KATP channel mutation disrupts hippocampal network activity and nocturnal gamma shifts.

ATP-sensitive potassium (KATP) channels couple cell metabolism to cellular electrical activity. Humans affected by severe activating mutations in KATP channels suffer from developmental delay, epilepsy, and neonatal diabetes (DEND syndrome). While the aetiology of diabetes in DEND syndrome is well understood, the pathophysiology of the neurological symptoms remains unclear. We hypothesised that impaired activity of parvalbumin-positive interneurons (PV-INs) may result in seizures and cognitive problems. We found, by performing electrophysiological experiments, that expressing the DEND mutation Kir6.2-V59M selectively in mouse PV-INs reduced intrinsic gamma frequency preference and short-term depression as well as disturbed cognition-associated gamma oscillations and hippocampal sharp waves. Furthermore, the risk of seizures was increased and the day-night shift in gamma activity disrupted. Blocking KATP channels with tolbutamide partially rescued the network oscillations. The non-reversible part may, to some extent, result from observed altered PV-IN dendritic branching and PV-IN arrangement within CA1. In summary, PV-INs play a key role in DEND syndrome, and this provides a framework for establishing treatment options.

Visceral Aorta Electrocautery Septotomy to Allow Branched Endovascular Aortic Repair in Ruptured Chronic Post-Dissection Thoraco-Abdominal Aneurysm.

PURPOSE: Endovascular repair of chronic post-dissection thoraco-abdominal aortic aneurysms (PD-TAAA) presents specific technical challenges due to the presence of chronic septum. Small true lumen diameter and false lumen visceral vessel origin can make branched endograft prohibitive. Septotomy may allow to overcome these challenges in cases of high complex anatomy. TECHNIQUE: We describe the application of electrocautery septotomy to the visceral aorta segment to deploy an off-the-shelf branched endograft in a chronic PD-TAAA rupture with true lumen collapse. CONCLUSIONS: Electrocautery septotomy can be an effective adjunctive technique to facilitate branched endograft, overcoming technical challenges associated with the endovascular treatment of chronic PD-TAAA. CLINICAL IMPACT: Electrocautery septotomy is an adjunctive technique that can facilitate endovascular treatment of post-dissection thoraco-abdominal aneurysm. By creating a common lumen, this technique might reduce the number of re-interventions associated with PD-TAAA endovascular exclusion.

Chemical and Energetic Characterization of the Wood of Prosopis laevigata: Chemical and Thermogravimetric Methods.

Diverse methodologies exist to determine the chemical composition, proximate analysis, and calorific value of biomass. Researchers select and apply a specific methodology according to the lignocellulosic material they study and the budgetary resources available. In this project, we determined the primary chemical constitution and proximate analysis of Prosopis laevigata (Humb. & Bonpl.) Jonhst wood using a traditional chemical method and a novel procedure based on the deconvolution of the DTG signal produced by TGA. The highest calorific value was verified using a calorimetric pump based on mathematical models. We also conducted elemental analysis and a microanalysis of ash, and applied Fourier transform infrared spectroscopic analysis (FT-IR). The means of the results obtained by the chemical method and TGA-DTG, respectively, were: hemicelluloses 7.36%-(8.72%), cellulose 48.28%-(46.08%), lignin 30.57%-(32.44%), extractables 13.53%-(12.72%), moisture 2.03%-(4.96%), ash 1.77%-(1.90%), volatile matter 75.16%-(74.14%), and fixed carbon 23.05%-(18.93%). The procedure with the calorimetric pump generated a calorific value above 20.16 MJ/kg. The range generated by the various models was 18.23-21.07 MJ/kg. The results of the elemental analysis were: carbon 46.4%, hydrogen 6.79%, oxygen 46.43%, nitrogen 0.3%, and sulfur 0.5%. The microanalysis of ash identified 18 elements. The most abundant ones were potassium ˃ calcium ˃ sodium. Based on the infrared spectrum (FT-IR) of Prosopis laevigata wood, we detected the following functional groups: OH, C-H, C=O, CH2, CH3, C-O-C, C-OH, and C4-OH. Our conclusion is that the TGA-DTG method made it possible to obtain results in less time with no need for the numerous reagents that chemical procedures require. The calorific value of P. laevigata wood is higher than the standards. Finally, according to our results, proximate analysis provides the best model for calculating calorific value.

Cerebellar Contributions to the Basal Ganglia Influence Motor Coordination, Reward Processing, and Movement Vigor.

Both the cerebellum and the basal ganglia are known for their roles in motor control and motivated behavior. These two systems have been classically considered as independent structures that coordinate their contributions to behavior via separate cortico-thalamic loops. However, recent evidence demonstrates the presence of a rich set of direct connections between these two regions. Although there is strong evidence for connections in both directions, for brevity we limit our discussion to the better-characterized connections from the cerebellum to the basal ganglia. We review two sets of such connections: disynaptic projections through the thalamus and direct monosynaptic projections to the midbrain dopaminergic nuclei, the VTA and the SNc. In each case, we review the evidence for these pathways from anatomic tracing and physiological recordings, and discuss their potential functional roles. We present evidence that the disynaptic pathway through the thalamus is involved in motor coordination, and that its dysfunction contributes to motor deficits, such as dystonia. We then discuss how cerebellar projections to the VTA and SNc influence dopamine release in the respective targets of these nuclei: the NAc and the dorsal striatum. We argue that the cerebellar projections to the VTA may play a role in reward-based learning and therefore contribute to addictive behavior, whereas the projection to the SNc may contribute to movement vigor. Finally, we speculate how these projections may explain many of the observations that indicate a role for the cerebellum in mental disorders, such as schizophrenia.

Activation of Intra-nodose Ganglion P2X7 Receptors Elicit Increases in Neuronal Activity.

Vagus nerve innervates several organs including the heart, stomach, and pancreas among others. Somas of sensory neurons that project through the vagal nerve are located in the nodose ganglion. The presence of purinergic receptors has been reported in neurons and satellite glial cells in several sensory ganglia. In the nodose ganglion, calcium depletion-induced increases in neuron activity can be partly reversed by P2X7 blockers applied directly into the ganglion. The later suggest a possible role of P2X7 receptors in the modulation of neuronal activity within this sensory ganglion. We aimed to characterize the response to P2X7 activation in nodose ganglion neurons under physiological conditions. Using an ex vivo preparation for electrophysiological recordings of the neural discharges of nodose ganglion neurons, we found that treatments with ATP induce transient neuronal activity increases. Also, we found a concentration-dependent increase in neural activity in response to Bz-ATP (ED50 = 0.62 mM, a selective P2X7 receptor agonist), with a clear desensitization pattern when applied every ~ 30 s. Electrophysiological recordings from isolated nodose ganglion neurons reveal no differences in the responses to Bz-ATP and ATP. Finally, we showed that the P2X7 receptor was expressed in the rat nodose ganglion, both in neurons and satellite glial cells. Additionally, a P2X7 receptor negative allosteric modulator decreased the duration of Bz-ATP-induced maximal responses without affecting their amplitude. Our results show the presence of functional P2X7 receptors under physiological conditions within the nodose ganglion of the rat, and suggest that ATP modulation of nodose ganglion activity may be in part mediated by the activation of P2X7 receptors.

Early Experience of Inner Branch Retrograde Cannulation With E-nside Branch Stent Graft for Thoracoabdominal Aortic Aneurysms.

PURPOSE: The aim of our study is to investigate the feasibility of retrograde cannulation using devices with inner branches (IB) for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs). MATERIALS AND METHODS: A retrospective analysis using IB configuration with retrograde cannulation was carried out on TAAAs patients undergoing endovascular treatment. RESULTS: Seven patients underwent IB endovascular treatment with retrograde cannulation between September 2020 and November 2021. The mean age was 80.4 years and 4 patients were male. A total of 26 of 28 target vessels were cannulated by retrograde access with a technical success of 93% (2 of 26 target vessels). Two intra-procedural complications were observed (1 renal artery dissection and 1 collateral renal artery rupture). In total, 26 of 28 treated vessels were retrograde cannulated with a technical success of 93%. A total of 39 stent bridges were used (all Viabahn VBX devices). The mean duration of the procedure was 321±102 minutes, and the mean scan time was 134±62 minutes. Mortality at 30 days was observed in 1 case. During the follow-up, 1 stent bridge occlusion was observed without the need for reintervention. CONCLUSION: Retrograde cannulation can also be successfully performed in the case of inner branches. CLINICAL IMPACT: In inner branched cases, retrograde cannulation should be taken into consideration in particular cases or it could become the option of choice. Dedicated endovascular material available such as steerable catheters and latest generation covered stents is fundamental for the success of the treatment.

Present status and future directions of intracanal medicaments.

Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.

Post-stroke epileptogenesis is associated with altered intrinsic properties of hippocampal pyramidal neurons leading to increased theta resonance.

Brain insults like stroke, trauma or infections often lead to blood-brain barrier-dysfunction (BBBd) frequently resulting into epileptogenesis. Affected patients suffer from seizures and cognitive comorbidities that are potentially linked to altered network oscillations. It has been shown that a hippocampal BBBd in rats leads to in vivo seizures and increased power at theta (3-8 Hz), an important type of network oscillations. However, the underlying cellular mechanisms remain poorly understood. At membrane potentials close to the threshold for action potentials (APs) a subpopulation of CA1 pyramidal cells (PCs) displays intrinsic resonant properties due to an interplay of the muscarine-sensitive K+-current (IM) and the persistent Na+-current (INaP). Such resonant neurons are more excitable and generate more APs when stimulated at theta frequencies, being strong candidates for contributing to hippocampal theta oscillations during epileptogenesis. We tested this hypothesis by characterizing changes in intrinsic properties of hippocampal PCs one week after post-stroke epileptogenesis, a model associated with BBBd, using slice electrophysiology and computer modeling. We find a higher proportion of resonant neurons in BBBd compared to sham animals (47 vs. 29%), accompanied by an increase in their excitability. In contrast, BBBd non-resonant neurons showed a reduced excitability, presented with lower impedance and more positive AP threshold. We identify an increase in IM combined with either a reduction in INaP or an increase in ILeak as possible mechanisms underlying the observed changes. Our results support the hypothesis that a higher proportion of more excitable resonant neurons in the hippocampus contributes to increased theta oscillations and an increased likelihood of seizures in a model of post-stroke epileptogenesis.

COVID-19 Impact on Vascular Surgery Practice: Experience From an Italian University Regional Hub Center for Vascular Pathology.

BACKGROUND: The aim of the study is to evaluate the impact of COVID-19 pandemic on vascular surgery practice in a regional hub center for complex vascular disease. METHODS: This is an observational single-center study in which we collected clinical and surgical data during (P1) and after (P2) the COVID-19 outbreak and the lockdown measures implemented in Northern Italy. We compared those data with the two-month period before the pandemic (P0). RESULTS: Compared to P0, ambulatory activities were severely reduced during P1 and limited to hospitalized patients and outpatients with urgent criteria. We performed 61 operations (18 urgent and 43 elective), with a decrease in both aortic (-17.8%), cerebrovascular (-53.3%), and peripheral artery (-42.6%) disease treatments. We also observed a greater drop in open procedures (-53.2%) than in endovascular ones (-22%). All the elective patients were treated for notdeferrable conditions and they were COVID-19 negative at the ward admission screening; despite this one of them developed COVID19 during the hospital stay. Four COVID-19 positive patients were treated in urgent setting for acute limb ischemia. Throughout P2 we gradually rescheduled elective ambulatory (+155.5%) and surgical (+18%) activities, while remaining substantially lower than during P0 (respectively -45.6% and -25.7%). CONCLUSIONS: Despite COVID-19 pandemic, our experience shows that with careful patient's selection, dedicated prehospitalization protocol and proper use of personal protective equipment it is possible to guarantee continuity of care.

Multi-objective admission planning problem: a two-stage stochastic approach.

Effective admission planning can improve inpatient throughput and waiting times, resulting in better quality of service. The uncertainty in the patient arrival and the availability of resources makes the patient's allocation difficult to manage. Thus, in the admission process hospitals aim to accomplish targets of resource utilization and to lower the cost of service. Both objectives are related and in conflict. In this paper, we present a bi-objective stochastic optimization model to study the trade-off between the resource utilization and the cost of service, taking into account demand and capacity uncertainties. Real data from the surgery and medical areas of a Chilean public hospital are used to illustrate the approach. The results show that the solutions of our approach outperform the actual practice in the Chilean hospital.

Characterization of LDLR rs5925 and PCSK9 rs505151 genetic variants frequencies in healthy subjects from northern Chile: Influence on plasma lipid levels.

BACKGROUND: Identification and characterization of genetic variants and their effects on human health may allow to establish relationships between genetic background and susceptibility to developing cardiovascular diseases. LDLR and PCSK9 polymorphisms have been associated with higher lipid levels and risk of cardiovascular diseases. Thus, the main aim of this study was to evaluate genotype distribution and relative allelic frequency of LDLR rs5925 (1959C > T) and PCSK9 rs505151 (23968 A > G) genetic variants and their effects on lipid levels of healthy subjects from northern Chile. METHODS: A total of 178 healthy individuals were recruited for this study. The genotyping of rs5925 (LDLR) and rs505151 (PCSK9) polymorphisms was performed by PCR-RFLP and qPCR, respectively. In addition, glucose and lipid levels were determined and associated with the genetic data. RESULTS: Genotype distribution for LDLR rs5925 polymorphism was as follows: CC = 19%; CT = 53%; and TT = 28% (HWE: χ2  = 0.80; P = .37), and for PCSK9 rs505151 genetic variant was as follows: AA = 93%; AG = 7%; and GG = 0% (HWE: χ2  = 0.22; P = .64). The frequency of T (rs5925) and G (rs505151) mutated alleles was 0.55 and 0.03, respectively. Data showed that individuals carrying LDLR mutated allele (T) presented lower values of total cholesterol, triglycerides, and LDL-cholesterol when compared to CC homozygous genotype (P < .05). Subgroup analysis revealed that women carrying the PCSK9 mutated allele (G) exhibited higher values of total cholesterol, triglycerides, HDL-C, and LDL-C when compared to male group carrying the same genotype (P < .05). CONCLUSIONS: The effect of LDLR rs5925 and PCSK9 rs505151 gene polymorphisms on lipid levels is associated with gender among healthy subjects from northern Chile.

Implications of macrophage polarization in autoimmunity.

Macrophages are extremely heterogeneous and plastic cells with an important role not only in physiological conditions, but also during inflammation (both for initiation and resolution). In the early 1990s, two different phenotypes of macrophages were described: one of them called classically activated (or inflammatory) macrophages (M1) and the other alternatively activated (or wound-healing) macrophages (M2). Currently, it is known that functional polarization of macrophages into only two groups is an over-simplified description of macrophage heterogeneity and plasticity; indeed, it is necessary to consider a continuum of functional states. Overall, the current available data indicate that macrophage polarization is a multifactorial process in which a huge number of factors can be involved producing different activation scenarios. Once a macrophage adopts a phenotype, it still retains the ability to continue changing in response to new environmental influences. The reversibility of polarization has a critical therapeutic value, especially in diseases in which an M1/M2 imbalance plays a pathogenic role. In this review, we assess the high plasticity of macrophages and their potential to be exploited to reduce chronic/detrimental inflammation. On the whole, the evidence detailed in this review underscores macrophage polarization as a target of interest for immunotherapy.

[Validation of a scale of health beliefs about type 1 diabetes for the Mexican context: HBM-T1DM]. / Validación de una escala de creencias de salud sobre diabetes tipo 1 para el contexto mexicano: HBM-T1DM.

OBJECTIVE: To generate a scale to measure health beliefs among Mexican adolescents and young people with type 1 diabetes (T1DM) to determine the extent to which they affect adherence to treatment and to be able to develop more effective social marketing campaigns. MATERIAL AND METHODS: Based on the Health Belief Model (HBM), a scale was generated; three field tests were applied, and it was administered in two regions of Mexico to young people with type 1 diabetes.Tests of reliability, stability, convergence-discrimination and predictive validity were developed. RESULTS: The main predictor is perceived barriers to treatment adherence, followed by self-efficacy to disease control, susceptibility/vulnerability to disease complications and perceived benefits of treatment. CONCLUSIONS: This scale may be especially useful for better monitoring young Mexican patients with T1DM and prevent sequelae of disease.

OBJETIVO: Generar una escala para medir las creencias de salud en adolescentes y jóvenes mexicanos con diabetes tipo 1 (T1DM) para determinar el grado en que éstas afectan la adherencia al tratamiento y ser capaces de desarrollar campañas de mercadotecnia social más efectivas. MATERIAL Y MÉTODOS: Con base en el Modelo de Creencias de la Salud (HBM, por sus siglas en inglés), se generó una escala que se sometió a tres pruebas de campo y se administró en dos regiones de México a jóvenes con diabetes tipo 1. Se realizaron pruebas de fiabilidad, estabilidad, validez por convergenciasdiscriminación y validez predictiva. RESULTADOS: El principal predictor son las barreras percibidas para apegarse al tratamiento, seguida de la autoeficacia para controlar la enfermedad, susceptibilidad/vulnerabilidad a complicaciones de la enfermedad y beneficios percibidos del tratamiento. CONCLUSIONES: Esta escala puede resultar especialmente útil para dar un mejor seguimiento a pacientes jóvenes mexicanos con T1DM y evitar secuelas de la enfermedad.

Biofilms in Endodontics-Current Status and Future Directions.

Microbiota are found in highly organized and complex entities, known as biofilms, the characteristics of which are fundamentally different from microbes in planktonic suspensions. Root canal infections are biofilm mediated. The complexity and variability of the root canal system, together with the multi-species nature of biofilms, make disinfection of this system extremely challenging. Microbial persistence appears to be the most important factor for failure of root canal treatment and this could further have an impact on pain and quality of life. Biofilm removal is accomplished by a chemo-mechanical process, using specific instruments and disinfecting chemicals in the form of irrigants and/or intracanal medicaments. Endodontic research has focused on the characterization of root canal biofilms and the clinical methods to disrupt the biofilms in addition to achieving microbial killing. In this narrative review, we discuss the role of microbial biofilms in endodontics and review the literature on the role of root canal disinfectants and disinfectant-activating methods on biofilm removal.

Preoperative hydration with 0.9% normal saline to prevent acute kidney injury after major elective open abdominal surgery: A randomised controlled trial.

BACKGROUND: Postoperative acute kidney injury (AKI) is the second leading cause of hospital-acquired AKI. Although many preventive strategies have been tested, none of them has been totally effective. OBJECTIVE: We investigated whether preoperative intravenous hydration with 0.9% normal saline could prevent postoperative AKI. DESIGN: Randomised controlled trial. SETTING: University Ramón y Cajal Hospital, Spain, from June 2006 to February 2011. PATIENTS: Total 328 inpatients scheduled for major elective open abdominal surgery. INTERVENTION: 0.9% normal saline at a dose of 1.5 ml kg h for 12 h before surgery. MAIN OUTCOME MEASURES: The primary outcome was the overall postoperative AKI incidence during the first week after surgery defined by risk, injury, failure, loss, end-stage kidney disease (RIFLE) and AKI network (AKIN) creatinine criteria. Secondary endpoints were the need for ICU admission, renal replacement therapy during the study period and adverse events and hospital mortality during hospital admission. RESULTS: There was no difference in the incidence of AKI between groups: 4.7% in the normal saline group versus 5.0% in the control group and 11.4% in the 0.9% normal saline group versus 7.9% in the control group as assessed by the RIFLE and AKIN creatinine criteria, respectively. Absolute risk reductions (95% confidence interval) were -0.3% (-5.3 to 4.7%) for RIFLE and 3.5% (-10.2 to 3.6%) for AKIN. ICU admission after surgery was required in 44.5% of all participants. Only 2 (0.7%) patients required renal replacement therapy during the first week after surgery. The analysis of adverse events did not show statistically significant differences between the groups except for pain. In our population, 8 (2.4%) patients died during their hospital admission. CONCLUSION: Intravenous hydration with 0.9% normal saline before major open abdominal surgery was not effective in preventing postoperative AKI. No safety concerns were identified during the trial. TRIAL REGISTRATIONS: Clinical trials.gov: NCT00953940 and EUDRA CT: 2005-004755-35.

Bacterial Species, Susceptibility to antibiotics and characteristics of patients with surgical site infections.

Surgical site infections (SSI) are the most common healthcare-associated infections. Approximately 2-5% of all surgeries develop SSI as a complication. These infections are responsible for significant fatality, morbidity, and length of hospital stay. The purpose of this study was to describe characteristics of SSI in a community hospital in Puerto Rico. This was cross-sectional study. Between July 2013 and August 2015, 5468 major operative procedures were performed and 31 SSI were reported for an overall SSI incidence rate of 0.57%. A total of 31 cases of SSI were studied. The mean age of patients was 59.4 years, with a range of to 29 to 89 years. The median age was 64 years. The sex distribution showed 22 women (71%) and 9 men (29%). The prevalence rate of diabetes mellitus was 13/31 (42%). In this study 90% of patients with SSI had at least one underlying health condition (diabetes, hypertension, obesity, age > 65 years). Location of surgical site infections were: abdominal 16 (52%), orthopedic 4 (13%), pelvic 7 (22%), stump 3 (10%), and chest tube 1 (3%). A total of 12 different bacterial pathogens were found. A single etiologic agent was identified in 18 patients (53%) and multiple agents were found in 13 patients (47%). Enterococcus faecalis was the most common pathogen (45% of patients) followed by Escherichia coli (39% of patients). The majority of bacteria isolated from cultures were susceptible to B-lactams and aminoglycosides.

Compliance with management guidelines in patients with suspected dengue.

Dengue is an endemic disease in Puerto Rico, with three to nine thousand suspected dengue cases reported yearly. In PR, physicians are required to maintain medical education courses about dengue in order to recertify their medical licenses. The purpose of this study was to describe characteristics of patients admitted to Bella Vista Hospital with suspected dengue and estimate the compliance with guidelines established by the CDC documented in medical records. A total of 197 medical records of patients admitted with diagnosis of suspected dengue during January 1, 2013 through December 31, 2013 were reviewed. The annual distribution of admitted cases showed a higher incidence during the months of June through September, with August having the higher incidence of all. Combined aches and pains were most commonly reported at admission with a prevalence of 82%. In general there was a low prevalence of severe disease as per definition at presentation (DM, clinical fluid accumulation, hepatomegaly, pregnancy and/or renal insufficiency). Overall, compliance with CDC established guidelines were only partially followed. The guideline that was followed more frequently was a daily CBC, with 95% of patients having this as part of their management. Prevalence of administration of isotonic intravenous fluids was 63%, monitoring of vital signs was 48%), and administration of bolus of intravenous fluid was11%. No fatalities were reported during the period.

3D mapping of the irrigated areas of the root canal space using micro-computed tomography.

OBJECTIVES: The aim of this study was to introduce a methodology to map irrigant spreadability within the root canal space using micro-computed tomography (micro-CT). MATERIALS AND METHODS: Mandibular molars presenting Vertucci's types I and II canal configurations were selected, and four scans using isotropic resolution of 19.5 µm were accomplished per tooth: prior to treatment (S1), after glide path (S2) and after root canal preparation (S3 and S4). A contrast solution (CS) was used to irrigate the canals at stages S2 and S4. The touched and untouched surface areas of the canals, the volume of irrigant-free areas and the percentage volume occupied by the CS were calculated. Density, surface tension and the spread pattern of the CS and 2.5% NaOCl were also evaluated. RESULTS: In the type I mesial root, there was an increase in the percentage volume of free-irrigated areas from S2 to S4 preparation steps, whilst in the distal roots and type II mesial root, a decrease of irrigant-free areas was observed. The use of CS allowed the quantification of the touched surface area and the volume of the root canal occupied by the irrigating solution. Density (g/mL) and surface tension (mN/m) of the CS and 2.5% NaOCl were 1.39 and 47.5, and 1.03 and 56.2, respectively. Besides, a similar spread pattern of the CS and 2.5% NaOCl in a simulated root canal environment was observed. CONCLUSIONS: This study introduced a new methodology for mapping the irrigating solution in the different stages of the root canal preparation and proved useful for in situ volumetric quantification and qualitative evaluation of irrigation spreading and irrigant-free areas. CLINICAL RELEVANCE: Micro-computed tomographic technology may provide a comprehensive knowledge of the flush effectiveness by different irrigants and delivery systems in order to predict the optimal cleaning and disinfection conditions of the root canal space.

Clinical and radiological indicators of severity in patients with acute pancreatitis.

UNLABELLED: The purpose of this study was to estimate the degree of association between clinical (Ranson criteria) and radiological variables (Abdominal CT scan) with degree of severity in patients with a diagnosis of acute pancreatitis. METHOD: All patients discharged with the diagnosis of acute pancreatitis from January 1, 2010 through December 31, 2012 in a community hospital were selected (N=174). The following variables were studied: sex; age; weight; height; admission and discharge dates; presence of several chronic conditions; laboratory results included in Ranson criteria; abdominal CT category; outcome, including fatality surgery, and other complications. Analysis included descriptive statistics and Risk-Ratios for complications for different groups of subjects, using clinical and radiological criteria. RESULTS: The incidence rate of complications, including fatality, surgery and organ failure was 36.2%. Factors that showed significant associations with the risk of complication on crude analysis were gallbladder disease with a RR=1.78 ($95% CI: 1.22, 2.60) and abnormal abdominal CT with a RR=1.85 (95% CI: 1.11, 3.07). with multivariate analysis, gallbladder disease, abnormal abdominal CT, and presence of 3 or more Ranson's criteria showed increased risk for complications, but the results did not reach statistical significance. DISCUSSION: The factors that seemed to be associated with increased rate of complications in subjects with acute pancreatitis were gallbladder disease, abnormal abdominal CT, and 3 or more Ranson's criteria. The Results did not show statistical significance probably because of low statistical power of the study.

The cerebellum directly modulates the substantia nigra dopaminergic activity.

Evidence of direct reciprocal connections between the cerebellum and basal ganglia has challenged the long-held notion that these structures function independently. While anatomical studies have suggested the presence of cerebellar projections to the substantia nigra pars compacta (SNc), the nature and function of these connections (Cb-SNc) is unknown. Here we show, in mice, that Cb-SNc projections form monosynaptic glutamatergic synapses with dopaminergic and non-dopaminergic neurons in the SNc. Optogenetic activation of Cb-SNc axons in the SNc is associated with increased SNc activity, elevated striatal dopamine levels and increased locomotion. During behavior, Cb-SNc projections are bilaterally activated before ambulation and unilateral lever manipulation. Cb-SNc projections show prominent activation for water reward and higher activation for sweet water, suggesting that the pathway also encodes reward value. Thus, the cerebellum directly, rapidly and effectively modulates basal ganglia dopamine levels and conveys information related to movement initiation, vigor and reward processing.