Effects of Transcranial Direct Current Stimulation and Pelvic Floor Muscle Training in Women: protocol for a controlled, randomized, double-blind clinical trial / Efectos de la estimulación transcraneal por corriente directa y del entrenamiento muscular del suelo pélvico en mujeres: protocolo de un ensayo clínico controlado, aleatorizado y doble ciego / Efeitos da estimulação transcraniana por corrente contínua e treinamento muscular do assoalho pélvico em mulheres: protocolo para um ensaio clínico controlado, randomizado e duplo-cego

ABSTRACT Pelvic floor muscle weakness can lead to urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Although it can be minimized by pelvic floor muscle training (PFMT), its effects are not lasting. Therefore, using combination therapy seems promising. This study aims to evaluate the effect of transcranial direct current stimulation (tDCS) combined with PFMT on intravaginal pressure, pelvic floor muscle strength (PFMS), sexual function (SF), and quality of life (QoL) in healthy women. A total of 32 women, aged from 18 to 45 years, will undergo PFMT (with perineal contractions and relaxation) with the aid of pressure biofeedback associated with active tDCS or sham tDCS. Sessions will last 20 minutes, three times per week, for four weeks, totaling 12 sessions. During the protocol, participants will be instructed to also perform the home-based PFMT daily. The tDCS anodal electrode will be positioned over the supplementary motor area of the dominant cortical hemisphere, whereas the cathodal will be over the contralateral supraorbital region, with a 2mA intensity for 20 minutes. Intravaginal pressure (pressure gauge), PFM strength (measured by digital palpation and the PERFECT scheme), FSFI (Female Sexual Function Index), and QoL (SF-36 questionnaire) will be evaluated before and after the 12 sessions and after a 30-day follow-up.

RESUMEN La debilidad de la musculatura del suelo pélvico puede provocar incontinencia urinaria, prolapso de órganos pélvicos y disfunción sexual, y puede minimizarse mediante el entrenamiento de la musculatura del suelo pélvico (EMSP). Sin embargo, este efecto no es duradero. En este contexto, una terapia combinada puede ser prometedora para mejorar la situación. Este estudio tiene por objetivo evaluar el efecto de la estimulación transcraneal por corriente directa (ETCC) combinada con EMSP sobre la presión intravaginal, la fuerza muscular del suelo pélvico (FMSP), la función sexual (FS) y la calidad de vida (CV) en mujeres sanas. Participarán 32 mujeres, de entre 18 y 45 años, que se someterán a EMSP (contracciones y relajación del perineo) y a Biofeedback asociado a ETCC activa o ETCC sham durante 20 minutos, tres veces por semana, durante 4 semanas, con un total de 12 sesiones. Durante el protocolo, las participantes también se someterán diariamente a EMSP en casa. El electrodo anodal de la ETCC se colocará sobre el área motora suplementaria del hemisferio cortical dominante, y el electrodo catodal sobre la región supraorbital contralateral, a una intensidad de 2 mA, durante 20 minutos. Se evaluarán la presión intravaginal (manómetro), la FMSP (palpación digital, esquema Perfect), la FS (Índice de Función Sexual Femenina) y la CV (cuestionario SF-36) antes y después de las 12 sesiones, así como tras un seguimiento de 30 días.

RESUMO A fraqueza muscular do assoalho pélvico pode gerar incontinência urinária, prolapso de órgãos pélvicos e disfunção sexual, e pode ser minimizada pelo treinamento muscular do assoalho pélvico (TMAP). No entanto, este efeito não é duradouro. Assim, terapia combinada parece ser promissora para a melhora deste quadro. Dessa forma, objetiva-se avaliar o efeito da estimulação transcraniana por corrente contínua (ETCC), combinada ao TMAP, sobre a pressão intravaginal, força muscular do assoalho pélvico (FMAP), função sexual (FS) e qualidade de vida (QV) em mulheres saudáveis. Serão 32 mulheres, entre 18 e 45 anos, que realizaram TMAP (contrações e relaxamento do períneo) e Biofeedback associados a ETCC ativa ou ETCC sham por 20 minutos, três vezes por semana, por 4 semanas, totalizando 12 sessões. Durante o protocolo, as participantes também realizarão diariamente, em domicílio, o TMAP. O eletrodo anodal da ETCC será posicionado sobre a área motora suplementar do hemisfério cortical dominante, e o catodal sobre a região supraorbital contralateral, com intensidade de 2mA, por 20 minutos. A pressão intravaginal (manômetro de pressão), FMAP (palpação digital, esquema Perfect), FS (Índice de Função Sexual Feminina) e QV (questionário SF-36) foram avaliadas antes e depois das 12 sessões, bem como após acompanhamento de 30 dias.

Preheated acid associated with silane and electric current in the adhesion of the resin cement to ceramic

Abstract This study verified the effect of the combination of preheated hydrofluoric acid/silane/electric current in the adhesion of the resin cement to ceramic. IPS E.max Press ceramic discs embedded in PVC rigid tubes were divided into four groups associating preheated hydrofluoric acid and silane applied with electrical current (n=10): Ha+S (Heated acid + silane); Ha+S+Ec (Heated acid + silane + electrical current); A+S (Acid + silane) and A+S+Ec (Acid + silano + electrical current). Resin cement/ceramic samples were stored in water at 37°C for 24h. After storage, they were submitted to the microshear test, fracture analysis, and contact angle at 24h or after thermocycling (10,000 cycles/5-55ºC). Bond strength data were evaluated by two-way ANOVA. For comparison between evaluation times (24h or thermocycling) was applied unpaired t-test. A significance post-hoc test of p=0.05 was assumed for analyses and graphs (GraphPad Prism 9.0 software). At 24h, the microshear strength showed similar values between Ha+S, Ha+S+Ec, and A+S+Ec groups, while A+S showed the lowest value with a statistical difference. After thermocycling, Ha+S and Ha+S+Ec were similar, as well as A+S and A+S+Ec. There was a significant difference in all groups comparing 24h (highest value) with after thermocycling (lowest value). Adhesive fracture was predominant in all groups and evaluation times. Ha+S and A+S groups showed higher contact angle values compared to the Ha+S+Ec and A+S+Ec with lower values. In conclusion, the association of preheated hydrofluoric acid/silane applied or not with electric current promoted different microshear strength values, fracture types, and contact angles in the resin cement/ceramic bond.

Resumo Este estudo verificou o efeito da combinação ácido fluorídrico pré-aquecido/silano/corrente elétrica na adesão do cimento resinoso à cerâmica. Os discos cerâmicos IPS E.max Press embutidos em tubos rígidos de PVC foram separados em quatro grupos associando ácido fluorídrico pré-aquecido e silano aplicado com corrente elétrica (n=10): Ha+S (ácido aquecido + silano); Ha+S+Ec (Ácido aquecido + silano + corrente elétrica); A+S (Ácido + silano) e A+S+EC (Ácido + silano + corrente elétrica). Amostras de cimento resinoso/cerâmica foram armazenadas em água a 37°C por 24 horas. Após o armazenamento foram submetidas ao ensaio de micro cisalhamento, análise de fratura e ângulo de contato no período de 24 horas ou após termociclagem (10.000 ciclos/5-55ºC). Os dados de resistência de união foram avaliados por ANOVA dois fatores. Para comparação entre os tempos de avaliação (24 horas ou termociclagem) foi aplicado o teste t não pareado. Foi assumida significância de 5% para análises e gráficos (software GraphPad Prism 9.0). Em 24 horas, a resistência ao micro cisalhamento apresentou valores similares entre os grupos Ha+S, Ha+S+Ec e A+S+Ec, enquanto A+S apresentou menor valor com diferença estatística. Após a termociclagem, Ha+S e Ha+S+Ec foram similares, assim como A+S e A+S+Ec. Houve diferença significativa em todos os grupos comparando 24 horas (maior valor) com após termociclagem (menor valor). A fratura adesiva foi predominante em todos os grupos e tempos de avaliação. Os grupos Ha+S e A+S apresentaram maiores valores de ângulos de contato comparados aos grupos Ha+S+Ec e A+S+Ec com valores menores. Em conclusão, a associação ácido fluorídrico pré-aquecido/silano aplicado com corrente elétrica promoveu diferentes valores de resistência ao micro cisalhamento, tipos de fratura e ângulos de contato na adesão do cimento resinoso à cerâmica.

Evaluation the stress distribution in root canals by 3D finite element analysis after the materials used in reattaching the vertically root fractured fragments

Abstract The aim was to evaluate the effect of stress distribution on vertical, horizontal, and oblique forces on the tooth model after reattaching the fragments of the maxillary incisor with vertical root fracture (VRF) using different materials, by 3D finite element analysis (FEA). Tooth with a root canal, spongious, and cortical bone models were designed. VRF was modeled on a tooth with 4 different re-attachment models: Group 1: dual-cure cement (DC)+fiber reinforced composite (FRC), Group 2: DC+polyethylene fiber, Group 3: DC+glass fiber, and Group 4:DC. 100 N force was applied in 3 different directions. Maximum principal stresses (σmax) of dentin, and re-attachment materials were evaluated on colored images. The highest σmax values ​​were on the repair materials under vertical forces for Groups 1 and 4, respectively; Groups 2 and 3 showed similarity. The highest σmax values in repair materials under horizontal and oblique forces were observed in Group 3 however the lowest σmax values in repair materials under oblique and horizontal forces were observed in Group 1. The stress values ​​on repair materials gradually increased respectively starting from horizontal to vertical. As the elasticity modulus of the repair materials increased, the stress values ​​on root dentin increased. Through all force directions, except vertical forces, lower stress values were observed with FRC. The fracture resistance was bigger when using solely FRC or dual-cure resin cement in comparison to fiber-supported designs. Adding polyethylene fiber to re-restorations decreased stress values ​​compared to glass fiber addition. Therefore, when adding fibers, polyethylene fiber will be advantageous.

Resumo O objetivo foi avaliar o efeito da distribuição de estresse nas forças verticais, horizontais e oblíquas no modelo de dente após a recolocação dos fragmentos do incisivo superior com fratura radicular vertical (FRV) usando diferentes materiais, por meio da análise de elementos finitos (FEA) em 3D. Métodos: Foram projetados modelos de dentes com canal radicular, osso esponjoso e cortical. A FRV foi modelada em um dente com 4 modelos diferentes de reataque, como Grupo 1: cimento de cura dupla (DC) + compósito reforçado com fibra (FRC), Grupo 2: DC + fibra de polietileno, Grupo 3: DC + fibra de vidro e Grupo 4: DC. Foi aplicada uma força de 100 N em 3 direções diferentes. As tensões principais máximas (σmax) da dentina e os materiais de recolocação foram avaliados em imagens coloridas. Resultados: Os valores mais altos de σmax foram registrados nos materiais de reparo sob forças verticais para os Grupos 1 e 4, respectivamente; os Grupos 2 e 3 apresentaram semelhança. Os valores mais altos de σmax nos materiais de reparo sob forças horizontais e oblíquas foram observados no Grupo 3; no entanto, os valores mais baixos de σmax nos materiais de reparo sob forças oblíquas e horizontais foram observados no Grupo 1. Os valores de tensão nos materiais de reparo aumentaram gradualmente, respectivamente, começando da holizontal para a vertical. À medida que o módulo de elasticidade dos materiais de reparo aumentava, os valores de tensão na dentina da raiz aumentavam. Em todas as direções de força, exceto nas forças verticais, foram observados valores de tensão mais baixos com o FRC. Conclusões: a resistência à fratura foi maior quando se utilizou apenas FRC ou cimento resinoso de cura dupla em comparação com os designs com suporte de fibra. A adição de fibra de polietileno às restaurações diminuiu os valores de tensão em comparação com a adição de fibra de vidro. Portanto, ao adicionar fibras, a fibra de polietileno será vantajosa.

Impact of Access Cavity Design on Fracture Resistance of Endodontically Treated Maxillary First Premolar: In Vitro

Abstract This study was designed to investigate the impact of access cavity designs on fracture resistance of endodontically treated maxillary first premolars. The study sample consisted of 72 intact maxillary first premolars, randomly divided into six groups (n = 12). A standardized proximal cavity preparation was prepared for all samples using standard bur. Groups I: control group with only standard proximal cavity and no endodontic access, group II: Truss access cavity, group III: Separated access to buccal and palatal canals without removal of dentine in between, group IV: Access to buccal and palatal canals with removal of dentine in between, group V: Traditional access cavity, group VI: Mesio-occlusal-distal cavity (MOD). For groups I and VI, only composite restoration was used to restore the proximal cavity, while for groups II- V, the access was prepared and endodontic treatment was performed on all teeth, then composite restoration was placed. The root canals were instrumented using nickel-titanium files, irrigated with sodium hypochlorite, and filled with AH plus sealer and gutta-percha using warm vertical condensation. All samples were then placed in an acrylic mold and underwent thermal aging for 10,000 cycles between 5 and 55°C. The samples were fixed in a universal testing machine with the long axis of the roots positioned at 20° to a load applied at a crosshead speed of 1 mm/min using a stainless steel semi-spherical indenter (Ø = 3 mm) until fracture occurred to determine the fracture resistance force in Newton. The normality test (Shapiro-Wilk) showed that data are normally distributed. Group II exhibited the highest mean fracture resistance, and group VI was the least likely to resist the fracture. No statistically significant differences between tested groups (p-value = 0.237). The MOD group showed a more unfavorable mode of fracture compared to other groups. No significant difference in fracture resistance between conservative and traditional access cavities. The missing marginal ridges, such as in MOD cavities played an important role in decreasing the fracture resistance of endodontically treated teeth.

Resumo O objetivo deste estudo foi investigar o impacto do design da cavidade de acesso na resistência à fratura de primeiros pré-molares superiores tratados endodonticamente. MÉTODOS: A amostra do estudo consistiu em 72 primeiros pré-molares superiores intactos, divididos aleatoriamente em seis grupos (n = 12). Um preparo padronizado da cavidade proximal foi realizado para todas as amostras usando broca padrão. Grupos I: grupo de controle com apenas cavidade proximal padrão e sem acesso endodôntico, grupo II: cavidade de acesso Truss, grupo III: acesso separado aos canais vestibular e palatino sem remoção de dentina entre eles, grupo IV: acesso aos canais vestibular e palatino com remoção de dentina entre eles, grupo V: cavidade de acesso tradicional, grupo VI: cavidade mesio-oclusal-distal (MOD). Para os grupos I e VI, apenas a restauração de compósito foi usada para restaurar a cavidade proximal. Já nos grupos II e V, o acesso foi preparado e o tratamento endodôntico foi realizado em todos os dentes e, em seguida, foi colocada a restauração de resina composta. Os canais radiculares foram instrumentados com limas de níquel-titânio, irrigados com hipoclorito de sódio e preenchidos com AH plus sealer e guta-percha usando condensação vertical quente. Todas as amostras foram então colocadas em molde de acrílico e submetidas a envelhecimento térmico por 10.000 ciclos entre 5 e 55°C. As amostras foram fixadas em uma máquina de teste universal com o eixo longo das raízes posicionado a 20° para uma carga aplicada a uma velocidade de cruzeta de 1 mm/min usando indentador semiesférico de aço inoxidável (Ø = 3 mm) até que ocorresse a fratura para determinar a força de resistência à fratura em Newton. RESULTADOS: O teste de normalidade (Shapiro-Wilk) mostrou que os dados são normalmente distribuídos. O grupo II apresentou a maior resistência média à fratura, e o grupo VI foi o menos propenso a resistir à fratura. Não houve diferenças estatisticamente significativas entre os grupos testados (p-valor = 0,237). O grupo MOD apresentou um modo de fratura mais desfavorável em comparação com os outros grupos. CONCLUSÕES: Não houve diferença significativa na resistência à fratura entre as cavidades de acesso conservador e tradicional. A ausência de cristas marginais, como nas cavidades MOD, desempenhou um papel importante na diminuição da resistência à fratura dos dentes tratados endodonticamente.

Non-invasive biomagnetic assessment of gastrointestinal motility in a loperamide-induced constipation model

Constipation is a disorder of the gastrointestinal (GI) and some of the main etiological mechanisms are directly related to changes in GI physiology. The capacity to carry out paired assessments and measure GI parameters under the influence of constipation is a relevant point in selecting a suitable methodology. We aimed to perform a non-invasive investigation of gastrointestinal motility in constipated rats using the alternating current biosusceptometry system (ACB). The animals were split into two groups: the pre-induction stage (CONTROL) and post-induction loperamide stage (LOP). We assessed GI motility parameters using the ACB system. Colon morphometric and immunohistochemical analyses were performed for biomarkers (C-kit) for interstitial cells of Cajal (ICC). Our results showed a significant increase in gastrointestinal transit in the LOP group in addition to a reduction in the dominant frequency of gastric contraction and an arrhythmic profile. A change in colonic contractility profiles was observed, indicating colonic dysmotility in the LOP group. We found a reduction in the number of biomarkers for intestinal cells of Cajal (ICC) in the LOP group. The ACB system can evaluate transit irregularities and their degrees of severity, while also supporting research into novel, safer, and more efficient treatments for constipation.

Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients / 中国康复理论与实践

ObjectiveTo explore the effect of brain-computer interface (BCI) based on visual, auditory and motor feedback combined with transcranial direct current stimulation (tDCS) on upper limb function in stroke patients. MethodsFrom March to October, 2023, 45 stroke inpatients in Xuzhou Rehabilitation Hospital and Xuzhou Central Hospital were divided into BCI group (n = 15), tDCS group (n = 15) and combined group (n = 15) randomly. All the groups received routine rehabilitation, while BCI group received BCI training, tDCS group received tDCS, while the combined group received tDCS and followed by BCI training immediately, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT), modified Barthel Index (MBI) and delta-alpha ratio (DAR) and power ratio index (PRI) of electroencephalogram before and after treatment. ResultsThe scores of FMA-UE, ARAT and MBI increased in all the groups after treatment (|t| > 5.350, P < 0.001), and all these indexes were the best in the combined group (F > 3.366, P < 0.05); while DAR and PRI decreased in all the groups (|t| > 2.208 , P < 0.05), they were the best in the combined group (F > 5.224, P < 0.01). ConclusionBCI based on visual, auditory and motor feedback combined with tDCS can further improve the motor function of upper limbs and the activities of daily living of stroke patients.

Effect of transcranial direct current stimulation on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis / 中国康复理论与实践

ObjectiveTo evaluate the effect of transcranial direct current stimulation (tDCS) on the cognitive function and quality of life in patients with Parkinson's disease. MethodsRandomized controlled trials (RCTs) on tDCS for Parkinson's disease were searched in PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang Data from the inception to September, 2023. Control group was administered standard Parkinson's medications or placebo, physical therapy, and cognitive rehabilitation, while treatment group received tDCS additionally. The quality of the researches was evaluated using the Cochrane Risk of Bias Tool. Data synthesis and analysis were performed using RevMan 5.4 and Stata 17.0, with heterogeneity and sensitivity analyses. ResultsEight articles were included. tDCS significantly improved the scores of Montreal Cognitive Assessment (MD = 2.00, 95%CI 1.13 to 2.87, P < 0.001). However, there was no significant difference in the scores of Parkinson's Disease Questionnaire (MD = 0.73, 95%CI -5.78 to 7.23, P = 0.830), Beck Depression Inventory-Ⅱ(MD = -0.77, 95%CI -7.14 to 5.60, P = 0.810), and Unified Parkinson Disease Rating Scale-Ⅲ (MD = 1.60, 95%CI -0.77 to 3.97, P = 0.190). ConclusiontDCS may improve cognitive function of patients with Parkinson's disease.

Effect of multi-target transcranial direct current stimulation on performance of working memory-postural control dual-task in healthy adults / 中国康复理论与实践

ObjectiveTo investigate the effect of multi-target transcranial direct current stimulation (tDCS) and single-target tDCS on the performance of working memory-postural control dual-task in healthy adults, and to compare the regulatory effect of the two stimulation protocols. MethodsFrom November, 2020 to February, 2021, 19 healthy adults in Shanghai University of Sport were recruited and randomly accepted multi-target tDCS, single-target tDCS and sham stimulation with at least one week interval between any two stimulation protocols. The target areas of multi-target tDCS included left dorsal lateral prefrontal cortex (L-DLPFC) and bilateral primary motor cortex (M1), and single-tDCS only applied to L-DLPFC. Before and after stimulation, participants completed walking and standing balance tests under single task and dual-task conditions with the second task being a N-back task. The dual-task postural control performance, dual-task cost (DTC) and working memory performance were observed before and after stimulation. ResultsSignificant differences were observed among three stimulation protocols in the changes of stride variability (F = 3.792, P = 0.029), DTC of stride variability (F = 3.412, P = 0.040) and velocity of center of pressure (Vcop) (F = 3.815, P = 0.029). The stride variability (P = 0.047) and Vcop (P = 0.015) were significantly lower and the decrease in DTC of stride variability tended to be significant (P = 0.073) following multi-target tDCS, as compared to sham stimulation. Single-target tDCS significantly decreased the changes of stride variability (P = 0.011), DTC of stride variability (P = 0.014) and Vcop (P = 0.025), as compared to sham stimulation. Compared with single target tDCS, multi-target tDCS reduced the changes of the dual-task cost of the area of center of pressure (P = 0.035). Moreover, no significant difference was observed among the three stimulation protocols in the changes of each measure in the working memory test (P > 0.05). ConclusionBoth multi-target tDCS and single-target tDCS can improve the performance of working memory-postural control dual-task in healthy adults, and compared with single-target tDCS, multi-target tDCS has some advantages in regulating postural control.

Investigation of the current situation of pharmaceutical clinics in medical institutions in China / 中国药房

OBJECTIVE To investigate the current situation of pharmaceutical clinic service in medical institutions in China and provide experience and suggestions for promoting the development of pharmaceutical clinics. METHODS Questionnaire survey was used to investigate the development of pharmaceutical clinics in medical institutions of 31 provinces （autonomous regions and municipalities directly under the central government） in March to April 2023， and the descriptive analysis was conducted. The regression analysis was carried out for the influential factors of pharmaceutical clinic service. RESULTS A total of 1 368 questionnaires were distributed in this survey and 1 304 valid questionnaires were collected with the effective response rate of 95.32%. A total of 463 medical institutions carried out pharmaceutical clinic service， the rate of which was 35.51% （463/1 304）； the rates of pharmaceutical clinics in tertiary， secondary， primary and other medical institutions were 52.80%， 17.18% and 5.88%， respectively. The frequency of opening pharmaceutical clinics was 3.17 days per week on average， with an average of 5.99 visiting pharmacists in each medical institution. Among the visiting pharmacists， clinical pharmacists accounted for the vast majority （88.68%， 2 459/2 773）. There were various categories of pharmaceutical clinics， including joint clinics and pharmacist-independent clinics； among pharmacist-independent clinics， pharmaceutical specialty/specialty disease clinics were the main ones， accounting for 89.72% of the total number of pharmaceutical clinics. The value of pharmacists in pharmaceutical clinics was manifested in various forms， among which the proportion of medical institutions charging pharmaceutical clinics was 10.80%. The main experiences in developing pharmaceutical clinics were to attach importance to discipline construction and personnel training. The main difficulties in developing pharmaceutical clinics were low compensation levels and a shortage of talent.The number of clinical pharmacists， the number of visiting pharmacists in pharmaceutical clinics and additional compensation were positively correlated with the amount of pharmaceutical clinic services（P＜0.05）. CONCLUSIONS In recent years， pharmaceutical clinics have made significant progress； in the future， it is still necessary to further strengthen discipline construction and talent cultivation， pay attention to the value embodiment of pharmacists， to promote the healthy development of pharmaceutical clinics.

Melatonin inhibits arrhythmias induced by increased late sodium currents in ventricular myocytes / 药学学报

Melatonin (Mel) has been shown to have cardioprotective effects, but its action on ion channels is unclear. In this experiment, we investigated the inhibitory effect of Mel on late sodium currents (INa.L) in mouse ventricular myocytes and the anti-arrhythmic effect at the organ level as well as its mechanism. The whole-cell patch clamp technique was applied to record the ionic currents and action potential (AP) in mouse ventricular myocytes while the electrocardiogram (ECG) and monophasic action potential (MAP) were recorded simultaneously in mouse hearts using a multichannel acquisition and analysis system. The results demonstrated that the half maximal inhibitory concentration (IC50) values of Mel on transient sodium current (INa.T) and specific INa.L opener 2 nmol·L-1 sea anemone toxins II (ATX II) increased INa.L were 686.615 and 7.37 μmol·L-1, respectively. Mel did not affect L-type calcium current (ICa.L), transient outward current (Ito), and AP. In addition, 16 μmol·L-1 Mel shortened ATX II-prolonged action potential duration (APD), suppressed ATX II-induced early afterdepolarizations (EADs), and significantly reduced the incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) in Langendorff-perfused mouse hearts. In conclusion, Mel exerted its antiarrhythmic effects principally by blocking INa.L, thus providing a significant theoretical basis for new clinical applications of Mel. Animal welfare and experimental process are in accordance with the regulations of the Experimental Animal Ethics Committee of Wuhan University of Science and Technology (2023130).

Research progress on dental materials for preventing root caries / 口腔疾病防治

@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.

An electric field modeling study with meta-analysis to understand the antidepressant effects of transcranial direct current stimulation (tDCS)

Objective: Transcranial direct current stimulation (tDCS) has mixed effects for major depressive disorder (MDD) symptoms, partially owing to large inter-experimental variability in tDCS protocols and their correlated induced electric fields (E-fields). We investigated whether the E-field strength of distinct tDCS parameters was associated with antidepressant effect. Methods: A meta-analysis was performed with placebo-controlled clinical trials of tDCS enrolling MDD patients. PubMed, EMBASE, and Web of Science were searched from inception to March 10, 2023. Effect sizes of tDCS protocols were correlated with E-field simulations (SimNIBS) of brain regions of interest (bilateral dorsolateral prefrontal cortex [DLPFC] and bilateral subgenual anterior cingulate cortex [sgACC]). Moderators of tDCS responses were also investigated. Results: A total of 20 studies were included (21 datasets, 1,008 patients), using 11 distinct tDCS protocols. Results revealed a moderate effect for MDD (g = 0.41, 95%CI 0.18-0.64), while cathode position and treatment strategy were found to be moderators of response. A negative association between effect size and tDCS-induced E-field magnitude was seen, with stronger E-fields in the right frontal and medial parts of the DLPFC (targeted by the cathode) leading to smaller effects. No association was found for the left DLPFC and the bilateral sgACC. An optimized tDCS protocol is proposed. Conclusions: Our results highlight the need for a standardized tDCS protocol in MDD clinical trials. Registration number: PROSPERO CRD42022296246.

Parameters and results of non-invasive neuromodulation in the management of chronic pelvic pain: integrative literature review / Parâmetros e resultados da neuromodulação não invasiva no manejo da dor pélvica crônica: revisão integrativa da literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic Pelvic Pain (CPP) is characterized by persistent pain in the pelvic region for more than six months, affecting both men and women and causing significant impairment in quality of life (QoL). Two of the main non-invasive approaches are Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS). These techniques aim to modulate neural activity and promote pain relief. In this context, this research conducted an integrative literature review to summarize the results of relevant studies, aiming to identify the key parameters used in TMS and tDCS for CPP treatment. The objective was to assess the effect and efficacy of non-invasive neuromodulation as a therapeutic intervention for CPP. CONTENTS: For this integrative review, electronic searches were conducted in Pubmed, Scielo, PEDro, Medline, Cochrane, and Scopus databases, examining studies in Portuguese, English, or Spanish. The keywords "pelvic pain," "transcranial direct current stimulation," and "transcranial magnetic stimulation" and their derivatives were searched in the three languages in studies from 2013 to 2023. Seven studies were included for analysis. Both techniques showed positive effects in managing CPP, improving pain levels and quality of life to a relevant extent. However, there is still no consensus on the parameters applied in TMS and tDCS techniques for CPP. CONCLUSION: Non-invasive neuromodulation improves pain levels and quality of life in patients with CPP. Further studies are needed to establish more reliable parameter relationships, and the limited number of studies restricts definitive conclusions on the subject.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor pélvica crônica (DPC) é caracterizada pela persistência da dor na região pélvica por mais de seis meses, afetando tanto homens quanto mulheres e causando prejuízos significativos na qualidade de vida (QV). Duas das principais abordagens não invasivas são Estimulação Magnética Transcraniana (EMT) e a Estimulação Transcraniana por Corrente Contínua (ETCC). Nesse contexto, esta pesquisa realizou uma revisão integrativa da literatura com o intuito de resumir os resultados de estudos relevantes, buscando identificar os principais parâmetros utilizados no tratamento da DPC. O objetivo foi fornecer uma visão abrangente sobre essas técnicas de neuromodulação e suas aplicações específicas no controle da dor pélvica crônica. CONTEÚDO: Para esta revisão integrativa, as buscas eletrônicas ocorreram nas bases de dados Pubmed, Scielo, PEDro, Medline, Cochrane e Scopus, verificando estudos em português, inglês ou espanhol. "Dor pélvica", "estimulação transcraniana por corrente contínua" e "estimulação magnética transcraniana" e suas derivações foram pesquisadas nos três idiomas em estudos entre 2013 e 2023. Sete estudos foram incluídos para análise. Ambas as técnicas apresentaram efeitos positivos no manejo da DPC, melhorando os níveis de dor e a QV em proporções relevantes. Entretanto, ainda não há um consenso sobre os parâmetros aplicados nas técnicas de EMT e ETCC para DPC. CONCLUSÃO: A neuromodulação não invasiva melhora os níveis de dor e a QV em pacientes com DPC. São necessários mais estudos para que relações mais confiáveis de parâmetros possam ser preestabelecidas e a ausência de um maior número de estudos limita conclusões acerca do assunto.

Role of Nurse Leadership to Evaluate the Current Status of Nurses with a View to Invest in Nursing to Secure Global Health An Exploratory Approach

There is an opportunity for nurses to better explain what we do, to break the myths around nursing and to advocate for investment in the profession. This study endeavoured to explore the role of nurse leadership to invest in nursing to secure global health and to identify role of nurse leaders according to their demographic variables. An exploratory sequential mixed method re- search design was selected in this study. Through purposeful sampling, the researcher selected 60 nurse administrators. Data was collected from the nurse administrators in the form of an electronic survey and virtual face-to- face semi structured interview method after obtaining a formal permission. The data collected from them was utilised only for the purpose of the study and was kept confidential. The final analysis summarised the findings that emerged from both quantitative and qualitative data. In the present study there were 50 (83.3%) females and 10 males (16.7 %) and them had nurse administrators 52(86.6%) of experience. The results covered the issues like current status of nurses, ways and benefits to invest in nursing for global health and the role of nurse leaders in investing in nursing for global Health. Nurses are the head honchos and lifeline of health-care organisations but still lack recognition. Concern on this has been expressed by many, but till date no strong visible implementation of laws and policies are seen. Nurses need to take initiation and leadership at higher levels to bring change in the existing scenario and implement the recommendations regarding basic pay and maximum working hours per week..

Association of low-dose naltrexone and transcranial direct current stimulation in fibromyalgia: a randomized, double-blinded, parallel clinical trial

Abstract Introduction Fibromyalgia is a complex, generalized, and diffuse chronic musculoskeletal pain. Pharmacological approaches are widely used to relieve pain and increase quality of life. Low-Dose Naltrexone (LDN) was shown to increase the nociceptive threshold in patients with fibromyalgia. Transcranial Direct Current Stimulation (tDCS) is effective for pain management. Objective The purpose of this study was to evaluate the analgesic and neuromodulatory effects of a combination of LDN and tDCS in patients with fibromyalgia. Methods This was a randomized, double-blinded, parallel, placebo/sham-controlled trial (NCT04502251; RBR-7HK8N) in which 86 women with fibromyalgia were included, and written informed consent was obtained from them. The patients were allocated into four groups: LDN + tDCS (n = 21), LDN + tDCS Sham (n = 22), placebo + tDCS (n = 22), and placebo+tDCS Sham (n = 21). The LDN or placebo (p.o.) intervention lasted 26 days; in the last five sessions, tDCS was applied (sham or active, 20 min, 2 mA). The following categories were assessed: sociodemographic, Visual Analog Pain Scale (VAS), Pain Catastrophizing Scale (PCS), State-Trait Anxiety Inventory (STAI), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI-II), Profile of Chronic Pain Scale (PCP:S), Pain Pressure Threshold (PPT), and Conditioned Pain Modulation (CPM). Blood samples were collected to analyze BDNF serum levels. Results At baseline, no significant difference was found regarding all measurements. VAS pain was significantly reduced in the LDN + tDCS (p = 0.010), LDN + tDCS Sham (p= 0.001), and placebo+tDCS Sham (p= 0.009) groups. In the PCP:S, the LDN+tDCS group showed reduced pain frequency and intensity (p= 0.001), effect of pain on activities (p= 0.014) and emotions (p= 0.008). Depressive symptoms reduced after all active interventions (p > 0.001). Conclusion Combined LDN+tDCS has possible benefits in reducing pain frequency and intensity; however, a placebo effect was observed in pain using VAS, and further studies should be performed to analyze the possible association.

Randomized clinical trial on the efficacy of a new transcranial direct current stimulation (tDCS) device in the treatment of depression: a low-cost option for developing countries? / Ensaio clínico randomizado sobre a eficácia de novo equipamento de estimulação transcraniana por corrente contínua (ETCC) no tratamento da depressão: uma opção de baixo custo para países em desenvolvimento?

ABSTRACT Objective: Verify the clinical efficacy and safety of a low-cost tDCS device, in a clinical trial for major depressive disorder. Methods: 168 persons were recruited; 32 depressed individuals with moderate or severe depressive symptoms (HDRS17 scores higher than 18) were included and randomized for the trial (16 individuals in each group). The intervention consisted of 10 active anodal tDCS sessions at 2 mA for 30 minutes over the left dorsolateral prefrontal cortex; or sham. The main outcome was HDRS17; secondary outcomes included satisfaction (TSQM II) and quality of life (WHOQOL-BREF). Assessments at baseline, endpoint and at 30 days follow-up. Results: The sample was composed by a total of 11 men and 21 women, mean age of 42.75 years (95% CI: 38.10-47.40). Active treatment was superior than sham: There was a significant interaction between group and time regarding HDRS-17 scores (F = 4.089, df = 2, p = 0.029; partial Eta squared = 0. 239). Post hoc analyses exhibited a statistically significant difference between active and sham group symptoms after a 30 days follow-up (difference = -7.75, p = 0.008, Cohen's d = 1.069). There were 3 dropouts, all in the active group, due schedule issues. No severe adverse effects reported. Conclusion: The current active tDCS protocol was related with clinical improvement of depressive symptoms. Intervention was well-tolerated. Non-invasive brain stimulation techniques are still not routinely used, although a viable strategy for treatment-resistant patients, partial responders and people unable to use pharmacological treatment. We aim to increase knowledge and use of tDCS for the Brazilian population.

RESUMO Objetivo: Testar a eficácia clínica e a segurança de equipamento de estimulação elétrica transcraniana por corrente contínua (ETCC) de baixo custo em ensaio clínico para transtorno depressivo maior (TDM). Métodos: Foram recrutadas 168 pessoas e incluídos e randomizados 32 indivíduos com depressão moderada ou grave (escores na HDRS17 >18; 16 indivíduos em cada grupo). A intervenção consistiu de 10 sessões de ETCC ativa a 2 mA no córtex pré-frontal dorsolateral esquerdo por 30 minutos, ou sham. O desfecho principal foi HDRS17; os desfechos secundários foram satisfação (TSQM II) e qualidade de vida (WHOQOL-BREF). Avaliações no início, no final do tratamento e após 30 dias de seguimento. Resultados: A amostra foi composta de 11 homens e 21 mulheres, com idade média de 42,75 anos (IC 95%: 38,10 a 47,40). O tratamento ativo foi superior ao sham: houve interação significativa entre grupo e tempo em relação aos escores de HDRS17 na ANOVA (F = 4,089, df = 2, p = 0,029; partial Eta squared = 0,239). A análise post hoc mostrou diferença significativa na HDRS17 no follow-up após 30 dias (diferença = -7,75, p= 0,008, Cohen's d = 1,069). Houve 3 dropouts, todos no grupo ativo, devido a problemas de agenda. Não houve registro de efeitos adversos graves. Conclusão: O tratamento ativo teve relação com melhora clínica de sintomas depressivos. A intervenção foi bem tolerada. Técnicas de estimulação cerebral não invasivas ainda não são rotina na prática clínica, apesar de estratégias viáveis para pacientes resistentes a tratamento, respondedores parciais e pessoas com intolerância a medicamentos. Esperamos ampliar o conhecimento e o uso de protocolos de ETCC na população brasileira.

Os impactos de técnicas não farmacológicas na impulsividade / The impacts of non-pharmacological techniques on impulsivity

A impulsividade é um fenômeno multifacetado e é caracterizada por diferentes padrões cognitivos e comportamentais que podem levar a consequências disfuncionais imediatas e em médio/longo prazo. O tratamento da impulsividade tem sido um grande desafio na área da saúde mental, pois não há muitas ferramentas bem descritas e cientificamente validadas que sejam eficazes para a melhora do bem-estar geral desses indivíduos. Dentre as abordagens gerais que podem ser utilizadas para isso, destacam-se as intervenções farmacológicas, atividades físicas e abordagens psicoterápicas como a terapia cognitivo-comportamental (TCC), o treinamento de habilidades sociais e emocionais e a terapia de controle de impulsos. Neste estudo, iremos analisar outras três técnicas não farmacológicas promissoras para serem utilizadas no controle de impulso que são as técnicas de Yoga, Mindfulness e Neuromodulação não invasiva. Para isso, fizemos três revisões sistemáticas conduzidas em acordo com os critérios do PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Os protocolos de revisão foram registrados no Registro Prospectivo Internacional de Revisões Sistemáticas (PROSPERO). Para escolha dos descritores que seriam utilizados na busca foi utilizado o Medical Subject Headings (MeSH). A pesquisa pelos artigos foi feita nas bases de dados da PubMed, Scopus, Science Direct e Embase. Só foram incluídos artigos em inglês e não houve delimitação de período de publicação dos artigos incluídos. Os artigos incluídos nesta revisão sistemática foram selecionados de forma independente por dois revisores distintos. Eles realizaram a seleção em duas etapas, sendo a primeira baseada na leitura dos títulos e resumos e a segunda com a leitura completa do texto e caso houvesse divergência na seleção dos artigos, um terceiro revisor foi acionado. A qualidade dos estudos incluídos nestas revisões sistemáticas foi avaliada utilizando a ferramenta Cochrane Risk of Bias tool. Ao final da seleção dos artigos, 6 artigos foram analisados no estudo sobre yoga, 18 no de Mindfulness e 18 no de Neuromodulação não invasiva (9 artigos sobre Estimulação Transcraniana por Corrente Contínua (ETCC) e 9 sobre Estimulação Magnética Transcraniana (EMT)) e foi realizada metanálise de seus dados. Com base nos resultados obtidos, as técnicas de Yoga e Mindfulness surgem como promissoras no tratamento da impulsividade, demonstrando efetividade em diversos testes psicométricos e escalas. Essas abordagens terapêuticas são de fácil implantação, escaláveis e apresentam baixo custo, o que as torna viáveis tanto para o contexto clínico quanto para a saúde pública. Por outro lado, os estudos sobre ETCC e EMT ainda carecem de evidências suficientes para embasar sua implementação no tratamento da impulsividade. A falta de padronização nos estímulos utilizados e a diversidade nos desenhos de estudo dificultam a definição de protocolos efetivos. Portanto, futuras pesquisas serão necessárias para estabelecer parâmetros mais específicos e padrões de intervenção claros para essas técnicas de neuromodulação não invasiva no contexto da impulsividade.

Impulsivity is a multifaceted phenomenon characterized by different cognitive and behavioral patterns that can lead to immediate and medium-to-long-term dysfunctional consequences. The treatment of impulsivity has been a major challenge in the field of mental health, as there are not many well-described and scientifically validated tools that are effective in improving the overall well-being of these individuals. Among the general approaches that can be used for this purpose, pharmacological interventions, physical activities, and psychotherapeutic approaches such as cognitive-behavioral therapy (CBT), social and emotional skills training, and impulse control therapy stand out. In this study, we will analyze three other promising non-pharmacological techniques for impulse control, namely Yoga, Mindfulness, and non-invasive neuromodulation. To do so, we conducted three systematic reviews in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. The review protocols were registered in the International Prospective Register of Systematic Reviews (PROSPERO). The Medical Subject Headings (MeSH) were used to select the descriptors for the search. The article search was conducted in the PubMed, Scopus, Science Direct, and Embase databases. Only articles in English were included, and there was no restriction on the publication period of the included articles. The articles included in this systematic review were independently selected by two different reviewers. They performed the selection in two stages, the first based on the reading of titles and abstracts, and the second with the full-text reading. In case of divergence in the article selection, a third reviewer was consulted. The quality of the studies included in these systematic reviews was assessed using the Cochrane Risk of Bias tool. At the end of the article selection process, 6 articles were analyzed in the Yoga study, 18 in the Mindfulness study, and 18 in the non-invasive neuromodulation study (9 articles on Transcranial Direct Current Stimulation (tDCS) and 9 on Transcranial Magnetic Stimulation (TMS)), and a meta-analysis of their data was performed. Based on the results obtained, Yoga and Mindfulness techniques emerge as promising in the treatment of impulsivity, demonstrating effectiveness in various psychometric tests and scales. These therapeutic approaches are easy to implement, scalable, and cost-effective, making them viable for both clinical and public health contexts. On the other hand, studies on tDCS and TMS still lack sufficient evidence to support their implementation in the treatment of impulsivity. The lack of standardization in the stimuli used and the diversity in study designs hinder the definition of effective protocols. Therefore, future research will be necessary to establish more specific parameters and clear intervention standards for these non-invasive neuromodulation techniques in the context of impulsivity

Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Considerations on investigation on quality standard of Chinese patent medicine / 药学学报

Chinese patent medicine (CPM) is an important part of traditional and Chinese medicine (TCM). Its quality has direct impact on the safety and effectiveness of clinical use. The quality standard is the pivotal approach to guarantee the quality of CPM. Due to the complex material basis, multitudinous quality influencing factors and unveiled active ingredients, dose-effect relationship and action mechanism, the investigation on quality standard faces many difficulties. This paper surveys the current quality status of CPM and the general situation of CPM standards. At present, the dosing problem has the crucial impact on the quality of CPM. The current quality standard system of CPM is confirmed and the limitations are indicated. Based on the above analysis, the principles and considerations on investigation of quality standard are proposed as follows: ① Adhere to safety as the bottom line, strengthen the risk-control ability of the standard of CPM; ② Adhere to theory of TCM and comprehensive quality, improve the integrative control level of the CPM standard; ③ Emphasize technological development and innovation, promote the quality control competence of CPM standard; ④ Facilitate planning and coordination, optimize the management of the CPM standard system; ⑤ Reinforce investigation on evaluation method, develop grade evaluation standard, accelerate high-quality development of CPM. Finally, the future perspective on investigation of CPM quality standard is prospected.

Inhibitory effects of a TRPM4 inhibitor 9-phenanthrol on electrical activity of INS-1 pancreatic β-cells / 药学学报

The Ca2+-activated monovalent cation selective transient receptor potential melastatin 4 (TRPM4) channel expressed in pancreatic β-cells is implicated in the β-cell function and insulin secretion, but how pharmacological function of TRPM4 channel affects membrane excitability of β-cells remains largely unknown. Here, we report that pharmacological inhibition of TRPM4 by specific inhibitor 9-phenanthrol attenuates electrical activities of pancreatic β-cells. In whole-cell current clamp recordings, 9-phenanthrol results in inhibition of action potential frequency induced by tolbutamide of the INS-1 pancreatic β-cells in a dose-dependent manner with an IC50 value of 14.99 ± 7.93 μmol·L-1. Similarly, 9-phenanthrol also inhibited action potential firing in INS-1 cells stimulated by current injection. Further recordings of β-cells demonstrate the significant inhibitory effects on action potential peak and action potential amplitude by 9-phenanthrol. Taken together, our results show the involvement of TRPM4 channel function in pancreatic β-cells depolarization and action potential, it provides pharmacological experimental methods and theoretical support for the study of TRPM4 channel in pancreatic β-cells.