UHPLC-HRMS/MS Chemical Fingerprinting of the Bioactive Partition from Cultivated Piper aduncum L.

Piper aduncum L. is widely distributed in tropical regions and the ethnobotanical uses of this species encompass medicinal applications for the treatment of respiratory, antimicrobial, and gynecological diseases. Chemical studies reveal a diverse array of secondary metabolites, including terpenes, flavonoids, and prenylated compounds. Extracts from P. aduncum have shown antibacterial, antifungal, and larvicidal activities. Our study explores the activity of extracts and partitions against Mycobacterium tuberculosis H37Rv, as well as the chemical diversity of the bioactive partition. This marks the first investigation of the bioactive partition of P. aduncum from agroecological cultivation. The ethyl acetate partition from the ethanolic leaf extract (PAEPL) was found to be the most active. PAEPL was subjected to column chromatography using Sephadex LH-20 and the obtained fractions were analyzed using UHPLC-HRMS/MS. The MS/MS data from the fractions were submitted to the online GNPS platform for the generation of the molecular network, which displayed 1714 nodes and 167 clusters. Compounds were identified via manual inspection and different libraries, allowing the annotation of 83 compounds, including flavonoids, benzoic acid derivatives, glycosides, free fatty acids, and glycerol-esterified fatty acids. This study provides the first chemical fingerprint of an antimycobacterial sample from P. aduncum cultivated in an agroecological system.

Centromere diversity: How different repeat-based holocentromeres may have evolved.

In addition to monocentric eukaryotes, which have a single localized centromere on each chromosome, there are holocentric species, with extended repeat-based or repeat-less centromeres distributed over the entire chromosome length. At least two types of repeat-based holocentromeres exist, one composed of many small repeat-based centromere units (small unit-type), and another one characterized by a few large centromere units (large unit-type). We hypothesize that the transposable element-mediated dispersal of hundreds of short satellite arrays formed the small centromere unit-type holocentromere in Rhynchospora pubera. The large centromere unit-type of the plant Chionographis japonica is likely a product of simultaneous DNA double-strand breaks (DSBs), which initiated the de novo formation of repeat-based holocentromeres via insertion of satellite DNA, derived from extra-chromosomal circular DNAs (eccDNAs). The number of initial DSBs along the chromosomes must be higher than the number of centromere units since only a portion of the breaks will have incorporated eccDNA at an appropriate position to serve as future centromere unit sites. Subsequently, preferential incorporation of the centromeric histone H3 variant at these positions is assumed. The identification of repeat-based holocentromeres across lineages will unveil the centromere plasticity and elucidate the mechanisms underlying the diverse formation of holocentromeres.

How diverse a monocentric chromosome can be? Repeatome and centromeric organization of Juncus effusus (Juncaceae).

Juncus is the largest genus of Juncaceae and was considered holocentric for a long time. Recent findings, however, indicated that 11 species from different clades of the genus have monocentric chromosomes. Thus, the Juncus centromere organization and evolution need to be reassessed. We aimed to investigate the major repetitive DNA sequences of two accessions of Juncus effusus and its centromeric structure by employing whole-genome analyses, fluorescent in situ hybridization, CENH3 immunodetection, and chromatin immunoprecipitation sequencing. We showed that the repetitive fraction of the small J. effusus genome (~270 Mbp/1C) is mainly composed of Class I and Class II transposable elements (TEs) and satellite DNAs. Three identified satellite DNA families were mainly (peri)centromeric, with two being associated with the centromeric protein CENH3, but not strictly centromeric. Two types of centromere organization were discerned in J. effusus: type 1 was characterized by a single CENH3 domain enriched with JefSAT1-155 or JefSAT2-180, whereas type 2 showed multiple CENH3 domains interrupted by other satellites, TEs or genes. Furthermore, while type 1 centromeres showed a higher degree of satellite identity along the array, type 2 centromeres had less homogenized arrays along the multiple CENH3 domains per chromosome. Although the analyses confirmed the monocentric organization of J. effusus chromosomes, our data indicate a more dynamic arrangement of J. effusus centromeres than observed for other plant species, suggesting it may constitute a transient state between mono- and holocentricity.

KNL1 and NDC80 represent new universal markers for the detection of functional centromeres in plants.

Centromere is the chromosomal site of kinetochore assembly and microtubule attachment for chromosome segregation. Given its importance, markers that allow specific labeling of centromeric chromatin throughout the cell cycle and across all chromosome types are sought for facilitating various centromere studies. Antibodies against the N-terminal region of CENH3 are commonly used for this purpose, since CENH3 is the near-universal marker of functional centromeres. However, because the N-terminal region of CENH3 is highly variable among plant species, antibodies directed against this region usually function only in a small group of closely related species. As a more versatile alternative, we present here antibodies targeted to the conserved domains of two outer kinetochore proteins, KNL1 and NDC80. Sequence comparison of these domains across more than 350 plant species revealed a high degree of conservation, particularly within a six amino acid motif, FFGPVS in KNL1, suggesting that both antibodies would function in a wide range of plant species. This assumption was confirmed by immunolabeling experiments in angiosperm (monocot and dicot) and gymnosperm species, including those with mono-, holo-, and meta-polycentric chromosomes. In addition to centromere labeling on condensed chromosomes during cell division, both antibodies detected the corresponding regions in the interphase nuclei of most species tested. These results demonstrated that KNL1 and NDC80 are better suited for immunolabeling centromeres than CENH3, because antibodies against these proteins offer incomparably greater versatility across different plant species which is particularly convenient for studying the organization and function of the centromere in non-model species.

Meiotic recombination dynamics in plants with repeat-based holocentromeres shed light on the primary drivers of crossover patterning.

Centromeres strongly affect (epi)genomic architecture and meiotic recombination dynamics, influencing the overall distribution and frequency of crossovers. Here we show how recombination is regulated and distributed in the holocentric plant Rhynchospora breviuscula, a species with diffused centromeres. Combining immunocytochemistry, chromatin analysis and high-throughput single-pollen sequencing, we discovered that crossover frequency is distally biased, in sharp contrast to the diffused distribution of hundreds of centromeric units and (epi)genomic features. Remarkably, we found that crossovers were abolished inside centromeric units but not in their proximity, indicating the absence of a canonical centromere effect. We further propose that telomere-led synapsis of homologues is the feature that best explains the observed recombination landscape. Our results hint at the primary influence of mechanistic features of meiotic pairing and synapsis rather than (epi)genomic features and centromere organization in determining the distally biased crossover distribution in R. breviuscula, whereas centromeres and (epi)genetic properties only affect crossover positioning locally.

Oligo-barcode illuminates holocentric karyotype evolution in Rhynchospora (Cyperaceae).

Holocentric karyotypes are assumed to rapidly evolve through chromosome fusions and fissions due to the diffuse nature of their centromeres. Here, we took advantage of the recent availability of a chromosome-scale reference genome for Rhynchospora breviuscula, a model species of this holocentric genus, and developed the first set of oligo-based barcode probes for a holocentric plant. These probes were applied to 13 additional species of the genus, aiming to investigate the evolutionary dynamics driving the karyotype evolution in Rhynchospora. The two sets of probes were composed of 27,392 (green) and 23,968 (magenta) oligonucleotides (45-nt long), and generated 15 distinct FISH signals as a unique barcode pattern for the identification of all five chromosome pairs of the R. breviuscula karyotype. Oligo-FISH comparative analyzes revealed different types of rearrangements, such as fusions, fissions, putative inversions and translocations, as well as genomic duplications among the analyzed species. Two rounds of whole genome duplication (WGD) were demonstrated in R. pubera, but both analyzed accessions differed in the complex chain of events that gave rise to its large, structurally diploidized karyotypes with 2n = 10 or 12. Considering the phylogenetic relationships and divergence time of the species, the specificity and synteny of the probes were maintained up to species with a divergence time of ~25 My. However, karyotype divergence in more distant species hindered chromosome mapping and the inference of specific events. This barcoding system is a powerful tool to study chromosomal variations and genomic evolution in holocentric chromosomes of Rhynchospora species.

Mitochondrial genome of Hancornia speciosa gomes: intergenic regions containing retrotransposons and predicted genes.

BACKGROUND: Plant mitochondrial genomes are characterized by high homologous recombination, extensive intergenic spacers, conservation in DNA sequences, and gene content. The Hancornia genus belongs to the Apocynaceae family, with H. speciosa Gomes being the sole species in the genus. It is an siganificant commercial fruit crop; however, only a number of studies have been conducted. In this study, we present the mitochondrial genome of H. speciosa and compare it with other mitochondrial genomes within the Apocynaceae family. METHODS AND RESULTS: A total of 2.8 Gb of Illumina paired-end reads were used to obtain the mitogenome, resulting in 22 contigs that were merged using 6.1 Gb of Illumina mate-pair reads to obtain a circular chromosome. The mitochondrial genome of H. speciosa is circular, containing 63 predicted functional genes, spanning a length of 741,811 bp, with a CG content of 44%. Within the mitogenome, 50 chloroplast DNA sequences, equivalent to 1.72% of the genome, were detected. However, intergenic spaces accounted for 703,139 bp (94.79% of the genome), and 287 genes were predicted, totaling 173,721 bp. CONCLUSION: This suggests the incorporation of nuclear DNA into the mitogenome of H. speciosa and self duplication. Comparative analysis among the mitogenomes in the Apocynaceae family revealed a diversity in the structure mediated by recombination, with similar gene content and large intergenic spaces.

Cholesteryl Hemiazelate Present in Cardiovascular Disease Patients Causes Lysosome Dysfunction in Murine Fibroblasts.

There is growing evidence supporting the role of fibroblasts in all stages of atherosclerosis, from the initial phase to fibrous cap and plaque formation. In the arterial wall, as with macrophages and vascular smooth muscle cells, fibroblasts are exposed to a myriad of LDL lipids, including the lipid species formed during the oxidation of their polyunsaturated fatty acids of cholesteryl esters (PUFA-CEs). Recently, our group identified the final oxidation products of the PUFA-CEs, cholesteryl hemiesters (ChE), in tissues from cardiovascular disease patients. Cholesteryl hemiazelate (ChA), the most prevalent lipid of this family, is sufficient to impact lysosome function in macrophages and vascular smooth muscle cells, with consequences for their homeostasis. Here, we show that the lysosomal compartment of ChA-treated fibroblasts also becomes dysfunctional. Indeed, fibroblasts exposed to ChA exhibited a perinuclear accumulation of enlarged lysosomes full of neutral lipids. However, this outcome did not trigger de novo lysosome biogenesis, and only the lysosomal transcription factor E3 (TFE3) was slightly transcriptionally upregulated. As a consequence, autophagy was inhibited, probably via mTORC1 activation, culminating in fibroblasts' apoptosis. Our findings suggest that the impairment of lysosome function and autophagy and the induction of apoptosis in fibroblasts may represent an additional mechanism by which ChA can contribute to the progression of atherosclerosis.

Association between attention performance and the different dimensions of DSM-5 depression symptoms.

Objective: Depressive symptoms can be assessed with self-reported questionnaires, such as the Patient Health Questionary-9 (PHQ-9). Previous studies have suggested that the PHQ-9 items can be grouped into somatic and non-somatic clusters. However, the classification of the PHQ-9 item "concentration difficulties" into somatic or non-somatic is still controversial. This controversy may be explained by difficulties experienced by subjects in accurately evaluating their attention problems. The primary objective of this study was to determine the correlation between objective attentional performance and the two clusters of depressive symptoms in hospital employees working in stressful conditions. Methods: The participants filled out the PHQ-9 to identify their depressive symptoms. Based on the PHQ-9, the somatic or non-somatic symptoms were measured without considering the question about subjective concentration difficulties. Then, a brief version of the Continuous Visual Attention Test (CVAT) was applied to assess four attentional subdomains. The CVAT is a Go/No-go task that measures number of correct responses (focused attention), number of incorrect responses (behavior-inhibition), average reaction time of correct responses (RT-alertness), and variability of reaction time (VRT-sustained attention). The entire task lasted 90 s. Correlation analyses assessed the relationships between attentional performance and the two dimensions of depressive symptoms. Results: After applying the inclusion/exclusion criteria, 359 individuals were selected. Their age ranged from 20 to 70 years (mean = 40.5, SD = 10.37), and the majority was female (67.6%). A predominance in somatic depressive symptoms was present in 231 (64%) participants, whereas 59 (16%) showed a predominance of non-somatic symptoms. Sixty-nine participants (20%) did not show any predominance. Higher somatic scores were associated with higher RTs, whereas higher non-somatic scores were related to an increase in the number of incorrect responses. Conclusion: The predominance of the somatic cluster was related to lower alertness, whereas the predominance of non-somatic cluster was associated with impulsivity/hyperactivity. This result may explain the difficulties associated with correctly classifying the item concentration difficulties. A brief attentional task can be used as an auxiliary tool to correctly identify the different dimensions of attention that are associated with different clusters of depressive symptoms.

Shaping Ability of Reciprocating and Rotary Systems After Root Canal Retreatment: a CBCT Study

Abstract The purpose of this in vitro study was to evaluate the shaping ability of reciprocating and continuous rotary systems after root canal retreatment. After preparation and root canal filling, mesial canals of 54 mandibular molars were distributed into 3 groups (n=18), according to the filling material removal and re-instrumentation protocols: WOG group - WaveOne Gold system; PTN group - ProTaper Next system; and PTU group - ProTaper Universal system. Cone-beam computed tomographic (CBCT) images acquisition of the mesial root canals was performed at different moments: (1) before instrumentation (unprepared root canals), (2) after preparation and filling, (3) after filling material removal and (4) re-instrumentation. The apical transportation (AT), centering ability (CA) and change in root canal diameter were assessed by CBCT analysis. The remaining filling material quantification was performed by radiographic examination. The statistical analyses were performed using the 3-way ANOVA, Tukey-Kramer, Kruskal-Wallis and Dunn multiple Comparison tests (p<0.05). The tested instruments did not show full CA (=1.0). PTN group had greater AT at the 5th mm in comparison with the WOG group (p<0.05). After re-instrumentation, WOG group had greater root canal diameter change at the 1st and 5th mm than PTN and PTU groups (p<0.05). There was no significant difference among groups when comparing the amount of remaining filling material after re-instrumentation (p>0.05). The tested systems provided minimal alteration in root canal morphology at the apical portion after root canal retreatment. However, WOG promoted greater change in root canal diameter.

Resumo O objetivo deste estudo in vitro foi avaliar a capacidade de modelagem de sistemas rotatórios e reciprocantes após o retratamento do canal radicular. Após o preparo e obturação do canal radicular, os canais mesiais de 54 molares inferiores foram distribuídos em 3 grupos, de acordo com os protocolos de remoção do material obturador e re-instrumentação: (n=18): grupo WOG - sistema WaveOne Gold; Grupo PTN - sistema ProTaper Next; e grupo PTU - sistema ProTaper Universal. A análise das imagens de tomografia computadorizada de feixe cônico foi realizada em diferentes momentos: (1) antes da instrumentação (canais radiculares não preparados), (2) após o preparo e obturação, (3) após a remoção do material obturador e (4) re-instrumentação. O transporte apical (TA), a capacidade de centralização (CC) e a mudança no diâmetro do canal radicular foram avaliados por análise tomográfica. A quantificação do restante do material obturador foi realizada por exame radiográfico. As análises estatísticas foram realizadas utilizando os testes de ANOVA de 3 fatores, Tukey-Kramer, Kruskal-Wallis e Comparações Múltiplas de Dunn (p<0,05). Os instrumentos não apresentaram CC perfeita (=1,0). PTN apresentou maior TA no 5º mm em comparação ao grupo WOG (p<0,05). Após a re-instrumentação, o grupo WOG apresentou maior aumento no diâmetro do canal radicular no 1° e 5° mm do que os grupos PTN e PTU. Não houve diferença significativa entre os grupos em relação à remoção do material obturador (p>0,05). Os sistemas testados proporcionaram alteração mínima na morfologia do canal radicular na porção apical após o retratamento do canal radicular. No entanto, WOG promoveu maior alteração no diâmetro do canal radicular.

Analysis of Posterior Tibial Slope as Risk Factor to Anterior Cruciate Ligament Tear / Análise da inclinação tibial posterior como fator de risco para lesão do ligamento cruzado anterior

Abstract Objective The objective of the present study was to evaluate the relationship between patients with anterior cruciate ligament (ACL) injury by indirect trauma and increased posterior tibial inclination. Methods Retrospective study, performed by analysis of medical records and digital radiographs of patients, present in a database of a tertiary orthopedic hospital. The sample consisted of two groups, the first group consisting of patients diagnosed with ACL injury by indirect trauma, and a control group matched by age. Results Each group consisted of 275 patients, whose measurements of posterior tibial inclination were measured by three specialists. It was observed that the group of patients with ACL lesion presented a significantly higher tibial slope (in degrees) than the control group in the total sample and in the subsamples stratified by gender. The best cutoff point for the first group was identified as a posterior tibial inclination ≥ 8º, achieving a sensitivity of 63.3% and a specificity of 62.5%. The first group also had a tibial slope ratio ≥ 8º (63.3%), significantly higher than the control group (37.5%), with an odds ratio of 2.8. Conclusion It was concluded that the increase of the posterior tibial inclination is associated with an increased risk for injury of the ACL by indirect trauma, mainly for values ≥ 8º.

Resumo Objetivo O objetivo do presente estudo foi avaliar a relação entre pacientes com lesão do ligamento cruzado anterior (LCA) por trauma indireto e o aumento da inclinação posterior da tíbia. Métodos Estudo retrospectivo, realizado por análise de prontuários e radiografias digitais de pacientes, presentes em banco de dados de um hospital terciário de ortopedia e traumatologia. A amostra foi composta por dois grupos, sendo o primeiro formado por pacientes com diagnóstico de lesão do LCA, por trauma indireto, e um grupo controle pareado por idade. Resultados Cada grupo foi formado por 275 pacientes, cujas medidas de inclinação tibial posterior foram aferidas por 3 especialistas. Observou-se que o grupo dos pacientes com lesão do LCA apresentou slope tibial (em graus) significativamente maior que o grupo controle na amostra total e nas subamostras estratificadas por gênero. Identificou-se como o melhor ponto de corte (cutoff) para o primeiro grupo uma inclinação tibial posterior ≥ 8º, atingindo uma sensibilidade de 63,3% e uma especificidade de 62,5%. O primeiro grupo também apresentou proporção de slope tibial ≥ 8º (63,3%), significativamente maior que o grupo controle (37,5%), com razão de chances de 2,8. Conclusão Concluiu-se que o aumento da inclinação tibial posterior está associado com um maior risco para lesão do LCA por trauma indireto, principalmente para valores ≥ 8º,

Registro Multicêntrico de Takotsubo (REMUTA) - Aspectos Clínicos, Desfechos Intra-Hospitalares e Mortalidade a Longo Prazo / Takotsubo Multicenter Registry (REMUTA) - Clinical Aspects, In-Hospital Outcomes, and Long-Term Mortality

Resumo Fundamento A síndrome de takotsubo (takotsubo) é uma forma de cardiomiopatia adquirida. Dados nacionais sobre essa condição são escassos. O Registro REMUTA é o primeiro a incluir dados multicêntricos dessa condição no nosso país. Objetivo Descrever as características clínicas, prognóstico, tratamento intra-hospitalar e mortalidade hospitalar e em 1 ano de seguimento. Métodos Estudo observacional, retrospectivo, tipo registro. Incluídos pacientes internados com diagnóstico de takotsubo ou que desenvolveram esta condição durante internação por outra causa. Os desfechos avaliados incluíram fator desencadeador, análise dos exames, uso de medicações, complicações e óbito intra-hospitalar e em 1 ano de seguimento. O nível de significância adotado foi de 5%. Resultados Foram incluídos 169 pacientes, em 12 centros no Estado do Rio de Janeiro. A idade média foi de 70,9 ± 14,1 anos e 90,5% eram do sexo feminino; 63% dos casos foram de takotsubo primário e 37% secundário. Troponina I foi positiva em 92,5% dos pacientes e a mediana de BNP foi de 395 (176,5; 1725). Supradesnivelamento do segmento ST esteve presente em 28% dos pacientes. A fração de ejeção do ventrículo esquerdo teve mediana de 40 (35; 48)%. Observamos taxa de 25,7% de ventilação mecânica invasiva e 17,4% de choque. Suporte circulatório mecânico foi utilizado em 7,7%. A mortalidade intra-hospitalar foi de 10,6% e a mortalidade ao final de 1 ano foi de 16,5%. Takotsubo secundário e choque cardiogênico foram preditores independentes de mortalidade. Conclusão Os resultados do REMUTA mostram que takotsubo não se trata de patologia benigna como se pensava, especialmente no grupo de takotsubo secundário que acarreta elevada taxa de complicações e de mortalidade. (Arq Bras Cardiol. 2020; 115(2):207-216)

Abstract Background Takotsubo syndrome (TTS) is an acquired form of cardiomyopathy. National Brazilian data on this condition are scarce. The Takotsubo Multicenter Registry (REMUTA) is the first to include multicenter data on this condition in Brazil. Objective To describe the clinical characteristics, prognosis, in-hospital treatment, in-hospital mortality, and mortality during 1 year of follow-up. Methods This is an observational, retrospective registry study including patients admitted to the hospital with diagnosis of TTS and patients admitted for other reasons who developed this condition. Evaluated outcomes included triggering factor, analysis of exams, use of medications, complications, in-hospital mortality, and mortality during 1 year of follow-up. A significance level of 5% was adopted. Results The registry included 169 patients from 12 centers in the state of Rio de Janeiro, Brazil. Mean age was 70.9 ± 14.1 years, and 90.5% of patients were female; 63% of cases were primary TTS, and 37% were secondary. Troponin I was positive in 92.5% of patients, and median BNP was 395 (176.5; 1725). ST-segment elevation was present in 28% of patients. Median left ventricular ejection fraction was 40 (35; 48)%. We observed invasive mechanical ventilation in 25.7% of cases and shock in 17.4%. Mechanical circulatory support was used in 7.7%. In-hospital mortality was 10.6%, and mortality at 1 year of follow-up was 16.5%. Secondary TTS and cardiogenic shock were independent predictors of mortality. Conclusion The results of the REMUTA show that TTS is not a benign pathology, as was once thought, especially regarding the secondary TTS group, which has a high rate of complications and mortality. (Arq Bras Cardiol. 2020; 115(2):207-216)

Effect of occlusal adjustment on postoperative pain after root canal treatment: a randomized clinical trial

Abstract The aim of this prospective, randomized, clinical study was to analyze the influence of occlusal adjustment on the prevalence of postoperative pain after endodontic treatment. Seventy-eight patients, diagnosed with symptomatic irreversible pulpitis with indication for endodontic treatment, were selected to participate in the study. The participants were randomized and divided into two groups: in the occlusal adjustment group (OAG), endodontic treatment was performed with subsequent occlusal adjustment. In the control group (CG), endodontic treatment was performed without occlusal adjustment. Treatments were performed by the same operator. Pain occurrence and intensity were recorded on two scales: the verbal rating scale (VRS) and numerical rating scale (NRS). Pain assessment was carried out by a second examiner, blinded to the experiment, 6, 24 and 72 h after endodontic treatment. Data were analyzed using Mann-Whitney, chi-squared, and Fisher's exact tests. In the occlusal adjustment group, 71.1% reported postoperative pain and 67.5% reported pain in the control group. At the 6-hour assessment, 21 individuals reported pain in the occlusal adjustment group and 24 in the control group (p=0.672). At the 24-hour assessment, 18 and 19 individuals reported pain (p=0.991) and at the 72-hour assessment, 8 and 4 reported pain (p=0.219), respectively. Occlusal adjustment did not influence the prevalence of postoperative pain of endodontically treated teeth with symptomatic irreversible pulpitis.

Resumo O objetivo deste estudo prospectivo, randomizado e clínico foi analisar a influência do ajuste oclusal na prevalência de dor pós-operatória após o tratamento endodôntico. Setenta e oito pacientes, diagnosticados com pulpite irreversível sintomática com indicação de tratamento endodôntico, foram selecionados para participar do estudo. Os participantes foram randomizados e divididos em dois grupos: no grupo de ajuste oclusal (GAO), foi realizado tratamento endodôntico com posterior ajuste oclusal. No grupo controle (GC), o tratamento endodôntico foi realizado sem ajuste oclusal. Os tratamentos foram realizados pelo mesmo operador. A ocorrência e a intensidade da dor foram registradas em duas escalas: a escala de classificação verbal (VRS) e a escala de classificação numérica (NRS). A avaliação da dor foi realizada por um segundo examinador, cego para o experimento, 6, 24 e 72 horas após o tratamento endodôntico. Os dados foram analisados utilizando testes de Mann-Whitney, qui-quadrado e exato de Fisher. No grupo de ajuste oclusal, 71,1% relataram dor pós-operatória e 67,5% relataram dor no grupo controle. Na avaliação de 6 horas, 21 indivíduos relataram dor no grupo de ajuste oclusal e 24 no grupo controle (p=0,672). Na avaliação de 24 horas, 18 e 19 indivíduos relataram dor (p=0,991) e, na avaliação de 72 horas, 8 e 4 relataram dor (p=0,219), respectivamente. O ajuste oclusal não influenciou a prevalência de dor pós-operatória após o tratamento endodôntico em dentes com pulpite irreversível sintomática.

Síndrome Cardiorrenal Aguda: Qual Critério Diagnóstico Utilizar e sua Importância para o Prognóstico? / Acute Cardiorenal Syndrome: Which Diagnostic Criterion to Use And What is its Importance for Prognosis?

Resumo A indefinição de critérios diagnósticos para síndrome cardiorrenal aguda (SCRA) impacta em diferentes resultados prognósticos. Objetivou-se avaliar os critérios diagnósticos da SCRA e o impacto no prognóstico. Procedeu-se à revisão sistemática utilizando-se a metodologia PRISMA e os critérios PICO nas bases MEDLINE, EMBASE e LILACS. A pesquisa incluiu artigos originais do tipo ensaio clínico, coorte, caso-controle e meta-análises publicados no período de janeiro de 1998 até junho de 2018. Não foi encontrada na literatura nem nas diretrizes de insuficiência cardíaca uma definição clara dos critérios diagnósticos da SCRA. O critério diagnóstico mais comumente utilizado é o aumento da creatinina sérica de pelo menos 0,3 mg/dl em relação à basal. Entretanto, existem controvérsias na definição de creatinina basal e de qual deveria ser a creatinina sérica de referência dos pacientes críticos. Esta revisão sistemática sugere que os critérios de SCRA devem ser revistos para que se inclua o diagnóstico de SCRA na admissão hospitalar. A creatinina sérica de referência deve refletir a função renal basal antes do início da injúria renal aguda.

Abstract The absence of a consensus about the diagnostic criteria for acute cardiorenal syndrome (ACRS) affects its prognosis. This study aimed at assessing the diagnostic criteria for ACRS and their impact on prognosis. A systematic review was conducted using PRISMA methodology and PICO criteria in the MEDLINE, EMBASE and LILACS databases. The search included original publications, such as clinical trials, cohort studies, case-control studies, and meta-analyses, issued from January 1998 to June 2018. Neither literature nor heart failure guidelines provided a clear definition of the diagnostic criteria for ACRS. The serum creatinine increase by at least 0.3 mg/dL from baseline creatinine is the most used diagnostic criterion. However, the definition of baseline creatinine, as well as which serum creatinine should be used as reference for critical patients, is still controversial. This systematic review suggests that ACRS criteria should be revised to include the diagnosis of ACRS on hospital admission. Reference serum creatinine should reflect baseline renal function before the beginning of acute kidney injury.

Endodontic Surgery Associated with Guided Tissue Regeneration Technique: Case Report / Cirurgia Parendodôntica Associada à Técnica de Regeneração Tecidual Guiada: Relato de Caso

Non-surgical endodontic retreatment should always be the first option for reintervention when the initial endodontic treatment fails. The surgical treatment, called periradicular surgery, will be the procedure of choice when there is no success after the conventional endodontic retreatment. The purpose of this article is to describe clinical case of endodontic surgery, associated with guided tissue regeneration (GTR). A male patient, 24 years old, was referred for endodontic surgery on tooth 12 after two unsuccessful endodontic interventions. During the surgery, osteotomy, lesion curettage, apicectomy, retrograde obturation with Mineral Trioxide Aggregate (MTA), and filling of the bone failure with lyophilized bone and reabsorbable collagen membrane were performed. After six months of follow-up, the patient did not present any type of painful symptomatology. The endodontic surgery, associated with a technique of guided tissue regeneration, was efficient to solve this clinical case. (AU)

O retratamento endodôntico não cirúrgico deve sempre ser a primeira opção de reintervenção quando o tratamento endodôntico inicial falha. Já o tratamento cirúrgico, ou cirurgia parendodôntica, será o procedimento de escolha quando não há sucesso após o retratamento endodôntico convencional. O objetivo deste artigo é descrever um caso clínico de cirurgia parendodôntica, associada à regeneração tecidual guiada (RTG). O paciente, gênero masculino, 24 anos, foi encaminhado para cirurgia parendodôntica no dente 12 após duas intervenções endodônticas sem sucesso. Durante a cirurgia foram realizadas manobras de osteotomia, curetagem da lesão, apicectomia, obturação retrógrada com Mineral Trióxido Agregado (MTA), além de preenchimento da falha óssea com osso liofilizado e membrana de colágeno reabsorvível. Após seis meses de acompanhamento do caso, o paciente não apresentou nenhum tipo de sintomatologia dolorosa. A cirurgia parendodôntica, associada à técnica de regeneração tecidual guiada, foi eficiente para solucionar este caso clínico. (AU).

Perfil das fraturas faciais em um serviço de emergência no Maranhão / Profile of facial fractures in an emergency service in Maranhão

O bjetivo: Avaliar o perfil das fraturas faciais em pacientes atendidos em serviço de emergência no estado do Maranhão. Método: Utilizou-se abordagem indutiva, com procedimento estatístico-descritivo e técnica de documentação direta, cuja amostra foi selecionada por conveniência e constituída pelos pacientes internados em decorrência de trauma facial (n = 100). Os dados foram coletados a partir dos prontuários dos pacientes que consentiram a participação na pesquisa mediante assinatura do TCLE. A análise dos dados empregada foi descritiva e inferencial (qui-quadrado; p<0,05), utilizando o software Statistical Package for Social Sciences. Resultados: O gênero masculino foi o mais acometido (63%), com a faixa etária de 19 a 30 anos (34%). Os atendimentos ocorreram frequentemente, no domingo (24%), e o acidente com motocicletas (56%) foi a principal etiologia. As principais fraturas identificadas foram na região mandibular (54%), maxilar (48%) e orbital (22%). O tratamento comumente realizado foi inclusão de miniplacas sem bloqueio intermaxilar (66%), com tempo de internação de 6-15 dias (49%). Conclusão: Houve maior prevalência de fraturas mandibulares em pessoas do gênero masculino com faixa etária jovem, sendo o acidente de motocicleta o principal fator etiológico e a ocorrência da maior parte dos casos nos finais de semana (domingo), com ingestão de bebida alcoólica... (AU)

Goal: Evaluate the profile of facial fractures in patients admitted in emergency care services in the state of Maranhão. Method: It was used na inductive approach, with a statistical-descriptive procedure and a right documentation technique, which sample was selected conveniently and constituted by the patients hospitalized because of facial trauma (n = 100). The data were collected through patients' medical reports who allowed their participating in the data research by signing the consent form. The data analysis applied was descriptive and inferential (qui-square; p<0,05), using the software Statistical Package for Social Sciences. Outcomes: the male gender was more affected (63%), with an age range from 19 to 30 years old (34%). The attendances occurred commonly on Sundays (24%) and the accident involving motorcycles (56%) was the major etiology. The main identified fractures were in the mandibular region (54%), jaw (48%) and orbital (22%). The treatment commonly performed was the application of miniplates withou intermaxillary blocking (66%), with admittance time between 6-15 days (49%). Conclusion: There was greater prevalence of mandibular fractures on male gender people in Young ages, being motorcycle accident the main etiological and the occurrence of most cases on the weekend (Sundays), involving alcoholic beverages ingestion... (AU)

Luxação extrusiva de um incisivo central Permanente jovem: relato de caso clínico / Extrusive luxation of an immature permanent central incisor: clinical case report

Objetivo: O objetivo deste artigo é apresentar o relato de um caso clínico de luxação extrusiva de dente permanente com rizogênese incompleta, onde não foi necessária a realização de intervenção endodôntica. Relato de caso: Paciente de 6 anos de idade compareceu ao serviço de urgência da Policlínica Odontológica da Universidade do Estado do Amazonas (UEA) para atendimento após queda durante atividade de lazer, apresentando traumatismo direto na boca. Foi informado durante a consulta inicial que o incidente havia ocorrido há cerca de três dias, e que o atendimento imediato logo após o trauma foi realizado em um Serviço de Pronto Atendimento, porém, nenhum tipo de procedimento na cavidade oral foi realizado. Após exames clínico e radiográfico observou-se que o dente 21 apresentava deslocamento parcial para fora do alvéolo dentário no sentido axial, com alteração da oclusão, dor local à palpação e mobilidade dentária. Foi realizada profilaxia da área afetada, e anestesia do dente luxado e tecidos adjacentes. O reposicionamento do dente foi realizado em seguida, pressionando-o e tracionando-o de forma suave e contínua até a sua correta posição dentro do alvéolo. A área afetada foi limpa com gaze estéril embebida em soro fisiológico, e foi instalada uma contenção rígida confeccionada com fio ortodôntico e resina composta. Conclusão: O reposicionamento da maneira adequada do dente traumatizado dentro do alvéolo dentário, num período de tempo hábil, seguido de sua proservação, permitiram a manutenção da vitalidade do tecido pulpar, e consequentemente, o desenvolvimento do segmento radicular.

Objective: The objective of this article is to present a clinical case of extrusive luxation of an immature permanent tooth, with no endodontic management. Case report: A 6-year-old patient was provided to emergency treatment at the State University of Amazonas, as a result of a fall, with a direct trauma to the mouth. It was informed during the initial consultation that the incidente has occurred three days after. Emergency examination had been carried out by an Emergency Service; however, any type of procedure in the oral cavity was performed in ths occasion. After clinical and radiographic examinations, it was observed that tooth 21 presented partial displacement from the alveolar socket in the axial direction, with occlusion alteration, local pain to palpation and dental mobility. Cleaning of the affected area and anesthesia of the dislocated tooth and adjacent tissues were performed. Then, tooth repositioning was performed by pressing and tracing it smoothly and continuously until its correct position within the alveolar socket. The affected area was cleaned with sterile gauze soaked in saline solution, and a rigid containment made of orthodontic wire and composite resin was installed. Conclusion: A proper repositioning of the traumatized tooth within the alveolar socket, followed by its clinical followup, allowed the pulp tissue to remain vital, and consequently, the complete development of the root portion

Effect of glide path on transportation promoted by NiTi and M-Wire instruments / Efeito do glide path no transporte promovido por instrumentos de NiTi e M-Wire

Objective: To evaluate the effect of glide path creation on transportation promoted by NiTi and M-Wire instruments. Material and Methods: Sixty polyester resin blocks containing a simulated root canal were distributed into four groups (n=15), according to the protocols/systems used for root canal preparation: GPR group - glide path + Revo-S system; R group - no glide path + Revo-S system; GPPN group - glide path + ProTaper Next system and PN group - no glide path + ProTaper Next system. Root canals were photographed before and after preparation, and the images were superimposed to evaluate the transportation at the apical, middle and coronal thirds. The time spent to perform preparation was also measured (seconds). Data were submitted to the non-parametric Kruskal-Wallis test (p0.05). GPR and R groups were similar in the middle third (p>0.05). However, the transportation value in GPR group was statistically higher in comparison with GPPN and PN groups (p0.05). Only R group presented significant difference in comparison with GPPN and PN groups (p0.05). Conclusion: None of the systems were capable of maintaining the original trajectory of the simulated root canal, and the glide path had no effect on the transportation promoted by instruments. (AU)

Objetivo: Avaliar o efeito do glide path no transporte promovido por instrumentos fabricados em NiTi e M-Wire. Material e Métodos: Sessenta blocos de resina poliéster contendo um canal simulado foram separados em quatro grupos (n=15), de acordo com os protocolos/ sistemas utilizados para realização do preparo: Grupo GPR - glide path + sistema Revo-S; Grupo R - sem glide path + sistema Revo-S; Grupo GPPN - glide path + sistema ProTaper Next e Grupo PN - sem glide path + sistema ProTaper Next. Os canais foram fotografados antes e após o preparo, e as imagens sobrepostas para avaliação do transporte nos terços apical, médio e cervical. O tempo para realização do preparo também foi mensurado (segundos). Os dados foram submetidos ao teste não-paramétrico de Kruskal-Wallis (p0,05). Os grupos GPR e R foram semelhantes no terço médio (p>0,05), entretanto, o transporte no grupo GPR foi estatisticamente maior em comparação aos grupos GPPN e P (p0,05). Somente o grupo R apresentou diferença em comparação aos grupos GPPN e PN (p0,05). Conclusão: Nenhum sistema foi capaz de manter a trajetória original do canal simulado, e o glide path não teve efeito sobre o transporte promovido pelos instrumentos.(AU)

Desvio apical promovido por sistemas rotatórios e reciprocantes: estudo piloto em canais simulados / Apical deviation promoted by rotary and reciprocating systems: pilot study in simulated canals

Objetivo: Instrumentos endodônticos de movimentos reciprocante estão entre as últimas inovações para o preparo do sistema de canais radiculares. O objetivo desse estudo piloto foi comparar o desvio apical promovido por sistemas reciprocantes e rotatório em canais simulados. Material e método: Quarenta e cinco canais simulados foram distribuídos aleatoriamente em três grupos experimentais (n=15), de acordo com o sistema utilizado para realização do preparo: Grupo PT - sistema ProTaper; Grupo RP - sistema Reciproc e Grupo WO - sistema WaveOne. O desvio apical foi avaliado por meio da análise de imagens obtidas pré e pós-instrumentação de cada canal simulado, com auxílio do programa ImageJ. Resultados: Todos os grupos apresentaram algum nível de desvio apical. O grupo PT apresentou maior desvio aos 2 mm, com diferença estatisticamente significante em relação aos demais grupos (p<0,05). Quando comparada a média dos 3 mm apicais, somente houve diferença significativa entre os grupos PT e RP (p<0,05). Conclusão: Nenhum dos sistemas testados, reciprocante ou rotatório, foi capaz de manter a posição original do forame apical após o preparo do canal simulado.

Objective: Endodontic instruments of reciprocating motion are among the latest innovations for root canal system preparation. The aim of this pilot study was to compare the apical deviation promoted by reciprocating and rotary systems in simulated canals. Methods: Forty-five simulated canals were randomly distributed into three experimental groups (n=15), according to the system used for preparation: PT group - ProTaper system; RP group - Reciproc and WO group - WaveOne system. The apical deviation was assessed by analysis of pre- and post-instrumentation images of each simulated canal, with the aid of the ImageJ software. Results: All groups presented some level of apical deviation. The PT group presented greater deviation at 2 mm, with statistically significant difference in comparison with the other groups (p<0.05). When compared the average of the final apical 3 mm, there was significant difference only between PT and RP groups (p<0.05). Conclusion: None of the tested systems, reciprocating or rotary, were able to maintain the original position of the apical foramen after preparation of the simulated canal.