The changes on salivary flow rates, buffering capacity and chromogranin A levels in adults after bariatric surgery.

OBJECTIVES: This study aimed to investigate changes in salivary flow rates, buffering capacity, and salivary chromogranin A (CHGA) levels in adults undergoing bariatric surgery (BS) compared with a non-obese control group. MATERIALS AND METHODS: Salivary analyses were performed on 62 participants aged over 50 years, stratified into two groups matched for age and gender-individuals who had undergone bariatric surgery (BS) (n = 31) and a corresponding healthy control group (n = 31). Before saliva collection, participants completed a comprehensive 11-point visual numerical rating scale (NRS 0-10) xerostomia questionnaire, assessing subjective perceptions of two key aspects: dryness of the oral mucosa and resultant impact on oral functional ability. Three distinct saliva measurements were obtained: unstimulated whole saliva (UWS), stimulated whole saliva (SWS), and unstimulated upper labial saliva (ULS). The buffering capacity of unstimulated saliva was assessed using pH indicator strips, and concentrations of salivary Chromogranin A (CHGA) were quantified in stimulated saliva via enzyme-linked immunosorbent assay (ELISA). RESULTS: After BS, more than 40% of BS group patients reported xerostomia, with 16.1% experiencing only mild symptoms without significant functional impact (p = 0.009). The prevalence of xerostomia and tongue dryness was higher in the BS group compared to the control group (p = 0.028 and p = 0.025, respectively). The comparative analysis unveiled no statistically significant differences in flow rates of unstimulated upper labial saliva (ULS), unstimulated whole saliva (UWS), and stimulated whole saliva (SWS) between the control group and patients who underwent bariatric surgery. However, in patients undergone BS with xerostomia, both ULS and UWS flow rates were significantly lower than in controls with xerostomia (p = 0.014 and p = 0.007, respectively). The buffering capacity was significantly lower in patients undergone BS than in controls (p = 0.009). No differences were found between groups regarding CHGA concentration and output values, nevertheless, higher values of CHGA concentrations were significantly correlated to lower flow rates. CONCLUSION: According to the results, this study suggests that individuals undergoing BS may exhibit altered salivary buffering capacity and reduced unstimulated salivary flows in the presence of xerostomia. Additionally, the findings suggest that elevated concentration of salivary CHGA might be associated, in part, with salivary gland hypofunction. CLINICAL RELEVANCE: The clinical significance of this study lies in highlighting the changes in salivary functions after BS. The identified salivary alterations might be attributed to adverse effects of BS such as vomiting, gastroesophageal reflux, and dehydration. Understanding these changes is crucial for healthcare professionals involved in the care of post-BS patients, as it sheds light on potential oral health challenges that may arise as a consequence of the surgical intervention. Monitoring and managing these salivary alterations can contribute to comprehensive patient care and enhance the overall postoperative experience for individuals undergoing BS.

Thermal Profiles in Water Injection Wells: Reduction in the Systematic Error of Flow Measurements during the Transient Regime.

This article presents an analytical solution for calculating the flow rate in water injection wells based on the established thermal profile along the tubing. The intent is to minimize the intrinsic systematic error of classic quasi-static methodologies, which assume that all thermal transience on well completion has passed. When these techniques are applied during the initial hours of injection well operation, it can result in errors higher than 20%. To solve this limitation, the first law of thermodynamics was used to define a mathematical model and a thermal profile was established in the injection fluid, captured by using distributed temperature systems (DTSs) installed inside the tubing. The geothermal profile was also established naturally by a thermal source in the earth to determine the thermal gradient. A computational simulation of the injection well was developed to validate the mathematical solution. The simulation intended to generate the fluid's thermal profile, for which data were not available for the desired time period. As a result, at the cost of greater complexity, the systematic error dropped to values below 1% in the first two hours of well operation, as seen throughout this document. The code was developed in Phyton, version 1.7.0., from Anaconda Navigator.

Experimental-Density Functional Theory (DFT) Study of the Inhibitory Effect of Furan Residues in the Ziegler-Natta Catalyst during Polypropylene Synthesis.

In this experimental-theoretical study, the effect of furan on Ziegler-Natta catalyst productivity, melt flow index (MFI), and mechanical properties of polypropylene were investigated. Through the analysis of the global and local reactivity of the reagents, it was determined that the furan acts as an electron donor. In contrast, the titanium of the ZN catalyst acts as an electron acceptor. It is postulated that this difference in reactivity could lead to forming a furan-titanium complex, which blocks the catalyst's active sites and reduces its efficiency for propylene polymerization. Theoretical results showed a high adsorption affinity of furan to the active site of the Ti catalyst, indicating that furan tends to bind strongly to the catalyst, thus blocking the active sites and decreasing the availability for propylene polymerization. The experimental data revealed that the presence of furan significantly reduced the productivity of the ZN catalyst by 10, 20, and 41% for concentrations of 6, 12.23, and 25.03 ppm furan, respectively. In addition, a proportional relationship was observed between the furan concentration and the MFI melt index of the polymer, where the higher the furan concentration, the higher the MFI. Likewise, the presence of furan negatively affected the mechanical properties of polypropylene, especially the impact Izod value, with percentage decreases of 9, 18, and 22% for concentrations of 6, 12.23, and 25.03 ppm furan, respectively.

Estrategias de prevención de lesiones en corredores de diferentes niveles y distancias. Revisión sistemática / Injury prevention strategies in runners of different levels and distances. A systematic review

RESUMEN Objetivo: Analizar los efectos de diferentes tipos de entrenamiento para la prevención de lesiones en corredores de diferentes niveles. Materiales y método: Revisión sistemática sin metaanálisis. Se realizó una búsqueda bibliográfica limitada a ensayos clínicos, estudios controlados no aleatorizados y estudios controlados aleatorizados realizados en corredores de todos los niveles y publicados entre enero de 2002 y enero 2022. Se analizaron los efectos de la aplicación de entrenamiento para la prevención de lesiones, en comparación con el entrenamiento normal o la no intervención, y su efectividad en la incidencia de lesiones en esta población. Resultados: Se incluyeron 10 artículos (N=7960 corredores) para la lectura completa y el análisis de datos. Múltiples intervenciones fueron aplicadas para la prevención de lesiones en corredores, con hallazgos contrapuestos en cuanto a la efectividad en la disminución de lesiones relacionadas con la carrera (en total, 3134). Los métodos más efectivos fueron los programas dirigidos y monitoreados por profesionales, enfocados en el fortalecimiento de los músculos del pie; los programas multicomponente y el entrenamiento funcional con reeducación neuromuscular del valgo dinámico de rodilla y reentrenamiento de la carrera. Los programas que no demostraron un impacto significativo en la reducción de lesiones relacionadas con la carrera fueron los programas en línea y autorregulados por el corredor. Conclusión: No puede establecerse con evidencia sólida que una estrategia sea significativamente más efectiva, en comparación con otras estrategias, para la disminución de la incidencia de lesiones en corredores. Existe una inferencia posible relacionada a la efectividad de programas individualizados y programas multicomponente que están enfocados en lo neuromuscular y la corrección de la carrera y monitoreados regularmente por profesionales; sin embargo, la cantidad de trabajos de buena calidad es limitada para establecer conclusiones confiables. Se necesitan más estudios en este campo.

ABSTRACT Objective: To analyze the effects of different training interventions for the prevention of injuries in runners of different levels. Materials and method: A systematic review without meta-analysis was conducted. A literature search limited to controlled clinical studies, non-randomized controlled studies, and randomized controlled studies conducted on runners of all levels and published from January 2002 to January 2022 was performed. We analyzed the effects of training for injury prevention, compared with normal training or non-intervention, and its effectiveness on the incidence of injuries in this population. Results: We included 10 articles (N=7960 runners) for full reading and data analysis. Multiple interventions were applied for the prevention of injuries in runners, with contradictory findings regarding the effectiveness in reducing race-related injuries (in total, 3134). The most effective training methods were professionally-directed and monitored programs, focused on strengthening foot muscles; multicomponent programs; and functional training with neuromuscular re-education of the dynamic valgus knee and running re-training. The programs that did not show a significant impact on reducing race-related injuries were online and self-regulated programs. Conclusion: We cannot confirm that one strategy is more effective than another in reducing the incidence of injuries in runners. Individualized programs and multicomponent programs focused on neuromuscular aspects and proper running technique, regularly monitored by professionals, may be considered effective; however, the number of reliable studies is limited. Further research is needed on this field.

LIMITED EVIDENCE SUGGESTS THAT END STAGE KIDNEY DISEASE AND HEMODIALYSIS MAY IMPACT SALIVARY FLOW RATE AND COMPOSITION.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Rodrigues RP, Vidigal MT, Vieira WA, Nascimento GG, Sabino-Silva R, Blumenberg C, Siqueira MF, Siqueira WL, Paranhos LR. Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis. Journal of Nephrology. 2022 Mar 2:1-29. SOURCE OF FUNDING: The work has been partially funded by CAPES-Finance Code 001. The authors have also acknowledged The Brazilian National Council for Scientific and Technological Development (CNPq) and Minas Gerais State Agency for Research and Development, Brazil (FAPEMIG) for the support. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Role of Nitrogen and Yttrium Contents in Manufacturing (Cr, Y)Nx Film Nanostructures.

The high-power impulse magnetron sputtering (HiPIMS) technique was applied to deposit multilayer-like (Cr, Y)Nx coatings on AISI 304L stainless steel, using pendular substrate oscillation and a Cr-Y target and varying the nitrogen flow rate from 10 to 50 sccm. The microstructure, mechanical and tribological properties were investigated by scanning and transmission electron microscopy, X-ray photoelectron spectroscopy, X-ray diffraction, instrumented nano-hardness, and wear tests. The columnar grain structure became highly segmented and nanosized due to pendular substrate oscillation and the addition of yttrium. The deposition rate increased continuously with the growing nitrogen flow rate. The increase in nitrogen flow from 10 to 50 sccm increased the hardness of the coatings (Cr, Y)Nx, with a maximum hardness value of 32.7 GPa for the coating (Cr, Y)Nx with a nitrogen flow of 50 sccm, which greatly surpasses the hardness of CrN films with multilayer-like (Cr, Y)Nx coatings architecture. The best mechanical and tribological performance was achieved for a nitrogen flow rate of 50 sccm. This was enabled by more elevated compressive stresses and impact energies of the impinging ions during film growth, owing to an increase of HiPIMS peak voltage with a rising N2/Ar ratio.

Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis.

OBJECTIVES: This study is aimed at describing changes in salivary flow rate and ionic composition present in the saliva of chronic kidney disease (CKD) patients by assessing the pH, calcium, phosphate, and phosphorus concentrations and comparing them to healthy individuals, along with exploring the influence of hemodialysis on these parameters. METHODS: The bibliographical search was performed in nine databases to find all types of studies, including observational clinical studies, without restrictions regarding publication year or language. Two reviewers selected the studies, extracted the data, and assessed the risk of bias using JBI tools. Random-effect meta-analysis was performed with the standardized mean difference (SMD) as effect estimate, at a 95% confidence interval. RESULTS: Thirty-three studies were included in the qualitative synthesis and 31 studies were included in the meta-analysis. Chronic kidney disease patients presented lower salivary flow rate (SMD: - 1.73; 95% CI = - 2.14; - 1.31), higher pH (SMD: 1.57; 95% CI = 1.11; 2.03), and higher phosphorus concentration (SMD: 0.86; 95% CI = 0.63; 1.09) in saliva. Concurrently, salivary flow rate and pH presented significant changes after hemodialysis, with higher salivary flow rate (SMD: 0.53; 95% CI = 0.25; 0.81) and lower pH (SMD: - 0.53; 95% CI = - 0.88; - 0.19) in patients on hemodialysis treatment. CONCLUSION: Chronic kidney disease patients present reduced salivary flow rate and increased pH and phosphorus concentration in saliva. Hemodialysis can increase the salivary flow rate of these patients.

Effect of bleaching gels with different thickeners under normal and hyposalivation conditions: in situ study

Abstract Bleaching gel thickeners induce important changes in tooth enamel and these changes are reversed by saliva. Objective This in situ study aimed to evaluate the effect of bleaching gels with different thickeners on tooth enamel under normal and hyposalivation conditions. Methodology Of 28 participants, 14 had normal salivary flow and 14 had low salivary flow. For each salivary flow, four types of treatment were performed with different thickeners: no bleaching (negative control), bleaching with a commercial 10% carbamide peroxide (CP) gel with carbopol (positive control) and bleaching with experimental 10% CP gels with natrosol and aristoflex. Participants used a palatal appliance containing bovine enamel/dentin specimens for 15 days. From day 2 to day 15, specimens were bleached extraorally. The bleaching gel was applied according to the groups for four hours. When the bleaching gel was removed, the palatal appliance was inserted again in the participants' mouth until the next day for another bleaching application. This procedure was repeated for 14 days and on day 15, surface microhardness (SMH), color (ΔE*ab and ΔE00), surface roughness (Ra), scanning electron microscopy (SEM), and energy-dispersive X-ray spectrometry (EDS) analyses were performed and data were subjected to statistical analysis. Results Neither salivary flow nor thickeners influenced ΔE*ab and ΔE00 results. Carbopol had the lowest SMH, the highest Ra, and the lowest Ca% among all groups. For normal flow, natrosol and aristoflex had higher SMH. For low flow, aristoflex had higher SMH and natrosol and aristoflex had lower Ra. Aristoflex had higher Ca% and Ca/P and differed from carbopol for normal flow. Conclusion For normal flow, 10% CP gels with natrosol and aristoflex caused fewer surface changes, and for low flow, only the 10% CP gel with aristoflex.

Assessment of apical pressures at different automated irrigant flow rates: an ex vivo study based on computational fluid dynamic analysis / Avaliação de pressões apicais em diferentes taxas de fluxo irrigante automatizadas: um estudo ex vivo baseado em análise dinâmica de fluidos computacionais

Objective: The current study aimed at assessing the induced apical pressure at various simulated irrigant flow rates. Materials and Methods: Forty eight freshly extracted single-rooted premolars were decoronated and prepared to size 30 0.04 taper using HY-Flex CM rotary file system and were scanned using cone-beam computed tomography (CBCT). The scanned images were reconstructed to three-dimensional Computer-aided design models (CAD) and the 3D needle was also reconstructed. Finally, simulations were done by placing the 30 gauge open-ended needle 3 mm short of the working length. Results: There was a statistically significant difference (p<0.05) among the different groups compared. 1 ml/min flow rate induced the least apical pressures (p<0.05) as compared to the other types. Conclusion: 1 ml/min flow rates induced the least apical pressures when open-ended needles are used for irrigation.(AU)

Objetivo: O presente estudo teve como objetivo avaliar a indução de pressão apical em várias taxas de fluxo irrigante simuladas. Material e Métodos: Quarenta e oito raízes de pré-molares unirradiculares recém extraídos tiveram suas coroas removidas, foram preparados para uma conicidade de tamanho 30 0.04 através de um sistema rotatório de limas HYFlex CM e foram escaneados via tomografia computadorizada cone-beam (CBCT). As imagens escaneadas e as agulhas para irrigação foram reconstruídas em modelos tridimensionais de design assistido por computador (CAD). Ao final, foram feitas simulações através de agulhas de calibre 30 e 3 mm a menos que o comprimento de trabalho. Resultados: Houve diferença estatisticamente significativa (p<0.05) entre os diferentes grupos. A taxa de fluxo de 1 ml/min induziu as menores pressões apicais (p<0.05) quando comparada às demais taxas. Conclusão: Taxas de fluxo de 1 ml/min induziram as menores pressões apicais quando agulhas de ponta aberta foram utilizadas para irrigação (AU)

Evaluación del Efecto de un Gel con Arginina sobre el PH y Flujo Salival / Evaluation of the Effect of Arginine Gel on pH and Salivary Flow

Se evaluó el efecto de un gel con arginina sobre el pH y flujo salival después de un uso de catorce días en mujeres con desmineralización dental leve. Se estableció un piloto de ensayo clínico controladoen el cual fueron incluidas 20 mujeres de 18 -23 años, sistémicamente sanas y con al menos un órgano dental con desmineralización ICDAS 3, dos grupos: Grupo A / sin arginina (N=10) y Grupo B/ con arginina (N=10). Se realizó una evaluación clínica y toma de una muestra de saliva no estimulada para la determinación del pH, y la medición del flujo salival al inicio y 15 días posterior a la utilización del gel. Se realizó el análisis estadístico con el programa GraphPadPrism versión 8. Una p<0,05 fue considerado como estadísticamente significativo. En ambos grupos se mantuvo el pH salival cercano a la neutralidad sin diferencias estadísticamente significativas y el flujo salival permaneció en valores normales tras la utilización del gel durante 14 días, aunque se observaron diferencias estadísticas significativas en la comparación inter-grupo. La utilización de un gel con arginina durante 14 días mantuvo el pH neutro y el flujo salival en niveles normales sin diferencias estadísticamente significativas con el grupo control.

The effect of an arginine gel on pH and salivary flow was evaluated after fourteen days of use in women with mild demineralization. A controlled pilot clinical trial was established in which 20 women aged 18-23 years, systemically healthy and with at least one dental organ with demineralization ICDAS 3 were included, two groups: Group A / without arginine (N = 10) and Group B / with arginine (N = 10). A clinical evaluation was carried out, and a sample of unstimulated saliva was taken to determine the pH and the measurement of salivary flow at the beginning and 15 days after using the gel. Statistical analysis was performed with the GraphPad Prism version 8 program. A p <0.05 was considered statistically significant. In both groups, salivary pH was maintained close to neutrality without statistically significant differences, and salivary flow remained at normal values after using the hydrogel for 14 days, although statistically significant differences were observed in the intergroup comparison. Using a gel with arginine for 14 days kept the neutral pH and salivary flow at normal levels without statistically significant differences from the control group.

Estimativa da taxa de pico de fluxo expiratório em jovens indianos / Estimation of peak expiratory flow rate in young Indians

INTRODUÇÃO: O pico de fluxo expiratório (PFE) é comumente usado para monitorar a progressão de doenças respiratórias, pois fornece boas informações sobre o estado das vias aéreas. Uma boa quantidade de pesquisas está sendo feita em todo o mundo para estabelecer uma equação de previsão local. A força-tarefa conjunta da Sociedade Torácica Americana e da Sociedade Respiratória Europeia promoveu pesquisas a esse respeito. Na Índia, os dados derivados da população caucasiana ainda são usados para o PFE. OBJETIVO: Estudar a relação dos parâmetros do PFE e os dados antropométricos como idade, altura, peso, índice de massa corporal (IMC), área de superfície corporal (ASC) e estabelecer uma equação de regressão para jovens adultos indianos. MÉTODOS: PFE foi feito em 1000 sujeitos de 15-25 anos da região metropolitana de Mumbai. O coeficiente de correlação de Pearson foi usado para entender a relação dos parâmetros antropométricos e PFE. A análise de regressão multivariada foi feita para estabelecer uma equação de predição. (Alfa 5%) RESULTADOS: Idade e todos os parâmetros antropométricos foram correlacionados com PFE. O pico de fluxo expiratório médio da população masculina foi de 515 ml / seg, enquanto a feminina foi de 399 ml / seg. Para o PFE, a maior correlação foi observada com a ASC seguida de altura, peso e idade, enquanto o IMC apresentou o menor coeficiente de correlação. TPFE teve a melhor significância com a idade, ASC, altura e IMC. Teve menos significado com o peso. No sexo feminino, a TPFE teve a melhor significância com altura, peso, IMC e idade. CONCLUSÃO: Existem diferenças de gênero na TPFE. Portanto, equações específicas de gênero são necessárias para a estimativa da TPFE

INTRODUCTION: Peak expiratory flow rate (PEFR) is commonly used to monitor the progression of respiratory diseases as it gives good information about the status of airways. A good amount of research is going across the world to establish a local prediction equation. The joint task force of the American thoracic society and European Respiratory Society has promoted research in this regard. In India, data derived from the Caucasian population are still used for PEFR. OBJECTIVE: To verify the relationship between PEF levels and the variables age, sex, anthropometric and body surface area, and establish the regression equation for young Indian adults. METHODS: A cross-sectional observational study was conducted in 15-25 years aged 1000 subjects from the Metropolitan region of Mumbai. Pearson's correlation coefficient was used to understand the relation of anthropometric parameters and PEFR. Multivariate regression analysis was done for establishing a prediction equation (Alpha 5%). RESULTS: Age and all anthropometric parameters were correlated with PEFR. The mean PEFR of the male population was 515 ml/sec, whereas, for females, it was 399 ml/sec, for PEFR highest correlation was observed with BSA (.696) followed by weight (.667), height (.630), age (.504) whereas BMI shown lowest correlation coefficient (.445). PEFR had the best significance with age, BSA, Height, and BMI. It had less significance with weight. In females, PEFR had the best significance with Height, weight, BMI, and Age. CONCLUSION: Gender-wise differences exist in PEFR. Hence gender-specific equations are needed for the estimation of PEFR.

Independência funcional e espirometria em pacientes adultos pós-unidade de terapia intensiva / Functional independence and spirometry in adult post-intensive care unit patients

RESUMO Objetivo: Relatar a independência funcional e o grau de comprometimento pulmonar em pacientes adultos 3 meses após a alta da unidade de terapia intensiva. Métodos: Este foi um estudo de coorte retrospectiva conduzido em uma unidade de terapia intensiva multiprofissional para pacientes adultos em um único centro. Incluíram-se pacientes admitidos à unidade de terapia intensiva entre janeiro de 2012 e dezembro de 2013 que, 3 meses mais tarde, foram submetidos à espirometria e responderam ao questionário Medida de Independência Funcional. Resultados: Os pacientes foram divididos em grupos segundo sua classificação de independência funcional e espirometria. O estudo incluiu 197 pacientes, que foram divididos entre os grupos maior dependência (n = 4), menor dependência (n = 12) e independente (n = 181). Na comparação dos três grupos com relação à classificação pela Medida de Independência Funcional, pacientes com maior dependência tinham escores Acute Physiology and Chronic Health Evaluation II e Sequential Organ Failure Assessment mais altos quando da admissão à unidade de terapia intensiva, idade mais avançada, mais dias sob ventilação mecânica e tempo mais longo de permanência na unidade de terapia intensiva e no hospital. A maioria dos pacientes apresentava comprometimento pulmonar, sendo o padrão obstrutivo o mais frequentemente observado. Na comparação da independência funcional com a função pulmonar, observou-se que, quanto pior a condição funcional, pior a função pulmonar, observando-se diferenças significantes em relação ao pico de fluxo expiratório (p = 0,030). Conclusão: Em sua maioria, os pacientes que retornaram ao ambulatório 3 meses após a alta tinham boa condição funcional, porém apresentavam comprometimento pulmonar relacionado com o grau de dependência funcional.

ABSTRACT Objective: To relate functional independence to the degree of pulmonary impairment in adult patients 3 months after discharge from the intensive care unit. Methods: This was a retrospective cohort study conducted in one adult intensive care unit and a multi-professional post-intensive care unit outpatient clinic of a single center. Patients admitted to the intensive care unit from January 2012 to December 2013 who underwent (3 months later) spirometry and answered the Functional Independence Measure Questionnaire were included. Results: Patients were divided into groups according to the classification of functional independence and spirometry. The study included 197 patients who were divided into greater dependence (n = 4), lower dependence (n = 12) and independent (n = 181) groups. Comparing the three groups, regarding the classification of the Functional Independence Measure, patients with greater dependence had higher Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment values at intensive care unit admission with more advanced age, more days on mechanical ventilation, and longer stay in the intensive care unit and hospital. The majority of patients presented with pulmonary impairment, which was the obstructive pattern observed most frequently. When comparing functional independence with pulmonary function, it was observed that the lower the functional status, the worse the pulmonary function, with a significant difference being observed in peak expiratory flow (p = 0.030). Conclusion: The majority of patients who returned to the outpatient clinic 3 months after discharge had good functional status but did present with pulmonary impairment, which is related to the degree of functional dependence.

Effect of Using Methylphenidate on Salivary Flow Rate and Salivary Buffering Capacity in Children with Attention-deficit/Hyperactivity Disorder

ABSTRACT Objective: Most drugs used to treat attention-deficit/hyperactivity disorder treatment can affect saliva secretion. Methylphenidate is the most commonly prescribed drug for the treatment of attention-deficit/hyperactivity disorder and was approved for use in children over the age of 6 years. However, limited information is available on the use and long-term adverse effects of methylphenidate in preschool children (< 6 years). We explored the effects of methylphenidate on salivary flow rate and salivary buffering capacity during treatment for attention-deficit/hyperactivity disorder. Methods: Children who were diagnosed with attention-deficit/hyperactivity disorder by expert psychiatrists, under medical treatment, and those who had no other systemic diseases were included. Stimulated saliva samples were collected before prescription of methylphenidate and after 15 days, 30 days and 3 months of regular drug intake. The samples were analysed for Streptococcus mutans, as well as salivary buffering capacity and salivary flow rate. Twenty children (age range, 6-15 years) with attention-deficit/hyperactivity disorder were included. Results: The mean salivary buffering capacity value at month 3 was significantly lower than that at baseline and at day 15. Regarding the distribution according to salivary flow rate, statistically significant differences were found between baseline and the first month and between baseline and month 3 These results indicate that methylphenidate consumption in children with attention-deficit/hyperactivity disorder leads to reduced salivary buffering capacity and salivary flow rate after 3 months of follow-up. Conclusion: Parents should be informed about necessary preventive dental treatments to minimize the negative oral and dental effects of long-term drug use in children.

Cough peak flow to predict the extubation outcome: Comparison between three cough stimulation methods.

OBJECTIVES: The purpose of this study was to compare the predictive value of three cough peak flow (CPF) maneuvers in predicting the extubation outcome in a cohort of mechanically ventilated subjects. METHODS: Eighty-one mechanically ventilated subjects who succeeded in the spontaneous breathing trial were included. In a randomized order, CPF was stimulated and measured using three methods: voluntary command (V_CPF), tracheal saline instillation (S_CPF), and mechanical stimulation with a catheter (C_CPF). Additionally, CPF was measured 20 min after the extubation (PE_CPF). The diagnostic accuracy of the CPF methods in relation to the extubation outcome was measured using the receiver operating characteristic (ROC) curve. ROC curve results were compared using the Hanley and McNeil method. RESULTS: The three methods presented high accuracy in predicting the extubation outcome (V_CPF = 0.89, S_CPF = 0.93, and C_CPF = 0.90), without statistically significant differences between them (V_CPF vs. S_CPF, p = 0.14; V_CPF vs. C_CPF, p = 0.84; S_CPF vs. C_CPF, p = 0.13). The optimum cutoff values were V_CPF = 45 L/min, S_CPF = 60 L/min, and C_CPF = 55 L/min. PE_CPF also showed high accuracy in predicting the extubation outcome (AUC = 0.95; cutoff = 75 L/min). CONCLUSIONS: In mechanically ventilated and cooperative subjects, there is no difference in the accuracy of CPF measured voluntarily, with stimulation using saline or by catheter stimulation in predicting the reintubation. CPF recording after endotracheal tube removal has high accuracy to predict the extubation outcome.

Peak Expiratory Flow as an Index of Frailty Syndrome in Older Adults: A Cross-Sectional Study.

OBJECTIVES: to compare the obtained and predicted peak expiratory flow (PEF) values between frail, pre-frail, and non-frail older adults; verify the association between PEF and FS; and establish cut-off points for PEF as determinants of frailty syndrome (FS). DESIGN: Cross-sectional study. LOCATION: Macapá, Amapá, Brazil. PARTICIPANTS: Community-based study community-dwelling older people. METHODS: PEF was evaluated using a peak-flow meter and FS was evaluated using Fried's frailty phenotype. The statistical analyses performed included a multinomial logistic regression model and Receiver Operating Characteristic (ROC) curves to establish cut-off points for discriminating FS. RESULTS: 409 older adults with a mean age of 70.09±7.22 years were evaluated; of these, 58.7% were pre-frail, and 12.7% were frail. PEF was lower in frail than in pre-frail participants, and lower in pre-frail than in non-frail. Frail and pre-frail older adults obtained lower PEF values than predicted. PEF (% Predicted) was inversely associated with frailty and pre-frailty even after adjustment. Cut-off points were established to discriminate the presence of frailty in older men (PEF≤350L/min; AUC=0.669; sensitivity=76.92%; specificity=52%) and women (PEF≤220L/min; AUC=0.597; sensitivity=71.79%; specificity=46.98%). CONCLUSIONS: Frail and pre-frail older adults presented significantly lower PEF than non-frail participants, and these values were lower than predicted. PEF was inversely associated with frailty and pre-frailty. PEF cut-off points can be used as a complementary method to indicate frailty in community-dwelling older adults.

Influence of the Flow Rate in an Automated Microfluidic Electronic Tongue Tested for Sucralose Differentiation.

Incorporating electronic tongues into microfluidic devices brings benefits as dealing with small amounts of sample/discharge. Nonetheless, such measurements may be time-consuming in some applications once they require several operational steps. Here, we designed four collinear electrodes on a single printed circuit board, further comprised inside a straight microchannel, culminating in a robust e-tongue device for faster data acquisition. An analog multiplexing circuit automated the signal's routing from each of the four sensing units to an impedance analyzer. Both instruments and a syringe pump are controlled by dedicated software. The automated e-tongue was tested with four Brazilian brands of liquid sucralose-based sweeteners under 20 different flow rates, aiming to systematically evaluate the influence of the flow rate in the discrimination among sweet tastes sold as the same food product. All four brands were successfully distinguished using principal component analysis of the raw data, and despite the nearly identical sucralose-based taste in all samples, all brands' significant distinction is attributed to small differences in the ingredients and manufacturing processes to deliver the final food product. The increasing flow rate improves the analyte's discrimination, as the silhouette coefficient reaches a plateau at ~3 mL/h. We used an equivalent circuit model to evaluate the raw data, finding a decrease in the double-layer capacitance proportional to improvements in the samples' discrimination. In other words, the flow rate increase mitigates the formation of the double-layer, resulting in faster stabilization and better repeatability in the sensor response.

Salivary flow rates and buffer capacity and its relationship with oral health status: a cross-sectional study on crack-cocaine-addicted males.

This cross-sectional study evaluated the saliva profile in crack-cocaine-addicted males and its relationship with dental caries, periodontal disease, and oral mucosal lesion (OML) using 148 adult male volunteers (37 addicted; 111 non-addicted) at the School of Dentistry, Federal University of Bahia. Data on decayed, missing and filled teeth (DMFT), periodontal disease and OML were collected from the clinical examination of the participants. Samples were analysed for the salivary flow rate (SFR) of unstimulated and wax-stimulated whole saliva and the saliva buffer capacity. Bivariate and regression analyses were conducted to assess the salivary profile and its association with the oral status of addicted participants (α = 0.05). The mean buffer capacity of stimulated saliva was significantly lower in the addicted participants (pH 5.2 ± 1.7) than in the non-addicted group (pH 5.8 ± 1.3, p = 0.03). In the addicted group, OML was associated with a stimulated SFR < 1.0 mL/min (OR = 11.98, 95% CI = 1.30-27.10, p = 0.04). The DMFT index and periodontal disease were not associated with the salivary profile, but with older age (OR = 7.20, 95% CI = 1.51-31.14, p = 0.01) and lower education levels (OR = 24.00, 95% CI = 1.68-341.00, p = 0.02), respectively. In conclusion, addiction was associated with the lower buffer capacity of stimulated saliva, and OML was associated with lower-stimulated salivary flow rate. Periodontal disease or DMFT was not associated with salivary factors in addicted males. Therapy approaches dealing with saliva status may be important for use with addicted males to reduce OMLs.

Effect of photobiomodulation on salivary flow and composition, xerostomia and quality of life of patients during head and neck radiotherapy in short term follow-up: A randomized controlled clinical trial.

Xerostomia and hyposalivation are frequent conditions in patients undergoing head and neck radiotherapy, which usually lead to a worsening of quality of life. This study aimed to assess whether photobiomodulation (PBM) can minimize hyposalivation, xerostomia and qualitative changes on saliva and improve quality of life in patients undergoing radiotherapy in short-term follow-up. Twenty-one patients were randomly divided into two groups: sham group (SG) and laser group (LG). A diode laser was used for intra- (660 nm, 10 J/cm2, 0.28 J per point, 40 mW) and extra-oral (810 nm, 25 J/cm2, 0.7 J per point, 40 mW) applications over the salivary glands, three times a week, during the entire radiotherapy period. In SG, the tip of the instrument was sealed with blue rubber to prevent the passage of light. Xerostomia and pH were evaluated and unstimulated and stimulated salivary flow was determined before the start of radiotherapy (T1), after the 15th session (T2), after the end of radiotherapy (T3) and 60 days after radiotherapy (T4). Concentrations of calcium, total proteins, chloride, sodium, potassium and amylase and catalase activities were evaluated in stimulated saliva samples. Quality of life was assessed at times T1 and T4. Generalized estimating equations were used to assess differences in the outcome between times and groups. All patients showed worsening in unstimulated (p = .003) and stimulated (p < .001) salivary flow, xerostomia (p < .05) and quality of life during radiotherapy (p = .001). An increase in chloride concentrations was observed at times T3 and T4 (p < 0,05), and a reduction in amylase activity at T3 (p < .05). Unstimulated saliva pH was higher in LG than SG at T3 (p = .037). No difference between groups was noted in relation to salivary flow and composition, xerostomia or quality of life. Our results suggest that PBM may help in preserving salivary pH during radiotherapy.

Assessment of ventilatory function in patients with spinocerebellar ataxia type 2 / Avaliação da função ventilatória em pacientes com ataxia espinocerebelar tipo 2

Abstract Subclinical ventilatory dysfunction is observed in individuals with spinocerebellar ataxias (SCA). No studies have correlated ventilatory dysfunction to clinical and functional decline in SCA2. Objective: To evaluate the relationship between the values of peak expiratory flow (PEF), maximum inspiratory pressure (MIP), and presence of respiratory complaints with age, disease duration, age at onset of symptoms, balance scores, independence in basic (ADL) and instrumental (IADL) Activities of Daily Living (ADLs), and severity of ataxia (SARA) in individuals with SCA2. Methods: Cross-sectional study evaluating age, disease duration, age at onset of symptoms, scores in the Berg Balance Scale and in the SARA, Functional Independence Measure and Lawton's scale, values of PEF and MIP, and the presence of respiratory complaints. Results: The study included 36 individuals with SCA2, with a mean age of 42.5±2.4 years, disease duration of 7.6±8.2 years, age 33.7±11.5 years at onset of symptoms, and 9.9±10.3 points in the SARA scale. The lowest PEF values correlated with the longer disease duration (p=0.021). The lowest values of PEF and MIP correlated with greater balance impairment (p=0.019 and p=0.045, respectively), increased degree of dependence in the ADL (p=0.006 and p=0.050, respectively) and IADL (p=0.003 and p=0.001, respectively) scales, and highest severity of ataxia (p=0.00 and p=0.017, respectively). Respiratory complaints were observed in 12 (33.3%) individuals and were not related to age, disease duration, age at onset of symptoms, balance, independence, ataxia severity, or PEF and MIP values. Conclusion: Ventilatory dysfunction, even when asymptomatic, is related to balance impairment, independence, and ataxia severity in individuals with SCA2.

Resumo Disfunção ventilatória subclínica tem sido observada em indivíduos com ataxias espinocerebelares (SCA). Não existem estudos relacionando disfunção ventilatória ao declínio clínico e funcional na SCA2. Objetivo: Avaliar a relação dos valores de Pico de Fluxo Expiratório (PFE), Pressão Inspiratória Máxima (PIMAX) e presença de queixas respiratórias com idade, tempo de doença, idade de início dos sintomas, escore de equilíbrio, independência para atividades básicas (AVD) e instrumentais (AIVD) de vida diária e gravidade da ataxia (SARA) em indivíduos com SCA2. Métodos: Estudo transversal, considerando: idade, tempo de doença, idade de início dos sintomas, escores nas Escalas SARA, Equilíbrio de Berg, Medida da Independência Funcional e de Lawton, valores de PFE, PIMAX e queixas respiratórias. Resultados: Foram avaliados 36 indivíduos com SCA2 com média de 42,5±2,4) anos de idade, 7,6±8,2 anos de tempo de doença, 33,7±11,5 anos de idade de início dos sintomas e 9,9±10,3 pontos na escala SARA. Os menores valores de PFE estiveram relacionados ao maior tempo de doença (p=0,021). Os menores valores de PFE e PIMAX estiveram relacionados ao maior comprometimento do equilíbrio (p=0,019; p=0,045, respectivamente), maior dependência para ADV (p=0,006; p=0,050, respectivamente) e AIVD (p=0,003; p=0,001, respectivamente) e maior gravidade da ataxia (p=0,006; p=0,017, respectivamente). Foram observadas queixas respiratórias em 12 (33,3%) indivíduos que não estiveram relacionadas à idade, idade de início dos sintomas, tempo de doença, equilíbrio, independência, gravidade da ataxia, ou valores de PFE e PIMAX. Conclusão: A disfunção ventilatória, mesmo quando assintomática, está relacionada ao comprometimento do equilíbrio, à independência e à gravidade da ataxia em indivíduos com SCA2.

Prognostic Prediction of Cardiopulmonary Exercise Test Parameters in Heart Failure Patients with Atrial Fibrillation / Previsão Prognóstica dos Parâmetros do Teste de Esforço Cardiopulmonar em Pacientes com Insuficiência Cardíaca e Fibrilação Atrial

Abstract Background: Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients. Objective: To evaluate whether the risk of AF patients can be precisely stratified by relation with cardiopulmonary exercise test (CPET) cut-offs for heart transplantation (HT) selection. Methods: Prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death or urgent HT in 1-year follow-up. The primary endpoint was analysed by several CPET parameters for the highest area under the curve and for positive (PPV) and negative predictive value (NPV) in AF and sinus rhythm (SR) patients to detect if the current cut-offs for HT selection can precisely stratify the AF group. Statistical differences with a p-value <0.05 were considered significant. Results: There were 51 patients in the AF group and 223 in the SR group. The primary outcome was higher in the AF group (17.6% vs 8.1%, p = 0.038). The cut-off value of pVO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, with a PPV of 38.5% and an NPV of 94.3% in the SR group. The cut-off value of VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%) to pVO2 results in the AF group. Conclusion: Despite the fact that AF carries a worse prognosis for HF patients, the current cut-off of pVO2 for HT selection can precisely stratify this high-risk group.

Resumo Fundamento: A fibrilação atrial (FA) está associada ao aumento da mortalidade em pacientes com insuficiência cardíaca (IC). Objetivo: Avaliar se o risco de pacientes com FA pode ser estratificado com precisão em relação aos pontos de corte do teste de esforço cardiopulmonar (TECP) para seleção do transplante cardíaco (TC). Métodos: Avaliação prospectiva de 274 pacientes consecutivos com IC com fração de ejeção do ventrículo esquerdo ≤ 40%. O endpoint primário foi um composto de morte cardíaca ou TC urgente no seguimento de 1 ano. O endpoint primário foi analisado através de vários parâmetros do TECP para a maior área sob a curva e para o valor preditivo positivo (VPP) e negativo (VPN) em pacientes com FA e ritmo sinusal (RS) para detectar se os atuais pontos de corte para a seleção de TC podem estratificar com precisão o grupo com FA. Diferenças estatísticas com valor de p < 0,05 foram consideradas significativas. Resultados: Havia 51 pacientes no grupo de FA e 223 no grupo RS. O endpoint primário foi maior no grupo FA (17,6% vs. 8,1%, p = 0,038). O valor de corte de pVO2 para a seleção do TC mostrou um VPP de 100% e um VPN de 95,5% para o endpoint primário no grupo FA, com um VPP de 38,5% e um VPN de 94,3% no grupo RS. O valor de corte da inclinação VE/VCO2 apresentou valores mais baixos de VPP (33,3%) e valor semelhante de VPN (92,3%) aos resultados de pVO2 no grupo FA. Conclusões: Apesar do fato de a FA apresentar um pior prognóstico para os pacientes com IC, o atual ponto de corte de pVO2 para a seleção de TC pode estratificar com precisão esse grupo de alto risco.