Relationship between extreme precipitation and acute gastrointestinal illness in Toronto, Ontario, 2012-2022.

Extreme precipitation events are occurring more intensely in Canada. This can contaminate water sources with enteric pathogens, potentially increasing the risk of acute gastrointestinal illness. This study aimed to investigate the relationship between extreme precipitation and emergency department (ED) visits for acute gastrointestinal illness in Toronto from 2012 to 2022. Distributed lag non-linear models were constructed on ED visit counts with a Quasi Poisson distribution. Extreme precipitation was modelled as a 21-day lag variable, with a linear relationship assumed at levels ≧95th percentile. Separate models were also conducted on season-specific data sets. Daily precipitation and gastrointestinal illness ED visits ranged between 0 to 126 mm, and 12 to 180 visits respectively. Overall, a 10-mm increase in precipitation >95th percentile had no significant relationship with the risk of ED visits. However, stratification by seasons revealed significant relationships during spring (lags 1-19, peak at lag 14 RR = 1.04; 95% CI: 1.03, 1.06); the overall cumulative effect across the 21-day lag was also significant (RR = 1.94; 95% CI: 1.47, 2.57). Extreme precipitation has a seasonal effect on gastrointestinal health outcomes in Toronto city, suggesting varying levels of enteric pathogen exposures through drinking water or other environmental pathway during different seasons.

Deep Reinforcement Learning for Resource Management on Network Slicing: A Survey.

Network Slicing and Deep Reinforcement Learning (DRL) are vital enablers for achieving 5G and 6G networks. A 5G/6G network can comprise various network slices from unique or multiple tenants. Network providers need to perform intelligent and efficient resource management to offer slices that meet the quality of service and quality of experience requirements of 5G/6G use cases. Resource management is far from being a straightforward task. This task demands complex and dynamic mechanisms to control admission and allocate, schedule, and orchestrate resources. Intelligent and effective resource management needs to predict the services' demand coming from tenants (each tenant with multiple network slice requests) and achieve autonomous behavior of slices. This paper identifies the relevant phases for resource management in network slicing and analyzes approaches using reinforcement learning (RL) and DRL algorithms for realizing each phase autonomously. We analyze the approaches according to the optimization objective, the network focus (core, radio access, edge, and end-to-end network), the space of states, the space of actions, the algorithms, the structure of deep neural networks, the exploration-exploitation method, and the use cases (or vertical applications). We also provide research directions related to RL/DRL-based network slice resource management.

Region-Specific Associations between Environmental Factors and Escherichia coli in Freshwater Beaches in Toronto and Niagara Region, Canada.

Poor freshwater beach quality, measured by Escherichia coli (E. coli) levels, poses a risk of recreational water illness. This study linked environmental data to E. coli geometric means collected at 18 beaches in Toronto (2008-2019) and the Niagara Region (2011-2019) to examine the environmental predictors of E. coli. We developed region-specific models using mixed effects models to examine E. coli as a continuous variable and recommended thresholds of E. coli concentration (100 CFU/100 mL and 200 CFU/100 mL). Substantial clustering of E. coli values at the beach level was observed in Toronto, while minimal clustering was seen in Niagara, suggesting an important beach-specific effect in Toronto beaches. Air temperature and turbidity (measured directly or visually observed) were positively associated with E. coli in all models in both regions. In Toronto, waterfowl counts, rainfall, stream discharge and water temperature were positively associated with E. coli levels, while solar irradiance and water level were negatively associated. In Niagara, wave height and water level had a positive association with E. coli, while rainfall was negatively associated. The differences in regional models suggest the importance of a region-specific approach to addressing beach water quality. The results can guide beach monitoring and management practices, including predictive modelling.

Antimicrobial peptides purified from hydrolysates of kanihua (Chenopodium pallidicaule Aellen) seed protein fractions.

The kanihua (Chenopodium pallidicaule Aellen) Andean grain from the Peruvian Altiplano presents proteins of 15% to 19%. The objective was to obtain purified bioactive antimicrobial peptides (AMPs), hydrolyzed with Alcalase and Pepsin-pancreatin sequential system of protein fractions of kanihua varieties Ramis (KR) and Cupi-Sayhua (KS), and hydrolysates with different degrees of hydrolysis (DH) and percentage inhibition (IP) of the growth of E. coli, S. aureus, and C. albicans. To obtain AMPs, nutraceuticals, bio-preservatives, and novel ingredients in food design. The results showed 216 hydrolysates (1%, w/v), only 28 presented significant difference compared to controls (IP ≥ 45%, p ≤ 0.05), 4 AMPs were purified by chromatography, glutelins KS 4 h (1:10) stood out with DH 40% and IP 52% and 70% of S. aureus and C. albicans, respectively (p ≤ 0.05), showed minimum inhibitory concentration (MIC) of 95% for E. coli (p ≤ 0.05), and presented an anionic charge. In conclusion, the simulated digestion in vitro showed higher DH (7%-67%) than Alcalase (13%-54%); the majority were extensive; of 28 hydrolysates with IP ≥ 45% 4 AMPs with important IPs were obtained, and one was anionic.

Effect of the manual manipulation of composite resin with latex gloves / Efecto de la manipulación manual de resina compuesta con guantes de látex

Purpose: This in vitro study aimed to evaluate the influence of the manual manipulation of two composite resins: Filtek™ Z350XT (3M ESPE) and Herculite Précis® (Kerr), with latex gloves contaminated with powder, human saliva and alcohol, on the microhardness values. Material and Methods: Manual manipulation was evaluated using latex gloves with powder, latex gloves without powder, latex gloves without powder with saliva, latex gloves without powder with alcohol, and without hand manipulation or contaminants (control). Each resin was manually manipulated for 10 seconds and photoactivated for 20 seconds with a light intensity of 1000mW/cm2 using a VALO ­Ultradent LED light­ cured unit, and then each sample was evaluated on the microhardness Vickers tester Leitz (Wetzlar). The collected data were analyzed using Kruskal ­Wallis and Mann ­ Whitney post-test (p<0.05). Results. Microhardness values showed a significant difference between the evaluated and control groups, showing lower microhardness values in the group of latex glove with powder for Filtek™ Z350XT and the group of latex glove without powder with saliva for Herculite Précis®. Conclusion. The manual manipulation of composite resins decreases their surface microhardness.

Propósito: Este estudio in vitrotuvo como objetivo evaluar la influencia de la manipulación manual de dos resinas compuestas: Filtek ™ Z350XT (3M ESPE) y Herculite Précis® (Kerr), con guantes de látex contaminados con polvo, saliva humana y alcohol, sobre los valores de microdureza. Material y Métodos: La manipulación manual se evaluó utilizando guantes de látex con polvo, guantes de látex sin polvo, guantes de látex sin polvo con saliva, guantes de látex sin polvo con alcohol, y sin manipulación manual o contaminantes (control). Cada resina fue manipulada manualmente durante 10 segundos y fotoactivada durante 20 segundos con unaintensidad de luz de 1000mW/cm2 usando una unidad de fotocuración LED VALO - Ultradent, y luego cada muestra fue evaluada en el tester de microdureza Vickers Leitz (Wetzlar). Los datos recopilados se analizaron utilizando Kruska ­Wallis y post-test Mann­ Whitney (p<0.05). Resultados: Se observó una diferencia significativa en los valores de microdureza entre los grupos evaluados y el grupo control, con valores más bajos de microdureza en el grupo de guantes de látex con polvo para Filtek™ Z350XT y el grupo de guantes de látex sin polvo con saliva para Herculite Précis®. Conclusión. La manipulación manual de resinas compuestas disminuye su microdureza superficial.

Predominance of Lactobacillus plantarum Strains in Peruvian Amazonian Fruits.

The objective of this research was the identification and characterization of lactic acid bacteria (LAB) isolated from Peruvian Amazonian fruits. Thirty-seven isolates were obtained from diverse Amazonian fruits. Molecular characterization of the isolates was performed by ARDRA, 16S-23S ITS RFLP and rep-PCR using GTG5 primers. Identification was carried out by sequencing the 16S rDNA gene. Phenotypic characterization included nutritional, physiological and antimicrobial resistance tests. Molecular characterization by Amplified Ribosomal DNA Restriction Analysis (ARDRA) and 16S-23S ITS RFLP resulted in four restriction profiles while GTG5 analysis showed 14 banding patterns. Based on the 16S rDNA gene sequence, the isolates were identified as Lactobacillus plantarum (75.7%), Weissella cibaria (13.5%), Lactobacillus brevis (8.1%), and Weissella confusa (2.7%). Phenotypic characterization showed that most of the isolates were homofermentative bacilli, able to ferment glucose, maltose, cellobiose, and fructose and grow in a broad range of temperatures and pH. The isolates were highly susceptible to ampicillin, amoxicillin, clindamycin, chloramphenicol, erythromicyn, penicillin, and tetracycline and showed great resistance to kanamycin, gentamycin, streptomycin, sulfamethoxazole/trimethoprim, and vancomycin. No proteolytic or amylolytic activity was detected. L. plantarum strains produce lactic acid in higher concentrations and Weissella strains produce exopolymers only from sucrose. Molecular methods allowed to accurately identify the LAB isolates from the Peruvian Amazonian fruits, while phenotypic methods provided information about their metabolism, physiology and other characteristics that may be useful in future biotechnological processes. Further research will focus especially on the study of L. plantarum strains.The objective of this research was the identification and characterization of lactic acid bacteria (LAB) isolated from Peruvian Amazonian fruits. Thirty-seven isolates were obtained from diverse Amazonian fruits. Molecular characterization of the isolates was performed by ARDRA, 16S-23S ITS RFLP and rep-PCR using GTG5 primers. Identification was carried out by sequencing the 16S rDNA gene. Phenotypic characterization included nutritional, physiological and antimicrobial resistance tests. Molecular characterization by Amplified Ribosomal DNA Restriction Analysis (ARDRA) and 16S-23S ITS RFLP resulted in four restriction profiles while GTG5 analysis showed 14 banding patterns. Based on the 16S rDNA gene sequence, the isolates were identified as Lactobacillus plantarum (75.7%), Weissella cibaria (13.5%), Lactobacillus brevis (8.1%), and Weissella confusa (2.7%). Phenotypic characterization showed that most of the isolates were homofermentative bacilli, able to ferment glucose, maltose, cellobiose, and fructose and grow in a broad range of temperatures and pH. The isolates were highly susceptible to ampicillin, amoxicillin, clindamycin, chloramphenicol, erythromicyn, penicillin, and tetracycline and showed great resistance to kanamycin, gentamycin, streptomycin, sulfamethoxazole/trimethoprim, and vancomycin. No proteolytic or amylolytic activity was detected. L. plantarum strains produce lactic acid in higher concentrations and Weissella strains produce exopolymers only from sucrose. Molecular methods allowed to accurately identify the LAB isolates from the Peruvian Amazonian fruits, while phenotypic methods provided information about their metabolism, physiology and other characteristics that may be useful in future biotechnological processes. Further research will focus especially on the study of L. plantarum strains.

Epicrania fugax combining forward and backward paroxysms in the same patient: the first four cases.

BACKGROUND: The first description of epicrania fugax (EF) reported brief painful paroxysms that start in posterior regions of the scalp and move forward to reach the ipsilateral forehead, eye, or nose. A backward variation, wherein pain stems from frontal areas and radiates to the posterior scalp, has also been acknowledged. We report four patients with features reminiscent of EF and the coexistence of forward and backward pain paroxysms. METHODS: We considered all patients attending the headache outpatient office at two tertiary hospitals from March 2008 to March 2016. We enrolled four patients with paroxysms fulfilling criteria for EF and a combination of forward and backward radiations. RESULTS: In all cases, pain paroxysms moved both in forward and backward directions with either a zigzag (n=2) or linear (n=2) trajectory. Three patients presented two stemming points, in the occipital scalp and forehead (n=2) or in the parietal area and eye (n=1), whereas the fourth patient only had a stemming point located in the parietal region. Pain quality was mainly stabbing, and its intensity was moderate (n=1) or severe (n=3). The duration of the paroxysms was highly variable (3-30 seconds), and two patients reported autonomic symptoms. CONCLUSION: The clinical picture presented by our patients does not fit with other types of known headache or neuralgia syndromes; we propose it corresponds to a bidirectional variant of EF.

Women's views and postpartum follow-up in the CHIPS Trial (Control of Hypertension in Pregnancy Study).

OBJECTIVE: To compare women's views about blood pressure (BP) control in CHIPS (Control of Hypertension In Pregnancy Study) (NCT01192412). DESIGN: Quantitative and qualitative analysis of questionnaire responses. SETTING: International randomised trial (94 sites, 15 countries). POPULATION/SAMPLE: 911 (92.9%) women randomised to 'tight' (target diastolic blood pressure, 85mmHg) or 'less tight' (target diastolic blood pressure, 100mmHg) who completed questionnaires. METHODS: A questionnaire was administered at ∼6-12 weeks postpartum regarding post-discharge morbidity and views about trial participation. Questionnaires were administered by the site co-ordinator, and contact was made by phone, home or clinic visit; rarely, data was collected from medical records. Quantitative analyses were Chi-square or Fisher's exact test for categorical variables, mixed effects multinomial logistic regression to adjust for confounders, and p<0.001 for statistical significance. NVivo software was used for thematic analysis of women's views. MAIN OUTCOME MEASURES: Satisfaction, measured as willingness to have the same treatment in another pregnancy or recommend that treatment to a friend. RESULTS: Among the 533 women in 'tight' (N=265) vs. 'less tight' (N=268) control who provided comments for qualitative analysis, women in 'tight' (vs. 'less tight') control made fewer positive comments about the amount of medication taken (5 vs. 28 women, respectively) and intensity of BP monitoring (7 vs. 17, respectively). However, this did not translate into less willingness to either have the same treatment in another pregnancy (434, 95.8% vs. 423, 92.4%, respectively; p=0.14) or recommend that treatment to a friend (435, 96.0% and 428, 93.4%, respectively; p=0.17). Importantly, although satisfaction remained high among women with an adverse outcome, those in 'tight' control who suffered an adverse outcome (vs. those who did not) were not consistently less satisfied, whereas this was not the case among women in 'less tight' control among whom satisfaction was consistently lower for the CHIPS primary outcome (p<0.001), severe hypertension (p≤0.01), and pre-eclampsia (p<0.001). CONCLUSIONS: Women in 'tight' (vs. 'less tight') control were equally satisfied with their care, and more so in the face of adverse perinatal or maternal outcomes.

The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. CLINICAL TRIAL REGISTRATION: URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412.

Metformin in women with type 2 diabetes in pregnancy (MiTy): a multi-center randomized controlled trial.

BACKGROUND: The incidence of type 2 diabetes in pregnancy is rising and rates of serious adverse maternal and fetal outcomes remain high. Metformin is a biguanide that is used as first-line treatment for non-pregnant patients with type 2 diabetes. We hypothesize that metformin use in pregnancy, as an adjunct to insulin, will decrease adverse outcomes by reducing maternal hyperglycemia, maternal insulin doses, maternal weight gain and gestational hypertension/pre-eclampsia. In addition, since metformin crosses the placenta, metformin treatment of the fetus may have a direct beneficial effect on neonatal outcomes. Our aim is to compare the effectiveness of the addition of metformin to insulin, to standard care (insulin plus placebo) in women with type 2 diabetes in pregnancy. METHODS: The MiTy trial is a multi-centre randomized trial currently enrolling pregnant women with type 2 diabetes, who are on insulin, between the ages of 18-45, with a gestational age of 6 weeks 0 days to 22 weeks 6 days. In this randomized, double-masked, parallel placebo-controlled trial, after giving informed consent, women are randomized to receive either metformin 1,000 mg twice daily or placebo twice daily. A web-based block randomization system is used to assign women to metformin or placebo in a 1:1 ratio, stratified for site and body mass index. The primary outcome is a composite neonatal outcome of pregnancy loss, preterm birth, birth injury, moderate/severe respiratory distress, neonatal hypoglycemia, or neonatal intensive care unit admission longer than 24 h. Secondary outcomes are large for gestational age, cord blood gas pH < 7.0, congenital anomalies, hyperbilirubinemia, sepsis, hyperinsulinemia, shoulder dystocia, fetal fat mass, as well as maternal outcomes: maternal weight gain, maternal insulin doses, maternal glycemic control, maternal hypoglycemia, gestational hypertension, preeclampsia, cesarean section, number of hospitalizations during pregnancy, and duration of hospital stays. The trial aims to enroll 500 participants. DISCUSSION: The results of this trial will inform endocrinologists, obstetricians, family doctors, and other healthcare professionals caring for women with type 2 diabetes in pregnancy, as to the benefits of adding metformin to insulin in this high risk population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: no. NCT01353391 . Registered February 6, 2009.

Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial.

INTRODUCTION: For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. MATERIAL AND METHODS: This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48 h, or birthweight <10th percentile) or maternal outcomes (severe hypertension, preeclampsia, or delivery at <34 or <37 weeks). A model containing all candidate predictors was used to start the stepwise regression process based on goodness of fit as measured by the Akaike information criterion. For face validity, these variables were forced into the model: treatment group ("less tight" or "tight" control), antihypertensive type at randomization, and blood pressure within 1 week before randomization. Continuous variables were represented continuously or dichotomized based on the smaller p-value in univariate analyses. An area-under-the-receiver-operating-curve (AUC ROC) of ≥0.70 was taken to reflect a potentially useful model. RESULTS: Point estimates for AUC ROC were <0.70 for all but severe hypertension (0.70, 95% CI 0.67-0.74) and delivery at <34 weeks (0.71, 95% CI 0.66-0.75). Therefore, no model warranted further assessment of performance. CONCLUSIONS: CHIPS data suggest that when women with chronic hypertension develop an elevated blood pressure in pregnancy, or formerly normotensive women develop new gestational hypertension, maternal and current pregnancy clinical characteristics cannot predict adverse outcomes in the index pregnancy.

Influence of delivered radiant exposure values on bonding of fiber posts to root canals.

PURPOSE: To evaluate the effect of different radiant exposure values delivered to two simplified etch-and-rinse adhesive systems on push-out bond strength (PBS) of fiber posts to root canal, as well as nanoleakage (NL) and in situ degree of conversion (DC) within the hybrid layer. MATERIALS AND METHODS: The roots of human premolars were endodontically prepared and divided into 6 groups according to the combination of the main factors adhesive/resin cement (2 commercial brands) and radiant exposure (4, 16, 48, and 288 J/cm2). The posts were cemented and the PBS tested at 0.5 mm/min (n = 7). The NL (n = 3) was evaluated using SEM after immersion of specimens in 50% silver nitrate. Micro-Raman spectroscopy was performed to determine the in situ DC (n = 2). Data were analyzed by three-way repeated measures ANOVA and Tukey's post-hoc test (5%). RESULTS: PBS (MPa) showed a significant difference only for the middle third when an increase in radiant exposure from 4 to 16 J/cm2 or higher was used (p < 0.05). The NL (%) decreased significantly with increasing radiant exposure from 48 to 288 J/cm2 in the middle and apical thirds when compared to lower radiant exposure (p < 0.05). The radiant exposure of 288 J/cm2 significantly increased the DC (%) in the middle and apical thirds, compared the other radiant exposure values (p < 0.05). CONCLUSION: The increase in radiant exposure delivered to the cervical third of root canals during post cementation improved the adhesive performance of simplified etch-and-rinse adhesive systems in the apical and middle thirds.

Less-tight versus tight control of hypertension in pregnancy.

BACKGROUND: The effects of less-tight versus tight control of hypertension on pregnancy complications are unclear. METHODS: We performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational hypertension, office diastolic blood pressure of 90 to 105 mm Hg (or 85 to 105 mm Hg if the woman was taking antihypertensive medications), and a live fetus. Women were randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg). The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications occurring up to 6 weeks post partum or until hospital discharge, whichever was later. RESULTS: Included in the analysis were 987 women; 74.6% had preexisting hypertension. The primary-outcome rates were similar among 493 women assigned to less-tight control and 488 women assigned to tight control (31.4% and 30.7%, respectively; adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.77 to 1.35), as were the rates of serious maternal complications (3.7% and 2.0%, respectively; adjusted odds ratio, 1.74; 95% CI, 0.79 to 3.84), despite a mean diastolic blood pressure that was higher in the less-tight-control group by 4.6 mm Hg (95% CI, 3.7 to 5.4). Severe hypertension (≥160/110 mm Hg) developed in 40.6% of the women in the less-tight-control group and 27.5% of the women in the tight-control group (P<0.001). CONCLUSIONS: We found no significant between-group differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications, although less-tight control was associated with a significantly higher frequency of severe maternal hypertension. (Funded by the Canadian Institutes of Health Research; CHIPS Current Controlled Trials number, ISRCTN71416914; ClinicalTrials.gov number, NCT01192412.).

Effects of sonic application of adhesive systems on bonding fiber posts to root canals.

INTRODUCTION: Luting posts inside the root canal is still a challenge because of the difficulty of bonding adhesive materials in the apical third of roots. This study evaluated the effect of the application mode of 3 simplified etch-and-rinse adhesives on the push-out bond strength (PBS), nanoleakage (NL), and in situ degree of conversion (DC) of fiber posts in the root canal. METHODS: The roots of human premolars were endodontically prepared and divided into 6 groups according to the combination of the main factors: adhesive (Ambar, FGM, Joinville, SC, Brazil; Adper Single Bond 2, 3MESPE, St Paul, MN; and XP Bond+self-cure activator, DeTrey Dentsply, Konstanz, Germany) and application mode (manual or sonic). The posts were cemented and the PBS tested at 0.5 mm/min. The NL was evaluated by scanning electron microscopy after the immersion of specimens in 50% silver nitrate. Micro-Raman spectroscopy was used to measure the in situ DC. Root third was also considered in the statistical evaluation. Data were analyzed by 3-way repeated measures analysis of variance and Tukey tests (5%). RESULTS: Under sonic application, the PBS and the in situ DC increased, whereas NL decreased significantly for all groups in the middle and apical thirds (P < .05). CONCLUSIONS: The application of simplified adhesives by sonic mode in the root canal is a feasible tool to increase the fiber post bond to root canals.

Multiple courses of antenatal corticosteroids for preterm birth study: outcomes in children at 5 years of age (MACS-5).

IMPORTANCE: A single course of antenatal corticosteroid therapy is recommended for pregnant women at risk of preterm birth between 24 and 33 weeks' gestational age. However, 50% of women remain pregnant 7 to 14 days later, leading to the question of whether additional courses should be given to women remaining at risk for preterm birth. The Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study (MACS) was an international randomized clinical trial that compared multiple courses of antenatal corticosteroids with a single course in women at risk of preterm birth. OBJECTIVE: To determine the effects of single vs multiple courses of antenatal corticosteroid therapy on death or neurodevelopmental disability (neuromotor, neurosensory, or neurocognitive/neurobehavioral function) at 5 years of age in children whose mothers participated in MACS. Our secondary aims were to determine the effect on height, weight, head circumference, blood pressure, intelligence, and specific cognitive (visual, spatial, and language) skills. DESIGN, SETTING, AND PARTICIPANTS: Cohort follow-up study of children seen between June 2006 and May 2012 at 55 centers. In total, 1724 women (2141 children) were eligible for the study, of whom 1728 children (80.7% of the 2141 eligible children) participated and 1719 children contributed to the primary outcome. INTERVENTION: Single and multiple courses of antenatal corticosteroid therapy. MAIN OUTCOMES AND MEASURES: The primary outcome was death or survival with a neurodevelopmental disability in 1 of the following domains: neuromotor (nonambulatory cerebral palsy), neurosensory (blindness, deafness, or need for visual/hearing aids), or neurocognitive/neurobehavioral function (abnormal attention, memory, or behavior). RESULTS: There was no significant difference between the groups in the risk of death or neurodevelopmental disability: 217 of 871 children (24.9%) in the multiple-courses group vs 210 of 848 children (24.8%) in the single-course group (odds ratio, 1.02 [95% CI, 0.81 to 1.29]; P = .84). CONCLUSIONS AND RELEVANCE: Multiple courses, compared with a single course, of antenatal corticosteroid therapy did not increase or decrease the risk of death or disability at 5 years of age. Because of a lack of strong conclusive evidence of short-term or long-term benefits, it remains our opinion that multiple courses not be recommended in women with ongoing risk of preterm birth. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00187382.

Estudio epidemiológico de caries dental y enfermedad periodontal en la población interna de un centro de reclusión de Colombia / Epidemiological study of dental carie

La población interna del centro de reclusión estudiado por sus condiciones de vida, se encuentran expuestas a diferentes factores que desencadenan patologías orales, por tal motivo se llevo a cabo un estudio epidemiológico de prevalencia de caries dental y enfermedad periodontal y se exploraron factores de riesgo asociados a estas patologías con el fin de presentar estos resultados a la institución gubernamental pertinente con el propósito de implementar acciones preventivas para esta población. Se evaluaron un total 114 internas voluntarias a quienes se les realizó un examen clínico para evaluar la historia y su severiadad por medio del índice COP y la prevalencia de enfermedad periodontal y necesidades de tratamiento por medio del índice de Ramfjord con adaptación de criterios del índice de criterios del índice de Extención y Severidad (ESI) y el índice INTCP y se aplicó una encuesta para explorar factores de riesgo para estas dos patologías. Se observó una alta prevalencia de caries y perdidas de inserción periodontal en relación a la observada en la población general. De gran interés se encontró en este estudio una asociación estadísticamente significativas entre enfermedad periodontal y el consumo de sustancias psicoactivas(marihuna). Los resultados de este estudio sustentan la nesecidad de implementar programas de atención y de promoción y de prevención específicos para esta población ya que presentan unas características especiales que la hace mas bunerables a factores de riesgos por su condiciones de vida.