Low-intensity pulsed ultrasound stimulates proliferation of stem/progenitor cells: what we need to know to translate basic science research into clinical applications / 亚洲男科学杂志(英文版)

Low-intensity pulsed ultrasound (LIPUS) is a promising therapy that has been increasingly explored in basic research and clinical applications. LIPUS is an appealing therapeutic option as it is a noninvasive treatment that has many advantages, including no risk of infection or tissue damage and no known adverse reactions. LIPUS has been shown to have many benefits including promotion of tissue healing, angiogenesis, and tissue regeneration; inhibition of inflammation and pain relief; and stimulation of cell proliferation and differentiation. The biophysical mechanisms of LIPUS remain unclear and the studies are ongoing. In recent years, more and more research has focused on the relationship between LIPUS and stem/progenitor cells. A comprehensive search of the PubMed and Embase databases to July 2020 was performed. LIPUS has many effects on stem cells. Studies show that LIPUS can stimulate stem cells in vitro; promote stem cell proliferation, differentiation, and migration; maintain stem cell activity; alleviate the problems of insufficient seed cell source, differentiation, and maturation; and circumvent the low efficiency of stem cell transplantation. The mechanisms involved in the effects of LIPUS are not fully understood, but the effects demonstrated in studies thus far have been favorable. Much additional research is needed before LIPUS can progress from basic science research to large-scale clinical dissemination and application.

Effects of ultrasound and stretching on skeletal muscle contusion in rats: immunohistochemistry analysis / Efectos de ultrasonido y estiramiento en la contusión muscular esqueletal en ratas: análisis inmunohistoquímico

SUMMARY: The aim of this study was to evaluate the effects of stretching and therapeutic ultrasound (TUS) on desmin and laminin contents of rat muscle after contusion. Male Wistar rats (n = 35, 8-9 weeks of age, 271 ± 14g body weight) were divided into five groups: Control group (CG) (n= 03); Injured group (IG) (n= 8); Injured + ultrasound group (IUSG) (n= 8); Injured+stretching group (ISG) (n= 8); Injured +ultrasound + stretching group (IUSSG) (n= 8). The application of ultrasound started 72 hours after the contusion, using the 50 % pulsed mode, 0.5 W/cm2, 5 min, once a day, for five consecutive days. Passive manual stretching was started on the tenth day after injury, with four repetitions of 30 s each and 30 s rest between repetitions, once a day, five times per week, for a total of ten applications. After 22 days, the rats were euthanazied and the gastrocnemius of both limbs removed for desmin and laminin immunohistochemistry morphometric measurement. Analysis was conducted using ANOVA one way post-hoc Tukey to parametric data and Kruskall-Wallis for non-parametric data. The IUSSG animals showed a larger area of desmin than ISG (p<0.05). It was found a decrease in laminin comparing IUSG to IG. However, laminin area was higher in ISG than all groups (p<0.05). UST isolated or in combination with stretching influenced gastrocnemius regeneration in different manners. While stretching applied isolated enhanced gastrocnemius regeneration noticed by the increase in laminin area, in combination with TUS strengthened the muscle healing rising desmin area.

RESUMEN: El objetivo de este estudio fue evaluar los efectos del estiramiento y la ecografía en los contenidos de desmina y laminina del músculo de rata después de la lesión. Ratas Wistar macho (n = 35, 8-9 semanas de edad, 271 ± 14 g de peso corporal) se dividieron en cinco grupos: grupo de control (CG) (n = 03); Grupo lesionado (GL) (n = 8); Lesionado + grupo de ultrasonido (LGU) (n= 8); Lesionado + grupo de estiramiento (LGE) (n = 8); Lesionado + ultrasonido + grupo de estiramiento (LUGE) (n = 8). La aplicación de ultrasonido comenzó 72 horas después de la lesión, usando el modo pulsado al 50 %, 0,5W / cm2, 5 min, una vez al día, durante cinco días consecutivos. El estiramiento manual pasivo se inició el décimo día después de la lesión, con cuatro repeticiones de 30 seg cada una y 30 seg de descanso entre repeticiones, una vez al día, cinco veces por semana, para un total de diez aplicaciones. Las ratas fueron sacrificadas después de 22 días, y se extrajo el músculo gastrocnemio de ambos miembros para la medición morfométrica de desmina y laminina a través de inmunohistoquímica. El análisis se realizó utilizando ANOVA unidireccional Tukey post-hoc para datos paramétricos y Kruskall-Wallis para datos no paramétricos. Los animales LUGE mostraron un área mayor de desmina que LGE (p <0,05). Se encontró una disminución en la laminina comparando LGU con GL. Sin embargo, el área de laminina fue mayor en LGE que en todos los grupos (p <0,05). El tratamiento con ultrasonido aislado o en combinación con estiramiento influyó en la regeneración del músculo gastrocnemio de diferentes maneras. Si bien el estiramiento aplicado, en combinación con tratamiento de ultrasonido, fortaleció el área de desmina, la regeneración del músculo gastrocnemio mejoró por el aumento en el área de laminina aumentando la curación muscular.

Uso de agentes antimicrobianos como solução refrigerante no ultrassom para tratamento das doenças periodontais: uma revisão de literatura / The use of antimicrobial agents as a cooling solution in ultrasound devices for periodontal diseases treatment: a literature review

Objetivo: revisar a literatura quanto ao uso de soluções no reservatório líquido do ultrassom (US) para o tratamento das doenças periodontais, avaliando as contribuições dessa associação e as soluções mais eficazes para essa terapêutica. Métodos: foi realizada pesquisa bibliográfica nas bases de dados Public Medline (PubMed), Lilacs, Science Direct e ISI web of knowledge. As palavras-chave utilizadas foram: "periodontal disease", "ultrasonic", "cooling solution", "antimicrobial" e "irrigation". Como critérios de inclusão, foram selecionados estudos prospectivos, retrospectivos, caso controle, transversal e relatos de casos, publicados em inglês. Resultados: após pesquisa e minuciosa revisão por título e resumo de cada estudo, 15 estudos foram selecionados para avaliação dos desfechos investigados. As principais soluções associadas ao US foram povidono-iodo (PVPI), clorexidina, óleos essenciais, bicarbonato de sódio. O irrigante mais utilizado foi o PVPI, seguido por clorexidina e óleos essenciais. Os agentes podem conferir discretas melhoras no nível clínico de inserção e profundidade de sondagem, porém os resultados são controversos, já que nem todos os ensaios demonstraram efeitos positivos. Uma importante evidência observada foi em relação à redução dos níveis de microrganismos derivados do aerossol do US quando essas substâncias foram utilizadas no reservatório de água, sendo esse um aspecto positivo de seu uso como solução refrigerante ao US. Considerações finais: de modo geral, não puderam ser confirmados benefícios adicionais dos irrigantes antimicrobianos nos principais parâmetros periodontais avaliados, porém não se pode descartar o potencial uso desses agentes para a redução da dispersão de microrganismos advindos do aerossol, promovendo assim maior proteção ao paciente e ao profissional.(AU)

Objective: to review the literature regarding the use of solutions in the liquid ultrasonic (US) reservoir devices for the treatment of periodontal diseases, evaluating the benefits of this association, and the most effective solution for this therapy. Methods: bibliographic research was carried out in the Public Medline (PubMed), Lilacs, Science Direct, and ISI web of knowledge databases. The keywords used were: "periodontal disease", "ultrasonic", "cooling solution", "antimicrobial", and "irrigation". Inclusion criteria were prospective, retrospective, case-control, cross-sectional studies, and case reports published in English. Results: after a meticulous analysis of each paper by title and summary, 15 studies were selected for further investigation of clinical outcomes. The main solutions associated with US devices as coolant were PVPI, Chlorhexidine, Essential Oils and Sodium Bicarbonate. The most used coolant agent was PVPI, followed by chlorhexidine and essential oils. It has been shown that irrigating solutions can provide improvements in the clinical attachment level and probing depth, but the results are controversial since not all trials showed positive effects. Important evidence observed was the reduction of the levels of microorganisms derived from the US aerosol when these substances were used as a cooling solution. Conclusions: in general, additional benefits of coolant solutions could not be confirmed in the main periodontal parameters evaluated, however, the potential use of these agents to reduce the dispersion of microorganisms derived from the aerosol cannot be ruled out, thus promoting additional protection to the patient and professional.(AU)

Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Effect of ultrasonic and Nd: Yag laser activation on irrigants on the push-out bond strength of fiber post to the root canal

Abstract Objective: This in vitro study aimed to compare the efficacy of irrigants using various irrigation activation methods to the push-out bond strengths of fiber post to root canal luted with self-adhesive resin cement (SARC). Methodology: Forty-eight decoronated human canines were used. The specimens were divided into four groups corresponding with the post-space irrigation process and were treated as follows: distilled water (DW) (Control) group received 15 mL of DW; sodium hypochlorite (NaOCl)+ethylenediaminetetraacetic acid (EDTA) group was treated with 5 mL of 5.25% NaOCl, 5 mL of 17% EDTA, and 5 mL of DW; passive ultrasonic irrigation (PUI) group was treated with 5 mL of 5.25% NaOCl, 5 mL of 17% EDTA, and 5 mL of DW, and each irrigant was agitated with an ultrasonic file; and laser activated irrigation (LAI) group was treated with 5 mL of 5.25% NaOCl, 5 mL of 17% EDTA, and 5 mL of DW, and each irrigant was irradiated with Nd: YAG laser. Fiber posts were luted with SARC, and a push-out test was performed. Data was analyzed using one-way analysis of variance and Tukey HSD test. Results: The bond strength values for the groups obtained were as follows: Control (10.04 MPa), NaOCl+EDTA (11.07 MPa), PUI (11.85 MPa), and LAI (11.63 MPa). No statistically significant differences were found among all experimental groups (p>0.05). The coronal (12.66 MPa) and middle (11.63 MPa) root regions indicated a significantly higher bond strength compared with the apical (9.16 MPa) region (p<0.05). Conclusions: Irrigant activation methods did not increase the bond strength of fiber post to canal.

Low-intensity pulsed ultrasound promotes tissue regeneration in rat dental follicle cells in a porous ceramic scaffold

Abstract The aim of this study was to investigate the effects of low-intensity pulsed ultrasound (LIPUS) on the osteogenic differentiation of dental follicle cells (DFCs) in vitro and on the regenerative effects of DFC-OsteoBoneTM complexes in vivo. DFCs were isolated and characterized. In the in vitro study, DFCs were cultured in an osteogenic medium in the presence or absence of LIPUS. The expression levels of ALP, Runx2, OSX, and COL-I mRNA were analyzed using real-time polymerase chain reaction (RT-PCR) on day 7. Alizarin red staining was performed on day 21. The state of the growth of the DFCs that were seeded on the scaffold at 3, 5, 7, and 9 days was detected by using a scanning electron microscope. In our in vivo study, 9 healthy nude mice randomly underwent subcutaneous transplantation surgery in one of three groups: group A, empty scaffold; group B, DFCs + scaffold; and group C, DFCs + scaffold + LIPUS. After 8 weeks of implantation, a histological analysis was performed by HE and Mason staining. Our results indicate that LIPUS promotes the osteogenic differentiation of DFCs by increasing the expression of the ALP, Runx2, OSX, and COL-I genes and the formation of mineralized nodules. The cells can adhere and grow on the scaffolds and grow best at 9 days. The HE and Mason staining results showed that more cells, fibrous tissue and blood vessels could be observed in the DFCs + scaffold + LIPUS group than in the other groups. LIPUS could promote the osteogenic differentiation of DFCs in vitro and promote tissue regeneration in a DFCs-scaffold complex in vivo. Further studies should be conducted to explore the underlying mechanisms of LIPUS.

Anti-inflammatory and antinociceptive effects of phonophoresis in animal models: a randomized experimental study

The aim of this study was to evaluate the therapeutic effects of ultrasound (US)-mediated phonophoresis alone or in association with diclofenac diethylammonium (DCF) administered topically in animal models of inflammation. A pre-clinical, prospective, and randomized experimental study of quantitative and qualitative nature was carried out. Phonophoresis was performed using a therapeutic ultrasound apparatus in two distinct models of acute inflammation. Edema was induced by an intraplantar injection of carrageenan and measured by plethysmography. The Hargreaves test was used to evaluate the antinociceptive activity and investigate the action of phonophoresis on tumor necrosis factor (TNF)-α production. A histological analysis with hematoxylin-eosin was used to evaluate tissue repair, and the expression of COX-2 was determined by immunohistochemical analysis. At the peak of inflammatory activity (3 h), treatment with US, US+DCF, and DCF significantly reduced edema formation compared to the control group. Treatment with US+DCF was more effective than treatment with US alone at both analyzed times. In the analysis of the antinociceptive activity, the treatments significantly increased the latency time in response to the thermal stimulus. Histopathological analysis revealed a reduction of the inflammatory infiltrates and immunohistochemistry demonstrated that the association was effective in reducing COX-2 expression compared to the control group. The association of DCF with US produced anti-inflammatory and antinociceptive effects in rat models of inflammation, which may be associated with inhibition of COX-2 and TNF-α production.

Effect of ultrasound streaming on the disinfection of flattened root canals prepared by rotary and reciprocating systems

Abstract New technical and scientific developments have been advocated to promote the success of the endodontic treatment. In addition to rotary and reciprocating systems, irrigating solution agitation has been suggested and passive ultrasonic irrigation (PUI) is the most used. Objective: To evaluate, in vitro, the effect of ultrasound streaming (US) in the disinfection of flattened root canal systems prepared by the ProTaper, BioRaCe and Reciproc systems, utilizing the microbiological culture. Methodology: Extracted human mandibular incisors (n=84) were used. Suspensions of Enterococcus faecalis (ATCC 29212) were standardized and inserted along with the teeth immersed in brain-heart infusion (BHI) broth. The contamination was made following a protocol during 5 days. The teeth were randomly divided into six groups: G1, ProTaper Universal; G2, ProTaper Universal with US; G3, BioRaCe; G4, BioRaCe with US; G5, Reciproc; and G6, Reciproc with US. Irrigation was performed with saline solution. After biomechanical preparation, microbiological samples were performed with sterilized paper points, which were diluted and spread on BHI agar; after 48 h, the colony forming units (CFU/mL) were counted for each sample. Results: Groups using ultrasonic agitation presented a greater antibacterial effect than the other ones, even using saline solution as irrigant. The ProTaper Universal system showed the best antibacterial activity of the tested systems (median of 0 CFU/mL with and without surfactant or ultrasonic activation [PUI]). Even with PUI, Reciproc (median of 2.5 CFU/mL with PUI and 5 without it) could not reduce as many colonies as ProTaper Universal without US. The BioRaCe system had greater bacterial reduction when using US (median of 0 CFU/mL with PUI and 30 without it). Conclusions: US promoted greater reduction in the number of bacteria in the flattened root canals prepared with nickel-titanium mechanized systems. Regarding the instruments used, the ProTaper Universal system was the most effective in reducing the bacterial number.

Embarazo ectópico cervical / Cervical Ectopic Pregnancy

El embarazo ectópico cervical es la implantación del huevo fertilizado a nivel del orificio cervical interno o por debajo de este. Se describe un caso de embarazo ectópico cervical en una paciente de 43 años con historia obstétrica de tres gestaciones, un parto por cesárea hace 19 años y un aborto provocado. El embarazo ectópico cervical representa 0,1 por ciento de los embarazos ectópicos y su diagnóstico se realiza a través de criterios clínicos, ultrasonográficos y anatomopatológicos específicos. En mujeres en edad fértil que asisten a consulta por sangrado vaginal o dolor abdominal, siempre hay que tener presente esta afección, en especial si presentan factores de riesgo. Su manejo está estrechamente relacionado con la edad gestacional, condiciones clínicas y paridad de la paciente. Actualmente su tratamiento es controvertido por su poca frecuencia. La conducta es emergente en casos complicados pues la hemorragia puede conducir a la muerte materna(AU)

Cervical ectopic pregnancy is the implantation of embryo at the cervical internal hole or below. Case report: A case of cervical ectopic pregnancy is described in a 43-year-old patient with obstetric history of three gestations, one childbirth by means of cesarean surgery 19 years ago and one induced abortion. The cervical ectopic pregnancies represent 0,1 percent of ectopic pregnancies and its diagnosis is carried out through clinical exam, ultrasonography and specific anatomic pathological approaches. When treating childbearing-age women who attend consultation due to vaginal bleeding or abdominal pain, doctors must always keep in mind this condition, especially if they have risk factors. The management of this condition is closely related with the gestational age, clinical conditions and the patient's parity. Its treatment is now controverted since it is rare. The medical action is emergent in complicated cases, because hemorrhage can lead to mother´s death(AU)

Penetración Dentinaria in vitro del Hipoclorito de Sodio a Diferentes Concentraciones con las Técnicas de Irrigación Convencional y Ultrasónica Pasiva / In vitro Dentinary Penetration of Sodium Hypochlorite at Different Concentrations with the Conventional and Ultrasonic Passive Irrigation Techniques

RESUMEN: El objetivo del presente trabajo fue comparar la penetración dentinaria in vitro entre las concentraciones de hipoclorito de sodio (NaClO) al 5 % y al 2,5 % con técnicas de irrigación convencional e irrigación ultrasónica pasiva. Este fue un estudio transversal, prospectivo y experimental. Se trabajó con 40 segmentos radiculares (especímenes) de 5 mm de longitud, divididos en 4 grupos. Todos los especímenes se sumergieron en violeta cristal durante 24 horas. Se realizó la preparación biomecánica con sistema rotatorio Pro Taper. Al primer grupo se irrigó con NaClO al 2,5 % con irrigación convencional, al segundo grupo con NaClO al 2,5 % con irrigación convencional más irrigación ultrasónica pasiva por 30 segundos, al tercer grupo con NaClO al 5 % con irrigación convencional y al cuarto grupo con NaClO al 5 % con irrigación convencional más irrigación ultrasónica pasiva por 30 segundos. Al final de la preparación a todos los especímenes se les realizó un corte mesio distal. La profundidad de la penetración del NaClO fue deterrminado por el blanqueamiento de la mancha y medido con un microscopio de luz con una magnificación de 40 X. La prueba estadística usada fue ANOVA con un nivel de significancia de 5 %. El NaClO al 5 % con técnica de irrigación ultrasónica pasiva presentó la mayor penetración dentinaria in vitro.

ABSTRACT: The objective of the present study was to compare in vitro dentin penetration between 5 % and 2.5 % sodium hypochlorite (NaClO) concentrations using conventional irrigation and passive ultrasonic irrigation techniques. This was a cross-sectional, prospective and experimental study. It was worked with 40 root segments (specimen) of 5 mm length, divided into 4 groups. All specimens were immersed in crystal violet for 24 hours. The biomechanical preparation was performed with Pro Taper rotary system. The first group was irrigated with 2.5 % NaClO with conventional irrigation, the second group with 2.5 % NaClO with conventional irrigation plus ulrasonic passive irrigation for 30 seconds, the third group with 5 % NaClO with conventional irrigation and the fourth with 5 % NaClO with conventional irrigation plus ultrasonic passive irrigation for 30 seconds. At the end of the preparation, all specimens had a distal mesio cut. The depth of NaClO penetration was determined by bleaching of the stain and measured with a light microscope at a magnification of 40 X. The statistical test used was ANOVA with a significance level of 5 %. The 5 % NaClO with passive ultrasonic irrigation showed the highest dentin penetration in vitro.

Effectiveness of various irrigation protocols for the removal of calcium hydroxide from artificial standardized grooves

Abstract Objective The aim of this study was to investigate the ability of laser-activated irrigation (LAI), XP-endo Finisher, CanalBrush, Vibringe, passive ultrasonic irrigation (PUI), and conventional syringe irrigation systems on the removal of calcium hydroxide (CH) from simulated root canal irregularities. Material and Methods The root canals of one hundred and five extracted single-rooted teeth were instrumented using Reciproc rotary files up to size R40. The teeth were split longitudinally. Two of the three standard grooves were created in the coronal and apical section of one segment, and another in the middle part of the second segment. The standardized grooves were filled with CH and the root halves were reassembled. After 14 days, the specimens were randomly divided into 7 experimental groups (n=15/group). CH was removed as follows: Group 1: beveled needle irrigation; Group 2: double side-vented needle irrigation; Group 3: CanalBrush; Group 4: XP-endo Finisher; Group 5: Vibringe; Group 6: PUI; Group 7: LAI. The amount of remaining CH in the grooves was scored under a stereomicroscope at 20× magnification. Statistical evaluation was performed using Kruskal-Wallis and Bonferroni-Correction Mann-Whitney U tests. Results Groups 1 and 2 were the least efficient in eliminating CH from the grooves. Groups 6 and 7 eliminated more CH than the other protocols; however, no significant differences were found between these two groups (P>.05). Conclusions Nevertheless, none of the investigated protocols were able to completely remove all CH from all three root regions. LAI and PUI showed less residual CH than the other protocols from artificial grooves.

Comparison of two methods of irrigant agitation in the removal of residual filling material in retreatment

Abstract: The aim of this study was to compare the efficacy of passive ultrasonic irrigation and EasyClean for removing residual filling material in retreatment. Twenty-two maxillary lateral incisors with apical curvature were instrumented with ProTaper files and filled with Endofill using the lateral compactation technique. Removal of filling material was performed with Reciproc, Mtwo and ProDesign Logic 50/.01 files. The teeth were inserted in a silicone mould, which was placed in a metal muffle, and split to visualize the residual filling material. The samples were divided into two groups (n = 11) according to the irrigation protocol: Passive ultrasonic irrigation (PUI group) with 3 activations of 20 seconds and EasyClean (Easy Equipamentos Odontológicos, Belo Horizonte, Brazil) (EC group) used in continuous rotation with 3 activations of 20 seconds, both using NaOCl and EDTA. Environmental scanning electron microscopic images of the apical, middle, and cervical thirds were taken before and after the irrigant activation. The Kappa test was used to determine interexaminer agreement. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests (p < 0.05). PUI and EC improved the removal of remnant filling material in all root canal thirds (p < 0.05). PUI and EC presented similar performance in the final step of retreatment (p > 0.05). No significant difference was observed in the removal of filling material in the apical, middle, and cervical thirds in both groups (p > 0.05). EasyClean in continuous rotary motion is useful in retreatment and was shown to be as effective as ultrasonic activation in the removal of remnant filling material.

Termoterapia para la espasticidad post accidente cerebro vascular: revisión sistem / Thermotherapy for spasticity post stroke: systematic review

Objective: Determine whether there is scientific evidence to support the effectiveness of thermotherapy in the management of spasticity in adult patients post stroke. Method: A systematic review of randomized trials were performed, the databases searched were Medline, Cinahl, Central, PEDro, SPORTDiscus and Lilacs. Results: 4 studies that metour eligibility criteria and selection were selected. Conclusion: There is controversial evidence that the US produces are duction in neural electrophysiological excitability compared to US placeboand IR; moderate evidence that US not produces clinical improvement in range of motion or level of spasticity, compared to US placebo, IR, TENS and botulinum toxin.

Objetivo: Determinar si existe evidencia científica que avale la efectividad de la termoterapia en el manejo de la espasticidad en pacientes adultos post accidente cerebro vascular. Método: Se realizó una revisión sistemática de estudios clínicos aleatorizados, las bases de datos consultadas fueron: Medline, Cinahl, Central, PEDro, SPORTDiscus y Lilacs. Resultados: Se seleccionaron 4 artículos que cumplían con nuestros criterios de elegibilidad y selección. Conclusión: Existe evidencia contradictoria que el US produce una reducción electrofisiológica de la excitabilidad neural comparado con US apagado e IR; existe moderada evidencia que el US no produce una mejoría clínica del rango de movimiento ni del nivel de espasticidad, comparado con US apagado, IR, TENS y toxina botulínica.

An in vitro evaluation of various irrigation techniques for the removal of double antibiotic paste from root canal surfaces

ABSTRACT Objective The aim of this study was to investigate the effectiveness of conventional syringe irrigations, passive ultrasonic irrigation (PUI), Vibringe, CanalBrush, XP-endo Finisher, and laser-activated irrigation (LAI) systems in removing double antibiotic paste (DAP) from root canals. Material and Methods One hundred five extracted single-rooted teeth were instrumented. The roots were split longitudinally. Three standard grooves were created and covered with DAP. The roots were distributed into seven groups: Group 1, beveled needle irrigation; Group 2, double side-vented needle irrigation; Group 3, CanalBrush; Group 4, XP-endo Finisher; Group 5, Vibringe; Group 6, PUI; Group 7, LAI. The amount of remaining DAP was scored under a stereomicroscope. Results Group 4, Group 6, and Group 7 removed significantly more DAP than the other protocols in the coronal region. Group 7 was more efficient in the middle region; however, no significant difference was found between Group 7 and Group 6. No differences were found between groups in the apical region either, except for the comparisons between groups 7 and 2, and groups 2 and 3. Conclusions None of the investigated protocols were able to completely remove the DAP from the grooves. The Vibringe and XP-endo Finisher systems showed results similar to those of conventional needle irrigation.

Effect of ultrasonic streaming on intra-dentinal disinfection and penetration of calcium hydroxide paste in endodontic treatment

ABSTRACT Objective The antimicrobial effect of ultrasonic agitation of calcium hydroxide (CH) pastes in infected bovine dentin and their penetrability were evaluated using confocal laser scanning microscopy (CLSM) and microbiological culture. Material and Methods Fifty-two bovine teeth were infected with Enterococcus faecalis using a new contamination protocol; then they received CH paste and were divided into groups with or without ultrasound. Ultrasonic agitation was conducted for 1 min with a plain point insert. After 15 d, the CLSM analyzed the viable and dead bacteria with Live and Dead assay. The dentinal wall debris was collected by burs, and the colony forming units (CFU/mL) were counted. The penetrability of the paste inside dentinal tubules was tested using the B-rodamine dye. Results The calcium hydroxide paste showed better results with the use of ultrasonic agitation (p<0.05). Conclusion The ultrasonic agitation of CH paste increased its antimicrobial action and was responsible for intradentinal penetration with the fulfilment of the tubules.

Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study

ABSTRACT Objective This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS), passive ultrasonic irrigation (PUI) with EndoUltra and standard needle irrigation (SNI) in the removal of calcium hydroxide [Ca(OH)2] from the mesial roots of Weine Type II mandibular molars. Material and Methods Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH)2 paste. Specimens were divided into three groups (n=10) according to the technique used for Ca(OH)2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle). Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH)2 present and to assess the residual volume of Ca(OH)2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%). Results The mean volume of Ca(OH)2 before removal was significantly higher in the coronal third than in the middle and apical third (p<0.001). Ca(OH)2 was similarly removed from the coronal and middle thirds with the three methods used (p>0.05). PIPS (median 0%; IQR: 0-0) showed significant higher Ca(OH)2 removal in the apical third than PUI (median 100%, IQR: 85-100) and SNI (median 47%; IQR: 16-72) (p<0.001). Conclusions PIPS laser-activation was more effective for the removal of Ca(OH)2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI.

Morphometric and fractal analysis of injured skeletal muscle tissue subjected to a combination of treatments; cryotherapy and therapeutic ultrasound / Análisis de la morfometría y de la dimensión fractal en la lesión del tejido muscular esquelético expuesto en la combinación de los tratamientos de crioterapia y ultrasonido

The aim of this study was to analyze the effects of an association of cryotherapy and therapeutic ultrasound on the treatment of muscle injured by impact. Fifty-five Wistar rats were divided into five groups (n = 11), Acute Injury (AI), Injury (I), Cryotherapy (CR), Therapeutic Ultrasound (TU) and Association of Cryotherapy and Therapeutic Ultrasound (CRTU). The CR and CRTU groups received applications of Cryotherapy three times (immediately, 24 and 48 h after injury) of 20 minutes duration. The TU and CRTU groups received applications of Therapeutic Ultrasound for seven days, for five minutes, in pulsed mode, 0.5 w/cm intensity, frequency 1 MHz. Body mass and gastrocnemius mass were analyzed. In addition to histological slides stained with hematoxylin and eosin used for morphometric analysis, picrosirius dye was used for quantification of collagen by Fractal Dimension (FD). The results of the intra-group analysis showed lower body mass and gastrocnemius in the CRTU group in relation to the AI (p = 0.001), I (p = 0.001), CR (p = 0.001) and TU groups (p = 0.001), and lower values of FD to quantify collagen in the CRTU group in relation to the AI (p = 0.007) and CR groups (p = 0.014). In summary, the present study showed that the association of Cryotherapy with Therapeutic Ultrasound promoted better results in the aspects analyzed compared to application of the therapies in isolation.

El objetivo del estudio fue evaluar los efectos de la asociación de las técnicas de crioterapia y ultrasonido terapéutico en el tratamiento de la lesión muscular por impacto. Fueron utilizadas 55 ratas Wistar, expuestas a lesión y separadas en grupos (n = 11): Lesión aguda (LA), Lesión (L), Crioterapia (CR), Ultrasonido Terapéutico (UT) y Crioterapia + Ultrasonido Terapéutico (CRUT). Los grupos CR y CRUT recibieron la aplicación, durante 20 minutos, en tres momentos (inmediatamente, 24 y 48 horas, después de la lesión). Los grupos UT y CRUT, recibieron UT por siete días, con una duración de cinco minutos, en modo pulsado, con una intensidad de 0,5 W/cm2 y frecuencia de 1 MHz. Fueran medidos el peso corporal y el peso de los músculos gastrocnemios y se realizaron cortes histológicos del músculo gastrocnemio, los cuales fueron teñidos con hematoxilina-eosina (HE) para el análisis morfométrico y con picrosirius para el análisis del colágeno por dimensión fractal (DF). Los resultados de los análisis intragrupo demostraron una menor disminución de la masa coporal y muscular en el grupo CRUT. Además, fue observado un valor inferior en la morfometría en el grupo CRUT en comparación a los grupos LA (p = 0,001), L (p = 0,001), CR (p = 0,001) y UT (p = 0,001), y un menor valor de la DF con respecto al colágeno en el grupo CRUT en comparación a los grupos LA (p = 0,007) y CR (p = 0,014). En síntesis, el presente estudio demostró que el protocolo de asociación de las técnicas de CR y UT causaron mayores respuestas benéficas en los aspectos analizados en comparación a los protocolos con los tratamientos aplicados de forma aislada.

Low intensity ultrasound therapy induces angiogenesis and persistent inflammation in the chronic phase of the healing process of third degree burn wounds experimentally induced in diabetic and non-diabetic rats

ABSTRACT PURPOSE: To evaluate the effects of low intensity ultrasound on the healing process of third degree burn wounds in experimentally induced diabetic Wistar rats. METHODS: One hundred rats were divided into: control group; non-diabetic treated group; diabetic control group; diabetic treated group. The therapy was performed with a 3MHz ultrasound application, pulsed emission at 100Hz frequency, modulated at 20% with a dosage of 0.5W/cm2 during three minutes throughout 30 days. The surgical debridement of the wound was performed once at day 2. The wounds were morphometrically, macroscopically and microscopically evaluated at 3, 7, 14, 21 and 30 days. RESULTS: The wound contraction and collagen quantification were higher in all treated groups. Macroscopically, necrosis was higher in the diabetic control group. Granulation tissue was higher in treated groups during the proliferative and remodeling phase. Microscopically, there were greater mononuclear inflammatory infiltration, angiogenesis and fibroblast quantification in treated groups during the proliferative and remodeling phases. CONCLUSIONS: therapeutic ultrasound is beneficial in the inflammatory and proliferative phases of the healing process because it controlled the necrotic tissue, increased the granulation tissue and wound contraction. However in the remodeling phase it is not beneficial because of the continued angiogenesis and a mononuclear inflammatory infiltration.

Efficacy of ultrasonic activation of NaOCl and orange oil in removing filling material from mesial canals of mandibular molars with and without isthmus

Objectives The aim of this study was to evaluate the volume of remaining filling material after passive ultrasonic irrigation (PUI) of sodium hypochlorite (NaOCl) and orange oil in mesial canals of mandibular molars, with and without isthmus. Material and Methods Thirty mesial roots of mandibular molars were divided according to the presence or absence of isthmus. Canals were prepared and filled (Micro-CT #1). Filling was removed using rotary instruments, and specimens were sub-divided into three groups according to the irrigation procedures: Conventional – conventional irrigation with NaOCl, PUI/NaOCl – PUI of NaOCl (three activations, 20 seconds each), and PUI/orange oil – PUI of orange oil (Micro-CT#2). Specimens were enlarged using the X2 and X3 ProTaper Next instruments and submitted to the same irrigation protocols (Micro-CT #3). Results No differences were found between the experimental groups in each stage of assessment (P>0.05). The volume of residual filling material was similar to that in Micro-CT #2 and Micro-CT #3, but lower than that observed in Micro-CT #1 (P<0.05). When groups were pooled according to the presence or absence of an isthmus, volume of residual filling material was higher in specimens presenting isthmus (P<0.05). Conclusions PUI of NaOCl or orange oil did not improve filling removal. Isthmus consists in an anatomical obstacle that impairs the removal of filling material.