The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study.

The hepatitis E virus is a major etiological agent of chronic hepatitis in immunosuppressed individuals. Seroprevalence in the liver transplantation setting varies according to the seroprevalence of the general population in different countries. This was a prospective cohort study of liver transplant recipients in southeastern Brazil. Recipients were systematically followed for one year, with the objective of determining the prevalence, incidence, and natural history of HEV infection in this population. We included 107 liver transplant recipients and 83 deceased donors. Positivity for anti-HEV IgG was detected in 10.2% of the recipients and in 9.7% of the donors. None of the patients tested positive for HEV RNA at baseline or during follow-up. There were no episodes of reactivation or seroconversion, even in cases of serological donor-recipient mismatch or in recipients with acute hepatitis. Acute and chronic HEV infections seem to be rare events in the region studied. That could be attributable to social, economic, and environmental factors. Our data indicate that, among liver transplant recipients, hepatitis E should be investigated only when there are elevated levels of transaminases with no defined cause, as part of the differential diagnosis of seronegative hepatitis after transplantation.

Diagnostic accuracy of paranasal sinus measurements on multislice computed tomography for sex estimation: A systematic review, meta-analysis, and meta-regression.

This systematic review aimed to answer the question, "Are paranasal measurements obtained with multislice computed tomography able to accurately estimate sex?" This PROSPERO-registered systematic review included six databases and gray literature. Meta-analysis of linear and volumetric data was performed using a random-effects model, mean differences (MDs), and inverse variance. The QUADAS-2 tool-related risk of bias (RoB) and certainty evidence (GRADE approach) were assessed. A total of 1651 articles were initially selected from the main electronic databases for title and abstract screening. After removing duplicates and studies that did not meet the inclusion criteria, 18 studies were eligible for the meta-analysis. The screened studies included 2507 computed tomography of non-pathologic paranasal sinuses of adults aged between 18 and 40 years. Frontal sinus (FS) width (-4.89 mm; p < 0.00001) and maxillary sinus (MS) height (-3.73 mm; p < 0.00001) showed the greatest MD between females and males. Regarding volume, the MD was significant (p < 0.00001) in both paranasal sinuses (-3.01 and -1.04 cm3 , respectively). The best sensitivity (ability to identify males) and specificity (ability to identify females) were found for the anteroposterior (72.3%) and intermaxillary (69%) MS distances, respectively. In general, all studies exhibited low RoB and applicability concerns. The certainty of the evidence was categorized as very low to moderate. Both paranasal sinuses were shown to be dimorphic structures, which could be valuable tools for forensic identification using the FS width and MS anteroposterior distance measurements. However, heterogeneity among studies must be considered.

Galactomannan of Delonix regia seeds modulates cytokine expression and oxidative stress eliciting anti-inflammatory and healing effects in mice cutaneous wound.

The galactomannans property of forming viscous solutions, along with the traditional use of Delonix regia as anti-inflammatory, antinociceptive and wound healing, justify the investigation of the healing mechanism of Delonix regia galactomannan (GM-DR) in a model of excisional cutaneous wound. GM-DR (% 0.01-1) was topically applied to the wounds of female Swiss mice during 14 days. The wound healing effect of GM-DR was evaluated by the following parameters: wound closure and clinical signs (hyperemia, edema and exudate by macroscopy, nociception by analgesimetry), oxidative stress markers (malondialdehyde - MDA, reduced glutathione - GSH) by ELISA, histopathological (HE and Picrosirius red), and histomorphometric (collagenesis, blood vessels, polymorphonuclear, mononuclear, fusiform cells) and immunohistochemistry (inflammatory and growth factor mediators) by tissue microarrayer. GM-DR reduced wound area (7-14th day) and hypernociception (6 h - 5th day), leukocyte infiltration (2 -7th days), expression and levels of IL-1ß (2th day), IL-6 (2th day), MDA (44% - 2th day), and increased fusiform cells, granulation tissue, collagen deposition, GSH (25 - 50%, 2-5th day), expression of the transforming growth factor beta (TGF-ß) (7-10th day) and smooth muscle alpha actin (α-SMA) (7-14th day). In conclusion, GM-DR accelerates the mice healing process acting both in the inflammatory and proliferative phases.

Bone morphogenetic proteins in biomineralization of two endodontic restorative cements.

To assess the effect of biodentine (BD) and MTA-angelus (MTA) on biocompatibility, BMP2, BMP4, and osteocalcin (OC) expression. Subcutaneously implanted tubes of four groups (MTA, BD, Control, and Sham) were kept over 15, 30, and 60 days; histological analyses were performed using H&E and Von Kossa; ELISA quantified IL-1ß and IL-8 expression; and qRT-PCR verified gene expression of BMPs and OC. Sham showed slight changes in profile/intensity of inflammatory infiltrate in all periods. Control had an inflammatory score significantly higher than Sham at 15 days (p < .05). BD revealed a similar inflammatory response to Sham, without significant changes over periods. MTA group exhibited an increase in chronic inflammatory profile at 30 days, with significant reduction at 60 days, when compared to Sham (p < .05). At 30/60 days, experimental groups presented birefringent areas. At 30/60 days, BD and MTA significantly increase IL-1ß compared to Control, whereas an increase in IL-8 was observed only in BD. At 30/60 days, BD produces an expression of BMP2 whereas MTA influenced BMP4 and OC. Materials tested are biocompatible and they have osteoinductive activity; the materials influenced the expression of the tested mediators differently, suggesting different affinities with the substrate and the dental substrates.

Evaluation of Usability, Perception of Usefulness, and Efficiency of an Application in Interpreting Imaging Examinations and Supporting Decision-Making in Orthopedics.

Background: Medical smartphone applications have rendered positive results in daily practice and also serve as potentially valuable educational tools. In orthopedics, radiograph analysis and angle measurements comprise an essential mechanism in the diagnosis, treatment, planning, and evaluation of the results in orthopedic surgery. Purpose: Thus, the present study aimed to evaluate an application for mobile devices for orthopedic doctors and orthopedic residents. The application proposes the analysis and interpretation of radiographic imaging examinations through assessments and angle measurements. In this survey, we analyzed the parameter usability and usefulness of a mobile application for the iOS system, in addition to conducting its validation. Patients and Methods: The application was tested by 26 volunteers: 13 orthopedists and 13 orthopedic residents. Results: After applying the System Utility Score (SUS) questionnaire, which assesses the usability of an application, a score of 84.5 was obtained, a value that represents an A+ rating on the Sauro and Lewis scale. There was no statistically significant difference when comparing the SUS between the orthopedic residents and orthopedists. According to the usefulness perception analysis, 90% of the residents responded positively to the questions, while among orthopedists, the percentage was 75%, denoting a statistically significant difference (p = 0.002). Subsequently, the application underwent validation to assess whether the calculated angle measurements were reliable when compared with those obtained using the goniometer. No significant differences were observed when comparing the angles measured by the two evaluated methods. Conclusion/Clinical Relevance: In conclusion, the developed application can reliably contribute to the measurement of angles in radiographs, assisting in therapeutic decision-making, and may be used as an instrument to promote the teaching and learning processes in orthopedics.

Electronic von Frey as an objective assessment tool for oxaliplatin-induced peripheral neuropathy: A prospective longitudinal study.

OBJECTIVE: There is wide discrepancy on how to perform clinical assessment of oxaliplatin-induced peripheral neuropathy. In this scenario, the Electronic von Frey (EVF), which evaluates pain objectively based upon mechanical pain thresholds (MPTs), may be a valuable tool. The present study aims to quantify hyperalgesia in the hands and feet of patients treated with oxaliplatin and to propose a novel method to classify the degree of neurotoxicity using EVF-derived measures as cut-off points. METHODS: This is a prospective cohort study including 46 patients treated for colorectal cancer with the FLOX regimen. Before each oxaliplatin administration, patients were evaluated with the Acute and Chronic Neuropathy Questionnaire, Oxaliplatin-Specific Neurotoxicity Scale and National Cancer Institute Common Terminology Criteria for Adverse Events scale. Also, objective pain assessment with the EVF was performed. RESULTS: For both upper and lower extremities, EVF was shown to correlate well with patients' symptoms and functional impairment, as assessed by subjective scales. Also, when cut-off MPT variations were determined for diagnosis of neurotoxicity grade 2 or 3, the method showed good sensitivity and specificity. CONCLUSION: Electronic von Frey is a noninvasive and easy-to-perform objective method with potential to supplement the current assessment tools for oxaliplatin-induced peripheral neuropathy, which are mostly subjective.

Meningiomas and the tumor microenvironment: expression of PD-L1 and expression of PD-L1 and interferon-gamma in the prognosis / Meningiomas e microambiente tumoral: expressão de PD-L1 e interferon gama no prognóstico

ABSTRACT Introduction: Meningiomas are the most common intracranial tumors in adults. One of the mechanisms used by tumor cells to escape death by immune cells is to interfere with immunological checkpoints, thereby preventing the establishment of adequate immune response. Following this concept, a promising target for an immunomodulatory therapy is blocking programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1 axis), which is known to be crucial for immune escape mechanisms. Interferon-gamma (IFN-γ) is related to PD-L1 expression, produced by activated T cells, and may promote hyper-regulation of PD-L1 expression in tumor cells. Methods: The retrospective cross-sectional cohort study analyzed 93 patients diagnosed with meningioma of different degrees, and immunohistochemical reactions of PD-L1 and IFN-γ proteins were performed. Results: This study did not detect PD-L1 immunoexpression in any of the 93 analyzed cases. The PD-L1 expression in meningioma cells and their potential role in local immunosuppression are not fully established and their indication for anti-PD-L1 therapy as an alternative treatment for meningiomas is still controversial. Conclusion: IFN-γ immunoexpression was related to lower rates of tumor recurrence and longer progression-free survival time; there was also a relationship with the absence of pleomorphism, better differentiation and lower tumor grade for this marker.

RESUMEN Introducción: Los meningiomas son los tumores intracraneales más comunes en personas adultas. Uno de los mecanismos utilizados por células tumorales para escapar de la muerte es interferir con los puntos de control inmunológicos, impidiendo así el establecimiento de una respuesta inmunitaria adecuada. Siguiendo este concepto, un objetivo prometedor para una terapia inmunomoduladora es el bloqueo del eje de la proteína de muerte celular programada 1 (PD-1)/ligando 1 de muerte celular programada (PD-L1), que es conocido por ser crucial para los mecanismos de escape inmune. El interferón gamma (IFN-γ) se relaciona con la expresión de PD-L1, es producido por células T activadas y puede promover la hiperregulación de la expresión de PD-L1 en células tumorales. Métodos: El estudio de cohorte transversal retrospectivo analizó a 93 pacientes diagnosticados con meningioma de grados variables; se realizaron reacciones inmunohistoquímicas de las proteínas PD-L1 y del IFN-γ. Resultados: Este estudio no detectó inmunoexpresión de PD-L1 en ningún de los 93 casos analizados. La expresión de PD-L1 en células de meningioma y su función potencial en la inmunosupresión local no están totalmente establecidas, y su indicación de terapia anti-PD-L1 como tratamiento alternativo para meningiomas aún es controvertida. Conclusión: La inmunoexpresión de IFN-γ se relacionó con bajas tasas de recidiva tumoral y más tiempo de supervivencia libre de enfermedad, y se constató relación con ausencia de pleomorfismo, mejor diferenciación y grado tumoral más bajo para este marcador.

RESUMO Introdução: Os meningiomas são os tumores intracranianos mais comuns em adultos. Um dos mecanismos utilizados por células tumorais para escapar da morte por células imunes é interferir em checkpoints imunológicos, impedindo, assim, o estabelecimento de resposta imune adequada. Seguindo esse conceito, um alvo promissor para uma terapia imunomoduladora é o bloqueio do eixo de morte celular programada 1 (PD-1)/ligante de morte celular programada 1 (PD-L1), conhecido por ser crucial para mecanismos de escape imune. O interferon gama (IFN-γ) se relaciona com a expressão de PD-L1, sendo produzido por células T ativadas; pode promover a hiper-regulação da expressão de PD-L1 em células tumorais. Métodos: Estudo de coorte transversal retrospectivo que analisou 93 pacientes diagnosticados com meningioma de diversos graus. Reações imuno-histoquímicas das proteínas PD-L1 e do IFN-γ foram realizadas. Resultados: Este estudo não detectou imunoexpressão de PD-L1 em nenhum dos 93 casos analisados. A expressão de PD-L1 em células de meningioma e seu papel potencial na imunossupressão local não estão totalmente estabelecidos, e a indicação de terapia anti-PD-L1 como tratamento alternativo para meningiomas ainda é controversa. Conclusão: A imunoexpressão de IFN-γ relacionou-se com menores taxas de recidiva tumoral e maior tempo de sobrevida livre de progressão de doença. Constatou-se ainda relação com ausência de pleomorfismo, melhor diferenciação e menor grau tumoral para este marcador.

Effect of beverage solutions and toothbrushing on the surface roughness, microhardness, and color stainability of a vitreous CAD-CAM lithium disilicate ceramic.

STATEMENT OF PROBLEM: Computer-aided design and computer-aided manufacturing (CAD-CAM) has enhanced the physicomechanical stability of ceramics. However, various factors in the oral cavity may impair the longevity of restorations by negatively affecting their properties. Appropriate surface treatments such as glaze application or mechanical polishing are necessary to diminish these effects. PURPOSE: The purpose of this in vitro study was to evaluate the influence of common beverages and toothbrushing on the surface roughness, microhardness, and color stainability of a vitreous CAD-CAM lithium disilicate ceramic with a glazed or mechanically polished surface. MATERIAL AND METHODS: Specimens (N=160) were divided into 2 groups according to the surface treatment method: polishing with abrasive disks or glaze application. Each group was subdivided (n=8) according to the immersion solution and toothbrushing: distilled water and distilled water plus brushing; coffee and coffee plus brushing; black tea and black tea plus brushing; red wine and red wine plus brushing; and cola and cola plus brushing. Before and after simulating a 5-year period of immersion and toothbrushing, a contact profilometer and a Vickers microhardness tester were used to measure the surface roughness and microhardness. CIELab parameters were assessed by using a portable spectrophotometer, and color differences were calculated by using the CIEDE2000 formula (ΔE00). Data were compared by using 3-way ANOVA/Bonferroni test for post hoc analysis (α=.05). RESULTS: Surface roughness increased irrespective of solution (P=.763), being influenced by surface treatment (P<.001), with the glazed groups presenting higher values. Microhardness decrease was influenced by solutions (P<.038) and surface treatment (P<.001), and glazing was associated with lower values. Irrespective of the surface treatment, color stainability was influenced by solutions (P<.001), with ΔE00 values for red wine being above the perceptibility threshold (ΔE00>1.30). No influence of toothbrushing was found for any parameter (P>.05). CONCLUSIONS: Despite its excellent mechanical properties, CAD-CAM lithium disilicate ceramic degraded after exposure to commonly consumed beverages. Irrespective of surface treatment, beverages decreased microhardness and caused color changes. Surface roughness increased, showing higher variation for glazed groups. Toothbrushing was unable to potentiate or diminish the observed effects. In general, the results showed that proper mechanical polishing can produce a surface with desirable properties.

Development and Evaluation of a Mobile Oral Health Application for Preschoolers.

Background:Dental caries comprises the most prevalent chronic disease in children worldwide and is considered a public health problem.Introduction:Few educational oral health applications, directed to the preschool public, are available. The present study aimed at developing an educational game in application format for mobile devices and tested its usability.Materials and Methods:Forty-three children were randomly selected to participate in the study. The methodology used in the development of the application was based on an interactive children's book flux design. The application was elaborated for the Android™ and iOS™ platforms. To evaluate usability, a test method composed of observation and interview surveying was used, and the measuring mechanism consisted of the User's Success Rate. The sample (N = 43) was randomly composed of preschool students (3-5 years of age) from a public school in Brazil.Results:In the effectiveness tests, the success rates of the Story and Game Menus were 97.6% and 85.3%, respectively. In the efficiency tests, the respective rates were 80.2% and 82.1%. The satisfaction evaluation rate was 99.7%.Discussion:The game "Put the healthy food into the mouth" showed to be difficult in utilization due to the children's lack of knowledge concerning healthy foods (p < 0.001 and 95% confidence interval). Three year olds demonstrated a greater requirement for assistance during navigation.Conclusions:The application was successful regarding the following three assessed attributes: (1) effectiveness, (2) efficiency, and (3) satisfaction. However, dietary education was observed to be necessary for the children and their guardians.

Avaliação da relação entre procedimentos odontológicos e comportamento infantil / Evaluation of the dental procedures and child behavior

Objetivo: Avaliar se existe relação entre os diferentes procedimentos odontológicos e o comportamento infantil. Material e método: Em crianças com idade entre oito e dez anos, pacientes da Clínica de Odontopediatria do Curso de Odontologia da Universidade Federal do Ceará foram utilizados para aferição de dor e desconforto: o questionário CFSS-DS, a classificação de Frankl, a Escala Visual Analógica, a Escala SOM, a Escala de Ansiedade da Face, e aferição dos batimentos cardíacos da criança. A amostra foi estratificada de acordo os procedimentos clínicos, grupo 1: procedimentos invasivos e grupo 2: procedimentos não invasivos. Resultados: No questionário CFSS-DS a amostra ficou caracterizada como de pouco medo para os dois grupos. Foi encontrado maior desconforto para procedimentos invasivos na Escala Analógica Facial, Escala Analógica Visual e Escala SOM. Por outro lado não foi encontrado um padrão para os batimentos cardíacos dentro de cada grupo. Verificou-se que não há grande diferença entre procedimentos invasivos e procedimentos não invasivos do ponto de vista comportamental da criança. Pois, nos parâmetros utilizados, como: Batimentos Cardíacos, Escala Visual Analógica, Escala Analógica Facial Depois e Escala SOM, houve uma sensação de desconforto em ambos os procedimentos. Percebe-se então, a necessidade constante da utilização de técnicas de controle e condicionamento comportamental e psicológico para a realização do atendimento ao paciente pediátrico.

Objective: To evaluate whether there is a relationship between the different dental procedures and child behavior. Methods: In children aged eight and ten, patients of the Clinic of Pediatric Dentistry of the Federal University of Ceará Dentistry Course were used to measure pain and discomfort: the CFSS-DS questionnaire, the Frankl classification, the scale Visual Analog, Scale SOM, the Face Anxiety Scale, and measurement of the child's heartbeat. The sample was stratified by clinical procedures, group 1: invasive procedures and group 2: non-invasive procedures. Results: In the CFSS-DS questionnaire sample was characterized as little scared for both groups. It found greater discomfort for invasive procedures in Facial Analogue Scale, Visual Analogue Scale and Scale SOM. On the other hand it was not found a pattern to the heartbeat within each group. Conclusion: It was found that no great difference between invasive and non-invasive procedures behavioral point of view of the child. For the used parameters, such as: Heart Rate, Visual Analogue Scale, Analog Scale and Scale Facial After SOM, there was a sense of discomfort in both procedures. It can be seen then, the constant need to use control techniques and behavioral and psychological conditioning for the realization of care to pediatric patients.

Estudo da imunidade celular em tuberculosos pulmonares bacilíferos tuberculino negativos / Cellular immunity in patients with pulmonary tuberculosis with negative tuberculin bacillus

Estudando sessenta e oito doentes portadores de Tuberculose pulmonar com Bacilos-cópia positiva, foi-nos possível determinar a prevalência de Tuberculino-negativos num índice de 61,8%. Comparando esse achado excepcional com as diferentes variáveis, concluimos que essa alta incidência de näo reatores ao P.P.D., foi ocasionada por um estado de imunodeficiência adquirida relacionado, predominantemente, à gravidade da própria doença (formas de apresentaçäo muito avançada de 90,5%)