Comparison of Casein Phosphopeptide with Potassium Nitrate and Sodium Monofluorophosphate Desensitizing Efficacy after In-Office Vital Bleaching—A Randomized Trial

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), potassium nitrate, and sodium monofluorophosphate are desensitizing agents that help in reducing teeth sensitivity. However, indecisive evidence exists regarding their efficacy. Therefore, this study was conducted to compare the desensitizing efficacy of casein phosphopeptide-amorphous calcium phosphate and potassium nitrate with sodium monofluorophosphate agents after in-office vital bleaching. A randomized controlled trial was conducted on 2011 patients. The patients were randomly and equally divided into the CPP-ACP group (group 1), potassium nitrate with sodium monofluorophosphate group (group 2), and placebo gel (group 3). The upper and lower anterior teeth including the first premolar were isolated with a rubber dam, then the bleaching agents were applied on the labial surface of all the teeth, followed by light activation for 15 min. The procedure was repeated 3 times with an interval of 5 min in-between. After carrying out the bleaching procedure, patients were given a desensitizing gel or placebo gel in unmarked syringes with an instruction to apply it every 12 h for up to 3 days. The intensity of pain was recorded using a discomfort interval scale (DIS). A decrease in pain was observed 24 h after the application of the desensitizing gel in groups 1 and 2. However, in group 3, the pain persisted, with 46 (69.69%) patients having moderate pain and 14 (21.21%) developing severe pain over time. A significant difference in discomfort level with time was noted in group 1 (p = 0.015) and group 2 (p = 0.036). However, no significant difference was found in group 3 (p = 0.085). It was concluded that both desensitizing agents performed exceptionally well in reducing teeth sensitivity.

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Bond Strength of an Amorphous Calcium Phosphate–Containing Orthodontic Adhesive

The Angle Orthodontist ◽

10.2319/020807-60 ◽

2008 ◽

Vol 78 (2) ◽

pp. 339-344 ◽

Cited By ~ 27

Author(s):

Jeff A. Foster ◽

David W. Berzins ◽

Thomas G. Bradley

Keyword(s):

Calcium Phosphate ◽

Bond Strength ◽

Amorphous Calcium Phosphate ◽

Shear Bond Strength ◽

Significant Difference ◽

Group 3 ◽

Bond Strengths ◽

Group 2 ◽

Post Hoc ◽

Group 1

Abstract Objective: To determine whether an amorphous calcium phosphate (ACP)-containing adhesive has an acceptable level of shear bond strength to be used as an orthodontic adhesive. Materials and Methods: Sixty extracted premolars were randomly divided into three groups for orthodontic bonding. Group 1 used a composite resin adhesive (Transbond XT), group 2 was bonded with an ACP-containing adhesive (Aegis Ortho), and group 3 used a resin-modified glass ionomer (Fuji Ortho LC). All bonded teeth were stored in distilled water at 37°C for 40 ± 2 hours prior to debonding. Shear bond strength and adhesive remnant index (ARI) were recorded for each specimen. Results: The mean shear bond strengths for the three test groups were: group 1 (15.2 ± 3.6 MPa), group 2 (6.6 ± 1.5 MPa), and group 3 (8.3 ± 2.8 MPa). A one-way analysis of variance showed a significant difference in bond strengths between the groups. A post hoc Tukey test showed group 1 to be significantly (P < .001) greater than groups 2 and 3. A Kruskal-Wallis test and a Mann-Whitney U-test showed groups 1 and 3 exhibited lower ARI scores than group 2, but a majority of specimens in each group had greater than 50% of the cement removed along with the bracket during debonding. Conclusions: The ACP-containing adhesive demonstrated a low, but satisfactory bond strength needed to function as an orthodontic adhesive.

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Reversal of Root Caries with Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Varnish in Xerostomia

Caries Research ◽

10.1159/000516176 ◽

2021 ◽

pp. 1-10

Author(s):

Ahmed Sleibi ◽

Anwar R. Tappuni ◽

Aylin Baysan

Keyword(s):

Calcium Phosphate ◽

Amorphous Calcium Phosphate ◽

Primary Root ◽

Severity Index ◽

Salivary Flow ◽

Root Caries ◽

Carious Lesions ◽

Group 2 ◽

Casein Phosphopeptide ◽

Group 1

Different formulas of topical fluoride have been used to manage root carious lesions. This clinical trial aimed to investigate the efficacy of a dental varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride compared with fluoride alone in reversing/arresting root caries in xerostomic patients over 1 year. A total of 80 patients (age range 45–92 years) with primary root caries (n = 184 root carious lesions) and unstimulated salivary flow rate of <0.2 mL/min were randomly allocated to receive either dental varnish containing CPP-ACP and 5% fluoride (group 1: MI varnish; GC, Japan) (n = 41, 83 lesions), or dental varnish with 5% fluoride alone (group 2: NUPRO White; Dentsply, USA) (n = 39, 101 lesions). Clinical assessments with Severity Index (SI) for root caries, DIAGNOdent measurements, and varnish application were carried out at baseline, 3, 6, and 12 months. Standard oral hygiene instructions with 1,450 ppm fluoride toothpastes were provided for both groups. After 3 months, 63.9% (n = 46) of root caries in group 1 became hard (SI: 0) compared with 39.3% (n = 35) in group 2 (p < 0.01). After 6 and 12 months, the differences in SI were insignificant (group 1, n = 60, 83.3%) (group 2, n = 66, 74.2%) (p = 0.36), and (group 1, n = 60, 89.6%) (group 2, n = 67, 81.7%, n = 1 soft, 1.2%) (p = 0.29), respectively. In both groups, noncavitated leathery lesions were more likely to become hard when compared to the cavitated root caries. A significant decrease in plaque index, surface roughness, lesion dimension, and DIAGNOdent readings with a significant increase in lesion distance from the gingival margin was reported in both groups (p < 0.05). This study has provided evidence that fluoride dental varnish either with or without calcium and phosphate has the potential to arrest/reverse root caries, especially noncavitated lesions for patients with xerostomia.

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Evaluation of Apical Filling after Warm Vertical Compaction using Two Different Endodontic Materials: Resilon® and Gutta-Percha

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1150 ◽

2012 ◽

Vol 3 (2) ◽

pp. 166-170

Author(s):

Carla Zogheib ◽

Etienne Medioni

Keyword(s):

Group 4 ◽

Gutta Percha ◽

Anterior Teeth ◽

Significant Difference ◽

Ah Plus ◽

Group 3 ◽

Group 5 ◽

Group 2 ◽

Warm Vertical Compaction ◽

Group 1

ABSTRACT Forty-eight extracted maxillary anterior teeth instrumented with ProTaper system to apical preparations 0.25, 0.40 and 0.60 mm (n = 16 each) were divided into six groups for filling as following: Group 1: Apical preparation 25/100 + gutta-percha/AH Plus sealer, group 2: Apical preparation 25/100 + Resilon/Real Seal, group 3: Apical preparation 40/100 + gutta-percha/AH plus sealer, group 4: Apical preparation 40/100 + Resilon/Real Seal, group 5: Apical preparation 60/100 + gutta-percha/AH plus, group 6: Apical preparation 60/100 + Resilon/Real Seal. All teeth were filled using the warm vertical technique. Horizontal sections at 1, 2 and 3 mm from the apex were observed by SEM under 200 × magnification. Sections were digitally photographed under a stereomicroscope and the images were transferred to a compatible PC for image analysis. The surface area of voids were calculated and compared at all levels; using the Kruskal-Wallis test with Sidak correction and Mann-Whitney U test (p > 0.05). Comparisons within each group (gutta-percha/AH plus and Resilon/Real Seal) showed the presence of voids but there was no significant difference between any level of sectioning for apical preparations of 25 and 40 (p > 0.05). The only difference was in the groups prepared to size 60 and filled with Resilon/ Real Seal which showed significantly more voids than the group filled with gutta-percha/AH plus and especially at the 3 mm level. Conclusion The system Resilon/Real Seal did not achieve better results in terms of sealing ability in the apical third when compared to the conventional gutta-percha/AH plus sealing system. How to cite this article Zogheib C, Naaman A, Medioni E. Evaluation of Apical Filling after Warm Vertical Compaction using Two Different Endodontic Materials: Resilon® and Gutta-Percha. World J Dent 2012;3(2):166-170.

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Antibacterial Efficacy of Casein Phosphopeptide-Amorphous Calcium Phosphate Compared to Calcium Hydroxide as Intracanal Medicaments against Enterococcus faecalis: In-vitro Study

The Open Dentistry Journal ◽

10.2174/1874210602115010257 ◽

2021 ◽

Vol 15 (1) ◽

pp. 257-261

Author(s):

Rahaf Almohareb ◽

Reem Barakat ◽

Alhanouf Alshamsan ◽

Manal Almutairi ◽

Norah Alfuraih ◽

...

Keyword(s):

Calcium Phosphate ◽

Calcium Hydroxide ◽

Enterococcus Faecalis ◽

Amorphous Calcium Phosphate ◽

Negative Control ◽

Antibacterial Efficacy ◽

Group 3 ◽

Group 2 ◽

Casein Phosphopeptide

Background: Endodontic infection may persist despite root canal instrumentation. Thus, the use of intracanal medicaments plays an essential role in eliminating resistant bacteria like Enterococcus faecalis, known to be associated with persistent infections in endodontically treated teeth. Although calcium hydroxide is the gold standard intracanal medicament, it has been reported that Enterococcus faecalis is immune to its effects. Therefore, several studies assessed the efficacy of other intracanal medicaments, but none to date evaluated Casein Phosphopeptide-Amorphous Calcium Phosphate. Objectives: This in-vitro randomized controlled study aimed to assess the antibacterial efficacy of Casein phosphopeptide-amorphous calcium phosphate as an intracanal medicament against Enterococcus faecalis and compared it to calcium hydroxide. Methods: 60 extracted single root canal permanent teeth were prepared and later divided into three equal groups according to the intracanal medicament used. Group 1: No intracanal medicament (negative control), Group 2: Calcium hydroxide paste, and Group 3: Casein phosphopeptide-amorphous calcium phosphate paste. The intracanal medicaments were placed on the canals for 7 days. The outcome of this procedure was measured by counting colony-forming units. Statistical analysis was carried out using One-Way ANOVA and Tukey’s Post Hoc Test to determine significant differences between the groups. Results: The mean bacterial count for Group 2 was significantly lower than Group 1 and Group 3. Calcium hydroxide showed significantly more antibacterial efficacy against Enterococcus faecalis than Casein phosphopeptide-amorphous calcium phosphate and the negative control groups. Conclusion: Casein Phosphopeptide-amorphous calcium phosphate is ineffective in inhibiting Enterococcus faecalis growth compared to Calcium hydroxide.

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Bond Strength of Amorphous Calcium Phosphate–Containing Orthodontic Composite Used as a Lingual Retainer Adhesive

The Angle Orthodontist ◽

10.2319/112807-560.1 ◽

2009 ◽

Vol 79 (1) ◽

pp. 117-121 ◽

Cited By ~ 12

Author(s):

Tancan Uysal ◽

Mustafa Ulker ◽

Gulsen Akdogan ◽

Sabri Ilhan Ramoglu ◽

Esra Yilmaz

Keyword(s):

Calcium Phosphate ◽

Bond Strength ◽

Amorphous Calcium Phosphate ◽

Testing Machine ◽

Internal Diameter ◽

Compression Load ◽

Significant Difference ◽

Group 2 ◽

Lingual Retainer ◽

Group 1

Abstract Objective: To evaluate the shear bond strength and fracture mode difference between amorphous calcium phosphate (ACP)–containing adhesive and conventional resin-based composite material used as an orthodontic lingual retainer adhesive. Materials and Methods: Forty crowns of extracted lower human incisors were mounted in acrylic resin, leaving the buccal surface of the crowns parallel to the base of the molds. The teeth were randomly divided into two groups: experimental and control, containing 20 teeth each. Conventional lingual retainer composite (Transbond-LR, 3M-Unitek) and ACP-containing orthodontic adhesive (Aegis-Ortho) were applied to the teeth surface by packing the material into the cylindrical plastic matrices with a 2.34-mm internal diameter and a 3-mm height (Ultradent) to simulate the lingual retainer bonding. For shear bond testing, the specimens were mounted in a universal testing machine, and an apparatus (Ultradent) attached to a compression load cell was applied to each specimen until failure occurred. The shear bond data were analyzed using Student's t-test. Fracture modes were analyzed by χ2 test. Results: The statistical test showed that the bond strengths of group 1 (control Transbond-LR, mean: 24.77 ± 9.25 MPa) and group 2 (ACP-containing adhesive, mean: 8.49 ± 2.53 MPa) were significantly different from each other. In general, a greater percentage of the fractures were adhesive at the tooth-composite interface (60% in group 1 and 55% in group 2), and no statistically significant difference was found between groups. Conclusion: The ACP-containing Aegis-Ortho adhesive resulted in a significant decrease in bond strength to the etched enamel surface.

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Effect of Acidulated Phosphate Fluoride and Casein Phosphopeptide–Amorphous Calcium Phosphate Application on Shear Bond Strength of Orthodontic Brackets

The Angle Orthodontist ◽

10.2319/122506-529.1 ◽

2008 ◽

Vol 78 (1) ◽

pp. 129-133 ◽

Cited By ~ 38

Author(s):

Defne Keçik ◽

Sevi Burçak Çehreli ◽

Çağla Şar ◽

Bahtiyar Ünver

Keyword(s):

Calcium Phosphate ◽

Bond Strength ◽

Amorphous Calcium Phosphate ◽

Shear Bond Strength ◽

Control Group ◽

Significant Difference ◽

Acid Etch ◽

Bond Strengths ◽

Group 2 ◽

Casein Phosphopeptide

Abstract Objective: To evaluate the effect of a recently introduced prophylactic agent, casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), on shear bond strength of brackets and compare it with the effect of acidulated phosphate fluoride (APF). Materials and Methods: Forty-eight freshly extracted mandibular bovine incisors were used. Teeth were randomly divided into four groups (n = 12) as follows: group 1 served as control, and no pretreatment was performed on the enamel; group 2, enamel was treated with 1.23% APF and CPP-ACP, respectively; group 3, enamel was treated with CPP-ACP; and group 4, enamel was treated with 1.23% APF for 4 minutes. In all groups, brackets were bonded using a conventional acid-etch and bond system (Transbond XT, 3M Unitek, Monrovia, Calif). Bonded specimens were first stored in deionized water at 37°C for 24 hours, subjected to thermal cycling for 1000 cycles, and further stored in distilled water for 6 weeks before debonding procedures. After debonding, teeth and brackets were examined under a stereomicroscope at 10× magnification for any adhesive remaining, in accordance with the modified adhesive remnant index. Results: The shear bond strengths of all experimental groups were significantly higher than that of the control group (P < .01). There was no significant difference between the shear bond strengths of the experimental groups (P > .05). Conclusion: The use of CPP-ACP either alone or combined with APF could be considered as an alternative prophylactic application in orthodontic practice since it did not compromise bracket bond strength.

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Efficacy of Nano Crystallised Calcium Phosphate (NCCP) and Casein Phosphopeptide – Amorphous Calcium Phosphate (CPP-ACP) for Controlling Postoperative Sensitivity After Power Bleaching-A Comparative In-Vivo Study

International Journal of Medical Science and Diagnosis Research ◽

10.32553/ijmsdr.v6i1.893 ◽

2022 ◽

Vol 6 (1) ◽

Author(s):

Ramesh T ◽

A. Shilpa ◽

Sarjeev Singh Yadav ◽

Kavitha. A ◽

P. Prathibha ◽

...

Keyword(s):

Calcium Phosphate ◽

Amorphous Calcium Phosphate ◽

Dental Fluorosis ◽

Tooth Bleaching ◽

Control Group ◽

Anterior Teeth ◽

Dental Procedures ◽

Desensitizing Agents ◽

Casein Phosphopeptide

Tooth bleaching is one of the most popular cosmetic dental procedures opted by the patients who desire pleasing smile. It is the simplest, least invasive means available to lighten discolored vital teeth. A number of desensitizing agents have been tried in an attempt to counteract bleaching-related sensitivity. This study was done to compare the effect of two different desensitizing agents for controlling post operative sensitivity after power bleach procedure. Sixty volunteers with mild to moderate dental fluorosis in maxillary anterior teeth, who fulfilled the inclusion and exclusion criteria, were randomly selected for this study. After the bleaching procedurea demo was given to the patient while application of desensitising gel and was instructed to use the gel for 14 days.All the patients were recalled at an interval of 1st day, 3rdday, 5th day, 7th day, and on 14th day to record the post operative sensitivity after power bleach procedure. The observations were analyzed using one way analysis of variance (ANOVA), Tukeys post hoc test. On the basis of VAS results, all the groups showed post operative sensitivity of varied intensity at different intervals. NCCP showed less sensitivity followed by CPP-ACP and Control group. Keywords: Power Bleaching, Post operative sensitivity, Nano Crystallized Calcium Phosphate, Casein Phosphopeptide-Amorphous Calcium Phosphate

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Effect of Fluoride Varnish Containing CPP-ACP on Preventing Enamel Erosion

Scanning ◽

10.1155/2017/1897825 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Sule Bayrak ◽

Nuray Tuloglu ◽

Huseyin Bicer ◽

Emine Sen Tunc

Keyword(s):

Surface Roughness ◽

Calcium Phosphate ◽

Amorphous Calcium Phosphate ◽

Fluoride Varnish ◽

Surface Pretreatment ◽

Positive Effects ◽

Enamel Erosion ◽

Group 2 ◽

Casein Phosphopeptide ◽

Group 1

This study aimed to investigate the effect of a fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate treatment on the prevention of enamel erosion, and it compared the results with those of other fluoride varnishes. Fifty enamel specimens obtained from bovine incisors were randomly divided into five groups (n=10) based on the type of surface pretreatment used: intact enamel (Group 1); intact enamel+erosive cycles (Group 2); intact enamel+MI varnish+erosive cycles (Group 3); intact enamel+Clinpro White varnish+erosive cycles (Group 4); and intact enamel+Duraphat varnish+erosive cycles (Group 5). The specimens were subjected to erosive cycles for five days. The surface roughness was evaluated using atomic force microscopy. The results were statistically analyzed using one-way ANOVA and Tukey’s tests. Group 1 had the smoothest surfaces. After the erosive cycles, the greatest surface roughness values were observed in Group 2, followed by Groups 5, 4, and 3, respectively. Statistically significant differences were observed among all groups (p<0.05). The application of fluoride varnishes had some positive effects on preventing enamel erosion; however, the most effective agent was fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate.

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In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽

10.1024/0301-1526/a000867 ◽

2020 ◽

Vol 49 (4) ◽

pp. 281-284

Author(s):

Atıf Yolgosteren ◽

Gencehan Kumtepe ◽

Melda Payaslioglu ◽

Cuneyt Ozakin

Keyword(s):

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Prosthetic Vascular Graft Infection ◽

Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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Isometric Handgrip Exercise Training Improves Spirometric Parameters and Pulmonary Capacity

Pathophysiology ◽

10.3390/pathophysiology28030022 ◽

2021 ◽

Vol 28 (3) ◽

pp. 328-338

Author(s):

Ogbutor Udoji Godsday ◽

Nwangwa Eze Kingsley ◽

Nwogueze Bartholomew Chukwuebuka ◽

Chukwuemeka Ephraim ◽

Ezunu Emmanuel ◽

...

Keyword(s):

Pulmonary Function ◽

Isometric Exercise ◽

Handgrip Exercise ◽

Isometric Handgrip ◽

Post Exercise ◽

Significant Difference ◽

Isometric Handgrip Exercise ◽

Group 3 ◽

Group 2 ◽

Group 1

Decline in normal physiological pulmonary function has been attributed to premorbid conditions such as prehypertension. Research evidence suggests that physical activity reduces age-related decline in pulmonary function and improves the efficiency of the lungs in prehypertensive patients. However, there is a scarcity of data evidence relating to isometric exercise and pulmonary function. Furthermore, the interrelationship between the intensity and duration of isometric exercise and pulmonary function in these patients is still uncertain. Therefore, this study was undertaken to investigate the effect of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. To determine the effectiveness of isometric handgrip exercise on pulmonary function capacity in adults with prehypertension. A quasi experiment using a pre- and post-exercise method was carried out in two out-patients hospital settings. The sample comprised 192 sedentary pre-hypertensive subjects, aged between 30–50 years, that were randomly distributed into three groups of 64 participants each. The subjects performed, for 24 consecutive days, an isometric handgrip exercise at 30% Maximum Voluntary Contraction (M.V.C.). At the end of the 24 days, group one (GP1) discontinued, while group two (GP2) continued the exercise protocol for another 24 consecutive days and group three (GP3) continued with the exercise protocol for another 24 consecutive days but at 50% M.V.C. Determinants of lung function (outcomes) were Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), FEV1/FVC Ratio and Peak Expiratory Flow Rate (PEFR). The study shows that there was no statistically significant difference in the pre- and post-exercise outcomes for FEV1, FVC, FEV1/FVC Ratio and PEFR after 24 days for group 1. In group 2, there was a statistically significant difference in the FVC [(mean = 0.12 ± 0.12), (p = 0.002)], FEV1 [(mean = 0.15 ± 0.17), (p = 0.003)] and PEF [(mean = 0.85 ± 0.35), (p = 0.001)] after 48 days. In group 3, there was a statistically significant difference (p = 0.001) in all the outcomes assessed after 48 days. There was a between groups difference in favour of group 2 compared with group 1 for outcomes of FEV1 [(mean = 0.142 ± 0.68), (p = 0.005)] and PEF [(mean = 0.83 ± 0.19), (p = 0.0031)]. There was statistically significant difference in favour of group 3 compared to group 2, by increasing the exercise intensity from 30% to 50% M.V.C., for outcomes of FVC [mean change = 0.10 ± 0.052), (p = 0.005)], FEV1/FVC [mean change = 3.18 ± 0.75), (p = 0.017)] and PEF [(mean change = 0.86 ± 0.35), (p = 0.001)] after 48 days. Isometric handgrip exercise (after 48 days at 30% to 50% M.V.C.) improves outcomes of pulmonary function capacity in adults with prehypertension. Meanwhile, duration and/or increase in intensity of the isometric effort significantly contributed to the affects attained.

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