Clinical study on the association between keratinized mucosa and peri-implant health when external hexagon implants are installed in the posterior region of the maxilla and mandible: a cohort study.

This study evaluated the association between keratinized mucosa (KM) and peri-implant health of external hexagon implants in the posterior region in 84 patients with 242 implants. Modified plaque index (MPI), modified sulcular bleeding index (MSBI), probing depth (PD), keratinized mucosa (KM) width, and peri-implant bone loss were evaluated. The implants were divided according to the KM: (1) absence of KM, (2) KM width >0 and <2 mm, and (3) KM width ≥2 mm. Of the 242 implants evaluated, 63 (26.0%) had no KM band, 56 (23.1%) had KM width <2 mm, and 123 (50.8%) had KM width ≥2 mm. One hundred and sixty-seven (69.0%) were used in multiple unit restorations and 75 (31.0%) in single tooth restorations; 66.9% were placed in the mandible and 33.1% in the maxilla. For single tooth and multiple unit implant restorations, MPI (P=0.069 and P=0.387, respectively), MSBI (P=0.695 and P=0.947, respectively), PD (P=0.270 and P=0.258, respectively), and mesial bone loss (P=0.121 and P=0.239, respectively) were not affected by the KM width. On the distal surface, bone loss was influenced by the absence of KM when single tooth implant restorations were used (P=0.032). No association was found between KM width and the peri-implant tissue health.

Deep-learning model for background parenchymal enhancement classification in contrast-enhanced mammography.

Background.Breast background parenchymal enhancement (BPE) is correlated with the risk of breast cancer. BPE level is currently assessed by radiologists in contrast-enhanced mammography (CEM) using 4 classes: minimal, mild, moderate and marked, as described inbreast imaging reporting and data system(BI-RADS). However, BPE classification remains subject to intra- and inter-reader variability. Fully automated methods to assess BPE level have already been developed in breast contrast-enhanced MRI (CE-MRI) and have been shown to provide accurate and repeatable BPE level classification. However, to our knowledge, no BPE level classification tool is available in the literature for CEM.Materials and methods.A BPE level classification tool based on deep learning has been trained and optimized on 7012 CEM image pairs (low-energy and recombined images) and evaluated on a dataset of 1013 image pairs. The impact of image resolution, backbone architecture and loss function were analyzed, as well as the influence of lesion presence and type on BPE assessment. The evaluation of the model performance was conducted using different metrics including 4-class balanced accuracy and mean absolute error. The results of the optimized model for a binary classification: minimal/mild versus moderate/marked, were also investigated.Results.The optimized model achieved a 4-class balanced accuracy of 71.5% (95% CI: 71.2-71.9) with 98.8% of classification errors between adjacent classes. For binary classification, the accuracy reached 93.0%. A slight decrease in model accuracy is observed in the presence of lesions, but it is not statistically significant, suggesting that our model is robust to the presence of lesions in the image for a classification task. Visual assessment also confirms that the model is more affected by non-mass enhancements than by mass-like enhancements.Conclusion.The proposed BPE classification tool for CEM achieves similar results than what is published in the literature for CE-MRI.

Wearable pulmonary monitoring system with integrated functional lung imaging and chest sound recording: a clinical investigation in healthy subjects.

Objective.Current wearable respiratory monitoring devices provide a basic assessment of the breathing pattern of the examined subjects. More complex monitoring is needed for healthcare applications in patients with lung diseases. A multi-sensor vest allowing continuous lung imaging by electrical impedance tomography (EIT) and auscultation at six chest locations was developed for such advanced application. The aims of our study were to determine the vest's capacity to record the intended bio-signals, its safety and the comfort of wearing in a first clinical investigation in healthy adult subjects.Approach.Twenty subjects (age range: 23-65 years) were studied while wearing the vests during a 14-step study protocol comprising phases of quiet and deep breathing, slow and forced full expiration manoeuvres, coughing, breath-holding in seated and three horizontal postures. EIT, chest sound and accelerometer signals were streamed to a tablet using a dedicated application and uploaded to a back-end server. The subjects filled in a questionnaire on the vest properties using a Likert scale.Main results.All subjects completed the full protocol. Good to excellent EIT waveforms and functional EIT images were obtained in 89% of the subjects. Breathing pattern and posture dependent changes in ventilation distribution were properly detected by EIT. Chest sounds were recorded in all subjects. Detection of audible heart sounds was feasible in 44%-67% of the subjects, depending on the sensor location. Accelerometry correctly identified the posture in all subjects. The vests were safe and their properties positively rated, thermal and tactile properties achieved the highest scores.Significance.The functionality and safety of the studied wearable multi-sensor vest and the high level of its acceptance by the study participants were confirmed. Availability of personalized vests might further advance its performance by improving the sensor-skin contact.

Calvarial graft resorption index in the reconstruction of the maxillary sinus in patients with atrophic maxillas: a prospective clinical study.

The objective of this study was to assess the resorption index of particulate calvarial grafts in maxillary sinuses of patients undergoing total reconstruction of an atrophic maxilla with residual alveolar bone that was less than, or equal to, 3mm thick. Twenty-one maxillary sinus floor elevations were carried out using particulate calvarial grafts in 11 individuals with totally edentulous maxillas. All patients had computed tomography (CT) before (T0), and 48hours (T1) and six months after surgery (T2). For each CT scan, linear measurements were taken of sections of the anterior, medial, and posterior regions of the maxillary sinus. There was a significant increase in the height of the maxillary sinus floor when T0 was compared with T1 (p=0.001). There was a statistically significant reduction in all maxillary sinus measurements when T1 was compared with T2; the mean height reduction being 2.36mm (16.87%) in the anterior region, 3.53mm (22.47%) in the medial region, and 2.21mm (22.78%) in the posterior region (p=0.001). Mean resorption was 20.7%. Autogenous calvarial bone used alone is an option for graft material in pneumatised maxillary sinuses and in cases where there is limited alveolar bone.

Short-term use of an exposed polypropylene barrier in the preservation of alveolar bone after extraction: randomized clinical trial.

This study was performed to evaluate the short-term preservation of alveolar bone volume with or without a polypropylene barrier and exposure of the area after extractions. Thirty posterior tooth extraction sockets were distributed randomly to a control group (n=15; extraction and suture) and a barrier group (n=15; extraction, barrier, and suture). All sutures and barriers were removed 10 days postoperatively. Cone beam computed tomography scans taken with the aid of a tomographic guide were obtained preoperatively, immediately postoperative, and at 120 days postoperative. A visual analysis of the coronal sections of the alveolus was performed, and vertical loss in the mesial, distal, buccal, and lingual bone ridges and horizontal thickness were evaluated. The mean vertical loss after extraction did not differ significantly between the control and barrier groups (Student t-test: mesial P= 0.989, buccal P= 0.997, lingual/palatal P= 0.070, distal P= 0.107). The mean vertical loss at 120 days postoperative did not differ significantly between the control (0.65 mm) and barrier (0.52 mm) groups (P> 0.05), with an effect size of 0.13 mm. At 120 days, the barrier group presented a mean resorption in thickness (0.45 mm) that was significantly lower than that in the control group (0.76 mm) (P= 0.021), with an effect size of 0.31 mm. The polypropylene barrier reduced the horizontal resorption in sockets of posterior teeth after extraction.

Identification and analysis of stable breathing periods in electrical impedance tomography recordings.

Objective. In this paper, an automated stable tidal breathing period (STBP) identification method based on processing electrical impedance tomography (EIT) waveforms is proposed and the possibility of detecting and identifying such periods using EIT waveforms is analyzed. In wearable chest EIT, patients breathe spontaneously, and therefore, their breathing pattern might not be stable. Since most of the EIT feature extraction methods are applied to STBPs, this renders their automatic identification of central importance.Approach. The EIT frame sequence is reconstructed from the raw EIT recordings and the raw global impedance waveform (GIW) is computed. Next, the respiratory component of the raw GIW is extracted and processed for the automatic respiratory cycle (breath) extraction and their subsequent grouping into STBPs.Main results. We suggest three criteria for the identification of STBPs, namely, the coefficient of variation of (i) breath tidal volume, (ii) breath duration and (iii) end-expiratory impedance. The total number of true STBPs identified by the proposed method was 294 out of 318 identified by the expert corresponding to accuracy over 90%. Specific activities such as speaking, eating and arm elevation are identified as sources of false positives and their discrimination is discussed.Significance. Simple and computationally efficient STBP detection and identification is a highly desirable component in the EIT processing pipeline. Our study implies that it is feasible, however, the determination of its limits is necessary in order to consider the implementation of more advanced and computationally demanding approaches such as deep learning and fusion with data from other wearable sensors such as accelerometers and microphones.

Polyploids require Bik1 for kinetochore-microtubule attachment.

The attachment of kinetochores to spindle microtubules (MTs) is essential for maintaining constant ploidy in eukaryotic cells. Here, biochemical and imaging data is presented demonstrating that the budding yeast CLIP-170 orthologue Bik1is a component of the kinetochore-MT binding interface. Strikingly, Bik1 is not required for viability in haploid cells, but becomes essential in polyploids. The ploidy-specific requirement for BIK1 enabled us to characterize BIK1 without eliminating nonhomologous genes, providing a new approach to circumventing the overlapping function that is a common feature of the cytoskeleton. In polyploid cells, Bik1 is required before anaphase to maintain kinetochore separation and therefore contributes to the force that opposes the elastic recoil of attached sister chromatids. The role of Bik1 in kinetochore separation appears to be independent of the role of Bik1 in regulating MT dynamics. The finding that a protein involved in kinetochore-MT attachment is required for the viability of polyploids has potential implications for cancer therapeutics.

Assessment of accessory canals of the canalis sinuosus: a study of 1000 cone beam computed tomography examinations.

The aim of this study was to verify the presence, spatial location, and calibre of the accessory canals (AC) of the canalis sinuosus by cone beam computed tomography, and their relationship to the anterior maxilla. This retrospective analysis included the scans of 1000 subjects. Parameters registered were sex, age, number of AC, presence or absence of AC with a diameter <1.0mm, AC diameter (only for AC with a diameter >1.0mm), and AC location in relation to the adjacent teeth. Males showed a statistically higher frequency of AC than females. The difference in age distribution was not statistically significant. Twenty percent of all AC presented a diameter of a least 1.0mm. The end of the AC trajectory was most frequently located palatal to the anterior maxillary teeth. All relationships analyzed here were very weak (age vs. number of AC, age vs. AC diameter, number of AC vs. sex). Overall, the results of this study showed that AC of the canalis sinuosus are a common anatomical structure in the anterior maxilla, regardless of age and sex.

Perinatal outcome comparing triplets and singleton births at a reference maternity hospital.

OBJECTIVE: The objective of the present study was to evaluate adverse perinatal outcome in a group of high order pregnancies pared with singletons by BW and GA at birth. METHODS: Data was reviewed for all admissions of triplets and quadruplets in a 7 year period. For each study neonate we selected two singleton infants to constitute a control group. Variables analyzed included: respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia, retinopathy of prematurity and periventricular leukomalacia. RESULTS: We studied a total of 128 multiple and 260 singleton infants. Mean gestational age and birth weight were similar in both groups (31.3 ± 2,5 wks e 31.5 ± 2,8 wks; 1470 ± 461 g vs 1495 ± 540 g). There was no significant difference between the groups in the majority of main morbidities. The incidence of NEC was higher in triplets (6.3 vs 0.8%, p value <0.01). Mortality was higher in singletons (9.6 vs 3.1%, p value <0.037). CONCLUSIONS: Results show that major neonatal outcomes are very similar between multiples and singletons births when paired by gestational age and birth weight. NEC remained a significant morbidity in infants born from multiple gestations after adjustment for maternal and neonatal risk factors.

Integration of Different Risk Assessment Tools to Improve Stratification of Patients with Coronary Artery Disease.

Cardiovascular disease (CVD) causes unaffordable social and health costs that tend to increase as the European population ages. In this context, clinical guidelines recommend the use of risk scores to predict the risk of a cardiovascular disease event. Some useful tools have been developed to predict the risk of occurrence of a cardiovascular disease event (e.g. hospitalization or death). However, these tools present some drawbacks. These problems are addressed through two methodologies: (i) combination of risk assessment tools: fusion of naïve Bayes classifiers complemented with a genetic optimization algorithm and (ii) personalization of risk assessment: subtractive clustering applied to a reduced-dimensional space to create groups of patients. Validation was performed based on two ACS-NSTEMI patient data sets. This work improved the performance in relation to current risk assessment tools, achieving maximum values of sensitivity, specificity, and geometric mean of, respectively, 79.8, 83.8, and 80.9 %. Additionally, it assured clinical interpretability, ability to incorporate of new risk factors, higher capability to deal with missing risk factors and avoiding the selection of a standard CVD risk assessment tool to be applied in the clinical practice.

Biosynthesis of friedelane and quinonemethide triterpenoids is compartmentalized in Maytenus aquifolium and Salacia campestris.

Maytenus aquifolium (Celastraceae) and Salacia campestris (Hippocrateaceae) species accumulate friedelane and quinonemethide triterpenoids in their leaves and root bark, respectively. Enzymatic extracts obtained from leaves displayed cyclase activity with conversion of the substrate oxidosqualene to the triterpenes, 3beta-friedelanol and friedelin. In addition, administration of (+/-)5-(3)H mevalonolactone in leaves of M. aquifolium seedlings produced radio labelled friedelin in the leaves, twigs and stems, while the root bark accumulated labelled maytenin and pristimerin. These experiments indicated that the triterpenes once biosynthesized in the leaves are translocated to the root bark and further transformed to the antitumoral quinonemethide triterpenoids.

Osteonecrosis of the femoral head treated with total hip arthroplasty without cement.

With use of porous-coated implants, total hip arthroplasty was performed in a consecutive series of thirty patients (thirty-five hips) who had a preoperative diagnosis of late-stage (Ficat and Arlet stage-III or IV) osteonecrosis of the femoral head. The patients were evaluated clinically and radiographically, and the data were recorded in a prospective manner. The average duration of follow-up was seven and one-half years (range, five to ten years). The average age of the patients at the time of the operation was thirty-two years (range, twenty-one to forty years). Signs of osseointegration of the femoral stem to the host bone were demonstrated in thirty-three hips (94 per cent). In the porous-coated hemispherical acetabular cups of these hips, an optimum bone-implant interface was identified and maintained, suggesting bone ingrowth. The rate of revision was 3 per cent (one hip) for the femoral side and 6 per cent (two hips) for the acetabular side, for an over-all rate of 6 per cent. All patients maintained a high level of activity postoperatively. There was moderate or severe remodeling of proximal femoral resorptive bone and stress-shielding in six hips (17 per cent) and osteolytic reactions in six hips. Complications were frequent (six hips) and included one deep infection; two dislocations; two instances of heterotopic ossification; and one fracture of the calcar femorale, which occurred intraoperatively. The thirty patients had a lower rate of revision and improved clinical outcomes compared with other reported series of young patients managed with total hip arthroplasty with cement who had the same diagnosis and similar postoperative follow-up. However, the latter series involved implants of an earlier design that had been inserted with older techniques of cementing. When arthroplasty is considered for the treatment of late-stage osteonecrosis of the femoral head in young patients, the use of total hip implants without cement that allow for bone ingrowth appears to be a viable alternative to arthroplasty with use of cement. However, longer follow-up is needed to determine the outcome of the osteolytic reactions that we observed. We therefore recommend this procedure with some caution because of the high rate of complications and the potential for failure of the arthroplasty related to the osteolytic reactions.

Influence of bed preparation on the incorporation of autogenous bone grafts: a study in dogs.

To study the influence of bed preparation on the incorporation of autogenous bone grafts in mandibles, 6 dogs with 3 different types of receptor bed were used: cortical, perforated, and decorticated. After 45 and 90 days, the animals were sacrificed and block sections of grafted and adjacent bone were removed. The specimens were prepared and stained with hematoxylin and eosin and Masson's trichromic. The autogenous bone grafts were integrated with the receptor bed, mainly in the perforated and decorticated groups. The poorest results were found in the cortical group.

Chemical composition and antimicrobial activity of the essential oil of Cordiaverbenacea D.C.

Cordiaverbenacea D.C. (Boraginaceae) is found along the coastal regions of Brazil, from the Amazon basin to the southernmost state of Rio Grande do Sul. The aerial parts of this plant have been used in folk medicine since colonial times for their anti-rheumatic, anti-inflammatory, analgesic and healing properties. The objectives of this study were: the extraction of the essential oil of the aerial parts of this species and quantification of the yield thereof; the identification and quantification of the principal components of the essential oil; and the determination of its antimicrobial activity by plate diffusion method. The yield of essential oil was 0.19% (v/w) in relation to the fresh flowering aerial parts and 0.23% (v/w) of the leaves. The main constituents of the essential oil, identified by gas chromatography/mass spectrometry (GC/MS), were alpha-pinene (29.69%), trans-caryophyllene (25.27%) and aloaromadendrene (9.99%). The Gram-positive bacteria and yeast tested were sensitive to the essential oil of Cordiaverbenacea D.C., but most of the Gram-negative bacteria were resistant.

Leishmaniasis phytotherapy. Nature's leadership against an ancient disease.

The use of phytotherapy to treat human diseases has its roots in pre-historical times. Despite the modern advances achieved in the field of synthetic chemistry, the most efficient drugs available have their genesis directly or indirectly related with the vegetal kingdom. Indigenous communities have long used plant extracts to treat illnesses. Many of these extracts have shown effective action, with new bioactive compounds being extracted and screened every year. These extracts have also proven to be good sources of therapeutic agents to the treatment of Leishmaniasis. This work highlights some of these agents, while trying to emphasize the importance of plants as a source of new and powerful drugs against this widespread disease.

Treatment of fibrinolytic alveolitis with rifamycin B diethylamide associated with gelfoam: a histological study.

The most common complication in the healing of extraction wounds is fibrinolytic alveolitis, which may also be termed "dry socket". Reduction in the incidence of this condition after the application of topical antibiotics and the use of systemic antibiotics has been reported. A histological study of disturbed alveolar socket healing in rats was carried out to analyze the influence of application of rifamycin B diethylamide (Rifocin M) associated or not with Gelfoam. Sixty-four male rats (Rattus norvegicus albinus, Wistar), weighing 120-150 g, were divided into 4 groups of 16 animals each. In the second group of rats which received implants of Gelfoam, there was an intense resorption of bone walls in the initial stage. The rats that received implants of Gelfoam saturated with Rifocin M (fourth group) showed better results than the second group. The third group (only irrigation with rifamycin) showed better bone formation in the alveolar socket compared to the first, second and fourth groups. Thus, these results showed that rifamycin irrigation is useful in the control of alveolar infections.

[Acute paraplegia. A rare complication of aortic dissection]. / Paraplegia aguda. uma complicação rara da dissecção aórtica.

A 67 year-old normotensive woman had a syncope followed by shock and remained anuric after hemodynamic stabilization. Paraplegia and paresis of the right upper limb, as well as signs of ischemia of the distal lower limbs were noted. The possibility of acute aortic dissection was raised and confirmed by computed tomography. The paraplegia was attributed to an ischemic infarction of the spinal cord. The patient died on the fourth hospital day due to a pericardial temponade. This rare and not well recognized complication of aortic dissection is briefly reviewed.

[General characteristics of the spermatozoa in oligozoospermic men with and without clinical varicocele]. / Características gerais dos espermatozóides em homens oligozoospérmicos com e sem varicocele clínica.

UNLABELLED: Patients with oligozoospermia show a reduction in the semen quality, independent of the etiology of the disturbance. PURPOSE: To investigate the role of the varicocele in the decrease of the semen quality in oligozoospermic men. METHODS: Ten patients with left clinical varicocele (termed PCV) and 21 patients without this entity (termed PSV) attended in a private laboratory from Petrópolis, RJ, were investigated. Sperm count, vitality, motility, and morphology of spermatozoa were examined and the results were compared between them and a control group consisting of 15 patients without clinical varicocele and with normal spermiogram. RESULTS: PCV and PSV had showed significant decrease in the vitality (43.9% and 34.9% versus 73.0% in the control group), grade (a) (5.3% and 2.4% versus 32.4% and grade (d) (76.7% and 83.8% versus 44.9%) of sperm progression and in the percentage of oval sperms (25.5% and 22.9% versus 61.2%), amorphous head (25.4% and 23.8% versus 12.5%) and other anomalies (23.8% and 30.5% versus 13.0%). PCV had also showed significant difference in the percentage of tapered sperm (10.9% versus 1.3%), whereas PSV had showed significant difference in the grade (b) of sperm motility (11.0% versus 22.0%), both in regard to the control group. Between PCV and PSV had not been found significant differences. CONCLUSION: Varicocele reduces the semen quality in oligozoospermic men, but this reduction also occurs in oligozoospermia of any etiology.

Personalization algorithms applied to cardiovascular disease risk assessment.

Cardiovascular disease (CVD) is the major cause of death in the world. Clinical guidelines recommend the use of risk assessment tools (scores) to identify the CVD risk of each patient as the correct stratification of patients may significantly contribute to the optimization of the health care strategies. This work further explores the personalization of CVD risk assessment, supported on the evidence that a specific CVD risk assessment tool may have good performance within a given group of patients and might perform poorly within other groups. Two main personalization methods based on the proper creation of groups of patients are presented: i) clustering patients approach; ii) similarity measures approach. These two methodologies were validated in a Portuguese population (460 Acute Coronary Syndrome with non-ST segment elevation (ACS-NSTEMI) patients). The similarity measures approach had the best performance, achieving maximum values of sensitivity, specificity and geometric mean of, respectively, 77.7%, 63.2%, 69.7%. These values represent an enhancement in relation to the best performance obtained with current CVD risk assessment tools applied in clinical practice (78.5%, 53.2%, 64.4%).

An effective wavelet strategy for the trend prediction of physiological time series with application to pHealth systems.

This work proposes a wavelet decomposition based scheme to estimate the evolution trend of physiological time series. The scheme does not involve the explicit development of a model and is essentially supported on the hypothesis that future evolution of a biosignal can be estimated from similar historic patterns. The strategy considers an a-trous wavelet decomposition, where the most representative trends are extracted from the historic similar patterns. Then, a set of distance-based measures able to assess the prediction likelihood of each representative trend, is introduced. From these measures and through an optimization process, a subset of these trends is selected and aggregated to derive the required time series evolution trend. The effectiveness of the methodology is validated in the prediction of blood pressure signals collected in two telemonitoring studies: TEN-HMS and MyHeart. Additionally, Friedman and Nemenyi statistics tests are implemented to rank several methods, confirming the value of the proposed strategy.