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Incomplete endodontic treatment has been associated with detrimental health outcomes.This retrospective study reviewed charts of patients receiving endodontic care over a 1-year period at the Postgraduate Endodontic Clinic at Rutgers School of Dental Medicine, Newark, NJ, to assess whether factors such as receipt of palliative endodontic care and demographic factors were associated with completion, or noncompletion, of initial nonsurgical root canal therapy (RCT).A total of 1806 patient charts met the study inclusion criteria. With descriptive statistics and bivariate analysis, the variables of palliative care, Medicaid recipient, age group, and distance from the clinic were significantly associated with RCT completion (P .05). In the binary logistic regression with all independent variables, palliative care and age group variables were the significant factors (P .05). Patients who had no palliative care had 8.5 times the odds of completing RCT than patients who had received palliative care. The age group of 18-35 years had 0.59 times the odds of complete RCT than the age group18 years.Incomplete nonsurgical endodontic treatment is highly associated with the receipt of prior palliative care. Further research is indicated to investigate additional factors that may influence patient completion of endodontic care and opportunities to improve public health care program design to obtain optimal patient-centered outcomes.

Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the “Sunna” also encourages Muslims to practice IF all along the year (e.g.;two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic. © 2021 Institute of Sport. All rights reserved.

Background Diverticular bleeding is the main cause of lower gastrointestinal bleeding in both Eastern and Western countries. Several risk factors have been identified, such as comorbidities and concomitant medications. In Eastern population, the prevalence of right-side diverticulosis is higher than in Western one, and some Authors identified bilateral diverticulosis as a risk factor for bleeding. Aims To identify risk factors for diverticular bleeding in patients admitted for diverticular disease (DD). Methods All patients admitted for DD from January 2017 to December 2018 were retrieved from the hospital Information System. For each patient, age, gender, clinical presentation and concomitant medication were recorded. All patient underwent imaging assessment (computed tomography, ultrasound or MRI) and colonoscopy during hospitalization or within one month. Results Among 1248 patients discharged with a diagnosis of DD during the study period, 293 (52.2% male, median age 75 years) were finally analyzed; of them, 105 (35.8%) for diverticular bleeding. On multivariate analysis, male gender (OR 4.27), age (OR 1.12), anti-thrombotic medications (OR 2.60) and right-sided DD (OR 5.70) were independently correlated to diverticular bleeding. Conclusion Our study provides evidence that, together with age, male gender and concomitant anti-thrombotic treatment, right-sided DD represents an independent risk factor for bleeding.

Opuntia ficus-indica Mill. fruit and cladodes are a source of mucilage, a carbohydrate complex, as well as of phytochemicals and other nutrients, useful in the food industry. Despite the environmental-based composition variability studied, there is no information on its seasonal variability, which is particularly important for its industrial use. In this study, some technological, nutritional, and bioactive properties of O. ficus-indica Mill. cladodes mucilage were analysed during the seasonal growth period. Total proteins did not change during the whole period and the lipid content significantly decreased from winter to the onset of summer. The fatty acid profile showed high levels of palmitic (16:0), oleic (18:1n9), and linoleic (18:2n6) acids and that the polyunsaturated fatty acid class (PUFA) is the most abundant fatty acid class, which showed a significant increase during the growth period. In this class, the presence of 20:5n-3 (EPA) and 22:6n-3 (DHA), two of the most important human nutrition essential fatty acids, is worth noting as well as the positive effect of the omega- 3 series founder, α-linolenic acid 18:3 n-3. Total polyphenol values indicated that extract quality changes with the sampling period and is not closely related to the total extract yield. All the descriptors of the antioxidant power seem to indicate that the best properties are exhibited during the summer. The principal component analysis can significantly help identify the technological, nutritional, and bioactive factors that make it possible to distinguish the quality of O. ficus-indica Mill. mucilage, in order to harvest it in the most appropriate season.

BACKGROUND Cardiac rehabilitation (CR) reduces mortality among patients with coronary artery disease (CAD), yet participation rates are suboptimal particularly among women. Symptoms of anxiety and depression are more common in females with CAD and may interfere with CR participation. This retrospective analysis of data investigated sex differences in psychological distress at CR outset and their influence on CR participation and cardiometabolic outcomes. METHODS AND RESULTS Data were collected at a large, Canadian outpatient CR clinic between 1996-2016. Patients with CAD were referred to a 12-week exercise-based CR program and attended either an early-CR access stream (i.e., automatic CR referral triggered at hospital discharge post-acute coronary syndrome [ACS] event; “ECAC” stream), or a non-ACS stream (i.e., coronary surgery and other non-ACS CAD referrals; “SPS” stream). Both streams completed an exercise stress test and medical evaluation (cardiometabolic risk factors, cardiorespiratory fitness [CRF], Hospital Anxiety and Depression Scale [HADs]) at CR outset and 12-weeks. HADs scores were dichotomized into “probably clinically-significant” anxiety/depression (HADS ≥11) or mild/no anxiety/depression (HADS .05). CONCLUSION Symptoms of psychological distress may exacerbate CR non-completion rates in females. Males with anxious and/or depressive symptoms at CR outset may be at greater risk than females for lower CR exercise adherence; suboptimal adherence is a potential mediator of poorer CRF at 12-weeks. Screening and treating patients with psychiatric symptoms at CR outset may improve CR participation and enhance cardiac health outcomes for both sexes.

Normal standards for peak oxygen consumption (VOHospital readmission was assessed in 1283 male patients with coronary heart disease (CHD) three years after enrolment, and related to the age-predicted VODuring the 3-years after baseline, readmission rate was lower across increasing tertiles of FRIENDAge-predicted VO

The removal of one cell from cleaving embryos (blastomere biopsy, BB) is the main component of pre-implantation genetic diagnosis (PGD), a diagnostic test aimed to select only healthy embryos before transfer in utero. Studies on animals have suggested BB as risk factor for impaired development during both pre- and postnatal life. However, we still have incomplete knowledge on the real side effects of BB and the mechanisms underlying them. The present study was designed to evaluate whether BB or miscellaneous factors (in vitro culture, IVC; and embryo transfer, ET) may affect developmental potential of conceptuses obtained following BB (i.e. pregnancy rate/loss, fetal/placental weight, feto:placenta ratio) and placental epigenetic programming. To this aim, 3-month-old C57 females, naturally mated without hormonal stimulation, were used as donors. At 2.5 days post-coitum (dpc), 8-cell stage embryos were collected and subjected to BB in PBS (without Ca2+/Mg2+) supplemented with 0.4% BSA and antibiotics. Embryos were cultured in KSOM medium in an incubator at 37.5°C and 5% CO2. Two in vitro control groups were used: (1) IVC, embryos cultured in vitro, not subjected to biopsy; (2) ET, blastocysts collected at 3.5 dpc and directly transferred into recipient females. At 3.5 dpc, 10 to 12 blastocysts were transferred into pseudo pregnant females (n ≥ 7/group). An additional control group consisted of naturally conceived pregnancy (n = 8, in vivo control, CTR). At 18.5 dpc, conceptuses were collected and subjected to gross morphological evaluations (n > 20 conceptuses/group). Placentae (n ≥ 4/group) were analysed for 5-methylation and hydroxymethylation content by ELISA assay. Decimal variables were analysed using the Mann-Whitney test, and percentages were analysed with the Fisher exact test. Assessment of development to term revealed reduced survival rate in BB, IVC, and ET v. CTR (45.23, 47.82, 60, and 98.15% respectively; P

Cardiac resynchronization therapy (CRT) is a valuable approach to improving clinical status in patients with heart failure (HF). Given the changes in cardiac function and geometry, parallel improvements in cardiorespiratory fitness (CRF) can also be expected. The current analysis assesses: 1)

INTRODUCTION: The appropriate physiological response to an acute bout of progressive aerobic exercise requires proper functioning of the pulmonary, cardiovascular and skeletal muscle systems. Unfortunately, these systems are all negatively impacted in patients with heart failure (HF), resulting in significantly diminished aerobic capacity compared with apparently healthy individuals. Cardiopulmonary exercise testing (CPX) is a noninvasive assessment technique that provides valuable insight into the health and functioning of the physiological systems that dictate an individual’s aerobic capacity. The values of several key variables obtained from CPX, such as peak oxygen consumption and ventilatory efficiency, are often found to be abnormal in patients with HF. In addition to the ability of CPX variables to acutely reflect varying degrees of pathophysiology, they also possess strong prognostic significance, further bolstering their clinical value. Once thought to be contraindicated in patients with HF, participation in a chronic aerobic exercise program is now an accepted lifestyle intervention. Following several weeks/months of aerobic exercise training, an abundance of evidence now demonstrates an improvement in several pathophysiological phenomena contributing to the abnormalities frequently observed during CPX in the HF population. These exercise-induced adaptations to physiological function result in a significant improvement in aerobic capacity and quality of life. CONCLUSIONS: Furthermore, there is initial evidence to suggest that aerobic exercise training improves morbidity and mortality in patients with HF. This paper provides a review of the literature highlighting the clinical significance of aerobic exercise testing and training in this unique cardiac population.INTRODUÇÃO: A resposta fisiológica aguda ao exercício aeróbio progressivo demanda funcionamento adequado dos sistemas pulmonares, cardiovasculares e músculo-esquelético. Infelizmente, todos estes sistemas estão negativamente afetados em pacientes com insuficiência cardíaca (IC), resultando numa redução significativa da capacidade aeróbia comparada com indivíduos aparentemente saudáveis. O teste de exercício cardiopulmonar (TCP) representa uma técnica não-invasiva de avaliação que fornece compreensão valiosa sobre a saúde e funcionamento dos sistemas fisiológicos que ditam a capacidade aeróbia de um indivíduo. Os valores de várias variáveis-chave obtidas através do TCP, como consumo pico de oxigênio e eficiência ventilatória são encontrados frequentemente como anormais em pacientes com IC. Além da capacidade das variáveis do TCP refletir de maneira aguda os graus variáveis da fisiopatologia, também possuem forte significância prognóstica, aumentando ainda mais o seu valor clínico. A participação num programa de exercícios aeróbios crônicos, anteriormente era contra-indicada em pacientes com IC. Agora é uma intervenção aceitável de estilo de vida. Após um período de treinamento com exercícios aeróbios, durante várias semanas/meses, tem sido evidenciada uma melhora em vários fenômenos fisiopatológicos que contribuem às anormalidades constatadas frequentemente durante TCP na população com IC. CONCLUSÕES: As adaptações fisiológicas induzidas por exercícios aeróbios resultam em uma melhora significativa de capacidade aeróbia e de qualidade de vida. Além disso, há evidências sugerindo que treinamento com exercícios aeróbios melhora a morbidade e a mortalidade em pacientes com IC. Este artigo fornece uma revisão da literatura que destaca a significância clínica dos testes de exercícios aeróbios e treinamento nesta população cardíaca única.

Background & Aims Indocyanine green retention test (ICG-r15) is a non-invasive marker of functional hepatic reserve. Among patients with compensated cirrhosis, ICG-r15 correlates to the degree of portal hypertension (PH); however, its prognostic relationship with the occurrence of decompensation events still requires clarification. Methods ICG-r15 was prospectively measured in 154 patients with compensated cirrhosis. Patients with hepatocellular carcinoma (HCC), Child–Pugh B-C, MELD>15, bilirubin > 2 mg/dl, INR > 1.5 or portal vein thrombosis were excluded. All patients underwent laboratory tests, upper endoscopy and hepatic venous pressure gradient (HVPG). Decompensation, development of HCC, liver transplant and death were recorded and analysed through competing-risk analysis. Results The study group was composed of 134 patients who were followed for a median of 39 months. During follow-up, 46 patients (34.3%) developed liver decompensation. Hepatocellular carcinoma occurred in 18 patients and two patients died from non-liver-related causes. The 1-, 2- and 3-year cumulative incidences of decompensation were 9.7%, 28.4% and 33.4% respectively. Patients with ICG-r15 < 10% did not experience any decompensation events during follow-up, while the 3-year cumulative incidence of decompensation of patients with ICG-r15 between 10% and 22.9% was 29.2% and that of patients with ICG-r15 ≥ 23% was 70.0% (P < 0.001). ICG-r15 gave the lowest pseudo-log-likelihood value, in comparison to oesophageal varices present, MELD, low platelet count and HVPG. Conclusions ICG-r15 appears to be strictly related to liver decompensation, longitudinally confirming the preliminary findings of its correlation with PH among patients with compensated cirrhosis, and can be used for patient prognostication.

Women who discover they are pregnant after exposure to a drug and pregnant women who have a condition that requires continued treatment during pregnancy are told to balance the benefits and risks of the exposure to justify continuation of treatment, discontinuation of treatment or, possibly, pregnancy termination. However, there are limited data available to inform decision-making. The Merck Pregnancy Registry Program is a company-run pregnancy registry whose objective is to acquire and analyse information on drug exposures and pregnancy outcomes to better describe the safety profile of Merck products used during pregnancy. Information is collected from women and healthcare providers who call to report drug exposure during pregnancy. Prospective pregnancies are followed up to outcome and data are collected via questionnaires, telephone calls and a review of medical records. Reports are classified as prospective (information received prior to knowledge of pregnancy outcome) or retrospective (received after the outcome is known). Congenital anomaly reports are assessed for timing of exposure, maternal age and medical history, biological plausibility and concomitant medication exposures. Rates of pregnancy outcomes and birth defects in the prospective cohort are computed and confidence intervals are calculated to reflect the strength of the finding based on the sample size. Rates of pregnancy outcomes in the Pregnancy Registry are compared with the rates of pregnancy outcomes in the general US population and, if available, in subpopulations with the relevant disease states. The limitations of post-marketing surveillance are well known as voluntary reporting of individuals and healthcare professionals is known to be subject to various types of bias. Small sample size is another major limitation. However, the strength of the registry lies in its ability to gather pregnancy outcome reports early in the life of a product and to recognise and analyse unusual birth defects. Our data suggest that pregnancy registries can be used to review human exposure data in a systematic fashion so that useful information can be shared with women and their healthcare providers. The use of the pregnancy registry design has allowed for the collection and analysis of data on the effects of drug exposures on human pregnancies that have otherwise been difficult to obtain.

Exercise is an important part of chronic obstructive pulmonary disease (COPD) treatment. However, it is not know about the minimum effective time of physical training that could beneficially modify the cardiac autonomic modulation (CAM) and exercise capacity in these patients.To contrast the potential effects of a physical training program (PTP), for 6 versus 12 weeks, on CAM by linear and nonlinear heart rate variability (HRV) indices and exercise capacity in COPD patients.Prospective randomized controlled trial.Outpatient pulmonary rehabilitation.Twenty moderate-to-severe COPD patients were randomly assigned to either a training group (N.=10) or a control group (N.=10).HRV at rest and during submaximal test was determined by linear (rMSSD and SDNN) and non-linear indices (SD1, SD2 and sample entropy [SE]). In addition, key responses were obtained during cardiopulmonary exercise testing (CPET), the walking distance (WD) during the six minute walking test and submaximal constant speed testing (CST). PTP consisted of 30 minutes of aerobic exercise training on a treadmill, 3 times per week at 70% of CPET peak speed rate. Patients were evaluated on baseline, 6 and 12 weeks.Significant improvements in HRV indices, WD, as well as, other physiological responses were observed after 6 weeks of the PTP and maintained until 12 weeks (P0.05). However, after 12 weeks, the SD1 index demonstrated an additional improvement compared with 6 weeks (P0.05). Peak oxygen uptake and dioxide carbon production improved only after 12 weeks (P0.05). Interestingly, the 6th week-baseline delta (6th week-baseline) of WD, SDNN and SE were significantly higher than 12th week-6th week delta (P0.05).These results indicate that beneficial changes on cardiac autonomic modulation in conjunction with improvement in submaximal functional capacity occur in the first 6 weeks of PTP in moderate to severe COPD.Short-term rehabilitation (6 weeks) is an effective sufficient time to beneficially modify important outcomes as cardiac modulation and exercise capacity in COPD patients.

An experimental attitude control algorithm design using prototypes can minimize space mission costs by reducing the number of errors transmitted to the next phase of the project. The Space Mechanics and Control Division (DMC) of INPE is constructing a 3D simulator to supply the conditions for implementing and testing satellite control hardware and software. Satellite large angle maneuver makes the plant highly nonlinear and if the parameters of the system are not well determined, the plant can also present some level of uncertainty. As a result, controller designed by a linear control technique can have its performance and robustness degraded. In this paper the standard LQR linear controller and the SDRE controller associated with an SDRE filter are applied to design a controller for a nonlinear plant. The plant is similar to the DMC 3D satellite simulator where the unstructured uncertainties of the system are represented by process and measurements noise. In the sequel the State-Dependent Riccati Equation (SDRE) method is used to design and test an attitude control algorithm based on gas jets and reaction wheel torques to perform large angle maneuver in three axes. The SDRE controller design takes into account the effects of the plant nonlinearities and system noise which represents uncertainty. The SDRE controller performance and robustness are tested during the transition phase from angular velocity reductions to normal mode of operation with stringent pointing accuracy using a switching control algorithm based on minimum system energy. This work serves to validate the numerical simulator model and to verify the functionality of the control algorithm designed by the SDRE method.

Heart rate recovery (HRR) is an important indicator of cardiovascular health. The purpose of the present investigation is to examine the influence of sex on the relationship between HRR and other markers of cardiovascular health. Two hundred and seventy-five apparently healthy subjects participated in this study. Subjects underwent cardiopulmonary exercise testing (outcome measures: VO(2max) and HRR 1 and 2 min into recovery), lipid analysis, measurement of resting systolic and diastolic blood pressure and measurement of aortic wave velocity (AWV in m/s) via magnetic resonance. HRR both at 1 min (HRR(1)) and at 2 min (HRR(2)) were higher in males. In general, the correlation between HRR(1) and other measures of interest was weaker than that found with HRR(2) in both male and female subjects. With respect to HRR(2), the relationship with other measures of interest was stronger in the female subgroup. Specific to arterial stiffness, the correlation between HRR(2) and AWV was -0.33 and -0.46 (P0.001 for both) in male and female subgroups, respectively. The results of the present study indicate that both gender and the timing of HRR measurement influence its relationship with other important cardiovascular risk factors.

Avarol, a sesquiterpenoid hydroquinone, its quinone avarone, both main secondary metabolites from the marine sponge Dysidea avara and nine of their natural and synthetic derivatives were tested for ability to interact selectively with rat liver microsomal phenobarbital (PB)- or 3-methylcholanthrene (3-MC)-induced cytochrome (cyt.) P-450 isoenzymatic forms. Ethoxy- and pentoxyresorufin, aminopyrine and ethoxycoumarin were the specific substrates used for assaying cyt.P-450-dependent mono-oxygenase activities. All compounds were more effective in inhibiting the enzymatic activities measured in microsomes from PB-induced rat liver than those measured in microsomes from 3-MC-treated rats. Avarol and avarone, which were the most active inhibitors, act as mixed-type inhibitors of pentoxyresorufin- O -dealkylase activity. Mono- and diacetyl-derivatives of avarol, being deacetylated by rat liver microsomes, were almost as effective as the parent compound. Conversely, avarone derivatives, where one or two hydrogen atoms of the quinone ring have been substituted, were less effective inhibitors than the parent compound. The selective inhibition of PB-inducible cyt.P-45 0IIB by avarol and avarone was confirmed by their ability to inhibit the mutagenic activation of cyclophosphamide, as opposed to that of benzo[ a ]py rene, which is activated mainly by the 3-MC-inducible cyt.P-450IA.

Heavy metals, phthalates, characterizing elements, CO2 concentrations and pH and hardness levels were measured in forty samples of bottled mineral waters. In some samples arsenic, manganese, mercury and selenium were present in higher concentrations than permitted by Italian law. No significant release of phthalates from containers in PET was observed. In the same samples, toxicity tests with Daphnia magna were carried out. Toxicity levels, expressed as % of immobile organisms, ranged from 0 to 100%; generally the highest toxicity values were found in the hardwaters.

In Salmo gairdneri Richardson trouts, a comparison was made between macrophages (MO) derived from head kidney and peripheral blood monocytes. Morphologically and cytochemically no differences were observed between these two types of mononucleated cells. On the other hand, in parallel studies the ability of trout erythrocytes to engulf Candida albicans (CA) was evaluated and compared to the MO phagocytosis. In erythrocytes, engulfment is preceded by binding to CA and cell membrane invagination, while this was not the case for MO. Finally, MO stimulated with lipopolysaccharides (LPS) did not modify their phagocytic capacities, thus suggesting a lack of LPS receptors or a tolerance to LPS.

Mild to moderate autoimmune thrombocytopenia (AITP) is a common finding in patients receiving interferon-based antiviral treatment, due to bone marrow suppression. Here we report the case of a patient with chronic genotype 1b hepatitis C virus (HCV) infection treated with pegylated-interferon alpha-2a, ribavirin and telaprevir for 24 wk; the patient developed severe AITP three weeks after treatment withdrawal. We performed a systematic literature search in order to review all published cases of AITP related to HCV antiviral treatment. To our knowledge, this is the second case of AITP observed after antiviral treatment withdrawal. In most published cases AITP occurred during treatment; in fact, among 24 cases of AITP related to interferon-based antiviral treatment, only one occurred after discontinuation. Early diagnosis of AITP is a key factor in order to achieve an early interferon discontinuation; in the era of new direct antiviral agents those patients have to be considered for interferon-free treatment regimens. Prompt prescription of immuno-suppressant treatment (i.e., corticosteroids, immunoglobulin infusion and even rituximab for unresponsive cases) leads to favourable prognosis in most of cases. Physicians using interferon-based treatments should be aware that AITP can occur both during and after treatment, specially in the new era of interferon-free antiviral treatment. Finally, in the case of suspected AITP, presence of anti-platelet antibodies should be checked not only during treatment but also after discontinuation.

Late preterm infants (LPI) represent a growing population with own peculiar vulnerabilities; only recently attention has been focused on the impact of late preterm birth on child health, in order to define short and long-term outcomes [1,2]. LPI are physiologically and metabolically immature; they are at higher risk than term infants of developing medical complications, resulting in greater rate of mortality and morbidity not only in the neonatal period, but also during infancy, childhood, adolescence, and through adulthood [2,3]. Increasing evidence shows the association between late-preterm birth and various long-term medical and behavioral morbidities, including cerebral palsy, attention problems and antisocial behavior, as well as lower IQ, impaired cognitive and academic performance at school age. Fetal brain undergoes a dramatic growth and maturation during last four weeks of gestation, and this is probably the most important reason of LPI worse neurodevelopmental outcomes compared to full-term infants [3-5]. Physical development is an other important outcome for LPI; in addition to intrauterine growth restriction, LPI may be susceptible to feeding difficulty resulting in poor weight gain and underweight. Since failure to thrive in early infancy may be also associated with adverse cognitive and developmental outcomes, close monitoring of LPI growth pattern is needed [6]. Moreover, late-preterm birth has a negative effect also on maturation of the lungs, interrupting evolution from alveolar saccules to mature alveoli. LPI have been shown to develop early respiratory morbidities more frequently than infants born at term. However, the risk for long-term respiratory problems, such as asthma, has not yet been established in this group of patients [3,7]. Therefore LPI need a multidisciplinary, personalized and effective follow–up care that begins at birth and continues, with varying degrees of surveillance and reflecting individual needs, throughout the lifespan. Pediatricians must play a crucial role by ensuring that appropriate screening and assessments are completed, referrals are made and continuity of care is coordinated. They have to be aware of the major problems that LPI may encounter, providing anticipatory guidance when needed. Pediatricians together with parents, child development specialists, and education professionals need to know the possible school underachievement and behavioral problems so that prompt referrals to early intervention services are made [8,9]. Up to now, standardized short and long term followup schedule for LPI has not been developed yet; therefore, further research should focus on systematic evaluation of outcomes of LPI, in order to optimize follow-up monitoring of this population of children.