Hardness and Depth of Cure of Conventional and Bulk-Fill Composite Resins in Class II Restorations with Transparent and Metal Matrix Strips.

Objectives: Hardness is relevant to the degree of conversion (DC) and depth of cure (DoC). The aim of this study was to determine the micro-hardness and DoC of conventional and bulk-fill composite resins in class II restorations using metal and clear matrix bands. Materials and Methods: Twelve specimens of each of the two composite resins, i.e., Filtek Z350 XT bulk-fill and Gradia posterior conventional composite, were prepared in the form of a class II cavity in a tooth mold, using a clear or metal matrix band. All specimens were cured and stored at 37°C for 24 hours. Vickers hardness was measured as a function of DoC at 2mm intervals. Data were analyzed by two-way ANOVA (alpha=0.05). Results: The bulk-fill composite exhibited significantly higher hardness levels than the conventional composite in all tested surfaces (P<0.001). However, while the metal matrix band had a significant impact on the bottom surface (P=0.059) and also on the furthest surface from the matrix and light source (P=0.04), it did not have a consistent effect across all tested surfaces. The simultaneous interaction of the composites and matrix band types in all surfaces, did not show significant differences in hardness values. The highest bottom-to-top surface hardness ratio (73%) was observed in the conventional composite near the metal matrix band. Conclusion: In deep class II cavities, the bottom-to-top surface hardness ratio did not reach the maximum of 80%, neither for bulk-fill nor conventional posterior composites. Therefore, in such cavities extended light-curing and more incremental composite placement is needed.

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People.

Objectives: Older people have a fear of falling, which is far more difficult than falling itself. We measured the extent of this feeling using a short and valid Falls Efficacy Scale-International (FES-I) 7-item questionnaire for the aging community in Iran. Methods: The present psychometric work deals with outlining the validation and translation of FES-I (short version) among 9117 Persian-speaking elderly people with a mean age of 70.2±8.3 years (54.1% female and 45.9% male) in July 2021. Investigations were performed on confirmatory factor analysis, exploratory factor analysis, internal consistency, and construct validity along with test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity. Results: 72.4% of the subjects were living alone, 92.9% required support in activities of daily living, and 93.0% experienced falling in the past two years. A one-factor solution was assigned by exploratory factor analysis for FES-I. Thus, this model was proved by the confirmatory factor analysis with valid fit indices. Based on Cronbach's alpha, intra-cluster correlation coefficient, and McDonald's omega (≥ 0.80), internal consistency was confirmed. The exact cut-off value was represented by the receiver operating characteristic analysis for male/female and between with/without fear of falling among older samples with higher measures of specificity and sensitivity. Moreover, a significant effect of age, aging in place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.80, p ≤ 0.05) on fear of falls was detected using analysis of variance. Conclusions: The psychometric properties of the original scale were preserved by the Persian version of FES-I seven items as a self-reported measure of fear of falling. It could be assuredly a measure in both community and clinical settings. The possible uses and limitations of the Iranian FES-I were also discussed.

Electrospun nanofibers using ß-cyclodextrin grafted chitosan macromolecules loaded with indomethacin as an innovative drug delivery system.

Electrospun nanofibers, as an innovative drug delivery system, provide selective, effective, and safe drug release. The present study aimed to fabricate nanofibers based on ß-cyclodextrin grafted chitosan (ß-CD-g-CS) macromolecules with incorporated drug via the blend electrospinning technique. The grafting of ß-CD onto chitosan (CS) was confirmed by FT-IR, 1H NMR, TGA, XRD, and EDX analysis. Indomethacin was encapsulated in the ß-CD-g-CS matrix as blend nanofibers using electrospinning in presence of polyvinyl alcohol (PVA). The SEM images revealed nanofibers with diameters at the nanoscale. The unique features of ß-CD-g-CS/PVA as drug delivery system were investigated using indomethacin as a model drug molecule. Controlled release of indomethacin from nanofibers was studied in PBS solution by measuring the absorbance by UV-Vis spectrophotometer. The drug release profile exhibited that the rate of drug release can be tailored by polymer type and changing the drug/polymer ratio. The physicomechanical properties of the developed nanofibers were analyzed by tensile strength and water contact angle. The results demonstrated that ß-CD-g-CS revealed enhanced wettability as well as favorable physicomechanical properties. In addition, the growth rate of the L929 cells on the CS and ß-CD-g-CS nanofibers was not significantly inhibited and even improved cell proliferation. These findings indicated that ß-CD-g-CS nanofibers could be appropriate as a smart drug delivery system for sustained release of indomethacin as an anti-inflammatory medicine in the wound healing and tissue engineering approaches in orthopedic applications.

Effect of Adding Intravenous Somatostatin to Rectal Indomethacin on Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis in High-risk Patients: A Double-blind Randomized Placebo-controlled Clinical Trial.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has an important role in the treatment of pancreaticobiliary disorders. GOALS: Considering the high prevalence and importance of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) and the controversial findings, we aimed to determine the effect of adding intravenous somatostatin to rectal indomethacin on the incidence of PEP in high-risk patients. STUDY: In this prospective study, 530 patients underwent ERCP during March 2018 and February 2019. Patients were randomized into 2 groups. The intervention group received a bolus injection of 250 µg somatostatin followed by an infusion of 500 µg of somatostatin for 2 hours. In both groups, 100 mg of pre-ERCP suppository indomethacin was administrated. All patients were screened for PEP symptoms and signs for 24 hours after ERCP (Iranian Registry of Clinical Trials code: IRCT20080921001264N11). RESULTS: A total of 376 patients were finally analyzed. PEP was the most common adverse event with 50 (13.2%) episodes, including 21 (5.5%) mild, 23 (6.1%) moderate, and 6 (1.2%) severe. The rate of PEP was 15.2% in the control group and 11.4% in the intervention group ( P =0.666). The incidence of post-ERCP hyperamylasemia was 21.7% in the control group and 18.2% in the intervention group ( P =0.395). No death occurred. CONCLUSIONS: In this study administration of somatostatin plus indomethacin could safely reduce the rate of post-ERCP hyperamylasemia and PEP in the intervention group compared with the control group, but the differences were not significant. Further studies with larger sample sizes are required.

Free Fatty Acids from Type 2 Diabetes Mellitus Serum Remodel Mesenchymal Stem Cell Lipids, Hindering Differentiation into Primordial Germ Cells.

Type 2 diabetes mellitus (T2DM) adversely affects the essential characteristics of adipose tissue-derived mesenchymal stem cells (AdMSCs). Given that T2DM is associated with an altered serum free fatty acid (FFA) profile, we examined whether diabetic serum FFAs influence the viability, differentiation, and fatty acid composition of the major lipid fractions of human AdMSCs in vitro. Serum FFAs were isolated from 7 diabetic and 10 healthy nondiabetic female individuals. AdMSCs were cultured and differentiated into primordial germ cell-like cells (PGCLCs) in the presence of either diabetic or nondiabetic FFAs. Cell viability was assessed using trypan blue staining. Cell differentiation was evaluated by measuring the PGCLC transcriptional markers Blimp1 and Stella. Lipid fractionation and fatty acid quantification were performed using thin-layer chromatography and gas-liquid chromatography, respectively. Both diabetic and nondiabetic FFAs significantly reduced the viability of PGCLCs. The gene expression of both differentiation markers was significantly lower in cells exposed to diabetic FFAs than in those treated with nondiabetic FFAs. Saturated fatty acids were significantly increased and linoleic acid was significantly decreased in the cellular phospholipid fraction after exposure to diabetic FFAs. In contrast, monounsaturated fatty acids were reduced and linoleic acid was elevated in the cellular triglyceride fraction in response to diabetic FFAs. Such an altered serum FFA profile in patients with T2DM reduces the proliferation and differentiation potential of AdMSCs, presumably due to the aberrant distribution of fatty acids into cell phospholipids and triglycerides.

Strategies for Mammalian Mesenchymal Stem Cells Differentiation into Primordial Germ Cell-Like Cells: A Review.

Primordial germ cells develop into oocytes and sperm cells. These cells are useful resources in reproductive biology and regenerative medicine. The mesenchymal stem cells (MSCs) have been examined for in vitro production of primordial germ cell-like cells. This study aimed to summarize the existing protocols for MSCs differentiation into primordial germ cell-like cells (PGLCs). In the limited identified studies, various models of mesenchymal stem cells, including those derived from adipose tissue, bone marrow, and Wharton's jelly, have been successfully differentiated into primordial germ cell-like cells. Although the protocols of specification induction are basically very similar, they have been adjusted to the mesenchymal cell type and the species of origin. The availability of MSCs has made it possible to customize conditions for their differentiation into primordial germ cell-like cells in several models, including humans. Refining germ cell-related signaling pathways during induced differentiation of MSCs will help define extension to the protocols for primordial germ cell-like cells production.

Fatty acids of type 2 diabetic serum decrease the stemness properties of human adipose-derived mesenchymal stem cells.

In type 2 diabetes, dyslipidemia and increased serum free fatty acids (FFAs) exacerbate the development of the disease through a negative effect on insulin secretion. Adipose-derived mesenchymal stem cells (AdMSCs) play a key role in regenerative medicine, and these cells can potentially be applied as novel therapeutic resources in the treatment of diabetes. In this study, AdMSCs were treated with diabetic or nondiabetic serum FFAs isolated from women of menopausal age. Serum FFAs were analyzed using gas-liquid chromatography. The expression level of the stemness markers CD49e and CD90 and the Wnt signaling target genes Axin-2 and c-Myc were evaluated using real-time PCR. The proliferation rate and colony formation were also assessed using a BrdU assay and crystal violet staining, respectively. The level of glutathione was assessed using cell fluorescence staining. Compared to nondiabetic serum, diabetic serum contained a higher percentage of oleate (1.5-fold, p < 0.01). In comparison with nondiabetic FFAs, diabetic FFAs demonstrated decreasing effects on the expression of CD90 (-51%, p < 0.001) and c-Myc (-48%, p < 0.05), and proliferation rate (-35%, p < 0.001), colony formation capacity (-50%, p < 0.01), and GSH levels (-62%, p < 0.05). The negative effect of the FFAs of diabetic serum on the stemness characteristics may impair the regenerative capabilities of AdMSCs.

A systematic review and meta-analysis for association of Helicobacter pylori colonization and celiac disease.

BACKGROUND AND OBJECTIVES: Based on some previous observational studies, there is a theory that suggests a potential relationship between Helicobacter pylori (H. pylori) colonization and celiac disease (CeD); however, the type of this relationship is still controversial. Therefore, we aimed to conduct a systematic review and meta-analysis to explore all related primary studies to find any possible association between CeD and human H. pylori colonization. DATA SOURCES: Studies were systematically searched and collected from four databases and different types of gray literature to cover all available evidence. After screening, the quality and risk of bias assessment of the selected articles were evaluated. SYNTHESIS METHODS: Meta-analysis calculated pooled odds ratio (OR) on the extracted data. Furthermore, heterogeneity, sensitivity, subgroups, and publication bias analyses were assessed. RESULTS: Twenty-six studies were included in this systematic review, with a total of 6001 cases and 135512 control people. The results of meta-analysis on 26 studies showed a significant and negative association between H. pylori colonization and CeD (pooled OR = 0.56; 95% CI = 0.45-0.70; P < 0.001), with no publication bias (P = 0.825). The L'Abbé plots also showed a trend of having more H. pylori colonization in the control group. Among subgroups, ORs were notably different only when the data were stratified by continents or risk of bias; however, subgroup analysis could not determine the source of heterogeneity. CONCLUSIONS: According to the meta-analysis, this negative association might imply a mild protective role of H. pylori against celiac disease. Although this negative association is not strong, it is statistically significant and should be further considered. Further investigations in both molecular and clinic fields with proper methodology and more detailed information are needed to discover more evidence and underlying mechanisms to clear the interactive aspects of H. pylori colonization in CeD patients. SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO): CRD42020167730 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167730.

Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials.

BACKGROUND: Soy has several beneficial effects on cardiovascular disease (CVD); however, results of clinical trial studies are equivocal. Thus, the present study sought to discern the efficacy of soy intake on blood pressure. METHODS: The search process was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, to ascertain studies investigating the efficacy of soy intake on blood pressure in adults, published up to June 2020. A random-effects model was applied to pool mean difference and 95 % confidence interval (CI). Begg's and Egger's methods were conducted to assess publication bias. RESULTS: Pooled effects from 17 effect sizes revealed a significant improvement in systolic blood pressure (SBP) (-1.70; -3.34 to -0.06 mmHg; I2 = 45.4 %) and diastolic blood pressure (DBP) (-1.27; -2.36 to -0.19 mmHg, I2 = 43.9 %) following soy consumption, in comparison with controls. Subgroup analysis demonstrated a reduction in both SBP and DBP in younger participants with lower baseline DBP and intervention durations of <16 weeks. CONCLUSION: Our results suggest that soy intake is associated with an ameliorating effect on blood pressure in adults.

Utilizing a nanocomposite consisting of zinc ferrite, copper oxide, and gold nanoparticles in the fabrication of a metformin electrochemical sensor supported on a glassy carbon electrode.

The conception and development of a new electrochemical sensor is reported for the detection of metformin (MET). Zinc ferrite and copper oxide nanostructure (ZnFe2O4-CuO) and gold nanoparticles (AuNPs) have been used to prepare a nanocomposite in modifying a glassy carbon electrode (GCE). The unique ZnFe2O4-CuO/Au nanocomposite was applied as a sensor for the determination of traces of MET by some electroanalytical techniques. Experimental parameters affecting the results were investigated and optimized. Under the optimum conditions and at a working potential of 0.85 V (vs. Ag/AgCl/3.0 M KCl), the sensor response is linear in the MET range of 1.0 nmol L-1 to 1.0 µmol L-1 MET. The limit of detection (LOD) is 0.3 nmol L-1 (at an S/N ratio of 3) and the sensitivity is 1.13 µA µmol L-1 cm-2. The sensor was applied to the determination of MET in real samples where it gave acceptable results. Graphical abstract.

Effect of Remineralizing Agents on Tooth Color after Home Bleaching.

OBJECTIVES: The purpose was to investigate the effect of casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) paste, Remin Pro paste, and 0.05% sodium fluoride (NaF) mouthwash on teeth discoloration after home bleaching. MATERIALS AND METHODS: In this in-vitro study, 48 intact and unstained human incisors were divided into four groups (n=12): control (Group 1), CPP-ACPF paste (Group 2), Remin Pro paste (Group 3), and 0.05% NaF mouthwash (Group 4). The specimens were bleached using 20% carbamide peroxide gel for 21 days and were subjected to pH cycling and surface treatment with remineralizing agents for one month. The color of the specimens was determined according to the CIELAB color space at baseline, after bleaching, and after surface treatment. Data were analyzed using one-way analysis of variance (ANOVA), post-hoc least significant difference (LSD) test, and one-sample t-test (P=0.05). RESULTS: ANOVA showed a significant difference in the mean ΔE of the four groups after surface treatment (P<0.05). Post-hoc LSD test showed a significant difference between the mean ΔE of the control group and those of the treatment groups (P<0.05) with no significant difference between the treatment groups, except for Remin Pro. The mean ΔE and ΔL of the Remin Pro group showed less change than those of the CPP-ACPF and NaF groups, indicating that Remin Pro has the lowest potential for post-bleaching tooth discoloration. CONCLUSION: CPP-ACPF paste, Remin Pro paste, and 0.05% NaF mouthwash cause noticeable teeth discoloration immediately after bleaching. Remin Pro has less effect on tooth color than the other two products.

Comparison of the effect of standardized patient-based training with team-based learning on the knowledge of midwifery students in providing services to victims of rape.

BACKGROUND: Rape is a widespread and important issue in the field of public health, and its victims require comprehensive and gender-sensitive health services. Healthcare providers, especially midwives, play an important role in the diagnosis and treatment of rape, and improving their knowledge has been an essential factor in enhancing the quality of service provided. OBJECTIVE: The objective of the study is to compare the impact of standardized patient-based training and team-based learning on midwifery students' knowledge for providing services to rape victims. MATERIALS AND METHODS: In this randomized quasiexperimental study, 75 midwifery students of Mashhad School of Nursing and Midwifery were selected using available sampling method and were assigned to two groups of standardized patient-based training (n = 38) and team-based learning (n = 37). After performing pretest, standardized patient-based training group and team-based learning group were trained separately for 6 h. One week after intervention, posttest was performed. Data were collected and analyzed using the Academic Specifications Questionnaire and the Knowledge Assessment Questionnaire. Significance level was considered at P < 0.05. RESULTS: The two groups were homogeneous in terms of demographic characteristics. There was no statistically significant difference between the two groups in the posttest in terms of knowledge score (P = 0.079). However, there was a statistically significant difference in the level of knowledge between the two groups (P = 0.037). CONCLUSIONS: Given the effectiveness of both standardized patient-based training method and team-based learning method on enhancing midwifery students' knowledge for providing services to rape victims, these methods can be used in students' education.