Study of pulp blood flow in normal adult first molars detected by laser Doppler flowmetry / 口腔疾病防治

Objective @#To explore the "clinical normal reference range" of pulpal blood flow (PBF) in the physiological state in an effort to provide a reference for clinical diagnosis and treatment.@* Methods@# According to the working principle and operational considerations of laser Doppler flowmetry (LDF), the PBF blood flow value of the first molars of the upper and lower mandibles of normal adults was detected by LDF, and the clinical reference value range under physiological conditions was analyzed and calculated. The differences in PBF values by sex, dental position and location (left and right side, upper and lower jaw) were analyzed. @*Results @#A total of 200 normal adult participants with an average age of (22.76 ± 3.26) years were included. The cohort included 95 males and 105 females, with a total of 800 first molars. Neither the PBF values of the left and right first molars nor the PBF values of the upper and lower first molars in males or females significantly differed (P>0.05). The PBF value for females was higher than that of males. Specifically, the clinical reference PBF values for males and females were (8.56 ± 3.25) PU and (9.51 ± 3.47) PU, respectively.@*Conclusion @#The PBF values of normal adult first molars in healthy subjects were higher in females than in males, and in the PBF values of first molars of the same sex did not significantly differ between the left side and right side or upper and lower jaw; these values could be used as a reference for the selection of control teeth.

Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study

Abstract Objective This study aims to determine and compare the dental pulp and gingival blood flow in patients referred for oropharyngeal radiotherapy (RT) at three different time points: before the start, immediately after, and six months following the completion of RT. The aim is also to evaluate the dependence of the pulp and gingival blood flow on the radiation dose. Methodology A prospective study included 10 patients referred for intensity-modulated RT (IMRT) in the oropharyngeal region, with at least one intact tooth surrounded by a healthy gingiva. The dose received by each selected tooth and adjacent gingiva was determined according to the map of treatment planning and computer systems. The blood flow measurements were performed using the laser Doppler flowmetry (LDF) method. Results Comparing vascular flows at three different time points, the median blood flow in the dental pulp showed no statistically significant difference (p=0.325), contrary to gingiva (p=0.011). Immediately after RT completion, the gingival flow significantly increased compared to its starting point (p=0.012). The pulp flow correlated negatively with the radiation dose, whereas a strong correlation was noted 6 months following the RT completion. Conclusions RT caused a significant acute gingival blood flow increase, followed by a long-term (over six months) tendency to return to the starting levels. The dental pulp blood flow is differently affected by higher radiation doses (over 50Gy) in comparison to lower doses (below 50Gy). During RT planning, considering the possibility of protecting the teeth localized near the Gross Tumor Volume as a sensitive organ is recommended.

Effects of regular physical exercise on skin blood flow and cardiovascular risk factors in overweight and obese subjects / Efeitos do exercício físico regular sobre o fluxo sanguíneo da pele e nos fatores de risco cardiovascular em indivíduos com sobrepeso e obesidade

Objective: it is well known that low omentin levels and reduced bioavailability of nitric oxide (NO) are outgrowth of obesity. Besides, in obese subjects, microvascular dysfunction can be an initial stage of cardiovascular diseases. This situation can be evaluated with skin laser­Doppler flowmetry (LDF). Methods: in this study we investigated the effects of 12 weeks moderate physical exercise on microvascular reactivity and plasma levels of omentin and NO in 25 overweight and obese subjects. Control group was composed of 28 sedentary participants who were neither obese nor overweight. Microvascular reactivity was handled by measurement of skin blood flow from the ring finger of the right hand with LDF, which is a non­invasive method for evaluation. With this method, it was aimed to examine the post­occlusive reactive hyperemia response of the patients. None of the participants in both groups have never followed a regular exercise schedule in their life span. Results: with regular exercise, there was a statistically significant decrease in glucose (p=0.008), cholesterol (p=0.05), and triglyceride (p=0.048) levels, while body mass index, high­density lipoprotein, and low­density lipoprotein levels did not change significantly in overweight/obese group. Also, the omentin level significantly increased (p=0.01), but NO level did not change significantly. Moreover, the amount of change in omentin and NO levels measured before and after the physical exercise were significantly correlated (r=0.57). Considering the microcirculation, rest flow (p=0.001) and peak flow value of LDF (p=0.001) increased after the physical exercise. Conclusion: our study shows that moderate physical exercise affects microvascular reactivity and plasma levels of omentin in overweight and obese subjects.

Objetivo: sabe-se que níveis baixos de omentina e a reduzida biodisponibilidade de óxido nítrico (NO) são consequências da obesidade. Além disso, a disfunção microvascular pode ser um estágio inicial de doenças cardiovasculares em indivíduos obesos. Essa situação pode ser avaliada com a fluxometria de pele laser-Doppler (LDF). Métodos: foram investigados os efeitos do exercício físico moderado por 12 semanas na reatividade microvascular e nos níveis plasmáticos de omentina e NO em 25 indivíduos com sobrepeso e obesidade. O grupo controle foi composto por 28 participantes sedentários que não eram obesos nem com sobrepeso. A reatividade microvascular foi obtida pela medida do fluxo sanguíneo da pele do dedo anelar da mão direita com LDF, que é um método não invasivo de avaliação. Com este método, objetivou-se examinar a resposta da hiperemia reativa pós-oclusiva dos pacientes. Os participantes de ambos os grupos nunca seguiram um cronograma regular de exercícios em sua vida. Resultados: com o exercício regular houve diminuição estatisticamente significativa dos níveis de glicose (p=0,008), de colesterol (p=0,05) e de triglicerídeos (p=0,048), enquanto o índice de massa corporal e os níveis de lipoproteínas de alta e baixa densidade não se alteraram significativamente no grupo com sobrepeso/obesidade. Além disso, o nível de omentina aumentou significativamente (p=0,01), mas o nível de NO não apresentou modificações significas. Observou-se, também, que as modificações nos níveis de omentina e NO mensurados antes e após o exercício físico foram significativamente correlacionados (r=0,57). Em relação à microcirculação, os valores do fluxo de repouso (p=0,001) e do valor de fluxo de pico e da LDF (p=0,001) aumentaram após o exercício físico. Conclusão: nosso estudo mostra que o exercício físico moderado afeta a reatividade microvascular e os níveis plasmáticos de omentina em indivíduos com sobrepeso e obesidade.

Guía de manejo obstétrico y del recién nacido en madre aloinmunizada / Guidelines for the obstetric management of an alloimmune mother and her newborn / Guia de manejo obstétrico e neonatal em mães aloimunizadas

Resumen: La aloinmunización es una respuesta biológica frente a la exposición de antígenos no propios. La gestación, las transfusiones de hemocomponentes, los trasplantes de órganos sólidos y células hematopoyéticas, así como el consumo de drogas intravenosas exponen a las pacientes al desarrollo de aloanticuerpos antieritrocitarios. El hallazgo de los mismos debe cumplir con las instancias diagnósticas para identificar la probabilidad de estar asociados a enfermedad hemolítica feto neonatal (EHFN) y su oportuna derivación a policlínica de alto riesgo obstétrico (ARO) para su correcto seguimiento. Es fundamental que sean los laboratorios de inmunohematología de los servicios de hemoterapia y medicina transfusional los encargados de los estudios diagnósticos de aloinmunización eritrocitaria(1). En este sentido hemos elaborado esta guía con el objetivo de protocolizar de manera multidisciplinaria el manejo de las embarazadas aloinmunizadas y sus recién nacidos.

Abstract: Alloimmunization is the biological response to exposure to non-HLA antigens. Pregnancy, transfusion of blood components, solid organ and hematopoietic cell transplantation, as well as intravenous drug use expose patients to the development of anti-erythrocyte antibodies. When the latter are found, they must match diagnostic criteria to identify the potential association to hemolytic disease of the fetus and newborn (HDFN) and its timely referral to the high-risk obstetric risk polyclinic for due follow-up. It is of the essence for erythrocyte alloimmunization diagnostic tests to be carried out by the immunohematology laboratories of the Hemotherapy and Transfusional Medicine services. To that end, we have prepared these guidelines with the purpose of providing a multidisciplinary protocol for the handling of maternal alloimmunization and alloimmunization of the newborn.

Resumo: A aloimunização é uma resposta biológica à exposição a antígenos não próprios. A gravidez, as transfusões de hemocomponentes, os transplantes de órgãos sólidos e células hematopoiéticas, bem como o uso de drogas intravenosas expõem os pacientes ao desenvolvimento de anticorpos antieritrocitários. O achado destes deve obedecer a critérios diagnósticos para identificar a doença e a probabilidade de estarem associados a doença hemolítica feto neonatal (DHPN) e seu encaminhamento oportuno para uma unidade de alto risco obstétrico para acompanhamento adequado. É fundamental que os laboratórios de imuno-hematologia dos serviços de Hemoterapia e Medicina Transfusional se encarreguem dos estudos diagnósticos da aloimunização eritrocitária. Elaboramos este guia com o objetivo de estabelecer um protocolo multidisciplinar para o manejo de gestantes aloimunizadas e seus recém-nascidos.

Laser doppler flowmetry as a method of analysis for the evaluation of chemo - induced oral mucositis: a pilot study / Flujometría por láser doppler como método de análisis para la evaluación de la mucositis oral inducida por quimioterapia: un estudio piloto

Background: Oral mucositis (OM) is an inflammation of the oral mucosa due to cancer therapy that compromises the patient's quality of life. Laser Doppler flowmetry (LDF) is a non-invasive method to monitor microvascular blood flow (BF) in real-time. Purpose: Develop a method to evaluate BF in the genian region cheek in patients undergoing chemotherapy by LDF and compare the degrees of OM and pain with evaluation of BF. Material and methods: Evaluation of OM was performed using the World Health Organization (WHO) and Oral Mucositis Assessment Scale (OMAS) scales and the visual analog scale for pain evaluation. For flowmetry analysis, a laser Doppler flowmeter (moorVMSTM™, 780 nm wavelength and VP3 probe), fixed by an acrylic resin support was used; VP3 probe was positioned on the genian region and the patient's head was stabilized with a neck pillow for an accurate measurement. The Wilcoxon test was used to compare the flowmetry results at the studied times. The Pearson correlation coefficient was used to evaluate relationships between BF and the WHO, OMAS and visual analog scales. Results: Eleven patients of both sexes, aged between 30 and 78 years, with OM were included. An increase in cutaneous BF was observed at the initial times of OM, with progressive reduction during the chemotherapy cycle. There was a statistical difference (p<0.05) between time point T0 (first consultation) and time point T6 (last consultation). Conclusion: The method developed in this pilot study is effective, reliable, and reproducible, and allows the evaluation of BF dynamics in the genian region using LDF of patients undergoing chemotherapy at risk of developing OM.

Antecedentes: La mucositis oral (MO) es una inflamación de la mucosa oral debido a la terapia del cáncer, que compromete la calidad de vida del paciente. La flujometría láser Doppler (FLD) es un método no invasivo para monitorear el flujo sanguíneo microvascular (FS) en tiempo real. Objetivo: Desarrollar un método para evaluar la FS en la mejilla de la región geniana en pacientes sometidos a quimioterapia por FLD y comparar los grados de MO y dolor con la evaluación del FS. Material y Métodos: La evaluación de la MO se realizó utilizando las escalas de la Organización Mundial de la Salud (OMS) y la Escala de Evaluación de la Mucositis Oral (OMAS) y la escala analógica visual para la evaluación del dolor. Para el análisis de flujometría se utilizó un flujómetro láser Doppler (moorVMSTM™, longitud de onda de 780 nm y sonda VP3), fijado por un soporte de resina acrílica; La sonda VP3 se colocó en la región geniana y la cabeza del paciente se estabilizó con una almohada para el cuello para una medición precisa. Se utilizó la prueba de Wilcoxon para comparar los resultados de la flujometría en los tiempos estudiados. Se utilizó el coeficiente de correlación de Pearson para evaluar las relaciones entre FS y las escalas de la OMS, OMAS y analógicas visuales. Resultados: Se incluyeron 11 pacientes de ambos sexos, con edades comprendidas entre 30 y 78 años, con MO. Se observó un aumento del FS cutáneo en los momentos iniciales de la MO, con reducción progresiva durante el ciclo de quimioterapia. Hubo una diferencia estadística (p<0.05) entre el momento T0 (primera consulta) y el momento T6 (última consulta). Conclusión: El método desarrollado en este estudio piloto es efectivo, confiable y reproducible, y permite evaluar la dinámica del FS en la región geniana utilizando FLD de pacientes sometidos a quimioterapia con riesgo de desarrollar MO.

Ecografía doppler de la arteria pulmonar como indicador de madurez pulmonar fetal, Cuenca ­ Ecuador / Doppler ultrasound of the pulmonary artery as fetal lung maturity indicator, Cuenca - Ecuador

Introducción: la flujometría de la arteria pulmonar en fetos sanos puede ser un estudio predictor de la madurez pulmonar, lo que conlleva a un impacto en la disminución de la mortalidad perinatal.Objetivo: establecer el índice de tiempo de aceleración/tiempo de eyección de la arteria pulmonar (TA/TE) como un indicador de madurez pulmonar fetal en gestantes entre 26 y 40 semanas de gestación (SG), usuarias del Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo, periodo 2017.Métodos: estudio de validación de prueba diagnóstica. Se evaluó la flujometría de la arteria pulmonar por ecografía doppler en 300 fetos sanos de gestantes entre 15 y 45 años de edad. Para la recolección de datos se utilizó encuestas y para la determinación de la validez se usó los estadísticos sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Resultados: el valor del índice TA/TE de la arteria pulmonar fue 0.216 para las gestantes entre 26-28 SG; de 0.253 entre 29-31 SG; de 0.279 entre 32-34 SG; de 0.315 para las gestantes entre 35-37 SG y de 0.349 entre 38-40 SG. Las 37 SG en punto de corte fue de 0.320; el área ROC fue 0.98 con una S: 95.2%, E: 97.2%. VPP 93.0% y VPN 98.1%.Conclusiones: el índice TA/TE de la arteria pulmonar demostró correlación con la edad gestacional. Un índice TA/TE de 0.320, como punto de corte, predice madurez pulmonar fetal (AU);

Introduction: pulmonary artery flow metric in healthy fetuses can be a predictive study of lung maturity, which leads to an impact on the decrease in perinatal mortality.Objective: to establish the ratio of pulmonary artery acceleration time to ejection time (AT/ET) as an indicator of fetal lung maturity in pregnant women from 26 to 40 weeks of gestation (WG), users of the "Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo", period 2017.Methods: A validity study of diagnostic tests was carried out. Pulmonary artery flow metric was evaluated by Doppler ultrasound in 300 healthy fetuses of pregnant women between 15 to 45 years old. Surveys were used to collect data. Sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) were used to determine validity.Results: the value of the TA / TE index of the pulmonary artery was 0.216 for pregnant women between 26-28 WG; of 0.253 between 29-31 WG; 0.279 between 32-34 WG; 0.315 for pregnant women between 35-37 WG and 0.349 between 38-40 WG. The 37 WG at the cut-off point was 0.320; the ROC area was 0.98 with a S: 95.2%, E: 97.2%. The PPV 93.0% and NPV 98.1%.Conclusions: the AT/ET ratio of pulmonary artery showed correlation with gestational age. An AT/ET ratio of 0.320, as a cut-off point, predicts fetal lung maturity (AU);

Microcirculation changes in gingival tissue after ultrasonic tooth preparation in beagle dogs

Abstract Ultrasonic wave technology is widely used during dental treatments. We previously demonstrated that this method protects the gingival tissue. However, the physiological change on the gingival microvasculature caused by this method remains unclear. Objective The aim of this study was to investigate the relationship between the morphological and physiological effects on gingival microcirculation when preparing teeth, using the conventional dental turbine or ultrasonic method. Methodology The lower premolar teeth of beagle dogs were prepared along the gingival margin by using a dental turbine or ultrasonic wave instrument. Gingival vasculature changes were investigated using scanning electron microscopy for corrosion resin casts. Gingival blood flow at the preparation site was determined simultaneously by laser Doppler flowmetry. These assessments were performed immediately (Day 0), at 7 days and 30 days after tooth preparation. Results At day 0, in the turbine group, blood vessels were destroyed and some resin leaked. Furthermore, gingival blood flow at the site was significantly increased. In contrast, the ultrasonic group demonstrated nearly normal vasculature and gingival blood flow similar to the non-prepared group for 30 days after preparation. No significant alterations occurred in gingival circulation 30 days after either preparation; however, the turbine group revealed obvious morphological changes. Conclusions Based on multiple approach analyses, this study demonstrated that ultrasonic waves are useful for microvascular protection in tooth preparation. Compared with a dental turbine, ultrasonic wave instruments caused minimal damage to gingival microcirculation. Tooth preparation using ultrasonic wave instruments could be valuable for protecting periodontal tissue.

Case report and literature review of vital pulp preservation by endodontic microsurgery at the distal buccal root of maxillary molar / 口腔疾病防治

Objective@#To investigate the diagnosis, treatment and prognosis of nonodontogenic periapical lesions and to provide a reference for clinical diagnosis and treatment.@*Methods@# A case of a patient with right upper molar pulp with apical penetration and local occlusion admitted to the West China Stomatological Hospital of Sichuan University was retrospectively analyzed, and the curative effect of microapical surgery and pith preservation was also analyzed.@*Results @#The imaging features of tooth 16 showed periradicular radiolucency combined with local radiopaque lesions around the distal buccal apical area. Endodontic microsurgery was performed under local anesthesia. Soft tissue coverage was observed in the distal buccal apical area during the surgery, and no radiopaque tissue was detected. The distal buccal root apex was cut by 3 mm, and mineral trioxide aggregate was used for root-end backfilling. The postoperative pathological results revealed fibrous connective tissue. One-week recall X-ray examination showed tight root-end backfilling and no periradicular radiolucency; an electrical test of pulp vitality showed positive results. The four-year follow-up showed that there was no discoloration in tooth 16 and no significant difference in thermal and electrical tests of pulp vitality compared with control teeth. Combining the clinical manifestations, imaging features, surgical exploration results and pathological reports, the case was most likely to be cemental hypoplasia. Through the literature review, the treatment and healthy pulp preservation of such cases by endodontic microsurgery under the premise of preserving teeth has not been reported.@*Conclusion@#For maxillary posterior teeth with periapical lesions but healthy pulp, accurate estimation of pulp status, endodontic microsurgical exploration and application of bioactive materials can achieve vital pulp preservation while removing the lesions.

Confusion and solution for vital pulp therapy / 华西口腔医学杂志

Dental pulp tissue plays a role in forming dentin, providing nutrition, conducting pain, and generating protective responses to environmental stimuli. Bacterial infection is the main cause of pulp disease, where histopathological changes are the histological basis for determining the choice of treatment and the evaluation of therapeutic effect. Thus, particular attention should be given to eliminate infection, as well as preserve and maintain pulpal health in teeth that show reversible or limited pulpal injuries. Vital pulp therapy, especially its indications and prognostic factors, has been a research hotspot that often causes confusion among clinicians. In this paper, we briefly introduce the confusion and solution for vital pulp therapy in terms of indications, pulp condition assessment, infection elimination, and capping material selection. In addition, we develop a clinical pathway and an operation normalization of vital pulp therapy to better perform the therapy.

Study on using laser Doppler flowmetry to determine the pulpal blood flow of immature maxillary incisors / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to evaluate the influence of age on the pulpal blood flow (PBF) of immature maxillary incisors of maxillary incisors, which was detected by laser Doppler flowmetry (LDF).</p><p><b>METHODS</b>LDF was used to detect the PBF value of maxillary central and lateral incisors of a child group (aged 7-13 years old) and a positive control group (aged 18-25 years old), as well as the central incisor of a negative control group (the central incisor had undergone endodontic treatment). We then compared the features of PBF in all groups with the influence of gender and position on PBF. The relation of maxillary central incisor and lateral incisor, age, and maxillary incisor were analyzed.</p><p><b>RESULTS</b>The PBF value of the negative control group was (2.08±0.73) PU. The PBF values in the positive control group in central and lateral incisors were (8.49±1.88) and (7.52±1.82) PU. In the child group, PBF values in central incisors and lateral incisors were (11.31±2.21) and (12.18±2.65) PU. A significant difference was observed between different groups and between central and lateral incisors (P<0.01). Meanwhile, no significant difference was found in the PBF values between the right and the left parts in both males and females (P>0.05). Age had a linearity negative correlation with the PBF value of incisors in the child group. A linear negative correlation existed between the age and PBF of central and lateral incisors (r=-0.310 and r=-0.510, respectively) (P<
0.01).</p><p><b>CONCLUSIONS</b>PBF value decreased with increased age in children aged 7-13 years old.</p>

Establishment of canine spinal cord injury model and significance of laser-doppler flowmetry evaluation / 重庆医学

Objective To investigate the effect of laser‐doppler flowmetry (LDF) in the evaluation of established canine spi‐nal cord injury(SCI) model .Methods Totally 15 beagle dogs were randomly divided into the group A ,B and C .Through the im‐proved numerical control SCI apparatus ,different impacts and compression time were adopted to establish the different acute SCI models .The group A was 1 .2 m/s+5 mm+5 mm+15 mns ,the group B was 1 .2 m/s+5 mm+5 mm+10 mns ,while the group C wastakenasthecontrolgroup.LDFwasusedtomeasurethespinalcordbloodflow(SCBF)chart,thepathologicchangewasevalu‐ated by measuring the spinal cord necrosis area .Results The SCBF chart in 3 groups measured by LDF showed that the decrease of SCBF in the group A was most obvious ,the injury degree in the group A was more severe than those in the group B and C ,the difference was statistically significant(P<0 .05) .The motor evoked potential displayed that the decrease degree of SCBF was close‐ly related with the prognosis and motion function .Conclusion LDF could effectively judge the degree of spinal injury and SCBF sit‐uation ,which has a good application prospect in animal experiments and clinical field .

Pilot study of laser-doppler flowmetry measurement of oral mucosa blood flow / 北京大学学报(医学版)

Objective:To explore and compare the perfusion pattern of oral mucosa on Han Chinese and Caucasian by laser-doppler flowmetry.Methods:A cross-sectional study was carried out,in 20 healthy Han Chinese adult subjects (average age:28.4 years)and 20 healthy Caucasian (average age:25.3 years)adult subjects,either gender with 10 subjects.Gingival perfusion was evaluated at 8 points (including upper incisor labial gingival,lower incisor labial gingival,palatal mucosa,cheek mucosa) using a laser-doppler flowmetry(O2C,Medizintechnik GmbH,Germany).Each measurement was car-ried out 25 seconds consisting 5 seconds of foreperiod and 20 seconds of work period,without pressure. The measurements were taken by two well-trained doctors,each measurement was exammed 3 times by an examiner,and the average value was recorded as final data.Each measurement has 4 parame ters:SpO2 (oxygen saturation),rHB (relative amount of hemoglobin),flow (the blood flow of unit interval),and velocity (blood flow velocity).We compared the data by different sites,different genders,and different races.Results:For palatal gingival,the average SpO2 was 77.1% ±10.9%,the average rHB 67.8 ± 11.1,and the average flow 194.1 ±63.7,which presented significant lower values than other oral muco-sa.There was no significant difference among other sites.There was some significant difference between the Caucasian and the Han Chinese:the maxillary central incisor oxygen saturation (SpO2)which were averages of 75.6% ±8.2% and 70.4% ±7.6%;buccal mucosa hemoglobin (rHB)averages of 79.9 ±5.8 and 83.5 ±6.6,which had statistical differences.For most measurement points,the oxygen saturation on men was lower than that on women,which had significant difference.Conclusion:To inves-tigate microcirculation pattern,oral mucosa can be the good observation site.Laser-doppler flowmetry is a well-documented instrument to survey on microcirculation.There may be differences between the genders in hemoglobin oxygen-binding capacity,which may have some impact on the ability of soft tissue healing. Oral mucosa display more blood perfusion than attached gingival.As the recipient site of gingival graft, maxilla and mandible have slight difference in blood supply.

Assessment of Circulatory Status of the Newborn in the Neonatal Intensive Care Unit

Birth is a moment of transition from intra- to extra-uterine life, which is characterized as switching of gas-exchanging organs from the placenta to the lungs. It is achieved by aeration as well as perfusion of the lungs (increase in pulmonary blood flow). This is, without doubt, the most challenging event in human life. Assessment of circulatory status of the newborn in this critical period is challenging as well. For monitoring those tiny, vulnerable, and unstable creatures, technology requires non-invasiveness and a reasonably high signal/noise ratio. Conventionally, we have monitored circulatory status of newborns by inspection and physical examination, including vital signs such as body temperature, skin color, heart rate and blood pressure. Echocardiography was introduced in the 1980's and its function has been developing and advancing ever since. It is certainly the most powerful tool for both the assessment and management of circulation in the newborn infants. Although echocardiography is actually not a 'continuous monitor' but an 'intermittent check-up'. Its disadvantage can be overcome to some extent by performing it quickly and frequently. However, some novel methods for monitoring circulation are being developed and becoming available in clinical neonatology. For example, near-infrared spectroscopy, electrical cardiometry and laser Doppler flowmetry may be useful for monitoring other aspects of circulation.

AST-120 Improves Microvascular Endothelial Dysfunction in End-Stage Renal Disease Patients Receiving Hemodialysis

PURPOSE: Endothelial dysfunction (ED) is a pivotal phenomenon in the development of cardiovascular disease (CVD) in patients receiving hemodialysis (HD). Indoxyl sulfate (IS) is a known uremic toxin that induces ED in patients with chronic kidney disease. The aim of this study was to investigate whether AST-120, an absorbent of IS, improves microvascular or macrovascular ED in HD patients. MATERIALS AND METHODS: We conducted a prospective, case-controlled trial. Fourteen patients each were enrolled in respective AST-120 and control groups. The subjects in the AST-120 group were treated with AST-120 (6 g/day) for 6 months. Microvascular function was assessed by laser Doppler flowmetry using iontophoresis of acetylcholine (Ach) and sodium nitroprusside (SNP) at baseline and again at 3 and 6 months. Carotid arterial intima-media thickness (cIMT) and flow-mediated vasodilation were measured at baseline and 6 months. The Wilcoxon rank test was used to compare values before and after AST-120 treatment. RESULTS: Ach-induced iontophoresis (endothelium-dependent response) was dramatically ameliorated at 3 months and 6 months in the AST-120 group. SNP-induced response showed delayed improvement only at 6 months in the AST-120 group. The IS level was decreased at 3 months in the AST-120 group, but remained stable thereafter. cIMT was significantly reduced after AST-120 treatment. No significant complications in patients taking AST-120 were reported. CONCLUSION: AST-120 ameliorated microvascular ED and cIMT in HD patients. A randomized study including a larger population will be required to establish a definitive role of AST-120 as a preventive medication for CVD in HD patients.

Características ultrassonográficas mamárias e índices hemodinâmicos das artérias mamárias internas durante a gravidez normal / Breast ultrasonographic features and internal mammary artery hemodynamic indexes during normal pregnancy

OBJETIVO: Avaliar as características ultrassonográficas mamárias e os índices hemodinâmicos das artérias mamárias internas em grávidas normais, correlacionando-os com os períodos da gestação.MÉTODOS: Estudo epidemiológico, observacional e transversal, realizado entre agosto de 2013 e fevereiro de 2015, com 93 mulheres distribuídas em três grupos: primeiro trimestre, segundo trimestre e terceiro trimestre. As variáveis dependentes foram as espessuras da pele, do tecido celular subcutâneo, do tecido fibroglandular, do tecido adiposo retromamário, o diâmetro dos ductos, assim como os índices de pulsatilidade e resistência das artérias mamárias internas. As variáveis independentes foram os três períodos da gestação. Para a análise estatística, empregou-se o teste de Levene (variâncias uniformes entre os períodos da gestação), o teste ANOVA com medidas repetidas, o teste de Tukey de comparação múltipla e de contraste. O teste t de Student foi utilizado para avaliar a diferença entre nulíparas e não nulíparas, e o coeficiente de correlação de Pearson para a correlação entre as duas mamas. Foi considerado o nível de significância de 5%.RESULTADOS: A média de idade foi 26,6±4,6 anos, a qual não houve diferença significativa entre os grupos. A localização da mama (direita/esquerda) e o período gestacional não tiveram efeito significativo sobre as espessuras mamárias da pele, tecido celular subcutâneo e tecido adiposo retromamário, porém a espessura do tecido fibroglandular e o diâmetro dos ductos apresentaram diferença significativa em relação ao período gestacional (p<0,001) do primeiro para o terceiro e do segundo para o terceiro trimestres. A dopplerfluxometria das artérias mamárias internas revelou diferença entre as mamas e o período gestacional, ou seja, o lado direito apresentou medidas superiores ao lado esquerdo, e os valores foram decrescentes ao longo da gestação (p<0,001).CONCLUSÃO: A espessura média de tecido fibroglandular e o diâmetro dos ductos mostraram diferenças significativas do primeiro para o segundo e do primeiro para o terceiro trimestre, não sendo observadas diferenças entre as duas mamas. O índice de pulsatilidade e o índice de resistência das artérias mamárias internas foram progressivamente menores durante a gravidez.

PURPOSE: To evaluate breast ultrasonographic features and hemodynamic indexes of the internal mammary arteries in normal pregnant women, and their correlation with the gestational periods.METHODS: Observational and cross-sectional, epidemiological, study, conducted between August 2013 and February 2015, with 93 women divided into three groups: first trimester, second trimester and third trimester. The dependent variables were thickness of the skin, of subcutaneous tissue, fibroglandular tissue, and retrommamary adipose tissue, the diameter of the ducts, as well as the pulsatility and resistance indexes of the internal mammary arteries. Independent variables were the three periods of gestation. Repeated measures ANOVA with the multiple comparison Tukey test and a test of contrasts were used for statistical analysis. The Levene test was used to test the homogeneity of variances between periods of gestation. Student's t-test was used to evaluate the difference between nulliparous and non -nulliparous women, and Pearson's correlation coefficient was used for correlation analysis between the two breasts. The level of significance was set at 5%.RESULTS: Mean age was 26.6±4.6 years, with no significant difference among groups. Breast location (right/left) and gestational period had no significant effect on the thickness of the skin, of subcutaneous tissue and adipose retromammary tissue. However, the thickness of fibroglandular tissue and the diameter of the ducts showed a significant difference according to gestational period (p<0.001), i.e., from the first to the second and to the third trimesters. Doppler flowmetry of the internal mammary arteries showed a difference between breasts and between gestational periods, i.e., the measurements of the right breast were greater than those of the left, and these values decreased throughout pregnancy (p<0.001).CONCLUSION: The average thickness of fibroglandular tissue and the diameter of the ducts showed significant differences from the first to the second and to the third trimesters, with no differences being observed between the two breasts. The pulsatility and resistance indexes of the internal mammary arteries decreased progressively throughout pregnancy.

Flowmetry/pelvic floor electromyographic findings in patients with detrusor overactivity

To evaluate different flowmetry/EMG patterns in patients with proven detrusor overactivity (DO) and compare them with that of a group of patients with lower urinary tract symptoms (LUTS) but without DO.

In-office bleaching effects on the pulp flow and tooth sensitivity – case series

Laser Doppler flowmetry (LDF) is a noninvasive method capable of evaluating variations in pulp blood flow (PBF) and pulp vitality. This method has thus far not been used to assess changes in blood flow after in-office bleaching. The aim of this case series report was to measure changes in PBF by LDF in the upper central incisor of three patients submitted to in-office bleaching. The buccal surfaces of the upper arch were bleached with a single session of 35% hydrogen peroxide gel with three 15-min applications. The color was recorded using a value-oriented Vita shade guide before in-office bleaching and one week after the procedure. The tooth sensitivity (TS) in a verbal scale was reported, and PBF was assessed by LDF before, immediately, and one week after the bleaching session. The lower arch was submitted to dental bleaching but not used for data assessment. A whitening degree of 3 to 4 shade guide units was detected. All participants experienced moderate to considerable TS after the procedure. The PBF readings reduced 20% to 40% immediately after bleaching. One week post-bleaching, TS and PBF were shown to be equal to baseline values. A reversible decrease of PBF was detected immediately after bleaching, which recovered to the baseline values or showed a slight increase sooner than one week post-bleaching. The LDF method allows detection of pulp blood changes in teeth submitted to in-office bleaching, but further studies are still required.

Doppler flowmetry of ophthalmic arteries for prediction of pre-eclampsia / Dopplerfluxometria de artérias oftálmicas para predição de pré-eclâmpsia

Background: central nervous system (CNS) hyperperfusion is one of the events that constitute the pathophysiological basis for the clinical manifestations and complications of pre-eclampsia (PE). Detecting the increased flow in the CNS through Doppler flowmetry of the ophthalmic artery might precede the clinical onset of PE and could be used as a marker for subsequent development of PE. Objective: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. Objective: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. Methods: a total of 73 patients with risk factors for the development of PE were selected from the prenatal service at the HC-UFMG. They were submitted to ophthalmic artery Doppler flowmetry between 24 and 28 weeks of pregnancy and monitored until the end of the pregnancy to verify the occurrence of PE. ROC curves were created to determine the predictive characteristics of the OARI. Results: fourteen of the patients selected developed PE and 59 remained normotensive until the postpartum period. Patients with subsequent development of PE presented OARI values lower than patients that remained normotensive (0.682±0.028 X 0.700±0.029, p=0.044). Considering the development of PE as an outcome, the area under the OARI curve was 0.694 (CI 0.543 to 0.845), with no points obtaining good values of sensitivity or specificity. Conclusion: Doppler flowmetry of ophthalmic arteries between 24 and 28 weeks of pregnancy did not present itself as a good exam for predicting PE. .

Introdução: a hiperperfusão do sistema nervoso central (SNC) é um dos eventos que constitui substrato fisiopatológico para as manifestações clínicas e complicações da pré-eclâmpsia (PE). O fluxo aumentado no SNC, detectado por meio da dopplerfluxometria de artérias oftálmicas, poderia anteceder as manifestações clínicas da PE e, consequentemente, ser utilizado como marcador de subsequente desenvolvimento de PE. Objectivo: avaliar os valores do índice de resistência das artérias oftálmicas (Irao) no segundo trimestre gestacional para a predição das manifestações clínicas da PE. Métodos: pacientes com fatores de risco para desenvolvimento de PE foram selecionadas no serviço de pré-natal do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG). Elas foram submetidas à dopplerfluxometria de artérias oftálmicas entre 24 e 28 semanas de gestação e acompanhadas até o final da gestação para averiguar a ocorrência de PE. Curvas ROC foram criadas para determinar as características preditivas do Irao. Resultados: das pacientes selecionadas, 14 desenvolveram PE e 59 mantiveram-se normotensas até o puerpério. Pacientes com subsequente desenvolvimento de PE apresentaram valores de Irao menores do que pacientes que se mantiveram normotensas (0,682±0,028 vs. 0,700±0,029, p=0,044). Ao considerar o desenvolvimento de PE como desfecho, a área sobre a curva do Irao foi de 0,694 (IC 0,543-0,845), sem pontos com bons valores de sensibilidade ou especificidade. Conclusão: a dopplerfluxometria de artérias oftálmicas entre 24 e 28 semanas de gestação não se demonstrou um bom exame para a predição de PE. .

Intrauterine growth restriction in monochorionic-diamniotic twins / Restrição de crescimento intrauterino em gêmeos monocoriônicos diamnióticos.

Objective: to evaluate neonatal morbidity and mortality in monochorionic- -diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins’ growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR. .

Objetivo: avaliar a morbidade e mortalidade neonatal em gestações monocoriônicas e diamnióticas (MCDA) acometidas pela restrição de crescimento fetal seletiva (RCFS) e não seletiva (RCFNS). Métodos: os parâmetros de morbidade e mortalidade neonatais foram avaliados em 34 gêmeos com RCF (abaixo do percentil 10 de uma curva de crescimento para gêgêmeos): 18 com RCFS e 16 com RCFNS. O grupo com RCFS teve origem em 18 gestações, em que somente um feto apresentava RCF. O grupo com RCFNS teve origem em 8 gestações em que ambos os fetos apresentavam RCF. Foram excluídos deste estudo casos da síndrome da transfusão feto-fetal e malformações fetais. Resultados: os gêmeos de gestações MCDA com RCFS apresentaram maior frequência de entubação orotraqueal (p=0,001), ventilação mecânica (p=0,0006) e maior tempo em jejum durante internação (p=0,014), quando comparados aos gêmeos de gestações MCDA com RCFNS. No grupo com RCFS, também foram observados maior frequência de tipos II e III de dopplervelocimetria de artéria umbilical (p=0,002). Não houve diferença significativa entre os grupos quanto à mortalidade neonatal (p=0,09). Conclusão: em gestações gemelares MCDA, a RCFS representa maior frequência de alterações severas na velocimetria Doppler da artéria umbilical e piores resultados na morbidade neonatal. .