Application of the plasmatrix in alveolar ridge preservation / 口腔疾病防治

@#After tooth extraction, significant absorption occurs in the soft and hard tissues of the alveolar ridge. The goal of alveolar ridge preservation is to maintain the volume and shape of the alveolar ridge's soft and hard tissues as much as possible so as to provide suitable conditions for implant placement. Currently, there are challenges in classifying the socket for alveolar ridge preservation, such as the difficulty in directly guiding the selection of graft materials and clinical procedures and the insufficient space for particle xenograft maintenance, resulting in poor bone regeneration. Plasmatrix is an autologous blood derivative that effectively enhances tissue regeneration. This article introduced the characteristics of soft and hard tissue defects after tooth extraction and the primary applications of plasmatrix for alveolar ridge preservation (liquid plasmatrix, solid plasmatrix membrane/plug, and plasmatrix bone blocks) as well as the proposed methods for the reclassification of sockets for alveolar ridge preservation based on soft and hard tissue defects at the extraction site to facilitate the creation of clinical recommendations. The proposed classifications are as follows: Class I, extraction socket without bone defect, with or without soft tissue defect; Class Ⅱ, extraction socket with bone defect, both sides with bone wall defect less than 50%, with or without soft tissue defect; Class Ⅲ, extraction socket with bone tissue defect, at least one side with bone wall defect greater than 50%, with or without soft tissue defect. For the Class I socket, a solid plasmatrix membrane or plug is inserted, followed by injection of liquid plasmatrix, using a double-layer solid plasmatrix membrane for socket closure; for the ClassⅡ socket, plasmatrix bone blocks are inserted, followed by injection of liquid plasmatrix and secondary solidification, using absorbable collagen membrane and double-layer solid plasmatrix membrane for socket closure; for the ClassⅢ socket, tenting screws are used to maintain height, followed by implantation of plasmatrix bone blocks, injection of liquid plasmatrix and secondary solidification, using absorbable collagen membrane and double-layer solid plasmatrix membrane for socket closure. The aim of this article is to provide comprehensive knowledge of plasmatrix for oral clinicians to serve as a reference to simplify the clinical decision-making process and procedures for alveolar ridge preservation.

Bloqueos Nerviosos. Bases Anatómicas del Dolor Somático Abdomino-Pélvico / Nerve Blocks. Anatomy of the Somatic Innervation of the Abdomino-Pelvic Cavity

El dolor abdominal es una de las sintomatologías que afectan con frecuencia la cavidad abdomino-pélvica. Dicha cavidad posee una inervación somática en la que intervienen del séptimo a doceavo nervios intercostales, ramos colaterales y terminales del plexo lumbar y el nervio pudendo; siendo objetivo de este trabajo la descripción anatómica del dolor abdominopélvico a través del plexo lumbar, nervios intercostales y nervio pudendo, sus diferentes patrones y variaciones de conformación, y las implicancias de éstas últimas en las distintas maniobras clínico-quirúrgicas. Se realizó un estudio descriptivo, observacional y morfométrico de la inervación somática de la cavidad abdomino-pélvica, en 50 preparaciones cadavéricas, fijadas en solución de formaldehído, de la Tercera Cátedra de Anatomía, Facultad de Medicina, Universidad de Buenos Aires, entre Agosto/2017-Diciembre/2019. La descripción clásica del plexo lumbar se encontró en 35 casos; la presencia del nervio femoral accesorio en ningún caso; así como también la ausencia del nervio iliohipogástrico en ningún caso; el nervio obturador accesorio se halló en 2 casos; el nervio genitofemoral dividiéndose dentro de la masa muscular del psoas mayor en 6 casos; el nervio cutáneo femoral lateral emergiendo únicamente de la segunda raíz lumbar en 6 casos y por último se encontró la presencia de un ramo del nervio obturador uniéndose al tronco lumbosacro en un caso. Los nervios intercostales y el nervio pudendo presentaron una disposición clásica en todos los casos analizados. Es esencial un adecuado conocimiento y descripción del plexo lumbar, nervios intercostales y nervio pudendo para un adecuado abordaje de la cavidad abdomino-pélvica en los bloqueos nerviosos.

SUMMARY: Abdominal pain is one of the symptoms that affect the abdominal-pelvic cavity. The abdominal-pelvic cavity has a somatic innervation involving the seventh to twelfth intercostal nerves, collateral and terminal branches of the lumbar plexus and the pudendal nerve. The objective of this work is the description of the lumbar plexus, intercostal nerves and pudendal nerve, its different patterns and structure variations, as well as its implications during pain management in patients. A descriptive, observational, and morphometric study of patterns and structure variations of the lumbar plexus, intercostal nerves and pudendal nerve was conducted in 50 formalin-fixed cadaveric dissections of the Third Chair of Anatomy at the School of Medicine in the Universidad de Buenos Aires from August 2017 to December/2019. The standard description of the lumbar plexus was found in 35 cases; accessory femoral nerve was not present in any of the cases; absence of the iliohipogastric nerve was also not found in any case, while the accessory obturating nerve was found in 2 cases; genitofemoral nerve dividing within the muscle mass of psoas in 6 cases; lateral femoral cutaneous nerve emerging only from the second lumbar root in 6 cases and finally, presence of a branch of the obturating nerve was found joining the lumbosacral trunk in one case. The pudendal and intercostal nerve patterns presented a typical pathway in all cases. Adequate knowledge and description of the lumbar plexus, intercostal nerves and pudendal nerve is essential for an adequate approach of the abdominal-pelvic cavity in nerve blocks.

Good anesthetic for good esthetic: Blocks in oculoplasty

Background: A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon carry out each step of the surgery precisely and beautifully. The art of giving a good local anesthesia is to be learnt and practiced not only by anesthetists, but also by the practicing ophthalmologists. Purpose: This video gives an overview of anatomy in terms of the nerve supply of the orbit, the surface marking, and the techniques of giving regional and nerve blocks. Synopsis: In this video, we describe the anatomy, the surface marking, the technique of regional anesthesia including peribulbar, retrobulbar, and subtenon blocks and of nerve blocks, specifically of facial, frontal nerve and its branches, infraorbital, nasociliary, infratrochlear, and dorsal nasal nerves, with their application in ocular plastic surgery. Highlights: This video highlights the essence of providing appropriate and good anesthesia so that the surgeon works in an optimal field with maximum comfort to the patients.

Debridement of axillary necrotizing fasciitis under anesthetic blocks of the serratus plane and supraclavicular brachial plexus: a case report

Abstract The regional techniques for axillary analgesia are well established. However, few studies have investigated surgical anesthesia. In this report, extensive debridement of axillary necrotizing fasciitis, including the posteromedial region of the right arm, performed under exclusive regional anesthesia in a patient with probable difficult airway is described. The procedure was accomplished under a Serratus Plane Block (SPB) and supraclavicular brachial plexus block, guided by ultrasound, and with venous sedation. We observed satisfactory anesthesia 15 minutes after the intervention, efficient intraoperative pain control and within the following 24 hours. Surgical axilla anesthesia is feasible with the described blocks.

Knowledge, attitude, and practices regarding cervical collars in adult trauma patients amongst practitioners at three hospitals in KwaZulu-Natal, South Africa

Background: The use of cervical collars in adult patients with possible injuries to the cervical spine has been an accepted standard of care for many years, despite the absence of evidence for the efficacy of these devices in preventing unwanted movement and harm. Changes to the terminology and recommendations of major trauma guidelines have been made but are limited by low quality evidence. In this context, little is known about what practitioners know, believe, and do, when managing the cervical spine of trauma patients. Methods: In this quantitative, observational, descriptive, cross-sectional survey a specifically designed questionnaire was used to collect data on the knowledge, attitude, and practices of practitioners managing adult trauma patients regarding cervical collars at three hospitals in KwaZulu-Natal, South Africa. Results: A total of 128 completed questionnaires were collected, captured, and analysed. Participants with the additional qualification of ATLS and DipPEC had a mean knowledge score of 8.1 (SD=1.70), compared to those with no additional qualification of 4.5 (SD=1.9) (p<0.001). Participants in the Emergency Department (ED) attained a mean knowledge score of 7.1 (SD=2.2) followed by Surgery (Mean=6, SD=2.0), Orthopaedics (Mean=5.5, SD=1.7) and ICU/Anaesthetics (Mean=4.4, SD=1.8), p<0.001. Head blocks only were most frequently used by 97.4 % of ED, 55.6 % of Surgery, 3.8 % Orthopaedic and 22.2 % ICU/Anaesthetics participants (p<0.001). Conclusion: The knowledge of management principles of cervical spine injuries was influenced by the department in which practitioners worked, the frequency that they managed patients with suspected injuries and additional courses. Head blocks were the most frequently used spinal protection device in all three hospitals. Most participants would be open to a change in practice if new guidelines were recommended. Further research is needed to determine the optimal management of patients with suspected cervical spine injuries and the role of motion restriction devices in limiting movement of the injured spine.

Estudio de supervivencia de Streptococcus mutans en un tipo de fomite / Survival study of Streptococcus mutans in a type of fomite

Objetivo: Evaluar la supervivencia de Streptococcus mutans (S.mutans)en un tipo de fómite. Método: Se reactivó una cepa de S.mutans ATCC25175 criopre-servada en agar TYCSB. El inóculo se estandarizó en PBS buffer hasta obtener turbidez equivalente al 0,5 de Mc Farland y un OD = 0.01 por espectrofotome-tría. Bloques plásticos de 2cm2/superficie fueron seleccionados como fómites. La descontaminación de los bloques se realizó por inmersión en alcohol etílico 70% v/v durante 10 minutos, los que fueron secados en cabina de seguridad biológica. La conta-minación de los mismos se realizó por inmersión en inóculo estandarizado durante 10 minutos. Los blo-ques contaminados se extrajeron y depositaron so-bre placas de Petri estériles hasta cumplir los tiem-pos propuestos (T0-T4 con intervalos de 30 minutos). A cada tiempo, los bloques fueron eluidos en 20 ml de buffer PBS y agitados en vortex durante 30 segun-dos. 100 µl de cada eluato fueron sembrados por dis-persión en agar TYCSB e incubados en anaerobiosis por 48 horas a 37°C. El recuento de colonias (UFC/ml) se realizó bajo lupa estereoscópica 50X. Resulta-dos: El recuento inicial de S.mutans fue de 7,8 X 106(DS+1,7 X 106) UFC/ml y para cada tiempo de estu-dio fue de: T0=3.25 X 104 (DS+1.9 X 103); T1=2.63X104 (DS+4,50E+03); T2= 1.85 X 104 (DS+9,45E+02); T3=1.93 X103(DS+1,29E+03) y T4=1.2X103 (DS+7,21x102). Conclusión: En los rangos de tiempos establecidos, la cepa de S.mutans ensayada permaneció viable sobre la superficie plástica (AU)

Aim: To evaluate the survival time of Streptococcus mutans (S.mutans) in a type of fomites. Method: A strain of cryopreserved S.mutans ATCC 25175 was reactivated in TYCSB agar. The inoculum was standardized in the PBS buffer to obtain turbidity equivalent to 0.5 Mc Farland and OD = 0.01 by spectrophotometry. Plastic blocks of 2 cm2 /surface were selected as fomites. Decontamination of the blocks was carried out for 10 minutes by immersion in ethyl alcohol 70% v/v, which were dried in a biosafety chamber. Contamination was carried out by immersion in standardized inoculum for 10 minutes. The contaminated blocks were extracted and put on sterile Petri dishes until the proposed times were met (T0-T4 at 30-minute intervals). At each time, the blocks were eluted in 20 ml of PBS buffer and vortexed for 30 seconds. 100 µl of each eluate were dispersed on TYCSB agar and incubated anaerobically for 48 hours at 37°C. Colony count (CFU/ml) was performed under a 50X stereoscopic magnifying glass. Results: The initial S.mutans count was 7,8 X 106 (DS+1,7 X 106) CFU/ml and for each study time was: T0=3.25 X 104 (DS+1.9 X 103); T1=2.63X104 (DS+4,50E+03); T2= 1.85 X 104 (DS+9,45E+02); T3=1.93 X103(DS+1,29E+03) y T4=1.2X103 (DS+7,21x102). Conclusion: Within the established time ranges, the tested S.mutans strain remained viable on the plastic surface (AU))

Los bloques gemelos en el tratamiento de las maloclusiones clase III. Revisión / Twin blocks in the treatment of class III malocclusions. Review / Blocos gêmeos no tratamento das más oclusões de classe III. Revisão

RESUMEN El tratamiento de las maloclusiones clase III en pacientes en crecimiento suele realizarse con aparatos de ortopedia intraoral o extraoral. El objetivo fue analizar el uso de los bloques gemelos en el tratamiento de las maloclusiones de clase III. Se realizó una revisión sistemática siguiendo los lineamientos PRISMA versión 2009. Las búsquedas se realizaron en las bases de datos Pubmed, Embase, Scopus y Cochrane, así como en una base de datos de literatura gris, y se complementaron con búsquedas manuales. Se incluyeron cinco artículos de los cuales se registraron las siguientes variables: autor, año de publicación, país y resultados. De acuerdo a la bibliografía revisada, los bloques gemelos clase III constituyen una opción terapéutica que producen una mejoría de la estética facial al modificarse la relación esquelética máxilomandibular, la relación de oclusión dentaria anterior y la posición de los tejidos blandos.

ABSTRACT Treatment of class III malocclusions in growing patients is usually performed with intraoral or extraoral braces. The objective was to analyze the skeletal changes by treating class III malocclusions with twin blocks. A systematic review was carried out following the PRISMA 2009 version guidelines. Searches were carried out in the Pubmed, Embase, Scopus and Cochrane databases, as well as in a gray literature database, and were supplemented by hand searches. Five articles were included, of which the following variables were recorded: author, year of publication, country, and results. According to the reviewed bibliography, class III twin blocks constitute a therapeutic option that produces an improvement in facial aesthetics by modifying the maxillomandibular skeletal relationship, the anterior dental occlusion relationship, and the position of the soft tissues.

RESUMO O tratamento das más oclusões de classe III em pacientes em crescimento geralmente é realizado com aparelho intraoral ou extraoral. O objetivo foi analisar o uso de blocos gêmeos no tratamento das más oclusões de classe III. Uma revisão sistemática foi realizada seguindo as diretrizes do PRISMA versão 2009. As pesquisas foram realizadas nos bancos de dados Pubmed, Embase, Scopus e Cochrane, bem como em um banco de dados de literatura cinza, e foram complementadas por pesquisas manuais. Foram incluídos cinco artigos, dos quais foram registradas as seguintes variáveis: autor, ano de publicação, país e resultados. De acordo com a bibliografia revisada, os bloqueios gêmeos de classe III constituem uma opção terapêutica que produz uma melhora na estética facial ao modificar a relação esquelética maxilomandibular, a relação de oclusão dentária anterior e a posição dos tecidos moles.

Strengthening the oral health system in Nigeria: A health systems building block approach

Aim: The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. Methodology: This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. Results: More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Conclusion: Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Profiles of sugar fermenting bacteria of the oral cavity among children with dental caries attending stomatology services at Ruhengeri referral hospital in Musanze District, Northern Rwanda

Background: Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally. Objective: This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children. Materials and Methods: This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables. Results: About 67.6% were male, while children of age 7­9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x2 = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901­0.5785), S. aureus (x2 = 34.59, P < 0.00001, 95% CI = 0.3541­0.6292), Enterobacter aerogenes (x2 = 13.5, P = 0.000239, 95% CI = 0.151­0.4622), Serratia marcescens (x2 = 11.64, P = 0.00645, 95% CI = 0.1275­0.4418) and Klebsiella pneumonia (x2 = 13.51, P = 0.000237, 95% CI = 0.1511­0.4623) were significantly associated with dental caries. Teeth loss (x2 = 51.04, P < 0.00001, 95% CI = 0.4757­0.7205), teeth pain (x2 = 5.05, P = 0.0246, 95% CI = 0.0249­0.33499), and infection (x2 = 4.73, P = 0.02964, 95% CI = 0.0186­0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant. Conclusion: Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

Comparison of two volumes for sciatic perineural injection using 1% methylene blue in rabbit cadavers / [Comparação de dois volumes para injeção perineural no nervo isquiático utilizando azul de metileno 1% em cadáveres de coelhos]

The purpose of this study was to assess the efficacy of a blind technique for sciatic and femoral nerve block in rabbit cadavers by evaluating the spread of 1% methylene blue at two different volumes. Nine recently euthanized rabbits weighing 2.5(0.3kg were used. The sciatic (SN) and femoral (FN) nerves of each limb were randomly assigned for injection with 1% methylene blue at 0.2mL/kg (G0.2) or 0.3mL/kg (G0.3). Nerves were dissected and measured for depth and extension of staining (cm). Mean comparisons were performed using paired t test. The relation between volume and nerve staining ( 2cm was assessed using chi-square test. The mean depth of SN was 1.9±0.2 and 1.6±0.3cm and staining 1.9±1.4 and 2.0±1.2cm, respectively in G0.2 and G0.3. No relation was found between depth and dye spread and there was no association between nerve staining ( 2.0cm and volume of solution. The FN failed to be stained in all subjects. In conclusion, SN injection can be successfully performed without guidance in rabbits. The lower volume (0.2mL/kg) is recommended to avoid systemic toxicity.(AU)

O objetivo deste estudo foi avaliar a eficácia de uma técnica para bloqueio às cegas dos nervos isquiático e femoral em cadáveres de coelhos, por meio da avaliação da dispersão de azul de metileno 1% em dois volumes distintos. Nove coelhos recém-eutanasiados, com peso 2,5(0,3kg, foram utilizados. Os nervos isquiático (NI) e femoral (NF) de cada membro foram aleatoriamente designados para injeção com azul de metileno 1% a 0,2mL/kg (G0,2) ou 0,3mL/kg (G0,3). Em seguida, foram dissecados e mensurados em relação à sua profundidade e extensão corada (cm). As médias foram comparadas por meio de teste t pareado. A relação entre volume e extensão corada ( 2cm foi avaliada utilizando-se teste de qui-quadrado. A profundidade média do NI foi 1,9±0,2 e 1,6±0,3cm, e a extensão corada 1,9±1,4 e 2,0±1,2cm, respectivamente, no G0,2 e no G0,3. Não houve relação entre a profundidade e a extensão corada ou entre a extensão corada ( 2,0cm e o volume de solução. Não foi observada coloração do NF em nenhum cadáver. Concluiu-se que a injeção do NI pode ser realizada com sucesso sem auxílio de tecnologias em coelhos. O menor volume (0,2mL/kg) é recomendado para evitar toxicidade sistêmica.(AU)

The effect of glide path preparation on the shaping ability of XP-endo® Shaper in simulated canals

Aims: To compare the shaping efficiency of the XP-endo Shaper with or without glide path preparation with sequenced Scout Race files in J-shaped resin blocks Material and Methods: Forty simulated J-shaped root canals were classified into two groups (n=20). While the root canals were shaped with XPS after a glide path was created with Scout Race files in Group 1, the same procedures were done without the glide path preparation in Group 2. The pre-and post-instrumentation images were taken and superimposed. Transportation value (TV), centering ability (CA) and the total amount of resin removed (TRR) was calculated by using the obtained images with Adobe Photoshop CS5 software. These parameters were calculated based on 18 reference points (9 inner/9 outer walls) with 1-mm intervals according to 3 sections (coronal, middle, and apical of the canals). The data were analyzed with Kruskal-Wallis and then Dunn's multiple comparison tests (p ≤ 0.05). Results: More resin was removed in Group 2 apical and coronal sections than in Group 1 (p=0.036). In Group 2, a higher transportation value was obtained in apical and middle sections compared to Group 1 (p<0.001). Group 1 showed a higher centering ratio in apical and middle sections than in Group 2 (p<0.001). The centering ability of the instruments was decreased in the curvature part (middle section) of the canals. Conclusions: Within the limits of this study, glide path preparation using Scout Race instruments improved the shaping ability of XPS instrument by leading to less transportation and maintaining centering ability.

Segmentation of retinal vessels by fusing contour information and conditional generative adversarial / 生物医学工程学杂志

The existing retinal vessels segmentation algorithms have various problems that the end of main vessels are easy to break, and the central macula and the optic disc boundary are likely to be mistakenly segmented. To solve the above problems, a novel retinal vessels segmentation algorithm is proposed in this paper. The algorithm merged together vessels contour information and conditional generative adversarial nets. Firstly, non-uniform light removal and principal component analysis were used to process the fundus images. Therefore, it enhanced the contrast between the blood vessels and the background, and obtained the single-scale gray images with rich feature information. Secondly, the dense blocks integrated with the deep separable convolution with offset and squeeze-and-exception (SE) block were applied to the encoder and decoder to alleviate the gradient disappearance or explosion. Simultaneously, the network focused on the feature information of the learning target. Thirdly, the contour loss function was added to improve the identification ability of the blood vessels information and contour information of the network. Finally, experiments were carried out on the DRIVE and STARE datasets respectively. The value of area under the receiver operating characteristic reached 0.982 5 and 0.987 4, respectively, and the accuracy reached 0.967 7 and 0.975 6, respectively. Experimental results show that the algorithm can accurately distinguish contours and blood vessels, and reduce blood vessel rupture. The algorithm has certain application value in the diagnosis of clinical ophthalmic diseases.

Identification of patterns related to linkage groups or disequilibrium by factor analysis / Identificação de padrões relacionados a grupos de ligação ou de desequilíbrio por análise de fatores

ABSTRACT: Empirical patterns of linkage disequilibrium (LD) can be used to increase the statistical power of genetic mapping. This study was carried out with the objective of verifying the efficacy of factor analysis (AF) applied to data sets of molecular markers of the SNP type, in order to identify linkage groups and haplotypes blocks. The SNPs data set used was derived from a simulation process of an F2 population, containing 2000 marks with information of 500 individuals. The estimation of the factorial loadings of FA was made in two ways, considering the matrix of distances between the markers (A) and considering the correlation matrix (R). The number of factors (k) to be used was established based on the graph scree-plot and based on the proportion of the total variance explained. Results indicated that matrices A and R lead to similar results. Based on the scree-plot we considered k equal to 10 and the factors interpreted as being representative of the bonding groups. The second criterion led to a number of factors equal to 50, and the factors interpreted as being representative of the haplotypes blocks. This showed the potential of the technique, making it possible to obtain results applicable to any type of population, helping or corroborating the interpretation of genomic studies. The study demonstrated that AF was able to identify patterns of association between markers, identifying subgroups of markers that reflect factor binding groups and also linkage disequilibrium groups.

RESUMO: Padrões empíricos de desequilíbrio de ligação (LD) podem ser utilizados para aumentar o poder estatístico do mapeamento genético. Este trabalho foi realizado com o objetivo de verificar a eficácia da análise de fatores (AF) aplicada a conjuntos de dados de marcadores moleculares do tipo SNP, visando identificar grupos de ligação e blocos de haplótipos. O conjunto de dados SNPs utilizado foi oriundo de um processo de simulação de uma população F2, contendo 2000 marcas com informações de 500 indivíduos. A estimação das cargas fatoriais (loadings) da AF foi feita de duas formas, considerando a matriz de distâncias entre os marcadores (A) e considerando a matriz de correlação (R). O número de fatores (k) a ser utilizado foi estabelecido com base no gráfico scree-plot e com base na proporção da variância total explicada. Os resultados indicam que as matrizes A e R conduzem a resultados similares. Com base no scree-plot considerou-se k igual a 10 e os fatores interpretados como sendo representativos dos grupos de ligação. O segundo critério conduziu a um número de fatores igual a 50, e os fatores interpretados como sendo representativos dos blocos de haplótipos. Isto mostra o potencial da técnica que permite obter resultados aplicáveis ​​a qualquer tipo de população, corroborando a interpretação de estudos genômicos. O trabalho demonstrou que a AF foi capaz de identificar padrões de associação entre marcadores, identificando subgrupos de marcadores que refletem grupos de ligação fatorial e também grupos de desequilíbrio de ligação.

Fracture Resistance of Anterior CAD/CAM Nanoceramic Resin Endocrowns with Different Preparation Designs / Resistência à Fratura de Endocrowns de Resina Nanocerâmica CAD / CAM Anterior Com Diferentes Projetos de Preparação

Objective: The aim of the study was to evaluate the effect of extension of endocrown in pulp space and the effect of ferrule on the fracture resistance of anterior endocrowns made of nano-ceramic resin blocks. Material and Methods: Twenty-eight freshly extracted human upper central incisor teeth were prepared to receive CAD/CAM nanoceramic resin endocrowns with four different designs. The specimens were divided into two groups (n = 14) according to the extension of the endocrown inside root canal (A:short and B:long), then each group was further subdivided into another two subgroups (n = 7) according to the presence or absence of ferrule effect (1:ferrule and 2: no ferrule). Endocrowns were then fabricated using CEREC in lab and nanoceramic resin blocks (DENTSPLY Sirona, Germany) and LAVA ultimate (3M ESPE, Germany) blocks size 14L. Results: Two-way ANOVA showed that the ferrule (p > 0.0001) had statistically significant effect on the fracture resistance. However, the extension of the endocrown into the canal had no statistical significant effect on the fracture resistance (p = 0.837). The interactions between the independent variables (extension into the canal and ferrule) had statistically significant effect on the fracture resistance (p = 0.029). Load to fracture for group 1A was 439.53 N, 1B was 306.46 N, 2A was 516.29 N and 2B was 242.04 N. Conclusions: Fracture resistance was not improved by the long or short extensions of the endocrowns in the pulp space, however, the ferrule effect shows significant improvement of the fracture resistance of the nanoceramic resin endocrowns. (AU)

Objetivo: O objetivo deste estudo foi avaliar o efeito da extensão da coroa endocrown na câmara pulpar e o efeito férula na resistência à fratura de coroas endocrowns anteriores confeccionadas através de blocos de resina nanocerâmica. Material e Métodos: Vinte e oito dentes incisivos centrais superiores humanos recém-extraídos foram preparados para receber endocrowns de resina nanocerâmica CAD / CAM com quatro diferentes tipos de preparos. Os espécimes foram divididos em dois grupos (n = 14) de acordo com a extensão da endocrown dentro do canal radicular (A: curto e B: longo), então cada grupo foi subdividido em outros dois subgrupos (n = 7) de acordo com presença ou ausência do efeito férula (1: com férula e 2: sem férula). As endocrowns foram usinadas através do CEREC In Lab e blocos de resina nanocerâmica (DENTSPLY Sirona, Alemanha) e blocos de LAVA ultimate (3M ESPE, Alemanha) tamanho 14L. Resultados: ANOVA dois fatores demostrou que a férula (P> 0,0001) teve efeito estatisticamente significativo na resistência à fratura. No entanto, a extensão do endocrown no canal não teve efeito estatisticamente significativo na resistência à fratura (P = 0,837). As interações entre as variáveis independentes (extensão no canal e férula) tiveram efeito estatisticamente significativo na resistência à fratura (P = 0,029). A carga para fratura do grupo 1A foi de 439,53 N, 1B foi de 306,46 N, 2A foi de 516,29 N e 2B foi de 242,04 N. Conclusões: A resistência à fratura não foi melhorada pelas extensões longas ou curtas das endocrowns na câmara pulpar, no entanto, o efeito férula mostrou uma melhora significativa na resistência à fratura das coroas endocrowns de resina nanocerâmica (AU)

Awake Fiberoptic Assisted Nasotracheal Intubation in Oral Malignancies - A Comparison between Airway Blocks and LA Spray - A Randomized, Interventional Crossover Trial

Awake fiberoptic assisted nasal intubation is the gold standard for securing airway in cases of oral malignancy posted for radical surgeries. Different techniques such as airway blocks, LA gargles, spray, nebulization along with light sedation are in practice. We wanted to evaluate the efficacy of airway blocks over airway spray for intubation conditions, time taken to intubation, patient comfort and complications. METHODSThis randomized, interventional and crossover study was conducted at Chirayu Medical College and Hospital. A total of 60 patients of ASA grade I-II with Mallampati score 3 & 4 undergoing wide local excision and neck dissection were selected after fulfilling of the selection criterion and were divided into two groups, Airway Block (AB, n-30) and Airway Spray group (AS, n-30). AB group received bilateral superior and transtracheal recurrent laryngeal nerve blocks and group AS local anaesthetic spray through the working channel of the fiberoptic scope. Haemodynamics, time taken for intubation, intubating conditions, patients’ comfort, and complications if any were noted. All data was tabulated and analysed using software SPSS 17.0. RESULTSMean total time taken for intubation in seconds was less. Intubating conditions were optimal in 90 % cases. 5-point comfort during and 3-point score immediately after intubation were excellent in AB compared AS group. Haemodynamically both the groups were comparable. CONCLUSIONSCombined block of the superior and recurrent laryngeal nerves provides optimal conditions to facilitate a successful fibreoptic assisted awake nasotracheal intubation in anticipated difficult airway

Experimental study on central location ability and clearance rate of three nickel-titanium instruments for root canal retreatment / 口腔疾病防治

Objective@# Comparision of the central location ability and clearance rate of ProTaper retreatment, Fengdu O-file and M3-RT three kinds of nickel-titanium instruments and hand stainless instruments K-file, H-file. Observe the form of the root canal wall. To provide experimental basis and reference for the clinical application of nickel-titanium instruments for root canal retreatment.@*Methods @#40 simulated resin blocks with the same specification were randomly divided into four groups (n=10). Each group was separately prepared with hand stainless instruments K-file and H-file (group A1), ProTaper retreatment (group B1), Fengdu O-file (group C1), and M3-RT (group D1). Using scanner to obtain the pre- and post-operative images and overlapping the images through Photoshop. Measuring the root canal inner and outer wall resin removal with Image J, compared the central location ability of the four group. A total of 60 mandibular single canal premolars extracted due to orthodontics were collected. The teeth were randomly divided into four groups (n=15) after filling the root canal. Use hand stainless instruments K-file,H-file(group A2), ProTaper retreatment (group B2), Fengdu O-file(group C2) , M3-RT(group D2) to remove the filling materials. The roots were longitudinally sectioned, and the image of the root surface was photographed under the 10 × magnification microscope. The software was used to trace the area of the root canal wall and residual root filling, and the root filling clearance rate of each group was calculated. Two teeth were randomly selected in each group and observed under scanning electron microscope.@*Results@#Within 9 mm from the root tip hole, the central location ability of group B1, C1, D1 was better than that of group A1(P ＜ 0.05). At 4 mm from the root tip hole, group D1 has the best central location ability(P ＜ 0.05). There was no difference of the four instruments at a distance of 10 mm from the root tip hole（P ＞ 0.05）. There were various degree of filling material remained in the root canal after the four groups of instruments for retreatment canal preparation. There was no significant difference between group B2, C2, D2（P ＞ 0.05）, and both were higher than group A2(P ＜ 0.05). Scanning electron microscope observation results shown that the root canal wall prepared by group B2, C2, D2 was more smooth and continuous than group A2, and the residual filling material was less. @*Conclusion @#The central location ability of three kinds of nickel-titanium root canal retreatment instruments were significantly better than that of hand stainless instruments. ProTaper retreatment, Fengdu O-file and M3-RT three kinds of nickel-titanium root canal retreatment instruments showed good performance, the central location ability of M3-RT was slightly better. Nickel-titanium root canal retreatment instruments are more efficient than traditional hand stainless instruments in removing root fillings and the root canal wall after preparation is smoother and has good continuity.

Projeção populacional, mudanças climáticas e efeitos econômicos: uma avaliação a partir de blocos econômicos agrícolas / Population projection, climate change and economic effects: assessment based on agricultural economic blocks / Proyección de la población, cambio climático y efectos económicos: una evaluación basada en bloques económicos agrícolas

A trajetória populacional futura e as mudanças climáticas são aspectos que geram incertezas quanto aos seus prováveis efeitos sobre a economia, especialmente a produção agrícola e indústria de alimentos. O artigo simula os efeitos de cenários populacionais e um de mudanças climáticas a partir do modelo de equilíbrio geral computável GTAP. É construída uma versão do GTAP 10 para reconhecer as atividades da agropecuária e silvicultura e indústria de alimentos, além de oito regiões denominadas blocos econômicos agrícolas, construídos a partir de técnicas de análise multivariada. As simulações dinâmicas do desvio acumulado entre o baseline e os cenários de política até 2050 apontaram, isoladamente, efeitos negativos generalizados das mudanças climáticas sobre o PIB e atividades econômicas dos blocos. Os resultados dos cenários populacionais indicaram que os blocos constituídos por países mais ricos e com economias mais diversificadas tenderiam a ganhar em detrimento dos demais em termos de PIB. Por outro lado, seria incentivada, de forma generalizada, a produção da agropecuária e silvicultura e da indústria de alimentos dos blocos. Em termos conjuntos, os efeitos negativos das mudanças climáticas tenderiam a superar os efeitos positivos dos cenários populacionais e de forma mais intensiva naqueles que projetam menor crescimento populacional.

The future population trajectory, as well as climate change, are aspects that generate uncertainties as to their probable effects on the economy, especially on agricultural production and food industry. This paper simulates the effects of population scenarios and one of climate change using the GTAP computable general equilibrium model. A version of GTAP 10 was created to identify Agriculture, Forestry and Food Industry activities, and eight regions, called Agricultural Economic Blocks, using multivariate analysis techniques. The dynamic simulations of the accumulated deviation between thebaseline and the policy scenarios up to 2050 in isolation indicated widespread negative effects of climate change on the GDP and economic activities of the blocs. The results of the population scenarios indicated that the blocks made up of richer countries and with more diversified economies would tend to win at the expense of the others in terms of GDP. On the other hand, they would generally encourage the blocks' Agriculture, Forestry and Food Industry productions. Taken together, the negative effects of climate change would tend to outweigh the positive effects of population scenarios and more intensively on those which project less population growth.

La trayectoria futura de la población así como el cambio climático son aspectos que generan incertidumbres con respecto a sus probables efectos en la economía, especialmente en la producción agrícola y en la industria alimentaria. El artículo simula los efectos de los escenarios de población y del cambio climático utilizando el modelo de equilibrio general computable GTAP. Se creó una versión de GTAP 10 para reconocer las actividades de la agricultura y la silvicultura y la industria alimentaria en ocho regiones llamadas bloques económicos agrícolas, construidas con técnicas de análisis multivariados. Las simulaciones dinámicas de la desviación acumulada entre la línea de base y los escenarios de política hasta 2050 solo indicaron efectos negativos generalizados del cambio climático sobre el producto interno bruto (PIB) y las actividades económicas de los bloques. Los resultados de los escenarios de población indicaron que los bloques formados por países más ricos y con economías más diversificadas tenderían a ganar a expensas de los demás en términos de PIB. Por otro lado, alentarían, generalizadamente, la producción de agricultura y silvicultura y también la industria alimentaria de los bloques. Tomados en conjunto, los efectos negativos del cambio climático tenderían a superar los efectos positivos de los escenarios de población, más intensamente en aquellos que proyectan un menor crecimiento de la población.

Bloqueos de extremidad inferior / Lower extremity blocks

Lower limb blocks are described with emphasis on distribution according to sensitive distribution and its sonoanatomy.

Se describen los bloqueos de la extremidad inferior haciendo énfasis en la distribución de acuerdo a distribución sensitiva y a su sonoanatomia.

Control of Shivering with Prophylactic Ketamine During Subarachnoid Block: A Placebo-Controlled Randomised Double- Blind Study

Introduction: Shivering is a common and challenging sideeffect of anaesthesia and may result in different degrees ofperioperative hypothermia. Hence, the aim of the study was tocompare the efficacy of ketamine to prevent shivering duringsubarachnoid block inpatient undergoing elective surgery.Material and Methods: We conducted a prospectiverandomized, double-blind placebo-controlled trial with totalof 90 ASA I and II patients of either sex between the agesof 18 – 60 years undergoing elective infra- umbilical surgeryunder subarachnoid blocks. Random allocation of patientswas done into Group1: ketamine at dose of 0.5 mg /kg (n=30),Group2: ketamine at dose of 0.25 mg /kg (n=30), Group3:saline (n=30).Results: The study groups were comparable at the baseline.After spinal anaesthesia and concomitant administration ofthe study drug, shivering was observed only in 10% of patientwith score 1 in Group 1 and Group 2. Whereas in placebogroup 50% patients suffered different degrees of shivering andrequired treatment (p<0.05). After drug injection % of patienthad higher sedation score (3 or 2) which was significantlyhigher in Group 1 (3%) than Groups 2 and 3 (0%) (P=0.002).Only 3.3% patients of group1 experienced hallucination andrest of the patients in any group had no hallucination (P value=0.045)Conclusion: Ketamine at a dose of 0.5 mg /kg had similareffects as that of ketamine at dose of 0.25 mg /kg whencompared to placebo group. However, ketamine at dose of 0.5mg /kg caused higher effects of sedation and hallucination.

Intervencionismo guiado por ultrasonido en cirugía torácica y pared abdominal / Ultrasound-guided intervention in thoracic surgery and abdominal wall

Resumen: Cada vez es más frecuente el uso de la ecografía para identificar las capas interfasciales, el cual ha llevado al desarrollo de varias técnicas de inyección para la analgesia del tórax y la pared abdominal. Para la realización de este tipo de abordajes es importante tener el conocimiento y dominio del ultrasonido, de los bloqueos troncales, anestésicos locales y toxicidad. Estos bloqueos interfasciales se desarrollaron como alternativas al bloqueo epidural, paravertebral, intercostal e intrapleural torácico, principalmente para la analgesia perioperatoria. En esta revisión incluimos diferentes abordajes guiados por ultrasonido como son el bloqueo del plano del erector espinal (ESP), el bloqueo del serrato anterior, bloqueo PEC1 y PEC2, bloqueo BRILMA, bloqueo paravertebral, bloqueo del plano del transverso abdominal (TAP), bloqueo del cuadrado lumbar, bloqueo de la vaina de los rectos. Se incluyen enlaces con videos para poder revisar la técnica, indicaciones y dosis (visite http://www.painoutmexico.com para ver artículo completo y videos).

Abstract: The increasing use of ultrasound to identify the interfascial layers has led to the development of several injection techniques for analgesia of the thorax and abdominal wall. For this type of approach it is important to have knowledge of ultrasound, trunk blocks, local anesthetics and toxicity. These interfascial blocks were developed as alternatives to epidural, paravertebral, intercostal and intrapleural thoracic block, mainly for perioperative analgesia. In this review, we include different approaches guided by ultrasound such as: erector spinae plane block (ESP), anterior serratus block, PEC1 and PEC2 block, BRILMA block, paravertebral block, transverse abdominal plane block (TAP), quadratus lumbar block (QLB) and rectus sheath block. Links with videos are included to review the technique, indications and dosage (visit http://www.painoutmexico.com obtain full version and videos).