Articoli di riviste sul tema "Wl 340.2"

340 Background: This prospective preliminary study is a first report to compare photodynamic diagnosis (PDD) with narrow band imaging (NBI) in the same patients with flat suspicious lesions of carcinoma in situ (CIS) of bladder. Methods: PDD was approved by the ethics committees of our institution for 10 patients with non muscle invasive bladder cancer. Between November 2012 and April 2013, 10 patients with abnormal cytology (class III or more) but undefined papillary mucosa underwent TURBT using PDD and NBI in same time. Each patient received 1.0g ALA hydrochloride (Cosmo Bio Co., Tokyo, Japan) dissolved in 50 mL water, and was given orally 3 hours before the TURBT. The bladder was mapped first under white light (WL), then under NBI, and subsequently under blue light (BL) in odd-numbered patients. The bladder was mapped first under WL, then under BL, and subsequently under NBI in even- numbered patients. Biopsies were carried out from all suspicious areas noting if NBI, PDD or both detected lesions. Random cold cup biopsies were performed from negative lesions of PDD and NBI. Results: The sensitivity and specificity of PDD for detection CIS were 1.00 and 0.714, and those of NBI were 0.75 and 0.814, respectively. There were no cancer and dysplasia in 43 lesions both PDD and NBI negative. Of 50 lesions with negative PDD, only 2 (4%) were dysplasia and there was no cancerous lesion. Of 60 lesions with negative NBI, 3 (5%) were cancer and 6 (10%) were dysplasia. The AUC for detection CIS in PDD, in NBI and in combined use of PDD and NBI were 0.869, 0.782 and 0.964, respectively. Conclusions: When both PDD and NBI were negative, the possibility of CIS might be very low. The usefulness of the combination of PDD with NBI was suggested in this study. [Table: see text]

Background: Sex differences characterize the prevalence and attitudes toward weight management. Despite limited evidence suggesting greater weight loss in women with anti-obesity pharmacotherapy, sex-specific analysis remains underexplored. This retrospective study aimed to evaluate the sex-specific response to liraglutide 3.0 mg treatment in people with obesity without type 2 diabetes (T2D). Methods: Data were collected from 47 patients (31 women, 16 men) with age > 18 years; BMI ≥ 30 kg/m2; absence of T2D; and exclusion of prior anti-obesity treatment, comorbidities, or bariatric surgery. Only patients who maintained the liraglutide 3.0 mg dose for at least 6 months were included. Results: Both sexes showed significant reductions in weight and BMI at 3 and 6 months. Men achieved greater weight loss (WL), BMI reduction, %WL, WL > 5%, and >10% than women, and they also showed more significant improvements in metabolic parameters (total and LDL cholesterol, Fibrosis-4 Index FIB-4). No significant sex differences were observed in glucose metabolism or renal function. Conclusions: This study showed a greater therapeutic effect of liraglutide 3.0 mg in men. Given men’s higher risk of cardiovascular disease (CVD), and underrepresentation in clinical weight loss programs, these findings may increase male engagement and improve their CVD risk.

138 Background: Unintentional weight loss (WL) can be a disruptive symptom of cancer, yet its psychosocial impact is not well understood. We examined cancer survivors’ experiences with unintentional WL. Methods: 320 cancer survivors completed an online survey, provided demographic, health, and unintentional WL history, and rated (0 = not at all; 4 = extremely) 19 statements about WL outcomes. We examined bivariate associations between weight status, unintentional WL, and WL outcomes. Results: Participants were 90% White; mean age = 58.8 years, SD= 11; 41% breast cancer, 23% blood cancer, 8% prostate cancer, mean time since diagnosis = 6.0 years, SD= 5; 18% metastatic, 22% current recurrence/relapse, 51% remission. 55 participants (17%) reported unintentional WL in the past 6 months (mean = 16lbs; range = 2-70; mean BMI = 27.6, SD= 6.3). These participants were less likely to be in disease remission ( p< .05). Participants with unintentional WL tended to underestimate their weight category (e.g., of BMI-classified healthy weight participants, 26% believed they were underweight); κ = -.17, p< .01. 51% of participants felt (somewhat to extremely) positive about WL, 49% said their health care team was supportive of WL; these statements were more strongly endorsed by people describing themselves as overweight ( ps < .05). 27% believed WL caused physical weakness, 23% said WL resulted in lost control over nutrition/eating, 16% said WL made them feel like a burden, 14% said WL caused them to lose their identity; these statements were more strongly endorsed by people describing themselves as underweight ( ps < .01). 20% viewed their WL as a sign of approaching end of life, 13% believed WL meant they would not be able to continue treatment; these views did not differ by perceived weight status. Conclusions: Many cancer survivors experience unintentional weight loss and associate their weight loss with negative outcomes. Survivors also often underestimate their weight status, which is notable given that personal views of one’s weight status, not BMI-derived weight status, is associated with beliefs about the impact of unintentional weight loss. Our findings suggest that people believe unintentional WL meaningfully affects their quality of life.

The effect of film thickness on the structural- and electrical-properties is investigated in Co2FeAl0.5Si0.5 (CFAS) thin films of thickness, t, in the range 12–75 nm. These films are grown by ultrahigh vacuum dc magnetron sputtering on Si(100) substrates with SiO2 buffer layer (300 nm), at the substrate temperature of 500 ◦C. The GIXRD patterns reveal that B2 structural order decreases with increasing t. The film with t = 75 nm has sizable A2 disorder. Irrespective of t, ρ(T, H = 0) goes through a minimum at T min. An elaborate quantitative analysis of the ρ(T, H = 0) data, taken over the temperature range 5 K to 300 K, demonstrates that the electron-diffuson ( e– d) and weak localization (WL) effects (responsible for the negative temperature coefficient of resistivity (TCR) for T < T min) compete with the electron-magnon ( e– m) and electron–phonon ( e– p) scattering ( positive TCR) contributions to produce a minimum at T min. Residual resistivity, ρ5K, and the e– d, wl, e– m and e– p scattering contributions to ρ(T, H = 0), ρ e– d, ρ wl, ρ e– m and ρ e– p, all go through a minimum at t = 50 nm. Regardless of t, the thermal renormalization of the spin-wave stiffness makes a significant contribution to ρ e– m.

Abstract We study properties of intensity disturbances along polar coronal rays that are associated with plumes below. For this, we draw azimuth–time images of extreme ultraviolet (EUV) emission of 171 Å band observed by the SDO/AIA and white light (WL) observed by the SOHO/LASCO C2 in 2020 July. From the azimuth–time image, we define two tracks in which the EUV intensities were recurrently enhanced during two weeks. The two EUV tracks are rooted at 78.°8 and 81.°4 latitudes, but their projected azimuth angles are changed with time as the Sun rotates. Coherent WL tracks at different altitudes are determined by scaling the azimuth angles of the EUV tracks, accounting for the effect of inclination of coronal rays. From this, we construct time–distance images of WL intensities along WL tracks, whose projected azimuth angle changes along time and altitude, but the intensities are correlated with the EUV intensities measured below. The time–distance images of WL show repeated and inclined intensity features. The propagation speeds in the altitude range 2.3–6 solar radii are calculated to be 159 ± 8 km s−1 and 300 ± 24 km s−1. The EUV and WL intensities are found to be coherent at 1–2 day periods. It is also found that dynamic burst events along the EUV track are responsible for the enhanced emission. We conclude that the variation of the WL intensity along the polar coronal rays is related with the evolution of the EUV intensity below.

e21706 Background: Up to 20% of breast cancer survivors develop breast cancer related lymphedema (BCRL), and current therapies are limited. In a previous single armed study, acupuncture appeared to reduce BCRL. In this study, we compared our specific protocol of acupuncture (AC) to usual care wait list control (WL). Methods: Women with moderate persistent BCRL were randomized to AC or WL. The AC protocol included twice-weekly manual acupuncture over 6 weeks. The primary endpoint was change in circumference difference between affected/unaffected arms. Responders were defined as having > 30% improvement in arm circumference difference between arms. We also evaluated the change in difference between affected/unaffected arm bioimpedance. We used analysis of covariance for circumference and bioimpedance measurements and Fisher’s exact test for proportion of responders. Results: Among 82 patients, 73 (89%) were evaluable for the primary endpoint (36 in AC and 37 in WL). The median age in AC was 65 (IQR 54, 71) and 58 (IQR 49, 70) in WL. Most patients in both arms had undergone mastectomy (74%) and axillary lymph node dissection (96%), and had a history of prior lymphedema treatment (96%). Median duration of lymphedema was 2.2 years in AC (IQR 1.3, 3.0) and 2.5 years in WL (IQR 1.4, 3.4). We found no evidence of a difference in either arm circumference difference improvement (β -0.38cm, 95% CI -0.89, 0.12, p = 0.14) or bioimpedance difference improvement (β -1.06, 95% CI -7.85, 5.72, p = 0.8) between AC and WL at Week 6. There was also no difference in proportion of responders: 17% AC vs. 11% WL (6% difference, 95% CI -10%, 22%, p = 0.5). No severe adverse events (AE) were reported. Grade 1 treatment-related AEs such as bruising (58%), hematoma (2%), and pain (2%) were reported in patients receiving AC. Among the 837 acupuncture treatments provided, one possibly related grade 2 skin infection was reported. Conclusions: Although it appears to be safe and well tolerated, our acupuncture protocol did not offer additional clinically meaningful reductions in BCRL compared with usual care among patients who had received lymphedema treatment. This regimen should not be recommended for breast cancer survivors with persistent BCRL. Clinical trial information: NCT01706081.

The syndrome of inappropriate antidiuretic hormone (SIADH) is associated with water retention and hyponatremia. The kidney adapts via a transient natriuresis and persistent diuresis, i.e., vasopressin escape. Previously, we showed an increase in the whole kidney abundance of aldosterone-sensitive proteins, the α- and γ (70-kDa-band)-subunits of the epithelial Na+ channel (ENaC), and the thiazide-sensitive Na-Cl cotransporter (NCC) in our rat model of SIADH. Here we examine mean arterial pressure via radiotelemetry, aldosterone activity, and cortical vs. medullary ENaC subunit and 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD-2) protein abundances in escape. Eighteen male Sprague-Dawley rats (300 g) were sham operated ( n = 6) or infused with desmopressin (dDAVP; n = 12, a V2 receptor-selective analog of AVP). After 4 days, one-half of the rats receiving dDAVP were switched to a liquid diet, i.e., water loaded (WL) for 5–7 additional days. The WL rats had a sustained increase in urine volume and blood pressure (122 vs. 104 mmHg, P < 0.03, at 7 days). Urine and plasma aldosterone levels were increased in the WL group to 844 and 1,658% of the dDAVP group, respectively. NCC and α- and γ-ENaC (70-kDa band) were increased significantly in the WL group (relative to dDAVP), only in the cortex. β- and γ-ENaC (85-kDa band) were increased significantly by dDAVP in cortex and medulla relative to control. 11β-HSD-2 was increased by dDAVP in the cortex and not significantly affected by water loading. These changes may serve to attenuate Na+ losses and ameliorate hyponatremia in vasopressin escape.

ABSTRACT Objective The aim of this study was to compare the cleaning of main and lateral canals using the irrigation methods: negative pressure irrigation (EndoVac system), passive ultrasonic irrigation (PUI) and manual irrigation (MI). Materials and methods Resin teeth were used. After root canal preparation, four lateral canals were made at 2 and 7 mm from the apex. Root canals were filled with contrast solution and radiographed pre- and post-irrigation using digital radiographic system [radiovisiography (RVG)]. The irrigation protocols were: MI1—manual irrigation [22 G needle at 5 mm short of working length-WL]; MI2—manual irrigation (30G needle at 2 mm short of WL); PUI; EV1—EndoVac (microcannula at 1 mm short of WL); EV2—Endovac (microcannula at 3 mm short of WL). The obtained images, initial (filled with contrast solution) and final (after irrigation) were analyzed by using image tool 3.0 software. Statistical analysis was performed by analysis of variance (ANOVA) and Tukey tests (5% significance level). Results EV1 and EV2, followed by PUI showed better cleaning capacity than manual irrigation (MI1 and MI2) (p < 0.05). Conclusion Negative pressure irrigation and PUI promoted better cleaning of main and simulated lateral canals. Clinical significance Conventional manual irrigation technique may promote less root canal cleaning in the apical third. For this reason, the search for other irrigation protocols is important, and EndoVac and PUI are alternatives to contribute to irrigation effectiveness. How to cite this article Tanomaru-Filho M, Miano LM, Chávez-Andrade GM, Torres FFE, de Toledo RL, Guerreir-Tanomaru JM. Cleaning of Root Canal System by Different Irrigation Methods. J Contemp Dent Pract 2015;16(11):859-863.

‘10 Years On: The Significant Impact of Controlled DCD Lung Donors on Lung Transplant Opportunities and Outcomes’ Purpose Since 2006, the Alfred Hospital has increasingly utilised controlled DCD donor lungs to optimise LTx opportunities and reduced waiting list (WL) deaths. This study evaluated the impact of DCD donation on LTx WL time and mortality, and compared post-LTx outcomes of DCD and contemporaneous DBD LTx performed over the first 10 years. Method This was a retrospective analysis of all LTx done at our institution between May 2006 and February 2017 (n=696, 150 DCD LTx, 546 DBD LTx) was undertaken. WL time/mortality, donor and recipient demographics, early outcome measures, survival and cause of death were compared. Our institution regularly utilises extended DCD and DBD donor lungs; however, it does not yet routinely utilise ex-vivo lung perfusion (EVLP) to evaluate these extended donor lungs, unlike many programs in the USA and Europe. Results The use of DCD donors has resulted in 25% more LTx annually, reduced overall WL times (245 to 135 days, p<0.001) and WL mortality (29% to 5%, p<0.01) from 2006 to 2017 respectively. Compared to DBD, DCD donors were intubated in ICU Longer (115 vs 79hrs, p<0.01), were older (45 vs 41 yrs, p<0.01) and were less commonly distant (>300 km) donors (20% vs 35%, p<0.01). DCD recipients compared to DBD had a reduced WL time (101 vs 120 days, p=0.03) and longer graft ischaemic time (323 vs 287 mins, p<0.01). There was no difference in intensive care unit (ICU) or hospital length of stay between DCD and DBD; and importantly, no significant difference in 1, 5 or 10 year survival rates comparing DCD vs DBD (96%, 69% and 53% vs 92%, 64% and 51% respectively, p=ns). Conclusions Controlled DCD donation has significantly and safely increased overall LTx numbers, without reducing DBD LTx (Figure 1), and has also reduced WL time and mortality with excellent 1, 5 and 10 year LTx survival for both DCD and DBD LTx compared to ISHLT at our institution (Figure 2). Importantly, our results also show that EVLP is not required for a successful utilisation of DCD donor lungs for LTx.

e21655 Background: Unintentional weight loss is common in cancer and associated with increased morbidity and mortality. Most research to date has examined weight loss in advanced disease. The clinical significance of any weight change (WC) (loss/gain) before/at cancer diagnosis remains unclear. This study aimed to determine the prevalence and clinical significance of WC at diagnosis in out-patients with solid tumours presenting to a tertiary academic medical centre. Methods: A retrospective study of the electronic medical record (EMR) was conducted (n=6477). Those with a pre-diagnosis weight, T0, (recorded within 6 months of cancer diagnosis) and 2 subsequent weights (diagnosis, T1; final visit, T2) were identified (n=4258). Logistic regression and survival analysis identified WC predictors and overall survival respectively. The significance threshold was p < 0.05. Results: Mean age was 61 ±12.5 years. 54% (n=2315) were male. Common tumour sites were breast (17%; n=725), prostate (16%; n=664), lung (14%; n=599) and upper GI (11%; n=470). Known metastatic disease present at T1=15% (n=652). 68% (n=2908) were overweight or obese (WHO BMI Classification) at T1. 98% (n=4159) had WC from T0-T1(loss: 58%; n=2454; gain: 40%; n=1705). Primary tumour sites significantly associated with weight loss (WL) included colon, head & neck, kidney, lung and upper GI. 8% (n=320) were cachectic (>5% WL in previous 6 months) and 50% (n=2134) were pre-cachectic (≤ 5% WL) at T1; 3% had “Abnormal Weight Loss” (ICD 9 Code). Survival was worst with WL >5% and weight gain (WG) ≥ 10% from T0-T1 (p<0.05). However, those with 2.5-5% WL from T0-T1 were also at risk (p<0.05); 0.1-2.4% WG was protective. Primary tumour site (lung, upper GI) and normal/underweight BMI at T1 predicted poor prognosis. Conclusions: Weight changes were highly prevalent, but WL typically was undiagnosed. Most were overweight or obese at diagnosis. Nevertheless 58% (n=2454) of those reviewed at T1 met current criteria for cachexia or pre-cachexia. Those with WL > 5% or WG ≥ 10% had worst survival. The majority had evidence of significant, yet frequently undiagnosed, WC abnormalities at diagnosis.

UNINCORPORATED ASSOCIATIONS: PROPERTY HOLDING, CHARITABLE PURPOSES AND DISSOLUTIONThe decision of Mr Justice Lewison in Hanchett-Stamford v HM Attorney General and Dr William Johnston Jordan1 provides us with a useful analysis of the legal principles relating to the thorny issues of: (i) how unincorporated associations hold property; (ii) the applicability of the law of charities to unincorporated associations and (iii) the property rights of a declining membership upon the dissolution of such associations.

In this paper, the preparation method and reasonable mix ratio of non-calcination brick with rock powder, cement, lime and fly ash ceramsite (FAC) as the raw materials were experimentally evaluated. To better understand the effects of each component on the performance of non-calcination rock powder brick (NCRPB), an orthogonal experimental design was conducted with the water–cement ratio (W/C), rock powder–cement ratio (R/C), lime content (wl) and FAC content (wf) as the main factors, which involved four factors and three factor levels. According to the orthogonal experimental design, the compressive strength, water resistance and bulk density of nine groups of NCRPB specimens were tested. The results show that R/C was the most important factor affecting the compressive strength and water resistance, while the FAC content influenced the bulk density of NCRPB greatly. In this study, the reasonable mix of W/C, R/C, wl, and wf in weight was 0.6, 3.0, 30% and 21%, respectively. In addition, the microstructure and strength formation mechanism of NCRPB were analyzed by using SEM and XRD. The test results show that the rock powder having pozzolanic activity could react with the additional Ca(OH)2 to produce hydration products, leading to the improvement of the performance of NCRPB.

Study Design: Retrospective cohort study.Purpose: To determine the effects of massive weight loss on perioperative complications after lumbar fusion surgery (LFS).Overview of Literature: Patients who are obese are more likely to experience low back pain, which would require LFS. Nonetheless, they have a higher risk of perioperative complication development compared with individuals who are not obese.Methods: Patients who underwent LFS at hospitals that participated in the National Surgical Quality Improvement Program database within the United States between 2005 and 2015. Outcomes included 30-day medical complications, surgical complications, and length of stay (LOS). We analyzed a total of 39,742 patients with the use of the International Classification of Disease, ninth revision codes. The patients were categorized in the following two groups: group 1, individuals with a history of massive weight loss within 6 months before LFS, and group 2, individuals without a history of massive weight loss before surgery. Massive weight loss was defined as loss of 10% of total body weight. Patients with a history of malignancy or chronic disease were excluded from the study. Patients in each group were randomly matched based on age, gender, sex, smoking status, and body mass index. Paired two-tailed Student t -tests were used to compare the outcomes.Results: Of the 39,742 patients identified, 129 (0.32%) met the criteria for inclusion in the weight loss group (WL group) and were successfully matched to individuals in the non-weight loss group (non-WL group). Compared with the non-WL group, the WL group had a significantly longer LOS (9.7 vs. 4.0 days, <i>p</i> <0.05), higher surgical site infections (SSIs) (8.0 vs. 3.0, <i>p</i> <0.05), increased number of blood transfusions (40.0 vs. 20.0, <i>p</i> <0.05), and greater deep vein thrombosis (DVTs) (5.0 and 0.00, <i>p</i> <0.05).Conclusions: On a nationwide scale, rapid weight loss before LFS is associated with a higher rate of postoperative complications, including SSI and DVTs, longer average LOS, and more frequent blood transfusions.

The electrical and magnetotransport properties of nanocrystalline tin dioxide films were studied in the temperature range of 4–300 K and in magnetic fields up to 8 T. SnO2−δ films were fabricated by reactive direct current (DC) magnetron sputtering of a tin target with following 2 stage temperature annealing of synthesized samples. The nanocrystalline rutile structure of films was confirmed by X-ray diffraction analysis. The temperature dependences of the resistance R(T) and the negative magnetoresistance (MR) were explained within the frame of a model, taking into account quantum corrections to the classical Drude conductivity. Extracted from the R(T) and R(B) dependences electron dephasing length values indicate the 3D character of the weak localization (WL) in our samples.

Abstract. The SPIRIT telescope aboard the CORONAS-F satellite (in orbit from 26 July 2001 to 5 December 2005), observed the off-limb solar corona in the 175 Å (Fe IX, X and XI lines) and 304 Å (He II and Si XI lines) bands. In the coronagraphic mode the mirror was tilted to image the corona at the distance of 1.1...5 Rsun from the solar center, the outer occulter blocked the disk radiation and the detector sensitivity was enhanced. This intermediate region between the fields of view of ordinary extreme-ultraviolet (EUV) telescopes and most of the white-light (WL) coronagraphs is responsible for forming the streamer belt, acceleration of ejected matter and emergence of slow and fast solar wind. We present here the results of continuous coronagraphic EUV observations of the solar corona carried out during two weeks in June and December 2002. The images showed a "diffuse" (unresolved) component of the corona seen in both bands, and non-radial, ray-like structures seen only in the 175 Å band, which can be associated with a streamer base. The correlations between latitudinal distributions of the EUV brightness in the corona and at the limb were found to be high in 304 Å at all distances and in 175 Å only below 1.5 Rsun. The temporal correlation of the coronal brightness along the west radial line, with the brightness at the underlying limb region was significant in both bands, independent of the distance. On 2 February 2003 SPIRIT observed an expansion of a transient associated with a prominence eruption seen only in the 304 Å band. The SPIRIT data have been compared with the corresponding data of the SOHO LASCO, EIT and UVCS instruments.

BackgroundDentistry has undergone an evolution in endodontics practice caused by the advancement of rotary techniques for root canal preparation and their subsequent incorporation into the teaching of dentistry undergraduates. This research aimed to evaluate the shaping ability of third-year dental students as their first experience in rotary instrumentation using ProTaper Universal (PTU) and ProTaper Next (PTN) (Dentsply Maillefer) rotary instruments in simulated curved canals.MethodsForty students instrumented 200 simulated canals with a 40° curvature in resin blocks according to the manufacturer’s instructions with PTU and 39 students and 195 canals with PTN files. The canals were prepared at a speed of 300 rpm using a 16:1 reduction hand-piece powered by an electric motor (Xsmart; Dentsply Maillefer). The final apical preparation was set to F2 for the PTU and X2 for the PTN group. The change in canal curvature was evaluated based on Schneider technique using the AutoCAD 2007 software on post-digital photographs. The incidence of instrument fracture and deformation, the incidence of ledge, the change in working length (WL), and the working time were noted. The data were analyzed with Student’st-test and Chi-Square test at a significance level of 0.05 using SPSS.ResultsPTN maintained the original canal curvature better, resulting in fewer fractures and ledges, and shaped the canals faster than the PTU (P < 0.05). The mean curves of the resin canals after the instrumentation for the PTU and PTN groups were 24.03° ± 3.14° and 25.64° ± 2.72°, respectively. Thirty-three (17.4%) PTU and 18 (9.3%) PTN files fractured (p < 0.05). Nine (4.5%) PTU and 2 (2.6%) PTN deformed (p > 0.05). The change in WL after instrumentation was 0.97 mm ± 0.95 mm in PTU and 0.96 mm ± 0.80 mm in PTN (p < 0.05). The mean times were 627 s ± 18 s for PTU and 379 s ± 18 s for PTN (p < 0.000).DiscussionPTN can be recommended in severely curved root canals in terms of maintenance of the original canal curvature, superior instrument fracture and fewer ledges. Even if training before preparation provides an acceptable level of canal shaping for preclinical students, the use of NiTi rotary instruments should be included in the undergraduate dental curriculum, contributing to an increase in the quality of root canal shaping and, consequently, to an improvement of the clinical experience of students.

Background: The protocol for MSCT Thorax examination is axial/coronal/sagittal. The slice thickness parameter has an important role in examining MSCT Thorax in breast cancer cases using contrast media. The thinner the slice thickness, the better the detailed image obtained. The aim of this study is to explain the MSCT Thorax examination procedure in breast cancer cases using positive contrast media, the role of slice thickness in diagnosis and to find out diagnostic information on the MSCT Thorax examination in cancer cases breast. Methods: This type of research is qualitative with a literature study approach. The data were obtained by identifying the problem then looking for keywords, namely MSCT Thorax, Slice thickness, breast cancer. Literature reviews are carried out through journal search engine searches, such as: Google Scholar, American Journal Rontgenology (AJR), Pubmed, Proquest. The collected journals are reduced based on inclusion criteria so that 3 relevant journals are obtained then analyzed descriptively so that they can answer the objectives to be drawn conclusions. Results: The results of a literature study show that the MSCT Thorax examination procedure in cases of breast cancer using contrast media is fasting 6 hours before the examination, laboratory checks (urea cratinin within normal limits), releasing all metals in the body, CT scan plane, fixation tools, blankets. , contrast media, injector set. Conclusion: Contrast media dosage 1-2 ml / kg body weight, flow rate 2-4 ml / s, concentration 300-350 mgl / ml, patient position supine feet first, upper limit of lung Apex and lower limit of diaphragm (depending on needs), axial cut, coronal, sagittal, the parameters used were kV, mAs, slice thickness, matrix, WW, WL. A thin slice thickness will provide more accurate diagnostic information and a clear picture of metastases and small lesions can be seen.

Introduction; p to 300 million people have the body mass index (BMI) greater than 30 kg/m2. Obesity is the cause of many serious diseases, such as type 2 diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD). Bariatric surgery is the only effective method of achieving weight loss in patients with morbid obesity. Objectives: The aim of the study was to assess the impact of bariatric surgery on non-alcoholic fatty liver disease in patients operated on due to morbid obesity. Material and Methods: We included 20 patients who were qualified for bariatric procedures based on BMI > 40 kg/ m2 or BMI > 35kg/m2 with the presence of comorbidities. The average body weight in the group was 143.85kg, with an average BMI of 49.16kg/m2. Before the procedure, we evaluated the severity of non-alcoholic fatty liver disease in each patient using the Sheriff-Saadeh ultrasound scale. We also evaluated the levels of liver enzymes. Follow-up evaluation was performed twelve months after surgery. Results: Twelve months after surgery, the average weight was 102.34 kg. The mean %WL was 33.01%, %EWL was 58.8%, and %EBMIL was 61.37%. All patients showed remission of fatty liver disease. Liver damage, evaluated with ultrasound imaging, decreased from an average of 1.85 on the Sheriff-Saadeh scale, before surgery, to 0.15 twelve months after surgery (p < 0.001). As regards liver enzymes, the level of alanine aminotransferase decreased from 64.5 (U/l) to 27.95 (U/l) (p < 0.001), and the level of aspartate aminotransferase decreased from 54.4 (U/l) to 27.2 (U/l). Conclusions: Bariatric procedures not only lead to a significant and lasting weight loss, but they also contribute to the reduction of fatty liver disease and improve liver function.

In this paper we present the interpretation of the observations of the flare from 6 September 2017 reported in Paper I. These include gamma-ray (GR), hard X-ray (HXR), soft X-rays, Lyα line, extreme ultraviolet (EUV), Hα, and white light (WL) emission, which were recorded during the two flaring events 1 (FE1) and 2 (FE2) that occurred at 11:55:37 UT (FE1) and 12:06:40 UT (FE2). Paper I also reported the first detection of the sunquake with first and second bounces of seismic waves combined with four other sunquakes in different locations supported with the observations of HXR, GR, EUV, Hα, and WL emission with strongly varying spatial resolution and temporal coverage. In the current paper, we propose some likely scenarios for heating of flaring atmospheres in the footpoints with sunquakes which were supported with EUV and Hα emission. We used a range of parameters derived from the HXR, EUV, and Hα line observations to generate hydrodynamic models, which can account for the blueshifts derived from the EUV emission and the redshifts observed with the EUV Imaging Spectrometer in the He II line and by the CRisp Imaging Spectro-Polarimeter in the Swedish Solar Telescope in Hα line emission. The parameters of hydrodynamic shocks produced by different beams in flaring atmospheres were used as the initial conditions for another type of hydrodynamic models that were developed for acoustic wave propagation in the solar interior. These models simulate the sets of acoustic waves produced in the interior by the hydrodynamic shocks from atmospheres above deposited in different footpoints of magnetic loops. The Hα line profiles with large redshifts in three kernels (two in FE1 and one in FE2) were interpreted with the full non-local thermodynamic equilibrium radiative simulations in all optically thick transitions (Lyman lines and continuum Hα, Hβ, and Pα) applied for flaring atmospheres with fast downward motions while considering thermal and non-thermal excitation and ionisation of hydrogen atoms by energetic power-law electron beams. The observed Hα line profiles in three kernels were fit with the simulate blue wing emission of the Hα line profiles shifted significantly (by 4–6 Å) towards the line red wings, because of strong downward motions with velocities about 300 km s−1 by the shocks generated in flaring atmospheres by powerful beams. The flaring atmosphere associated with the largest sunquake (seismic source 2 in FE1) is found consistent with being induced by a strong hydrodynamic shock produced by a mixed beam deposited at an angle of −30° from the local vertical. We explain the occurrence of a second bounce in the largest sunquake by a stronger momentum delivered by the shock generated in the flaring atmosphere by a mixed beam and deeper depths of the interior where this shock was deposited. Indeed, the shock with mixed beam parameters is found deposited deeply into the interior beneath the flaring atmosphere under the angle to the local vertical that would allow the acoustic waves generated in the direction closer to the surface to conserve enough energy for the second bounces from the interior layers and from the photosphere. The wave characteristics of seismic sources 1 and 3 (in FE1) were consistent with those produced by the shocks generated by similar mixed beams deposited at the angles −(0 − 10)° (seismic source 1) and +30° (seismic source 3) to the local vertical. The differences of seismic signatures produced in the flares of 6 September 2011 and 2017 are also discussed.

Background:Chronic inflammatory rheumatic diseases are associated with a high cardiovascular risk. However, data in ankylosing spondylitis (AS) are still limited.Objectives:The aim of our study was to assess the atherosclerotic risk in patients with AS, by comparing the Systematic coronary risk evaluation: SCORE, with biomarkers of atherosclerosis: High sensitivity C-reactive protein (Hs-CRP), LDL/HDL ratio and apoliprotein A1 (Apo A) /apolipoprotein B (Apo B) ratio.Methods:We conducted a cross-sectional observational study of 40 patients with AS, over a period of 3 months. Socio-demographic data, clinical characteristics of the disease, as well as biological, radiological and therapeutic data were collected for each patient. Coagulated blood samples were collected following a 12-hour fast. Cardiovascular risk was considered high for Hs-CRP>3.0 mg/L [1], LDL/HDL> 3.5 in men and 3.0 in women [2], and ApoB/ApoA level>0.9 [3,4]. SCORE was calculated for all patients.Results:The mean age of our population was 44±10 years. Male predominance was noted with a sex ratio =11.1. The mean ASDAS-CRP and BASDAI levels were 2.1±0.95 and 2.25±1.33. Thirty-two percent of the patients had a high risk of cardiovascular diseases according to Hs-CRP level, with an average of 10.7 mg/L. The mean LDL/HDL ratio was high in twenty-two percent of the patients. The mean value of ApoA1 and ApoB was respectively 1.3 g/l. and 0.9 g/l. Low values of Apo A1 were determined in 12.5% of the subjects, and high values of ApoB were found in 15% of subjects. The mean value of ApoA/ApoB ratio was 0.7. Ten percent of the studied subjects had an unfavourable ApoB/ApoA1. The predicted 10-year risk of CV mortality according to SCORE was high in 5% of the patients, very high in 2.5% and moderate in 35% of them. Over 17 patients with moderate, high and very high risk according to SCORE: Four patients (23.5%) had high LDL/HDL ratio, 8 (47%) had high waist/hip ratio, 5 (29.4%) had high Hs-CRP level, and 2 (11.7%) had high ApoB/ApoA ratio.We found ApoB/ApoA to be positively correlated with Hs-CRP (r=0.31, p=0.05). The SCORE was correlated to the age at the onset of the disease (r=0.78, p<10-3).Conclusion:The atherosclerotic risk in our population ranged from 10 to 43%. SCORE presented with the highest percentage, making it more suitable for mass screening. Biomarkers on the other hand are more precise. Hs-CRP is biomarker to be included in daily practice, even when AS is in remission. Accuracy of the apoB/apoA ratio is significantly great and appears to be associated with inflammation.References:[1]Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, Biasucci LM, et al. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Report From the Laboratory Science Discussion Group. Circulation [Internet]. 2004 Dec 21 [cited 2020 Oct 20];110(25).[2]Munoz. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. VHRM. 2009 Sep;757.[3]Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. The Lancet. 2001 Dec;358(9298):2026–33.Disclosure of Interests:None declared.

Abstract The diagnosis of heparin-Induced thrombocytopenia (HIT) is based on the presence of a compatible clinical picture combined with laboratory evidence of heparin-dependent, platelet-activating IgG antibodies. The 4T's Score is a clinical prediction rule that determines the likelihood that a patient has HIT before laboratory testing is performed. A rapid assay (H/PF4-PaGIA, Diamed, Switzerland) uses gel centrifugation to measure binding of antibodies to antigen-coated polystyrene beads (15 min turnover time). The purpose of this study is to evaluate the clinical utility of a diagnostic strategy which combines the 4T's Score with a H/PF4-PaGIA result to guide management of patients with suspected HIT while awaiting results of the serotonin-release assay (SRA). Methods Prospective cohort study of 538 consecutive adult patients with suspected HIT at 4 Canadian hospitals. Physicians completed a standardized 4T's Score sheet and the H/PF4-PaGIA was performed using fresh plasma in a central lab by technologists blinded to the 4T's Score (frozen plasma was used for 85 patients due to disruptions in worldwide availability of the assay.) The SRA and an in-house IgG anti-PF4/H enzyme-immunoassay (EIA) were performed on all patients by blinded technologists. Serologically-confirmed HIT (“HIT positive”) was defined as >50% serotonin release (mean) at three reaction conditions (0.1 U/mL heparin; 0.3 U/mL heparin; enoxaparin, 0.1 U/ml), as well as inhibition (<20% release or >50% inhibition) at 100 U/mL heparin and in the presence of Fc receptor-blocking monoclonal antibody, and a positive EIA. Thrombotic events, major bleeding events, and mortality were captured at day 30. Recommendations for management of patients while awaiting the SRA: patients with a Low 4T's Score (irrespective of H/PF4-PaGIA result) and patients with an Intermediate 4T's Score and negative H/PF4-PaGIA were to receive low-dose danaparoid or fondaparinux. Therapeutic-dose non-heparin anticoagulation was recommended for all patients with an Intermediate 4T's Score and positive H/PF4-PaGIA and for all patients with a High 4T's Score irrespective of H/PF4-PaGIA result. The primary outcome measure was the frequency of management failures defined as a patient with serologically-confirmed HIT who had one of the following combinations of diagnostic testing (a) Low 4T's Score and negative H/PF4-PaGIA; (b) Low 4T's Score and positive H/PF4-PaGIA or (c) Intermediate 4T's Score and negative H/PF4-PaGIA. Results 527 patients with mean age 66.5 yr (sd 15.4) were analyzed; 11 patients with missing diagnostic testing results were excluded. Clinical outcomes of the management of patients according to the diagnostic strategy will be reported separately. Results of diagnostic accuracy of the 4T's Score and H/PF4-PaGIA compared to the SRA are provided below. The prevalence of serologically-confirmed HIT in the study population was 6.5%. Two patients with indeterminate SRAs but IgG>1.0 were reported as HIT Positive. A negative H/PF4-PaGIA result reduced the probability of HIT based on the 4T's Score from 2.5% to 0.7% (95% CI: 0.1-2.6%) in the Low group, from 6.1% to 0% (95% CI: 0-2.7%) in the Intermediate group and from 35.7% to 0% (95% CI: 0-14.3%) in the High group. A positive H/PF4-PaGIA result increased the probability of HIT based on the 4T's Score to 15.4% (Low 4T's), 38.5% (intermediate 4T's) and 83.3% (High 4T's). The proportion of management failures was 1.5% (95% CI : 0.7%-3.0%). Of the 8 patients who were identified as management failures, 2 (Low 4T's) had a negative H/PF4-PaGIA. Out of 33 HIT Positive patients, 8 (24.2%) would have been missed based on a Low 4T's Score alone and 2 (6.1%) based on negative H/PF4-PaGIA alone. The combination of a Low or Intermediate 4T's Score and a negative H/PF4-PaGIA result had a negative predictive value for HIT of 99.5% (95% CI: 98.3-99.9). Conclusions The proportion of management failures was low (1.5%) and within acceptable limits (95% CI : 0.7%-3.0%). Combining the 4T's Score with the result of H/PF4-PaGIA excludes the diagnosis of HIT in the majority of patients with a Low or Intermediate probability for HIT and raises the likelihood of HIT in patients with a High probability. Disclosures: Linkins: BioRad DiaMed: PaGIA assays purchased at cost for study Other. Bates:BioRad Diamed: provided assays for study at cost Other. Lee:BioRad Diamed: provided assays for study at cost Other. Warkentin:GSK: Research Funding; WL Gore: Consultancy; Immucor GTI Diagnostics: Research Funding; Paringenix: Consultancy; Pfizer Canada: Honoraria; BioRad Diamed: provided assays for study at cost, provided assays for study at cost Other.

Introdução: A candidemia é uma das infecções nasocomiais mais frequentes a nível mundial e apresenta diferentes espécies de Candida envolvidas com o desenvolvimento dessa patologia. Objetivo: Este estudo analisou os aspectos epidemiológicos e as diferentes espécies de Candida associadas à candidemia. Material e Métodos: Uma revisão de literatura foi realizada, através da leitura de artigos científicos publicados nas bases de dados Pubmed e Scielo nos últimos cinco anos. Utilizou-se as seguintes combinações de descritores: Candidemia, Candidemia e Prevalência, Candidemia e Incidência, Candidemia e Candida. Resultados: A candidemia é a infecção fúngica mais hostil atualmente encontrada e prevalente nas populações estudadas. A população mais afetada são os recém-nascidos. Apresenta altas taxas de mortalidade e disseminação em várias partes do mundo. A nutrição parenteral, a administração de antibióticos de amplo espectro, hospitalização prolongada, cirurgia prévia e colonização por Candida sp são os principais fatores de risco relatados na literatura. Múltiplas espécies fúngicas estão associadas a essa condição, porém C. albicans é a mais predominante, seguida por C. parapsilosis e C. tropicalis. Conclusões: A Candidemia é uma patologia prevalente e apresenta alta incidência e morbimortalidade nas populações estudadas das diferentes partes do mundo. C. albicans é a espécie mais associada, seguida por C. parapsilosis e C. tropicalis. Descritores: Candidemia; Prevalência; Incidência; Candida. Referências Treviño-Rangel RJ, Peña-López CD, Hernández-Rodríguez PA, Beltrán-Santiago D, González GM. Association between Candida biofilm-forming bloodstream isolates and the clinical evolution in patients with candidemia: An observational nine-year single center study in Mexico. Rev Iberoam Micol. 2018;35(1):11-16. Kaur H, Chakrabarti A. Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries. J Fungi (Basel). 2017;3(3):41. Wu PF, Liu WL, Hsieh MH, Hii IM, Lee YL, Lin YT et al. Epidemiology and antifungal susceptibility of candidemia isolates of non-albicans Candida species from cancer patients. Emerg Microbes Infect. 2017;6(10):e87. Vasilyeva NV, Raush ER, Rudneva MV, Bogomolova TS, Taraskina AE, Fang Y et al. Etiology of invasive candidosis agents in Russia: a multicenter epidemiological survey. Front Med. 2018;12(1):84-91. Barchiesi F, Orsetti E, Osimani P, Catassi C, Santelli F, Manso E. Factors related to outcome of bloodstream infections due to Candida parapsilosis complex. BMC Infect Dis. 2016;16:387. Barchiesi F, Orsetti E, Mazzanti S, Trave F, Salvi A, Nitti C, Manso E. Candidemia in the elderly: What does it change? PLoS One. 2017;12(5):e0176576. Benedict K, Roy M, Kabbani S, Anderson EJ, Farley MM, Harb S et al. Neonatal and pediatric candidemia: results from population-based active laboratory surveillance in four US locations, 2009-2015. J Pediatric Infect Dis Soc. 2018;7(3):e78-e85. Bhattacharjee P. Epidemiology and antifungal susceptibility of Candida species in a tertiary care hospital, Kolkata, India. Curr Med Mycol. 2016;2(2):20-7. Breda GL, Tuon FF, Meis JF, Herkert PF, Hagen F, de Oliveira LZ, Dias VC, da Cunha CA, Queiroz-Telles F. Breakthrough candidemia after the introduction of broad spectrum antifungal agents: A 5-year retrospective study. Med Mycol. 2018;56(4):406-15 Caggiano G, Lovero G, De Giglio O, Barbuti G, Montagna O, Laforgia N et al. Candidemia in the Neonatal Intensive Care Unit: a retrospective, observational survey and analysis of literature Data. Biomed Res Int. 2017;2017:7901763. Fu J, Ding Y, Wei B, Wang L, Xu S, Qin P, Wei L, Jiang L. Epidemiology of Candida albicans and non-C.albicans of neonatal candidemia at a tertiary care hospital in western China. BMC Infect Dis. 2017;17(1):329. Guzzetti LB, Vescina CM, Gil MF, Gatti BM. Candidemias en pediatría: distribución de especies y sensibilidad a los antifúngicos [Candidemia in Pediatrics: Species distribution and antifungal susceptibility]. Rev Argent Microbiol. 2017;49(4):320-22. Kofteridis DP, Valachis A, Dimopoulou D, Andrianaki AM, Christidou A, Maraki S, Spernovasilis NA, Samonis G. Factors Influencing Non-albicans Candidemia: A Case-Case-Control Study. 2017; 182(7-8):665-72. Kubiak DW, Farmakiotis D, Arons V, Hollins RM, Rostas SE, Weiser LM et al. Utility of in-house fluconazole disk diffusion susceptibility testing in the treatment of candidemia. Diagn Microbiol Infect Dis. 2016;84(3):223-26. Li D, Zhang W, Zheng S, Ma Z, Zhang P, Liu Z. Surveillance study of candidemia in cancer patients in North China. Med Mycol. 2013;51(4):378-84. Li D, Xia R, Zhang Q, Bai C, Li Z, Zhang P. Evaluation of candidemia in epidemiology and risk factors among cancer patients in a cancer center of China: an 8-year case-control study. BMC Infect Dis. 2017;17(1):536. Lortholary O, Renaudat C, Sitbon K, Desnos-Ollivier M, Bretagne S, Dromer F; French Mycoses Study Group. The risk and clinical outcome of candidemia depending on underlying Intensive Care Med. 2017; 43(5):652-62. Lovero G, De Giglio O, Montagna O, Diella G, Divenuto F, Lopuzzo M, Rutigliano S, Laforgia N, Caggiano G, Montagna MT. Epidemiology of candidemia in neonatal intensive care units: a persistent public health problem. Ann Ig. 2016;28(4):282-87. Márquez F, Iturrieta I, Calvo M, Urrutia M, Godoy-Martínez P. Epidemiología y susceptibilidad antifúngica de especies causantes de candidemia en la ciudad de Valdivia, Chile [Epidemiology and antifungal susceptibility of species producing candidemia in Valdivia, Chile]. Rev Chilena Infectol. 2017;34(5):441-46. Pinhati HM, Casulari LA, Souza AC, Siqueira RA, Damasceno CM, Colombo AL. Outbreak of candidemia caused by fluconazole resistant Candida parapsilosis strains in an intensive care unit. BMC Infect Dis. 2016;16(1):433. Siri L, Legarraga P, García P, González T, Rabagliati R. Cambios clínicos y epidemiológicos de candidemias en pacientes adultos desde 2000 a 2013. Rev Chilena Infectol. 2017;34(1):19-26. Spiers R, Smyth B, Lamagni T, Rooney P, Dorgan E, Wyatt T et al. The epidemiology and management of candidemia in Northern Ireland during 2002-2011, including a 12-month enhanced case review. Med Mycol. 2019;57(1):23-9. Tiraboschi IN, Pozzi NC, Farías L, García S, Fernández NB. Epidemiología, especies, resistencia antifúngica y evolución de las candidemias en un hospital universitario de Buenos Aires, Argentina, durante 16 años [Epidemiology, species, antifungal resistance and outcome of candidemia in a university hospital in Buenos Aires, Argentina for 16 years]. 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The impact of agricultural intensification on soil degradation now is occurring in tropical countries. The objective of this study was to determine the effect of long-term tillage and N fertilization on soil properties and crop yields in corn-soybean rotation. This long-term study which initiated since 1987 was carried out on a Typic Fragiudult soil at Politeknik Negeri Lampung, Sumatra (105o13’45.5"-105o13’48.0"E, 05o21’19.6"-05o21’19.7"S) in 2010 and 2011. A factorial experiment was arranged in a randomized block design with four replications. The first factor was tillage system namely intensive tillage (IT) and conservation tillage (CT) which consist of minimum tillage (MT) and no-tillage (NT); while the second factor was N fertilization with rates of 0, 100 and 200 kg N ha-1 applied for corn, and 0, 25, and 50 kg N ha-1 for soybean. The results showed that bulk density and soil strength at upper layer after 24 years of cropping were similar among treatments, but the soil strength under IT at 50-60 cm depth was 28.2% higher (p<0.05) than NT. Soil moisture and temperature under CT at 0-5 cm depth were respectively 38.1% and 4.5% higher (p<0.05) than IT. High N rate decreased soil pH at 0-20 cm depth as much as 10%, but increased total soil N at 0-5 cm depth as much as 19% (p<0.05). At 0-10 cm depth, MT with no N had highest exchangeable K, while IT with medium N rate had the lowest (p<0.05). At 0-5 cm depth, MT with no N had highest exchangeable Ca, but it had the lowest (p<0.05) if combined with higher N rate. Microbial biomass C throughout the growing season for NT was consistently highest and it was 14.4% higher (p<0.05) than IT. Compared to IT, Ap horizon of CT after 24 years of cropping was deeper, with larger soil structure and more abundance macro pores. Soybean and corn yields for long-term CT were 64.3% and 31.8% higher (p<0.05) than IT, respectively. Corn yield for long-term N with rate of 100 kg N ha-1 was 36.4% higher (p<0.05) than with no N.Keywords: Conservation tillage, crop yields, N fertilization, soil properties[How to Cite: Utomo M, IS Banuwa, H Buchari, Y Anggraini and Berthiria. 2013.Long-term Tillage and Nitrogen Fertilization Effects on Soil Properties and Crop Yields. J Trop Soils 18 (2): 131-139. Doi: 10.5400/jts.2013.18.2.131][Permalink/DOI: www.dx.doi.org/10.5400/jts.2013.18.2.131] REFERENCESAl-Kaisi and X Yin. 2005. Tillage and crop residue effects on soil carbon dioxide emission in corn- soybean rotation. J Environ Qual 34: 437-445. Pub Med. Barak P, BO Jobe, AR Krueger, LA Peterson and DA Laird. 1997. Effects of long-term soilacidification due to nitrogen inputs in Wisconsin. Plant Soil 197: 61-69.Blake GR and KH Hartge. 1986. Bulk density. In: A Klute (ed). Methods of Soil Analysis. ASA and SSSA. 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Abstract The Late Devonian-Early Carboniferous (DC) Antler orogeny in southwestern Laurentia is contemporaneous with influx of clastic sediments, unconformities, and volcanism across much of western Laurentia (WL), suggesting the demise of the Paleozoic passive margin. However beyond the type Antler orogeny in southwestern Laurentia, the DC tectonic setting is still unclear. Westerly sediment provenance has been suggested as evidence of a convergent margin setting in a foreland basin. However, there is a gap in our understanding in central WL (Alberta and Montana) despite the fact that paleogeographic reconstructions place this area at the centre of WL. We provide detrital zircon (DZ) U-Pb geochronological data from strata in Alberta, Montana, and Nevada that are synchronous with the Antler orogeny to constrain sediment dispersal patterns and test the westerly sediment sourcing hypothesis. We show three DZ facies specific to particular geographic locations: DZ facies 1 in southern Nevada has a prominent subpopulation of early to mid-Mesoproterozoic (mode at 1430 Ma), DZ facies 2 in northeastern Nevada has a late Paleoproterozoic population (mode at 1823 Ma), and DZ facies 3 in Alberta and Montana displays Mesoproterozoic to Neoproterozoic (mode at 1036 Ma), mid-Paleozoic (mode at 411 Ma), and depositional (ca. 360-340 Ma) ages. North-south variation in DZ facies indicates that WL basins were locally sourced from various tectonic fragments having different signatures. Comparing our data with published data, we show that WL is dominated by DZ recycled from uplifted older strata with input from mid-Paleozoic arc terrane (s) to the west. Westerly sourcing is evidenced by the presence of near-depositional ages and affinities of this study’s DZ facies with strata located to the west. Our results and geological evidence from other studies suggest that the Antler orogeny triggered a depositional shift and controlled sediments dispersal in WL, signaling the demise of the Paleozoic passive margin.

Background There are several techniques for localization of non-palpable breast tumors, but comparisons of these techniques in terms of margin positivity and volume of tissue resected are lacking. Methods Between 2011-2013 and 2016-2018, 2 randomized controlled trials involving 10 centers across the United States accrued 631 patients with stage 0-3 breast cancer, all of whom underwent breast conserving surgery. Of these, 522 had residual non-palpable tumors for which localization was required. The localization technique was left to the discretion of the individual surgeon. We compared margin positivity and volume of tissue resected between various localization techniques. Results The majority of the patients (n = 465; 89.1%) had wire localization (WL), 50 (9.6%) had radioactive seed (RS) localization, and 7 (1.3%) had Savi Scout (SS) localization. On bivariate analysis, there was no difference in terms of margin positivity (37.8% vs. 28.0% vs. 28.6%, P = .339) nor re-excision rates (13.3% vs. 12.0% vs. 14.3%, P = .961) for the WL, RS, and SS groups, respectively. Further, the volume of tissue removed was not significantly different between the 3 groups (71.9 cm3 vs. 55.8 cm3 vs. 86.6 cm3 for the WL, RS, and SS groups, respectively, P = .340). On multivariate analysis, margin status was affected by tumor size (OR = 1.336; 95% CI: 1.148-1.554, P<.001) but not by type of localization ( P = .670). Conclusions While there are a number of methods for tumor localization, choice of technique does not seem to influence volume of tissue resected nor margin status.

Abstract Background We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care. Methods Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS. Results Data on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival. Conclusions Inadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel.

Objectives. We explored the prognostic utility of the unique combination of C‐reactive‐protein‐to‐albumin ratio (CAR) and significant weight loss (WL > 5%) over the preceding 6 months, namely, the CARWL score, in stage IIIC non‐small‐cell lung cancer (NSCLC) patients who underwent concurrent chemoradiotherapy (CCRT). Methods. For each patient, the CAR was calculated using C‐reactive protein and albumin measurements obtained on the first day of CCRT: CAR = C‐reactive protein ÷ albumin. The availability of an ideal CAR cutoff that may categorize patients into two distinct progression‐free (PFS) and overall survival (OS) outcomes was explored by employing receiver operating characteristic (ROC) curve analysis. Patients were additionally divided into two groups based on their status of significant WL according to the well‐recognized Delphi criteria. Then, the CARWL score was created by combining all feasible combinations of the CAR and significant WL groupings. The potential links between pretreatment CARWL groups and the post‐CCRT OS and PFS outcomes were determined as the primary and secondary endpoints. Results. This retrospective cohort study comprised a total of 651 stage IIIC NSCLC patients. ROC curve analysis indicated that rounded 3.0 was the ideal CAR cutoff (area under the curve (AUC): 70.1%; sensitivity: 67.8%; specificity: 65.9%), which categorized the patients into CAR < 3.0 (N = 324) and CAR ≥ 3.0 (N = 327) groups. There were 308 (47.3%) and 343 (52.7%) patients without and with significant WL, respectively. The created CARWL groups were CARWL‐0: CAR < 3.0 and WL ≤ 5.0%; CARWL‐1: CAR < 3.0 and WL > 5.0%, or CAR ≥ 3.0 and WL ≤ 5.0%; and CARWL‐2: CAR > 3.0 and WL > 5.0%. The Kaplan–Meier curves showed that the PFS (14.2 vs. 11.4 vs. 7.5 months; P < 0.001) and OS (37.3 vs. 23.6 vs. 12.8 months; P < 0.001) durations were gradually and significantly lowered from the CARWL‐0 to CARWL‐2 groups. The CARWL score’s significant impacts on PFS and OS outcomes were found to be independent of the other variables in the multivariate analysis (P < 0.001, for each). Conclusions. Our findings indicate that the novel CARWL score, which accounts for pretreatment CAR and significant WL during the preceding 6 months, can reliably stratify newly diagnosed stage IIIC NSCLC patients into three groups with significantly different PFS and OS after definitive CCRT.

Introduction: Exercise-induced hypertension increases reactive oxygen species (ROS) generation and threatens vascular endothelial health. Recent studies indicate conditioned subjects (EX) are protected from endothelial dysfunction observed in sedentary (SED) subjects after acute hypertension induced by weight lifting (WL). Hypothesis: We hypothesized that: chronic exercise protects against endothelial dysfunction induced by acute exertion and the mechanism of maintained dilation after acute hypertension involves hydrogen peroxide (H 2 O 2 ) in microvessels from exercise trained subjects. Methods: Healthy, lean SED and EX subjects (runners > 15 miles/week or WL > 3x/week), underwent a single progressive 15 minute leg press WL session. Brachial artery flow- mediated dilation (FMD) and nitroglycerin (NTG; 0.4 mg) dilations were measured with ultrasound. Isolated arterioles (gluteal fad pad biopsies) from the same subjects were cannulated to assess dilation to acetylcholine (ACh; 10 −9 –10 −4 M) pre and post WL. Separately, H 2 O 2 production was assessed with DCF fluorescence. Results: All subjects were free of hypertension with similar blood pressure responses to WL (max SBP: 183.7±5 mmHg). Brachial artery FMD was maintained after WL in EX (+2.0±0.3%; p<0.001 vs. SED; n=48) but not SED (−3.0±0.2%; n = 28). Dilation to ACh was maintained in EX [Max dilation (MD): 87±3 %; n = 10] but not SED (50±5%; n = 10) post WL. Inhibition of NOS with LNAME eliminated baseline ACh dilation in EX but not post WL (73±6%). Indomethacin and 17-ODYA had no effect on post WL ACh responses. In EX subjects, WL increased hydrogen peroxide (DCF fluorescence ratio: 3.4±0.4; p = 0.001 vs. baseline; n = 9). The H 2 O 2 scavenger PEG-catalase (500 U/ml) reduced DCF fluorescence and ACh dilation post WL (29±7%; p<0.001 vs. pre WL) but had no effect before WL. Endothelium-independent responses to papaverine were similar pre and post WL. In conclusion, these data indicate chronic exercise protects against microvascular endothelial dysfunction after exertion and although NOS is responsible for ACh dilation before acute weight lifting in EX, H 2 O 2 maintains endothelium-dependent dilation in microvessels after exposure to exercise-induced hypertension.

Purpose: To explore a telehealth-based lifestyle therapeutics (THBC) program on weight loss (WL) and program satisfaction in an employer population. Design: This study was a collaboration between inHealth Lifestyle Therapeutics and a large national employer group including 685 participants (296 women [64% obese] and 389 men [62% obese]). Measures: Percent WL and subjective rating (Perceived Program Value measured by a questionnaire) were assessed. Intervention: Average number of visits was 3.1 ± 0.4; each visit ranged between 20 and 45 minutes. Analysis: This study utilized a 2 × 2 block design using analysis of variance techniques based on sex (male and female) and initial body mass index (BMI) category (overweight and obese) tested at P ≤ .05. Results: There was no statistical difference in %WL between by sex ( F 1,681 = 0.398, P = .528) nor an interaction between sex and BMI ( F 1,681 = 0.809, P = .369). There was a statistically significant difference in %WL from pre to post program across initial BMI category ( F 1,681 = 13.707, P ≤ .001) with obese participants losing an average of 1.1% (0.5%-1.6%) more than overweight participants (overweight 2.5% [2.1%-3.0%] vs obese 3.6% [3.2%-3.9%]). Obese participants were 1.15 (1.07-1.25) times more likely to lose weight compared to overweight participants. Analysis of variance power analysis indicated sufficient power on minimum factor combination n = 106 ( Effect Size = 0.282). Conclusion: Results support the efficacy THBC in supporting WL with no reported differences between men and women, while having a high perceived value for employee participants.

4-(2-chlorophenyl)hydrazineylidene-1-phenyl-2-pyrazolin-5-one derivatives (2-CPH) were examined as safe corrosion hindrance for 304 stainless steel (SS 304) in 1.0 M HCl utilizing weight loss (WL) and electrochemical tests such as potentiodynamic polarization (PP), electrochemical impedance spectroscopy (EIS) and electrochemical frequency modulation (EFM). The outcome data displayed that the protection efficiency (IE%) rises with improving the dose of 2-CPH compounds and lower with raising the temperature. The adsorption of these inhibitors on the surface of SS 304 follows Langmuir isotherm. The 2-CPH are the best inhibitors for the dissolution of SS 304 in 1M HCl and they are mixed kind inhibitors. Quantum calculations (QM) display the impact of the chemical structure of the 2-CPH on its %IE. Additionally, 304 stainless surface topography in one molar HCl solution without and with 2-CPH compounds appending utilizing atomic force microscopy (AFM) approves the protection of 304 stainless via adsorbed 2-CPH compounds by a formed protective layer.

Abstract Purpose Chemotherapy-induced nausea and vomiting (CINV)’s impact on work loss remains poorly described. We evaluated associations between the duration of CINV episodes, CINV-related work loss (CINV-WL), and CINV-related activity impairment (CINV-AI) in patients with breast cancer receiving highly emetogenic chemotherapy. Methods We analyzed data from a prospective CINV prophylaxis trial of netupitant/palonestron and dexamethasone for patients receiving an anthracycline and cyclophosphamide (AC) for breast cancer (NCT0340371). Over the observed CINV duration (0–5 days), we analyzed patient-reported CINV-WL and CINV-AI for the first two chemotherapy cycles. We categorized patients as having either extended (≥ 3 days) or short (1–2 days) CINV duration and quantified its impact on work using the Work Productivity and Activity Impairment Questionnaire (WPAI). Results Overall, we captured data for 792 cycles in 402 women, including 136 (33.8%) employed patients with 35.3% reporting CINV. Of those with CINV, patients reported CINV-WL in 26 cycles and CINV-AI in 142 cycles. Of those with CINV, 55.3% of extended CINV cycles experienced CINV-WL compared to 16.7% of short CINV cycles (p < 0.001). The relative risk of CINV-WL between extended and short CINV was 3.32 (p < 0.01) for employed patients. The mean difference in CINV-AI scores (higher = worse) between extended and short duration CINV was 5.0 vs. 3.0 (p < 0.001). Conclusion Extended (≥ 3 days) CINV was associated with more than triple the risk of CINV-WL and higher CINV-AI compared with short CINV.

AbstractBackgroundTraditionally, weight loss (WL) trials utilize dual energy X‐ray absorptiometry (DXA) to measure lean mass. This method assumes lean mass, as the sum of all non‐bone and non‐fat tissue, is a reasonable proxy for muscle mass. In contrast, the D3‐creatine (D3Cr) dilution method directly measures whole body skeletal muscle mass, although this method has yet to be applied in the context of a geriatric WL trial. The purpose of this project was to (1) describe estimates of change and variability in D3Cr muscle mass in older adults participating in an intentional WL intervention and (2) relate its change to other measures of body composition as well as muscle function and strength.MethodsThe INVEST in Bone Health trial (NCT04076618), used as a scaffold for this ancillary pilot project, is a three‐armed, 12‐month randomized, controlled trial designed to determine the effects of resistance training or weighted vest use during intentional WL on a battery of musculoskeletal health outcomes among 150 older adults living with obesity. A convenience sample of 24 participants (n = 8/arm) are included in this analysis. At baseline and 6 months, participants were weighed, ingested a 30 mg D3Cr tracer dose, provided a fasted urine sample 3–6 days post‐dosage, underwent DXA (total body fat and lean masses, appendicular lean mass) and computed tomography (mid‐thigh and trunk muscle/intermuscular fat areas) scans, and performed 400‐m walk, stair climb, knee extensor strength, and grip strength tests.ResultsParticipants were older (68.0 ± 4.4 years), mostly White (75.0%), predominantly female (66.7%), and living with obesity (body mass index: 33.8 ± 2.7 kg/m2). Six month total body WL was −10.3 (95% confidence interval, CI: −12.7, −7.9) kg. All DXA and computed tomography‐derived body composition measures were significantly decreased from baseline, yet D3Cr muscle mass did not change [+0.5 (95% CI: −2.0, 3.0) kg]. Of muscle function and strength measures, only grip strength significantly changed [+2.5 (95% CI: 1.0, 4.0) kg] from baseline.ConclusionsAmong 24 older adults, significant WL with or without weighted vest use or resistance training over a 6‐month period was associated with significant declines in all bioimaging metrics, while D3Cr muscle mass and muscle function and strength were preserved. Treatment assignment for the trial remains blinded; therefore, full interpretation of these findings is limited. Future work in this area will assess change in D3Cr muscle mass by parent trial treatment group assignment in all study participants.

Non-invasive assessment of plaque burden by Multislice Computed Tomography (MDCT) has been recently shown to be feasible. However, to date, there is no data on its accuracy to assess changes in atheroma burden We and others have previously shown that apoA-IMilano (apoA-IM) infusion induces a large plaque regression in a very short period of time The aim of our study was to assess the feasibility of MDCT to accurately quantify the changes in atheroma volume induced by apoA-IM infusion Methods Aortic atherosclerotic lesions were induced in New-Zealand-White Rabbits (n=7) by 9-month atherogenic diet and aortic denudation, as previously reported. Animals were then randomized to receive 2 infusions, 4 days apart, of apoA-IM (ETC-216, Pfizer. n=4) or equal volume of placebo (n=3). All animals underwent 2 imaging studies in a 64-Slice MDCT scanner (Sensation 64, Siemens), pre- and post-treatment (Rx). After last MDCT study, animals were sacrificed and the aorta processed for histological atherosclerotic lesions characterization and volume quantification . Axial MDCT images were reconstructed (3 mm thick, no overlap). Display settings were manipulated according to previous validated studies. For lumen delineation: window width (WW) 1 and level (WL) 65% of lumen attenuation . For outer vessel boundaries: WW 155% and WL 65%. Results MDCT showed that plaque burden regressed by 29% in apoA-IM group (418mm 3 pre-Rx vs. 302mm 3 post-Rx, p=0.031). Conversely, no significant change was observed by MDCT studies done pre- and post-placebo administration. MDCT performed post-Rx showed that mean plaque volume in apoA-IM animals was 11.5% smaller than that of placebo animals (p=0.018). Mean plaque volume in histology showed similar results:plaque volume was 10.6% smaller in the apoA-IM group (p=0.005 vs. placebo). The interobserver variability for plaque volume quantification in MDCT was 10±4%. Conclusion MDCT detects the changes in atherosclerotic plaque volume induced by apoA-IM infusion. Furthermore, an excellent correlation was found between MDCT and histological plaque volumes. These results, combined to the short time of scan and the accessibility to the coronary territory suggest that MDCT could be applied in human studies testing changes in coronary plaque volume.

Various light spectra, especially red (RL) and blue light (BL), have great effects on physiological processes and growth of plants. Previously, we revealed that the plant photomorphogenesis and photosynthesis of sweet pepper was significantly altered under BL or mixed RL and BL. The present study aimed to elucidate how mixed RL and BL influences plant photosynthesis during photomorphogenesis. We examined the growth, plant morphology, photosynthetic response of sweet pepper seedlings under monochromatic RL, BL, different ratios of mixed RL and BL (9R1B, 6R1B, 3R1B, 1R1B, 1R3B) with the same photosynthetic photon flux density of 300 μmol·m-2·s-1. White light (WL) were used as a control. The findings showed that the elongation of hypocotyl and first internode as well as leaf expansion were all stimulated by RL, while significantly restrained by BL compared with WL. Conversely, the leaf development, biomass accumulation and photosynthetic properties were inhibited by RL but promoted by BL. Additionally, compared with WL and other treatments, 3R1B could significantly improve the net photosynthetic rate, gas exchange, photosynthetic electron transport capacity, photochemical efficiency, shoot and root biomass accumulation. Furthermore, seedlings grew robustly and exhibited the greatest value of seedling index when exposed to this treatment. Overall, these results suggested that pepper seedlings grown under 3R1B performed better, possibly due to the more balanced light spectrum. It was more conducive to improve the plant photomorphogenesis and photosynthesis of sweet pepper, and a higher biomass accumulation and energy utilization efficiency could be achieved simultaneously under this mixed light spectrum.

In the present study, we have investigated the effect of magnetic Cr doping on the transport properties of a sputtered Bi2Se3 thin film on the SrTiO3 (110) substrate. The high-resolution x-ray diffraction and Raman spectroscopy measurements revealed the growth of rhombohedral Bi2Se3 thin films. Further electronic and compositional analysis was done by x-ray photoemission spectroscopy and Rutherford backscattering spectroscopy, and the x-value was estimated to be 0.18 in the Bi2−xCrxSe3 thin film. The variation in the resistivity with temperature (2–300 K) revealed the metallic nature in undoped Bi2Se3 up to 30 K and upturn resistivity below 30 K. The Cr-doped Bi2Se3 resistivity data show a traditional semiconducting nature up to 25 K and take an abrupt upturn resistivity below 25 K. The resistivity behavior of both samples was explained by adopting a model that consists of the total resistance, a combination of bulk and surface resistance in parallel. The bulk bandgap value determined by this method is obtained to be 256 meV in an undoped Bi2Se3 thin film. Magnetoconductance data of the undoped thin film revealed a weak anti-localization (WAL) effect, while the Cr-doped thin film showed a weak localization (WL) effect at low temperatures (&lt;50 K). At low magnetic field and low temperature, a competing nature of WAL and WL effects was prominent in the Cr-doped film. A drastic increase in the electrical resistance suggests that Cr doping can significantly modify the electrical properties of Bi2Se3 thin films, which could have potential applications in futuristic devices.

ABSTRACTWe demonstrate ultrafast dynamical imaging of surfaces using a scanning tunneling microscope with a low-temperature-grown GaAs tip photoexcited by 100-fs, 800-nm pulses. We detect picosecond transients on a coplanar stripline and demonstrate a temporal resolution (full-width at half maximum) of 1.7 ps. By dynamically imaging the stripline, we demonstrate that the local conductivity in the sample is reflected in the transient correlated current and that 20-nm spatial resolution is achievable for a 2 ps transient, correlated signal. We apply this technique of photoconductively-gated ultrafast scanning tunneling microscopy to study carrier dynamics in InAs/GaAs self-assembled quantum dot samples at T=300 K. The initial carrier relaxation proceeds via Auger carrier capture from the InAs wetting layer (WL) on a timescale of 1–2 ps, followed by recombination of carriers on a 900 ps timescale. Finally, we demonstrate junction-mixing ultrafast STM (JM-USTM) using picosecond voltage pulses propagating on a patterned metal-on-metal (Ti/Pt). Using JM-USTM we have achieved a spatio/temporal resolution of 1 nm/8 ps.

Introdução: As anomalias de desenvolvimento dentário ocorrem devido a distúrbios que acontecem durante a formação e a diferenciação celular. Dentre as radiografias odontológicas, a panorâmica se destaca por ser um exame radiográfico mais abrangente, que auxilia no diagnóstico e no planejamento terapêutico dos processos patológicos dos dentes e dos ossos da face. Objetivo: O objetivo desse estudo é determinar a prevalência de anomalias dentárias em radiografias panorâmicas de pacientes em tratamento no Centro Universitário Católica de Quixadá-CE e no Centro de Especialidades Odontológicas de Quixeramobim-CE. Métodos: A análise radiográfica foi realizada por um único pesquisador e os achados radiográficos foram escritos em uma ficha devidamente desenvolvida para este estudo. Resultados: Foram analisadas 500 radiografias panorâmicas de pacientes que possuíam entre 5 e 50 anos de idade. Desses, 67% (n=333) pertenciam ao sexo feminino e 33% (n=167) ao masculino. Foi encontrado um total de 1150 anomalias, correspondentes a: dentes não irrompidos 41,7% (n=480), giroversão 24,4% (n=281), dilaceração radicular 20,3% (n=234), microdontia 6,7% (n=77), agenesia 3,9% (n=45), dentes supranumerários 2,4% (n=28), taurodontia 0,3% (n=4) e a macrodontia 0,1% (n=1). As radiografias também foram divididas pelo tipo de arcada ocorrendo 48% (n=307) na maxila e 52% (n=330), na mandíbula. As anomalias dentárias hiperplasiantes foram encontradas em 2,9% (n=33) da amostra, as hipoplasiantes em 10,6% (n=122) e as heterotópicas em 86,5% (n=995). Desta forma conclui-se que na população estudada a maior prevalência correspondeu ao sexo feminino, à anomalia de desenvolvimento heterotópica e ao dente não irrompido.Descritores: Anormalidades Dentárias; Radiografia; Radiografia Panorâmica.ReferênciasCarneiro GV. Estudo radiográfico da prevalência de anomalias dentárias por meio de radiografias panorâmicas em diferentes faixas etárias [tese]. 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Eur J Dent. 2012;6(3):330-34.Menini AAS, Silva MC, Iwaki LCV, Takeshita WM. Estudo radiográfico da prevalência de anomalias dentárias por meio de radiografias panorâmicas em diferentes faixas etárias. Rev Odontol Univ Cid São Paulo. 2012;24(3):170-77.Barbosa DFM, Cruz CM, Crepaldi MV, Oliveira BLS. Agenesias múltiplas, planejamento e hereditariedade. Rev Faipe. 2016;6(2):14-27.Inoue T, Saito M, Nishimura F, Miyazaki T. Three-dimensional representation of microdontia of the maxillary third molar. Clin Case Rep. 2017;5(4):547-48.Costa MA, Oliveira AEF, Costa JF, Silva RA, Lopes FF, Silva APB. Incidência das posições anatômicas e agenesia dos terceiros molares em estudantes de São Luís, Maranhão. Pesqui bras odontopediatria clin integr. 2010;10(3):399-403.King NM, Wong WL, Wong HM. Caries experience of Chinese children with cleft lip and palate. Cleft Palate Craniofac J. 2013;50(4):448-55.Yamada N. Radiographic abnormalities in genetic diseases. 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A 22-year-old man presented with a 3-week history of increased thirst, polydipsia, and polyuria. He described consuming large volumes of water and waking up multiple times throughout the night to drink and urinate. He also endorsed symptoms of fatigue and frequent headaches. Prior to this, he had been well. There was no history of diuretic use, lithium use, or renal disease. There was no prior head trauma, cranial irradiation, or intracranial pathology. He denied consumption of nutritional or protein supplements. Clinical exam revealed a well appearing young man with normal heart rate and blood pressure. Visual fields and general neurologic exam were grossly normal.Baselines investigations revealed serum sodium ranging from 141–142 mmol/L (reference range 133–145 mmol/L), creatinine 92 umol/L (50–120 umol/L), random glucose 5.4 mmol/L (3.3–11.0 mmol/L), potassium 4.0 (3.3–5.1 mmol/L) and ionized calcium 1.25 mmol/L (1.15–1.35 mmol/L). A 24-hour urine collection was arranged, and returned a urine volume of 5.6L (normal less than 3 litres/24 hours). Further investigations revealed a serum sodium of 142 mmol/L, serum osmolality 306 mmol/kg (280–300 mmol/kg), and urine osmolality of 102 mmol/kg (50–1200 mmol/kg). AM cortisol was 372 nmol/L (200–690 nmol/L).These results demonstrated inability to concentrate the urine, despite the physiologic stimulus of hyperosmolarity. Based on this, a presumptive diagnosis of diabetes insipidus was made. The patient was instructed to drink as much as he needed to satiate his thirst, and to avoid fluid restriction. The patient was started on DDAVP intranasal spray, which provided immediate relief from his symptoms. Magnetic resonance imaging of the brain revealed an unremarkable pituitary gland with abnormal thickening of the pituitary stalk and loss of the posterior pituitary bright spot. This confirmed the diagnosis of central diabetes insipidus, presumed secondary to infiltrative disease affecting the pituitary stalk.IntroductionPolyuria is defined as inappropriately high urine output relative to effective arterial blood volume and serum sodium. In adults, polyuria can be objectively quantified as urine output in excess of 3–3.5 L per day with a low urine osmolality (<300 mmol/kg).2Daily urine output is dependent on 2 major factors. The first is the amount of daily solute excretion, and the second is the urine concentrating capability of the nephron.3 Disturbances in either of these factors can occur by many different mechanisms, and can lead to a diuresis. This diuresis can be driven either by solute (solute diuresis), water (water diuresis) or a combination of these processes.4 A diagnostic algorithm for polyuria is outlined in Figure 1.Figure 1. Diagnostic Approach to Polyuria Solute DiuresisDaily solute intake varies between individuals, but typically averages about 10 mmol/kg or 500–800 mmol/day.2,3 Solute diuresis is the result of a higher solute load that exceeds the usual solute excretion. 4 Higher solute loads can be a consequence of either increased solute intake or increased solute generation through metabolism. High solute intake can occur from intravenous fluids, enteral or parental nutrition, and any other sources of exogenous protein, glucose, bicarbonate, or sugar alcohols.2,4 Metabolic processes leading to increased solute generation include hyperglycemia and azotemia. 2,4 Increased solute excretion drives urine output in a linear fashion.3 Furthermore, solute diuresis impairs the ability of the kidney to concentrate urine. Typically, in a pure solute diuresis, urine concentration is between 300 and 500 mmol/kg.2,4 The specific cause of solute diuresis can be further delineated with estimation of the urine electrolyte solute over 24 hours: 2(urine [Na]+urine [K]) ×24 hours.4 Values greater than 600 mmol/day suggest electrolytes are the solutes driving the diuresis, while values less than 600 mmol/day imply that the diuresis is due to a non-electrolyte solute, typically glucose or urea.Water DiuresisWater diuresis can occur due to excessive amounts of free water consumption (primary polydipsia) or impaired secretion or response to ADH (diabetes insipidus). In both cases, urine osmolality should be less than 100 mmol/kg.2 Primary polydipsia is characterized by excessive water consumption. This can be a result of compulsive water drinking (often observed in psychiatric disorders) or a defect in the thirst centre of the hypothalamus due to an infiltrative disease process.5,6The osmotic threshold for ADH release occurs at 280–290 mmol/kg. Failure to maximally concentrate the urine (1000–1200 mmol/kg in healthy kidneys) when serum osmolality rises above the osmotic threshold suggest diabetes insipidus.3 Diabetes insipidus (DI) can result from either insufficient ADH secretion from the posterior pituitary (central DI) or ADH resistance (nephrogenic DI).1Central DI can be caused by both congenital and acquired conditions known to affect the hypothalamic-neurohypophyseal system7,8 (Table 1). Polyuria occurs when 80% or more of the ADH secreting neurons are damaged 7. Metastatic disease has a predilection for the posterior pituitary, as its blood supply is derived from the systemic circulation, in contrast to the anterior pituitary which is supplied by the hypophyseal portal system.9 Rapid onset of polydipsia and polyuria in a patient older than 50 years of age should therefore raise immediate suspicion for metastatic disease.9 Treatment of adrenal insufficiency may “unmask” or exacerbate central DI, as normalization of blood pressure following glucocorticoid replacement inhibits ADH release.10 In the pregnant state, ADH degradation is increased due to placental production of vasopressinase. Any mechanism of hepatic dysfunction that occurs in pregnancy (pre-eclampsia, HELLP, acute fatty liver) will augment this normal physiology by reducing vasopressinase clearance, and can subsequently lead to transient DI 11In nephrogenic DI, ADH is present but the kidneys are unable to respond appropriately.8 In normal physiology, ADH acts to concentrate the urine via activation of the vasopressin V2 receptor, which leads to insertion of aquaporin-2 water channels in the collecting duct. 3,12 Nephrogenic DI can be primary (genetic) or secondary (acquired). Primary nephrogenic DI occurs as a result of genetic mutations affecting either the vasopressin 2 receptor or aquaporin-2 water channels; typically, such conditions present in infancy.12 Secondary nephrogenic DI can occur by a variety of mechanisms; the most common is chronic lithium administration. Lithium enters the principal cell in the collecting duct via epithelial sodium channels, and is thought to impair urinary concentrating ability via reduction in the number of principal cells and interference in signalling pathways involved in aquaporin. 12,13 Hypercalcemia, hypokalemia, obstructive uropathy, and pregnancy can lead to transient nephrogenic DI. 12,13 Hypercalcemia can lead to nephrogenic DI by causing a renal concentrating defect when calcium levels are persistently above 2.75 mmol/ L.14 Increased hydrostatic pressure from obstructive uropathy may lead to suppression of aquaporin-2 expression, resulting in transient nephrogenic DI.12 Nephrogenic DI can be caused by various renal diseases due to impairment of renal concentrating mechanisms, even before glomerular filtration rate is impaired. Polycystic kidney disease causes anatomic disruption of the medullary architecture. Polyuria in sickle cell disease results from a similar mechanism, as sickling in the vasa recta interferes with the countercurrent exchange mechanisms 16. Infiltrative renal disease including amyloid and Sjogren’s syndrome impair renal tubular function due to amyloid deposition and lymphocytic infiltration.17,18Mixed Water-Solute DiuresisIn some cases, polyuria can be caused by a combination of both mechanisms. The linear relationship between solute excretion and urine output described above is strongly influenced by ADH. In the setting of a solute diuresis, absence or deficiency of ADH can augment the degree of polyuria quite dramatically.14,19 Clinical examples of mixed diuresis include concurrent loading of both water and solute, chronic renal failure or infiltrative renal disease, relief of prolonged urinary obstruction, and partial DI.2,4 Typically in such scenarios, urine osmolality ranges from 100–300 mmol/kg.2 Conclusion Polyuria has a broad range of causes and can be a diagnostic challenge for clinicians. Understanding the pathophysiology that underpins the different mechanisms of polyuria is essential to appropriate workup, diagnosis, and treatment of this condition. If this is a complaint, the first step is to quantitate the 24-hour urine volume. We recommend referral to endocrinology when there is evidence of hypothalamic or pituitary disease, when a water deprivation test is required, or in cases where the diagnosis is unclear. DisclosureFunding sources: None.Conflicts of interest: None. References 1. Leung AK, Robson WL, Halperin ML. Polyuria in childhood. Clin Pediatr (Phila) 1991;30(11):634–40.2. Bhasin B, Velez JC. Evaluation of polyuria: the roles of solute loading and water diuresis. Am J Kidney Dis 2016;67(3):507–11.3. Rennke HG, Denker BM. Renal pathophysiology: the essentials. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014.4. Oster JR, Singer I, Thatte L, Grant-Taylor I, Diego JM. The polyuria of solute diuresis. Arch Intern Med 1997;157(7):721–9.5. Grois N, Fahrner B, Arceci RJ, Henter JI, McClain K, Lassmann H, et al. Central nervous system disease in Langerhans cell histiocytosis. J Pediatr 2010;156(6):873–81, 81.e1.6. Stuart CA, Neelon FA, Lebovitz HE. Disordered control of thirst in hypothalamic-pituitary sarcoidosis. N Engl J Med 1980;303(19):1078–82.7. Di Iorgi N, Napoli F, Allegri AE, Olivieri I, Bertelli E, Gallizia A, et al. Diabetes insipidus--diagnosis and management. Horm Res Paediatr 2012;77(2):69–84.8. Mahzari M, Liu D, Arnaout A, Lochnan H. Immune checkpoint inhibitor therapy associated hypophysitis. Clin Med Ins Endocrin Diabet 2015;8:21–8.9. Hermet M, Delévaux I, Trouillier S, André M, Chazal J, Aumaître O. Diabète insipide révélateur de métastases hypophysaires : quatre observations et revue de la littérature. La Revue de Médecine Interne 2009;30(5):425-9.10. Martin MM. Coexisting anterior pituitary and neurohypophyseal insufficiency: A syndrome with diagnostic implication. Arch Intern Med 1969;123(4):409–16.11. Aleksandrov N, Audibert F, Bedard MJ, Mahone M, Goffinet F, Kadoch IJ. Gestational diabetes insipidus: a review of an underdiagnosed condition. J Obstet Gynaecol Can 2010;32(3):225–31.12. Bockenhauer D, Bichet DG. Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nat Rev Nephrol 2015;11(10):576–88.13. Grünfeld JP, Rossier BC. Lithium nephrotoxicity revisited. Nat Rev Nephrol 2009;5(5):270.14. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill, Medical Pub. Division; 2001, 754.15. Gabow PA, Kaehny WD, Johnson AM, Duley IT, Manco-Johnson M, Lezotte DC, et al. The clinical utility of renal concentrating capacity in polycystic kidney disease. Kidney Internat 35(2):675–80.16. Hatch FE, Culbertson JW, Diggs LW. Nature of the renal concentrating defect in sickle cell disease. J Clin Invest 1967;46(3):336–4517. Carone FA, Epstein FH. Nephrogenic diabetes insipidus caused by amyloid disease: Evidence in man of the role of the collecting ducts in concentrating urine. Am J Med 1960;29(3):539–44.18. Shearn MA, Tu W-H. Nephrogenic diabetes insipidus and other defects of renal tubular function in Sjögren's syndrome. Am J Med 1965;39(2):312–8.19. Rennke HG, Denker BM. Renal pathophysiology: the essentials. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014. Figure 3.7, effects of ADH and solute excretion on urine volume, 88.

O objetivo do presente artigo foi relatar uma forma de confecção de prótese total utilizando a clonagem da prótese provisória com a finalidade de reduzir as etapas do tratamento. Paciente desdentada total superior e classe I de Kennedy inferior compareceu ao consultório apresentando inflamação severa do tecido periodontal, mobilidade grau III de todos os dentes e supuração à sondagem. Optou-se por realizar prótese total superior convencional e realização das exodontias dos dentes remanescentes, seguida de prótese total provisória e como tratamento definitivo mandibular uma prótese total convencional. Na primeira sessão foi realizada a reavaliação dos tecidos bucais, moldagem da prótese total superior para obter o modelo antagonista, seleção da cor do dente, registro para montagem no articulador semi-ajustável e a clonagem da prótese total inferior provisória. Após polimerizada, a réplica em resina acrílica incolor foi ajustada em boca e realizada a moldagem de borda com godiva em bastão, seguida da moldagem funcional com silicone de condensação. Ambos modelos foram montados no articulador para montagem dos dentes artificiais. A prova estética e funcional foi realizada na segunda consulta e na terceira a prótese foi instalada junto com as instruções de uso e higiene oral. Os controles foram realizados após 24 horas, 3, 7 e 14 dias. O uso de uma técnica alternativa para confecção de uma moldeira individual pode reduzir o tempo clinico, trazendo assim vantagens tanto para o paciente como para o profissional, desde que haja um bom planejamento e conhecimento da técnica.Descritores: Prótese Total; Técnica de Moldagem Odontológica; Materiais para Moldagem Odontológica.ReferênciasEmami E, Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent. 2013;2013:498305Williams SE, Slice DE. 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Clin Oral Implants Res. 2000;11(1):108-25.Telles D, Coelho AB. Próteses sobre implantes. Rio de Janeiro: SobreImplantes.com; 2006.Calvani L, Michalakis K, Hirayama H. The influence of full-arch implant-retained fixed dental prostheses on upper lip support and lower facial esthetics: preliminary clinical observations. Eur J Esthet Dent. 2007;2(4):420-28.Cooper LF. The current and future treatment of edentulism. J Prosthodont. 2009;18(2):116-22Thomason JM, Lund JP, Chehade A, Feine JS. Patient satisfaction with mandibular implant overdenture and conventional denture 6 months after delivery. Int J Prosthodont. 2003;16(5):467-73.Silva-Junior MF, Fonseca EP, Batista MJ, Sousa MLR. Spatial distribuition of tooth loss in a population of adults. RGO. 2017;65(2):115-20.Ettinger RL. Managing and treating the atrophic mandible. J Am Dent Assoc. 1993;124(7):234-41Lindquist TJ, Narhi TO, Ettinger RL. Denture duplication technique with alternative materials. J Prosthet Dent. 1997;77(1):97-8.Barros AWP, Porto E, Lima JFS, Brito NMSO, Soares RSC. Steps for biomodel acquisition through addtive manufacturing for health. RGO. 2016;64(4):442-6.Watamabe Y. Observation of horizontal mandibular positions in an edentulous patient using a digital gothic arch tracer: a clinical report. J Prosthet Dent. 2004;91(1):15-9.Williamson RA, Williamson AE, Bowley J, Toothaker R. Maximizing mandibular prosthesis stability utilizing linear occlusion, occlusal plane selection, and centric recording. J Prosthodont. 2004;13(1):55-61.Paixão F, Silva WAB, Silva FA, Ramos GG, Cruz MVJ. Evaluation of the reproducibility of two techniques used to determine and record centric relation in Angle's class I patients. J Appl Oral Sci. 2007;15(4):275-79.Duncan JP, Taylor TD. Simplified complete dentures. Dent Clin North Am. 2004; 48(3):25-40.Nascimento DFF, Patto RBL, Marchini L, Cunha VPP. Double-nlind study for evaluation of complete dentures made by two techniques with and without face-bow. Braz J Oral Sci. 2004;3(9):439-45.Kawai Y, Murakami H, Takanashi Y, Lund JP, Feine JS. Efficient resource use in simplified complete denture fabrication. J Prosthodont. 2010;19(7):512-16.Heydecke G, Vogeler M, Wolkewitz M, Türp JC, Strub JR. Simplified versus comprehensive fabrication of complete dentures: patient ratings of denture satisfaction from a randomized crossover trial. Quintessence Int. 2008;39(2):107-16.Duncan JP, Taylor TD. Teaching an abbreviated impression technique for complete dentures in an undergraduate dental curriculum. J Prosthet Dent. 2001;85(2):121-25.Heydecke G, Akkad AS, Wolkewitz M, Vogeler M, Türp JC, Strub JR. Patient ratings of chewing ability from a randomised crossover trial: lingualised vs. first premolar/canine-guided occlusion for complete dentures. Gerodontology. 2007;24(2):77-86.Ansari IH. A one-appointment impression and centric relation record technique for compromised complete denture patients. J Prosthet Dent. 1997;78(3):320-23.Davis DM, Watson RM. A retrospective study comparing duplication and conventionally made complete dentures for a group of elderly people. Br Dent J. 1993;175(2):57-60.Clark RfK. The future of teaching of complete denture construction to undergraduates. Br Dent J. 2002;193(1):13-4.Ellis JS, Pelekis ND, Thomason JM. Conventional rehabilitation of edentulous patients: the impact on oral health-related quality of life and patient satisfaction. J Prosthodont. 2007;16(1):37-42.Rodrigues AHC, Morgano SM. An expedited technique for remaking a single complete denture for an edentulous patient. J Prosthet Dent. 2007;98(3):232-34.Tamaki T. Dentaduras completas, 4. ed. São Paulo: Sarvier; 1983.Reis JMSN, Perez LECP, Nogueira S, Ariolli Filho JN, Moll Júnior FA. Moldagem em prótese total: uma revisão de literatura. RFO. 2007;12(1):70-4.Bonachela WC, Rosseti PHO. Overdentures: das raízes implantadas osseointegrados - planejamentos, tendências e inovações. São Paulo: Santos; 2002.Telles D. Prótese total - convencional e sobre implantes. 2. ed. São Paulo: Santos; 2010.Felton DA, Cooper LF, Scurria MS. Predictable impression procedures for complete dentures. Dent Clin North Am. 1996; 40(1):39-51.Lee RE. Mucostatics. Dent Clin North Am. 1980; 24(1):81-96.DeFranco RL, Sallustio A. An impression procedure for the severely atrophied mandibule. J Prosthet Dent. 1995;73(6):574-77.Tripathi A, Singh SV, Aggarwal H, Gupta A. Effect of mucostatic and selective pressure impression techniques on residual ridge resorption in individuals with different bone mineral densities: A prospective clinical pilot study. J Prosthet Dent. 2019;121(1):90-4.Levin BL. Impressions for complete dentures. Chicago: Quintessence; 1984.Turano JC, Turano LM. Consertos e Reembasamentos. Fundamentos da prótese total, 7.ed. São Paulo: Santos; 2004.Caputi S, Murmura G, Ricci L, Varvara G, Sinjari B. Immediate denture fabrication: a clinical report. Ann Stomatol (Roma). 2013;4(3-4):273-77.Seals Jr RR, Kuebker WA, Stewart KL. Immediate complete dentures. Dent Clin North Am. 1996; 40(1):151-67.Cerveira Neto H. Prótese total imediata. 2. ed. São Paulo: Pancast Editorial; 1987.Marchini L, Santos JFF, Cunha VPP. Prótese total imediata: considerações clínicas. Robrac. 2000;9(27):45-9.Wagner AG. Making duplicate dentures for use as final impression trays. J Prosthet Dent. 1970;24(1):111-13.Anusavice KJ. Phillips: materiais dentários. 10.ed. Rio de Janeiro: Guanabara Koogan;1998.Elie E. Daou. The elastomers for complete denture impression: a review of the literature. Saudi Dent J. 2010;22(4):153-60.Goldfogel M, Harvey WL, Winter D.Dimensional change of acrylic resin tray materials. J Prosthet Dent. 1985;54(2):284-86.Pagniano RP, Scheid RC, Clowson RL, Dagefoerde RO, Zardiackas LD. 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Introdução: O maior foco das pesquisas odontológicas nos últimos 60 anos tem sido a adesão e suas técnicas. Mais de 7000 artigos já foram publicados a este respeito. O desenvolvimento dos materiais odontológicos adesivos e as técnicas a eles relacionadas possuem uma história interessante, onde descobertas do passado ainda são usadas de alguma forma no presente. Objetivo: expor, através de uma revisão de literatura, um breve histórico sobre materiais e técnicas restauradoras, bem como o estágio atual da odontologia adesiva, com ênfase na tradução de evidências baseadas em pesquisas laboratoriais para a prática clínica. Materiais e Métodos: Foram selecionados livros de preferência do autor para a introdução de conceitos clássicos e artigos de revisão publicados nos últimos 10 anos, utilizando as cinco palavras-chave: “Dental Bonding” AND “Dental Cements” AND “Resin Cements” AND “Adhesives” AND “Ceramics”, sorteados pela melhor combinação na plataforma Pub/Med/MEDLINE. Resultados: Duzentos e um artigos, foram encontrados, sendo utilizados para análise qualitativa e quantitativa aqueles pertinentes ao direcionamento do autor, de acordo com o tema. Conclusão: Considerando as limitações do estudo, concluiu-se que a odontologia adesiva é uma área que segue em constante desenvolvimento, fundamental para a realização de restaurações minimamente invasivas e estéticas. Onde para que seja possível consequentemente longevidade clínica, os materiais utilizados e substrato dentário requerem conhecimento do profissional e fidelidade na execução de um correto pré-tratamento das superfícies, respeitando suas naturezas e composições.Descritores: Colagem Dentária; Cimentos Dentários; Cimentos de Resina; Adesivos; Cerâmica.ReferênciasVan Meerbeek B, De Munck J, Yoshida Y, Inoue S, Vargas M, Vijay P, et al. Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future challenges. Oper Dent. 2003;28:215-35.Miyashita E, Fonseca AS. 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