering the chemical composition and the in vitro digestibility. We have used four seeds (lupine, barley, wheat, and corn) and two substrates (water and whey). Lupine HMG showed higher values of crude fat (2.12%) and crude protein (8.59%). Within cereal HMGs, corn HMG showed higher DM (34.37%), OM (36.27%), and starch (27.17%) values; wheat HMG stood out for crude protein content (4.23%) and barley for NDF (5.68%). The pH values were low for all HMG, with lupine having the highest value (4.39). Ammoniacal nitrogen had the highest value for wheat HMG (6.10%). When whey was used as substrate, it improved the characteristics of the HMG. Regarding in vitro digestibility, of the four HMGs studied, wheat showed the highest value for DM (89.93%), while lupine showed the highest value for crude protein (96.12%). When considering the substrates, whey showed better results for all in vitro digestibility's parameters (87.48%, 90.95%, and 90.59%, for DM, OM, and crude protein, respectively). Overall, all HMGs showed good conservation of nutritional value and high in vitro digestibility. The use of whey as a substrate was beneficial for HMG quality. Results show that the analyzed HMG can be efficiently used in the framework of swine production.

Potential Mosquito Vectors for Shuni Virus, South Africa, 2014-2018.

Shuni virus is associated with neurologic and febrile illness in animals and humans. To determine potential vectors, we collected mosquitoes in South Africa and detected the virus in species of the genera Mansonia, Culex, Aedes, and Anopheles. These mosquitoes may be associated with Shuni virus outbreaks in Africa and emergence in other regions.

Augmenting Adaptive Machine Learning with Kinetic Modeling for Reaction Optimization.

We combine random sampling and active machine learning (ML) to optimize the synthesis of isomacroin, executing only 3% of all possible Friedländer reactions. Employing kinetic modeling, we augment machine intuition by extracting mechanistic knowledge and verify that a global optimum was obtained with ML. Our study contributes evidence on the potential of multiscale approaches to expedite the access to chemical matter, further democratizing organic chemistry in a data-motivated fashion.

Motoneurone synchronization for intercostal and abdominal muscles: interneurone influences in two different species.

The contribution of branched-axon monosynaptic inputs in the generation of short-term synchronization of motoneurones remains uncertain. Here, synchronization was measured for intercostal and abdominal motoneurones supplying the lower thorax and upper abdomen, mostly showing expiratory discharges. Synchronization in the anaesthetized cat, where the motoneurones receive a strong direct descending drive, is compared with that in anaesthetized or decerebrate rats, where the direct descending drive is much weaker. In the cat, some examples could be explained by branched-axon monosynaptic inputs, but many others could not, by virtue of peaks in cross-correlation histograms whose widths (relatively wide) and timing indicated common inputs with more complex linkages, e.g., disynaptic excitatory. In contrast, in the rat, correlations for pairs of internal intercostal nerves were dominated by very narrow peaks, indicative of branched-axon monosynaptic inputs. However, the presence of activity in both inspiration and expiration in many of the nerves allowed additional synchronization measurements between internal and external intercostal nerves. Time courses of synchronization for these often consisted of combinations of peaks and troughs, which have never been previously described for motoneurone synchronization and which we interpret as indicating combinations of inputs, excitation of one group of motoneurones being common with either excitation or inhibition of the other. Significant species differences in the circuits controlling the motoneurones are indicated, but in both cases, the roles of spinal interneurones are emphasised. The results demonstrate the potential of motoneurone synchronization for investigating inhibition and have important general implications for the interpretation of neural connectivity measurements by cross-correlation.

Deciphering the role of ttrA and pduA genes for Salmonella enterica serovars in a chicken infection model.

Salmonella enterica serovars use self-induced intestinal inflammation to increase electron acceptor availability and to obtain a growth advantage in the host gut. There is evidence suggesting that the ability of Salmonella to use tetrathionate and 1,2-propanediol provides an advantage in murine infection. Thus, we present here the first study to evaluate both systemic infection and faecal excretion in commercial poultry challenged by Salmonella Enteritidis (SE) and S. Typhimurium (STM) harbouring deletions in ttrA and pduA genes, which are crucial to the metabolism of tetrathionate and 1,2-propanediol, respectively. Mutant strains were excreted at higher rates when compared to the wild-type strains. The highest rates were observed with white egg-layer and brown egg-layer chicks (67.5%), and broiler chicks (56.7%) challenged by SEΔttrAΔpduA, and brown egg-layer chicks (64.8%) challenged by STMΔttrAΔpduA. SEΔttrAΔpduA presented higher bacterial counts in the liver and spleen of the three chicken lineages and caecal contents from the broiler chickens, whereas STMΔttrAΔpduA presented higher counts in the liver and spleen of the broiler and brown-egg chickens for 28 days post-infection (P < 0.05). The ttrA and pduA genes do not appear to be major virulence determinants in faecal excretion or invasiveness for SE and STM in chickens. RESEARCH HIGHLIGHTSttrA and pudA do not impair gut colonization or systemic infection in chicks.Mutant strains were present in higher numbers in broilers than in laying chicks.Mutants of SE and STM showed greater pathogenicity in broiler chicks than layers.

A data-driven model for COVID-19 pandemic - Evolution of the attack rate and prognosis for Brazil.

We introduce a compartmental model SEIAHRV (Susceptible, Exposed, Infected, Asymptomatic, Hospitalized, Recovered, Vaccinated) with age structure for the spread of the SARAS-CoV virus. In order to model current different vaccines we use compartments for individuals vaccinated with one and two doses without vaccine failure and a compartment for vaccinated individual with vaccine failure. The model allows to consider any number of different vaccines with different efficacies and delays between doses. Contacts among age groups are modeled by a contact matrix and the contagion matrix is obtained from a probability of contagion p c per contact. The model uses known epidemiological parameters and the time dependent probability p c is obtained by fitting the model output to the series of deaths in each locality, and reflects non-pharmaceutical interventions. As a benchmark the output of the model is compared to two good quality serological surveys, and applied to study the evolution of the COVID-19 pandemic in the main Brazilian cities with a total population of more than one million. We also discuss with some detail the case of the city of Manaus which raised special attention due to a previous report of We also estimate the attack rate, the total proportion of cases (symptomatic and asymptomatic) with respect to the total population, for all Brazilian states since the beginning of the COVID-19 pandemic. We argue that the model present here is relevant to assessing present policies not only in Brazil but also in any place where good serological surveys are not available.

A novel de novo heterozygous ALPL nonsense mutation associated with adult hypophosphatasia.

Using genetic, clinical, biochemical, and radiographic assessment and bioinformatic approaches, we present an unusual case of adult HPP caused by a novel de novo heterozygous nonsense mutation in the alkaline phosphatase (ALPL). INTRODUCTION: Hypophosphatasia (HPP) is caused by genetic alterations of the ALPL gene, encoding the tissue-nonspecific isozyme of alkaline phosphatase (TNSALP). Here, the purpose was to perform clinical and molecular investigation in a 36-year-old Caucasian woman suspected to present adult HPP. METHODS: Medical and dental histories were obtained for the proposita and family members, including biochemical, radiographic, and dental assessments. ALPL mutational analysis was performed by the Sanger sequencing method, and the functional impact prediction of the identified mutations was assessed by bioinformatic methods. RESULTS: We identified a novel heterozygous nonsense mutation in the ALPL gene (NM_000478.6:c.768G>A; W[TGG]>*[TGA]) associated with spontaneous vertebral fracture, severe back pain, musculoskeletal pain, low bone density, and short-rooted permanent teeth loss. Functional prediction analysis revealed that the Trp256Ter mutation led to a complete loss of TNSALP crown domain and extensive loss of other functional domains (calcium-binding domain, active site vicinity, and zinc-binding site) and over 60% loss of homodimer interface residues, suggesting that the mutant TNSALP molecules are nonfunctional and form unstable homodimers. Genotyping of the ALPL in the proposita's parents, sister, and niece revealed that in this case, HPP occurred due to a de novo mutation. CONCLUSION: The present study describes a novel genotype-phenotype and structure-function relationship for HPP, contributing to a better molecular comprehension of HPP etiology and pathophysiology.

Acquired hepatocerebral degeneration and hepatic encephalopathy: one or two entities?

BACKGROUND AND PURPOSE: Acquired hepatocerebral degeneration (AHD) and hepatic encephalopathy (HE) are neurological complications of chronic liver disease (CLD) with portosystemic shunt. While HE is common, AHD is a rare entity, and the clinical imaging relationships observed in small series lack validation in large patient cohorts. The aim of this study was to characterize a cohort of AHD patients and to explore possible associations with HE coexistence. METHODS: We performed a retrospective analysis of patients with a working AHD diagnosis, between 2008 and 2019. Clinical, laboratory, imaging and neuropsychological results at first neurological observation were reviewed and compared between the 'AHD' group and the 'AHD with HE' group. RESULTS: A total of 76 patients were recruited. The most frequent neurological manifestations were neuropsychiatric (93.4%) and extrapyramidal (84.2%). Only 38% of patients had hypermanganesemia. Compared with the AHD group, the AHD with HE group had more hyperkinetic movement disorders (71.4% vs. 38.5%; P = 0.05), a higher number of patients on the dementia spectrum (57.7% vs. 20%; P = 0.04), higher median ammonia levels (P = 0.014) and more widespread cortico-subcortical and pyramidal involvement on brain magnetic resonance imaging. Nineteen patients underwent liver transplantation, with significantly improved survival (P = 0.006). DISCUSSION: Hepatic encephalopathy and AHD often coexist in the same patient. Seventy-six patients with CLD and AHD were evaluated, making this one of the largest reported AHD cohorts. Blood manganese level was a weak diagnostic marker in AHD. Early liver function restoration through liver transplantation improved survival. Our report provides a detailed description of the phenotype and long-term outcome of AHD, with relevance for diagnosis and treatment.

Late-gestation heat stress impairs daughter and granddaughter lifetime performance.

Records of late-gestation heat stress studies conducted over 10 consecutive years in Florida were pooled and analyzed to test the hypothesis that maternal hyperthermia during late gestation impairs performance of the offspring across multiple generations and lactations, ultimately impeding the profitability of the US dairy sector. Dry-pregnant multiparous dams were actively cooled (CL; shade of a freestall barn, fans and water soakers, n = 196) or not (HT; shade only, n = 198) during the last 46 d of gestation, concurrent with the entire dry period. After data mining, records of 156 daughters (F1) that were born either to CL (CLF1, n = 77) or HT dams (HTF1, n = 79) and 45 granddaughters (F2) that were born either to CLF1 (CLF2, n = 24) or HTF1 (HTF2, n = 21) were used in the analysis. Life events and daily milk yield for 3 lactations of daughters and granddaughters were obtained. Milk yield, reproductive performance, and productive life data were analyzed using MIXED and GLIMMIX procedures, and lifespan was analyzed using PHREG and LIFETEST procedures of SAS (SAS Institute Inc., Cary, NC). Milk production of HTF1 was reduced in their first (2.2 kg/d), second (2.3 kg/d), and third lactations (6.5 kg/d) compared with CLF1. More HTF1 were culled before first calving, and the productive life and lifespan of HTF1 were reduced relative to CLF1 (4.9 and 11.7 mo, respectively). The granddaughters (HTF2) born to HTF1 produced less milk in their first lactation (1.3 kg/d) relative to granddaughters (CLF2) born to CLF1. More HTF2 were culled before first breeding relative to CLF2; however, productive life and lifespan were not different between HTF2 and CLF2 animals. An economic analysis was then performed based on the number of heat stress days, dry cows per state, and the aforementioned impairments on daughters' lifespans and milk production. Collectively in the United States, the economic losses for additional heifer rearing cost, reduced productive life, and reduced milk yield of the F1 offspring were estimated at $134, $90, and $371 million per year, respectively. In summary, late-gestation heat stress exerts carryover effects on at least 2 generations. Providing heat abatement to dry-pregnant dams is important to rescue milk loss of the dam and to prevent losses in their progeny.

Energy requirements and efficiency of energy utilization in growing dairy goats of different sexes.

The aim of this study was to investigate the effects of sex on the requirements for maintenance and efficiency of energy utilization in growing Saanen goats. A database from 7 comparative slaughter studies that included 238 Saanen goats was gathered to provide information for the development of prediction equations of energy requirements for maintenance and efficiency of energy utilization. The experimental design provided different levels of metabolizable energy intake (MEI) and empty body weight (EBW). The data were analyzed so that sex (e.g., intact males, castrated males, and females; n = 98, 80, and 60, respectively) was a fixed effect, and blocks nested in the studies and goat sex were random effects. For the development of linear and nonlinear equations, we used the MIXED and NLMIXED procedures in SAS (SAS Institute Inc., Cary, NC). Nonlinear regression equations were developed to predict heat production (HP, kcal/kg0.75 of EBW; dependent variable) from MEI (kcal/kg0.75 of EBW; independent variable). Using the comparative slaughter technique, the net energy requirement for maintenance (NEM) was calculated as the value of HP at MEI equal to zero. Additionally, NEM was evaluated based on the degree of maturity. The metabolizable energy requirement for maintenance was calculated as the value at which HP is equal to MEI. Efficiency of ME utilization for maintenance (km) was calculated as the ratio between NEM and the metabolizable energy requirement for maintenance. Efficiency of energy utilization for growth (kg) was assumed to be the slope of the linear regression of retained energy (RE) on MEI above the maintenance stage (model intercept equal to 0). Efficiencies of RE as protein (kp) and as fat (kf) were calculated using the multiple linear regression of MEI above the maintenance (model intercept equal to 0) on RE as protein and as fat, respectively. Sex affected NEM (75.0 ± 1.76 kcal/kg0.75 of EBW for males and 63.6 ± 2.89 kcal/kg0.75 of EBW for females) and sex did not affect km (0.63). In contrast, sex no longer affected NEM when degree of maturity was considered on its estimation. The kg was different between sexes (0.31 for castrated males and females, and 0.26 for intact males), but kp (0.21) and kf (0.80) were similar between sexes. These results may be useful for improving robustness of the energy requirement recommendations for dairy goats.

Shaping ability of XP-endo Shaper and ProTaper Next in long oval-shaped canals: a micro-computed tomography study.

AIM: To evaluate the shaping ability of the single-file XP-endo Shaper system (XP-S; FKG Dentaire, La Chaux-de-Fonds, Switzerland) employing a different working time and of the multiple-file ProTaper Next system (Dentsply Sirona, Ballaigues, Switzerland) using micro-computed tomography (micro-CT) technology. METHODOLOGY: Twenty long oval-shaped canals in mandibular incisors were matched anatomically and scanned by micro-CT (Skyscan 1172; Bruker micro-CT, Kontich, Belgium). The canals were divided into two groups (n = 10) according to the canal preparation protocol: XP-endo Shaper (XP-S) with an extra 45 s of instrumentation and ProTaper Next (PTN X4). The images recorded before and after preparation were evaluated for morphometric measures of volume, surface area, structure model index and untouched walls. The data were compared statistically (Student's t-test for homogenous variances and Mann-Whitney test) between the two groups (XP-S and PTN X4) at α = 5%. RESULTS: Root canal preparation significantly increased all parameters (volume, surface area, structure model index and untouched walls) tested in each group (P < 0.05). There was no significant difference (P > 0.05) in the percentage increase of volume (107.50%-93.13%), surface area (27.74%-29.68%) or untouched canal wall (13.08%-11.74%) between XP-S and PTN X4, respectively. CONCLUSIONS: The XP-endo Shaper system (single-file) with an extra 45 s of instrumentation and the ProTaper Next system (multiple files) had a similar root canal shaping ability. Neither technique was able to fully prepare the long oval-shaped canals of mandibular incisors.

A spatial analysis of the Spanish tobacco consumption distribution: Are there any consumption clusters?

OBJECTIVES: The objective of this short communication is to provide a previous empirical analysis to locate the regions that have distortions in per capita tobacco consumption. The location of these regions and their proximity to other countries allow us to detect the need that governments have to harmonize policies. STUDY DESIGN: The design of this study is a cross-sectional spatial descriptive analysis. METHODS: By using panel data from the 47 Spanish provinces from 2002 to 2017, we implement the Moran's I test which allows us to detect areas where low or high per capita tobacco consumption clusters are generated. RESULTS: The results show that areas of Spain bordering countries with high price differentials, such as Gibraltar and France, generate clusters of low and high per capita tobacco consumption, respectively. Indeed, maintaining a low price differential seems not to generate distortions, as revealed by the Portugal case. CONCLUSIONS: Spatial clusters of per capita tobacco consumption are located in regions close to countries where there is high price differential.

[Large Pneumothorax in a Sleep Apnea Patient with CPAP without Previously Known Lung and Thoracic Diseases - a Case Report]. / Großer Pneumothorax unter CPAP-Therapie beim Schlafapnoepatienten ohne vorbekannte Lungen- und Thoraxerkrankungen ­ ein Fallbericht.

CPAP is the most common treatment for obstructive sleep apnea.Serious complications from this treatment are very rare. Pneumothorax following lung barotrauma under CPAP therapy has been described in case reports only in patients with pre-existing lung and thoracic diseases.A 68-year-old sleep apnea patient without pre-existing lung or thoracic diseases and with established CPAP therapy since many years was admitted to the hospital after a severe thoracic pain event with persistent shortness of breath. Chest radiograph and computed tomography showed an extensive right-sided pneumothorax with basal bullous emphysema. After surgical treatment of the secondary spontaneous pneumothorax, on the third postoperative day CPAP with reduced pressure was re-introduced with satisfactory sleep apnea findings and without pneumothorax recurrence.As possible cause of pneumothorax in the patient, alveolar inflammatory changes due to over-distention and increased pressure in the alveoli was assumed, which can occur after years of CPAP treatment with gradual pressure increase.In summary, in sleep apnea patients treated with CPAP for years, after sudden onset of thoracic pain and shortness of breath possible spontaneous pneumothorax should be considered.

Vitamin D levels reverberate in monocytes modulation in hemodialysis patients.

BACKGROUND: Patients with chronic kidney disease (CKD) have a severe vitamin D deficiency and increasing epidemiological data suggesting that this deficiency may play a role in overall morbidity and mortality associated with CKD. It is known that vitamin D regulates the immune system, however, in dialysis patients this deficiency and the modulation of proinflammatory cells is unclear. Among these, monocytes arouse interest considering they constitutively express vitamin D receptors. AIM: This study aimed the evaluation of monocytic profile in CKD patients according to vitamin D levels. METHODS: Patients in hemodialysis (HD) were divided into two groups, regarding vitamin D levels: Group 1, vitamin D <26 ng/ml (n = 15) and Group 2, vitamin D ≥26 ng/ml (n = 18). Whole blood was collected aiming evaluation of (a) monocytic populations through CD14 and CD16 expression, (b) reactive oxygen species (ROS) generation, and (c) apoptosis. RESULTS: We observed that in Group 1, when compared to Group 2, there was a significant increase in intermediate monocytes (CD14++ CD16 + ; 34.7 ± 31.6 vs. 12.1 ± 6.3; p = 0.006, respectively) and decrease in classical ones (CD14 ++ CD16 - ; 45.3 ± 31.8 vs. 70.4 ± 25.1; p = 0.017, respectively). There was no difference between groups regarding nonclassical monocytes (CD14 + CD16 ++ ), as well as to apoptosis and to ROS generation. CONCLUSION: This study suggests that HD patients with lower vitamin D levels might have an intensified inflammatory outline as intermediate monocytes with an inflammatory pattern are increased in this population, when compared with patients with higher levels of vitamin D.