Influence of root dentin treatment on the push-out bond strength of fiber posts.

The aim of the present study was to assess whether different dentin conditioning protocols with different acids [phosphoric acid, ethylene diamine tetra acetic acid (EDTA), and polyacrylic acid (PAA)] influence the bond strength of fiber posts along the radicular depth when luted with self-adhesive resin cement. Twenty single-rooted teeth were randomly divided into four experimental groups (n = 5) according to dentin treatment: Group 1: no treatment; Group 2: etching with 35 % phosphoric acid for 10 s; Group 3: 17 % EDTA application for 60 s; and Group 4: conditioning with 25 % PAA for 30 s. RelyX Fiber Posts were luted with the self-adhesive resin cement RelyX Unicem 2 Automix (3M ESPE). Roots were transversally sectioned into nine 1-mm thick specimens, three corresponding to each root third and a push-out test was performed. Data were analyzed by two-way ANOVA and Tukey test (p < 0.05). Failure mode was determined and specimens with representative failures for each group were observed under scanning electron microscopy. According to the results, dentin treatment influenced the bond strength (p < 0.001), whereas the root third did not (p > 0.05). Fiber posts luted after treating dentin with phosphoric acid, and PAA exhibited the highest push-out bond strength values, while the lowest were obtained after EDTA application. Intermediate results were obtained when dentin was not conditioned. In conclusion, the bond strength of the self-adhesive resin cement RelyX Unicem 2 improves when root dentin is treated with 35 % phosphoric acid or 25 % PAA, before fiber posts luting irrespective of the root depth.

Debunking myths in radiology: ending pre-contrast fasting.

Radiology departments have traditionally observed fasting protocols for patients undergoing radiological studies with intravenous contrast. However, there is no scientific evidence to support these protocols. This practice has potentially harmful consequences, such as interruptions to long-term medication, dehydration, hypoglycaemia, test delays or anxiety, and has no benefits in terms of study interpretation or patient safety. Numerous studies now suggest the need to review these protocols, as reflected in the updated policies of our specialty's main societies, such as the ESUR (European Society of Urogenital Radiology) and the ACR (American College of Radiology). In this article, we review the available scientific evidence on this topic, and present our centre's experience of eliminating fasting prior to contrast-enhanced imaging studies.

[The natriuretic peptides in the diagnosis of heart failure in primary care setting]. / Los péptidos natriuréticos en el diagnóstico de la insuficiencia cardíaca en atención primaria.

Heart failure (HF) is a clinical syndrome characterized by symptoms and signs caused by structural and/or functional abnormalities of the heart that cause reduced cardiac output and/or elevated intracardiac pressures at rest or during exercise. Its prevalence and incidence are increasing and it is the leading cause of hospitalization in people over 65years of age. The new American and European guidelines for the management of HF emphasize that the measurement of natriuretic peptide (NP) concentrations constitutes a cornerstone of the diagnostic management of HF, and that the history, physical examination, electrocardiogram, and chest X-ray, complete the beginning of the HF diagnostic process. All these actions and diagnostic tests can be performed and requested from the primary care office. The authors of this document, on behalf of the SEMERGEN Hypertension and Cardiovascular Disease Working Group, have reviewed the most recent scientific evidence related to the preventive diagnostic management of NP in patients with HF in primary care setting.

Radiology of acute pancreatitis today: the Atlanta classification and the current role of imaging in its diagnosis and treatment. / Radiología de la pancreatitis aguda hoy: clasificación de Atlanta y papel actual de la imagen en su diagnóstico y tratamiento.

Acute pancreatitis is common and requires multidisciplinary management. The revised Atlanta classification, published in 2012, defines the terminology necessary to enable specialists from different backgrounds to discuss the morphological and clinical types of acute pancreatitis. Radiologists' role depends fundamentally on computed tomography (CT), which makes it possible to classify the morphology of this disease and to predict its clinical severity by applying imaging severity indices. Furthermore, CT- or ultrasound-guided drainage is, together with endoscopy, the current technique of choice in the initial approach to collections that appear as a complication. This paper aims to disseminate the concepts coined in the revised Atlanta classification and to describe the current role of radiologists in the diagnosis and treatment of acute pancreatitis.

Community-wide measles outbreak in the Region of Madrid, Spain, 10 years after the implementation of the Elimination Plan, 2011-2012.

We describe a community-wide outbreak of measles due to a D4 genotype virus that took place in the Region of Madrid, Spain, between February 2011 and August 2012, along with the control measures adopted. The following variables were collected: date of birth, sex, symptoms, complications, hospital admission, laboratory test results, link with another cases, home address, places of work or study, travel during the incubation period, ethnic group, and Mumps-Measles-Rubella (MMR) vaccination status. Incidences were calculated by 100,000 inhabitants. A total of 789 cases were identified. Of all cases, 36.0% belonged to Roma community, among which 68.7% were 16 months to 19 y old. Non-Roma cases were predominantly patients from 6 to 15 months (28.1%) and 20 to 39 y (52.3%). Most cases were unvaccinated. We found out that 3.0% of cases were healthcare workers. The first vaccination dose was brought forward to 12 months, active recruitment of unvaccinated children from 12 months to 4 y of age was performed and the vaccination of healthcare workers and of members of the Roma community was reinforced. High vaccination coverage must be reached with 2 doses of MMR vaccine, aimed at specific groups, such as young adults, Roma population and healthcare workers.

c-Myc-deficient B lymphocytes are resistant to spontaneous and induced cell death.

C-myc gene is a member of the myc family of proto-oncogenes involved in proliferation, differentiation, and apoptosis. Overexpression of c-myc in fibroblasts causes apoptosis under low serum conditions in a process that requires the interaction of CD95 and CD95L on the surface. We have previously reported an in vivo conditional model to inactivate the c-myc gene in B lymphocytes. Here, we show that c-Myc-deficient primary B lymphocytes are resistant to different apoptotic stimuli. Nonactivated c-Myc-deficient B cells are resistant to spontaneous cell death. Upon activation, c-Myc-deficient B lymphocytes express normal surface levels of activation markers, and show resistance to staurosporine and CD95-induced cell death.

Woodsmoke exposure and risk for obstructive airways disease among women.

OBJECTIVE: To investigate if exposure to firewood smoke and other indoor pollutants is a potential risk factor for obstructive airways disease (OAD) among women in Bogota in whom cigarette smoking and other known risk factors may not be the most frequent. DESIGN AND SETTING: We conducted a hospital-based case-control study to identify risk factors for OAD among women in Bogota. An interview was conducted using a modified questionnaire recommended by the American Thoracic Society for epidemiologic studies. PATIENTS: We compared 104 OAD cases with 104 controls matched by hospital and frequency matched by age. ANALYSIS: The odds ratio (OR) was used as the basic statistic to evaluate risk. Multivariate analysis (MA) was conducted by the Mantel-Haenszel procedure and by logistic regression. MAIN RESULTS: Univariate analysis showed that tobacco use (OR = 2.22; p < 0.01), wood use for cooking (OR = 3.43; p < 0.001), passive smoking (OR = 2.05; p = 0.01), and gasoline use for cooking (OR = 0.52; p = 0.02) were associated with OAD. Trends for years of tobacco use and years of wood cooking were present (p < 0.05). After MA, variables remained significant except gasoline use. CONCLUSIONS: This study showed that among elderly women of low socioeconomic status in Bogota, woodsmoke exposure is associated with the development of OAD and may help explain around 50% of all OAD cases. The role of passive smoking remains to be clarified. This work may set the basis for interventional studies in similar settings.

Determination of microscopic dissociation constants of 3-hydroxy-alpha-(methylamino)methyl-benzenemethanol by a spectral deconvolution method.

Microscopic dissociation constants of 3-hydroxy-alpha-(methylamino)methyl-benzenemethanol have been calculated from the titration spectrophotomeric data (c = 3.8 x 10(-4) M. Ionic strength = 0.16; buffer system: H3BO3/KOH) by application of a spectral deconvolution method. The results found (pKa = 9.48; pKb = 9.71; pKc = 10.12 and pKd = 9.88) are in good concordance with those obtained from the conventional regression linear method (pKa = 9.45; pKb = 9.77; pKc = 10.14 and pKd = 9.81).

[Omental torsion: imaging techniques can prevent unnecessary surgical interventions]. / Torsión de epiplón: las técnicas de imagen pueden evitar intervenciones innecesarias.

INTRODUCTION: Segmentary infarction of the greater omentum produces a clinical profile of acute abdomen. To date, the cause has been discovered during surgery. Greater use of ultrasonography and computed tomography (CT) in the emergency department could lead to preoperative diagnosis. The aim of this study was to describe the advisability of avoiding surgery in selected patients. PATIENTS AND METHOD: A series of nine adult patients (six men and three women), aged between 18 and 50 years, with a final diagnosis of primary omental torsion were reviewed. The first three patients underwent surgery: two underwent laparotomy for suspected acute appendicitis and the third underwent laparoscopy with a diagnosis of non-specific acute abdomen. The six remaining patients, who received a diagnosis of primary omental torsion or infarction based on ultrasonography and CT, underwent conservative treatment. The patients who did not undergo surgery were subsequently evaluated with imaging techniques to confirm resolution. RESULTS: In the first three patients, symptoms were resolved by resection of the affected omental section. In the six remaining patients, a 3-6 cm mass of soft tissue in the paraumbilical region, between the rectal sheath and the transverse colon, was found. The lesions were hyperechoic or of mixed attenuation. These findings, together with the absence of other radiological and clinical signs, led to the preoperative diagnosis. Treatment was conservative and a fast recovery, observed both clinically and radiologically, was made. CONCLUSIONS: Surgery should be avoided in selected cases of acute abdomen diagnosed as primary omental torsion.

Influence of post-cure time on the microhardness of self-adhesive resin cements inside the root canal.

PURPOSE: To compare the microhardness of several dual-cure, self-adhesive resin cements used to lute fiber posts at 24 hours and seven days after cementation. METHODS: Bovine incisors were selected to lute 15 fiber posts that were 12 mm long (FRC Postec Plus size 3, Ivoclar-Vivadent). Five resin cements were tested: Multilink Automix (Ivoclar-Vivadent), without light-curing, and the self-adhesive resin cements Maxcem Elite (Kerr), RelyX Unicem (3M ESPE), G-Cem (GC), and Smartcem 2 (Dentsply), which were light-cured for 40 seconds (LED Bluephase, Ivoclar-Vivadent). Each root was embedded in chemically cured acrylic resin and stored at 37°C for 24 hours. The roots were transversally sectioned into nine specimens that were each 1 mm thick, with three specimens corresponding to each root third. Indentations (100g, 30 seconds) were performed on each section in the resin cement, at 24 hours and seven days after cementation, using a Vickers digital microdurometer (Buehler). Data were analyzed by two-way analysis of variance, Student-Newman-Keuls test, and paired t-test (p<0.05). RESULTS: A significant influence was found (p<0.05) for the resin cement evaluated, the root third, and their interactions on microhardness values at 24 hours and seven days after post cementation. RelyX Unicem and G-Cem exhibited the highest microhardness values, whereas Multilink Automix presented the lowest. All resin cements suffered a decrease in microhardness according to root canal depth, with the exception of G-Cem and Multilink Automix at 24 hours and Smartcem 2 after seven days. After seven days, the evaluated resin cements showed a significant increase in microhardness values, with the exception of Maxcem Elite and Smartcem 2 at the coronal third. CONCLUSIONS: Microhardness of the self-adhesive resin cements when used to lute fiber posts was material-dependent and higher values were obtained in the coronal third, revealing their sensitivity to light irradiation. More information regarding the polymerization reaction of these cements is warranted. According to the current results, microhardness values were significantly higher one week after post luting.

Los péptidos natriuréticos en el diagnóstico de la insuficiencia cardíaca en atención primaria / The natriuretic peptides in the diagnosis of heart failure in primary care setting

La insuficiencia cardíaca (IC) es un síndrome clínico que se caracteriza por síntomas y signos causados por anomalías estructurales y/o funcionales del corazón que provocan una reducción en el gasto cardíaco y/o elevación de las presiones intracardíacas en reposo o durante el ejercicio. Su prevalencia y su incidencia están aumentando y constituye la primera causa de hospitalización en mayores de 65años. Las nuevas guías europeas y americanas para el manejo de la IC destacan que la medición de las concentraciones de péptidos natriuréticos (PN) constituye una piedra angular del manejo diagnóstico de la IC, y que la anamnesis, la exploración física, el electrocardiograma y la radiografía de tórax completan el inicio del proceso diagnóstico de la IC. Todas estas acciones y pruebas diagnósticas son susceptibles de realizarlas y solicitarlas desde la consulta del médico de familia. Los autores del presente documento, en nombre del Grupo de Trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN, han revisado la evidencia científica más reciente relacionada con el manejo diagnóstico de los PN en los pacientes con IC en el ámbito de la atención primaria (AU)

Heart failure (HF) is a clinical syndrome characterized by symptoms and signs caused by structural and/or functional abnormalities of the heart that cause reduced cardiac output and/or elevated intracardiac pressures at rest or during exercise. Its prevalence and incidence are increasing and it is the leading cause of hospitalization in people over 65years of age. The new American and European guidelines for the management of HF emphasize that the measurement of natriuretic peptide (NP) concentrations constitutes a cornerstone of the diagnostic management of HF, and that the history, physical examination, electrocardiogram, and chest X-ray, complete the beginning of the HF diagnostic process. All these actions and diagnostic tests can be performed and requested from the primary care office. The authors of this document, on behalf of the SEMERGEN Hypertension and Cardiovascular Disease Working Group, have reviewed the most recent scientific evidence related to the preventive diagnostic management of NP in patients with HF in primary care setting (AU)

Ruptured gastrointestinal stromal tumors: radiologic findings in six cases.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are characterized by the expression of c-KIT (antigen CD 117) and are the most common mesenchymal tumors of the digestive tract. An important complication, although infrequently described in the literature, is the rupture of these tumors with accompanying hemoperitoneum. METHODS: We performed a retrospective evaluation of the clinical history and radiologic records of 23 patients with a diagnosis of GIST and anatomopathologic and immunohistochemical confirmation at our hospital between 1999 and 2004. RESULTS: In five cases there was rupture of the primary tumor (four gastric and one jejunal). In all five cases ultrasonographic and computed tomographic examinations showed a heterogenic tumor of laminated or whirled appearance, associated with echogenic or dense ascites. No relation was found between histologic criteria of malignancy and the rupture. Four patients underwent surgical intervention, three of them urgently. Two of five patients died. There was a sixth case with rupture of a hepatic metastasis, with accompanying hemoperitoneum and subcapsular hematoma. This patient died at 3 months, after recurrence of bleeding. CONCLUSIONS: The finding of a heterogeneous tumor of laminated or whirled appearance associated with ascites with characteristics compatible with hemoperitoneum in an appropriate context must lead to a suspicion of the existence of a ruptured GIST.

[Acute promyelocytic leukemia in the west of Venezuela]. / Leucemia promielocítica aguda en el occidente de Venezuela.

Twenty-nine cases of acute promyelocytic leukaemia of children and adults are reported. This figure represents 13.61% of all the acute leukaemias and 27.88% of the acute non-lymphoblastic leukaemias found in Zulia State between 1982 and 1987. Those findings mean a higher frequency than reported in other childhood as well as adult series. So, Zulia State appears as an important geographic area for the occurrence of this type of leukaemia.

Síndrome de apnea-hipoapnea del sueño en el 2009. ¿Qué hay de nuevo? / Sleep apnea-hypoapnea syndrome in 2009. What is new?

Resumen. Durante los primeros 6 meses del año 2009 se han editado numerosos artículos sobre el síndrome de apnea-hipoapnea del sueño (SAHS). En estos trabajos se reafirman diferentes aspectos ya publicados y se dan nuevas luces sobre otros ámbitos menos explorados. Se refuerza la evidencia de que el SAHS se relaciona con un incremento de los mecanismos inflamatorios y que éstos se aminoran con el tratamiento con CPAP. Asimismo, se robustece la asociación entre el SAHS y morbimortalidad, especialmente morbilidad cardio-cerebrovascular. La dimensión que adquiere el SAHS hace necesario una mayor sensibilización ante esta patología para conseguir un adecuado cribaje poblacional, un correcto tratamiento y un seguimiento cercano, en aras de conseguir un mejor control de estos pacientes y un menor número de complicaciones (AU)

Summary. During the first 6 months of the year 2009 have been published numerous articles about sleep apnea-hypoapnea syndrome (SAHS). These articles reaffirm different aspects published previously and gives new light on other areas less explored. Thus, these publications reinforce the evidence that SAHS is associated with increased inflammatory mechanisms and that CPAP therapy decrease inflammatory mechanisms. Also, these articles strengthens the association between this patology and morbidity-mortality, especially cardio-cerebrovascular disease. The dimension that reaches sleep apnea does necessary to achieve an appropriate population screening, a correct treatment and close follow-up, in order to obtain better control of these patients and fewer complications (AU)

Angina inestable y síndrome de apnea-hipoapnea del sueño. A propósito de un caso / Unstable angina and sleep apnea-hypoapnea syndrome. A case report

Existe una amplia evidencia científica de la presencia de enfermedades cardiovasculares en los pacientes con síndrome de apnea-hipoapnea del sueño (SAHS); sin embargo, se desconoce la incidencia de angina vasoespástica en estos pacientes, debido a una baja prevalencia de la angina de Prinzmetal y su dificultad para el diagnóstico. Se expone el caso de un paciente que presentó un episodio de angina vasoespástica durante la realización de una poligrafía cardiorrespiratoria nocturna hospitalaria (AU)

There is an extensive evidence of cardiovascular disease in patients with sleep apnea syndrome, but the incident of coronary artery disease with coronary spasm in these patients is unknown, because of a low prevalence and a difficult diagnosis. We describe a patient who present an episode of variant angina during a nocturnal respiratory polygraphy (AU)

Fiebre por humo de metal en un soldador de profesión / Fever due to metal smoke in a professional welder

La fiebre por humo de metal consiste en un cuadro agudo, en relación con la inhalación de distintos metales pesados, particularmente el óxido de Cinc (Zn), objetivado en soldadores que trabajan con estos elementos. La prevalencia es desconocida. La aparición de sabor metálico, fiebre, tos, disnea, entre otros síntomas, durante las 4-10 horas posteriores a soldadura con metal, nos deben poner alerta sobre este posible cuadro

Fever due to metal smoke consists in an acute picture in relationship with inhalation of different heavy metals,especially zinc oxide (Zn), observed in welders who work with these elements. Its prevalence is unknown. The appearance of metallic taste, fever, cough, dyspnea, among other symptoms, for 4-10 hours after soldiering metal alerts us on this possible picture