A case image of epicardial implants in a young male with mixed germ cell tumor.

Epicardial metastasis from mixed germ cell tumors is exceedingly rare and poses a significant risk for cardiac morbidity. This case highlights the crucial need for comprehensive systemic evaluation in patients with known malignancies presenting with cardiac symptoms.

Chemometric study on the effect of cooking on bioactive compounds in tomato pomace enriched sauces.

Tomato pomace (TP) is an underutilized source of bioactive compounds with potential application in the food sector. A factorial experiment was designed to compare three culinary techniques, Thermomix®, Roner®, and traditional pan-frying, for the preparation of tomato sauces, enriched or not with TP, applying two temperatures and two cooking times. A multivariate analysis was performed on all the results obtained for the metabolites. The addition of TP significantly increased the content of bioactive compounds, especially phenolic compounds. OPLS-DA models were generated using cooking technique, temperature, and time as discriminant factors. The cooking technique had a greater effect on the phenolic content than cooking temperature or time. Thermomix® released bioactive compounds from the tomato into the sauce to a similar extent as pan-frying. Roner® proved to be effective in preserving the volatile fraction of the sauce. The Thermomix® significantly increased the amount of bioactive compounds, while the Roner® increased the volatile compounds.

Long-term Health Outcomes After Hospital Discharge Among Children Hospitalized for MIS-C or COVID-19, September 29, 2021, to June 21, 2022.

BACKGROUND: The long-term effects of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) or acute COVID-19 are not well known. Our objective was to determine long-term outcomes. METHODS: Children hospitalized with MIS-C or COVID-19 at 3 US hospitals from March 2020, through February 2021 were followed to assess health through 2 years post-hospitalization using medical records and patient surveys. RESULTS: Medical record abstraction was performed for 183 patients hospitalized with MIS-C, 53 of whom participated in surveys, and 97 patients hospitalized with COVID-19, 35 of whom participated in surveys. Patients with MIS-C were younger (median, 9 vs. 14 years of age for COVID-19 patients; P = 0.004), more frequently male (62% vs. 39%; P < 0.001) and had more cardiac (14% vs. 2%; P = 0.001) and neurologic sequelae (8% vs. 1%; P = 0.023). Children with COVID-19 more often had other comorbidities (59% vs. 19%; P < 0.001). Full mental recovery at the time of survey 2 (median, 16 months post-hospitalization for patients with MIS-C and 20 months for patients with COVID-19) was 85% and 88%, respectively; full physical recovery was 87% and 81%, respectively; and nearly all had resumption of normal activities. Patients with MIS-C reported more frequent headache at 1 month (45% vs. 20%; P = 0.037). Patients with COVID-19 were more likely to report cough at 1 month (37% vs. 17%; P = 0.045). Fatigue persisted >1 year in 15%-20% of patients in both groups. CONCLUSIONS: Approximately 20% of children with MIS-C and COVID-19 continued to have symptoms including fatigue and headache >1 year after hospital discharge. The duration of these findings emphasizes the importance of providers following patients until sequelae have resolved.

Comparative analysis of optical and numerical models for reflectance and color prediction of monolithic dental resin composites with varying thicknesses.

OBJECTIVE: To assess the prediction accuracy of recent optical and numerical models for the spectral reflectance and color of monolithic samples of dental materials with different thicknesses. METHODS: Samples of dental resin composites of Aura Easy Flow (Ae1, Ae3 and Ae4 shades) and Estelite Universal Flow Super Low (A1, A2, A3, A3.5, A4 and A5 shades) with thicknesses between 0.3 and 1.8 mm, as well as Estelite Universal Flow Medium (A2, A3, OA2 and OA3 shades) with thicknesses between 0.4 and 2.0 mm, were used. Spectral reflectance and transmittance factors of all samples were measured using a X-Rite Color i7 spectrophotometer. Four analytical optical models (2 two-flux models and 2 four-flux models) and two numerical models (PCA-based and L*a*b*-based) were implemented to predict spectral reflectance of all samples and then convert them into CIE-L*a*b* color coordinates (D65 illuminant, 2°Observer). The CIEDE2000 total color difference formula (ΔE00) between predicted and measured colors, and the corresponding 50:50% acceptability and perceptibility thresholds (AT00 and PT00) were used for performance assessment. RESULTS: The best performing optical model was the four-flux model RTE-4F-RT, with an average ΔE00 = 0.72 over all samples, 94.87% of the differences below AT00 and 65.38% below PT00. The best performing numerical model was L*a*b*-PCHIP (interpolation mode), with an average ΔE00 = 0.48, and 100% and 79.69% of the differences below AT00 and PT00, respectively. SIGNIFICANCE: Both optical and numerical models offer comparable color prediction accuracy, offering flexibility in model choice. These results help guide decision-making on prediction methods by clarifying their strengths and limitations.

Promoting sleep and rest in hospitalized children: a best practice implementation project.

OBJECTIVE: The objective of this project was to implement scientific evidence to promote sleep and rest in pediatric patients during hospitalization. INTRODUCTION: Hospitals are not conducive to quality sleep, as external factors such as light, noise, and interruptions from health care staff can disturb patients. Being hospitalized has a detrimental impact on children's sleep because it reduces how much sleep they get and the quality of that sleep. It has been reported that up to 20% to 30% of hospitalized children experience sleep problems. METHODS: This project was conducted at the Marqués de Valdecilla University Hospital in Cantabria, northern Spain. The project used the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process, together with a structured approach to identifying and managing barriers to change. The study subjects were 100 children aged 2 to 16 years, who were admitted to the hospital's pediatric unit from November to December 2021, and 27 multi-disciplinary health care staff. RESULTS: Implementing the evidence-based strategies improved our care practices, with the follow-up audit results showing a marked improvement in compliance. Thus, training health care staff on pediatric sleep increased from 4% to 80%; using a multi-faceted approach to sleep promotion increased from 21% to 87%; and promoting relaxation techniques to promote sleep increased from 0% to 80%. CONCLUSIONS: The project met its objectives. Areas for improving children's sleep and rest during hospitalization were identified. To avoid resistance to change, it was necessary to involve the entire team and maintain training. We recommend follow-up audits once a year, to ensure the sustainability of the project. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A252.

Measurement invariance of the Intuitive Eating Scale-2 across country, ethnicity, sex, and sexual orientation: A cross-cultural study between Brazil and the U.S.

Intuitive eating is defined as being connected to internal hunger, satiety, and appetitive cues and flexibly using these cues to determine when, what, and how much to eat. The Intuitive Eating Scale-2 (IES-2) is a widely used measure of facets of intuitive eating. However, the scale has shown unstable factor structure in several validation studies and there is a lack of studies investigating the measurement invariance of the IES-2 beyond sex. We aimed to evaluate the psychometric properties of the IES-2, testing several factor structures among Brazilian and U.S. samples of men and women; to test measurement invariance across country of origin, ethnicity, sex, and sexual orientation; and to evaluate its internal consistency. Three models of the latent structure of the IES-2 were tested using confirmatory factor analyses (CFA) in a total of 1072 young adults (452 Brazilians and 620 Americans), aged 18-35 years. Results demonstrated that only a 3-factor solution with 11 items of the IES-2 showed adequate fit to the data for both countries. This model demonstrated scalar invariance across sex and sexual orientation, but only configural invariance was found across country of origin and ethnicity. Good internal consistencies were found for both the Brazilian and American samples. The present study provides support for a 3-factor solution with 11 items of the IES-2, to Brazilian and American samples. The study also offers evidence of internal consistency, and invariance between sex (i.e., male and female) and sexual orientation (i.e., heterosexual participants and sexual minority participants).

SEOM-GEICO Clinical Guidelines on cervical cancer (2023).

Cervical cancer (CC) is the fourth most common cancer and the fourth leading cause of mortality in women worldwide. It is strongly associated with high-risk human papillomavirus infection. High-income countries that have implemented human papillomavirus (HPV) vaccination and screening programs have seen dramatic reductions in CC incidence, while developing countries where these programs are not available continue to experience high rates of CC deaths. In early-stage CC, the primary treatment is surgery or radiotherapy, whereas concurrent chemo-radiotherapy (CRT) remains the conventional approach in locally advanced stages until the upcoming approval of immunotherapy. The incorporation of immunotherapy in combination with chemotherapy (with or without bevacizumab) in first line and as monotherapy in second line after platinum-based chemotherapy, has significantly increased overall survival (OS) in recurrent or metastatic CC. The purpose of this guideline is to summarize the most relevant evidence in the diagnosis, treatment, and follow-up of CC and to provide evidence-based recommendations for clinical practice.

The impact of the COVID-19 pandemic on childhood vaccination rates and the role of sociodemographic factors: A cohort study.

OBJECTIVE: This study examines the impact of the COVID-19 pandemic on both routine and non-routine vaccinations in infants during their initial 18 months of life, concurrently exploring the complex influence of sociodemographic factors. METHODS: A cohort study was conducted, involving 2007 children in two distinct periods: pre-pandemic (January-June 2018) and pandemic (March 2020-May 2021). Participants were classified into two cohorts: 962 children in the 2018 group and 1045 children in the 2020-21 group. Utilizing unconditional logistic regression, the association between vaccination (complete or non-routine) and socioeconomic factors was examined, with adjustments for potential confounding variables such as age, breastfeeding, gestational age, and twins. RESULTS: The study's analysis reveals that in the post-pandemic period, mothers were three times more likely to opt for non-routine vaccines (95% CI 2.25-4.23). However, no significant alterations were observed in routine vaccination rates. Protective factors for complete vaccination included having an employed mother, higher education, and a medium-to-high income. Conversely, a higher income was associated with a reduced likelihood of complete vaccination (OR 0.34, 95% CI 0.20-0.59). CONCLUSION: Contrary to initial expectations, this study concludes that the COVID-19 pandemic did not have a substantial impact on childhood complete vaccination rates. Nevertheless, a noticeable increase in the choice of non-routine vaccination was observed. Sociodemographic factors, such as maternal education, income, and employment status, emerged as key influencers, particularly in the context of deciding on non-routine vaccinations.

Effect of a Triterpenoid-Rich Olive Oil on Chronic Kidney Disease in an Experimental Model of Diabetes Mellitus.

The aim of this study was to assess the effect of triterpenoids on the development of diabetic nephropathy in an experimental model of diabetes mellitus. For this purpose, a destoned and dehydrated olive oil (DDOO) was used, comparing its effects to a destoned olive oil (DOO). DDOO had a higher triterpenoid content than DOO but an equal content of alcoholic polyphenols. Four study groups (n = 10 animals/group) were formed: healthy rats, diabetic control rats (DRs), and DRs treated orally with 0.5 mL/kg/day of DOO or DDOO for two months. DRs showed impaired renal function (proteinuria, increased serum creatinine, decreased renal creatinine clearance) and morphology (glomerular volume and glomerulosclerosis). These alterations correlated with increased systemic and renal tissue oxidative stress and decreased prostacyclin production. DDOO administration significantly reduced all variables of renal damage, as well as systemic and renal oxidative stress, to a greater extent than the effect produced by DOO. In conclusion, triterpenoid-rich olive oil may prevent kidney damage in experimental diabetes mellitus.

Vapor Pressure and Evaporation Studies of Saline Solutions on Natural and Synthetic Fabrics for Industrial Water Treatment.

In the present paper, we have conducted a comprehensive analysis of vapor pressures of both saturated and unsaturated solutions, alongside a study of evaporation using synthetic and natural fabrics for industrial applications in brackish water treatment under zero liquid discharge (ZLD) philosophy. By determining the vapor pressures of saturated solutions, we obtained results consistent with those of other researchers, extending the range of tested temperatures from 1 to 50 °C and successfully fitting the parameters of an Antoine-type equation. Similarly, positive results were achieved for unsaturated solutions, where various parameters of different equations accounting for the salt concentration were estimated, simplifying the fitting procedure. Natural evaporation tests from water surfaces using saturated solutions revealed that salts with higher associated vapor pressures exhibit higher evaporation rates. On the other hand, hydrated salts retain water in their structure and are significantly affected by ambient humidity. Evaporation studies on natural and synthetic fabrics with saturated NaCl and CuSO4·5H2O solutions showed distinct behaviors. NaCl increased both the evaporation rate and salt deposition with each cycle. In contrast, CuSO4·5H2O reduced the absorption capacity by blocking the fabric's structure, decreasing the evaporation efficiency over successive cycles.

Exploring the CIEDE2000 thresholds for lightness, chroma, and hue differences in dentistry.

OBJECTIVE: To evaluate the perceptibility and acceptability CIEDE2000 (KL:KC:KH) thresholds for lightness, chroma and hue differences in dentistry. METHOD: A Python-based program was developed to conduct a psychophysical experiment based on visual assessments of computer-simulated images of human teeth. The experiment was performed on a calibrated display. A 40-observer panel: dentists and laypersons (male and female; n=10), evalu- ated three subsets of simulated human teeth: the lightness subset (%∆L00 ≥ 98 %), the chroma subset (%∆C00 ≥ 98 %) and the hue subset (%∆H00 ≥ 98 %), using ∆E00 ≥ 5 units. A Takagi-Sugeno-Kang Fuzzy Approximation model was used as fitting procedure, and 50:50 % lightness, chroma and hue CIEDE2000 (1:1:1) and CIEDE2000 (2:1:1) perceptibility (PT00) and accept- ability (AT00) thresholds were calculated. Data was statistically analyzed using t-test (p < 0.05). RESULTS: The 50:50 % PT00 for KL=1 were ∆L00=1.04, ∆C00=1.58 and ∆E00=1.01; and for KL=2 were ∆L00=0.51, ∆C00=1.58 and ∆E00=0.71. The 50:50 % AT00 for KL=1 were ∆L00=2.82, ∆C00=3.04 and ∆E00=2.66; and for KL=2 were ∆L00=1.40, ∆C00=3.04 and ∆E00=1.78. PT00 and AT00 ∆H00 may be considered no computable. A significant difference was found between CIEDE2000(1:1:1) and CIEDE2000(2:1:1), between lightness and chroma metrics, and between observer groups. No differences for lightness and chroma PT00 were found between male and female groups. CONCLUSIONS: It is important to use PT00 and AT00 for lightness, chroma and hue specific to evaluate perceptual sensitivity for color changes in the tooth color space. AT00 for lightness and chroma are influenced by the observer's experience and gender. Males and laypersons show more tolerance for changes in chroma (∆C00) and in lightness (∆L00). SIGNIFICANCE: Hue and chroma mismatch are more difficult to be accepted in dental color space.

Rhabdomyolysis in Acute HIV Infection.

Rhabdomyolysis is a rare but potentially life-threatening complication of acute HIV infection. We present a case report of a young adult male who presented with fever, myalgia, and elevated creatine phosphokinase levels, ultimately diagnosed with acute HIV infection-associated rhabdomyolysis. This case highlights the importance of considering HIV infection in the differential diagnosis of rhabdomyolysis, particularly in at-risk populations, even in the absence of typical HIV-related symptoms.

Yoga in Pediatric Gastroenterology.

PURPOSE OF REVIEW: Pediatric use of yoga as an integrative medicine modality has increased in prevalence over the last several decades. In this article, we review the available evidence for yoga in pediatric gastrointestinal disorders. RECENT FINDINGS: Evidence supports that in many pediatric disorders of gut brain interaction (DGBI), including irritable bowel syndrome, functional abdominal pain and functional dyspepsia, yoga decreases pain intensity and frequency and increases school attendance. Yoga has been shown to improve health-related quality of life and improve stress management as an effective adjunct to standard medical therapy in pediatric inflammatory bowel disease (IBD). Further studies are needed regarding optimal frequency, duration of practice and evaluation of the impact on IBD disease activity measures. Yoga may benefit pediatric gastroenterology patients with DGBIs and IBD through improving quality of life and reducing pain. Future yoga studies could investigate biomarkers and continued research will help integrate this modality into routine pediatric gastroenterology care.

Musicianship and prominence of inter-hemispheric connectivity determine two different pathways to atypical language dominance.

During infancy and adolescence, language develops from a predominantly inter-hemispheric control - through the corpus callosum - to a predominantly intra-hemispheric control - mainly subserved by the left arcuate fasciculus. Using multimodal neuroimaging, we demonstrate that human left-handers (both male and female) with an atypical language lateralization show a rightward participation of language areas from auditory cortex to inferior frontal cortex when contrasting speech to tones perception, and an enhanced inter-hemispheric anatomical and functional connectivity. Crucially, musicianship determines two different structural pathways to this outcome. Non-musicians present a relation between atypical lateralization and intra-hemispheric underdevelopment across the anterior arcuate fasciculi, hinting at a dysregulation of the ontogenetic shift from an inter-hemispheric to an intra-hemispheric brain. Musicians reveal an alternative pathway related to inter-hemispheric overdevelopment across the posterior corpus callosum and the auditory cortex. We discuss the heterogeneity in reaching atypical language lateralization and the relevance of early musical training in altering the normal development of language cognitive functions.Significance statement Since the discovery in the 19th century that left-handedness predisposes to an atypical lateralization of language, progress in understanding how this condition appears in healthy individuals has been scarce. Here, we introduce a new relevant factor: musical training. We demonstrate how this early and intensive audiomotor learning can potentially modify the hemispheric specialization of language by prompting a differential development of the callosal fibers. Importantly, this perspective also reveals an alternative route to atypical lateralization - unrelated to musicianship - through an underdevelopment of the arcuate fasciculi. In both scenarios, interhemispheric connectivity through the callosum remains prominent, directly or indirectly. Therefore, the historical lack of definitive answers to this phenomenon might be attributed to the existence of multiple potential pathways.

Temporal assessment of Gross alpha emissions from the petroleum industry in Tenerife, Canary Islands (2001-2022).

A ca. 76% decrease in gross alpha activity levels, measured in surface aerosols collected in the city of Santa Cruz de Tenerife (Spain), has been explained in the present study in connection with the reduction of activities, and eventual closure, of an oil refinery in the city. Gross Alpha in surface aerosols, collected at weekly intervals over a period of 22 years (2001-2022), was used for the analysis. The dynamic behaviour of the gross alpha time series was studied using statistical wavelet, multifractal analysis, empirical decomposition method, multivariate analysis, principal component, and cluster analyses approaches. This was performed to separate the impact of other sources of alpha emitting radionuclides influencing the gross alpha levels at this site. These in-depth analyses revealed a noteworthy shift in the dynamic behaviour of the gross alpha levels following the refinery's closure in 2013. This analysis also attributed fluctuations and trends in the gross alpha levels to factors such as the 2008 global economic crisis and the refinery's gradual reduction of activity leading up to its closure. The mixed-model approach, incorporating multivariate regression and autoregressive integrated moving average methods, explained approximately 84% of the variance of the gross alpha levels. Finally, this work underscored the marked reduction in alpha activity levels following the refinery's closure, alongside the decline of other pollutants (CO, SO2, NO, NO2, Benzene, Toluene and Xylene) linked to the primary industrial activity in the municipality of Santa Cruz de Tenerife.

Influence of educational level on the prevalence of risk behaviors during the perinatal period. / Influencia del nivel de estudios en la prevalencia de conductas de riesgo durante el periodo perinatal.

The objective of this work was to assess changes during pregnancy and after childbirth in diet, consumption of tobacco, electronic cigarettes, cannabis, alcohol use and exposure to environmental tobacco smoke depending on the mother's educational level.A cross-sectional study was carried out whose target population was 18,822 Galician women aged 18-49 who gave birth between September 2015 and August 2016, and their 19,204 live-born children. A descriptive analysis was performed, and the prevalence of different behaviors was estimated at three time points - pre-pregnancy, pregnancy and after childbirth - depending on the mother's educational level. Percentages of change were calculated.Information was obtained from 6,436 women. Regardless of the educational level, during pregnancy there was an improvement in the different lifestyles. In the first months after childbirth, lifestyles worsened, except for exposure to environmental tobacco smoke and the use of electronic cigarettes. Most of the risk behaviors showed a gradient depending on the educational level; thus, the lower the educational level, the higher the prevalence of risk behaviors.In general, during pregnancy all women adopted healthier lifestyles that they abandoned in the months following childbirth. Women with a lower level of education showed a higher prevalence of risk behaviors, both in the period prior to pregnancy, as well as during pregnancy and after childbirth.

El objetivo de este trabajo fue valorar cambios durante el embarazo y tras el parto en la dieta, consumo de tabaco, cigarrillos electrónicos, alcohol, cannabis y exposición al humo ambiental de tabaco en función del nivel de estudios de la madre. Para ello, se llevó a cabo un estudio transversal cuya población objetivo fueron 18.822 mujeres gallegas de 18-49 años que dieron a luz entre septiembre 2015 y agosto 2016, y sus 19.204 hijos/as nacidos vivos. Se realizó un análisis descriptivo y se estimó la prevalencia de diferentes conductas en tres momentos temporales ­pre-embarazo, embarazo y tras el parto­ en función del nivel de estudios de la madre. Se calcularon los porcentajes de cambio. Se obtuvo información de 6.436 mujeres. Con independencia del nivel de estudios, durante el embarazo se produce una mejora en los diferentes estilos de vida. En los primeros meses tras el parto los estilos de vida empeoran, con excepción de la exposición al humo ambiental de tabaco y el consumo de cigarrillos electrónicos. La mayoría de las conductas de riesgo muestran un gradiente dependiente del nivel educativo; así, a menor nivel educativo, mayor es la prevalencia de conductas de riesgo. En general, durante el embarazo todas las mujeres adoptan estilos de vida más saludables que abandonan en los meses siguientes al parto. Las mujeres con menor nivel de estudios muestran una mayor prevalencia de conductas de riesgo, tanto en el periodo previo al embarazo, como en el embarazo y tras el parto.

Neurological outcomes and mortality of hyperoxaemia in patients with acute brain injury: protocol for a systematic review and meta-analysis.

INTRODUCTION: Oxygen is frequently prescribed in neurocritical care units. Avoiding hypoxaemia is a key objective in patients with acute brain injury (ABI). However, several studies suggest that hyperoxaemia may also be related to higher mortality and poor neurological outcomes in these patients. The evidence in this direction is still controversial due to the limited number of prospective studies, the lack of a common definition for hyperoxaemia, the heterogeneity in experimental designs and the different causes of ABI. To explore the correlation between hyperoxaemia and poor neurological outcomes and mortality in hospitalised adult patients with ABI, we will conduct a systematic review and meta-analysis of observational studies and RCTs. METHODS AND ANALYSIS: The systematic review methods have been defined according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and follow the PRISMA-Protocols structure. Studies published until June 2024 will be identified in the electronic databases MEDLINE, Embase, Scopus, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov. Retrieved records will be independently screened by four authors working in pairs, and the selected variables will be extracted from studies reporting data on the effect of 'hyperoxaemia' versus 'no hyperoxaemia on neurological outcomes and mortality in hospitalised patients with ABI. We will use covariate-adjusted ORs as outcome measures when reported since they account for potential cofounders and provide a more accurate estimate of the association between hyperoxaemia and outcomes; when not available, we will use univariate ORs. If the study presents the results as relative risks, it will be considered equivalent to the OR as long as the prevalence of the condition is close to 10%. Pooled estimates of both outcomes will be calculated applying random-effects meta-analysis. Interstudy heterogeneity will be assessed using the I2 statistic; risk of bias will be assessed through Risk Of Bias In Non-Randomised Studies of Interventions, Newcastle-Ottawa or RoB2 tools. Depending on data availability, we plan to conduct subgroup analyses by ABI type (traumatic brain injury, postcardiac arrest, subarachnoid haemorrhage, intracerebral haemorrhage and ischaemic stroke), arterial partial pressure of oxygen values, study quality, study time, neurological scores and other selected clinical variables of interest. ETHICS AND DISSEMINATION: Specific ethics approval consent is not required as this is a review of previously published anonymised data. Results of the study will be shared with the scientific community via publication in a peer-reviewed journal and presentation at relevant conferences and workshops. It will also be shared key stakeholders, such as national or international health authorities, healthcare professionals and the general population, via scientific outreach journals and research institutes' newsletters.

SEOM-GEICO clinical guideline on epithelial ovarian cancer (2023).

In recent years, the incorporation of new strategies to the therapeutic armamentarium has completely changed the outcomes of epithelial ovarian cancer (EOC). The identification of new predictive and prognostic biomarkers has also enabled the selection of those patients more likely to respond to targeted agents. Nevertheless, EOC is still a highly lethal disease and resistance to many of these new agents is common. The objective of this guideline is to summarize the most relevant strategies to manage EOC, to help the clinician throughout the challenging diagnostic and therapeutic processes and to provide evidence-based recommendations.

Effect of polishing and bleaching on color, whiteness, and translucency of CAD/CAM monolithic materials.

OBJECTIVE: To evaluate the effect of polishing and bleaching on the recovery of lightness, color, whiteness, and relative translucency parameter (RTP) in CAD/CAM materials and changes in these properties when another staining in coffee was conducted after the treatments. MATERIALS AND METHODS: Disks of Lava Ultimate (LU), Vita Enamic (VE), IPS Empress CAD (EMP), IPS e.max CAD (EMAX), and Vita Suprinity (VS) were (1) not treated (control), (2) polished with Proxyt or (3) Ceramisté, (4) bleached with Opalescence PF or (5) Whiteness HP Blue, and (6) air polished with Clinpro Prophy Powder. CIE L*a*b* color coordinates were registered at baseline (R0), after staining with coffee for 30 min daily for 36.5 days and treatment (R1), and after another staining (R2). Differences (R1-R0 and R2-R0) in lightness (ΔL00), color (ΔE00), RTP (ΔRTP00), and whiteness (ΔWID) were evaluated by mixed repeated measures ANOVA and 95% confidence intervals (α = 0.05) and interpreted in function of their respective 50:50% PT and AT thresholds. Topography was evaluated by scanning electron microscopy (SEM). RESULTS: In LU, Opalescence PF and Proxyt decreased Δ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {\mathrm{R}}_0\right)} $$ , and ΔWI D R 1 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_1\hbox{--} {R}_0\right)} $$ and showed lower Δ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , and ΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ . In VE, all treatments decreased Δ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , and ΔWI D R 1 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_1\hbox{--} {R}_0\right)} $$ , whereas Δ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , and ΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ were lower in Opalescence PF than in the control group. In both moments, ΔE00 and ΔWID in EMP (also ΔL00) and EMAX were higher in Opalescence PF than in the control group, from which the other treatments did not differ in R1-R0. In EMP, Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ in Whiteness HP Blue (also Δ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ ) and Proxyt were also higher in comparison to the control group and in VS, Ceramisté decreased Δ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , and Δ R T P 00 R 1 - R 0 $$ \varDelta RT{P}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , whereas Opalescence PF increased ΔRTP 00 R 1 - R 0 $$ {\Delta \mathrm{RTP}}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ . Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ of Ceramisté and ΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ and Δ R T P 00 R 2 - R 0 $$ \varDelta RT{P}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ of Proxyt were lower than those of the control group. CONCLUSIONS: The most suitable treatment to recover the lightness, color, whiteness, and RTP without changing these properties after another coffee exposure is material-dependent. CLINICAL SIGNIFICANCE: Although the effectiveness of the treatment was material-dependent, Proxyt was the only treatment that promoted clinically acceptable changes for both LU and VE, while for purely ceramic materials, this condition was observed with Ceramisté and Clinpro Prophy Powder.