Uncovering the neural control of laryngeal activity and subglottic pressure in anaesthetized rats: insights from mesencephalic regions.

To assess the possible interactions between the dorsolateral periaqueductal gray matter (dlPAG) and the different domains of the nucleus ambiguus (nA), we have examined the pattern of double-staining c-Fos/FoxP2 protein immunoreactivity (c-Fos-ir/FoxP2-ir) and tyrosine hydroxylase (TH) throughout the rostrocaudal extent of nA in spontaneously breathing anaesthetised male Sprague-Dawley rats during dlPAG electrical stimulation. Activation of the dlPAG elicited a selective increase in c-Fos-ir with an ipsilateral predominance in the somatas of the loose (p < 0.05) and compact formation (p < 0.01) within the nA and confirmed the expression of FoxP2 bilaterally in all the domains within the nA. A second group of experiments was made to examine the importance of the dlPAG in modulating the laryngeal response evoked after electrical or chemical (glutamate) dlPAG stimulations. Both electrical and chemical stimulations evoked a significant decrease in laryngeal resistance (subglottal pressure) (p < 0.001) accompanied with an increase in respiratory rate together with a pressor and tachycardic response. The results of our study contribute to new data on the role of the mesencephalic neuronal circuits in the control mechanisms of subglottic pressure and laryngeal activity.

M-CSF as a therapeutic target in BRAFV600E melanoma resistant to BRAF inhibitors.

BACKGROUND: Disseminated BRAFV600E melanoma responds to BRAF inhibitors (BRAFi) but easily develops resistance with poor prognosis. Secretome plays a pivotal role during tumour progression causing profound effects on therapeutic efficacy. Secreted M-CSF is involved in both cytotoxicity suppression and tumour progression in melanoma. We aimed to analyse the M-CSF contribution in resistant metastatic melanoma to BRAF-targeted therapies. METHODS: Conditioned media from melanoma cells were analysed by citoarray. Viability and migration/invasion assays were performed with paired melanoma cells and tumour growth in xenografted SCID mice. We evaluated the impact of M-CSF plasma levels with clinical prognosis from 35 metastatic BRAFV600E-mutant melanoma patients. RESULTS: BRAFi-resistant melanoma cells secretome is rich in pro-tumour cytokines. M-CSF secretion is essential to induce a Vemurafenib-resistant phenotype in melanoma cells. Further, we demonstrated that M-CSF mAb in combination with Vemurafenib and autophagy blockers synergistically induce apoptosis, impair migration and reduce tumour growth in BRAFi-resistant melanoma cells. Interestingly, lower M-CSF plasma levels are associated with better prognosis in metastatic melanoma patients. CONCLUSIONS: Secreted M-CSF induces a BRAFi-resistant phenotype and means worse prognosis in BRAFV600E metastatic melanoma patients. These results identify secreted M-CSF as a promising therapeutic target toward BRAFi-resistant melanomas.

Antibiofilm potential over time of a tricalcium silicate material and its association with sodium diclofenac.

OBJECTIVES: The objectives of this study are to investigate, over time, the antimicrobial activity against polymicrobial biofilms and ability to inhibit biofilm formation, of Biodentine (BD) alone and with 5% and 10% sodium diclofenac (DC). MATERIAL AND METHODS: The antimicrobial activity of BD alone and modified with 5% and 10% DC against polymicrobial biofilm growth in dentin was determined by a modified direct contact test. The study groups were (1) BD; (2) BD + 5% DC; and (3) BD + 10% DC. The viability of microorganisms after 1 and 4 weeks was quantified by means of an ATP assay and flow cytometry. The antibiofilm efficacy of the materials, preventing polymicrobial biofilm formation over time, was assessed by confocal laser scanning microscopy (CLSM). RESULTS: The results obtained with both the ATP test and flow cytometry showed that BD alone and with 5% and 10% DC exerted antibiofilm activity with respect to the control, in the two evaluated times (p < 0.001). Comparison between groups showed a tendency of increased antimicrobial effect, both over time and depending on the DC concentration. These results coincide with those obtained in CLSM analysis, where efficacy increased with time and DC concentration. CONCLUSIONS AND CLINICAL RELEVANCE: Biodentine, over time, showed antimicrobial and antibiofilm efficacy on polymicrobial biofilms. The addition of 5% and 10% DC to BD enhanced this effect, in a concentration- and time-dependent manner.

Influence of dentine debris and organic tissue on the properties of sodium hypochlorite solutions.

AIM: To determine the free available chlorine of 2.5% sodium hypochlorite (NaOCl) alone and combined with 9% etidronic acid (HEDP) in the presence of inhibitors, organic tissue and organic tissue plus dentine debris; to evaluate the influence of dentine debris on the tissue-dissolving capacity of both NaOCl solutions; and to determine the antimicrobial action of these solutions when in contact with organic tissue and organic tissue plus dentine debris. METHODOLOGY: The available chlorine of the solutions over time in the absence and presence of the inhibitors was measured using a titration method. The organic tissue dissolution by the solutions alone and in the presence of dentine powder was evaluated by weighing bovine tissue specimens before and after exposure to the solutions for 3 and 10 min. For the antimicrobial activity, biofilms of Enterococcus faecalis were exposed to the solutions for 3 min in the absence and presence of organic tissue and organic tissue + dentine debris. The biovolume and percentage of damaged membrane cells of the biofilm were measured by means of confocal microscopy and the live/dead technique. Nonparametric tests were used to determine statistical differences (P < 0.05). RESULTS: Both inhibitors consumed the free available chlorine of the solutions over time. The presence of dentine debris significantly reduced the tissue dissolution capacity of the NaOCl solutions (P < 0.05). The percentages of biovolume reduction were not affected by the presence of the inhibitors in the two NaOCl solutions, whereas the percentage of damaged membrane cells was significantly reduced (P < 0.001). Overall, a similar behaviour was observed in the NaOCl and NaOCl/HEDP groups. CONCLUSIONS: The presence of organic tissue and organic tissue + dentine debris favoured rapid consumption of the free chlorine of NaOCl and NaOCl/HEDP. This resulted in a decreased ability to dissolve organic tissue without affecting the short-term antimicrobial activity.

Efficacy of antimicrobial solutions against polymicrobial root canal biofilm.

AIM: To evaluate the antibiofilm activity of 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 2% alexidine (ALX) and 0.2% cetrimide (CTR) alone and in combination on mature polymicrobial root canal biofilms on human dentine using confocal laser scanning microscopy (CLSM). METHODOLOGY: Twenty-eight human dentine specimens were infected for 21 days with microbial samples collected from infected root canals of three volunteers. Antibiofilm activity of the irrigating solutions was evaluated after 3 min of contact time under CLSM. For quantification purposes, bioimage_L software was used. The variables evaluated were the log10 of total biovolume (µm3 ) and percentage of live cells (green) population. Statistical analysis of both variables was performed using an anova test and a post hoc Duncan test to determine significant clusters amongst groups. The variable green population percentage was previously subjected to the normalized Anscombe transformation. RESULTS: The NaOCl group had a total biovolume and percentage of live cells significantly lower than the other groups (P Ë‚ 0.001). The addition of 0.2% CTR significantly increased the antimicrobial effect of 2% CHX (P Ë‚ 0.001). There were no significant differences between 0.2% CTR, 2% ALX and the combination of both (P Ë‚ 0.05). CONCLUSIONS: Overall, 2.5% NaOCl dissolved and killed bacteria significantly more efficiently when used against polymicrobial mature biofilm on human dentine. Cetrimide improved the antimicrobial activity of chlorhexidine and alexidine.

The effect of benzalkonium chloride additions to AH Plus sealer. Antimicrobial, physical and chemical properties.

OBJECTIVES: The aim of this study was to determine the antimicrobial and antibiofilm activities and physicochemical properties of AH Plus sealer mixed with different concentrations of benzalkonium chloride (BC). METHODS: AH Plus was tested alone and mixed with 1%, 2% and 3% of BC. The antimicrobial and antibiofilm activities of the sealers against Enterococcus faecalis were evaluated by the direct contact test (DCT) and by confocal laser scanning microscopy, respectively. Setting time, flow and solubility were assessed according to ANSI/ADA specifications. Microhardness and contact angle tests were also performed. The chemical changes of the sealers were evaluated by X-ray diffraction analysis, and both Fourier transform infrared spectroscopy (FT-IR) and attenuated total reflectance Fourier transform infrared (ATR FT-IR). RESULTS: AH Plus+3% BC was the only sealer to promote total elimination of E. faecalis and the biovolume in this group was significantly lower than in the rest of the sealers (p>0.05). The physical properties of the sealers were according to the ANSI/ADA specifications. The microhardness decreased significantly when BC was added and a significant reduction in contact angle was obtained when incorporating 2% and 3% BC (p<0.05). No phase changes were observed with the modified sealers. CONCLUSIONS: The addition of 2% or higher concentrations BC to AH Plus showed antimicrobial and antibiofilm activities without affecting the properties specified in ANSI/ADA standards. However, additives to the root canal sealer altered other physical and chemical properties that are not commonly found in the literature to evaluate filling materials. CLINICAL SIGNIFICANCE: The present study highlights that the antimicrobial properties of AH Plus can be significantly improved with the addition of BC. Testing beyond what is specified in standards may be indicated.

Antimicrobial activity of Chlorhexidine, Peracetic acid and Sodium hypochlorite/etidronate irrigant solutions against Enterococcus faecalis biofilms.

AIM: To evaluate the antimicrobial effect of 2.5% sodium hypochlorite alone (NaOCl) and associated with 9% HEBP (NaOCl/HEBP), 2% peracetic acid (PAA) and 2% chlorhexidine (CHX), on the viability of Enterococcus faecalis biofilms attached to dentine. METHODOLOGY: Biofilms of E. faecalis were grown on the surface of dentine blocks for 5 days and then exposed to the irrigating solutions for 3 min. Distilled water was used as the control. The total biovolume and the percentage of dead cells of the infected dentine were measured by means of confocal microscopy and the live/dead technique. Nonparametric tests were used to determine statistical differences (P < 0.05). RESULTS: NaOCl and the NaOCl/HEBP mixture were associated with a significantly greater percentage of dead cells, followed by PAA (P < 0.05). No significant antimicrobial effect of CHX was observed in comparison with the control group. Total biovolume decreased significantly in NaOCl, NaOCl/HEBP and PAA solutions in comparison with the CHX and control groups. CONCLUSIONS: NaOCl alone or associated with HEBP were the most effective irrigant solutions in dissolving and killing E. faecalis biofilms.

¿Cómo seleccionar el paciente candidato a cirugía estética facial y qué hacer ante un paciente insatisfecho? / How to select the adequate patient for a aesthetic facial surgery and what to do when facing a dissatisfied one?

Objetivo: Este artículo pretende dar a conocer aspectos importantes para la selección del paciente candidato a cirugía estética facial y cómo actuar en caso de insatisfacción. Diseño: Revisión narrativa de la literatura. Métodos: Revisión narrativa de la literatura que resume aspectos relevantes en la relación médico paciente y los factores en la selección y el manejo de los pacientes candidatos a cirugía plástica facial. Conclusión: El objetivo de la cirugía estética facial es satisfacer al paciente para generar el cambio deseado tanto físico como funcional. Muchas veces los objetivos, las motivaciones y las expectativas de los pacientes son complejas, y para satisfacerlas es necesario determinar aspectos psicológicos de cada uno de ellos y mantener una relación médico - paciente basada en la comunicación y cordialidad, con el fin de evitar daño físico, emocional y económico, e identificar como actuar en caso de enfrentar un paciente insatisfecho.

Objective: This article seeks to show the most important aspects for the selection of adequate patients for aesthetic facial surgery and to give recommendations on how to approach and manage patients that are not satisfied with their procedures. Design: Narrative Review. Methods: Narrative review of the literature summarizing relevant aspects of the doctor-patient relationship and factors in the selection and management of patients candidates for facial plastic surgery. Conclusion: The objective of aesthetic facial surgery is to be able to satisfy the patient generating the physical and functional changes that he or she wishes. The are many cases where the objectives, motivations and expectations from patients are very complex and in order to fulfill them it is necessary to determine the psychological aspects from each one of them individually. Maintaining a doctor-patient relationship based in communication and cordiality is very important, in order to avoid physical, emotional and economic harm and to be able to know how to react and manage patients in case of dissatisfaction.

Reduction in Enteroccocus faecalis counts - a comparison between rotary and reciprocating systems.

AIM: To compare the chemomechanical reduction and regrowth of Enterococcus faecalis between rotary and reciprocating systems in root canal preparation. METHODOLOGY: Seventy-six single-rooted human mandibular premolars were selected and standardized to 15 mm in length. Root canals were enlarged up to a size 25 K-file and irrigated with distilled water and then were infected with E. faecalis for 4 weeks. The specimens were divided into 3 groups (n = 24) for instrumentation with Mtwo, Twisted File and WaveOne. Each group was further divided into two subgroups (n = 12) according to the irrigant used: distilled water or 5.25% sodium hypochlorite (NaOCl). Before and after rotary preparation, microbiological samples were collected using three sterilized paper points, and efficacy was expressed as reduction in percentage. The proportion of grown samples for 60 days was evaluated using nonparametric Kaplan-Meier survival analysis. Differences amongst groups were tested using the log-rank test at a significance level of 0.05. RESULTS: In the main root canal, the percentage reduction in the distilled water and 5.25% NaOCl groups ranged from 95.9% to 100%, with no significant differences amongst the three systems (P > 0.05). The bacterial regrowth in NaOCl groups revealed that Mtwo had the lowest number of samples regrown at 60 days, giving statistically significant differences with respect to Twisted File (P = 0.029) and WaveOne (P = 0.005). CONCLUSIONS: Reciprocating and rotary systems resulted in similar percentage reduction in E. faecalis when using either distilled water or 5.25% NaOCl solution. Over time, the Mtwo system was more effective regarding disinfection.

A Study of the Sugarcane Yellow Leaf Disease in Argentina.

Yellow leaf disease, caused by Sugarcane yellow leaf virus (SCYLV), is widespread around the world but very little information is available on this viral disease in Argentina. Therefore, the aims of the study were to assess the presence of SCYLV, analyze its distribution in the main sugarcane production areas of Argentina, characterize the virus, and determine histological alterations caused by its presence. For this purpose, 148 sugarcane samples with and without symptoms were collected in 2011 and 2012 from the province of Tucumán. One additional sample was collected in Salta, a different geographical, agroecological, and producing region. Results showed that SCYLV is widely distributed in commercial varieties of sugarcane throughout Tucumán in both symptomatic and asymptomatic leaves. A low but statistically significant positive correlation with virus detection and disease symptoms was found. BRA-PER was the only genotype detected by reverse-transcription polymerase chain reaction and sequence analysis of the SCYLV capsid protein gene. SCYLV-positive samples showed high starch levels in bundle sheath cells, whereas the asymptomatic ones, probably in an early stage of infection, were found to contain more chloroplasts. Symptomatic noninfected samples presented crystal formation probably associated with phytoplasma infection.

[Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000]. / Litiasis vesícular post- gastrectomía radical por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas, enero 1990 a diciembre del 2000.

SUBJECT: To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru. METHODS: In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones. RESULTS: A total de 148 patients were involved in this study. 29 of them (19.6%) develop gallbladder stones during the (x years of) follow up vs 119 (80.9%) . The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male.\The mean time of develop gallbladder stones was 3.1 years.According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy. CONCLUSIONS: The frecuency of gallbladder stones post gastrectomy in this study was 19.6%. The mean time of the develop and diagnosis of litiasis was 3.1 years.To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer.We need furthermore studies to have conclusions about the risk factors.

Dissolving efficacy of eucalyptus and orange oil, xylol and chloroform solvents on different root canal sealers.

AIM: To evaluate the solubility of five root canal sealers in orange oil, eucalyptol, xylol and chloroform solvents. METHODOLOGY: The solubility of RoekoSeal, Sealer 26, Epiphany, Endomethasone and EZ-Fill sealers was assessed in orange oil, eucalyptol, xylol, chloroform and distilled water. Seventy-five samples of root canal sealers were prepared and then divided into five groups for immersion in solvent for 2, 5 or 10 min. The means of loss weight were determined for each material in each solvent at all immersion periods, and the values were compared by factorial analysis of variance (anova) and SNK multiple comparisons. RESULTS: In the orange and eucalyptus oil groups, there was no significant difference among RoekoSeal, Sealer26, Epiphany and EZ-Fill at the three immersion periods (P > 0.05). With xylol, no significant differences were found at 5 and 10 min (P > 0.05) for each root sealer. Orange and eucalyptus oil solvents were as effective as chloroform at 2 min in dissolving all the root sealers. CONCLUSIONS: Xylol was the most effective solvent followed by the chloroform and the essential oils (eucalyptol and orange oil). Orange oil behaved in a similar way to eucalyptus oil.

Litiasis vesícular post-gastrectomía radical por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas, enero 1990 a diciembre del 2000 / Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000

OBJETIVO: Determinar la frecuencia de litiasis vesicular en pacientes post-operados con gastrectomía por adenocarcinoma gástrico, determinar el tiempo de aparición de litiasis vesicular en pacientes gastrectomizados por Adenocarcinoma Gástrico. MÉTODOS: Se realizo un estudio observacional, descriptivo retrospectivo. Se revisó un total de 148 historias clínicas de pacientes sometidos a gastrectomía por adenocarcinoma gástrico en el Instituto Nacional de Enfermedades Neoplásicas en el periodo de 1990 al 2000. RESULTADOS: De los 148 casos de pacientes post gastrectomizados por adenocarcinoma gástrico que fueron enrolados, 29(19.6 por ciento) presentaron litiasis vesicular versus 119(80.9 por ciento) que no presentaron litiasis vesicular como complicación post gastrectomía. La media de edad de 29 pacientes con litiasis vesicular post gastrectomía por adenocarcinoma gástrico fue de 59.9años (min. 39años máx.74años). La distribución de la litiasis vesicular en relación al sexo fue, femenino 18(62.1 por ciento) casos y masculino 11(37.9 por ciento) casos. La media del tiempo de aparición de la litiasis vesicular post gastrectomía fue de 3.1 años, para el sexo masculino 2.7años y para el sexo femenino de 3.3 años. Según el tipo de cirugía se presento litiasis vesicular en 14 pacientes que fueron sometidos a Gastrectomía Subtotal Distal y a 15 pacientes a los que se les practicó Gastrectomía Total. CONCLUSIONES: la Frecuencia de litiasis vesicular post gastrectomía fue de 19.6 por ciento. El periodo de aparición de colelitiasis fue de 3.1 años. La colecistectomía podría ser una toma de decisión importante en pacientes con alto riesgo de litiasis y cáncer vesicular post gastrectomía. El presente trabajo de investigación invita a realizar otros estudios de tipo cohorte en el cual se determine el factor de riesgo principal para la aparición de esta complicación.

SUBJECT: To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru. METHODS: In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones. RESULTS: A total de 148 patients were involved in this study. 29 of them (19.6 percent) develop gallbladder stones during the (x years of) follow up vs 119(80.9 percent). The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male./The mean time of develop gallbladder stones was 3.1 years. According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy. CONCLUSIONS The frecuency of gallbladder stones post gastrectomy in this study was 19.6 percent. The mean time of the develop and diagnosis of litiasis was 3.1 years. To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer. We need furthermore studies to have conclusions about the risk factors.

El final de la vida en la Unidad de Cuidados Intensivos desde la perspectiva enfermera: un estudio fenomenológico / The end of the life in the Intensive Unit Care from the nursing perspective: a phenomenological study

IntroducciónLas Unidades de Cuidados Intensivos no se adaptan a la realidad social y sanitaria con respecto al fenómeno de la muerte, lo que produce un alto grado de insatisfacción entre profesionales, familiares y pacientes. Las características especiales de estas unidades adjudican a la enfermera el puesto protagonista como cuidadora del paciente crítico moribundo. El objetivo principal de este estudio es conocer las vivencias y actitudes del profesional de enfermería ante el fenómeno de la muerte en la Unidad de Cuidados Intensivos.Participantes y métodosEstudio cualitativo descriptivo de carácter fenomenológico. Comparación constante e incorporación progresiva de participantes mediante muestreo intencional hasta llegar a la saturación de datos (n=16). La técnica de recogida de datos empleada fue la entrevista en profundidad semiestructurada, las entrevistas fueron grabadas y transcritas literalmente. Los datos recogidos fueron verificados por los informantes y analizados siguiendo los pasos propuestos por Taylor-Bogdan.ResultadosEl análisis reveló cinco categorías temáticas: la muerte y las creencias, trabajo emocional, factores ambientales, toma de decisiones frente a la limitación del soporte vital y relación con la familia.ConclusionesEl modelo de gestión de la muerte en la Unidad de Cuidados Intensivos se centra en la intervención médica y deja de lado la opinión de enfermeras, familiares y pacientes. Este estudio refleja las contribuciones que el profesional de enfermería puede realizar en la toma de decisiones y atención al paciente moribundo ingresado en estas áreas (AU)

IntroductionIntensive Care Units do not adapt to the social and health reality regarding the phenomenon of death and this results in a high degree of dissatisfaction among professional, relatives and patients. The special characteristics of these units give the nursing staff a main roll as carers of critical dying patients. The principal aim of this study is to know the nursing staffs’ experiences and attitudes towards the phenomenon of death in the intensive care units.Participants and methodA descriptive qualitative study of phenomenological character was performed. Constant comparison and progressive incorporation of participants was made, using intentional sampling up to data saturation (n=16). The data collection technique used was a semi-structured in-depth interview, which were recorded and literally transcribed. The data collected was verified by the informants and analyzed according to the steps proposed by Taylor-Bogdan.ResultsThe analysis shows 5 thematic categories: death and beliefs, emotional work, environmental factors, decision-making management of death in intensive care units and relationships with relatives.ConclusionsThe management model of death in intensive care units focuses on medical intervention and overlooks the opinions of the nurses, relatives and patients. This study shows the contributions that can be provided by the nursing staff in decision making and in the care of the dying patients in these wards (AU)

[The end of life in the intensive care unit from the nursing perspective: a phenomenological study]. / El final de la vida en la Unidad de Cuidados Intensivos desde la perspectiva enfermera: un estudio fenomenológico.

INTRODUCTION: Intensive Care Units do not adapt to the social and health reality regarding the phenomenon of death and this results in a high degree of dissatisfaction among professional, relatives and patients. The special characteristics of these units give the nursing staff a main roll as carers of critical dying patients. The principal aim of this study is to know the nursing staffs' experiences and attitudes towards the phenomenon of death in the intensive care units. PARTICIPANTS AND METHOD: A descriptive qualitative study of phenomenological character was performed. Constant comparison and progressive incorporation of participants was made, using intentional sampling up to data saturation (n=16). The data collection technique used was a semi-structured in-depth interview, which were recorded and literally transcribed. The data collected was verified by the informants and analyzed according to the steps proposed by Taylor-Bogdan. RESULTS: The analysis shows 5 thematic categories: death and beliefs, emotional work, environmental factors, decision-making management of death in intensive care units and relationships with relatives. CONCLUSIONS: The management model of death in intensive care units focuses on medical intervention and overlooks the opinions of the nurses, relatives and patients. This study shows the contributions that can be provided by the nursing staff in decision making and in the care of the dying patients in these wards.

Topographical evaluation of the major apical foramen in permanent human teeth.

AIM: To determine the distance from the anatomical root apex to the major apical foramen and the position of the major foramen on the root apex. METHODOLOGY: Crowns of 926 human teeth were sectioned at the cementum-enamel junction. Specimens were mounted on microscope slides for measurement parallel to the long axis of the teeth. The major foramen was identified as the largest-diameter opening at the root apex. A total of 1331 root specimens were evaluated using an optical stereomicroscope to an accuracy of 0.01 mm at 40 x (+/-10) magnification. The distance from the anatomical apex to the most apical point of the major foramen was measured, and its location (central, buccal, lingual, mesial and distal) was recorded. RESULTS: The mean distance between the major foramen and the anatomical root apex was 0.69 mm; the mean distance was larger in posterior teeth (0.82 mm) and smaller in anterior teeth (0.39 mm). A wide range of anatomical apex to major foramen distances were observed in all tooth groups: the greatest distance was in maxillary molars (0.95 mm) followed by mandibular pre-molars (0.87 mm) and mandibular molars (0.80 mm). The major foramen was at the tip of the root in 40% of teeth. The most frequent deviations of the foramen were to the buccal (20%) and distal (14%). CONCLUSION: In this sample of teeth without apical resorption the distance between the major foramen and the anatomical root apex was always <1 mm. Deviation of the major foramen from the anatomic apex varied widely amongst tooth groups.

Decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine.

AIM: To evaluate and compare ex vivo the decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine. METHODOLOGY: Two 2-mm-thick slices were cut from the coronal third of the root of 10 human incisors. Each slice was sectioned into two equal parts. Specimens were assigned to one of four groups (n = 10) for immersion in 20 mL of either 15% EDTA, or 15% citric acid, 5% phosphoric acid or 2.5% NaOCl, for three time periods (5, 10 and 15 min). The concentration of Ca(2+) extracted from the dentine was measured by atomic absorption spectrophometry. The amount of calcium extracted was analysed using the Kruskal-Wallis test for global comparisons and the Mann-Whitney U-test for pairwise comparisons. RESULTS: In the three time periods, 15% EDTA and 15% citric acid extracted the largest amount of calcium, with no significant differences between them. The 2.5% NaOCl solution extracted insignificant amounts of calcium, whereas 15% EDTA extracted 86.72% of the calcium in the first 5 min, and 15% citric acid and 5% phosphoric acid had a similar pattern of calcium removal (77.03% and 67.08% in first 5 min, respectively). CONCLUSIONS: Solutions of 15% EDTA, 15% citric acid and 5% phosphoric acid decalcify root dentine, with most calcium extracted during the first 5 min of action. The efficacy of 15% citric acid and 15% EDTA solutions was significantly greater than that of 5% phosphoric acid solution at each time period (5, 10 and 15 min).

In vitro evaluation of the accuracy of three electronic apex locators.

The accuracy of three electronic apex locators (EALs) (Justy II, Root ZX, and Neosono Ultima EZ) is evaluated, together with the concordance of the measurements obtained by two different operators. Twenty single-root human teeth were used, sectioning the crown to gain access to the root canal. A first operator (A) determined the reference (or control) length (corresponding to the actual length) for each tooth, after which all teeth were measured individually and independently by the other two operators (B and C). The results obtained with each EAL and by each operator were in turn compared with the corresponding control length. The statistical analysis of the results showed EAL reliability in detecting the apex to vary from 80% to 85% and 85% to 90% (depending on the operator) for the Justy II and Neosono systems, respectively, whereas reliability was found to be 85% for the Root ZX device. These results, combined with a high interobserver concordance, suggest electronic root canal measurement to be an objective and acceptably reproducible technique.