A Modified Corona Score Using Lung Ultrasound to Identify COVID-19 Patients.

BACKGROUND: COVID-19 continues to circulate around the world with multiple different strains being active at once. While diagnosis with antigen and molecular testing is more readily available, there is still room for alternative methods of diagnosis, particularly in out-of-hospital settings, e.g., home or nursing homes, and in low-medium income countries, where testing may not be readily available. STUDY OBJECTIVES: To evaluate the performance of two modified corona score methods compared with a traditional corona score approach to identify patients with COVID-19. METHODS: This was a retrospective multicenter study performed to compare the ability to predict SARS-CoV-2 test results on a nasopharyngeal swab between the corona scores and two novel corona scores (modified 1 corona score (M1CS) and modified 2 corona score (M2CS)). The M1CS included lung ultrasound (LUS) and chest X-ray (CXR) results, while the M2SC only utilized LUS findings without CXRs. Emergency physicians performed point-of-care LUS and a physical examination upon admission to the emergency department. RESULTS: Subjects positive for SARS-CoV-2 were older and had higher ferritin levels and temperature and lower diastolic blood pressure and oxygen saturation. The two groups differed on corona score and modified corona scores (p < 0.001 for all). SARS-CoV-2-positive patients had fewer pleural line irregularities (p = 0.025) but presented more frequently with an interstitial pattern on CXRs (p < 0.001). CONCLUSIONS: In our study, LUS alone provided a valuable contribution to the corona score and improved its performance more than when CXR results were included. These results suggest that resource-limited areas where CXRs may be unavailable or prohibitively expensive can utilize an ultrasound as the sole imaging modality without a loss of diagnostic performance for SARS-CoV-2 pneumonia diagnosis.

Esotropia, nystagmus and optic disk staphyloma in Donnai-Barrow syndrome / Esotropia, nistagmo e estafiloma de disco óptico na síndrome de Donnai-Barrow

ABSTRACT A 12-year-old boy with Donnai-Barrow syndrome diagnosed intra-uterus presented esotropia, high myopia, nystagmus, and optic disk staphyloma in an ophthalmologic examination. The patient had associated Fanconi syndrome and sensorineural hearing loss as well as facial manifestations as hypertelorism, downward slanting of palpebral fissures and low ear implantation. Magnetic resonance imaging revealed agenesis of the corpus callosum. To our knowledge, this is the first reported case associated with esotropia, nystagmus, and optic disk staphyloma.

RESUMO Paciente do sexo masculino, 12 anos, com diagnóstico intrauterino de síndrome de Donnai-Barrow, apresentava ao exame oftalmológico esotropia, alta miopia, nistagmo e estafiloma de disco óptico. Associado ao quadro, apresentava síndrome de Falconi e perda auditiva neurossensorial, além de alterações faciais, como hipertelorismo, inclinação inferior das fissuras palpebrais e implantação baixa das orelhas. Ressonância magnética revelou agenesia de corpo caloso. Ao nosso conhecimento, este é o primeiro caso relatado associando esotropia, nistagmo e estafiloma de disco óptico.

Early Lung Ultrasound Findings in Patients With COVID-19 Pneumonia: A Retrospective Multicenter Study of 479 Patients.

OBJECTIVES: Lung ultrasound (LUS) holds the promise of an accurate, radiation-free, and affordable diagnostic and monitoring tool in coronavirus disease 2019 (COVID-19) pneumonia. We sought to evaluate the usefulness of LUS in the diagnosis of patients with respiratory distress and suspicion of interstitial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, in comparison to other imaging modalities. METHODS: This was a multicenter, retrospective study. LUS was performed, on Emergency Department (ED) arrival of patients presenting for possible COVID-19 evaluation, by trained emergency physicians, before undergoing conventional radiologic examination or while waiting for the report. Scans were performed using longitudinal transducer orientation of the lung regions. CXR was interpreted by radiologists staffing ED radiology. Subjects were divided into two group based on molecular test results. LUS findings were compared to COVID test results, nonlaboratory data, and other imaging for each patient. Categorical variables were expressed as percentages and continuous variables as median ± standard error. RESULTS: A total of 479 patients were enrolled, 87% diagnosed with SARS-CoV-2 by molecular testing. COVID positive and COVID negative patients differed with respect to sex, presence of fever, and white blood cells count. Most common findings on lung point of care ultrasound (POCUS) for COVID-positive patients were B-lines, irregular pleural lines, and small consolidation. Normal chest X-ray was found in 17.89% of cases. CONCLUSIONS: This 479 patient cohort, with COVID-19, found LUS to be noninferior to chest X-ray (CXR) for diagnostic accuracy. In this study, COVID-positive patients are most likely to show B lines and sub-pleural consolidations on LUS examination.

Effect of root surface treatment with denusomab after delayed tooth replantation.

OBJECTIVES: To evaluate denosumab, a human monoclonal antibody that mimics the effects of osteoprotegerin in bone metabolism, as a topical treatment of root surface to be used prior to delayed tooth replantation. MATERIALS AND METHODS: Thirty-six rats' right incisors were used. Teeth were extracted and divided into: delayed replantation without root surface treatment (control); delayed replantation with root surface treatment with denosumab 60 mg/mL and 30 mg/mL, respectively, for 10 min both experimentals groups. After that, the root canals were filled with calcium hydroxide and replanted. After 15 and 60 days, the animals were euthanized, and the samples were collected and processed for microscopic analysis. Histological sections were performed, and stained with HE to describe the dental characteristics, measure ankylosis, replacement resorption, and dental resorption by conventional microscopy. Also, was performed Brown & Brenn staining and immunohistochemistry for RANKL, OPG, and periostin. RESULTS: Denosumab 60 mg/mL reducted ankylosis (p < 0.0001), replacement resorption (p < 0.0001), and tooth resorption, 60 days after replantation, compared to untreated replanted teeth (p < 0.005). Lower bacterial contamination in root surface in the denosumab treatment groups was found, regardless of the concentration used (p < 0.001). Also, denosumab treatment inhibited the expression of RANKL without modulating OPG. Periostin was observed in periodontal ligament of replanted tooth, although this labelling was absent in the ankylosis areas, in both experimental periods. CONCLUSION: Treatment of the root surface with denosumab at 60 mg/mL of rat teeth before delayed replantation reduced dental root resorption compared with the untreated teeth after 60 days. CLINICAL RELEVANCE: Survival of a replanted tooth has been a challenge in clinical practice. The use of a medication, such as denosumab, to limit dental root resorption represents an important therapeutical approach.

Accuracy of Point-of-Care Ultrasound in Detecting Fractures in Children: A Validation Study.

This study sought to compare point-of-care ultrasound (POCUS) and conventional X-rays for detecting fractures in children. This was a prospective, non-randomized, convenience-sample study conducted in five medical centers. It evaluated pediatric patients with trauma. POCUS and X-ray examination results were treated as dichotomous variables with fracture either present or absent. Descriptive statistics were calculated in addition to prevalence, sensitivity, specificity, positive predictive value and negative predictive value, including 95% confidence intervals (CIs). The Cohen κ coefficient was determined as a measurement of the level of agreement. A total of 554 examinations were performed with POCUS and X-ray. On physical examination, swelling, localized hematoma and functional limitation were found in 66.73%, 33.78% and 53.74% of participants, respectively. The most-studied areas were limbs and hands/feet (58.19% and 38.27%), whereas the thorax was less represented (3.54%). Sensitivity of POCUS was 91.67% (95% CI, 76.41-97.82%) for high-skill providers and 71.50 % (95% CI, 64.75-77.43%) for standard-skill providers. Specificity was 88.89% (95% CI, 73.00-96.34%) and 82.91% (95% CI, 77.82-87.06%) for high- and standard-skill providers, respectively. Positive predictive value was 89.19% (95% CI, 73.64-96.48%) and 75.90% (95% CI, 69.16-81.59%) for high- and standard-skill providers, respectively. Negative predictive value was 91.43% (95% CI, 75.81-97.76%) and 79.44% (95% CI, 74.21-83.87%) for high- and standard-skill providers, respectively. The Cohen κ coefficient showed very good agreement (0.81) for high-skill providers, but moderate agreement (0.54) for standard-skill providers. We noted good diagnostic accuracy of POCUS in evaluating fracture, with excellent sensitivity, specificity, and positive and negative predictive value for high-skill providers.

Factors involved in the treatment sought immediately after traumatic dental injuries in Brazilian children.

AIM: The aim of this study was to evaluate demographic and clinical factors involved in the immediate seeking of care after traumatic dental injury (TDI) in Brazilian children. MATERIALS AND METHODS: Records from 74 patients, age ranged 1-11 years, who sought treatment at the School of Dentistry of Ribeirão Preto at University of São Paulo, Brazil, were collected. Data was analyzed using the Epi Info 7.0 software by t-test, odds ratio calculation, Chi-square, or Fisher's exact tests. RESULTS: Twenty-three (31.1%) sought dental treatment immediately and 51 (68.9%) did not seek dental treatment immediately. The most common type of trauma was lateral luxation (44.6%). In primary teeth, 31 cases (60.78%) involved the soft tissue and 16 (39.2%) involved hard tissue injuries. While in permanent teeth, 20 cases (40%) involved soft tissue and 24 (60%) involved hard tissue injuries had more traumas in the hard tissue (P = 0.04). The type of injury and dentition was not associated with the time that the guardians sought dental treatment (P > 0.05). None of the factors were involved in immediately seeking care after TDI. CONCLUSION: Moreover, the majority of parents/caregivers did not immediately seek dental treatment after TDI, regardless of the type of injury.

In vitro evaluation of plants as storage media for avulsed teeth: A systematic review.

BACKGROUND/AIMS: Dental avulsion is defined as the complete displacement of a tooth from its socket owing to trauma. The treatment outcome depends on storage of the avulsed teeth in media capable of maintaining the viability of periodontal ligament cells, when immediate replantation is not possible. To maintain the viability of periodontal ligament cells, plants can be used as a storage medium because of their pharmacological and phytotherapic properties. The aim of this study was to evaluate the effect of plants on the tissue repair following tooth replantation. METHODS: This systematic review was conducted according to the PRISMA guidelines and included articles collected in the Cochrane, LILACS, PubMed, Science Direct, Scopus and Web of Science databases, plus articles found in the grey literature. The articles were screened for partial reading using the Endnote and Rayyan platform. The methodology of studies was evaluated by using the OHAT and GRADE. RESULTS: In the initial search, 2361 articles were obtained, only 51 articles were submitted to complete reading, and 35 articles were selected for the qualitative analysis. The evaluated plants had a potential effect on cell viability and proliferation. The articles evaluated mainly the action of plants on cells of the periodontal ligament. Propolis, coconut water and Aloe vera were the most common storage medium. CONCLUSION: The methodological limitations persist, and the evaluation of the pharmacological potential of plants on dental tissues still requires more research.

A Pilot Prospective Study to Validate Point-of-Care Ultrasound in Comparison to X-Ray Examination in Detecting Fractures.

Despite its limitations, conventional radiography is the method of choice for fracture evaluation in the emergency department. Only a few studies, moreover in limited populations, have evaluated the possible benefits of ultrasound (US), and especially of point-of-care ultrasound (POCUS), in the diagnosis of fractures. We sought to compare the accuracy of POCUS with that of conventional radiography in the diagnosis of bone fractures. This prospective study with a non-randomly allocated convenience sample was conducted at two academic medical centers. Four physicians, with focused training in musculoskeletal POCUS, evaluated consecutive patients with suspected orthopedic injury. US and X-ray examination results were treated as dichotomous variables with either fracture present or fracture absent. Descriptive statistics were calculated in addition to prevalence, sensitivity, specificity, positive predictive value and negative predictive value including 95% confidence intervals (CIs). Cohen's κ coefficient was determined as a measurement of the level of agreement. Four hundred sixty-nine patients (404 adult and 65 pediatric) ranging in age from 1-97 y were enrolled at two different hospitals. Seven hundred six examinations, both US and X-ray, were performed in 634 suspected fractures in adults (age ≥18 y) and 72 in children. On physical examination, swelling, localized hematoma and functional limitation were found in 64.61%, 34.97% and 53.52, respectively. The sensitivity of US examination was 93.89% (CI: 89.74%-96.49%) for all patients and 94.30% (CI: 89.77%-96.98%) and 91.67% (CI: 76.41%-97.82%) in adult and pediatric groups, respectively. Specificity was 94.13% (CI: 91.53-95.99), 94.56% (CI: 91.89-96.41) and 88.89% (CI: 73.00-96.38) for the whole group, adults and children, respectively. The positive predictive value was 88.48% (CI: 83.62%-92.08%), 88.35% (CI: 82.97%-92.24%) and 89.19% (CI: 73.64%-96.48%) for the whole group, adults and children, respectively. The negative predictive value was 96.98% (CI: 94.86%-98.27%), 97.43% (CI: 95.31%-98.64%) and 91.43% (CI: 75.81%-97.76%) in the three groups, respectively. Cohen's κ coefficient revealed high agreement of 0.87 for both the whole group and adult patients and 0.81 for pediatric patients. We found that POCUS has significant diagnostic accuracy in evaluating fracture compared with plain radiography, with excellent sensitivity, specificity and positive and negative predictive values.

Efficacy of a propolis solution for cleaning complete dentures.

PURPOSE: The efficacy of a propolis solution against denture biofilm was evaluated by means of an in vitro assessment and a cross-over randomized clinical trial. METHODS: Acrylic resin specimens were contaminated by Staphylococcus aureus, Streptococcus mutans, Escherichia coli, Candida albicans, Candida glabrata, Candida parapsilosis, immersed in a (A) propolis solution, (B) saline or (C) alkaline peroxide, applied onto Petri plates with culture medium and after incubation the number of colonies was counted. For the clinical trial, 30 complete denture wearers were randomly assigned to groups (A) propolis solution, and (B) saline, following one of the sequences (I)A/B or (II) B/A. After each intervention, biofilm was quantified by means of digital photos taken from the intaglio surface and a microbiological quantification of Candida spp. and mutans streptococci was conducted. RESULTS: Both propolis solution and alkaline peroxide reduced the microbial counts for S. mutans and C. albicans with significant and greater effect for group C (P< 0.05). However, no difference was found clinically between the interventions. The propolis solution showed an intermediate antimicrobial effect against S. mutans and C. albicans. Also, it did not exert an immediate effect on denture biofilm. CLINICAL SIGNIFICANCE: A commercially available propolis-based cleanser solution was evaluated in vitro and clinically for the treatment of denture stomatitis. Although an immediate effect on denture biofilm was not observed after a single application, It showed antimicrobial effect against S. mutans and C. albicans.

Efficiency of different storage media for avulsed teeth in animal models: a systematic review.

BACKGROUND/AIMS: Tooth avulsion consists of the complete displacement of a tooth from the alveolar socket. When immediate replantation is not possible, the avulsed tooth should be kept in a storage medium capable of maintaining the viability of periodontal ligament (PDL) cells on the root surface. However, there is no consensus on the best storage medium able to prevent sequels such as ankylosis and tooth resorption. The aim of this study was to perform a systematic review to evaluate the in vivo effectiveness of different storage media for avulsed teeth. METHODS: Two reviewers performed a database search for studies published between January 1950 and December 2015 which were indexed in the PubMed, Scopus, Web of Science, and Bireme databases. An additional manual search was performed. Studies with animal models that evaluated tooth avulsion, storage media, and replantation were included. After full-text analysis of the potentially relevant studies, the selected studies were included in the systematic review. RESULTS: The database search found 157 distinct studies evaluating avulsed teeth storage media. However, only six studies met the selection criteria and were included in the review. There was a high variability in the study estimates for the parameters analyzed. When assessing the quality and level of evidence of each study, one study was rated as having a very low level of evidence, four studies had low levels of evidence, and one had a moderate level of evidence. CONCLUSION: As a result of data heterogeneity and limitations of the studies, there was insufficient evidence to determine the most effective storage medium for avulsed teeth.

Cytokine profile changes in gingival crevicular fluid after placement different brackets types.

OBJECTIVE: The aim of this study was to examine the relationship between bracket design and ratio of five proinflammatory cytokine, in gingival crevicular fluid (GCF), and bacterial adhesion without tooth movement influence. DESIGN: The sample was comprised of 20 participants, aged 11 to 15 years old (mean age: 13.3 years±1.03). A conventional Gemini™ metallic bracket and two self-ligating brackets, In-Ovation®R and SmartClip™, were bonded to the maxillary incisors and canines. GCF was collected using a standard filter paper strip before and 60days after bonding. The cytokine levels (IL-12, IL-1α, IL-1ß, IL-6 and TNF-α) were performed by the LUMINEX assay. The levels of the red and orange bacterial complexes were analyzed by the Checkerboard DNA-DNA hybridization. The data of cytokine and bacterial complexes were carried out using the non-parametric tests at 5% of significance level. RESULTS: Increased cytokine levels were observed. However, only the SmartClip™ group showed a significantly increased level of TNF-α (p=0.046). The SmartClip™ brackets group presented higher levels of red complex bacteria. CONCLUSIONS: The bracket design affected cytokine levels and bacterial adhesion since it was observed that the proinflammatory cytokines released in GCF to the SmartClip™ group showed an increase in the TNF-α levels associated with higher bacterial levels, which possibly represents greater inflammatory potential. Thereby, the bracket design should be considered in patients with risk of periodontal disease and root resorption.

Microleakage of Sealants after Phosphoric Acid, Er: YAG Laser and Air Abrasion Enamel Conditioning: Systematic Review and Meta-Analysis.

PURPOSE: The aim of this systematic review and meta-analysis is to answer the focused question: Does the application of phosphoric acid, Er:YAG laser and air abrasion enamel conditioning methods previous to the oclusal sealant application in human permanent molars influence the microleakage? STUDY DESIGN: A literature research was carried out in the Pubmed Medline, Web of Science, Scopus and Cochrane databases using with the MeSH terms and keyword search strategy. A supplemental hand search of the references of retrieved articles was also performed. Inclusion criteria comprised ex vivo studies (extracted teeth) with permanent human teeth that used chemical (phosphoric acid) or mechanical (Er:YAG laser and air abrasion) conditioning methods previous the sealant application. The studies should evaluate microleakage as an outcome. Meta-analysis pooled plot were obtained comparing the microleakage after pre-treatment with phosphoric acid, Er:YAG and air abrasion enamel conditioning for sealant application using RevMan software. RESULTS: The search resulted in 164 articles, 55 records were excluded because they were duplicated. The analysis of titles and abstracts resulted in the exclusion of 105 studies. Four studies were included in the systematic review and the meta-analysis. According to the risk of bias evaluation, the four studies were considered low risk of bias. The meta-analysis showed that phosphoric acid had lower microleakage than Er:YAG laser (p < 0.001) and air abrasion (p < 0.001), with heterogeinity of I2 = 0% and I2 = 71%, respectively. It was not found statistical difference when compared phosphoric acid and phosphoric acid combined with Er:YAG laser and air abrasion (p > 0.05). CONCLUSION: The evidence supports that the pretreatment with phosphoric acid leads lower microleakage in oclusal sealants than Er:YAG laser and air abrasion.

Photo-ignition process of multiwall carbon nanotubes and ferrocene by continuous wave Xe lamp illumination.

This work aims to investigate and characterize the photo-ignition phenomenon of MWCNT/ferrocene mixtures by using a continuous wave (CW) xenon (Xe) light source, in order to find the power ignition threshold by employing a different type of light source as was used in previous research (i.e., pulsed Xe lamp). The experimental photo-ignition tests were carried out by varying the weight ratio of the used mixtures, luminous power, and wavelength range of the incident Xe light by using selective optical filters. For a better explanation of the photo-induced ignition process, the absorption spectra of MWCNT/ferrocene mixtures and ferrocene only were obtained. The experimental results show that the luminous power (related to the entire spectrum of the Xe lamp) needed to trigger the ignition of MWCNT/ferrocene mixtures decreases with increasing metal nanoparticles content according to previously published results when using a different type of light source (i.e., pulsed vs CW Xe light source). Furthermore, less light power is required to trigger photo-ignition when moving towards the ultraviolet (UV) region. This is in agreement with the measured absorption spectra, which present higher absorption values in the UV-vis region for both MWCNT/ferrocene mixtures and ferrocene only diluted in toluene. Finally, a chemo-physical interpretation of the ignition phenomenon is proposed whereby ferrocene photo-excitation, due to photon absorption, produces ferrocene itself in its excited form and is thus capable of promoting electron transfer to MWCNTs. In this way, the resulting radical species, FeCp2 +∙ and MWCNT-, easily react with oxygen giving rise to the ignition of MWCNT/ferrocene samples.

Cytotoxicity and cytokine expression induced by silorane and methacrylate-based composite resins.

OBJECTIVE: The aim of this study was to evaluate cytotoxicity and cytokine production induced by light-cured or non-light-cured methacrylate-based and silorane composite resins in RAW 264.7 macrophages. MATERIAL AND METHODS: Cells were stimulated with the extracts from light-cured or non-light-cured composite resins. After incubation for 24 h, cytotoxicity was assessed with the lactate dehydrogenase (LDH) and methyl thiazolyl tetrazolium (MTT) assays, and total protein was quantified using the Lowry method. TNF-α detection was examined with an enzyme-linked immunosorbent assay (ELISA) conducted with cell supernatants after cell stimulation for 6, 12, and 24 h. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey's post hoc test (α=0.05). RESULTS: KaloreTM and FiltekTM Silorane were cytotoxic with or without light curing (p<0.05) after 24 h of incubation. KaloreTM stimulated the early production of TNF-α in comparison with control (p<0.05), whereas FiltekTM Silorane did not affect TNF-α levels after 6 and 12 h (p>0.05). However, after 24 h FiltekTM Silorane inhibited the production of TNF-α (p<0.05). CONCLUSIONS: KaloreTM and FiltekTM Silorane were cytotoxic regardless of light curing. The extract obtained from KaloreTM after 15 days of incubation stimulated the production of TNF-α, unlike that obtained from FiltekTM Silorane.

Cytotoxicity and cytokine expression induced by silorane and methacrylate-based composite resins

ABSTRACT The successful use of composite resins in Dentistry depends on physicochemical properties, but also on the biological compatibility of resins, because of the close association between pulp and dentin. Objective The aim of this study was to evaluate cytotoxicity and cytokine production induced by light-cured or non-light-cured methacrylate-based and silorane composite resins in RAW 264.7 macrophages. Material and Methods Cells were stimulated with the extracts from light-cured or non-light-cured composite resins. After incubation for 24 h, cytotoxicity was assessed with the lactate dehydrogenase (LDH) and methyl thiazolyl tetrazolium (MTT) assays, and total protein was quantified using the Lowry method. TNF-α detection was examined with an enzyme-linked immunosorbent assay (ELISA) conducted with cell supernatants after cell stimulation for 6, 12, and 24 h. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey’s post hoc test (α=0.05). Results KaloreTM and FiltekTM Silorane were cytotoxic with or without light curing (p<0.05) after 24 h of incubation. KaloreTM stimulated the early production of TNF-α in comparison with control (p<0.05), whereas FiltekTM Silorane did not affect TNF-α levels after 6 and 12 h (p>0.05). However, after 24 h FiltekTM Silorane inhibited the production of TNF-α (p<0.05). Conclusions KaloreTM and FiltekTM Silorane were cytotoxic regardless of light curing. The extract obtained from KaloreTM after 15 days of incubation stimulated the production of TNF-α, unlike that obtained from FiltekTM Silorane.

Sex Differences in Pediatric Dental Pain Perception.

PURPOSE: To evaluate sex-related differences in dental pain perception in children. METHODS: Fifty-two children who received a dental procedure with local anesthesia were selected to participate. Pain perception levels were assessed with the Wong-Baker FACES Pain Rating Scale. Twenty-four and 48 hours following the procedure, the parents were contacted by phone for a verbal survey to assess their child's postoperative pain. Age, type of dental procedure, and behavior were also evaluated as covariables. The data were analyzed using Epi Info 7.0 software and GraphPad Prism 5.0 software. Chi-square or t test were performed with a significance level of five percent. RESULTS: The mean age of the children was 6.7 (±2.4 [SD]) years. Twenty-seven (51.9 percent) were boys. None of the parents reported pain at 48 hours. None of the covariables were differentially distributed among the sexes (P>0.05). There was no statistical difference between sex and pain perception immediately after the procedure (P=0.64) and after 24 hours (P=0.41). However, when the analysis was performed according to age group, a borderline association was found. Female preschoolers reported more pain immediately after the procedure than male preschoolers (P=0.06). CONCLUSION: There was no statistical difference in pain perception between sexes.

Validation of pH cycling model to induce artificial carious lesions in bovine dentin

Introduction and objective:The purpose of the study was to evaluate different pH cycling protocols on the induction of artificial carious lesions in bovine dentin, since the most appropriate protocol to be applied is still not fully established. Material and methods: Fragments of bovine dentin (4 x 4 x 2 mm) were embedded in resin, polished and 7 mm² of each fragment was isolated with wax. The specimens were divided into three groups (A, B, C) according to the time of immersion in the demineralizing solution (1.5 ml). Group A - 15 minutes; Group B - 30 minutes; Group C - 60 minutes and subsequently immersed for 22 hours in a remineralizing solution (1.5 ml). Microhardness measurements were conducted initially, daily and after each pH cycling for 4 days. The Split-plot design (ANOVA) was applied. Results: There was a significant interaction between time and cariogenic challenge (p<0.0001). Bonferroni comparisons were executed to identify the differences over the cariogenic challenge, showing that increasing the immersion time in demineralizing solution for each pH cycling assessed, the cariogenic challenge aggressiveness increased (A

Validation of the SAW-102 wrist home blood pressure monitor according to the protocols of the British Hypertension Society, the Association for the Advancement of Medical Instrumentation, and the European Society of Hypertension.

OBJECTIVE: To determine the accuracy of the SAW-102 wrist oscillometric blood pressure monitor developed by the Sensacare Company according to the protocols of the European Society of Hypertension (ESH), the Association for the Advancement of Medical Instrumentation (AAMI), and the British Hypertension Society (BHS). METHODS: SAW-102 was assessed on 33 participants according to ESH requirements, based on four zones of accuracy differing from the mercury standard by 5, 10, 15 mmHg or more. Then SAW-102 was tested on 85 participants according to AAMI criteria requiring mean device-observers discrepancy within 5+/-8 mmHg. Subsequently, SAW-102 was evaluated on 88 participants according to BHS requirements. Finally, 15 participants with wrist circumference greater than the manufacturer's recommendation (19.5 cm) were studied (large wrist group). Efforts were made to secure a stable position of wrist and arm at the heart level. RESULTS: SAW-102 passed all phases of ESH international protocol for both systolic blood pressure (SBP) and diastolic blood pressure (DBP). SAW-102 passed AAMI criteria with mean differences between SAW-102 and observers of 3.8+/-7.5 and 1.5+/-6.0 mmHg, SBP and DPB, respectively. According to BHS protocol, the device achieved final grading of B/B for SBP and DBP, respectively. Large wrist group did not pass the first phase of ESH protocol. CONCLUSION: This study demonstrated that SAW-102 meets the BHS, ESH, and AAMI standards when measurements are done at the heart level and when the manufacturer's specifications, regarding wrist circumference, are respected. Our data also indicate that exceeding 19.5 cm wrist circumference is accompanied by dramatic decrease of the accuracy of the device.

Chiari I malformation with syrinx: an unexpected diagnosis in the emergency department.

The authors describe a case of syringomyelia associated with Chiari I malformation in a patient in whom acute symptomatic exacerbation occurred after cervical spine trauma. The authors review the various factors in the pathogenesis of this unusual sequence of events.