Significant Increase in Cytomegalovirus (CMV) Infection in Solid Organ Transplants Associated With Increased Use of Thymoglobulin as Induction Therapy?

BACKGROUND: Cytomegalovirus (CMV) infection remains one of the most common viral pathogens affecting solid organ transplants (SOT). In 10 years of following the outcome of transplants, we noticed an increased incidence of CMV infection, along with increased use of rabbit anti-thymocyte globulin (rATG). The study aims to assess the incidence of active CMV infection and disease, response to treatment, and recurrence in a cohort of SOT. Furthermore, we look for correlating the CMV incidence with the type of induction therapy: r-ATG or interleukin 2 receptor-blocking antibody (basiliximab). METHODS: This was a single-center, retrospective 10-year study in patients submitted to kidney, kidney-liver, and kidney-pancreas transplants who used a preemptive therapy protocol for CMV. RESULTS: Among the 476 enrolled transplant recipients, 306 (64.2 %) had at least one episode of CMV infection (replication), and 71/306 patients (23.2 %) presented CMV-related disease. The most frequent clinical conditions associated with CMV disease were gastrointestinal. Among the 476 transplant patients, 333 received immunosuppressive induction with rATG (69.9 %); 140 (29.4 %) received induction with interleukin 2 receptor-blocking antibody (basiliximab). The initial maintenance immunosuppressive therapy in the patients who presented CMV infection was primarily performed with prednisone, tacrolimus, and sodium mycophenolate (91.7 %). The induction with rATG increased from 35.2%-94.6% in 10 years. The incidence of CMV infection was 20.7 % in the first year of observation and gradually increased to 87.3 % in the last year. CONCLUSIONS: The data suggest that the increase in the use of rATG in recent years could be responsible for the very expressive increase in the incidence of CMV infection/disease.

Predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS.

OBJECTIVE: To assess predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS (RP-EBUS). METHODS: This was a retrospective review of consecutive patients undergoing RP-EBUS between February of 2012 and January of 2020. Parameters including the presence of a bronchus sign on CT scans, the position of the radial EBUS probe, lesion size, lesion location, and lesion type were analyzed in relation to two defined outcomes (final diagnosis or no diagnosis). Univariate analysis was used in order to explore the individual effects of each parameter on diagnostic accuracy. Multivariate logistic regression was performed to identify significant predictors of diagnostic accuracy. RESULTS: RP-EBUS was used for diagnostic purposes in 101 patients. The lesion was < 3 cm in size in 59 patients (58.4%) and predominantly solid in 60.3%. There was a positive correlation between radial EBUS probe position and diagnostic accuracy (p = 0.036), with 80.9% of the patients showing a bronchus sign on CT scans. Furthermore, 89% of the patients showed a bronchus sign on CT scans and a correlation with diagnostic accuracy (p = 0.030), with 65.8% of the lesions being located in the left/right upper lobe (p = 0.046). When the radial EBUS probe was within the target lesion, the diagnostic yield was = 80.8%. When the probe was adjacent to the lesion, the diagnostic yield was = 19.2%. A bronchus sign on CT scans was the only parameter that independently influenced diagnostic accuracy (adjusted OR, 3.20; 95% CI, 1.081-9.770; p = 0.036). CONCLUSIONS: A bronchus sign on CT scans is a powerful predictor of successful diagnosis by RP-EBUS.

Efeito dos diferentes tipos de polimento sobre a rugosidade de superfície de uma resina acrílica comercial quimicamente ativada: estudo in vitro / Effect of different types of polishing on the surface roughness of a chemically activated commercial acrylic resin: an in vitro study

Objetivo: avaliar in vitro o polimento sobre resina acrílica quimicamente ativada (RAQA), por meio da rugosidade de superfície (Ra). Materiais e Método: Foram confeccionadas 40 amostras de RAQA, com dimensões de 10 a 10 x 2 mm, e foram divididas em quatro grupos (n=10): ausência do acabamento (AA); Ausência de polimento (AP); Polimento químico (PQ); Polimento com borrachas siliconadas + Escovas (PM). Os espécimes foram avaliados no quanto a rugosidade média (Ra) antes e após o envelhecimento em água destilada em uma estufa por 60 dias. Três medições de Ra (µm), na horizontal foram realizadas e calculada uma média para cada espécime. Os dados foram analisados de forma descritiva e inferencial, ANOVA de medidas repetidas e teste de Tukey com nível de significância de 5%. Resultados: Inicialmente, o grupo AA teve os menores valores de Ra e o grupo AP os maiores valores de rugosidade, com média e desvio padrão respectivamente 0,17 (±0,11) e 0,52 (±0,10). Após o envelhecimento, o grupo AA teve as menores médias e o grupo PQ os maiores valores de Ra, sendo 0,38 (±0,20) e 1,33 (±0,32), respectivamente. Os resultados evidenciaram diferença estatística significante quando as amostras foram submetidas ao acabamento com brocas. Conclusão: A RAQA necessita de polimento após acabamento com brocas, uma vez que a ausência de polimento comprometerá a lisura de superfície do material.(AU)

Objective: to evaluate in vitro polishing on chemically activated acrylic resin (RAQA), using surface roughness (Ra). Materials and Method: 40 RAQA samples were made, measuring 10 to 10 x 2 mm, and divided into four groups (n=10): absence of finishing (AA); Lack of polishing (AP); Chemical polishing (PQ); Polishing with silicone rubbers + Brushes (PM). The specimens were evaluated for their average roughness (Ra) before and after aging in distilled water in an oven for 60 days. Three horizontal Ra (µm) measurements were taken and an average was calculated for each specimen. Data were analyzed descriptively and inferentially, using repeated measures ANOVA and Tukey test with a significance level of 5%. Results: Initially, the AA group had the lowest Ra values and the AP group the highest roughness values, with mean and standard deviation respectively 0.17 (±0.11) and 0.52 (±0.10). After aging, the AA group had the lowest averages and the PQ group the highest Ra values, being 0.38 (±0.20) and 1.33 (±0.32), respectively. The results showed a statistically significant difference when the samples were finished with drills. Conclusion: RAQA requires polishing after finishing with drills, as the lack of polishing will compromise the surface smoothness of the material.(AU)

Effect of different materials for temporary removable partial denture: an in vitro study on surface roughness and fracture resistance / Efeito de diferentes materiais para confecção de prótese parcial removível provisória: um estudo in vitro sobre rugosidade superficial e resistência à fratura

ABSTRACT The use of removable partial dentures is considered a common and inexpensive treatment option to rehabilitate edentulous areas. The aim of this study was to evaluate the effect of different materials for provisional removable partial dentures, an in vitro study on surface roughness and fracture resistance. Thermopolymerizable acrylic resin and thermoplastic resin specimens with dimensions of 10 x 10 x 2 mm (blocks) (n=10) and with dimensions of 65 x 20 x 3 mm (bars) (n=10 were analyzed for their surface roughness (Ra) and three-point flexural strength test. All specimens were subjected to oven aging for 60 days at 37°C±0.5°C in distilled water. The statistical analysis was performed with a significance level of 5%, and the surface roughness data were submitted to the Two-way Anova statistical test (P < 0.05) and the mechanical strength data were subjected to One-way Anova statistical test (P < 0.05). For roughness, the factor resin type (P = 0.000) and the factor aging (P = 0.000) were statically significant, as well as showing interaction (P = 0.228). The Thermopolymerizable acrylic resin had the lowest mean roughness values compared to the thermoplastic resin and showed no statistical difference after aging. The same scenario was repeated for flexural strength values; Thermopolymerizable acrylic resin was statistically superior to thermoplastic resin (P = 0.000). Thermopolymerized acrylic resin showed lower surface roughness values and higher flexural strength values compared to thermoplastic resin.

RESUMO O uso de próteses parciais removíveis é considerado uma opção de tratamento comum e de baixo custo para reabilitar áreas edêntulas. O objetivo deste estudo foi avaliar o efeito de diferentes materiais para próteses parciais removíveis provisórias, um estudo in vitro sobre rugosidade superficial e resistência à fratura. Espécimes de resina acrílica termopolimerizável e de resina termoplástica com dimensões de 10 x 10 x 2 mm (blocos) (n = 10) e de 65 x 20 x 3 mm (barras) (n = 10) foram analisados em rugosidade superficial média (Ra) e teste de resistência à flexão de três pontos. Todos os espécimes foram submetidos ao envelhecimento em estufa por 60 dias a 37 ° C ± 0,5 ° C em água destilada. A análise estatística se deu com nível de significância de 5%, e os dados de rugosidade superficial foram submetidos ao teste estatístico Anova dois fatores (P <0,05) e os dados de resistência mecânica foram submetidos ao teste estatístico Anova um fator (P <0,05). Para rugosidade, o fator tipo resina (P = 0,000) e o fator envelhecimento (P = 0,000) foram estatisticamente significantes, além de apresentar interação (P = 0,228). A resina acrílica termopolimerizável apresentou menores valores médios de rugosidade em relação à resina termoplástica e não apresentou diferença estatística após envelhecimento. O mesmo cenário foi repetido para valores de resistência à flexão; a resina acrílica termopolimerizável foi estatisticamente superior à resina termoplástica (P = 0,000). A resina acrílica termopolimerizada apresentou menores valores de rugosidade superficial e maiores valores de resistência à flexão em relação à resina termoplástica.

Predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS / Fatores preditivos de maior precisão diagnóstica com EBUS com sonda radial

ABSTRACT Objective: To assess predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS (RP-EBUS). Methods: This was a retrospective review of consecutive patients undergoing RP-EBUS between February of 2012 and January of 2020. Parameters including the presence of a bronchus sign on CT scans, the position of the radial EBUS probe, lesion size, lesion location, and lesion type were analyzed in relation to two defined outcomes (final diagnosis or no diagnosis). Univariate analysis was used in order to explore the individual effects of each parameter on diagnostic accuracy. Multivariate logistic regression was performed to identify significant predictors of diagnostic accuracy. Results: RP-EBUS was used for diagnostic purposes in 101 patients. The lesion was < 3 cm in size in 59 patients (58.4%) and predominantly solid in 60.3%. There was a positive correlation between radial EBUS probe position and diagnostic accuracy (p = 0.036), with 80.9% of the patients showing a bronchus sign on CT scans. Furthermore, 89% of the patients showed a bronchus sign on CT scans and a correlation with diagnostic accuracy (p = 0.030), with 65.8% of the lesions being located in the left/right upper lobe (p = 0.046). When the radial EBUS probe was within the target lesion, the diagnostic yield was = 80.8%. When the probe was adjacent to the lesion, the diagnostic yield was = 19.2%. A bronchus sign on CT scans was the only parameter that independently influenced diagnostic accuracy (adjusted OR, 3.20; 95% CI, 1.081-9.770; p = 0.036). Conclusions: A bronchus sign on CT scans is a powerful predictor of successful diagnosis by RP-EBUS.

RESUMO Objetivo: Avaliar fatores preditivos de maior precisão diagnóstica com EBUS com sonda radial. Métodos: Revisão retrospectiva de pacientes consecutivos submetidos a EBUS radial entre fevereiro de 2012 e janeiro de 2020. Parâmetros como a presença do sinal brônquico na TC, a posição da sonda radial de EBUS, o tamanho da lesão, a localização da lesão e o tipo de lesão foram analisados em relação a dois desfechos definidos (diagnóstico final ou sem diagnóstico). A análise univariada foi usada para explorar os efeitos individuais de cada parâmetro na precisão do diagnóstico. A regressão logística multivariada foi realizada para identificar preditores significativos de precisão diagnóstica. Resultados: O EBUS radial foi usado para fins diagnósticos em 101 pacientes. A lesão era < 3 cm em 59 pacientes (58,4%) e predominantemente sólida em 60,3%. Houve correlação positiva entre a posição da sonda radial de EBUS e a precisão do diagnóstico (p = 0,036), sendo que 80,9% dos pacientes apresentaram o sinal brônquico na TC. Além disso, 89% dos pacientes apresentaram o sinal brônquico na TC e correlação com a precisão do diagnóstico (p = 0,030), sendo que 65,8% das lesões localizavam-se no lobo superior esquerdo/direito (p = 0,046). Com a sonda radial de EBUS dentro da lesão-alvo, o rendimento diagnóstico foi de 80,8%. Com a sonda adjacente à lesão, o rendimento diagnóstico foi de 19,2%. O sinal brônquico na TC foi o único parâmetro que influenciou de forma independente a precisão do diagnóstico (OR ajustada = 3,20; IC95%: 1,081-9,770; p = 0,036). Conclusões: O sinal brônquico na TC é um poderoso preditor de diagnóstico bem-sucedido por meio de EBUS radial.

Longevity of ceramic restoring materials in the confection of endocrowns restorations: an in vitro study on surface roughness and mechanical strength / Longevidade de materiais restauradores cerâmicos na confecção de restaurações endocrowns: um estudo in vitro sobre rugosidade superficial e resistência mecânica

ABSTRACT Objectives: The objective was to evaluate the longevity of ceramic restorative materials in the manufacture of endocrown restorations, through an in vitro study on surface roughness and mechanical strength. Methods: Three restorative materials were evaluated and assigned to experimental groups (n=10 disc specimens): Leucite Reinforced Ceramic, Lithium Disilicate and Nanoceramic Resin. These restorative materials were evaluated for surface before and after aging (n=02 specimens) under a stereomicroscope. The specimens were submitted to the average surface roughness test (Ra) (n=10) in a contact roughness meter before and after aging. As well as the biaxial flexural strength test (n=10), after aging, up to a test speed of 0.5 mm/min. Aging was carried out in a thermocycler, with 5,000 cycles with baths of 5 °C ± 1 ° and 55 °C ± 1 °. Fragments after fracture were observed under a stereomicroscope. The data obtained were tabulated and analyzed using the Minitab statistical program. Results: The surfaces of the specimens do not show changes between the restorative materials and also in relation to aging. For the roughness data, the restorative material factors (p=0.867) and aging (p=0.321) were not statistically significant. The DIS group presented the highest values of fracture resistance (p=0.000), in relation to the LEU and REN groups, which were statistically similar. The same statistical pattern was identified for post-fracture fragment data (p=0.030). Conclusions: The aging factors and restorative material do not interfere with the surface roughness performance. However, the mechanical performance and number of fragments after fracture is affected by the restorative material.

RESUMO Objetivos: Objetivou-se avaliar a longevidade de materiais restauradores cerâmicos na confecção de restaurações endocrowns, através de um estudo in vitro sobre rugosidade superficial e resistência mecânica. Métodos: Três materiais restauradores foram avaliados e distribuídos em grupos experimentais (n=10 espécimes em disco): Cerâmica Reforçada por Leucita, Dissilicato de Lítio e Resina Nanocerâmica. Estes materiais restauradores foram avaliados quanto a superfície antes e após ao envelhecimento (N=2 espécimes) em estereomicroscópio. Os espécimes foram submetidos ao ensaio de rugosidade superficial média (Ra) (N=10) em rugosímetro de contato antes e após o envelhecimento. Como também, ao teste de resistência à flexão biaxial (N=10), após envelhecimento, em uma velocidade de ensaio de 0,5 mm/min. O envelhecimento foi realizado uma termocicladora, sendo 5.000 ciclos com banhos de 5 °C ± 1° e 55 °C ± 1°. Os fragmentos após fratura foram observados em estereomicroscópio. Os dados obtidos foram tabulados e analisados no programa estatístico Minitab. Resultados: As superfícies dos espécimes não mostram alterações entre os materiais restauradores e também em relação ao envelhecimento. Para os dados de rugosidade, os fatores materiais restauradores (p=0,867) e envelhecimento (p=0,321) não foram estatisticamente significativos. O grupo DIS apresentou os maiores valores de resistência à fratura (p=0,000), em relação aos grupos LEU e REN que foram estatisticamente semelhantes. O mesmo padrão estatístico foi identificado para os dados de fragmentos após a fratura (p=0,030). Conclusão: Os fatores envelhecimento e material restaurador não interferem quanto a performance da rugosidade superficial. No entanto, o desempenho mecânico e número de fragmentos após a fratura é afetado pelo material restaurador.

Overexpression of a soybean Globin (GmGlb1-1) gene reduces plant susceptibility to Meloidogyne incognita.

MAIN CONCLUSION: The overexpression of the GmGlb1-1 gene reduces plant susceptibility to Meloidogyne incognita. Non-symbiotic globin class #1 (Glb1) genes are expressed in different plant organs, have a high affinity for oxygen, and are related to nitric oxide (NO) turnover. Previous studies showed that soybean Glb1 genes are upregulated in soybean plants under flooding conditions. Herein, the GmGlb1-1 gene was identified in soybean as being upregulated in the nematode-resistant genotype PI595099 compared to the nematode-susceptible cultivar BRS133 during plant parasitism by Meloidogyne incognita. The Arabidopsis thaliana and Nicotiana tabacum transgenic lines overexpressing the GmGlb1-1 gene showed reduced susceptibility to M. incognita. Consistently, gall morphology data indicated that pJ2 nematodes that infected the transgenic lines showed developmental alterations and delayed parasitism progress. Although no significant changes in biomass and seed yield were detected, the transgenic lines showed an elongated, etiolation-like growth under well-irrigation, and also developed more axillary roots under flooding conditions. In addition, transgenic lines showed upregulation of some important genes involved in plant defense response to oxidative stress. In agreement, higher hydrogen peroxide accumulation and reduced activity of reactive oxygen species (ROS) detoxification enzymes were also observed in these transgenic lines. Thus, based on our data and previous studies, it was hypothesized that constitutive overexpression of the GmGlb1-1 gene can interfere in the dynamics of ROS production and NO scavenging, enhancing the acquired systemic acclimation to biotic and abiotic stresses, and improving the cellular homeostasis. Therefore, these collective data suggest that ectopic or nematode-induced overexpression, or enhanced expression of the GmGlb1-1 gene using CRISPR/dCas9 offers great potential for application in commercial soybean cultivars aiming to reduce plant susceptibility to M. incognita.

Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil.

OBJECTIVE: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. METHODS: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. RESULTS: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. CONCLUSION: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.

Terapia de fotobiomodulação no tratamentode lesões no nervo alveolar inferior / Photobiomodulation therapy in the treatment of inferior alveolar nerve injuries

Objetivo: Realizar uma revisão integrativa da literatura acerca da eficácia da terapia de fotobiomodulação na amenização dos distúrbios neurossensoriais e da dor em pacientes com lesões no nervo alveolar inferior. Materiais e métodos: Para a pesquisa dos artigos foram utilizadas as bases de dados MEDLINE, LILACS, BBO, IBECS e SciELO com descritores em inglês combinados com os operadores booleanos. A busca limitou-se a artigos nos idiomas inglês, português ou espanhol, publicados nos últimos 10 anos, do tipo ensaios clínicos. Revisão de literatura: Nove artigos preencheram os critérios de inclusão, sendo oito ensaios clínicos randomizados e um ensaio clínico não randomiza-do. Os melhores resultados foram observados em testes de sensibilidade geral utilizando a Escala Visual Analógica. Os estudos atestaram melhora da condição independentemen-te do tempo pós-operatório, contudo, o início antecipado da terapia trouxe maiores benefícios. Ademais, embora a maioria dos artigos tenha apontado eficácia do tratamento, notou-se grande variabilidade nos protocolos de terapia a laser. Conclusão: O emprego da terapia de fotobiomodulação é eficaz no tratamento de injúrias iatrogênicas no nervo alveolar inferior. Entretanto, mais estudos são necessários a fim de estabelecer um protocolo para o uso do laser.

Objective: Conduct an integrative review of literature on the efficacy of photobiomodulation therapy in the aestheization of sensorineural disorders and pain in patients with lesions in the inferior alveolar nerve. Materials and methods: Medline, LILACS, BBO, IBECS and SciELO databases were used to search the articles with English descriptors combined with the boolean operators. The search was limited to articles in English, Portuguese or Spanish, published in the last 10 years, of the type clinical trials. Literature review: Nine articles met the inclusion criteria, eight randomized clinical trials and one non-randomized clinical trial. The best results were observed in general sensitivity tests using the Visual Analog Scale. Studies attested to an impro-vement in the condition regardless of postoperative time, however, early initiation of therapy brought greater benefits. Furthermore, although most articles have pointed out treatment efficacy, there was great variability in laser therapy protocols. Conclusion: The use of photobiomodulation therapy is effective in the treatment of iatrogenic injuries to the inferior alveolar nerve. However, more studies are needed in order to establish a protocol for the use of laser.

Non-flooded riparian Amazon trees are a regionally significant methane source.

Inundation-adapted trees were recently established as the dominant egress pathway for soil-produced methane (CH4) in forested wetlands. This raises the possibility that CH4 produced deep within the soil column can vent to the atmosphere via tree roots even when the water table (WT) is below the surface. If correct, this would challenge modelling efforts where inundation often defines the spatial extent of ecosystem CH4 production and emission. Here, we examine CH4 exchange on tree, soil and aquatic surfaces in forest experiencing a dynamic WT at three floodplain locations spanning the Amazon basin at four hydrologically distinct times from April 2017 to January 2018. Tree stem emissions were orders of magnitude larger than from soil or aquatic surface emissions and exhibited a strong relationship to WT depth below the surface (less than 0). We estimate that Amazon riparian floodplain margins with a WT < 0 contribute 2.2-3.6 Tg CH4 yr-1 to the atmosphere in addition to inundated tree emissions of approximately 12.7-21.1 Tg CH4 yr-1. Applying our approach to all tropical wetland broad-leaf trees yields an estimated non-flooded floodplain tree flux of 6.4 Tg CH4 yr-1 which, at 17% of the flooded tropical tree flux of approximately 37.1 Tg CH4 yr-1, demonstrates the importance of these ecosystems in extending the effective CH4 emitting area beyond flooded lands. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 2)'.

Effect of the nanofilm-coated zirconia ceramic on resin cement bond strength.

Background. New surface treatments have been proposed to expand the clinical indications of zirconia prostheses. This study aimed to evaluate the effect of silica and fluorine nanofilms on zirconia ceramic on the resin cement bond strength. Methods. Zirconia blocks and discs underwent different surface treatments: untreated zirconia (CON), sandblasted, silica-coated alumina particles (30 µm) (SC), silica nanofilm (SN), and fluorine nanofilm (FN). Nanofilm deposition was performed through plasma enhanced chemical vapor deposition (PECVD). Zirconia surfaces were characterized on disks by morphology (atomic force microscopy, AFM), chemical analysis (x-ray photoelectron spectroscopy, XPS), and contact angle analysis. A silane coupling agent was applied on each treated surface, and a cylinder of resin cement was built up. Half of the specimens in each group were submitted to 6000 thermal cycles (TC). Bond strength was analyzed using the shear test, and the fractographic analysis was performed with stereomicroscopy and SEM/EDS. Statistical analysis was performed through one-way ANOVA and Tukey test in the non-aged and aged specimens. Results. Nanofilms modified the zirconia surface, which became more hydrophilic and chemically reactive. Chemical bonding between Si-O was found in SN, and FN promoted a fluorination process on the ceramic surface, converting zirconia into zirconium oxyfluoride. Specimens of the SN (TC) group failed on pre-testing. FN (TC) bond strength (3.8 MPa) was lower than SC (TC) and CON (TC) after shearing. Adhesive failure predominated in the experimental groups. Silica nanofilm failure occurred after aging. Conclusion. Silica and fluorine nanofilms deposited by PECVD did not promote effective bonding between zirconia and resin cement.

Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil

ABSTRACT Objective: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. Methods: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. Results: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. Conclusion: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.

Endocrown as a restorative strategy in endodontically treated teeth: an integrative literature review / Endocrown como estratégia restauradora em dentes tratados endodonticamente: uma revisão integrativa da literatura

ABSTRACT With the consolidation of Adhesive Dentistry and the emergence of new aesthetic restorative materials, Endocrown has been studied as a rehabilitative option for endodontically treated teeth. This is an Integrative Literature Review, based on the PICO strategy, with articles selected from the databases of PubMed and BVS, with a period of time from 2011-2021. The database search strategy included the following keywords: ("Endocrown" OR "Endocrowns" OR "Endocrown Restoration" OR "no-post buildup" OR "adhesive endodontic crowns"). Inclusion criteria for this review were laboratory studies and observational clinical studies. Exclusion criteria were clinical case studies, literature review, systematic review and meta-analysis. Furthermore, articles that addressed only intraradicular retainers or other restorative strategies were also excluded. The selection of articles was based on abstracts. 5 articles were selected for analysis, obtaining data on the endocrown in relation to the stress on the tooth structure, aging, marginal adaptation, fracture resistance, endocrown versus conventional crown and integrity of the tooth structure. The findings in the literature are not yet established regarding the integrity of the dental structure, as the supporting evidence is limited. Only 1 in vitro article showed that dental failures in endocrowns are more favorable to repair and another 2 in silico studies show lower stress distribution on enamel, dentin and cement in the same restoration. Moreover, the restorative material seems to influence the possibility of fracture for both conventional crowns and endocrown restorations.

RESUMO Com a consolidação da Odontologia Adesiva e o surgimento de novos materiais restauradores estéticos, a Endocrown vem sendo estudada como uma opção reabilitadora para dentes tratados endodonticamente. Trata-se de uma Revisão Integrativa da Literatura, baseada na estratégia PICO, com artigos selecionados nas bases de dados da PubMed e BVS, com lapso temporal de 2011-2021. A estratégia de busca nas bases de dados foi utilizando as palavras chaves: ("Endocrown" OR "Endocrowns" OR "Endocrown Restoration" OR "no-post buildup" OR "adhesive endodontic crowns"). Os critérios de inclusão nesta revisão foram estudos laboratoriais e estudos clínicos observacionais. Os critérios de exclusão foram estudos de caso clínico, revisão de literatura, revisão sistemática e metanálise. Ademais, também foram excluídos artigos que abordavam apenas retentores intrarradiculares ou outras estratégias restauradoras. A seleção dos artigos foi realizada com base nos resumos. 5 artigos foram selecionados para análise, obtendo-se dados sobre a endocrown em relação à tensão sobre a estrutura dental, envelhecimento, adaptação marginal, resistência à fratura, endocrown versus coroa convencional, integridade da estrutura dental. Os achados da literatura ainda não estão estabelecidos em relação a integridade da estrutura dental, devido às evidências de apoio serem limitadas. Apenas 1 artigo in Vitro apresentou que as falhas dentais em endocrowns são mais favoráveis ao reparo e outros 2 estudos in Silico mostram menor distribuição de tensão sobre esmalte, dentina e cemento na mesma restauração. Além disso, o material restaurador parece influenciar a possibilidade de fratura tanto para as coroas convencionais quanto para as restaurações do tipo endocrowns.

Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil.

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.

Strategies to optimize the practice of dental impression during the Covid-19 pandemic / Estratégias para otimizar a prática da impressão dental durante a pandemia do Covid-19

ABSTRACT The Covid-19 is a global health threatening pandemic, so dental surgeons need to look for strategies to perform dental care safely for the patient, the dental professional himself, and the dental team. The goal is to design strategies to optimize dental impression practice during the Covid-19 pandemic. The strategies that optimize dental impression practice during the pandemic are to adopt the digital fingerprint workflow. If necessary, a conventional impression technique that favors the professional's performance, select the impression material that is easy to decontaminate and affinity for the professional; the plaster leak must be performed still inside the dental office, and then the disinfection of the plaster model must be previously sent to the prosthesis laboratory.

RESUMO A Covid-19 é uma pandemia que ameaça de saúde global, assim os cirurgiões-dentistas necessitam buscar estratégias para realizar o atendimento odontológico de forma segura para paciente, próprio profissional e equipe odontológica. Objetiva-se traçar estratégias que otimize a prática da impressão dental durante a pandemia da Covid-19. As estratégias que otimizam a prática da impressão dental, durante a pandemia, são adotar o fluxo de trabalho digital através da impressão digital. Caso necessário a impressão convencional, uma técnica de impressão que favoreça o desempenho do profissional, selecionar o material de moldagem de fácil descontaminação e de afinidade pelo profissional; o vazamento do gesso deve ser realizado ainda dentro do consultório odontológico, e em seguida a desinfecção do modelo em gesso previamente ser enviado ao laboratório de prótese.

Influence of fibromucosa height and loading on the stress distribution of a total prosthesis: a finite element analysis / Influência da altura da fibromucosa e carregamento na distribuição de tensões de prótese total: análise por elementos finitos

Purpose: To evaluate the effect of fibromucosa height on the stress distribution and displacement of mandibular total prostheses during posterior unilateral load, posterior bilateral load and anterior guidance using the finite element analysis (FEA). Material and methods: 3D virtual models were made to simulate the stress generated during different mandibular movements in a total prosthesis. The contacts were simulated according to the physiology, being considered perfectly bonded between cortical and medullar bones; and between cortical bone and mucosa. Non-linear frictional contact was used for the total prosthesis base and fibromucosa, allowing the prosthesis to slide over the tissue. The cortical bone base was fixed and the 100 N load was applied as unilateral load, posterior bilateral load and anterior guidance simulation. The required results were for maximum principal stress (MPa), microstrain (mm/mm) and total displacement (mm). The numerical results were converted into colorimetric maps and arranged according to corresponding scales. Results: The stress generated in all situations was directly proportional to the fibromucosa height. The maximum principal stress results demonstrated greater magnitude for anterior guidance, posterior unilateral and posterior bilateral, respectively. Only posterior unilateral load demonstrated an increase in bone microstrain, regardless of the fibromucosa height. Prosthesis displacement was lower under posterior bilateral loading. Conclusion: Posterior bilateral loading is indicated for total prosthesis because it allows lower prosthesis displacement, lower stress concentration at the base of the prosthesis and less bone microstrain. (AU)

Objetivo: Avaliar o efeito da altura da fibromucosa na distribuição de tensões e deslocamento das próteses totais mandibulares durante a carga unilateral posterior, carga bilateral posterior e orientação anterior usando a análise por elementos finitos (FEA). Material e métodos: Modelos virtuais 3D foram confeccionados para simular a tensão gerada durante diferentes movimentos mandibulares em uma prótese total. Os contatos foram simulados de acordo com a fisiologia, sendo considerados perfeitamente unidos entre os ossos corticais e medulares; e entre o osso cortical e a mucosa. O contato friccional não linear foi utilizado entre a base total da prótese e a fibromucosa, permitindo que a prótese deslizasse sobre o tecido. A base do osso cortical foi fixada e a carga de 100 N aplicada como carga unilateral, carga bilateral posterior e simulação de guia incisiva anterior. Os resultados foram calculados em tensão máxima principal (MPa), microdeformação (mm/mm) e deslocamento total (mm). Os resultados numéricos foram convertidos em mapas colorimétricos e organizados de acordo com as escalas correspondentes. Resultados: A tensão gerada em todas as situações foi diretamente proporcional à altura da fibromucosa. Os resultados de tensão máxima principal demonstraram maior magnitude durante a carga anterior, posterior unilateral e posterior bilateral, respectivamente. Apenas a carga unilateral posterior demonstrou aumento da microdeformação óssea, independente da altura da fibromucosa. O deslocamento da prótese foi menor sob carga bilateral posterior. Conclusão: A carga bilateral posterior é indicada para prótese total, pois permite menor deslocamento da prótese, menor concentração de tensões na base da prótese e menor microdeformação óssea (AU)

Strategies to optimize the practice of dental impression during the Covid-19 pandemic / Estratégias para otimizar a prática da impressão dental durante a pandemia do Covid-19

ABSTRACT The Covid-19 is a global health threatening pandemic, so dental surgeons need to look for strategies to perform dental care safely for the patient, the dental professional himself, and the dental team. The goal is to design strategies to optimize dental impression practice during the Covid-19 pandemic. The strategies that optimize dental impression practice during the pandemic are to adopt the digital fingerprint workflow. If necessary, a conventional impression technique that favors the professional's performance, select the impression material that is easy to decontaminate and affinity for the professional; the plaster leak must be performed still inside the dental office, and then the disinfection of the plaster model must be previously sent to the prosthesis laboratory.

RESUMO A Covid-19 é uma pandemia que ameaça de saúde global, assim os cirurgiões-dentistas necessitam buscar estratégias para realizar o atendimento odontológico de forma segura para paciente, próprio profissional e equipe odontológica. Objetiva-se traçar estratégias que otimize a prática da impressão dental durante a pandemia da Covid-19. As estratégias que otimizam a prática da impressão dental, durante a pandemia, são adotar o fluxo de trabalho digital através da impressão digital. Caso necessário a impressão convencional, uma técnica de impressão que favoreça o desempenho do profissional, selecionar o material de moldagem de fácil descontaminação e de afinidade pelo profissional; o vazamento do gesso deve ser realizado ainda dentro do consultório odontológico, e em seguida a desinfecção do modelo em gesso previamente ser enviado ao laboratório de prótese.

Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.

EBUS-TBNA versus surgical mediastinoscopy for mediastinal lymph node staging in potentially operable non-small cell lung cancer: a systematic review and meta-analysis.

OBJECTIVE: Lung cancer (LC) is one of the leading causes of death worldwide. Accurate mediastinal staging is mandatory in order to assess prognosis and to select patients for surgical treatment. EBUS-TBNA is a minimally invasive procedure that allows sampling of mediastinal lymph nodes (LNs). Some studies have suggested that EBUS-TBNA is preferable to surgical mediastinoscopy for mediastinal staging of LC. The objective of this systematic review and meta-analysis was to compare EBUS-TBNA and mediastinoscopy in terms of their effectiveness for mediastinal LN staging in potentially operable non-small cell lung cancer (NSCLC). METHODS: This was a systematic review and meta-analysis, in which we searched various databases. We included studies comparing the accuracy of EBUS-TBNA with that of mediastinoscopy for mediastinal LN staging in patients with NSCLC. In the meta-analysis, we calculated sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. We also analyzed the risk difference for the reported complications associated with each procedure. RESULTS: The search identified 4,201 articles, 5 of which (with a combined total of 532 patients) were selected for inclusion in the meta-analysis. There were no statistically significant differences between EBUS-TBNA and mediastinoscopy in terms of the sensitivity (81% vs. 75%), specificity (100% for both), positive likelihood ratio (101.03 vs. 95.70), or negative likelihood ratio (0.21 vs. 0.23). The area under the summary ROC curve was 0.9881 and 0.9895 for EBUS-TBNA and mediastinoscopy, respectively. Although the number of complications was higher for mediastinoscopy, the difference was not significant (risk difference: -0.03; 95% CI: -0.07 to 0.01; I2 = 76%). CONCLUSIONS: EBUS-TBNA and mediastinoscopy produced similar results for mediastinal staging of NSCLC. EBUS-TBNA can be the procedure of first choice for LN staging in patients with NSCLC.

Coronavirus Disease 2019 and the Myocardium. / Doença de Coronavírus-19 e o Miocárdio.

Infection with the coronavirus known as COVID-19 has promoted growing interest on the part of cardiologists, emergency care specialists, intensive care specialists, and researchers, due to the study of myocardial involvement based on different clinical forms resulting from immunoinflammatory and neurohumoral demodulation.Myocardial involvement may be minimal and identifiable only by electrocardiographic changes, mainly increased cardiac troponins, or, on the other side of the spectrum, by forms of fulminant myocarditis and takotsubo syndrome.The description of probable acute myocarditis has been widely supported by the observation of increased troponin in association with dysfunction. Classical definition of myocarditis, supported by endomyocardial biopsy of inflammatory infiltrate, is rare; it has been observed in only one case report to date, and the virus has not been identified inside cardiomyocytes.Thus, the phenomenon that has been documented is acute myocardial injury, making it necessary to rule our obstructive coronary disease based on increased markers of myocardial necrosis, whether or not they are associated with ventricular dysfunction, likely associated with cytokine storms and other factors that may synergistically promote myocardial injury, such as sympathetic hyperactivation, hypoxemia, arterial hypotension, and microvascular thrombotic phenomena.Systemic inflammatory and myocardial phenomena following viral infection have been well documented, and they may progress to cardiac remodeling and myocardial dysfunction. Cardiac monitoring of these patients is, therefore, important in order to monitor the development of the phenotype of dilated myocardiopathy.This review presents the main etiological and physiopathological findings, a description of the taxonomy of these types of cardiac involvement, and their correlation with the main clinical forms of the myocardial component present in patients in the acute phase of COVID-19.