Is it Always Laryngopharyngeal Reflux? How Voice Disorders Can Manifest as LPR

Introduction: Laryngopharyngeal reflux (LPR) manifests with a constellation of common throat symptoms and inconclusive signs on laryngoscopic exam. It is a diagnosis, often made clinically, that can lead to prescriptions of proton pump inhibitors that are unnecessary and potentially harmful. Glottic insufficiency (GI) and the accompanying hyperfunctional laryngeal behaviors can also present with similar, common throat complaints that may or may not include a qualitative change to the voice. Methods: This is a reflection article. It is written to summarize, explain, and support with evidence the opinion of the author on the topic of how symptoms of voice disorders can easily be mistaken for symptoms of LPR. The offered reflection is based on his experience, research and the available literature. Reflection: This article intends to explore the similarities between GI and LPR, how to ultimately differentiate them and how to approach treatment with a broader differential diagnosis. Conclusion: LPR and GI can present with identical, vague throat, and voice symptoms. Empiric medication trials, behavioral interventions and objective laryngovideostroboscopy, impedance-based reflux, and esophageal motility testing may all be needed, sometimes in a trial and error fashion, to correctly diagnose and treat a patient's symptoms.

Introducción: El reflujo laríngeo-faríngeo (LPR, por sus siglas en inglés) se manifiesta con una serie de síntomas comunes en la garganta y signos no concluyentes en el examen larinoscópico. Es un diagnóstico que a menudo se realiza clínicamente y que puede llevar a la prescripción de inhibidores de la bomba de protones que son innecesarios y potencialmente perjudiciales. La insuficiencia glótica (IG) y los comportamientos laríngeos hiperfuncionales que la acompañan también pueden presentar síntomas de garganta comunes similares, que pueden o no incluir un cambio cualitativo en la voz. Métodos: Este es un artículo de reflexión. Está escrito para resumir, explicar y respaldar con evidencia la opinión del autor sobre cómo los síntomas de los trastornos de la voz pueden confundirse fácilmente con los síntomas del LPR. La reflexión ofrecida se basa en su experiencia, investigación y la literatura disponible. Reflexión: Este artículo tiene la intención de explorar las similitudes entre la IG y el LPR, cómo diferenciarlos finalmente y cómo abordar el tratamiento con un diagnóstico diferencial más amplio. Conclusión: El LPR y la IG pueden presentar síntomas idénticos y vagos en la garganta y la voz. Puede ser necesario realizar ensayos de medicación empírica, intervenciones conductuales y pruebas objetivas de laringovideostroboscopia, reflujo basado en impedancia y motilidad esofágica, a veces de manera experimental, para diagnosticar y tratar correctamente los síntomas de un paciente.

Role of PPI and importance of anti-reflux agents in the treatment of NERD

Background: Esomeprazole, an S-isomer of omeprazole, is a much more potent acid inhibitor than most other currently available PPIs and gives excellent results. Therefore, it is a first-line drug for acid-related diseases like NonErosive Reflux Disease (NERD). Yet, patients demand faster onset and response. Aim : To establish the role of esomeprazole and the importance of anti-reflux agents like a combination of two antacids (calcium carbonate and sodium bicarbonate) and alginate in treating NERD. Conclusion: Esomeprazole therapy shows potential efficacy in the continuous maintenance treatment of the NERD. However, it is suggested that to improve the efficiency of esomeprazole for the treatment of NERD; we can supplement the drug with antacids (sodium bicarbonate and calcium carbonate) and alginates.

Extended-pour and conventional alginates: effect of storage time on dimensional accuracy and maintenance of details

ABSTRACT Objective: This study aimed to evaluate the dimensional stability and maintenance of details of conventional and high stability alginates up to 5-day storage. Methods: Two types of alginates were selected (n=10) for this study, conventional (Hydrogum) and high stability alginates (Hydrogum 5), which were produced with the aid of a cylindrical metal block and a ring-shaped metal mold (Specifications 18, 19, and 25, ANSI/ADA). Ten images were obtained from the molds for the dimensional stability test, which were taken immediately after their production and at each different storage periods (15 min, 24 h, 48 h, 72 h, 96 h, and 120 h) by a digital camera. The specimens were kept hermetically sealed in plastic bags (23°C) and then used to obtain 140 (n=70) dental stone models, used in the detail reproduction test, in which the angular accuracy of three grooves (20 µm, 50 µm, and 75 µm) was observed at each period. The details reproduction accuracy was classified using a predetermined score classification. Measurements of dimensional changes were made in the Corel DRAW X6 program. The data were submitted to the Student's t-test (α?#8197;= 0.05). Results: A statistically significant difference concerning the size of the matrix was observed after 24h for both alginates, and a statistically significant negative linear dimensional change (contraction) was verified after 24 h of storage (1.52% for the high stability alginate, and 1.32% for the conventional alginate). The high stability alginate kept the full details for 72 hours, while the conventional alginate, for 24 h. Both alginates reproduced the 75 µm groove at all storage periods. Conclusion: Impressions made with both alginates presented satisfactory clinical results when the alginates were immediately poured.

RESUMO Objetivo: O presente estudo teve como objetivo avaliar a estabilidade dimensional e manutenção de detalhes de alginatos convencionais e de alta estabilidade por até 5 dias de armazenamento. Métodos: Para esse estudo, foram selecionados dois tipos de alginatos: convencional (Hydrogum) (n = 10) e de alta estabilidade (Hydrogum 5) (n = 10), sendo produzidos com o auxílio de um bloco metálico cilíndrico e um molde metálico em forma de anel (especificações 18, 19 e 25, ANSI/ADA). Para o teste de estabilidade dimensional, dez imagens foram obtidas imediatamente e para cada tempo de armazenamento (15 min, 24, 48, 72, 96 e 120 horas), realizadas por câmera digital. As amostras foram mantidas hermeticamente fechadas em sacos plásticos (23°C). Para o teste de reprodução de detalhes, as amostras foram utilizadas para obter 140 (n = 70 por grupo) modelos de gesso, sendo observada a precisão angular de três sulcos (20 µm, 50 µm e 75 µm) para cada período. A precisão da reprodução de detalhes foi classificada usando uma classificação de pontuação predeterminada. As medições das mudanças dimensionais foram feitas no programa Corel DRAW X6. Os dados foram submetidos ao teste t de Student (α = 0,05). Resultados: Foi observada diferença estatística em relação à matriz após 24h para ambos os alginatos. Uma mudança dimensional linear negativa estatisticamente significativa (contração) foi verificada após 24 h de armazenamento (1,52% para alginato de alta estabilidade; 1,32% para alginato convencional). O alginato de alta estabilidade manteve os detalhes completos por até 72 horas, enquanto o alginato convencional, por 24 horas. Os alginatos reproduziram o sulco de 75 µm para todos os períodos. Conclusão: As impressões feitas com ambos os alginatos devem ser imediatamente vazadas para se ter resultados clínicos satisfatórios.

Criteria to evaluate the quality of alginate wound dressings / Criterios para evaluación de la calidad de coberturas de alginato en tratamiento de heridas / Critérios para avaliação da qualidade de coberturas de alginato no tratamento de feridas

ABSTRACT Objectives: to validate an instrument with criteria to evaluate the quality of calcium alginate wound dressings to treat skin injuries. Methods: methodological study, developed in two stages: the elaboration of criteria to evaluate the quality of the alginate wound dressing based on literature; validation of these criteria by a group of evaluators in two moments. Data was analyzed using descriptive statistics, central tendency measures and the Content Validity Index. Results: seven articles were selected, leading to the elaboration of 7 criteria and 11 expected results. The Content Validity Index was 0.98 in stage 1 and 0.93 in stage 2. After adjustments, 8 criteria were validated, and 13 results were expected. Final Considerations: the study allowed the validation of criteria to evaluate the quality of calcium alginate wound dressings, helping the nurses to choose with more autonomy and assertiveness.

RESUMEN Objetivos: validar un instrumento con criterios para evaluación de la calidad de coberturas de alginato de calcio para tratamiento de herida cutánea. Métodos: estudio metodológico, desarrollado en dos etapas: elaboración de criterios para evaluación de la calidad de la cobertura de alginato basándose en la literatura; validación de esos criterios por grupo de jueces en dos momentos. Los datos fueron analizados por estadística descriptiva, medidas de tendencia central e Índice de Validez de Contenido. Resultados: seleccionaron 7 artículos que respaldaron la elaboración de 7 criterios y 11 resultados esperados. El Índice de Validez de Contenido fue 0,98 en la etapa 1 y 0,93 en la etapa 2. Después de ajustes, fueron validados 8 criterios y 13 resultados esperados. Consideraciones Finales: el estudio permitió validar criterios para evaluación de la calidad de las coberturas de alginato de calcio, encaminando la elección de los enfermeros con mayor autonomía y asertividad.

RESUMO Objetivos: validar um instrumento com critérios para avaliação da qualidade de coberturas de alginato de cálcio para tratamento de ferida cutânea. Métodos: estudo metodológico, desenvolvido em duas etapas: elaboração de critérios para avaliação da qualidade da cobertura de alginato baseando-se na literatura; validação desses critérios por grupo de juízes em dois momentos. Osdados foram analisados por estatística descritiva, medidas de tendência central e Índice de Validação de Conteúdo. Resultados: selecionaram-se 7 artigos que respaldaram a elaboração de 7 critérios e 11 resultados esperados. O Índice de Validação de Conteúdo foi 0,98 na etapa 1 e 0,93 na etapa 2. Após ajustes, foram validados 8 critérios e 13 resultados esperados. Considerações Finais: o estudo permitiu validar critérios para avaliação da qualidade das coberturas de alginato de cálcio, direcionando a escolha dos enfermeiros com maior autonomia e assertividade.

Dimensional Stability of Casts Derived from Three Types of Alginate at Different Times After Impression

Objective: To evaluate the dimensional changes in three types of alginate following three different delay times after casting. Material and Methods: In this laboratory study, a maxillary arch-shaped stainless steel model was prepared and three pins with similar and determined diameters and heights were placed (one at mid-line and two on the underside of the model) as reference points to compare the dimensional stability of the three types of alginates. A special metal tray was made from the main model. The main moldel was imprisoned by the metal tray, and these were kept for a specific time in a humid environment. Gypsum Type 4 was poured over the impression to obtain 90 gypsum casts for three types of alginate. The dimensions of casts obtained from each alginate were compared in two lateral and anterior-posterior dimensions, they were compared with each other, and the alginates were also compared to the main model. Results: At a time interval of 15 minutes, the dimensional accuracy of the casts obtained from the three types of alginates, with the main model in both anterior-posterior and transverse dimensions was not significantly different (p<0.05); but there was a significant difference at 60 minutes and 24 hours in both dimensions (p<0.05). Although there was no significant difference between the alginates in both dimensions and all three studied time periods, the least difference with the main model was related to Zhermack and the highest difference was related to Golchai alginates. Pairwise comparisons showed that none of the samples had a significant difference in terms of dimensions. Conclusion: The dimensional stability of alginate was a time-dependent type of alginate and had no significant effect on the dimensional accuracy of casts.

Estabilidade dimensional de moldes obtidos com alginato de armazenamento tardio / Dimensional stability of molds obtained with late storage alginate

Resumo Introdução Recentemente, vêm surgindo no mercado alguns alginatos de armazenamento prolongado. Não há, no entanto, um consenso na literatura a respeito da estabilidade dimensional destes materiais durante este armazenamento Objetivo Avaliar, por meio de método prático experimental, a estabilidade dimensional de um alginato de armazenamento tardio. Material e método O material de moldagem utilizado foi o alginato Hydrogum 5 (Zhermack). Uma matriz metálica cilíndrica foi utilizada para a realização das moldagens, com 38 mm de diâmetro externo, 30 mm de diâmetro interno e cuja superfície superior apresenta três linhas paralelas entre si com 25 mm de comprimento e 20, 50 e 75 µm de largura. Após o tempo de geleificação do material de moldagem, 16 moldes foram colocados em um umidificador e essas amostras foram fotografadas utilizando-se uma câmera digital (Canon EOS Rebel 3Ti, Canon) associada a um software para análise das imagens obtidas (ImageJ 1.52a, U.S. National Institutes of Health; DI). A calibragem da régua foi 10 cm e, posteriormente, três linhas foram medidas três vezes, para se obter uma média dos comprimentos das linhas. As amostras foram fotografadas nos seguintes intervalos: imediatamente, 24, 48, 72, 96 e 120 horas. Resultado Os dados mostraram diferenças estatisticamente significantes para o fator tempo quando comparada a leitura imediata com os demais períodos de tempo de leitura (p<0,001) e quando comparada a leitura após 24 h de armazenagem com os demais períodos de tempo (p<0,001). Não houve diferença estatística (p>0,05) quando os tempos de armazenamento de 48 h, 72 h, 96 h e 120 h foram comparados entre si. Todos os valores encontravam-se dentro dos valores preconizados pela ISO 21563:2013. Conclusão Os moldes dos alginatos testados podem ser armazenados por até cinco dias em 100% de umidade relativa.

Abstract Introduction Recently, some extended-pour alginate impression materials have been placed in the market. However, there is no consensus in the literature regarding the dimensional stability of these materials during these storage. Objective To evaluate, through the experimental model, the durability and velocity with respect to dimensional alteration, analyzing the material and detecting distortions. Material and method The material for molding in this test was alginate (Hydrogum 5, Zhermack). A cylindrical metallic matrix was used to make the moldings with: 38 mm of external diameter, 30 mm of internal diameter and superior of the upper series of the card 3d transport lines with each 25 mm in length and 20, 50 and 75μm in width. After the time of jellification / polymerization of the molding material, 16 molds were inserted in a doser and were photographed with a digital camera (Canon EOS Rebel 3Ti, Canon) associated with a software for analysis of sacred images (ImageJ 1.52a, US National Institutes of Health, DI). The calibration of the ruler was performed in 10 cm and then in 3 lines were means 3 (three) times to obtain a mean of the lengths of the lines. The photographs were taken at the following intervals: immediately, 24, 48, 72, 96 and 120 hours after being cast. Result The data were found when compared with the other parts of the reading time (p <0.001) and when compared to the execution after 24 hours of locomotion with the other parts of the time (p <0.001). The rest time of 48 hours, 72 hours, 96 hours and 120 hours were compared to each other. Conclusion The molds of the tested alginates can be stored for 5 days in 100% relative sauce.

Influence of the geometry of nanostructured hydroxyapatite and alginate composites in the initial phase of bone repair

Abstract Purpose: To analyze, histomorphologically, the influence of the geometry of nanostructured hydroxyapatite and alginate (HAn/Alg) composites in the initial phase of the bone repair. Methods: Fifteen rats were distributed to three groups: MiHA - bone defect filled with HAn/Alg microspheres; GrHA - bone defect filled with HAn/Alg granules; and DV - empty bone defect; evaluated after 15 days postoperatively. The experimental surgical model was the critical bone defect, ≅8.5 mm, in rat calvaria. After euthanasia the specimens were embedded in paraffin and stained with hematoxylin and eosin, picrosirius and Masson-Goldner's trichrome. Results: The histomorphologic analysis showed, in the MiHA, deposition of osteoid matrix within some microspheres and circumjacent to the others, near the bone edges. In GrHA, the deposition of this matrix was scarce inside and adjacent to the granules. In these two groups, chronic granulomatous inflammation was noted, more evident in GrHA. In the DV, it was observed bone neoformation restricted to the bone edges and formation of connective tissue with reduced thickness in relation to the bone edges, throughout the defect. Conclusion: The geometry of the biomaterials was determinant in the tissue response, since the microspheres showed more favorable to the bone regeneration in relation to the granules.

The Clinical Efficacy of a Pure Alginate Formulation (Lamina G) for Controlling Symptoms in Individuals with Reflux Symptoms: A Randomized Clinical Study

BACKGROUND/AIMS: Bicarbonate-containing alginate formulations are reported to be effective for controlling reflux symptoms. However, the efficacy of Lamina G alginate without gas production has not been reported. The aim is to evaluate the efficacy of a non-bicarbonate alginate in individuals with reflux symptoms without reflux esophagitis. METHODS: Participants who had experienced heartburn or regurgitation for 7 consecutive days were randomized to one of the following treatment groups: proton pump inhibitors (PPI) plus alginate (combination) or PPI plus placebo (PPI only). In addition, as a reference group, patients received placebo plus alginate (alginate only). The primary endpoint compared the percentage of patients with complete resolution of symptoms for the final 7 days of the treatment. Secondary endpoints compared changes in symptom score, symptom-free days during the treatment period, the Reflux Disease Questionnaire, Patient Assessment of Upper Gastrointestinal Disorders (PAGI)-Quality of Life and PAGI-Symptoms Severity Index scores, the investigator's assessment of symptoms, and incidence of adverse events. RESULTS: Complete resolution of heartburn or regurgitation was not significantly different between the combination and PPI only groups (58.7% vs 57.5%, p=0.903). The secondary endpoints were not significantly different between the two groups. Complete resolution of heartburn or regurgitation, did not differ between the alginate only reference group and the PPI only group (75.0% vs 57.5%, p=0.146). CONCLUSIONS: The addition of non-bicarbonate alginate to PPI was no more effective than PPI alone in controlling reflux symptoms.

Applications of marine-derived chitosan and alginates in biomedicine / 生物医学工程学杂志

Marine-derived biopolymers are excellent raw materials for biomedical products due to their abundant resources, good biocompatibility, low cost and other unique functions. Marine-derived biomaterials become a major branch of biomedical industry and possess promising development prospects since the industry is in line with the trend of "green industry and low-carbon economy". Chitosan and alginates are the most commonly commercialized marine-derived biomaterials and have exhibited great potential in biomedical applications such as wound dressing, dental materials, antibacterial treatment, drug delivery and tissue engineering. This review focuses on the properties and applications of chitosan and alginates in biomedicine.

Endovascular interventional treatment of VX2 hepatocellular carcinoma in rabbits with Nordy-alginate microspheres / 中国介入影像与治疗学

Objective: To investigate the effect of endovascular intervention with Nordy-alginate microspheres (KMG) in treatment of rabbit VX2 hepatocellular carcinoma. Methods: Fifty rabbits with VX2 hepatocellular carcinoma were randomly divided into 5 groups (each n=10). The rabbits were then perfused of different drugs in the target vessels, which in group A was normal saline, in group B was Nordy, in group C was KMG, in group D were 5-fluorouracil+KMG and in Group E were Nordy-KMG. Enhanced CT scanning was performed 1 day before and 2 weeks after operation, and the volume and volume growth rate of tumors were compared among groups. Immunohistochemistry was used to detect the expression of vascular endothelial growth factor (VEGF) in tumor tissue, and the microvessel density (MVD) was counted. Results: There was no significant difference in the volume of tumors among 5 groups 1 day before operation (all P>0.05). Two weeks after operation, the volume and the volume growth rate of tumors in group A and B were higher than those in group C, D and E (both P<0.05). There were significant differences in the positive rate of VEGF and MVD among 5 groups (all P<0.01). The positive rate of VEGF and MVD in group E were lower than those in other groups (all P<0.05). Conclusion: Endovascular interventional therapy with Nordy-KMG is effective for VX2 hepatocellular carcinoma in rabbits.

The experimental research of calcium alginate gel loaded transforming growth factor beta 3 and compounded with adipose mesenchymal stem cells to repair rabbit articular cartilage defect / 中国医师杂志

Objective To investigate the effect of tissue engineered cartilage on the repair of artic ular cartilage defects in rabbits with calcium alginate gel (CAG) loaded transforming growth factor beta 3 (TGF-β3) and compounded with adipose mesenchymal stem cells (ADSCs).Methods The ADSCs were separated and cultured in subcutaneous fat of New Zealand white rabbits.The full-thickness articular cartilage defect model was made at the patellar groove by exposure of the femoral ankle joint.ADSCs were implanted into calcium alginate scaffolds loaded with TGF-β3 to construct tissue-engineered cartilage and transplanted into rabbit articular cartilage defects.The animals were divided into four groups:control group (injected with sterile isotonic saline),CAG group (injected with CAG),ADSCs + CAG group (injected with CAG loaded with ADSCs),TGF-β3 + CAG group (injected with CAG loaded with TGF-β3) and TGF-β3 + ADSCs + CAG group (injected with CAG loaded with TGF-β3 and ADSCs).At the end of 12 weeks,the repair of articular cartilage defects was observed by gross observation,hematoxylin-eosin (HE) staining,immunohistochemical staining of safranin-O and type Ⅱ] collagen,and the scoring method developed by In ternational Association of Cartilage Repair (ICRS) Histological score.Results The cartilage repair effect of TGF-β3 + ADSCs + CAG group was better than that of other groups,not only the neonatal tissue and the surrounding normal tissue closely,but also the secretion of extracellular matrix and normal tissue similar.The ICRS scores of each group were (7.06 ±+ 0.18) score,(7.15 + 0.23) score,(7.45 + 0.25) score,(7.47 + 0.24) score and (15.78 ±+ 0.24) score.That of TGF-β3 + ADSCs + CAG group was better than that of other groups,the difference was significant (P ＜ 0.05).Conclusions CAG loaded with TGF-β3 and combined with ADSCs has a good effect in repairing articular cartilage defects in rabbits,and is a structural repair.

Precisão dimensional de modelos obtidos de moldes de alginato pelos métodos invertido e não invertido / Dimensional accuracy of models obtained from pouring molds by inverted and non-inverted methods

Este é um estudo cuja finalidade foi demonstrar as possíveis deformações que podem ocorrer nos modelos obtidos de moldes de alginato, dependentes da forma de vazamento. Foram obtidos 20 moldes de alginato da marca Hydrogum 5 (Zhermack, Badia Polesine, Italy), através de um modelo de resina acrílica previamente preparado, divididos em dois grupos de 10: com vazamento invertido e não invertido. Os modelos foram analisados por fotografias, mensurados por um programa de computação (Corel Draw X3 Graphics Suíte (Corel Corporation ­ USA) e comparados com o modelo padrão. Os resultados mostraram que os vazamentos invertidos e não invertidos apresentaram valores clínicos diferentes do modelo padrão, mas que na comparação entre as técnicas, dos quatro segmentos analisados, apenas um apresentou diferença estatística significante(AU)

This is a study whose purpose was to demonstrate the possible deformations that may occur in the models obtained from alginate molds, depending on the form of flow. 20 alginate molds of Hydrogum 5 (Zhermack, Badia Polesine, Italy) were obtained through a previously prepared acrylic resin model, divided into two groups of 10: with inverted and non inverted casting. The models were analyzed by photographs, measured by a computer program (Corel Draw X3 Graphics Suite (Corel Corporation - USA) and compared with the standard model.The results showed that inverted and non inverted flow presented clinical values different from the standard model, But that in the comparison between the techniques, of the four analyzed segments, only one presented significant statistical difference(AU)

Continuation of Enteral Nutrition and Relief from Vomiting by Administration of a New Formula: a Case Report

Gastro-esophageal reflux (GER) is a common and serious complication in patients receiving enteral nutrition, making continuation of enteral nutrition difficult. Semi-solid enteral nutrients were developed to prevent feeding-related GER. Semi-solid enteral nutrients have high viscosity and, therefore, are typically administered through a large-diameter percutaneous endoscopic gastrostomy (PEG) tube. Recently, a new formula (Mermed®, Mermed Plus®) was introduced that uses alginate, which behaves like a gelatin in acidic conditions. This formula improved GER during enteral feedings. Our case report shows that this new formula enables the continuation of enteral nutrition via a nasogastric tube (NGT) in patients with difficulty tolerating enteral nutrition secondary to vomiting. An 86-year-old woman with an atherothrombotic cerebral infarction vomited during tube feeding, resulting in aspiration pneumonia. After 1 week, we introduced a viscosity regulator and restarted enteral feeding using a 100 mL liquid diet, but vomiting persisted. Because of the continued difficulty in tolerating enteral nutrition, the patient was transferred to our hospital. From hospital day 4, Mermed Plus® (300 mL/225 kcal, administered for 1 hour, 3 times a day) was started, eventually increasing to 535 mL/400 kcal at hospital day 5. After this, vomiting ceased. Mermed Plus® was easily administered via NGT, and its effects were immediate. This treatment appeared to improve the patient's quality of life while reducing the burden on medical staff.

Continuation of Enteral Nutrition and Relief from Vomiting by Administration of a New Formula: a Case Report

Gastro-esophageal reflux (GER) is a common and serious complication in patients receiving enteral nutrition, making continuation of enteral nutrition difficult. Semi-solid enteral nutrients were developed to prevent feeding-related GER. Semi-solid enteral nutrients have high viscosity and, therefore, are typically administered through a large-diameter percutaneous endoscopic gastrostomy (PEG) tube. Recently, a new formula (Mermed®, Mermed Plus®) was introduced that uses alginate, which behaves like a gelatin in acidic conditions. This formula improved GER during enteral feedings. Our case report shows that this new formula enables the continuation of enteral nutrition via a nasogastric tube (NGT) in patients with difficulty tolerating enteral nutrition secondary to vomiting. An 86-year-old woman with an atherothrombotic cerebral infarction vomited during tube feeding, resulting in aspiration pneumonia. After 1 week, we introduced a viscosity regulator and restarted enteral feeding using a 100 mL liquid diet, but vomiting persisted. Because of the continued difficulty in tolerating enteral nutrition, the patient was transferred to our hospital. From hospital day 4, Mermed Plus® (300 mL/225 kcal, administered for 1 hour, 3 times a day) was started, eventually increasing to 535 mL/400 kcal at hospital day 5. After this, vomiting ceased. Mermed Plus® was easily administered via NGT, and its effects were immediate. This treatment appeared to improve the patient's quality of life while reducing the burden on medical staff.

Análise dimensional de moldes de alginato após armazenagem / Dimensional analysis of alginate molds after storage

Objetivo: O objetivo neste trabalho foi avaliar a estabilidade dimensional de moldes de dois diferentes alginatos (Cavex Color Change®, Cavex Holland BV, Netherlands; Hydrogum®5, Zhermack, Italy), armazenados em diferentes intervalos de tempo, utilizando dois dispositivos diferentes (D1 e D2 - figuras 1 e 2 respectivamente). Métodos: Após a manipulação e presa completa dos alginatos, foram realizadas medidas diretamente nos moldes dos alginatos, nos tempos T0, T1, T2, T3, T4 e T5 (imediatamente, 30 minutos, 2 horas, 24 horas, 48 horas e 120 horas, respectivamente), para cálculo do percentual de alteração dimensional dos moldes em cada dispositivo. Os dados foram analisados pelo testes Two-Way ANOVA e Tukey, com nível de significância de 5%. Resultados: A análise estatística mostrou diferença entre os tempos (F=29,956; p<0,001), mas não houve diferença entre os alginatos (F=3,155; p=0,076) para o dispositivo 1. Em relação ao dispositivo 2, houve diferença tanto em relação aos tempos (F=21,495; p<0,001) quanto em relação aos alginatos (F=5,595; p=0,015). Conclusões: Os alginatos testados podem ser armazenados com segurança somente por até duas horas após sua presa.(AU)

Caracterização de condrócitos articulares cultivados em sistema tridimensional in vitro / Characterization of articular chondrocytes cultured in three-dimensional system in vitro

A osteoartrite é uma doença degenerativa da cartilagem articular que afeta, principalmente, idosos a partir dos 60 anos de idade. Sua degeneração é lenta e progressiva, causando dor e decréscimo da qualidade de vida dos pacientes acometidos pela doença. Atualmente, o tratamento da doença é de caráter meramente paliativo, resultando em cirurgia para completa remoção da cápsula articular do joelho e a substituindo por uma prótese. Este estudo avaliou as características dos condrócitos encapsulados por um hidrogel de alginato de sódio, que simula o microambiente original dessas células. Avaliamos a viabilidade dos condrócitos cultivados por 28 dias nesse modelo de cultivo, bem como a presença de proteoglicanos durante análise histológica. Através de microscopia eletrônica de varredura, observamos diferença significativa no microambiente interno do hidrogel e na disposição dos condrócitos, quando cultivados por até 28 dias na gota de alginato de sódio. Analisamos, ainda, a capacidade de deformação da gota de alginato de sódio quando pressionada, à fim de observar o quanto ela suporta até se romper. Nossos dados indicam que o hidrogel de alginato de sódio é um modelo eficaz para o cultivo de condrócitos e nos permite estudar suas características morfohistológicas. Além do mais, observamos o quão promissor é o uso desse biomaterial para a bioengenharia de tecido

Osteoarthritis is a degenerative disease of the articular cartilage that affects mainly elder people from 60 years old. Its degeneration is slow and progressive, causing pain and decreasing quality of life of patients affected by the disease. Currently, the treatment of the disease is merely palliative resulting in surgery for complete removal of the knee articular capsule and substituting it for a prosthesis. This study evaluated the characteristics of chondrocytes encapsulated by a sodium alginate hydrogel, which simulates a unique microenvironment of these cells. We evaluated the viability of chondrocytes cultured for 28 days in this model, as well as the presence of proteoglycan for histological analysis. Through scanning electron microscopy, we observed significant differences in the internal microenvironment of the hydrogel and chondrocytes disposition when cultured for up to 28 days in sodium alginate drop. We also analyzed the deformability of sodium alginate bead when pressed in order to observe how much it supports until it breaks. Our data indicate that sodium alginate hydrogel is an effective model to culture chondrocytes and allows us to study its morpho-histological characteristics. Moreover, we observed that this biomaterial can be very promising for tissue bioengineering

Influence of alginate impression materials and storage time on surface detail reproduction and dimensional accuracy of stone models / Influência dos alginatos e tempo de armazenamento na reprodução de detalhes da superfície e estabilidade dimensional de modelos de gesso

This study compared the surface detail reproduction and dimensional accuracy of stone models obtained from molds prepared using different alginate impression materials (Cavex Color Change, Hydrogum 5, or Jeltrate Plus) and with different storage times (1, 3, and 5 days) to models from molds that were filled immediatel y with no storage time. The molds were prepared over a matrix containing 50-μm line, (ISO 1563 standard) under pressure with a perforated metal tray. The molds were removed2 minutes after loss of sticky consistency and either filled immediately or stored in closed jars at 100% relative humidity and 37°C for 1, 3, or 5 days. The molds were filled with dental plaster (Durone IV). Surface detail reproduction and dimensional accuracy were evaluated using optical microscopy on the 50-μmwide line, which was 25 mm in length, according to ISO 1563 standard. The dimensional accuracy results (%) were subjected to analysis of variance. The 50-μm wide line (ISO 1563 standard)was completely reproduced by all alginate impression materials regardless of the storage time. There was no statistically significant difference in the mean dimensional accuracy values of stone models made from molds composed of different alginate impression materials and with different storage times (p = 0.989).In conclusion, storing the mold for five days prior to filling did not change the surface detail reproduction or dimensional accuracy of the alginates examined in this study.

Este estudo comparou a reprodução de detalhes da superfície e estabilidade dimensional de modelos de gesso obtidos a partir de diferentes alginatos (Cavex Color Change, Hydrogum 5, Jeltrate Plus) e com diferentes tempos de armazenagem (1, 3, e 5 dias)para modelos obtidos de moldes que foram preenchidos imediatamente sem tempo de armazenagem. Os moldes foram preparados sobre matriz contendo linha de 50 μm (norma ISO1563) realizado sob pressão com moldeira de metal perfurada.Os moldes foram removidos 2 minutos após a perda de consistência pegajosa e preenchidos imediatamente ou armazenado sem frascos fechados com temperatura (37°C) e umidade relativa(100%) controladas por 1, 3 ou 5 dias. Os moldes foram preenchidos com gesso dental (Durone IV). A reprodução de detalhes da superfície e a estabilidade dimensional foram avaliadas usando microscopia óptica na linha 50 μm com 25 mm de comprimento, de acordo com a norma ISO 1563. Os resultados de estabilidade dimensional (%) foram submetidos á análise de variância. A linha de 50 μm (norma ISO 1563) foi completamente reproduzida por todos os alginatos, independentemente do tempo de armazenagem. Não houve diferença estatisticamente significa -tiva nos valores médios de estabilidade de modelos de gesso obtidos de moldes de diferentes alginatos com diferentes tempos de armazenagem (p = 0.989). Em conclusão, o armazenamento do molde durante cinco dias antes do preenchimento não alterou a reprodução de detalhes da superfície ou estabilidade dimensional dos alginatos examinadas neste estudo.

Effect of interproximal undercut on the dimensional accuracy of impression / 대한치과보철학회지

PURPOSE: This study evaluated the effect of loss of interproximal papilla, creating an undercut, on the accuracy of impression materials. MATERIALS AND METHODS: Two addition type silicone impression materials (Extrude(R) Wash, Imprint(TM) II Quick Step Light Body) and one alginate impression material (Cavex Impressional) were used to make impressions of a maxillary master model simulating clinical conditions with or without interproximal papilla. Stone was poured in the impressions and working casts were fabricated. A total of 6 groups with 6 working casts in each group were scanned using 3-dimensional optical scanner. The accuracy of the impressions was assessed by measuring the dimensional changes (DeltaI (%)) of 6 distances on working casts compared to a master model with a 3-dimensional digitizing and inspection software. The data were analyzed by two-way ANOVA (P<.05). RESULTS: Three of 6 distances showed statistically significant differences among the impression materials. Only 1 of 6 distances in alginate impression showed a statistically significant difference between casts with and without interproximal papilla (P=.047). CONCLUSION: The presence of undercut due to loss of interproximal papilla did not significantly influence the dimensional accuracy of addition type silicone and alginate impression materials.

Alterações dimensionais de alginatos utilizados na Ortodontia / Dimensional changes of alginate used in Orthodontics

A produção de modelos de gesso em Ortodontia é imprescindível como auxiliar no diagnóstico e no desenvolvimento de planos de tratamento. O alginato é a primeira escolha dos profissionais devido ao seu baixo custo, facilidade de manipulação e ausência de equipamentos sofisticados para o manuseio. Assim como os demais materiais de moldagem, os moldes de alginato sofrem distorções com o passar do tempo. O objetivo deste estudo foi avaliar a estabilidade dimensional de cinco marcas de alginato, através de modelos tridimensionais obtidos em diferentes intervalos de tempo. Um manequim odontológico foi utilizado como modelo padrão e, a partir dele, foram obtidos moldes em cinco intervalos de tempo: imediatamente após a moldagem, seis horas, um dia, dois dias e cinco dias após. O método de armazenamento dos moldes foi realizado conforme instruções dos fabricantes. Os modelos obtidos e o modelo padrão foram digitalizados com escâner Maestro 3D. Cinco medidas lineares foram utilizadas como parâmetros. Apesar das alterações observadas em todos os modelos, em nenhum dos parâmetros de medida foram encontradas diferenças estatísticas nos diferentes intervalos de tempo. Portanto, o vazamento tardio de alginato pode ser realizado sem comprometer o resultado final dos modelos de estudo em Ortodontia, caso o armazenamento e as instruções do fabricante sejam seguidas a rigor.

The production of casts in orthodontics is indispensable as an auxiliary in the diagnosis and development of treatment plans. Alginate is the first choice of professionals due to its low cost, ease of handling and absence of sophisticated equipment for handling. As well as other impressions materials, alginate impressions suffer distortions over time. The aim of this study was to evaluate the dimensional stability of five brands of alginate through the three-dimensional models obtained at different time intervals. A dental mannequin was used as a standard model, and from it, molds were obtained in five time intervals: immediately after molding, six hours, one day, two days and five days after. The method of molds storage was done according to the instructions of the manufacturers. The models obtained and the standard model were scanned with a 3D scanner Maestro. Five linear measurements were used as parameters. Despite the observed changes in all models, in any parameter was found statistical differences in different time intervals. Therefore, the late leak alginate can be performed without compromising the final result of the study models in orthodontics, once the storage and the manufacturer's instructions are followed strictly.