Digital Photocolorimetric Analysis of In Vitro Tooth Color Changes.

OBJECTIVE: Tooth color matching is challenging, and digital photocolorimetry using eLABor_aid (eLAB) provides objective evaluation through polarized photographs. However, its comparability with spectrophotometry remains unclear. METHODS AND MATERIALS: Bovine incisor root canals (n=30) were prepared to simulate an incomplete root apex. The teeth were randomly assigned to three groups based on intracanal medication: control (without medication); calcium hydroxide/propylene glycol; and triple-antibiotic paste (n=10 each). Tooth color was assessed using both eLAB and spectrophotometry. Measurements were taken at the crown medio-cervical region on five-time intervals (baseline, 1, 3, 7, and 14 days). Statistical analysis included two-way repeated-measures ANOVA, Sidak post hoc and Pearson's correlation test (α=0.05). RESULTS: No significant differences were observed between the two methods for either medication or follow-ups (p>0.05). Triple-antibiotic paste exhibited higher color variation (p<0.05). After 7 days, all groups presented significant color changes (p<0.05). Moderate to high correlations (R2 from 0.51 to 0.84, p<0.0001) were found between both methods for all groups at all intervals. CONCLUSION: The eLAB is a reliable method for detecting tooth color changes, and its results are comparable to spectrophotometry analysis.

Fracture Resistance and Failure Mode of Custom-made Post-and-cores of Polyetheretherketone and Nano-ceramic Composite.

CLINICAL RELEVANCE: Custom-made post-and-cores of polyetheretherketone (PEEK) and nano-ceramic composite showed good fracture resistance and failure mode. Clinicians should be aware that these materials might be an efficient alternative for post-and-cores, because they promote esthetics while reducing the risk of root fractures. SUMMARY: Purpose: The purpose of this study was to evaluate the fracture resistance and failure mode of custom-made post-and-cores manufactured with different esthetic materials.Methods and Materials: A total of 48 mandibular premolar extracted teeth were selected, endodontically treated, and prepared to receive the posts. Specimens were randomly divided into four groups (n=12/group): group 1, polyetheretherketone (PEEK, Degos; G1); group 2, nano-ceramic composite (Lava Ultimate, 3M ESPE; G2); group 3, cast metal post (NiCr alloy, control; G3); group 4, fiberglass post (Whitepost, FGM, control; G4) customized with a nano-hybrid resin composite (Z250, 3M ESPE). Experimental post-and-cores (G1 and G2) were manufactured with a computer-aided design/computer-aided manufacturing system. All posts were cemented with self-adhesive resin cement (Rely X U200, 3M ESPE), and specimens were stored in distilled water at 37°C for 60 days. A universal testing machine was used to measure the fracture resistance (0.5 mm/min at an angle of 45° to the long axis of the tooth). Fractures were classified as repairable or catastrophic. One-way analysis of variance with Tukey post hoc and χ2 tests for independence and Bonferroni adjustments were applied (α=0.05).Results: The fracture resistance values (mean ± SD, in newtons) were 379.4 ± 119.8 (G1), 506.4 ± 138 (G2), 939.6 ± 146.5 (G3), and 449.6 ± 66.5 (G4). Only G3 exhibited a significant difference (p<0.05). The χ2 test showed an association between failure mode and post-and-core material [χ2(3) = 23.65; p<0.001]. After Bonferroni adjustment, only G3 presented a higher than expected incidence of catastrophic failures (p<0.001). In the remaining groups, most failures were repairable and related to debonding.Conclusions: Customized post-and-cores of PEEK and nano-ceramic composites exhibited good mechanical performance. Their fracture resistance was comparable to that observed for fiberglass customized posts, yet lower than that for cast metal posts. For PEEK post-and-cores, in particular, additional studies are needed to improve adhesiveness and reduce the risk of debonding.

En busca de la imagen corporal deseada después de la cirugía bariátrica / In search of the desired corporal image after bariatric surgery / Na busca da imagem corporal desejada depois da cirurgia bariátrica

Las terapias médicas y nutricionales no siempre producen una pérdida de peso significativa y sostenida, por lo que la cirugía bariátrica es una alternativa y el método más efectivo en el tratamiento para la obesidad; se ha relacionado con una mejoría de las patologías asociadas, la calidad de vida, la autoestima, los estados de ansiedad y depresión. Con la cirugía bariátrica se pretende reducir la morbimortalidad ligada a la obesidad. Enfermería requiere un mayor conocimiento científico, tecnológico y práctico para brindar un cuidado con calidad frente a estos nuevos procedimientos y tecnologías, y para colaborar en la prevención de complicaciones. Objetivo: Presentar la categoría en busca de la imagen corporal deseada después de la cirugía bariátrica. Métodos: Estudio cualitativo con 23 participantes (9 hombres y 14 mujeres), se realizaron entrevistas semiestructuradas; para el análisis de los datos se utilizaron las herramientas de la teoría fundamentada hasta alcanzar la saturación de la información. Resultados: La categoría en busca de la imagen corporal deseada está compuesta por las siguientes subcategorías: cumplimiento de los requisitos para la reconstrucción; aunque todo se cae no siempre se quiere la cirugía reconstructiva; complicándome con la reconstrucción; los vestigios: vanidad y adicción a las cirugías estéticas. Conclusiones: Realizarse la cirugía bariátrica no garantiza una imagen corporal esbelta, pues esto requiere de nuevas intervenciones para alcanzarla. Con la reconstrucción de la imagen corporal después de la cirugía bariátrica no siempre se queda satisfecho, quedan vestigios que afectan diferentes dimensiones del individuo.

Medical and nutritional therapies do not always produce a significant and sustained weight loss; and because of this, the bariatric surgery is an alternative and the most effective method in the treatment of obesity. Bariatric surgery has been associated with improvements in obesity related pathologies, quality of life, selfesteem, and anxiety and depression. Bariatric surgery is intended to reduce the obesity related morbidity and mortality. The profession of nursing needs to address the issue with enhanced scientific, technological, and practical knowledge to foster the prevention of complications. Objective: To present the category In search of the desired corporal image after bariatric surgery. Methods: This is a qualitative study with 23 participants (9 men and 14 women). Semi-structured interviews were conducted. Data were collected until theoretical saturation. Results: The category In search of the desired corporal image after bariatric surgery is constituted by the following sub-categories: fulfilling the requisites for the reconstruction; although everything is flaccid, reconstructive surgery is not always advisable; making my life more difficult with the reconstruction; the vanity and addiction to esthetical surgeries. Conclusions: Bariatric surgery does not guarantee a thin corporal image, and the reconstruction of the corporal image does not guarantee a complete satisfaction. There are always diverse affectations left on the individuals.

As terapias médicas e nutricionais não sempre produzem uma perda de peso significativa e sustentada, pelo que a cirurgia bariátrica é uma alternativa e o método mais efetivo no tratamento de obesidade, tem se relacionado com uma melhoria das patologias associadas, a qualidade de vida, a autoestima, os estados de ansiedade e depressão. Com a cirurgia bariátrica se pretende reduzir a morbimortalidade ligada à obesidade. A enfermagem requer um maior conhecimento científico, tecnológico e prático para brindar um cuidado com qualidade frente a estes novos procedimentos e tecnologias, e para colaborar na prevenção de complicações. Objetivo: Apresentar a categoria na busca da imagem corporal desejada após da cirurgia bariátrica. Métodos: Estudo qualitativo com 23 participantes (9 homens e 14 mulheres), realizaram-se entrevistas semiestruturadas, para a análise dos dados utilizaram-se as ferramentas da teoria fundamentada até atingir a saturação da informação. Resultados: A categoria na busca da imagem corporal desejada está composta pelas seguintes subcategorias: cumprimento dos requisitos para a reconstrução, ainda que tudo caia não sempre se quer a cirurgia reconstrutiva, complicando-se com a reconstrução, os vestígios, vaidade e adição às cirurgias estéticas. Conclusões: Realizar a cirurgia bariátrica não garante uma imagem corporal magra, pois isto requer de novas intervenções para ating-ila. Com a reconstrução da imagem corporal depois da cirurgia bariátrica não sempre se satisfaz, ficam vestígios que afeitam diferentes dimensões do individuo.

Impact of root fillings and posts on the diagnostic ability of three intra-oral digital radiographic systems in detecting vertical root fractures.

AIM: To evaluate (i) the accuracy of three intra-oral digital systems in detecting vertical root fractures (VRFs); and (ii) the influence of different intracanal conditions (without filling, filled with Gutta-percha and metal or fibreglass post). METHODOLOGY: Forty single-rooted human teeth were decoronated and the root canals prepared. VRFs were induced using a universal testing machine on 20 teeth. Radiographic images were obtained using the paralleling technique with three different horizontal angulations on conventional E/F film, two storage phosphor plates (Digora Optime and VistaScan) and one sensor system (SnapShot). All teeth were radiographed with all intracanal conditions tested. All images were evaluated by five examiners. After 30 days, 25% of the images were reviewed. Areas under ROC curves, sensitivity, specificity, accuracy, positive predictive and negative predictive values were compared by anova. RESULTS: The weighted kappa values for intra- and interobserver reproducibility were 0.48-0.74 and 0.57-0.66, respectively. The sensitivity revealed a significant difference between imaging modalities, with higher values for SnapShot (0.53) and VistaScan (0.46), followed by the film (0.41) and Digora (0.38). The area under the ROC curve for SnapShot (0.82) was greater than for the other systems in the teeth with a fibreglass post (VistaScan: 0.70; Digora: 0.64; film: 0.60). CONCLUSION: All systems gave a similar performance for detecting VRFs; all gave a good performance in the absence of intracanal materials, but performed less well in the presence of a metal post or Gutta-percha. In teeth with a fibreglass post, digital systems with higher resolution should be used.

Localización efectiva de un segundo conducto radicular en incisivos inferiores mediante magnificación, radiografía y diafanización / Effective location a second root canal in lower incisors by magnification radiography and diaphanization

Objetivo: Evaluar in vitro, la efectividad del método visual y radiográfico, comparándolos con la técnica de diafanización en la detección del segundo conducto radicular de incisivos inferiores tratados endodónticamente. Material y métodos: Fueron analizados 133 dientes incisivos inferiores permanentes, tratados endodónticamente, a través de métodos visuales (con y sin auxilio de magnificación), radiográficos y de diafanización. El análisis radiográfico fue realizado en negatoscopio utilizando una lupa estereoscópica (10X). Posteriormente, fue realizada la remoción completa de la obstrucción provisional para la exploración visual con y sin auxilio de microscopio clínico (MO) en un aumento de 12X. Finalmente los dientes fueron diafanizados y almacenados en salicilato de metila para posterior análisis. Dos evaluadores calibrados registraron los datos referentes a la presencia o no del segundo conducto radicular para cada uno de los métodos utilizados. Resultados: El análisis radiográfico mostró la presencia del segundo conducto en 24 dientes (18,05%. Visualmente, fue encontrado en 4 dientes (3,00%) sin magnificación y en 16 dientes (12,03%) con ayuda del MO. A través de la diafanización, 34 dientes (25,95%) presentaron segundo conducto. Conclusiones: La asociación de técnicas radiográficas y la magnificación visual obtenida con la utilización del MO se muestran como los aliados clínicos más efectivos para la localización del segundo conducto en incisivos inferiores.

Objective: To evaluate in vitro the effectiveness of the visual, radiographic and clearing technique on detection of two root canals in mandibular incisor teeth endodontically treated. Material and methods: One hundred thirty-three human permanent lower incisors were anlyzed through visual methods (with and without magnification), radiographic and clearing technique. Radiographic analysis was performed in light box using a stereomicroscope (10X). Then, the temporary filling of al specimens was removed for visual exploration with and without clinical microscope (OM) (12X). Finally the teeth were submitted to clearing technique and stored in methyl salicylate for subsequent analysis. Two calibrated reviewers recorded data about the presence or absence of the second root canal for each of the used methods. Results: Radiographic analysis showed the presence of the second root canal in 24 teeth (18.05%). Visually, it was found in 4 teeth (3.00%) and 16 teeth (12.03%) without and with the use of OM, respectively. Through clearing technique, in 334 teeth (25.95%) it was found the second root canal. Conclusion: The association of radiographic techniques and visual magnification with the use of MO has been shown as the most effective clinical partners to locate the second root canal in mandibular incisors.

Effect of a school-based intervention on physical activity: cluster-randomized trial.

PURPOSE: Physical activity in childhood has many health benefits; however, the majority of children in many countries, including Mexico, are insufficiently active. The objective of this investigation was to test the effect of a school-based environmental intervention on the physical activity and physical fitness of students attending public primary schools in Mexico City. METHODS: Twenty-seven schools were randomly assigned to basic or plus intervention or control. The basic and plus groups were exposed to school environment and policy changes to enhance physical activity. Physical activity was evaluated in 699 randomly selected fourth- and fifth-grade students by measuring school-day and all-day (24 h) steps using pedometers worn for 5 d before and after the 6-month intervention. Physical fitness was assessed by measuring the 9-min run, flexibility, and sit-ups. We calculated the average change in school-day and all-day steps and fitness measures from baseline to follow-up. Using linear regression, we tested the effect of intervention on change controlling for baseline measures and covariates and accounting for the design effect of school. Using logistic regression, we tested the effect of intervention on reaching step cutoffs at baseline and follow-up. RESULTS: The plus group significantly (P < 0.05) increased school-day steps relative to control (change = 687 vs -639). Significantly (P < 0.05) more participants in the basic (25.8%) and plus (36.4%) groups reached step cutoffs during school relative to control (12.0%). The basic group significantly (P < 0.05) increased all-day steps relative to control (change = 581 vs -419). The plus group significantly (P = 0.05) increased sit-ups relative to control (change = 0.3 vs -1.7). CONCLUSIONS: A school-based environmental intervention improved student physical activity during school in public schools in Mexico City.

Osteogenesis imperfecta with extreme bone fragility.

Osteogenesis Imperfecta ordinarily leads to an early death. Survival to age 30 is unusual. In this case the patient achieved some pleasure in life, was reported to be of normal intellectual capacity, and proved capable of great skill in certain crafts. He truly lived his life and his last years were made possible by skills of his home health care team, the devotion of his mother, and his own determination, humor, defiance, and toughness of character.

Value of tonometry in postoperative high risk patients with digestive surgery.

Intramucosal pH (pHi) in splanchnic organs is a reliable index of local tissular perfusion, and can be measured by tonometry. At the Surgical Intensive Care Unit we used tonometry to determine tissular perfusion in patients who underwent major digestive surgery. We report a prospective study of 20 patients with elective and emergency surgery. All of them underwent gastric tonometry and 10 of them, who had colonic disease, also underwent sigmoid tonometry. The values below pHi = 7.30 were associated with increased morbidity and mortality.

[Colangiocarcinoma on a choledochal cyst]. / Colangiocarcinoma sobre quiste de colédoco.

Patients with choledochal cysts have an increased incidence of biliary tract carcinoma. We report a case of adenocarcinoma arising in a type I choledochal cyst which was surgically treated by resection and biliodigestive anastomosis (hepaticojejunostomy).